Dear Assembly Member Lowenthal:
We write to oppose AB 2590, as amended, which would permit nonconsensual disclosure of HIV+ Californians’ names and contact information to state contractors, such as the AIDS Healthcare Foundation, allowing medical service providers to market their services to this vulnerable population. The Center for Heatlh Justice opposes this unprecedented disclosure of confidential HIV information to facilitate unnecessary and unsolicited contact by an economically interested medical provider at precisely the time when a person recently diagnosed with HIV may be struggling with the many ramifications of the diagnosis.
As amended, AB 2590 will result in the disclosure of previously highly protected confidential medical information of Medi-Cal recipients for the purpose of allowing private entities to market to individuals living with HIV without their consent and in a way that may compromise confidentiality. There is the potential over time that any private HIV medical service providing individual or entity such as AHF could solicit individuals already under appropriate HIV medical care. This is a breach of the physician’s basic code of ethics and may result in interfering with the individual’s medical care. Unwanted medical solicitation including direct contact of potential patients without their consent is prohibited by both state and federal law.
The history of “cold call” marketing of medical services by managed care providers has led to strong regulation of this type of conduct by federal law. 42 U.S.C. § 1396u-2(d)(2)(E); 42 C.F.R. § 438.106(b). This bill is a step in the opposite direction, allowing state contractors of HIV medical services care may disrupt excellent care networks Medi-Cal beneficiaries have already established.
Specifically, with regard to AHF, there is a vested financial interest in being able to recruit patients for medical care and privately funded lucrative medical and pharmaceutical research.
Operationally, this bill will result in a list of HIV+ Californians who are Medi-Cal recipients being shared with people not involved in the individual’s medical care. Even in the best of circumstances, this is likely to result in increased instances of unauthorized disclosures of confidential medical information.
Furthermore, risk of unauthorized disclosure of HIV information undermines public health efforts aimed at encouraging HIV testing and early treatment. Individuals who are fearful of HIV such disclosure may forego testing altogether.
Based on the history of stigma and discrimination associated with HIV and the public health interest in encouraging testing, voluntary disclosure, and seeking appropriate health care, HIV information is highly protected under current California law, and should remain so. As advocates for individuals living with HIV and their rights to confidentiality, we vigorously oppose AB 2950 as an attempt by one entity to unnecessarily change the HIV confidentiality law of California and undermine public health advances in order to facilitate its marketing to HIV+ Medi-Cal clients.
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( 3 / 270 )Next week the legislature will return to deal with the aftermath of the budget agreement. The final state budget anticipates the following savings in the CDCR’s budget:
• $182.1 million by deportation of undocumented state prisoners to U.S. Immigration and Customs Enforcement for deportation.
• $175 million by decreasing in the number of programs for parolees. Programs that have been demonstrated to effectively reduce recidivism will be retained. The CDCR will also attempt to achieve this savings through more efficient delivery of programs.
• $147.6 million in “operational savings” by a one-time reduction in facility repairs, headquarter savings, additional efficiencies within the operations of the juvenile programs, and other operational savings.
• $50 million from establishing limits on contract reimbursement rates for medical services.
That’s a total of over $500 million in speculative savings, but it’s just the beginning. An additional $630.8 million will be achieved through various reforms intended to reduce prison and parole populations.
It's going to be interesting, and the political posturing has already begun:
http://blogs.kqed.org/capitalnotes/2009 ... bers-game/
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( 2.9 / 679 )The CDCR is at the center of the problem of government spending, which also means change in it is the solution.
Morning Edition, July 15, 2009 · California is a mess financially, and one of its huge burdens is its prisons.
The state spends $10 billion a year on its prison system, which once was a model for states to follow but now is a model of what to avoid, NPR's Laura Sullivan tells Renee Montagne.
The prison population has grown from 25,000 to 175,000 since the early 1990s, not because of an increase in crime, Sullivan says, but because of the "tough-on-crime, three-strikes-and-you're-out" laws. But the growing population isn't the only prison-related challenge facing the state.
Unions are another factor. The prisons employ 33,000 people, including the nation's highest-paid correctional officers. The unions are a powerful political force, backing ballot measures for longer sentencing and punishment, for example.
Parole and probation represent another complicating factor. California has the country's toughest parole sanctions on the books. Each year the system releases 120,000 parolees, and each year 75,000 return to prison for violating their parole on technical terms, such as missing an appointment with a parole officer.
Texas used to have similar laws but found them too costly. So it slowly stopped returning parolees to prison for technical violations, and now Texas doesn't have the overcrowding and fiscal problems facing California, Sullivan says.
The three-strikes rule has returned as a ballot measure, but voters have not repealed it, she adds.
And yet another challenge is the rising cost of health care.
It all adds up to a vicious cycle that California's prisons can't seem to pull out of: Tough laws mean more prison time, more prison time means overcrowding, and overcrowding means less money for health care and other programs to help rehabilitate people and keep them from coming back to prison.
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( 3 / 668 )The California budget stand-off has gone from the ridiculous to the absurd. In a recent interview the Governor asserted that $1 billion could be saved by privatizing the state’s prisons. Specifically he said that $1 billion could be saved by “all the prisons being built by the private sector and also the new services by the private sector and that can save a billion dollars.” In a speech yesterday it became “billions” that could be saved.
California should be very careful when considering privatizing prisons. Proponents of privatizing prisons argue from the position that private enterprise does everything more cost-effectively than government, but recent analyses challenge this assumption. A report by the National Institute of Justice looked at wildly divergent assessments of the cost and performance analyses conducted of the same four prisons. When comparing the cost and performance of public and private prisons cost comparisons are complex and there is no standard way of accounting for “overhead costs” or measures of prison performance (i.e. drug use, escapes and other custody incidents). In short, the goal of justifying privatization may easily influence the analysis.
Privatizing prison services is extremely problematic. In the case of provision of prisoner healthcare – of particular concern in California where a federal judge oversees these services – privatization has been shown to cost more and result in more deaths: in a recent economic analysis out of UC San Diego a study found that those states that contracted out for prison medical care employed 13 percent more medical staff, cost more, and had a 1.8% higher mortality rate. Costs more, kills more.
The economic upside of prison privatization is far from clear, but there are other reasons we should be deeply concerned about an effort to privatize this public function. Prisons are intended to perform a public safety function: to remove those from society who are a danger to others, and to punish and/or rehabilitate (depending on your theory of incarceration) the rest. A private corporation’s only interest is to maximize profits, i.e. increase revenue and reduce expenses. A private corporation simply has no incentive to conduct the public functions of a prison in anything but the most minimally acceptable way, to meet contractual requirements. While the economic incentive is the root of the argument that privatization will increase efficiency, there is also the real, documented danger that prisoners will suffer. And, because the state cannot delegate its constitutional duties to treat prisoners properly, when injury occurs, the state will still be left liable.
There are other ways to meaningfully reduce the costs of prisons in California, without turning them over to the private sector, which will then, of self-interest, lobby for the system’s propagation. We can both reduce the cost of prisons and improve safety at the same time. As a report from the Pew Charitable Trust’s Center on the States highlights, Kansas and Texas – public systems – have found a solutions in combining incentives for reduced recidivism, community supervision of non-violent offenders and sanctions other than prison for minor parole violations. The goal of these measures is to encourage and support parolees in becoming become productive, taxpaying citizens instead of sending them back to prison at taxpayer expense.
Public safety and criminal justice activities are basic governmental functions. To delegate these to the private sector will solve none of the long term problems of California’s prison crisis. Let’s look further down the road and rethink our reliance on prisons to address public safety, with an eye towards fiscal control over our prison system. If we do, we’ll see that our current situation present opportunities to reduce costs over the long term.
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( 3 / 692 )As California prisons let in visitors and other "non-essentials," a time to reflect on disease and prisons
The closing of California prisons for the past two weeks to visitors and non-essential personnel based on one possible case of N1H1 virus in a Southern California highlights the link between infectious disease and incarceration and is yet another negative implication of California’s over-reliance on incarceration to address crime. In this case the conditions and numbers of people incarcerated may threaten the public health of California as an efficient system to transmit H1N1.California incarcerates over 170,000 people. Our prisons are filled to twice their capacity and because little forethought is given to the implications of “tough on crime” sentencing laws including mandatory minimums and three strikes. Despite the dire fiscal situation in the state, we continue to send more people to prison and for longer periods of time at exorbitant cost to California’s taxpayers.
While H1N1 is a concern in the community, in California’s overcrowded prisons where basic hygiene and medical care are difficult to maintain, H1N1 and other infectious diseases are an even greater problem because of the increased likelihood that they will spread, and without proper medical response. We know that H1N1 is highly treatable, but in a prison setting concerns that early symptoms may go without attention are real.
Prisons concentrate people who are more likely to have serious health issues: the rate of HIV, Hepatitis C and MRSA to name a few is much higher among prisoners than in the community. In prison, people at high risk for disease are placed in environments where disease is likely to spread. Outbreaks of Norovirus, tuberculosis and MRSA have all occurred in correctional facilities in California in recent years. It’s therefore unsurprising that an early case of H1N1 has occurred there, too.
Because prisoners are frequently transferred throughout the system and more than 95% of prisoners return to our community after an average sentence of two years, we should be concerned, too. It’s not unreasonable that a prisoner outside of San Diego might have just come through San Quentin’s reception center, or had contact with someone sent to Vacaville or Sacramento or any one of the 33 prisons in the state. Any of these prisoners could have come in contact with hundreds of correctional service staff and others who work in prisons daily. And, given the period before symptoms present, it’s not unreasonable to conclude that H1N1 might have been spread to others throughout the state’s prison system. The same is true of any infectious disease in this environment.
This situation highlights yet another deleterious effect of incarcerating hundreds of thousands of Californians each year in a system that can neither prevent nor treat disease at the basic level required by our federal constitution. When you think about H1N1, consider the effect California’s criminal justice laws have on the health of the broader community. It’s time for a change.
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