Outrageous! Crime Pays

... If you need top-notch medical care.

James Wolfe was doing hard time in Pennsylvania for raping an eight-year-old girl when he discovered that prison can be a pretty good deal. It seems James had always wanted to be a woman (he had even changed his name to Jessica), and a doctor labeled his condition "gender identity disorder." That made James eligible for hormone treatments to help change his gender -- at taxpayer expense. The state says these treatments don't cost much, but according to an estimate by the Pittsburgh Tribune-Review, they can run up to $8,000 per year.

Here's the really bitter medicine: That amount could go a long way toward providing health insurance for a family. With an estimated 44 million people in America lacking health coverage, one million of them in Pennsylvania alone, you'd think inmates would be the last to receive elective procedures. But Wolfe isn't the only criminal trying to get this sort of free treatment behind bars. Last year in New York State, for instance, a judge allowed a convicted murderer's lawsuit, demanding treatment for his gender identity disorder, to go forward. And in California this summer, an inmate allegedly got a state-funded breast reduction operation. He happens to be a man. Plastic surgeons typically charge close to $3,000 for this procedure. It gets worse because the problem goes well beyond these sorts of unusual treatments. Around the country, hardened criminals of every stripe receive top-notch care that many average families don't get, including expensive dental surgery. In Oregon, which has recently cut public health benefits, the state is spending about $120,000 per year on dialysis treatments for a convicted murderer on death row. In other words, it's shelling out big bucks to keep him alive until it's time to kill him. True, there's always the chance he'll get his death sentence revoked, but why are his costly treatments guaranteed and fully covered when plenty of law-abiding people can't afford the care they need?

Something to think about. So is the fact that other hugely expensive treatments, like bone marrow transplants and heart-bypass surgery, have been provided to prisoners, courtesy of your wallet and mine.

Convicts sometimes even qualify for precious organ transplants. Two years ago in California, a twice-convicted felon serving time for armed robbery got a new ticker, at an initial cost to the state of $900,000. At the time, 3,900 people were on the national waiting list for a new heart, and hundreds of them eventually died waiting. Meanwhile, a person without health insurance might never have made the list in the first place. Unlike an inmate with guaranteed coverage from the government, an uninsured individual may be judged too financially risky by many hospitals.

It's all startling evidence of a little-known quirk of American life: The only class of people with a constitutional right to health care in the United States are prison inmates. For the roughly one in seven Americans living without coverage, their best hope of seeing a doctor for free might be getting thrown behind bars. "Inmates are in the custody of the state, and it's our obligation to provide medical care to them," says Nick Lyman, a spokesman for the New York State corrections department.

How did it come to this? In 1976 the Supreme Court ruled that denying health care to inmates could amount to the "cruel and unusual" punishment prohibited by the U.S. Constitution. But thanks in part to a slew of prisoner lawsuits that have intimidated state officials, criminals often get care that others don't, or care that is far more than standard.

Take that California inmate who had breast surgery earlier this year. The prison's medical office insists that the inmate had a potentially cancerous lump removed. But state legislators had received a tip from a prison employee that the man was treated for overdevelopment of the breasts, possibly from steroid use, and legislators couldn't determine whether a biopsy was performed first. That was hardly the first case of its kind. "We found seven [breast reduction] cases in the last couple of years," says state assemblywoman Rebecca Cohn. Four of the seven procedures were done shortly before the inmates were released.

At times, the inmates even get top-dollar treatment. Cohn says the California state prison system spent $11 million for dermatology services in just one budget year -- including services performed by a Beverly Hills dermatologist. The state has also spent millions on hearing aids for prisoners, even though many private health plans don't cover hearing aids. It's no wonder, then, that California's prison health care costs soared by 11 percent over the past year, even as its Medi-Cal program for the poor was chopped by almost $240 million.

Sure, this can be a tricky issue. Should we just let inmates die of illness without treatment? Does anyone want to deny a jailed shoplifter an emergency room visit? Of course not. But maybe it's time to ration care behind bars more carefully.

Maybe a violent criminal who needs a liver should be bumped down the long waiting list. And surely criminals shouldn't be rewarded with better coverage than law-abiding people, who deal with ever-stricter managed-care plans. The bottom line, though, is simply this: Premium health care shouldn't be the reward for robbing a bank.

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