Last week, the American Friends Service Committee's Michigan Criminal Justice Program and Prison Legal Services of Michigan released a new report titled "Tolerating Failure: The State of Health Care and Mental Health Care in the Michigan Department of Corrections" that explores the state of health care and health services within Michigan's prison system. At the present time, Michigan's prison system--the Michigan Department of Corrections (MDOC)--houses 51,400 people--a number that has tripled in the past twenty-three years.

The report begins by explaining that under the Eighth Amendment and the Michigan state constitution that the state of Michigan has a legal obligation to provide healthcare to its prisoners. To support this, the report cites a 1976 US Supreme Court decision in which the court declared:

"These elementary principles establish the government's obligation to provide medical care for those whom it is punishing by incarceration. An inmate must rely on prison authorities to treat his medical needs; if the authorities fail to do so, those needs will not be met. In the worst cases, such a failure may actually produce physical torture or a lingering death, the evils of most immediate concern to the drafters of the [Eighth] Amendment. In less serious cases, denial of medical care may result in pain and suffering which no one suggests would serve any penological purpose."

With regard to the state constitution, the report cites Article 4, Section 51 that states, "The public health and general welfare of the people of the state are hereby declared to be matters of primary public concern. The legislature shall pass suitable laws for the protection and promotion of the public health."

However, the report argues convincingly that Michigan has failed in its obligations to provide prisoner healthcare. It cites several examples of cases resulting in death, including the cases of Timothy Joe Souders who was subject to physical torture and a lingering death at the Southern Michigan Correctional Facility in Jackson and Anthony McManus who starved to death in a segregation cell at the Baraga Maximum Security Facility. It further cites how a lack of healthcare can lead to unnecessary suffering. Such cases include that of Andre Davis who was subject to a painful and unnecessary bone marrow biopsy and that of Marc Janness who receives blood transfusions and injections because a MDOC dietician refuses to provide him with the diet that controlled his blood disorder for eleven years at another MDOC facility. These and several other cases are explored in detail in the report.

The report explains that those who go to prison are often those who have been neglected by social service programs and consequently have less access to healthcare. The report cites a study by the National Commission on Correctional Health Care to assert that:

"Inmates suffer from higher rates of communicable disease, chronic disease, and several mental illnesses than the U.S. population as a whole. This large concentration of infected and mentally ill persons in prisons and jails provides a unique opportunity to provide needed treatment and prevention services and to help protect the larger public health."

The report makes thirty-two recommendations for improving the state of healthcare inside Michigan's prisons. These include changes to the administrative system making the healthcare system easier to manage, ending the use of certain types of restraints, requiring more comprehensive medical and mental health evaluation procedures, and alterations to oversight procedures.

Finally, it is worth noting that while the report finds particular fault with Correctional Medical Services (CMS) who has an approximately $668 million contract to provide medical services to the prisons, it warns that "it has not been the sole cause of the serious failings of medical and mental health care delivery within MDOC" and that there are systemic problems that must be addressed.