They’re Out of Prison. Can They Stay Out of the Hospital?

SAN FRANCISCO — The night Ronald Sanders turned his life around, he had been smoking crack for 2 days in a tiny, airless room.

His infant son, Isaiah, was inhaling the fumes. “His chest was beating really hard,” Mr. Sanders recalled.

“So I pray: ‘If my son makes it through the night, that’s it.’

”Mr. Sanders quit using drugs and stopped cycling in and out of prison quite 20 years ago.

he's now a community doctor who helps people getting out of prison to affect a number of medical, psychiatric, and drug abuse disorders.

As the country tries to shrink its aging prison population, the inmates being released after years locked away often have mental illnesses and addictions which will land them back in prison if untreated.

Mr. Sanders and other former prisoners are central players in an approach to helping these men and ladies that are expanding in California and North Carolina, among other states.

By year’s end, l. a. County plans to possess hired 220 such workers to assist released inmates navigate life outside.

“We’ve always known incarceration is bad for health,” said Leah G. Pope, director of the substance use and psychological state program at the Vera Institute of Justice, a search and advocacy group.

“But in an age of accelerating attention to justice reform and health care reform, the 2 are increasingly connected.”

Mr. Sanders works for the Transitions Clinic Network, which has doubled in size over the past five years and now works out of 25 health centers in eleven states and Puerto Rico.

It has treated some 5,000 patients since it got its start here in 2006 at a city-run clinic for low-income residents in Bayview-Hunters Point, an area heavily suffering from incarceration.

At the time, the majority of inmates left prison without insurance.

The expansion of Medicaid in 32 states under the Affordable Care Act has been what many within the field consider a criminal justice milestone, making low-income men and ladies who are single and childless potentially eligible for free of charge health looks after the primary time.

Mr. Sanders, 54, who was incarcerated during his twenties for drug dealing and parole violations now counsel formerly incarcerated patients whose experiences echo his own.

He urges them to manage chronic diseases and quells their occasional scare.

Offenders incarcerated as teens emerge in a time of life as if from a machine, unacquainted transit swipe cards, smartphones, even email.

Among his regulars are Darryl, 58, who did time in prison for drug dealing, vehicle theft, and possession of a firearm.

Darryl, who asked that his surname not be wont to protect his privacy, has hypertension, near-crippling depression, and amnesia from a traumatic brain injury.

Mr. Sanders said Darryl was suicidal once they first met: He connected Darryl with a therapist, helped him get into treatment for white plague, and eventually found him housing during a single-room-occupancy hotel within the Tenderloin, an equivalent neighborhood where Mr. Sanders once lived on the streets.

When Darryl is out of touch, Mr. Sanders goes to his door.

“I don’t want to ascertain you dead because you haven’t checked your damn blood pressure!” Mr. Sanders chides him.

The community workers function mentors.

“You’re building that rapport with someone who has walked an equivalent walk and been successful,” said Nicole Sullivan, the re-entry director for the North Carolina Department of Public Safety.

It is spending $600,000 to expand the Transitions model, which started as a grant-funded pilot in Chapel Hill, across the state.

Prisons and jails are constitutionally mandated to supply health care, but that responsibility ends upon release.

For those getting out, the primary fortnight is particularly perilous.

A study in Washington State published within the New England Journal of drugs in 2007 found that former inmates are 12 times likelier to die than other state residents within the fortnight following their release, especially of lethal overdoses, a risk factor confirmed by later studies.

Access to health care is often a roll of the dice: Medical discharge plans vary from nonexistent to prisons with dedicated planners who coordinate insurance and medical appointments before release.

Most of the 32 Medicaid expansion states suspend, instead of terminate, coverage for inmates who previously had it and send them out with an insurance card once they leave.

Ohio and Indiana, among others, have programs to enroll inmates in Medicaid before release.

Preventive care is usually lacking within the disadvantaged neighborhoods that are habitat for several inmates, the overwhelming majority of whom are black and Hispanic.

“There’s mistrust combined with a scarcity of data about navigating the health system,” said Joseph Calderon, a Transitions worker.

“In our communities, people are taught the way to look out of their cars but not the way to look out of their health.”

Many ex-offenders ignore chronic conditions and finish up in costly emergency rooms or hospitalized for preventable conditions.

There is no definitive evidence yet that the Transitions program helps ex-inmates stay out of prison.

Preliminary data from a study in New Haven, Conn., suggests that folks who received care through the Transitions Network spent less time incarcerated than those during a control group within the year following their release.

There is some evidence that the program helps people stay out of emergency rooms and hospitals:

A study within the American Journal of Public Health of 200 chronically ill former inmates in San Francisco, half assigned to a Transitions clinic and half to a medical care program found that the Transitions patients’ use of emergency rooms was 50 percent lower.

“People coming home have many health needs,” said Dr. Shira Shavit, the network’s executive and a clinical professor of family and community medicine at the University of California, San Francisco.

“They need food, an area to remain and employment, and lots of face discrimination in housing and employment.

They'll have lost connections with family. So it's important to deal with the large picture.”

At the clinic, she saw a replacement patient who had just been released after 16 years and eight months in prison. “Any tattoos?” she asked him.

”Drug use? Sexual acts in prison?”

Knowing a patient’s history can yield important clues “about past drug abuse, trauma, poverty, violence, lack of access to wash needles for tattooing or drug use or PTSD from solitary, all of which are clinically relevant,” she said.