The Louisiana State Capitol. (Philip Kiefer/The Lens)

The Louisiana Legislature will consider two bills this session that seek to address the troubled state of health care in Louisiana prisons. One, House Bill 175, would eliminate co-pays for incarcerated people, and another, House Bill 517, would create an medical advisory council that would approve health care policies for the Department of Public Safety and Corrections and the hiring of a prison medical director, among other things. 

Health care in Louisiana’s prisons is in high demand, in part due to an aging population, but the state has long been criticized for not providing access to adequate care for people in their custody.  

According to a 2021 report on the adequacy of health care in Louisiana prisons produced by Loyola University New Orleans College of Law, LSU Health, and nonprofit group Voice of the Experienced, a majority of prisoners — between 58 percent and 95 percent depending on the facility — in the state take medication. Forty percent of incarcerated individuals in Louisiana have experienced mental illness, and 20 percent have been diagnosed with a serious mental illness, such as schizophrenia, 

Last  year, a federal judge ruled that the state’s largest prison, Louisiana State Penitentiary at Angola, was “deliberately indifferent to the inmates’ serious medical needs,” and was in violation of the Eighth Amendment’s prohibition on cruel and unusual punishment. 

In another lawsuit, against David Wade Correctional Center, the plaintiffs claim that conditions and lack of mental health care for people held in restrictive housing at the facility — which means being locked in their cell for up to 23 hours a day — cause them to further deteriorate, and can lead to self-harm and further disciplinary action. Lawyers for the state Department of Public Safety and Corrections argue that mental health care at the facility is constitutionally sufficient. A multi-week trial in the case concluded last month.

Some of those issues, critics say, stem from a lack of leadership and oversight. And the bill to create a medical advisory council, brought by Representative Larry Selders, Democrat of Baton Rouge, aims to address that. 

In the Angola lawsuit, federal Judge Shelly Dick found that both at the Department of Corrections and from the medical director at Angola at the time — Dr. Randy Lavespere — failed to ensure that people in custody were being given adequate health care.  

“There was no evidence of medical supervision by the DOC central office,” Dick wrote. “The buck stopped with Dr. Lavespere, and his medical supervision and quality review was woefully inadequate.” 

But Lavespere has since been promoted from medical director at LSP to overseeing health care throughout the entirety of the Louisiana prison system following the resignation in 2020 of Dr. John Morrison, who previously held the position.

Like many doctors working in Louisiana prisons, Lavespere was able to work behind bars despite having a suspended medical license.  Due to a provision in the The Louisiana State Board of Medical Examiners, doctors who have been barred from practicing in many hospital settings can still work at institutional settings — such as prisons. 

Lavespere had his medical license revoked following a 2006 conviction for possession with intent to distribute methamphetamine, for which he served time in federal prison. But in 2009, he was placed on “indefinite probation,” which only allowed him to practice medicine in institutional settings.  

The medical advisory council’s role in approving a prison medical director in the future would help to ensure a qualified candidate was selected, said Bruce Reilly, deputy director of Voice of the Experienced, who worked on the legislation. 

Reilly said that provision of health care in the prison system should ideally function like a “series of community clinics,” and he has concerns that Lavespere and others who have served in leadership roles administering health care at the Department of Corrections would not have been considered qualified for such a positions outside of the prison setting.

“If it was running like a series of community clinics, would they even have a shot?” Reilly said. Would they even get an interview? Or are they just a person with an MD?”

The council, according to the proposed legislation, would consist of representatives of various medical fields, along with the deans of Tulane and LSU medical schools or their designees, the dean of Xavier University College of Pharmacy or their designee, and the Director of the Louisiana Department of Health, or their designee. 

The council would also have an advise and consent role in approving DOC medical policies, post-mortem reviews, the establishment of an electronic medical records system, and any other “reasonably related responsibilities of institutional oversight.”

A spokesperson for the Department of Public Safety and Corrections did not respond to requests for comment on any of the prison health care legislation that is up during the current session. 

Bill seeks to eliminate prison medical debt

Another bill, brought by Representative Mandy Landry, Democrat of New Orleans, would eliminate medical co-pays that are frequently required in order for people incarcerated to access health care. According to the report by Loyola, LSU, and VOTE, prisoners must pay $3 for a sick call, $6 for an emergency visit, and $2 for a prescription.

While the amount may seem relatively small, prisoners can be paid as little as two cents per hour for work they do behind bars. 

“The real-world minimum wage equivalent of these rates for incarcerated people who earn incentive wages of $.02/per hour is: $1,087.5 for a routine visit, $2,175 for an emergency visit, and $725 for a prescription,” the report states. 

In addition, the report also says that while it is DOC policy to provide healthcare regardless of an individuals’ ability to pay, the co-pay charges are still assessed against a prisoner’s account, and can put them into debt.

“I was irate when I found out that we have incarcerated people with medical debt,” Rep. Landry said in a statement. “It’s counterproductive and on principle, the state is responsible for all health care needs for people we incarcerate.”

The report warns that medical co-pays in prison “may incentivize people to delay or avoid receiving healthcare Services.”

“Ultimately, the state has a responsibility to keep people alive and healthy if we’re going to choose to detain them,” Reilly said.  People are suffering and people need proper medical care. It’s just kind of plain and simple.”

As of Wednesday, both bills were awaiting hearings before the Committee on Administration of Criminal Justice.

Nick Chrastil

Nicholas Chrastil covers criminal justice for The Lens. As a freelancer, his work has appeared in Slate, Undark, Mother Jones, and the Atavist, among other outlets. Chrastil has a master's degree in mass...