The Cautionary Instruction: Using the medical model in the criminal justice realm

The Pittsburgh Post-Gazette/Ipso Facto
May 4, 2012

Anyone who has had a recent medical procedure knows that insurance companies are tightening the purse strings. Insurers are not paying for needless, unproven procedures -- treatment not supported by medical research.

The criminal justice system is experiencing the same phenomenon. The government controls the purse strings. Tough economic times are prompting a new look at spending priorities at all government levels, and scientific evidence of a program’s success or failure may play a part in whether it survives a budget cut.
The difference between medicine and criminal justice is that medical practitioners know what works -- criminal justice practitioners don’t.

A doctor in Georgia will treat the symptoms of acute myocardial infarction (AMI), or heart attack, with the same general protocol as doctors in Oregon or Kansas. The current protocol for treating patients with AMI is either pharmacological (clot-dissolving therapy) or mechanical (coronary angioplasty).

Criminal justice is different. Although criminal justice practitioners boast of using evidence-based practices there are no standard best practices accepted by all criminal justice practitioners.

A review of efforts across the nation to deal with prison overcrowding is instructive:

Pennsylvania plans on reducing inmates and costs by weeding out inefficiencies. The Department of Corrections suggests that slow processing keeps about 1,900 inmates per year in prison when they could safely be released on parole. Better processing alone could save nearly $61 million a year.

New Hampshire is considering privatizing its prison system. The state's prison population climbed 31 percent between 2000 and 2010 despite a stable crime rate. Half of that increase was attributed to inmates who leave prison and return for a parole violation or a new offense.

California has gone through an unprecedented realignment of its prison system shifting responsibility for a significant number of prisoners from state prisons to local county jails. This realignment has also shifted responsibility from the courts to the sheriff to release individuals who are in jail on bond pretrial, a significant portion of the county jail population.

Mississippi is testing a global-positioning device that costs about $13 a day per convict to keep tabs on individuals — far less than the $41.74 cost to house and feed a prisoner. Elderly and terminally ill inmates are being released to their families, or hospices, saving nearly $5 million.

Alabama, Colorado, Kentucky, and Rhode Island have reduced or eliminated jail or prison time for parole and probation violations, opting instead for stricter supervision and alternative sentences like community service.

Arkansas, Louisiana and Texas have attempted to reduce recidivism by stronger emphasis on reentry planning that is tailored to meet individuals' needs.

Florida and South Carolina have created alternative sentencing options for low-level, low-risk offenders, such as probation instead of jail time.

Tennessee and Virginia have removed minimum sentencing requirements for certain drug-related violations.

Above are 15 different approaches to the same problem. Why can’t prison wardens and corrections officials agree on a best practice to reduce prison crowding? Imagine a different treatment protocol in every state for AMI.

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