Mourning Jeff Adachi

A great light has dimmed. San Francisco Public Defender Jeff Adachi (Hastings '85) has died, leaving behind a tremendous legacy of advocacy of the highest quality for the indigent and disenfranchised. The Chronicle reports:

San Francisco Public Defender Jeff Adachi, a renowned advocate for the accused and an outspoken watchdog on police misconduct, has died. 

He was 59. 

Mayor London Breed confirmed Friday night that Adachi had died, saying that San Francisco had “lost a dedicated public servant.” He was the only elected public defender in California. 

The exact circumstances and cause of Adachi’s death were not immediately known, but sources said he died of a heart attack. 

“As one of the few elected public defenders in our country, Jeff always stood up for those who didn’t have a voice, have been ignored and overlooked, and who needed a real champion,” Breed said in a statement. “He was committed not only to the fight for justice in the courtroom, but he was also a relentless advocate for criminal justice reform.
“Jeff led the way on progressive policy reforms, including reducing recidivism, ending cash bail, and standing up for undocumented and unrepresented children.”

What a shocking loss, and what big shoes for all of us to fill. Jeff fought injustice and cruelty at every junction; I encountered him near San Quentin, working to abolish the death penalty, and at the courts fighting against cash bail. I found him in reentry meetings advocating for clean records and at the helm of realignment, probation, and community corrections. San Francisco is a beacon of common sense in an ocean of California counties that still massively incarcerate largely because of him. He will be, and is already, gravely missed.

CDCR Eliminates Inmate Copayments for Health Care

Today CDCR announced that, effective March 1, they will eliminate inmate copayments for healthcare, because an internal analysis reveals that copayments "have minimal fiscal benefit and are not aligned with patient care." 

Specifically, copayments may hinder patients from seeking care for health issues which, without early detection and intervention, may become exacerbated, resulting in decreased treatment efficacy and/or increased treatment cost. The Department’s health care delivery system, known as the Complete Care Model, is based on a preventative and comprehensive approach to patient care. Early detection and preventative health care aligns with most public and private health care organizations and can prove to be fiscally prudent.

The first thing that occurred to me upon reading this was how many people are probably unaware that incarcerated patients make copayments, just like patients on the outside. How did that come about? CDCR provides background:

In 1994, Section 5007.5(a) was added to the Penal Code (PC) to read: CDCR is authorized to charge a fee in the amount of five dollars ($5) for each inmate-initiated medical or dental visit of an inmate confined in the state prison, which will be charged to the prison account of the inmate. If the inmate has no money in his or her personal account, there shall be   no charge for the medical or dental visit. An inmate shall not be denied medical care because of a lack of funds in his or her prison account. The medical provider may waive the fee for any inmate-initiated treatment and shall waive the fee in any life-threatening or emergency situation, defined as those health services required for alleviation of severe pain or for immediate diagnosis and treatment of unforeseen medical conditions that if not immediately diagnosed and treated could lead to disability or death. Follow-up medical visits at the direction of the medical staff shall not be charged to the inmate.

This section aligns with other savings trends I reviewed in Cheap on Crime. The most egregious one is, of course, the pay-to-stay jail, but less egregious examples abound and participation in health care costs is one of them. 

What I find interesting is that the same savings rationale used for imposing the costs in the first place is now being used for getting rid of them--copayments are not vile and unjust; rather, the problem is that they don't pay off, because they deter people from seeking health care and thus make their condition worse and therefore more expensive.

The elephant in the room, of course, is the question of quality. Health care in California prisons is becoming more and more expensive and we are once again taking heat from the Ninth Circuit for the disappointing quality of mental health care in prison. But if it's not getting better, it is at least being offered for free.