DOC seeks money, staff to improve Racine prison health care as inmates wait for dental services10/3/2018  By Gretchen Schuldt More than 400 Racine Correctional Institution inmates were waiting to see a dentist as of July, and 23 of those had waited more than 40 weeks, according to a state budget request. Fifty-seven inmates on the list were waiting for "essential services" and 41 were waiting for dentures. Dental care at the prison is "inadequate," the request said. The Department of Corrections detailed the need for improved dental services at RCI in the 2019-21 budget request it submitted to Gov. Scott Walker, who has not visited a state prison during his years in office. The department is seeking 27 new positions to staff the new $8 million health services unit at RCI scheduled to open in April 2020. The department also is seeking $1 million in fiscal 2020 and $2.8 million in fiscal 2021 to pay for the new positions. The share of new staff that would go to dental services is fairly minimal - a 60 percent full-time equivalent dentist, a 60 percent full-time equivalent dental assistant, and a 20 percent full-time equivalent dental hygienist. Those position should, however, help the institution "rectify the inadequate dental care that inmates receive as a result of long delays" in getting treatment, the request said. Wisconsin is not alone in struggling to meet inmate dental needs. Standards vary from state to state and agency to agency, according to a report by The Marshall Project. "Even before their incarceration, prisoners are likely to have unmet dental needs, research shows," The Marshall Project reported. "While in prison, they have a constitutional right to dental care, but the courts have offered little guidance on the services that institutions must provide. If a tooth or gum problem is causing more than minimal pain, facilities are required to treat it, said David Fathi, director of the ACLU National Prison Project. 'Even a few days of untreated dental pain is not allowed.' ” Also included in the budget request for the new facility is funding for guards, nurses, and medical assistants. The new unit, triple the size of the existing one, will allow DOC to better meet health care needs, the request said. As of May, it said, "41.6 percent of RCI’s inmates had a mental health condition and 7.7 percent of inmates had a severe mental illness. ... Additionally, the DOC believes that the inmate population will continue to age going forward, which will further increase the need for expanded health services to inmates. "  Source: DOC 2019-21 budget request With the smaller facility and smaller staff used now, staff members "currently struggle to consistently monitor chronic conditions," the request said.
There are seven to 10 offsite medical visits every day, and about one of those is a trip to the local emergency room. "These offsite treatments not only have greater medical costs but also require at least one security staff member to accompany inmates on trips out of the institution," the request said. Adding the requested staff would allow for improved preventative care for inmates, it said. "Inmates’ chronic conditions, such as HIV, diabetes, and hypertension, would be less likely to worsen while they are incarcerated and less likely to result in expensive hospital visits," the request said. Improved on-site health care also means fewer off-site trips for corrections staff, it said. If the prison does not get the additional staff, it will have to rely on contracted help and limited-term employees, who are employees who sign on for short stints and do not plan to stay. Contracted and limited-term employees are harder to recruit and have higher turnover than full-time employees, the request said. Relying on contracted and limited-term employees also would reduce the benefits of the new building as they "provide less continuity of care to patients due to their higher turnover and they are often less experienced than FTE staff," the request said.
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 By Margo Kirchner Negligent – even reckless – horseback-riding facilities in Wisconsin are immune from liability for harm they cause customers, the U.S. Court of Appeals for the Seventh Circuit confirmed last week. The decision addressed two cases. In the first case, Holiday Stables employees sent Judy Dilley out on a horse without instructions or a helmet, even though Dilley had told a staffer she lacked prior horseback-riding experience. The employees also failed to adjust her stirrups. On the trail, Dilley told the guide riding in front of her that she did not have hold of the reins of her horse, Blue. The guide told her not to worry because Blue, who often carried small children, knew where to go. After about 20 minutes, Blue attempted to pass the guide’s horse, which kicked at Blue. Blue reared, throwing Dilley to the ground. Dilley suffered a head injury, fractured ribs and vertebra, and punctured lung. In the second case, Abigail Brown sued over multiple leg fractures sustained during a riding lesson. Brown took her own horse, Golden Gift, to Country View Equestrian Center in Monroe for the lesson. During the lesson Country View’s instructor allowed a second rider and horse to enter the arena, knowing that the second horse was high spirited. The second horse sped off, bucking and colliding with Golden Gift, tossing Brown from her horse. Both women were from out of state and so sued in federal court. They lost there and appealed. The court interpreted the state’s equine-immunity law that, with some exceptions, protects trail operators and riding instructors from paying a rider for injuries. U.S. Circuit Judge Diane Sykes wrote for the Seventh Circuit panel, joined by Circuit Judges Joel Flaum and David Hamilton. Under the statute, a person or facility renting out horses or receiving pay for riding lessons is generally immune from civil liability if a participant is injured due to “an inherent risk” of the equine activity. Holiday Stables employees sent Judy Dilley out on a horse without instructions or a helmet, even though Dilley had told a staffer she lacked prior horseback-riding experience. "Inherent risk" means “a danger or condition that is an integral part of equine activities” and includes collisions between animals, the unpredictability of a horse’s behavior or reactions to its surroundings, and the potential of a person participating in the activity to act negligently. Dilley argued that because negligence of a trail operator is avoidable, it is not an “integral part” of horseback riding and thus immunity does not arise. The Seventh Circuit rejected her argument based on the statute’s text. The court also rejected Dilley’s alternative argument that her case fit a couple exceptions to immunity. One exception permits recovery of damages when a trail operator provides a horse “and fails to make a reasonable effort to determine the ability of the person to engage safely in an equine activity or to safely manage the particular equine provided.” Dilley argued that the exception applies when the operator “fails to . . . safely manage” a horse, while Holiday argued that the exception applies only when an operator fails to assess “the ability of the person . . . to safely manage” the horse. With no Wisconsin Supreme Court interpretation of the language on the books, the Seventh Circuit predicted how the state’s high court would rule. Declaring the task “not difficult,” the Seventh Circuit agreed with Holiday’s interpretation. The exception does not affect immunity for the trail operator’s negligent management of a horse, said the court. During the lesson Country View’s instructor allowed a second rider and horse to enter the arena, knowing that the second horse was high spirited. Further, the court added, nothing in the statute suggests that immunity is lost when an operator fails to periodically review how a rider is doing; the exception concerns only the time when the rider is matched with the horse.
Brown argued the same exception, but lost because she rode her own horse. The exception applies only when an operator or instructor provides the horse. “[I]t strikes us as entirely reasonable that a rider who owns his own horse should bear the risk of a mismatch between his riding ability and his horse’s temperament,” Sykes wrote. Dilley also argued unsuccessfully that Holiday’s conduct was reckless, satisfying an exception for “willful or wanton disregard for the safety of the person.” The court, though, said the word “reckless” was not in the statute, as it was in other state laws. Even when an operator should be aware of a strong probability of harm and acts anyway, immunity applies, Sykes said. The court offered no sympathy for the unsuccessful plaintiffs, as courts sometimes do when ruling against them. Instead, the panel wrote a few parting words about the roles of court and legislature. Said the court: “The immunity statute and its exceptions necessarily entail policy judgments about how much exposure to liability is too much in this sphere of recreational activity. Unless the statute admits of no rational justification, it’s not our job to second-guess how Wisconsin’s legislature has drawn these lines.” |
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