Every year, more than 9,000 people are paroled in San Diego County. Most of them don't have health insurance. So they go to hospital emergency rooms for care, or forgo medical treatment altogether.
In San Francisco, a community clinic is trying to help parolees manage their chronic health conditions, and get their lives back on track. That service doesn't exist here.
"So right now," ask Juanita Alvarado, "what can I do for you to help you not end up going over to San Quentin?
"I would say," responds a parolee, "Same thing you did before, except maybe try to put a little bit more emphasis on advocating to my parole agent."
Transitions employee Juanita Alvarado hasn't seen this client in a while. He recently got sent back to prison for violating parole.
Alvarado is one of the clinic's community outreach workers. She recruits clients, helps them set up their medical appointments, and encourages them to stay on the straight and narrow path.
Transitions outreach worker Ron Sanders says parolees have a lot of needs. He says taking care of their medical issues is key.
"Cause usually when we keep them on top of their medical, you know, everything else falls in place," Sanders says. "When they're making their appointments, we can work with them, you know, in getting them some housing, getting them employment. You know, as long as they're making their appointments and everything, you know, we can work with them."
Sanders spent some time in prison himself.
"I understand where they come from, you know," relates Sanders. "I've been there, I've done that, and I also know what the end result is if you continue to do what you're doing."
Transitions is housed at a community clinic in San Francisco's Bayview neighborhood. It's open for parolees two days a week.
Dr. Shira Shavit is Transitions medical director. "These patients tend to be pretty medically complex," Shavit points out. "For instance, we know they have higher rates of substance abuse disorders, chronic diseases, and infectious diseases. So it's very important to them to have a medical home, and to have a place where they can get care, but also it's a challenge for patients to parole from prison, and be successful reintegrating into the community."
Shavit believes by addressing those issues, Transitions can help keep parolees from being sent back to prison.
Shavit says patient education is a big part of her job.
"What we're finding is, a lot of times people didn't have care prior to prison," says Shavit, "And they may often be diagnosed with diseases for the first time when they're in prison. So now they're coming out of prison, they may not have received much education on what to do to stay healthy, or how to refill their medications, what diet they should be eating."
The clinic is funded primarily by the San Francisco County Public Health Department. Alameda County has a similar program.
In contrast, San Diego County doesn't have any special medical services for parolees.
That's despite the fact there are more than nine-thousand people paroled in the county every year.
Minister Clovis Honore is lead organizer with the non-profit group Regional Congregations and Neighborhood Organizations.
"When we're able to identify folk coming home from prison up front and get them into treatment immediately," says Honore, "we reduce significantly the cost on the health care system, of emergency room visits and unaddressed costs that go into clinics."
