Sometimes going to prison can be an unfortunately rational health care decision.
A 41-year-old man who had been incarcerated came to see me recently. While in prison he got in a fight, which led to a CT scan. He hadn't broken anything, but the scan did surreptitiously show two aneurysms. Both were in his hepatic artery (the artery that feeds his liver).
They were small, so the doctors kept an eye on the aneurysms without doing surgery. But the next time they checked, they had nearly doubled in size.
He was referred to a surgeon at a different hospital than the one I work at, and underwent an angiogram, to see the aneurysms better. The surgeons there said that he was sure to die if they did not intervene, and that they should schedule a surgery within the coming weeks.
Fortunately for him (or so he thought) he was released from prison one week later. When he returned for his pre-op visit, though, he was told that since he'd been released from prison, he no longer had insurance to cover the operation.
He asked what he should do. The told him to figure out how to get insurance.
I think this patient would be the first to admit that he had made numerous mistakes in his life. And he had paid a significant price for them. He truly was ready to make changes, to live positively, to help those around him. But, not knowing what else to to, it occurred to him that the easiest way to get the care he needed would be to get back in prison.