CA Press Release

Contact:

Jack Beck Director, Prison Visiting Project 212-254-5700, ext. 310 917-853-4412 (cell)

Robert Gangi Executive Director, CA 212-254-5700 ext. 305 917-327-7648 (cell)

Despite advances in state prison healthcare, significant variations exist in medical services provided in prisons throughout the state.

New York, New York: The Correctional Association of New York (CA), the state’s oldest criminal justice organization, released today Healthcare in New York Prisons, 2004-2007, the most comprehensive report ever produced evaluating medical care within New York’s Department of Correctional Services (DOCS) prisons.  Based on observations at 19 prisons visited by the CA and an analysis of system-wide data concerning medical staffing, inmate grievances, specialty care services, and DOCS’s quality improvement program, the report concludes that significant problems in access to medical services and quality of care exist at many prisons, even while DOCS has made some progress in improving prison healthcare. 

Findings of the Healthcare Report
In the nine years since the CA’s last report on healthcare, DOCS has made some important improvements in the provision of medical care.  However, in spite of these developments, significant problems persist. Among these are: (1) staff shortages; (2) inadequate routine healthcare; (3) gaps in chronic diseases care; (4) inconsistencies with specialty care services; (5) inadequate access to medications; and (6) absence of outside monitoring of the healthcare provided by DOCS. 

Importance of Prison Healthcare - Jack Beck, Director of the Prison Visiting Project of the CA and the principal author of the report, said, “Providing quality medical care in prison is good public health policy.   Prisons provide an ideal opportunity to diagnose and treat inmates with chronic medical conditions that often go untreated.  Inmates will return to communities throughout the state, and educating them about proper healthcare and enrolling them in a care system benefits not only inmates themselves, but their families and communities as well.”

Each of the 70 DOCS facilities has a medical department in which DOCS medical personnel provide healthcare to the 61,000 inmates in state prisons.  DOCS also runs approximately 45 prison infirmaries and five Regional Medical Units and provides tens of thousands of in-house and external specialty care consultations per year.  DOCS will spend approximately $366 million in Fiscal Year 2009-10 on health services and employ more than 1,950 medical personnel.

New York prisons remain the epicenter of HIV in the U.S. prison system, representing 20% of all HIV-infected state inmates in the country.  New York State prisons also have 8,400 inmates infected with hepatitis C, and many others suffering from other chronic diseases such as hypertension (6,500), diabetes (2,500), and asthma (9,000).  More than 95% of these patients will return to their communities, and the effectiveness of DOCS’s efforts to provide meaningful patient education and adequate care will determine not only the inmates’ medical future, but the health of their communities.

Jack Beck observed, “It is essential to view healthcare in the Department not only from a system-wide perspective but at the level of individual facilities, because each prison operates, to a substantial degree, independently.  Consequently, the level of staffing, utilization of services and quality of patient care vary greatly from one prison to another.”

Variability in Care From Prison to Prison - At some prisons, the barrier to effective care is partially a question of resources (e.g., inadequate staffing or insufficient access to specialists) where the remedy will likely require the governor and legislature to authorize additional funding.  At other prisons, certain providers are unable, due to inadequate training or expertise, or unwilling to respond fully to inmates’ medical needs or to promptly follow up on their patients’ medical problems.

 “At these institutions, the poor quality of the medical personnel compromises the delivery of healthcare,” said Robert Gangi, Executive Director of the CA.  “Overall, our report describes breakdowns in services that can seriously endanger the lives of inmates housed in these facilities. Better scrutiny of care and an effective system of accountability will help identify where changes in policies, practices or staff are needed at a system-wide or facility level.  These steps will save the state money and save lives.”

Staff Shortages - DOCS has reduced system-wide vacancies for nurses and doctors during the last few years.  High vacancy rates, however, still exist for physician assistants (14%) and pharmacists (13%) primarily due to the low salary rates for these positions.  Some prisons have significant vacancies for all staff positions; in 2007, Great Meadow Correctional Facility was missing 40% of its doctors, half of its physician assistants and 30% of its nurses.  Moreover, some medical vacancies have gone unfilled for many months or years due to salary limitations.  Even at full staffing, however, some prisons do not have enough medical personnel.  For example, some facilities have only one clinical provider (doctor, physician assistant, or nurse practitioner) for every 600 to 800 inmates, whereas the system-wide average is one provider for 400 inmates.  These staff shortages have significant adverse impacts on patients’ access to services and the quality of care they receive.

Inadequate Routine Healthcare - At some prisons, the CA found inadequate access to routine healthcare such as examinations by nurses for assessments and appointments with clinic providers.  Inmates may wait many weeks to a few months for a routine appointment with a physician at some prisons; at Attica there was an 11-page waiting list for the doctors.  Inmates at many prisons reported cursory, inadequate, and sometimes disrespectful care once they were seen by the medical staff.  At several prisons—such as Auburn, Upstate, and Wyoming—a majority of inmates reported that the care provided by their doctors was poor. 

Gaps in Chronic Diseases Care - The care provided to inmates with chronic diseases (e.g., HIV, hepatitis C, asthma, diabetes, hypertension, etc.) varies greatly within the Department.  DOCS has attempted to standardize policies and practices through the promulgation of practice guidelines for many of these illnesses.  Some prisons, however, fail to fully conform to these clinical standards.  New York prisons have the highest prison HIV rates in the country with an estimated 6% of men and 12% of women inmates infected.  Prison AIDS deaths have declined and many HIV-infected inmates are doing well on medications provided by DOCS.  But not all HIV-infected inmates receive appropriate care.  Many HIV-infected inmates go without treatment because DOCS has identified less than half of its HIV-infected population.  For HIV-infected inmates known to DOCS, care throughout the Department varies greatly, with significantly different rates of treatment for HIV-infected inmates and with some prisons rarely referring HIV-infected inmates to infectious disease specialists.  For example, in northern New York prisons, HIV-infected inmates see an infectious disease specialist at one-tenth the rate of prisons in the southern region of the state. 

Hepatitis C (HCV) is also a serious problem in the prisons; an estimated 13% of the men and 22% of the women inmates are infected.  Although DOCS has improved the identification of its HCV-infected population, approximately 30% or more of HCV-infected inmates are unidentified.  More importantly, the care provided to HCV-infected inmates in different prisons varies significantly, with inadequate documentation of chronic HCV-infections, great variability in access to diagnostic specialists and procedures, and significant differences in rates of HCV treatment.  Although DOCS has increased the number of inmates receiving effective HCV treatment, it is providing therapy to only 6% of its HCV-infected inmates.  The disparities in HCV treatment can not be explained by differences in the patient population. 

Inconsistencies with Specialty Care Services - DOCS sends thousands of inmates to specialists throughout the state for consultations.  However, the utilization of these services varies greatly among the prisons, and a consistent inmate criticism is that prisons do not adequately follow up on specialists’ recommendations.

Inadequate Access to Medications - DOCS operates prison pharmacies that serve approximately 50 of the 70 state facilities. Due to problems hiring prison pharmacists, 20 facilities are using outside pharmacy services that are 27% more expensive than if the medications were provided by DOCS’s pharmacies.  These outside pharmacy services annually cost DOCS an additional $3.8 million to fill inmates’ prescriptions.  Inmates reported several problems with the medication delivery system at certain prisons, including: running out of essential medications for chronic conditions; failure to provide inmates with sufficient information about medications they are taking and their potential side effects; and failure to provide medications in a confidential manner. 

Absence of Outside Monitoring for Healthcare Within DOCS - Monitoring of healthcare by an outside agency is an essential component of good medical practice.  DOCS has implemented a Continuous Quality Improvement Program to monitor medical care in the prisons that attempts to assess compliance with its practice guidelines.  Although these are meaningful efforts, more needs to be done to improve prison practices.  Although the New York State Department of Health monitors the quality of medical care at private hospitals and clinics throughout the state pursuant to Article 28 of the Public Health Law, neither DOH nor any other state agency outside of DOCS assesses the quality of care provided within the prisons.  To create an ongoing process of improving prison healthcare, it is crucial that DOH monitor DOCS’s medical care system to make prison practices transparent and to hold DOCS accountable for the quality of medical care delivered to each inmate in its system.

Recommendations of the Healthcare Report
The report proposes detailed recommendations on how DOCS and the State can improve the quality of healthcare in the prisons: 

• The State should enact legislation to require the Department of Health to monitor and evaluate prison medical care.  Alternatively, the governor should order DOH to act pursuant to its authority under Public Health Law, Article 28, to monitor medical care in the prisons.
• State officials should take steps to promptly fill medical vacancies, enhance salaries for positions that are not competitive with community rates, and perform a staffing analysis to identify the prisons most in need of increased staff.
• State officials should ensure that: (1) inmates have timely access to providers, (2) medical staff provide adequate evaluation and timely and respectful treatment, and (3) medical exams occur in locations that permit confidential conversations between medical staff and inmates.
• State officials should implement a more effective chronic care system and assign patients with chronic illnesses to a specific provider.  For HIV-infected inmates, prison medical personnel should be more aggressive in identifying these patients and ensure that the system provides care consistent with community standards. 
• State officials should ensure that inmates with chronic hepatitis C (HCV) infections are appropriately diagnosed and that treatment is offered to all patients who would benefit from HCV therapy.
• State officials should improve access to specialists and ensure that prison providers promptly follow up on specialists’ recommendations.

Jack Beck concluded, “DOCS can begin to provide medical care consistent with community standards if it continues to improve services and if the state adopts the measures recommended in Healthcare in New York Prisons, 2004-2007.”

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