Inspections of prison medical facilities reveal low adherence to key policies

Nov. 23, 2009 | Julie Small | KPCC

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The state Inspector General’s Office will issue a report on the quality of prison medical care in California by the end of the year. It’ll include a summary of inspections at 11 state prisons. The report will help a federal judge determine when to return control of prison medical care to the state. KPCC’s Julie Small has looked over some of the preliminary scores.

A federal judge took over California prison medical care nearly five years ago in a case called Plata v. Schwarzenegger. The court determined an inmate a week died because the care was so poor.

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Since then, a court-appointed federal receiver has tried to improve that care. Chief Assistant Inspector General Jerry Twomey monitors the progress.

"Part of this is not just a medical review for the sake of having a medical review," Twomey says. "It’s a medical review to answer the question that the legal decision in Plata said, 'Your medical care is deficient in very specific areas in very specific ways.'”

Twomey and his inspection team grade 150 areas of prison medical care – from how a prison treats inmates with asthma, hepatitis, or other chronic conditions to how well a prison’s medical staff is trained and supervised. The top score is 100 percent.

Of 11 prisons inspected so far, the Central California Women’s Facility in Chowchilla scored the highest at 77.9-percent. The California Correctional Institution in Tehachapi scored the lowest at 64.3.

Jerry Twomey won’t put a value to those numbers. He says that’s the federal court’s job.

"Our role in this was not to say what’s an OK number. Our role was to tell people what the number is based on, the criteria we all agreed on to evaluate the medical care against. So what does a 56 mean? I’m not sure I can tell you. I can tell you 56 is not as good as 80 and better than 20, right?"

Attorney Steve Fama with the Prison Law Office is willing to interpret some of numbers. They’re found in the sub-scores that make up the aggregate score.

"Some of those scores – and it’s almost universal across all the prisons so far looked at – are horrible!" Fama exclaims.

Fama points to Pleasant Valley State Prison. For getting medication to chronically ill inmates, Pleasant Valley got a 4 percent score.

The prisons inspected so far scored less than 75 percent compliance in at least one of four priority areas: treatment of chronic illness; access to primary care; how well a prison assesses the health of newly-arrived inmates; and an inmate’s ability to see to a specialist. For that last one, all the prisons scored less than 75 percent.

The Inspector General’s Jerry Twomey says a low score in specialty raises the question of "are inmates, are patients, getting consults that they might need?"

Twomey says if an institution scores 42 percent, "then they’re not getting sent out as appropriately as they should be."

Twomey’s talking about the 42 percent score on specialty care his inspectors gave to the Central Medical Facility in Vacaville.

The Central Medical Facility houses chronically ill, infirm, and elderly inmates. It got that 42 percent score for specialty care – but in other key aspects of inmate care, the Central Medical Facility got 80 percent scores.

On a recent tour, chief medical officer Dr. Joseph Bick showed off a gleaming clinic, a gym where inmates with disabilities can exercise, and a hospice for end of life care. Dr. Bick says for the medical care it controls, the prison scores well.

"When a patient asks for services in here – did we get a nurse over to evaluate them? Did we assign them an appropriate level of need? Did we get them in to see their provider? Did we prescribe the appropriate medications?"

Dr. Bick says the Central Medical Facility’s low scores were for care it can't control, like specialty care. That’s when inmates need to see outside the prison. Dr. Bick says the reason it’s hard to line up those doctors is "Because as a clinician, I can identify a need to see a certain sub-specialist, but I don’t have the ability independently to initiate a contract with a provider who’s willing to see our patients at whatever rates the department is willing to pay them."

The Department of Corrections sets the pay rate for outside doctors. But some doctors won’t take prison cases because the pay’s too low. That delays specialized care – and Dr. Bick’s prison medical report card takes a hit.

The Inspector General’s Jerry Twomey says the point of scoring medical care is to identify areas that need improvement. Twomey says it’s really up to the federal receiver and the Department of Corrections to act on those low scores.

"To then take that number and say what didn’t we do, why did we get non-compliance, no responses, and then what do we need to do going forward so that we are compliant with those areas?"

The Inspector General’s Office plans to inspect the rest of California’s prisons and issue a final report on the findings by next summer.

ace
2 months, 2 weeks ago

What a pant load of a story. The only reason Fama "scores" the prisons so low is to keep getting paid. If he were to admit to anything else, he would have no further purpose and his pay would be stopped. Somehow with a score of four, inmates in prison have a lower mortality rate than parolees. Some institutions send inmates to Doctors appointments an average of twice a month or more. Imagine a city of 5000 where Doctors see 11000 patients in a month and Fama rating this as a 4. Now you begin to see how credible he and his opinion are worth. He's just an attorney trying to justify his taxpayer funded paycheck.

j
2 months, 2 weeks ago

Just ask the tax payers how much they want to fork over for inmate medical care and see if prison health care is sufficent. I bet they'll be fine with it!

Tito
2 months, 2 weeks ago

The whole rationale behind the court case ("Plata") is that inmate health care doesn't meet "community standards" and is therefore "unconstitutional". Since Mr. Twoney cannot tell what the numbers really mean, the only way to compare the scores with so-called "community standards" is to use the same grading tool to evaluate "community" health care. And I'm not talking California communities like Bel Air, Menlo Park, and Carmel. I'm talking Compton, downtown Oakland and other areas where most inmates come from.

T
2 months, 2 weeks ago

If I have to make an appointment with a Specialist, generally I have to wait 6-8 weeks for an appointment. On some occasions it can even be up to 4 months. Why should it be any different for inmates. I am a law abiding citizen, I work, pay my taxes, which supports the inmates, and I don't see anyone making any changes or calling it unconstitutional that I have to wait.

Mary Tunstall
2 months, 2 weeks ago

My husband Robert is one of those inmate you folks are so callously saying doesn't deserve medical care. He is a times 4 generational descendant of farmers, and hardworking people. The problem with all of you and most of society is you do not realize this could so easily be one of your loved ones tomarrow. My husband became suicidal several days ago and it is that darn dr Bick who calls to argue with me that my husband will never get well and I am just downright delusional. As a family member with MS it takes it's toll on me fighting to try to keep my husband alive. We have children and grandchildren and we have been married for 33 yrs next week. How can anyone say I don't have the right to want him to live! What you people don't realize is the reason so many are sick. Take the time to do some investigative work. Then see where you live and check it out as well go to http://Thisweknow.org and see how many chemicals your taking in huh. Bet your family dollar it will blow your mind when you see the results.

R. N
2 months, 2 weeks ago

As an employee of California's prison medical system, I believe that this report will not accurately reflect the quality of care, and therefore, will be useless in identifying those problem areas for which remedies need to be found.
As a seasoned nurse with many years in various care areas in the acute care hospital setting, I see a broken, dysfunctional hierarchical system. This approach of a top-down management model leaves no resources left at the bottom where the nurse interfaces with the patient/inmate.
Never before have I experienced such inept, unethical, apathetic, negative, and purposely unaware supervision.
It is the nurses who actually care for the inmates who should be consulted to obtain an accurate view of problem areas, and provide input as to solutions.
As it is now, I have no channel through which to voice my observations and concerns outside of the chain of command. As you may imagine, doing so within the chain of command achieves no change, and most times results in a negative consequence for the indivdual.
When the receiver's staff visits the prison, there is virtually no contact with the staff nurses, and none on a confidential basis without a supervisor present. There is much auditing of reports, inmate medical charts, and quick walk throughs of the clinics.
If the receiver's staff were to confientially interview nursing staff, and look at our own memos, notes, and other documentation which we keep and those sent to our supervisors, the validity of their reports would greatly increase.
Instead of a walk through the clinics, if they were to sit and observe us at work, notice our working conditions and what available resources we have, they would immediately identify many inexpensive and easily done improvements. These include a clean clinic with soap and water for handwashing, the organization of supplies, work flow, and work areas, and the presence of readily available basic supplies and functioning equiptment.
If they were to question us as to actual staffing levels, the greatly fluctuating work load, the overtime shifts we are mandated to work and the accessibility to supervisors who act when they are needed, they too would question the over 200% increase of supervisors in the last three years.
Most of the nurses at my institution have tried to communicate with the receiver's office in various ways, I know of none who have been able to obtain any meaningful contact.

Liz
2 months, 1 week ago

My Fiance is @ Techachpi where he was taken off his meds cold turkey, can anyone help me on who Would I
contact. The Nurse Clark told him to remove his shoes and socks, then his shirt, he stated to her
Im no here for a Physicial, I'm here for my medication
at that time she told him that, he no longer would recieve them.

PLEASE NEED SOME HELP

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