Prisoners at the California Institution for Men in Chino line up, waiting for medical appointments.
The federal receiver in charge of improving prison medical care brought in better doctors – and added prison staff to make sure inmates get to see those doctors. KPCC toured the California Institution for Men in Chino to see whether those changes improved conditions there.
One clinic at the prison in Chino is so small that sick inmates wait on outdoor bleachers. A canopy shelters them from sun and rain, but it can’t keep out the heat or the cold.
The prison’s chief medical officer, Dr. Muhammad Farooq, admits the clinic’s outside waiting area is far from ideal, but he’s proud of the changes inside.
"I can brag about it," Farooq says. "This is the best clinic. It’s very small – but still, it’s one of the best clinics."
Down a fluorescent-lit hallway four doctors work in offices, each barely big enough for an exam table. Those doctors handle 500 patients each – but Farooq organized primary care teams so inmates see the same staff on every visit. He says that creates greater consistency in medical care.
Farooq asks one of the clinic doctors, "How’s the clinic today?"
"Pretty crazy," the doctor replies.
"It’s always that way,” Farooq says.
The clinic’s busy – and crowded.
Farooq says staff continues to struggle with cramped quarters throughout CIM. Some medical staff work in converted cells, closets and storerooms. Dentists work in rooms so small they can’t recline their patients in the dentist’s chair.
In the prison’s reception center, nurses ask new inmates in 4x4 cages questions about their medical histories.
"We’re thinking of dividing those in four!" Farooq says with a laugh.
After the riot at the prison last August, medical teams had to stitch up inmates on benches in the yard.
Farooq says he can’t make the clinic bigger, but he can make the care better. And he can make sure inmates get access to that care.
When Farooq started at CIM in 2007 inmates often missed appointments. Medical staff marked them as “no-shows.”
"We have eliminated that," Farooq says. "'No-show' is not a term we use now."
Doctor's cops check inmates into the clinic
That’s because special access to healthcare officers check inmates into the clinic.
One correctional officer matches inmate IDs against a list on a clipboard.
"We get them here within a certain amount of time," the officer says. "They don’t show up, we shut the whole yard down and try to locate the inmate."
The federal receiver in charge of prison medical care in California created these “doctor’s cops.” He also paid prison doctors more, and hired better ones – among them, Farooq.
Farooq was recruited from Kaiser to replace Chino’s previous medical officer who agreed to quit – and never work in prisons again.
When Farooq took over, he gave up Chino’s hospital and emergency room licenses. He says neither was properly staffed or equipped.
Farooq, who still works part-time at Kaiser in Harbor City, insists the doctors at the Chino prison are just as good.
"Our doctors are qualified doctors, board-certified clinicians," he says. "They do a great job giving care to our patients."
'Just take a pill'
Inmate Charles McGee of San Bernardino, who came to the clinic for treatment of a spinal injury, says good care comes down to whether staff really wants to help, "instead of just brushing you off."
McGee says, "if you tell a nurse, 'My chest is really hurting,' some will say, 'Just take a pill.' And they are tired. And some will really go into what’s really going on with you."
McGee says his primary care nurse at CIM treats him well.
"I like him and my doctor because they try to help you. For a long time in prison, we didn’t get what we get now."
What was it like before?
"People would die!" McGee says.
Four years ago, the federal receiver found that asthma was the leading killer of inmates.
McGee says it was a problem in 1997 when he was at Tehachapi State Prison.
"People would be complaining about their asthma pumps, and people wouldn’t get them and die," McGee says.
Medical records are still on paper
Farooq says no inmates at Chino have died on his watch because they didn’t get the right care or the right medicine. But he says prison doctors are at a disadvantage because they often treat patients without knowing medical histories. That's because prison medical records are still on paper – paper that has a way of piling up.
"Right now, we’re averaging about 14 to 16 inches of loose filing a day," says Apryle James, who supervises medical records at Chino. James says it makes it tough to catch up because doctors ask for up to 600 inmate files a day – which means any loose papers can't get filed in those folders… and doctors can't find what they need.
"We spend a lot of time looking for paperwork for the doctors because we haven’t had the time or the staff to get the paperwork in there," James says.
Farooq says paper records also create problems for the doctor on call – because they can't access medical records remotely.
"I prescribe medication without knowing the rest of the history," Farooq says. "Is the person taking other medication? There could be some interactions there. I don’t know. Nurse doesn’t know. So we prescribe blindly."
Farooq says some lab results are now on computer – but getting all the records into a computer would remove the guesswork and save the state the money it spends on duplicate tests.
With the boxes out of the way, Farooq thinks he could convert some of those filing rooms into badly needed clinics.