Doctors at California Medical Facility (CMF) in Vacaville, Calif., see inmates in a modern medical clinic.
The federal receiver in charge of prison medicine considers one facility the gold standard for inmate care.
The California Medical Facility looks and feels different than other state prisons. The halls are wider to ease the way for inmates in wheelchairs. Those halls are busier, too. The prison’s chief medical officer, Dr. Joseph Bick, says that’s because most of these prisoners pose little security risk.
"Most of them move about the facility unescorted,” says Bick. “They have a little pass. They may be going to school, work or to a doctor’s appointment to get their blood drawn.”
Inmates chronically or terminally ill
Bick points into the prison’s gymnasium window. Most prisons have to use gyms as dorms. Here, the inmates use the gym to exercise. There’s no overcrowding, because to be in the California Medical Facility, an inmate has to be chronically or terminally ill.
"The overwhelming majority of the 3000 prisoners here have some major medical problem, often multiple," Bick says. "You see them walking around, they may be going to work or school. But they may have hepatitis, major mental illness, HIV disease, diabetes, asthma."
Bick says most of the inmates at the California Medical Facility can feed, dress and bathe themselves, but they need to be close to medical help.
The prison’s medical mandate inspires a professional tone between the staff and inmates. Bick says he treats inmates with respect, which earns their trust.
He stops to talk to prisoners in the hallways. He calls by name to a passing inmate. They shake hands.
"Oh hey, Dr. Bick! How you doing?" the inmate says.
Not exactly 'Cadillac care'
Prisons are typically noisy places. Bick tries to turn down the volume inside his medical clinics.
Prisons often treat inmates in converted cells, broom closets or storage rooms. Bick’s clinic is a real clinic. It's clean, white and quiet.
Bick says one of the biggest unexpected benefits of that clinic is that it changes the way his patients behave.
"They come into an environment that is clearly designated as a medical environment, their voices come down.”
Bick says his modern clinic also attracts a better staff. But he says it doesn’t administer “Cadillac care.”
Ask Johntae Bailey.
He was waiting for a dental appointment when his bad tooth got so bad that it woke him up in the middle of the night. A guard told Bailey he couldn’t get an emergency appointment unless his jaw was swollen.
"And I told him how’s it not a medical emergency if my tooth is throbbing and it’s killing me and I cannot sleep?" says Bailey.
Bailey asked the guard to check his file; there they found his three-week-old request to see a dentist. Bailey says the prison’s dentists care about their inmate patients.
"It just takes a long time to get there – I want you to hear it: It takes a long time to get in there!" Bailey laughs.
But Bailey says he’s waited longer for medical care at other prisons. He should know – he’s cycled through a few for drug sales or parole violations.
"You can put in a medical slip, and three or four weeks will pass and you won’t get to see them until then," Bailey says. "That’s why you hear the alarm go off a lot of times. Because people know they got a long wait, so they just go ‘man down’ so the medical will come to them."
When an inmate goes "man down" he collapses on the floor.
Inmates' health a public health issue
Bick says there’s usually some truth to inmate complaints – and he investigates them.
He also knows few Californians care about better inmate care. But most of these prisoners will get out one day.
Bick says that makes inmates’ health a public health issue that concerns everyone.
"If we don't do something to diagnose and treat the treatable diseases while they're here," Bick warns, "educate them about prevention of transmission of some of the illnesses they have, and then link them to services in the community, we’ve squandered a huge opportunity."
Clark Kelso, the federal receiver in charge of prison medical care, considers Vacaville’s California Medical Facility to be the best in the state prison system.
He wants a hub of similar places to cluster the sickest inmates together. The cost of sending sick inmates for care outside the prison has doubled since the receiver took over to $845 million in the most recent fiscal year. Kelso says his planwould save hundreds of millions of dollars a year.
In June, state lawmakers approved $2 billion to build Kelso’s medical hub. But it’ll take three years to complete the main building in Stockton and that medical facility will have only enough beds for a fraction of the number of inmates with chronic or serious conditions.