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Prison Health Care

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Prison Health Care

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Two years ago, poor medical care in state prisons accounted for about one inmate death each week. A federal judge took over and the state terminated about 60 substandard physicians. That's left many prisons without enough doctors, but not the Calipatria prison about 100 miles east of San Diego. KPCC's Julie Small reports on one doctor who's quickly building the staff.

California state prison bucks trend and builds medical staff
Friday, March 7, 2008

Julie Small: Calipatria State Prison is a cluster of cement buildings and barbed wire fences rising out of the Anza Borrego Desert. Getting doctors to work in prisons is tough. Getting them to work at Calipatria is a whole lot tougher.

Dr. Katrina Ball: ... we're entering Central Health. This is the hub of where it all happens. These officers here...

Small: Dr. Katrina Ball, the prison's energetic chief surgeon, is undaunted.

Ball: ... You know, "Can I talk you into working here? Come out here. It's wonderful. It's wonderful!" So my efforts, you know, I (laughs), I'm just constantly calling.

Small: Calling medical schools, residency programs, and unhappy doctors working at HMO's. Dr. Ball hired two physicians away from Kaiser Permanente.

Ball: I think they're suffering, because we are, statewide, stealing a lot of their physicians.

Small: That's because corrections has statewide openings for prison doctors. The pay's gone up. A board certified physician-surgeon at any state prison can earn a quarter of a million dollars a year. Dr. Ball says that's about a hundred thousand dollars more than a general physician would average in private practice. Prison doctors don't chase down reimbursements from insurance companies or Medicare. And, says Dr. Ball, her doctors work bankers' hours.

Ball: So I do want to get the news out there. Hey! This is the best paying, best stress-free doctor job in the state.

Small: "Stress-free," if you don't "stress" out surrounded by prison guards with machine guns. Most of Calipatria's 4,200 inmates are serving time for violent crimes, but Dr. Ball says they treat prison doctors well.

Ball: Well, as a woman, I feel really safe working here. The inmates look at us as a help. We're their advocates, we're they're helpers, we're the ones that, we care about them, and we're going to try to give them good medical care. Other than your few personality disorders, and your sociopaths (laughs), most of them are very grateful and respectful of the medical staff.

Small: And if they're not, prison guards steps in.

George Santana: He has a mini-14 up there, which he's supposed to have slung at all times, along with other...

Small: Corrections' information officer George Santana escorts Dr. Ball past the inmate exercise yard to one of the prison's medical clinics. There's a fence around the yard. Prison officials made it higher so inmates couldn't climb over it.

Santana: And this would be our medical.

Small: This is the place where Dr. James Ma sees about 20 patients a day.

Dr. James Ma: After three days, it should be fine.

Small: Inmate Brian Carlton has an infected ingrown toenail.

Brian Carlton: Do you think I should soak it?

Small: Dr. Ma usually treats more complex conditions. That's one reason he took the job. Prison doctors get great experience with a wide variety of diseases in an underserved population.

Ma: We see a lot of hypertension, diabetes, and also obesity, and cholesterol. And also, interesting enough, we have a lot of skin conditions, and also a lot of orthopedic conditions. Joint pain, shoulders, knees. And we have a lot of chance to do the injection, joint injection, which I love to do, too.

Small: A few years back, one Calipatria inmate, who injured his knee, got ibuprofen, and nothing else. Later, the prison medical staff told him he needed an orthopedic surgeon, but never sent him. That led to a lawsuit over poor medical care at state prisons. That suit is also why Calipatria hired Dr. Ball. She's committed to good medical care for the inmates, and she's weeded out the doctors who aren't.

Robert Blair: There have been a lot of doctors, and I have witnessed some of those doctors who, I don't think they had a real good interest in the patients and what they were doing.

Small: Inmate Robert Blair is 70. He's serving a life sentence for murder, and he's serving it in the prison infirmary. Blair has a degenerative disc condition that limits his movement. He's impressed with the improvements in medical care, and he credits Dr. Ball. Dr. Ball says she could use more help, but she's happy with the job.

Ball: I feel like I'm making a difference. And I know I've made a lot of good changes just since being the chief, so I'm very grateful and thankful for the opportunity to do that. I do believe that they are getting good care, and better care than they've ever gotten since the establishment of this prison.

Small: And it might get better still. Some prisons haven't hired any doctors since the state began its push to reform medical care for inmates. But at Calipatria, Dr. Katrina Ball plans to hire her fourth new doctor soon, and she's aiming to find money for a fifth down the line.

© 2008 KPCC (used by permission)