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Inspections of prison medical facilities reveal low adherence to key policies

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Inspections of prison medical facilities reveal low adherence to key policies

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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.

Monday, November 23, 2009

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.

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.

Are Inmates Getting Care They Need?

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.