The Federal Bureau of Prisons (BOP) has numerous policies and program statements, all meant to set a standard for operations in an agency responsible for the care of 160,000 prisoners. Among them is a program statement for medical care of prisoners entitled Patient Care. The overall goal of the program is stated as being, “Health care will be delivered to inmates in accordance with proven standards of care without compromising public safety concerns inherent to the agency’s overall mission.” However, those standards are being compromised as a result of staffing shortages that the agency has faced for years now.
The BOP’s prisoner population peaked at over 215,000 around the same time that the BOP updated its Patient Care Program in June 2014. Today, there are 155,000 prisoners, 60,000 fewer than in 2014, yet the BOP’s budget has increased over the same period of time. One cost driver is healthcare of prisoners.
When the BOP updated its Patient Care program statement, it had one lofty goal of creating something called Primary Care Provider Team (PCPT). According to the statement, a PCPT is a core group of health care providers and support staff whose function is to provide direct patient care. It was designed to improve health care services by “enhancing continuity of care and promoting preventive health care measures.” The BOP believed that it would function in the same manner as a medical office in a community setting, only it would be inside a prison. On paper, every inmate would be assigned to a medical team of health care providers and support staff who are responsible for managing the inmate’s health care needs. The statement went on with a lofty prediction that PCPT, “…when fully implemented, “sick call” will be eliminated.” Presumably this would be the case because a group of medical professionals would proactively manage and treat prisoners. Fast forward to the reality of today, nearly 8 years after PCPT, the BOP is struggling to care for prisoners in its care.
Be assured, “sick call” is still very much part of medical care inside of federal prisons where prisoners stand in line asking for medical attention for anything from fever, to chest pain, to aching limbs from an injury. Not much has changed. One of the conditions cited in the program statement to make the program a success is that “Appropriate levels of support staff must be achieved when implementing PCPT.” That is a problem in today’s BOP.
PCPT guidelines were provided for each institution so that for a day shift PCPT staffing pattern for 1,000 general population inmates will have; 1 physician, 3 mid-level practitioners, 1 registered nurse, 1 or 2 licensed practical nurses and/or medical assistants, 2 health information technicians, and a medical clerical staff person. On paper, it is a team of professionals all assigned to take care of a contingent of prisoners.
In March 2022, the Department of Justice Office of the Inspector General (OIG) issued a report on audits of three BOP contracts awarded to the University of Massachusetts Medical School (UMass) between 2012 and 2014 to provide comprehensive medical services at a few of its medical centers. The contracts totaled more than $304 million. Beyond the cited shortfalls in care noted by OIG, the report also provided insight into challenges facing the BOP’s medical care of prisoners. The report’s conclusions were:
“Although the BOP told us that it did not identify any significant problems with UMass’s performance related to the timely delivery of inmate healthcare and quality of care, we found that BOP did not have a reliable, consistent process in place to evaluate either the timeliness of inmate healthcare or the quality of that care.”
“Further, we found that the BOP faced challenges in transporting inmates to off-site appointments which resulted in a frequent need to reschedule appointments that could delay an inmate’s healthcare. In addition, the BOP did not have systems in place to track and monitor the causes for rescheduling appointments, including whether the reason for a cancellation was a BOP issue or one that was out of its control, such as the physician cancelling the appointment.
“BOP also did not have a process in place to monitor how long an inmate waited to receive care after a cancelled appointment. Because the BOP did not have systems to measure or track any of these issues, we believe it is difficult for the BOP to determine whether inmates are receiving care within the required community standard.”
A report by OIG is one thing, but how is it playing out on the front lines of providing care in prisons?
A senior medical person at FDC Miami (FL), frustrated with the lack of action by the Warden, sent OIG an account of what is happening at one federal prison with over 1,500 inmates. FDC Miami has been without a pharmacist for most of 2022. The result according to the submission to OIG is that “We now have several psychiatric patients decompensating daily. We also have many diabetics, hypertensives, cardiomyopathy and HIV inmates that have run out of medications and have no way of refilling them until they, as well as emergent issues, or are lucky enough to communicate the need to executive staff, or custody staff who communicate it to Medical. We repeatedly are responding to attorney, and family member inquiries about inmates who have not received medication. This, of course takes time away from patient care for the TWO BOP staff members who can resolve the issues, myself and the Nurse Practitioner. … There are currently OVER 750 unfilled prescriptions.”
I spoke with Charles Jones, Union President of AGFE Local 4036, who works at FCI Marianna in Florida, “The BOP till hasn’t implemented PCPT teams as outlined in policy at Marianna or anywhere from my understanding. This was suppose to be used to give inmates an experience similar to outside world.”
Jones told me that the same issues faced in 2014 have been exacerbated today. “Currently we are still down positions in medical and this doesn’t include the additional positions of 1 nurse and 1 doctor position that we have still not gained back from the 2016 staffing cuts. We had several medical staff leave once hired due to the lack of staff in the department and the expectation for those staff to do all the work all while being questioned about overtime. Those shortages put a lot of normal heath procedures for inmates on backlog. This has caused significant issues of scheduling many outside medical trips each day which is carried out by correctional services.” Jones’ observations are similar to the findings of OIG’s reports regarding cancelled appointments.
Aaron Mcglothin, Union President at FCI Mendota (California) said in an interview about whether his facility could pass PCPT, “I know our facility definitely does not meet that criteria. We have over 1,300 inmates and we would not pass that type of inspection but then again the only inspections that happen at our facilities are by agency representatives who cover for management.”
The FDC Miami staff member who submitted the plea for help to OIG ended with this ominous note [all CAPS were part of the original submission], “THIS IS UNACCEPTABLE, DANGEROUS. Literally a powder keg awaiting an explosion.”