It’s no easy task to find doctors, nurses and other health care professionals to take a job in a prison. The stigma alone is a major barrier. Not to mention concerns about personal safety.
Plus, prisons are often in out-of-the-way places.
Now, recruiting and retaining prison health care workers may get even harder because of the Affordable Care Act.
Inmate health care is a touchy subject because inmates sometimes have better access to care than many poor people on the outside.
But the courts have determined adequate medical care is a constitutional right for prisoners under the Eighth Amendment. That’s the one that bars cruel and unusual punishment. And if prisons don’t provide adequate care they get in serious legal trouble.
A revolving door
The Washington Corrections Center is about 30 miles northwest of Olympia. In the center of this sprawling 1960s-era complex is the prison infirmary where Eric Larsen works as an Advanced Registered Nurse Practitioner.
Larsen is doing a check-up on an offender named Bob. We’ve agreed not to use his last name for health care privacy reasons.
Bob been incarcerated here for seven years. After his check-up, he agrees to talk with me.
I asked if he noticed a lot of turnover in the medical staff here in seven years.
“Oh yes," he says. "Some people are just in and out you know.”
Like prison itself, correctional health care is a revolving door. Eric Larsen’s been working here five years -- longer than a lot of his colleagues.
“I did a mid-life career change," he says. "I used to be a state Fish and Wildlife biologist.”
Larsen says he decided to take this job largely because he gets loan repayment help through a national health service program. Plus, he gets to continue to build on the state retirement he earned as a longtime Fish and Wildlife employee.
“That’s just been a benefit that I feel fortunate to be able to take advantage of,” says Larsen.
High vacancy rates
Advanced Registered Nurse Practitioners like Larsen are among the hardest to recruit. Psychiatrists are the hardest. In some Washington lock-ups, health care job vacancy rates are 25 even 40 percent. Expensive, temporary contract workers often fill in the gaps.
Kevin Bovenkamp is assistant secretary for health services at Washington’s Department of Corrections. He describes trying to keep up with the turnover as like trying to speed date while on a treadmill.
“You hire one and some days you lose two, maybe you hire two and you lose two,” says Bovenkamp.
And now, with Obamacare coming on line, he’s pretty sure it’s going to get even harder. Expanded insurance coverage will mean more jobs in the health care industry. The American Correctional Association has warned that the Affordable Care Act may “significantly strain” the primary care workforce available to prison systems.
“I believe they’re going to have a lot of trouble," says Donna Strugar-Fritsch, a consultant in California who works with prison health care managers nationwide.
"And what I’ve been suggesting is that they take the time now to start looking at the efficiencies of their processes so as these shortages emerge they are able to do more with fewer people.”
Strugar-Fritsch says if prison systems don’t get smarter about how they deliver health care, “They will have unfilled positions which turn into lags in patient care which turn into bad outcomes which turn into lawsuits.”
Improving efficiency, avoiding lawsuits
As it is, Washington’s Department of Corrections has paid out more than $5 million in medical negligence claims since 2000 for everything from the loss of a testicle due to delayed treatment to a suicide that might have been prevented through better treatment and monitoring.
Individual claims are one thing. Class action lawsuits and federal intervention quite another. This fall, Idaho’s Department of Correction settled a decades-old health care lawsuit brought by inmates. And in 2005, California’s prison health system was put into federal receivership.
Bovencamp is all too aware of the troubles elsewhere.
“The goal is not to get in a situation where we’re struggling and somebody else is telling us how we should do our health care.”
Bovencamp says the Washington Department of Corrections is currently undertaking several efforts to improve health care efficiency so it can operate with fewer people. The agency is also looking to recruit doctors from overseas. And there’s talk of paying hiring and retention bonuses.
Back in the infirmary at the Washington Corrections Center, Eric Larsen pauses at a nurse’s station between patients.
I ask him what his level of job satisfaction is working at a prison everyday.
“There are challenges working in a prison environment," says Larsen. "They revolve mostly around access to patients, they revolve around the issues of safety.”
Larsen says he actually feels safer working in a prison than he did in an ER. But there’s a price that comes with that security. An inmate might not make an appointment because a rival gang member is in the infirmary at the same time.
Larsen says feels good about the work he does. Healthy inmates are better behaved and since the vast majority are eventually released, he sees a value in sending them back into society in good health.