Every day, approximately 20,000 more people are incarcerated in North Carolina County jails. According to years of research, these other people are more likely than the general population to suffer from substance use disorders, intellectual fitness problems, chronic ailments, and infectious diseases.
Despite this population’s significant desires for physical care, there is little data on how and through whom this care is delivered. That’s why an organization of local researchers set out to measure the amount and type of physical care in North Carolina and South Carolina prisons. , Georgia and Alabama.
Researchers conducted 45-minute phone surveys with jail personnel from 254 of the 346 jails identified in the four states from October 2020 to May 2021; North Carolina’s 95 jails had the highest response rate at 90 percent.
The survey, which was published last month, found that nearly 30 percent of jails routinely lacked on-site providers, and 50 percent lacked registered nurses. Additionally, in about half of the jails surveyed, neither a provider nor a registered nurse worked on site for more than two days per week — even as jails operate around the clock, every day.
“When you don’t have a lot of health care staff on site, you can’t provide a lot of health care,” said Jessica Carda-Auten, a researcher at UNC’s Institute for Global Health and Infectious Diseases who helped conduct the research. “We know that folks in jails have many health issues. The implications are, they might not be getting care as fast or as much care as they might need while they’re incarcerated.”
David Rosen, another researcher at the Institute for Global Health and Infectious Diseases leading the staffing assessment, said the survey findings indicate that jail health care likely falls short of community health care standards, resulting in missed opportunities for care and potentially endangering incarcerated people.
“I think this is cause for concern,” Rosen said. “These problems are necessarily new, but. . . By quantifying what really exists, we can start to talk about how those facilities can be improved. “
Because of the few hours of work by on-site physical care workers, the researchers found that many prisons relied heavily on licensed practical nurses and detention officers to perform a variety of day-to-day medical work and even to perform day-to-day work that may be out of reach. training.
Licensed practical nurses practice for one year and are talented at detecting important symptoms and following nursing care plans, but they do not practice in independent nursing tests or creating care plans.
Detention officers are even less educated. In North Carolina, the state education program required to become a detention officer includes less than 4 days of health-related instruction. Despite this minimal education, detention officers may have a wide range of medical responsibilities. In the jails surveyed, 67 percent indicated that detention officers if an arrested user is healthy enough to be incarcerated, 83 percent conduct a medical questionnaire upon entry, and 58 percent assess the urgency of medical requests.
The effects of officers’ daily work decreasing when there were more nursing hours in a week.
Carda-Auten said relying on detention officers for a host of health care duties likely results in poorer care. There’s also a bigger chance that incarcerated people have health conditions that are not fully recognized or detected. She explained that people may not feel comfortable disclosing personal health conditions, such as mental illness or substance use disorder, to a security official, as they could perceive that it might get them in more trouble.
This can become a challenge because failing to identify fitness issues can lead to serious problems in incarceration, such as suicides and other deaths in custody.
In March 2022, Disability Rights NC released a report examining the 56 criminal deaths that occurred in 2020. According to the report, Disability Rights staff found that in many deaths, offenders failed to recognize serious fitness issues. physical condition, failed to respond to serious medical emergencies, and failed to transfer patients to facilities with greater medical policy when required to save lives.
Although a formal report has not yet been released by the organization, Luke Woollard, an attorney at Disability Rights who is tracking jail deaths, told NC Health News that Disability Rights counted 67 in-custody deaths in 2021 and 77 in 2022.
Having detention officers handle physical care is also problematic and increases duty issues in jails run by county sheriff’s departments, Rosen said.
“They don’t need to be in a position where they’re being asked to make decisions that they don’t have the education or pleasure to make,” Rosen said. “I don’t think anyone needs to be in that kind of situation. “
Based on the survey results, Rosen said that medical care for criminals also lags behind the network’s criteria in terms of staffing criteria.
Rosen said he couldn’t believe in another context where non-medical staff would have as many daily physical care jobs as detention officers may have.
For example, the prisons studied were less likely to recruit registered nurses than U. S. public elementary and secondary schools, the researchers write in their paper.
The American College of Physicians affirmed its position in November 2022 that prisons provide “timely access to mandatory fitness services” that meet “prevailing network standards. “
While Rosen acknowledges that comparing jail health care to community health care settings is imperfect because of the patients’ wide range of severity of illness and varied lengths of stay, he said it’s important for care to be on a similar level.
“You really can’t create this dichotomy between health in carceral settings and community health,” Rosen said, explaining that people frequently cycle between jail and the community. “It’s really kind of this dynamic flow between the two, and so it’s really vital to community health as well that we be providing adequate care.”
Prisons are required by law to provide medical care to people in their custody (most of whom have not yet been convicted of a crime), but access to physical care varies widely because prisons are run and funded through individual counties and local sheriffs primarily directly. its management.
Funding for them is widespread.
“Care completely differs depending, often, on which side of the county line you’re on,” Woollard from Disability Rights said.
Carda-Auten acknowledges that providing physical care to this ever-changing population is complex and has spoken with many criminal workers who recognize the limitations of receiving physical care.
“Like many government entities, they are looking to do as productively as possible with very limited resources,” Carda-Auten said.
To increase physical care staffing, Rosen said jails deserve to employ telemedicine more often. The survey found relatively low use of telemedicine: thirteen percent of prisons employ it at least once a month for primary care and 55 percent for intellectual fitness care.
Rosen said other potential pathways to improved jail health care are new models of funding, greater accountability of private health care contractors and policies that could safely reduce the size of jail populations.
“What happens to these folks in the jails does not stay in the jails,” Woollard said. “It’s going to sort of echo in the communities.”
This can be a challenge when other people are released online sicker than when they went to prison, he said. This can lead to higher recidivism rates, which comes at the expense of taxpayers who fund prisons.
“If people go in and are not given health care, not given treatment they need, not provided programs — you get people going back to the community worse off,” Woollard said. “And that’s going to lead to more community health problems.”
But if care is good, he added, “that can be a positive thing. If we have good programs to rehabilitate folks in jails, and we have good health care, … that maybe could even diagnose something the person didn’t know they had and provide them care for that.”
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