Bureau of Prisons Health Care

Inmates' Access to Health Care Is Limited by Lack of Clinical Staff Gao ID: HEHS-94-36 February 10, 1994

Federal prisoners with special needs, including women, psychiatric patients, and those with chronic illnesses, have not been receiving all of the health care they need at medical referral centers run by the Bureau of Prisons (BOP). A lack of doctors and nurses is a major problem. Some of BOP's medical referral centers that GAO visited failed to correct identified quality-of-care problems. Although the doctors at each of the centers GAO visited were qualified, many physician assistants did not meet the training and certification requirements of the medical community outside of BOP. To reduce its reliance on community hospitals and other outside health care facilities, BOP is considering building six large hospitals and acquiring several military facilities. But BOP has yet to develop the data needed to determine the kind of medical services needed by inmates and the type of services it can effectively and efficiently deliver. Without such information, BOP can only guess at the numbers and types of staff it would need to run these hospitals. BOP should consider drawing on the experience of states with problems in providing inmates with adequate medical care. These states have successfully contracted out some or all of their inmate medical care.

GAO found that: (1) at the three medical referral centers reviewed, inmates with special needs and patients with chronic illnesses did not receive the health care they needed because of the lack of physicians and clinical staff; (2) some patients' conditions did not improve and others deteriorated because physicians could not adequately supervise their assistants and nurses could not adequately provide individual and group counseling to psychiatric patients; (3) although the three centers have quality assurance programs that are intended to identify health care problems, two centers have failed to correct identified quality assurance problems; (4) although physicians at each of the centers are qualified to perform medical services, many physician assistants have failed to meet training and certification requirements; (5) BOP is considering constructing six large acute tertiary care hospitals and acquiring several military facilities to reduce costs and its reliance on community hospitals; (6) BOP does not have sufficient information to determine the number and types of staff needed to operate the new facilities, inmate medical services needs, and the type of services it can effectively provide; and (7) BOP needs to determine its basic requirements and the costs and benefits of other alternatives for meeting its needs before proceeding with the construction or acquisition of facilities.


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