Life in Prison: Medical Care Considerations
When facing life in prison in a federal facility, individuals face many challenges.
One challenge that is not talked about is that of health care. Life in prison should not jeopardize an inmate’s health, but that is exactly what is happening throughout the Bureau of Prison’s (BOP) system. The health care that should be provided, at a very minimum should include medical, dental, hearing, eye care and pharmacy services.
This brief article offers information for those individuals who will soon be entering the federal prison system. For those defendants with acute or chronic medical conditions, this will be a valuable resource. For more detailed information, please check out this full report covering Medical Care in Prison.
Admission and Orientation Issues
The typical Admissions and Orientation manuals of the various Federal Prisons state that medical care will be provided to all inmates with adequate staffing including that of a Clinical Director, doctors, nurses, x-ray and other health information technicians, and a pharmacist. While this sounds good on paper, it sometimes does not correlate to the actual services being provided.
One of the BOP’s locations was found to be terribly lacking in offering these services. At one time or another this facility was without a physician, registered nurses, dentists, x-ray technicians and a pharmacist. In fact, the x-ray machine was not even functional for months. These issues persisted for long periods of time without being corrected.
Medical Designation Levels
On paper at least the BOP has four different medical designation levels for inmates with health issues. The concept is to direct inmates to the various BOP facilities to try and find the right fit for each inmate. This is the stated objective but is seldom the reality.
There are four different Medical Designations for considerations based on the inmate’s medical condition. These levels include:
- Level One inmates are usually healthy and require little medical care
- Level Two inmates may have some chronic health conditions but which are under good control
- Level Three inmates have more health conditions that require either weekly or monthly evaluations that may include asthma, diabetes, congestive heart failure or seizures.
- Level Four inmates require daily nursing care, and the health conditions are normally terminal
Medical Care of Inmates
The Bureau of Prisons has a responsibility to provide five major levels of medical care for all inmates. These five levels include:
- Medically Necessary-Acute or Emergent Medical Care (inmates that have an immediate acute condition)
- Medically Necessary Non-Emergent Medical Care (inmates that have medical conditions that are not life-threatening but without treatment could lead to premature death)
- Medically Acceptable – Not Always Necessary Medical Care (inmates with more elective care for treatment that may improve the inmate’s quality of life)
- Limited Value Medical Care (medical care for conditions in which treatment provides little or no medical value)
- Extraordinary Medical Care (interventions which affect the life of another individual such as organ transplants)
If you are facing detention in a Federal prison and you have health conditions that will need ongoing treatment, it is imperative that you consult with Jail Time Consulting to help you get placed in a BOP facility that best meets your needs. For a free confidential consultation please call 800-382-0868.
Inmate Dental Care
The BOP is supposed to offer dental service to inmates to “stabilize and maintain the inmate population’s oral health. Dental care will be conservative, providing the necessary treatment for the greatest number of inmates with available resources.”
The BOP staffing guidelines require one dentist for every 1,000 inmates. In the same two facilities in Miami, there was not even one dentist most of the time. Making matters even worse, if there are dentists who are inmates they are not permitted to work in the dental clinic in any capacity.
Dental treatment that is supposed to be provided includes patient education on brushing, flossing, other oral hygiene aids and diet and nutrition. Non-emergency dental services should be provided which includes radiographs, oral health instructions, indicated prophylaxis, other periodontal therapy, endodontic and restorative treatments, oral surgery and the fabrication of a prosthesis.
Even though these are all listed services that are supposed to be provided, there is little evidence that this is the normal practice. For those individuals facing life in prison, not having adequate access to proper dental care can be a significant issue. Careful planning and consultation prior to incarceration should be taken to assure the best possible placement for the individual.
The most important thing an individual can do prior to entering a Federal prison is to be proactive concerning their health. There are certain things individuals can do prior to entering prison, during incarceration and after being released, to maintain or even improve their health.
Before entering a federal prison, the defendant should complete the following:
- A complete medical and physical examination from his family physician or a local hospital
- All minor surgeries or surgical procedures
- A letter from the defendant’s physician stating any medications and dosages
- A complete dental check-up and dental service should be completed
- A complete hearing and eye examination and purchasing the necessary eye glasses or hearing aids
Inmate Eye Care
The BOP is required to furnish prescription eyeglasses to inmates that require them when documented through a professional prescription. In reality, the process for obtaining such a prescription is both long and frustrating. Besides having the inmate send in numerous Cop-Out forms, the actual visits with contracted optometrists and ophthalmologists are seldom regular.
Inmate Hearing Care
As with inmate eye care, as described above, inmate hearing care is also mandated by the BOPs regulations. If an inmate has a hearing aid prior to entering a BOP institution they are normally allowed to keep it. However, if an inmate has a bona fide clinical indication for a hearing aid, the BOP does not have contracted otolaryngologists. If it takes up to two years to get an appointment with a contracted provider, how long do you think it takes to get an appointment with a non-contracted otolaryngologist?
Prescriptions are supposed to be provided by a pharmacy on site. Prescriptions are provided daily, and inmates are to line up three times a day in at a pill line window. Controlled medications are issued on a per-dose basis, unless the inmate has a chronic condition, in which case the inmate could be given a 30 day supply. If an inmate is not getting his medication, he has to send out those dreaded Cop-Out forms that may end up going nowhere.
Primary Care Provider Teams
Each facility in the BOP system is required to have daily one physician, three mid-level practitioners (physician assistants), a registered nurse, one or two practical nurses or medical assistants, two health information technicians (example x-ray techs), and a medical clerical staff person per 1,000 inmates.
In at least two facilities in Miami Florida that were reviewed there was a combined total of 1,800 inmates, and only one physician (no other medical staffing at all).
If you are facing incarceration in a federal prison, and you have medical conditions or concerns, you should realize by now that even though there are regulations in place for taking care of the medical needs of inmates, there is little connection between the regulations and reality.
Careful planning and consultation is needed for defendants prior to incarceration to make sure that the best possible facility can be selected. For those facing life in prison, this is even more important.