New York Inmate Health Care Needs Pose Treatment, Design Challenges
Nadel, Barbara A., Travis, Kevin M., Corrections Today
Federal, state and local correctional systems are expected to provide comprehensive medical services to a rapidly growing inmate population. At the same time, these systems are burdened by skyrocketing operational costs, limited capital, aging physical plants and contagious diseases such as AIDS and tuberculosis.
Many correctional agencies, including the New York State Department of Correctional Services (DOCS), have created their own health-care networks. These networks use smaller, localized primary care clinics and larger, centralized regional medical facilities to deliver more cost-effective and labor-efficient health care services to their populations. The following article discusses how New York's DOCS is addressing the needs of its inmate population and how it uses facility design to enhance health care services.
The DOCS operates 68 correctional facilities, including 15 maximum security facilities, 37 medium security facilities and a number of minimum security facilities and work release centers. Two factors affecting the health care services provided by the DOCS are recent increases in the number of women inmates and the rise of communicable diseases among the offender population.
The numbers and proportion of women in the system have increased steadily in the last decade, rising from 2,450 women inmates, or 4.4 percent of the general population, in 1990 to 3,479 women inmates, or more than 6 percent of the total population, in 1993. The DOCS projects that by 1998, these figures will rise to 5,600 women, or 8 percent of a projected total population of well over 70,000.
Many women enter the system with medical problems, with an estimated 60 percent requiring secondary care follow-up services, especially for high-risk conditions. All this has heightened the need for the DOCS to address women inmates' health issues.
Among the most pressing problems among both men and women inmates are TB and AIDS. According to Dr. Robert Greifinger, deputy commissioner and chief medical officer, the demographics of the incarcerated population make it a prime target for the spread of TB. Communicable diseases among inmates are high, especially among those who are HIV-positive.
In 1992, among the state's incoming male inmates, 1.2 percent had hepatitis B, 8 percent had symptoms of syphilis, 13 percent were HIV-positive and 27 percent showed skin-tests positive for TB. For incoming women inmates, the rates were even higher: 25 percent had symptoms of syphilis and 20 percent were HIV-positive.
Plan of Action
In 1991 the DOCS and the New York State Office of General Services responded to these health care needs by developing the Health Care Plan of Action, a five-volume, 4,000-page plan evaluating medical services at all 68 correctional facilities. The plan presented regional- and facility-based solutions for addressing this issue over the next decade, in the form of new construction and renovations.
The DOCS began seeking cost-saving measures on a system-wide basis. Regionalization would enable the DOCS to combine certain activities and provide increased services to a larger inmate population more economically. The object was to move inmates in need of health care to where services and staff exist.
Based on a detailed analysis of demand for inpatient and outpatient services and staff availability, the Health Care Plan of Action called for creating four regional medical units--three for men and one for women--to be located within existing correctional facilities. According to the plan, each unit would have certain standard components and services, but the size and quantities of these elements, such as examination rooms and numbers of beds per nursing unit, would be based on regional need and available services.
The DOCS used the plan to develop architectural programs for new prototype facilities. The four regional units feature primary care clinics, infirmaries ranging in capacity from 12 to 30 beds, secondary care clinics, long-term care nursing units, medical/psychiatric units, pharmacies, dialysis units, support spaces and administrative areas. …