The State Worker

‘Unprecedented’ doctor shortage at California prison hurting inmate care, audit says

California State Prison-Sacramento has a difficult population of inmates who’ve been transferred from other institutions because of behavior issues. That population is one of the reasons that state doctors choose to work at other prisons.
California State Prison-Sacramento has a difficult population of inmates who’ve been transferred from other institutions because of behavior issues. That population is one of the reasons that state doctors choose to work at other prisons. Associated Press file photo, 2016

Investigators can’t say for sure that poor medical care contributed to the death of an inmate with a common heart condition at a high-security prison east of Sacramento last year, but the overworked system that ignored him didn’t help.

The inmate diagnosed with coronary artery disease died several months after he ran out of pills from his prescription for a cholesterol drug. He did not get a refill, and he did not see a doctor in the eight months he spent at California State Prison, Sacramento.

A summary of the unidentified inmate’s death is included in the latest report by a state inspector general calling attention to “inadequate” health services at a prison with a difficult population of 2,400 inmates that sits next door to Folsom State Prison.

The new report, released in late March by the state Office of Inspector General, faulted a “critical shortage” of doctors at the prison and a “seemingly unprecedented ability to recruit and retain” primary care providers.

Doctors there “complained that current work conditions were unsustainable, and many were actively looking for employment elsewhere,” the report says.

According to the report, medical staff at the prison struggled to respond quickly to emergencies, properly review medical records, maintain oversight of inmates receiving opioid-based medication and arrange medical appointments for new inmates.

The report was published as most California prisons are showing marked improvement in the medical services they provide. A court-appointed federal receivership took control of prison health care in 2006. Since 2015, the federal program has returned 11 prisons to state management because they’re consistently providing better care.

More prisons are expected to leave the federal receivership this year because their services now are rated as “adequate,” said Joyce Hayhoe, a spokeswoman for the receivership.

The audit was based primarily on reviews of records between July and September 2016. It noted that the prison had several projects underway that could contribute to better care in the future, such as construction of a new primary care clinic for patients with serious mental health diagnoses, renovation of other clinics and development of a new central health services building.

It reported seven “adverse” events, which the inspector general considered to be a high number. Some of these events included:

▪  The patient with coronary artery disease who died after his cholesterol prescription went unfilled. “The patient’s medical care was completely dropped” after he transferred to the prison, the report says.

▪  An incident in which an unresponsive patient did not receive cardiopulmonary resuscitation for 12 minutes after he became unconscious. The patient died, and an autopsy determined his death was not preventable.

▪  Nurses turned away an inmate twice after he complained about suffering bloody diarrhea. On the second occasion, he was carried to the nurse’s station on a gurney. After a third appeal for help, the inmate was transferred to an outside hospital. He recovered there.

Vicky Waters, a spokeswoman for the California Department of Corrections and Rehabilitation, declined to answer questions for this story and directed a reporter to call Hayhoe because the Sacramento prison’s health care is still managed by the receivership.

The state inspector general has published regular reports on prison health care since 2010. California State Prison, Sacramento, has remained in the bottom tier of prison health services since then.

It’s known as a difficult place to work, Hayhoe said, because it’s a maximum-security prison that houses inmates whose behavioral problems led to their removal from other prisons, inmates who rely on special mental health programs and inmates with high-risk medical conditions. An inmate stabbed a correctional officer there last week.

“When you put all of these factors together, when doctors choose to work in a state prison facility, they have other places that might be more attractive,” Hayhoe said.

The latest audit showed that the prison had an acute shortage of doctors and an 11 percent vacancy rate among its 137 medical positions.

Three of its seven spots for primary care providers were vacant. As a result, doctors at the prison often were handling the workload of two medical providers during their shifts.

The state has taken some steps to entice more doctors to apply for positions at California State Prison, Sacramento.

It’s one of 12 prisons that will be able to offer doctors a special 15 percent pay hike through 2020 under a tentative contract with the Union of American Physicians and Dentists announced in March. That special “recruiting and retention differential” will be added to the 9 percent wage increase that all state doctors would receive over the next three years.

The average pay for state prison doctors in 2014 was $240,000 a year, so the 24 percent wage increase for doctors at the 12 targeted facilities would receive substantial raises.

Negotiators from Gov. Jerry Brown’s administration agreed to the special raises only after the federal receivership raised concerns about staffing at certain prisons, the union said.

Stuart Bussey, the union’s president, did not return calls for comment for this story. The 1,600 state doctors he represents approved the contract last month. Their deal is awaiting adoption by the Legislature.

A similar inspector general report documenting a doctor shortage at Salinas Valley Prison in November prompted Bussey to issue a press release in which he said “the state can’t hire more doctors because doctors can work elsewhere with better compensation and working conditions.”

Another prison that will be able to offer higher pay is the California Health Care Facility in Stockton. Doctors there are eligible for a 12 percent differential in addition to the contract’s 9 percent general wage increase.

A new report from the inspector general released this week rated its medical services as “adequate,” but noted that vacancies there could hinder care in coming months.

“It was just barely passing” its inspection, the report said.

Adam Ashton: 916-321-1063, @Adam_Ashton. Sign up for state worker news alerts at