Bureau of Prisons Health Care:

Inmates' Access to Health Care Is Limited by Lack of Clinical Staff

HEHS-94-36: Published: Feb 10, 1994. Publicly Released: Mar 11, 1994.

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David P. Baine
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Pursuant to a congressional request, GAO reviewed the Federal Bureau of Prisons' (BOP) medical delivery system, focusing on whether: (1) inmates with special medical needs are receiving the care they need; (2) BOP quality assurance programs adequately detect quality-of-care problems; (3) BOP physicians are qualified to perform medical services; and (4) cost-effective alternatives exist to meet inmates' medical service needs.

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.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: BOP uses a system called the "Sensitive Medical Data Database" to prepare ongoing needs assessments of the inmate population. The system has been in process for approximately 2 years and has assisted BOP in determining what medical services its inmate population requires.

    Recommendation: The Attorney General should require the Director, BOP, to prepare a needs assessment of the medical services its inmate population requires and determine what medical services it can efficiently and effectively provide in-house.

    Agency Affected: Department of Justice

  2. Status: Closed - Implemented

    Comments: BOP has taken or is actively pursuing several steps to improve the cost-effectiveness of care provided to inmates. Although it has not completed its pilot study on whether emergency medical technicians can replace physician assistants, BOP has hired registered and licensed practical nurses in positions previously staffed by physician assistants. The cost for these nurses is less than that for physician assistants. Additionally, BOP completed its pilot study of preferred provider organizations and found that they apparently provide lower costs than the use of private physicians in the community. BOP continues to study ways to control costs, such as implementing telemedicine in three locations, using managed care where feasible, and pursuing an agreement with the Defense Personnel Supply Command whereby BOP can purchase volume medical supplies at discounted prices.

    Recommendation: The Attorney General should require the Director, BOP, to determine the most cost-effective approaches to providing appropriate health care to current and future inmate populations.

    Agency Affected: Department of Justice

  3. Status: Closed - Implemented

    Comments: BOP reexamined its hiring standard for physician assistants under its Title 38 authority and determined that Title 38 would be too costly to implement. Instead, BOP restructured its staffing of medical centers and now emphasizes the hiring of nurse practitioners who meet community standards, over physician assistants who lack certification. Also, BOP entered into an agreement with the Department of Defense to provide training for its physician assistants who do not meet the community standard of certification. This will permit BOP's physician assistants to apply for certification testing.

    Recommendation: The Attorney General should require the Director, BOP, to revise BOP hiring standards for physician assistants to conform to current community standards of training and certification.

    Agency Affected: Department of Justice

  4. Status: Closed - Implemented

    Comments: BOP has taken several actions to improve the quality of its health care program. Specifically, the Director of BOP: (1) sent a memorandum dated February 23, 1994, to all wardens emphasizing the importance of continuous quality improvements; (2) directed six regional offices to nominate a number of institutions for JCAHO survey training; (3) added a section entitled "Quality Assessment and Improvement Program" to its health services manual; and (4) provides minutes of governing body meetings to all institutions citing quality of health care issues discussed.

    Recommendation: The Attorney General should require the Director, BOP, to reemphasize to the wardens of medical referral centers the importance of taking corrective action on identified quality assurance problems.

    Agency Affected: Department of Justice


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