Skip to main content

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.
Jump To:
Skip to Highlights


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.


Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Justice 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.
Closed – Implemented
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.
Department of Justice 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.
Closed – Implemented
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.
Department of Justice 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.
Closed – Implemented
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.
Department of Justice 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.
Closed – Implemented
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.

Full Report

Office of Public Affairs


Access to health careCorrectional facilitiesCost effectiveness analysisHealth care cost controlHealth care facilitiesHealth care servicesHealth services administrationMedical information systemsPhysiciansPrisonersQuality assuranceQuality of care