After East Baton Rouge Parish Prison medical workers complained in past months of being short-staffed and underfunded, consultants said Wednesday the prison needs new, experienced medical leadership.
Harrowing stories from the prison’s nurses and doctors in the fall spurred the parish Metro Council to approve a $95,000 contract with Chicago-based Health Management Associates to study the prison’s medical services. The group’s consultants have spent the past several months interviewing the prison’s medical workers and other city-parish leaders to determine the areas most in need of change.
The first challenge, the consultants said, is to persuade the public to consider prison health care as part of the continuum of health providers in the city-parish. New leadership will be needed to make that happen, they said, noting that a lack of standard protocols and checks and balances has led to “episodic and inconsistent” health care in the prison.
Changes in the way prisoners across the state are cared for have caused problems for the nurses and doctors at the Parish Prison. They are now expected to provide more primary care and preventative care to divert inmates from emergency rooms but have complained they lack the staff and equipment to do so.
“How things worked in the past is not working anymore,” said Jack Raba, a physician and a principal with the consulting group.
The consultants said it’s impossible to compare the medical care at the Parish Prison with other prisons they have toured and made recommendations for across the country. But they said the rise of mentally ill people in prison and sicker prison populations are nationwide trends.
Also, the consultants said there are not enough people addressing medical and mental health at the prison. The physicians and other staffers meet only 36 percent of the prison’s medical needs and 61 percent of its mental health needs, the consultants estimated.
The consultants applauded the hard work and dedication of the jail’s current medical staff. But they said the staff is not capable of making the sweeping changes and managing the health care the prison needs.
The consulting group said the city-parish needs to hire a full-time administrative leader for the prison and hire others who can bring changes without clinging to the way things have been done in the past.
One new leader in particular should be devoted to implementing a program focusing on the quality of medical care, the consultants said. National standards and data should drive the new policies, they said.
In addition, the consultants recommended the jail quickly fill its vacancies, which are causing the staff more work and stress.
They applauded three aspects of care at the prison: the way social work screenings and triage requests work for inmates to see psychiatrists, the medical records system and the pharmacy management.
However, not enough inmates are receiving health assessments, and physicians are wasting time that could be spent elsewhere giving health assessments that could be performed by registered nurses, the consultants said.
They also looked at 30 of the prison’s transfers in January to Our Lady of the Lake’s emergency room. They determined only 16.7 percent of the cases were entirely appropriate ER transfers, while 40 percent were appropriate but avoidable and 43.3 percent were not appropriate.
Inmate transfers for emergency services have been one of the murkiest changes after the state privatized its charity hospital system. The mostly pretrial inmates at the Baton Rouge lockup used to go to the public charity hospital, the Earl K. Long Medical Center, for emergencies and nonemergencies alike.
The hospital treated them for free, but the state gave money to the hospital for that care.
Under the new model, city-parish government pays for medical care at the prison, while the state picks up the tab for all inmates who land in emergency rooms or who need specialists. But the state can reject paying for nonmedically necessary transfers to ERs, and then the bills fall back to local government.
The consultants also said the jail can do a better job of giving primary care to patients with chronic illnesses and HIV — the type of care that could keep some inmates out of emergency rooms. Baton Rouge leads the nation in cases of HIV and AIDS, and city-parish Emergency Medical Services administrator Chad Guillot has estimated the jail spends between $120,000 and $140,000 a month on medication, most of which is to treat HIV.
City-parish leaders have spent years pushing for a new prison, and the consultants noted the current prison creates problems for medical care. They said it has inadequate medical and dental suites and lacks sufficient space for those with disabilities.
Despite the findings, Raba and consultant Linda Follenweider praised Baton Rouge for seeking solutions for prison medical care on its own, rather than being told to do so by the U.S. Department of Justice or another agency.
“You recognize that people in jail are part of the community,” Follenweider said. “You’re shining a light where a lot of people hide.”