America’s prison population is, like the general public, aging rapidly. The wide net cast by the incarceration explosion of the 1980s and 1990s means that the percentage of prisoners needing increased health care has risen dramatically as well. This is particularly true in the Federal Bureau of Prisons, which has always had an older population than the national average, due to the profile of the offenders it prosecutes.
Basic Health Care in the Federal Bureau of Prisons
Every inmate entering the Federal Bureau of Prisons is given a general health screening which includes basic blood tests and a consultation (a psychology screening and a dental exam are also provided).
If the inmate is found to be in a generally healthy state, then further medical care is provided only upon request, with the exception of annual tuberculosis testing, which is mandatory. On occasion, an inmate may be called in for random HIV and other disease testing programs. Those deemed generally healthy are directed to use the sick call/triage program to access health care, as explained below.
Chronic Care in Federal Prison
Some inmates enter the Federal Bureau of Prisons with chronic health conditions, or develop them during their incarceration. For these inmates, they are assigned a “care level” commensurate with the care required. They will be seen regularly and monitored accordingly.
For example, inmates diagnosed with high blood pressure may be given medication, and seen for monitoring every three to six months for blood tests and other testing. Inmates with Type 1 Diabetes may be given insulin injections daily and seen on a more frequent basis. Other serious conditions are likewise treated.
Inmates with less urgent but chronic needs, such as those suffering from skin conditions or back pain, may be seen only twice a year.
Managed Care: Health Care Staffing
The Federal Bureau of Prisons utilizes a managed care model of treatment.
In this system, most inmates see a Mid-Level Practitioner (MLP) as their primary care provider. The MLP handles basic diagnostic care, provision of common treatments, and referrals for more specialized care. Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) also perform this duty.
An inmate may be referred to a Medical Doctor (MD) for further services. Very often, though, even chronic care inmates rarely see an MD, and communications with such a provider go through the MLP.
For those who need specialized care beyond the level of local staff, the BOP utilizes contract specialists in most regions. Such care is usually subject to several levels of approval.
Inmates who are injured, ill, or otherwise need medical attention can access health care via filling out a sick call/triage form (in the case of a true medical emergency, inmates can ask any staff member to contact medical staff for immediate assistance).
The sick call/triage process involves filling out a form, delivering it to a mailbox in the Health Services lobby, and awaiting further contact from medical staff. Such requests are triaged according to urgency. Some inmates will be called to Health Services the same day; others will be placed on callout for an appointment days or weeks later.
Medications that require a prescription are dispensed via the institution’s Pharmacy. Some drugs, such as daily medications for cholesterol, are picked up by the inmate for “self-carry.” Other medications, for example, anti-depressants and other mind-altering drugs, are dispensed via “pill line,” held one or more times a day at the pharmacy window.
For “over-the-counter” medications like aspirin, antacids, foot creams, etc., inmates are expected to purchase them from the commissary, unless they are deemed indigent.