Medical Care Within the State Prison System

Most Rhode Islanders are familiar with the large, gray stone building surrounded by a barbed wire fence that sits atop Pontiac Avenue at the former Howard complex in Cranston, now recognized as the Pastore Government Center. It is a part of the state prison system known as the Adult Correctional Facility [ACI]. Within its walls are approximately 3,000 incarcerated inmates who will need some form of medical care during their incarceration.

The healthcare services unit provides medical care under the direction of the medical program director, Jennifer Clarke. Services include medical, mental health, dental and health education and clinical services.

Prisoners’ medical treatment begins at the intake center. A medical intake screen provides a medical history and evaluation. Nursing staff records current and prior illnesses, verifies prescription medications and determines which housing is most appropriate for the inmate, based on medical and mental health needs.

The nursing staff provides daily care to inmates. They assist physicians with treatment, administer medications, monitor inmates for communicable diseases, monitor acute and chronically ill patients and attend to inmates who are at the clinic for sick call. An on call practitioner is available to assist with acute cases that may require a hospital transfer.

Behavioral health services is another important facet of the prison healthcare system. It provides mental health and substance abuse treatment to the inmates. About 20% of the prison population has been diagnosed with a mental illness and between 70% and 80% have a substance abuse history, which correlates with the national average.

Some inmates, upon admission to the intake center, may become psychotic and violent. Often they are detoxing from drug or alcohol abuse and may need to be restrained and sent to the observation and stabilization unit where they meet with a mental health professional who develops an individualized plan of treatment. Once the inmate is stabilized and reevaluated, he is returned to the appropriate population.

For prescribed medications, the healthcare administration contracts with CPS [Contract Pharmacy Services], an out-of-state pharmacy that specializes in providing prescription drugs to correctional facilities throughout the US.

The doctors and nurses use an electronic pharmacy order system to order medications, which are flown by a commercial carrier to RI, picked up at the airport by courier and delivered to each facility six days a week. However, if there is an emergency and medication is required immediately, a local drug store will deliver medications to the door of each facility.

Although the DOC Health Care Services is vast and has many components, it appears well organized and up to the task of providing quality medical care under potentially volatile circumstances to the inmates from their initial incarceration until their discharge.

However, according to a source at the ACI who wishes to remain anonymous, the one weak link may be the discharge planning component of the healthcare system. Once an inmate is scheduled for release, they meet with an assigned discharge planner who will assist them with their discharge goals and establish a discharge plan. It appears that at times the discharge process is slow, or a plan may be almost non-existent and the inmate may be left to fend for himself. Without a long-term plan for continuity of care upon discharge, the potential for the inmate remaining successfully in the community lessens.

The real challenge comes when those inmates being released do not have a home to discharge to or family to assist them upon release and are referred to shelters such as Crossroads and Harrington Hall. The shelters employ social workers who will assist released inmates with finding housing and applying for food stamps, medical care or social security. Inmates who are on medications will, upon discharge, receive a 30-day supply of meds, allowing the shelter staff time to follow up with future prescriptions. Former inmates who have a history of addiction are given a supply of Narcan for emergency purposes, though there is a debate over whether giving narcan ahead of time will encourage drug use or if those who will use drugs will use them with or without having Narcan available.

Inmates who have mental health issues are often referred to agencies such as The Providence Center, which will assist them with scheduling a psychiatric appointment and a primary care doctor who will provide the appropriate medications and provide the necessary medical care. Often times a case manager is assigned to follow them in the community to provide any support needed to help them remain stable.

Over the past several years since the Affordable Care Act went into effect, many past inmates who have entered hospital psychiatric units are often referred to nursing facilities where they receive medical and psychiatric treatment as well as assistance with finding housing, a primary care physician and home care services.

Depending on the patients’ medical insurance, psych residents may remain in the nursing facility if they are homeless until a placement can be found. This situation has been controversial with staff at times because nursing homes are not equipped to deal with the psychiatric behaviors that are often associated with many of the psych diagnoses. Assisting psychiatric residents requires a level of training that is not usually a part of a nursing home environment, creating a tension-filled atmosphere that is taxing on staff. And many patients who require medical treatment are often unable to receive the proper care. Unfortunately, many nursing facilities now have an environment that is more conducive to a psychiatric institution rather than a traditional nursing setting, which is making it difficult to meet the needs of the more traditional resident. However, many who were inmates and are homeless should find some comfort in knowing that there is a place where they can receive assistance and a little security.