County jails may be able to improve access to health care and reduce in-prison mortality rates through medical accreditation, but the process still involves inmates are said to be dissatisfied with the low standard of care.
A Harvard University study shared with the Times looked at 44 medium-sized prisons across the country and found that those accredited by the nonprofit National Commission on Correctional Health Services had a 93% lower monthly death rate than those that did not. It turned out that. That reduction may have saved about 15 lives over the study period, the researchers said in a preliminary draft of the study, which has not yet been peer-reviewed.
Crystal Yang, a professor at Harvard Law School and one of the study’s co-authors, said prisons seeking a stamp of approval from the NCCHC tend to better educate their staff about referring inmates to treatment. He said there is. The aim is to “ensure processes and procedures for inmate triage and management comply with standards,” she told the Times.
Certification takes several months, typically costs between $5,000 and $10,000, and typically requires a facility inspection by NCCHC experts, Harvard researchers said. Although the prisons in the study did not increase staff, change health care providers, or purchase new equipment, they still had lower death rates than facilities that did not seek accreditation.
“They were able to use the capital and labor they had to provide better services,” said Marcela Alsan, another study co-author and a professor of public policy at the Harvard Kennedy School.
The researchers did not examine whether accreditation would encourage doctors to see inmates more often, and said accreditation does not encourage facilities to offer a wider range of services. However, they said their findings suggest that some medical services, such as medical exams and mental health screenings for new inmates, are provided more frequently and timely in certified facilities.
Alsan said the certification process has facilitated communication between medical and correctional staff, improved compliance with safety and training standards, and increased job satisfaction.
The study comes amid rising deaths in prisons across the country, including Los Angeles, and growing criticism of prison conditions. In 2023, 45 people will die in Los Angeles County lock-ups, making the county’s jail mortality rate more than double what it was a decade ago.
Because participation was guaranteed anonymity, the study does not include the names of the prisons or counties covered. Nine of the prisons were located in California, and the average daily population of all prisons ranged from 100 to 3,000 people. That meant it didn’t include Los Angeles prisons, which house an average of about 12,800 inmates per day. The Los Angeles County Sheriff’s Department said in an email that the facility is not NCCHC certified.
The Harvard study included some indications that accreditation is not a panacea to solve prison health system problems.
Employees at accredited facilities surveyed self-reported lower levels of respect for inmates than employees at non-accredited prisons. Prisoners interviewed for this study expressed vague views about the treatment they received, regardless of their prison’s accreditation status.
“The medical staff thinks you’re lying. [about health issues]” one inmate told researchers. The anonymous prisoner added that he did not think the poor level of treatment he received at the prison, which is one of the accredited prisons, “could be possible in this country.” Similarly, inmates in unaccredited facilities told researchers they were treated like “animals.”
In 2021, researchers identified dozens of prisons interested in participating in the study and paid to become accredited. Over the next several years, the Harvard team interviewed staff and inmates and inspected the facility as the process progressed.
Two of the prisons that initially participated in the study dropped out early. One case was because someone on the facility’s medical leadership team had a heart attack, and the other was because someone on the facility’s detention leadership team was accused of sexual harassment. Of the remaining 44 prisons, half were assigned to be certified and the other half were not. Eleven people were successful and two others are on track to complete the race. Nationally, about 15 to 20 percent of prisons are certified, researchers say.
Researchers found that the 13 prisons that had completed certification or were planning to complete certification had 18% higher compliance rates for safety and prevention standards and 25% higher compliance rates for staff training standards. Additionally, the 13 facilities on the certified track had three deaths, while the 22 non-certified facilities had 27 deaths during the same period.
In their draft report, researchers suggest that the bar was low to begin with as to why there were such improvements in medical compliance and outcomes. Improvements are being made in U.S. prisons, where information friction and coordination problems are severe and health conditions are much worse than widely believed. ”
The Times previously reported that in recent years, inmates in Los Angeles County have died by jumping off railings, banging their heads against walls and injecting themselves with drugs using makeshift needles. At least three inmates stuffed paper, sanitary napkins and other items down their throats and died of suffocation before anyone could intervene. One man was beaten and bled to death for four hours before security guards noticed. A Times analysis of state and county data from last year found that deaths from natural causes, homicides and overdoses were all up in Los Angeles prisons compared to a decade ago.
But in the end, it turned out that the fatality rate was lower last year than the year before. The Sheriff’s Office reported that 32 people will have died in its custody by the end of 2024, the lowest number of deaths at the jail since 2019.
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