Prison 911:Prison 911:AvenalAvenalLori Kohler, MDShira Shavit, MDElena Tootell, MD

Correctional Medicine Consultation NetworkCorrectional Medicine Consultation NetworkDepartment of Family and Community MedicineUniversity of California, San Francisco

Prison 911Prison 911

Incarceration in the U.S. and California

Plata v. Schwarzenegger

Correctional Medicine Consultation Network

Avenal State Prison

Incarceration in the U.S.2.2 million people in prisons and jails

2.4 Million children have a parent in prison or jail

Highest per capita incarceration rate in the world 583/100k

½ of male children whose parent has been incarcerated will also be incarcerated

Chance of incarceration during lifetimeBlack males 1in 3 3.2/100 Latino males 1 in 6 1.2/100White males 1 in 17 0.4/100

Incarceration in California170,000 current; 302,000 total per year (8%incr)

32,400 life sentence, 650 condemned

Avg. sentence 4.5y, served 2y

Reading level 7th grade

29% African American

37% Latino

29% white

1961-1965

1984-1997

2001 - 2005

18801933

1852 Prisons in California

1941-1955World War II

Vietnam War

Reagan and the War on

Drugs

San Quentin State Prison (SQ)Folsom State Prison (FOL)

California Correctional Institution -- Women (Closed) (CCI)

1954 - California Correctional Institution – Men (CCI)

1941 - California institution for Men (CIM)1946 - Correctional Training Facility (CTF)

1953 - Deuel Vocational Institution (DVI)1952 - California Institution for Women (CIW)

1955 - California Medical Facility (CMF)1954 East - California Men’s Colony (CMC)

1961 West- California Men’s Colony (CMC)1962 – California Rehabilitation Center (CRC)

1963 - California Correctional Center (CCC)1965 – Sierra Conservation Center (SCC)

1984 – California State Prison Solano (SOL)1986 – California State Prison, Sacramento (SAC)1987 – Avenal State Prison (ASP)

1987 – Mule Creek State Prison (MCSP)1987 – R.J. Donovan Correctional Facility at Rock Mountain (RJD)1987 - Northern California Women’s Facility (NCWF)

1988 – California State Prison, Corcoran (COR) 1988 - Chuckawalla Valley State Prison (CVSP)

1989 – Pelican Bay State Prison (PBSP) 1990 – Central California Women’s Facility (CCWF)

1990 – Waco State Prison (WSP) 1992 – Calipatria State Prison (CAL)

1993 – California State Prison, los Angeles County (LAC) 1993 – North kern State Prison (NKSP)

1993 – Centinela State Prison (CEN) 1994 – Ironwood State prison (ISP)

1994 – Pleasant Valley State Prison (PVSP) 1995- Valley State Prison for Women (VSPW) 1992 – Calipatria State Prison (CAL)

1995 – High Desert State Prison (HDSP)1996 – Salinas Valley State Prison (SVSP)

1997 – California Substance Abuse Treatment Facility (SATF)Bush

2005 – Delano State Prison (DEL)

Medical Care for Prisoners

Eighth AmendmentPrison officials are obligated to provide prisoners with adequate medical care

Mid 1970s legal actions were first steps toward then recognition of health care needs of prisoners

Plata v. Schwarzenegger

The largest ever prison class action lawsuitPrisoners alleged that California officials inflicted cruel and unusual punishment by being deliberately indifferent to serious medical needsSettlement agreement filed in 2002 Requires the California Department of Corrections to completely overhaul its medical care policies and procedures

California Prison Receivership

Second time in U.S. history that a federal receiver has presided over a correctional system

Receiver has access to resources and ability to override usual procedures

CMCN MissionOur mission is to improve the quality of healthcare, the dignity, and the quality of life for inmates in California prisons. To insure this, we will provide support, training, and resources to CDCR medical personnel and foster the relationship between academic, community, and correctional medicine

Prison 911

CMCN faculty and administrative staff Short term intensive assessment and reorganizationCatch up on back log of visitsRecruit new providersConsult on complex patientsFacilitate referrals and transfers for care

Avenal State Prison

December 2006 received a phone call from the federal receiver’s officeEmerging crisis at Avenal 3 inmate deaths due to shortage of doctorsCMCN sent team of doctors, administrative staff, and nurse practitioners to Avenal

Avenal State PrisonMarch 7, 2007: total population = 7,494 vs

design capacity = 2,920

ASP 257 % occupied ratio, largest population in CA

TOTAL NUMBER OF YARDS: 6

TOTAL NUMBER OF PRIMARY CARE CLINICS: 6

Low-medium security institution

28-bed Outpatient Housing Unit (OHU) = Homecare

3-bed Treatment & Triage Area (TTA) = Urgent care

TOTAL PCP FTE = 9TOTAL FILLED =6 2 ATO, 1 MD/1 NP Registry

Avenal State Prison-Findings

1500 men > age 55150 men on insulin40-50 men on coumadin, no labs in months121 urgent referrals to specialists pendingPrimary and urgent care clinics backed up several monthsHundreds of 7362s (requests for appointment) untouchedHundreds of abnormal lab results not addressed

Avenal State Prison-FindingsMost yards with no primary care provider for monthsChronic care patients without follow up visits for over 8 monthsHundreds of medication refills pending authorizationNPs and PA working without supervisionPhlebotomy months behindOHU with several patients at acute hospital level of careMany gravely ill patients without care and at risk for Cocci

Avenal State Prison-Accomplishments

Reviewed 121 Urgent RFS. Prioritized and scheduled urgent referralsRan several clinic lines for 5 weeks (>300 patients, 600 visits)Reviewed hundreds of abnormal labs and anddiagnostic studies, follow up with appropriate patientsStarted database of chronic care inmates based on lab values, pharmacy profiles, physician and staff referrals, and CMCN encountersTransferred sickest patients to appropriate level of care

Avenal State Prison-Accomplishments

Consulted with NPs and PAsSupported leadership by facilitating discussion to problem solve obstaclesDefined levels of care Recruited physicians and contributed to retention of existing physiciansOngoing primary care via telemedicineCorral support from state and federal leadership

SummaryThe CMCN is a ground-breaking program with unlimited potential

The CMCN will improve the quality of healthcare in California State Prisons quickly and indefinitely

The CMCN loves student and resident participation in any and all of its activitiesThe CMCN has many fabulous job opportunities for faculty and staff

SummaryContact the CMCN for more information about Our programs.

Lori Kohler, MDShira Shavit, MDCorrectional Medicine Consultation Network1940 Bryant StreetSan Francisco, CA 94110(415) 476-2041lkohler@fcm.ucsf.edusshavit@fcm.ucsf.edu

Photos from Prison LawOffice Website

Contact InformationLori Kohler, MDShira Shavit, MDCorrectional Medicine Consultation Network3180 18th StreetSuite 302San Francisco, CA 94110(415) 476-2041lkohler@fcm.ucsf.edusshavit@fcm.ucsf.edu