County detention centers might enhance healthcare accessibility and diminish mortality rates within prisons through medical accreditation, yet the procedure still involves inmates expressing dissatisfaction regarding the subpar quality of care.
A Harvard University analysis shared with the Times examined 44 medium-sized correctional facilities nationwide and discovered that those accredited by the nonprofit National Board of Correctional Health Services experienced a 93% lower monthly death rate compared to those that were not. It was noted that this reduction might have resulted in saving approximately 15 lives throughout the study duration, as mentioned by the researchers in a preliminary draft, yet to undergo peer review.
Crystal Yang, a Harvard Law School professor and one of the co-authors of the study, indicated that prisons seeking approval from the NCCHC are more inclined to enhance staff training concerning inmate treatment referrals. She stated, the goal is to “ensure that inmate triage and management processes and procedures adhere to standards,” she informed the Times.
The certification process typically spans several months, generally costs between $5,000 and $10,000, and usually necessitates a facility inspection by NCCHC specialists, according to Harvard researchers. Although the facilities examined in the study did not augment staffing, alter healthcare providers, or acquire new equipment, they still achieved lower mortality rates compared to those that did not pursue accreditation.
“They were able to utilize the existing resources and workforce to offer improved services,” commented Marcela Alsan, another co-author of the study and a public policy professor at the Harvard Kennedy School.
The researchers did not investigate if accreditation would motivate doctors to frequently attend to inmates, stating that accreditation does not promote facilities to provide a broader array of services. However, they indicated their findings imply that certain medical services, like health assessments and mental health screenings for new inmates, are delivered with greater frequency and promptness in certified facilities.
Alsan mentioned that the certification procedure has enhanced communication between medical and correctional personnel, boosted adherence to safety and training standards, and heightened job satisfaction.
This study emerges amid escalating fatalities within prisons throughout the nation, including Los Angeles, alongside increasing criticism regarding prison conditions. In 2023, 45 individuals will perish in Los Angeles County lock-ups, resulting in the county’s jail death rate being more than double what it was a decade earlier.
Due to guaranteed anonymity for participants, the study does not disclose the identities of the prisons or counties involved. Nine of the prisons were situated in California, with the average daily population across all prisons fluctuating between 100 to 3,000 individuals. Consequently, it did not encompass Los Angeles facilities, which accommodate an average of about 12,800 inmates daily. The Los Angeles County Sheriff’s Department stated in an email that the facility lacks NCCHC certification.
The Harvard analysis included some indications that accreditation is not a catch-all solution for prison healthcare system issues.
Staff members in accredited facilities reported lower levels of respect for inmates compared to those in non-accredited prisons. Inmates interviewed for the study conveyed ambiguous perspectives regarding the treatment they received, irrespective of their prison’s accreditation status.
“The medical personnel assumes you’re fabricating (about health concerns),” one inmate conveyed to researchers. The unidentified inmate expressed disbelief that the inadequate level of care he received at the prison, which is certifiably accredited, “could be feasible in this country.” Likewise, inmates in non-accredited facilities recounted being treated like “animals.”
In 2021, researchers pinpointed numerous prisons keen on participating in the study and financially supported their accreditation endeavors. Over the subsequent years, the Harvard team conducted interviews with staff and inmates and evaluated the facility as the process advanced.
Two of the prisons that initially participated withdrew early. One instance was due to a member of the facility’s medical leadership team suffering a heart attack, while the other arose because a member of the facility’s detention leadership team faced allegations of sexual harassment. Among the remaining 44 prisons, half were designated for certification while the others were not. Eleven facilities succeeded and two others are poised to complete the accreditation process. Nationally, researchers estimate that approximately 15 to 20 percent of prisons hold certification.
Researchers discovered that the 13 prisons having completed certification or on track to do so exhibited 18% higher compliance rates for safety and prevention standards and 25% higher compliance rates for staff training standards. Moreover, the 13 facilities on the certification path had three deaths, while 22 non-certified facilities experienced 27 deaths during the same timeframe.
In their draft report, researchers suggest that the baseline for improvements in medical compliance and outcomes was initially low. However, advances are occurring within U.S. prisons, where informational barriers and coordination challenges are significant, and health conditions are far worse than commonly perceived.
The Times previously reported that in recent years, inmates in Los Angeles County have perished by leaping from railings, striking their heads against walls, and injecting themselves with drugs using makeshift implements. At least three inmates suffocated after stuffing paper, sanitary products, and other items down their throats before anyone could step in. One individual was bludgeoned and bled to death over four hours before security personnel recognized the situation. A Times analysis of state and county data from the previous year indicated that fatalities due to natural causes, homicides, and overdoses had all risen in Los Angeles prisons compared to a decade ago.
However, in the end, it was revealed that the mortality rate last year was lower than the one preceding it. The Sheriff’s Office projected that 32 individuals would die in its custody by the end of 2024, marking the fewest fatalities at the jail since 2019.