Prison officials debate health care issues Medical director sees need for added staff


State prison officials continued yesterday to debate whether they should add medical staff to evaluate inmates coming into the Central Booking and Intake Center, despite a memorandum from the medical director for the prison system expressing concern about health-care policies there.

In the memorandum, written July 25 and obtained by The Sun, Dr. Newton Kendig wrote to Dr. Anthony Swetz, director of inmate health services for the Department of Public Safety and Correctional Services, that he was particularly concerned about Central Booking, and about the view of top prison officials that there was a "minimal need" for medical services there.

He recommended that, among other things, a 24-hour medical triage unit be added "to protect the Department from present and future exposure."

Swetz would not comment on the memo yesterday, other than to say he met with Deputy Secretary David N. Bezanson and other prison officials about the booking center and how to deal with the unexpected volume of health problems that come through its doors.

"This is as much a public health issue as it is a public safety issue," Swetz said. "Where we find ourselves is having to provide public health services, and we're in the business of corrections."

Medical workers and an attorney for prisoners have complained that the procedures for seeing patients under a health contract that went into effect July 1 cause delays in emergency response and increase costly calls to 911. The loudest complaints have been about the booking center, where a maximum of two nurses have been on duty at any time for a population of 811.

PHP Healthcare Corp. of Reston, Va., took over responsibility July 1 for 7,266 inmate beds in home detention, the Baltimore City Detention Center, the booking center and six prisons. The $16 million contract calls for the equivalent of about 130 full-time employees to cover the inmates.

State health officials say many of the problems have to do with the transition between health care providers and are being worked out. PHP has said it is providing adequate care and blames a previous contractor for some problems.

The contract makes PHP responsible only for emergency care for booking center prisoners who have not had bail review, a situation some medical workers called hazardous.

In his memo, Kendig wrote that "the need for medical services at this facility is significant."

"The current screening process is inadequate," Kendig wrote. "Inmates with medical problems are not being adequately identified and triaged to medical for treatment. A simple screening form was developed but has never been implemented due to staffing and logistical issues."

He wrote that he also was concerned that inmates with medical problems from the nearby detention center had been housed at the booking center "for extended periods of time," a practice that "creates significant problems in health care delivery since inmates cannot be carefully monitored at the booking facility." He called the system for transporting sick inmates from prison to prison "poorly coordinated."

Kendig recommended immediately opening an observation unit at the booking center with 24-hour nursing care to evaluate prisoners with medical problems during the booking process. He also recommended that the department contract with another nurse to review costs for caring for prisoners before they have had bail reviews.

Swetz acknowledged the concerns but said other aspects of health care had improved since complaints surfaced last month. He said that physical examinations for sentenced inmates were going very well and that infirmary operations at the Maryland Penitentiary and detention center were much improved.

But auditors from the Maryland Commission on Correctional Standards found some deficiencies in the detention center medical operation when they conducted a regular audit last week, department sources said.

Swetz said he had heard of the problems at the detention center related to intake physicals not done by Prison Health Services, the previous contractor; and to the filling out of health forms for inmates who were released.

Pub Date: 8/02/96

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