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Prison 911: Avenal Lori Kohler, MD Shira Shavit, MD Elena Tootell, MD Correctional Medicine Consultation Network Department of Family and Community Medicine University of California, San Francisco

Prison 911 ƒ Incarceration in the U.S. and California ƒ Plata v. Schwarzenegger ƒ Correctional Medicine Consultation Network ƒ Avenal State Prison

Incarceration in the U.S. ƒ 2.2 million people in prisons and jails ƒ 2.4 Million children have a parent in prison or jail ƒ Highest per capita incarceration rate in the world 583/100k ƒ ½ of male children whose parent has been incarcerated will also be incarcerated ƒ Chance of incarceration during lifetime Black males 1in 3 3.2/100 Latino males 1 in 6 1.2/100 White males 1 in 17 0.4/100

Incarceration in California ƒ 170,000 current; 302,000 total per year (8%incr) ƒ 32,400 life sentence, 650 condemned ƒ Avg. sentence 4.5y, served 2y ƒ Reading level 7th grade ƒ 29% African American ƒ 37% Latino ƒ 29% white

1852

San Quentin State Prison (SQ)

1880 1933

Folsom State Prison (FOL)

World War II 1941-1955

Vietnam War 1961-1965 Reagan and the War on Drugs 1984-1997

Bush 2001 - 2005

Prisons in California

California Correctional Institution -- Women (Closed) (CCI) 1941 - California institution for Men (CIM) 1946 - Correctional Training Facility (CTF) 1952 - California Institution for Women (CIW) 1953 - Deuel Vocational Institution (DVI) 1954 East - California Men’s Colony (CMC) 1955 - California Medical Facility (CMF) 1954 - California Correctional Institution – Men (CCI) 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)

2005 – Delano State Prison (DEL)

Medical Care for Prisoners Eighth Amendment Prison 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 lawsuit Prisoners alleged that California officials inflicted cruel and unusual punishment by being deliberately indifferent to serious medical needs Settlement agreement filed in 2002 Requires the California Department of Corrections to completely overhaul its medical care policies and procedures

California Prison Receivership ƒ Second time in U.S. history that a federal receiver has presided over a correctional system ƒ Receiver has access to resources and ability to override usual procedures

CMCN Mission Our 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 ƒ CMCN faculty and administrative staff ƒ Short term intensive assessment and reorganization ƒ Catch up on back log of visits ƒ Recruit new providers ƒ Consult on complex patients ƒ Facilitate referrals and transfers for care

Avenal State Prison ƒ December 2006 received a phone call from the federal receiver’s office ƒ Emerging crisis at Avenal ƒ 3 inmate deaths due to shortage of doctors ƒ CMCN sent team of doctors, administrative staff, and nurse practitioners to Avenal

Avenal State Prison ƒ March 7, 2007: total population = 7,494 vs design capacity = 2,920 ƒ ASP 257 % occupied ratio, largest population in CA ƒ TOTAL NUMBER OF YARDS: 6 ƒ TOTAL NUMBER OF PRIMARY CARE CLINICS: 6 ƒ Low-medium security institution ƒ 28-bed Outpatient Housing Unit (OHU) = Homecare ƒ 3-bed Treatment & Triage Area (TTA) = Urgent care ƒ TOTAL PCP FTE = 9 TOTAL FILLED =6

2 ATO, 1 MD/1 NP Registry

Avenal State Prison-Findings ƒ ƒ ƒ ƒ ƒ

1500 men > age 55 150 men on insulin 40-50 men on coumadin, no labs in months 121 urgent referrals to specialists pending Primary and urgent care clinics backed up several months ƒ Hundreds of 7362s (requests for appointment) untouched ƒ Hundreds of abnormal lab results not addressed

Avenal State Prison-Findings ƒ Most yards with no primary care provider for months ƒ Chronic care patients without follow up visits for over 8 months ƒ Hundreds of medication refills pending authorization ƒ NPs and PA working without supervision ƒ Phlebotomy months behind ƒ OHU with several patients at acute hospital level of care ƒ Many gravely ill patients without care and at risk for Cocci

Avenal State PrisonAccomplishments ƒ Reviewed 121 Urgent RFS. Prioritized and scheduled urgent referrals ƒ Ran several clinic lines for 5 weeks (>300 patients, 600 visits) ƒ Reviewed hundreds of abnormal labs and and diagnostic studies, follow up with appropriate patients ƒ Started database of chronic care inmates based on lab values, pharmacy profiles, physician and staff referrals, and CMCN encounters ƒ Transferred sickest patients to appropriate level of care

Avenal State PrisonAccomplishments ƒ Consulted with NPs and PAs ƒ Supported leadership by facilitating discussion to problem solve obstacles ƒ Defined levels of care ƒ Recruited physicians and contributed to retention of existing physicians ƒ Ongoing primary care via telemedicine ƒ Corral support from state and federal leadership

Summary ƒ The CMCN is a ground-breaking program with unlimited potential ƒ The CMCN will improve the quality of healthcare in California State Prisons quickly and indefinitely ƒ The CMCN loves student and resident participation in any and all of its activities ƒ The CMCN has many fabulous job opportunities for faculty and staff

Summary Contact the CMCN for more information about Our programs. Lori Kohler, MD Shira Shavit, MD Correctional Medicine Consultation Network 1940 Bryant Street San Francisco, CA 94110 (415) 476-2041 lkohler@fcm.ucsf.edu sshavit@fcm.ucsf.edu

Photos from Prison Law Office Website

Contact Information Lori Kohler, MD Shira Shavit, MD Correctional Medicine Consultation Network 3180 18th Street Suite 302 San Francisco, CA 94110 (415) 476-2041 lkohler@fcm.ucsf.edu sshavit@fcm.ucsf.edu


Correctional Medicine Consultation Network: "Prison 911: Avenal"