Sign for the inpatient unit for inmates at UConn Health in Farmington. Photo Courtesy of UConn Health
A medical exam area in the Bridgeport Correctional Center. Inmate health workers say they are logging a significant amount of overtime. Photo courtesy of the CT Department of Correction

Note: This story was originally published on July 2, 2019.

A year has passed since lofty promises were made to repair the financially struggling and volatile health care system that serves inmates at Connecticut’s 14 prisons, but Department of Correction staff say little has improved.

Records show medical employees are working shifts that have stretched as long as 24 hours. State lawmakers recently pumped an extra $22 million into the system. And DOC leaders can’t say how services compare to the care offered in the private sector.

Information provided to the legislature’s nonpartisan Office of Fiscal Analysis by DOC in March showed the correction department had 309 nurses on staff to serve 13,320 inmates – a ratio of one nurse for every 43 inmates. Medical providers, including doctors and physician assistants, are in even shorter supply – one for every 579 inmates.

That has placed extraordinary demands on the limited staff, workers say, sometimes causing patient care to suffer.

On an overnight shift in June, Debra Cruz, the head nurse at Cheshire Correctional Institution, found herself solely responsible for handing out medications to hundreds of inmates.

Cruz, a department veteran, hustled to cover as many people as possible. But the staffing shortage meant that about 50 people didn’t get their medication.

“We are keeping it together as best as possible,” Cruz said in an interview. “We make sure our inmates are medicated. We make sure they get their treatments. We try to make sure that their mental health needs are met at every given moment. But there are going to be times we can’t meet those things. We do our best.”

Mental health staffing has also been an issue. On weekends at MacDougall-Walker Correctional Institution in Suffield, the DOC sometimes schedules only one mental health employee to cover 1,950 inmates.

Shirley Watson, a clinical social worker at the maximum security prison, said she must shuttle between the campus’ two buildings – a terrifying ordeal when she is the only one working and an emergency arises in the other facility.

“I’m hoping that an inmate is not actively trying to complete a suicide in about seven minutes,” Watson said. “I’m driving with my fingers crossed.”

Social workers are stretched thin. Kelly Schafer, who is assigned to the Robinson Correctional Institution in Enfield, has 120 people on her case load. She sees each patient once per month.

“Any provider who works in mental health would tell you, you don’t see patients for less than a 45-minute session once every two weeks,” she said. “We’re seeing them once a month for 10 minutes.”

The quality of inmate care has prompted a flurry of lawsuits, the most recent one filed in March by a woman who gave birth behind bars at York Correctional Institution in Niantic. The inmate, Tianna Laboy, alleges denial and delay in medical services.

DOC has settled at least seven medical lawsuits over the last two years and has at least seven pending, while several others are headed toward legal action. UConn Health, which oversaw inmate care for decades, failed to keep records that determined if appropriate services were delivered.

Amid the turmoil, the correction department ended its $100 million-a-year contract with UConn Health last July.

Staffing issues vex workers

Workers say one of the most pressing issues is that hiring has not kept up with departures. Data released by New England Health Care Employees, District 1199 SEIU, whose members staff the prisons, show at least 47 health care workers have left since DOC took over inmate medical services.

A pregnant inmate gave birth in her cell in 2018. She is suing the state, alleging denial and delay in medical care.

During the same stretch, DOC only brought on 29 health workers – some of them new hires and some transferred from other state departments. At least two of those employees have left. Union officials said the data was provided by the DOC.

To ensure all shifts are covered, many workers have logged a significant amount of overtime – sometimes staying on for 16 to 24 hours a day. If employees don’t volunteer to fill the shifts, they are mandated.

Kara Philips, a nurse supervisor at Corrigan-Radgowski in Uncaseville, said she has worked about 20 hours of overtime during some recent, two-week pay periods. Last winter she racked up as many as 40 hours of overtime in some pay periods.

“It’s exhausting,” said Philips, a single mother of two children. “The kids miss me. It’s hard on anybody’s family life. You still have all your responsibilities at home.”

Employees who turn down mandatory overtime may receive a negative review in their annual evaluations, which influence pay and promotions.

Karen Martucci, a DOC spokeswoman, acknowledged that the department had lost a number of health workers during the transition of oversight, but said interviews are underway to fill several positions.

Overtime is offered on a voluntary basis, she said, but if enough people don’t come forward, managers must assign extra hours to maintain appropriate staffing levels. Those levels differ depending on the shift and the prison.

Hiring has been a challenge, Martucci said. The process of running a background check, verifying credentials and other hurdles can mean it takes months to fill a position. Retention is also an issue. Once on board, some workers resign abruptly.

To address the swift exits, DOC now gives applicants a tour of the prison so they have an idea of their work environment.

“You may be a seasoned nurse at Hartford Hospital and you get here and it’s not for you,” Martucci said. “We’re trying to work things into that process to keep longtime, qualified candidates. If people decide it’s not for them, then it’s not for them.”

The correction department has identified 66 positions it is looking to fill for inmate medical services. The union says more than 200 additional workers are needed to maintain safe staffing levels and reduce overtime.

Lawmakers approved spending $85 million for inmate health care this fiscal year. They budgeted $72 million for the service last year, but ultimately spent $94 million. Legislators and a report by the nonpartisan Office of Fiscal Analysis pointed to an increase in overtime costs as the key reason for the overage.

DOC disputes that. In an email, Martucci said, “spending for drugs and pharmaceuticals” was the main driver of the deficit.

Legislative leaders have recognized the need for more funding. They set aside $107 million for inmate medical services in 2021.

An exam room at UConn Health where inmates needing outpatient care would be seen at the Outpatient Pavilion. Oversight of inmate medical care moved from UConn to DOC last year. Photo courtesy of UConn Health

Union officials say full-time staff has dropped since DOC took over last summer. They released data that show there are 434 full-time positions, compared to 479 in August 2018. The department also employs 21 part-time workers, 77 per diem employees, and 41 others who are on comp or medical leave, the data show.

Martucci said the number of full-time workers is 510 and part-time is 95. She did not specify whether those figures included per diem employees or workers who are on leave.

Martucci said the DOC is bringing on 20 new health care workers in the next four-to-six weeks. The agency held a job fair in March and has assigned a human resources specialist to focus on recruitment for inmate medical positions.

“It’s fair to say that we have been challenged with filling health care vacancies, but that doesn’t mean that we haven’t seen progress,” she said. “We have adopted several strategies to attract top notch health care professionals to join our team.”

Meanwhile, the union workers are awaiting reinforcements. Overtime has become even trickier as summer vacation season sets in and people want time off.

“The staff that are on the ground, we’re doing a damn good job. But we need them to notice – hey, they can’t keep working under these conditions,” Cruz, the head nurse at Cheshire Correctional, said of DOC management. “We need help.”

CT Mirror Staff Writer Keith M. Phaneuf contributed to this report

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Jenna CarlessoHealth Reporter

Jenna is CT Mirror’s Health Reporter, focusing on health access, affordability, quality, equity and disparities, social determinants of health, health system planning, infrastructure, processes, information systems, and other health policy. Before joining CT Mirror Jenna was a reporter at The Hartford Courant for 10 years, where she consistently won statewide and regional awards. Jenna has a Master of Science degree in Interactive Media from Quinnipiac University and a Bachelor or Arts degree in Journalism from Grand Valley State University.

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Kelan is a Report For America Corps Member who covers the intersection of mental health and criminal justice for CT Mirror. Before joining CT Mirror, Kelan was a staff writer for City Weekly, an alt weekly in Salt Lake City, Utah, and a courts reporter for The Bryan-College Station Eagle, in Texas. He is originally from Philadelphia.

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