Bureau of Prisons Health Care: Inmates' Access to Health Care Is Limited by Lack of Clinical Staff

BOP uses a system called the "Sensitive Medical Data Database" to prepare ongoing needs assessments of the inmate population. The system has been in process for approximately 2 years and has assisted BOP in determining what medical services its inmate population requires.

BOP has taken or is actively pursuing several steps to improve the cost-effectiveness of care provided to inmates. Although it has not completed its pilot study on whether emergency medical technicians can replace physician assistants, BOP has hired registered and licensed practical nurses in positions previously staffed by physician assistants. The cost for these nurses is less than that for physician assistants. Additionally, BOP completed its pilot study of preferred provider organizations and found that they apparently provide lower costs than the use of private physicians in the community. BOP continues to study ways to control costs, such as implementing telemedicine in three locations, using managed care where feasible, and pursuing an agreement with the Defense Personnel Supply Command whereby BOP can purchase volume medical supplies at discounted prices.

BOP reexamined its hiring standard for physician assistants under its Title 38 authority and determined that Title 38 would be too costly to implement. Instead, BOP restructured its staffing of medical centers and now emphasizes the hiring of nurse practitioners who meet community standards, over physician assistants who lack certification. Also, BOP entered into an agreement with the Department of Defense to provide training for its physician assistants who do not meet the community standard of certification. This will permit BOP's physician assistants to apply for certification testing.

BOP has taken several actions to improve the quality of its health care program. Specifically, the Director of BOP: (1) sent a memorandum dated February 23, 1994, to all wardens emphasizing the importance of continuous quality improvements; (2) directed six regional offices to nominate a number of institutions for JCAHO survey training; (3) added a section entitled "Quality Assessment and Improvement Program" to its health services manual; and (4) provides minutes of governing body meetings to all institutions citing quality of health care issues discussed.