National Nurses United

Prisons:3 6/7/07 2:57 PM Page 15 "You can't have a caregiver and a jailer in the same body. It doesn't work. The entire prison system favors punishment and incarceration. But as a nurse you are legally and morally bound to deliver care. But if the correctional system says, no, this guy is going into solitary, or this guy is going to be transported here or there, and he can't take that pill or get that shot right now, corrections rules." where employees' bags are searched. Crossing the parking lot, she disappears into the prison. Built in 1953 as a military facility, Deuel Vocational Institute, or DVI, is a row of putty-colored buildings with three-story housing units at one end, administrative buildings at the center. On the opposite side of the road that cleaves the grounds in half are a dairy farm and a minimum-security facility. It serves as a receiving center where inmates are moved from county jails to the state institutions that will contain them for the life of their sentence. At DVI, prisoners receive a medical and mental health examination, and a plan of care. It is the entry point where severe medical problems that may be exacerbated or created by medical neglect at county jails and correctional facilities can, with diligent care by medical personnel, be nipped in the bud. But recruiting, retaining, and encouraging skilled medical staff at DVI, and throughout the California prison system, is part of the challenge. And conditions of overcrowding and health system mismanagement discourage dedicated nurses from staying. Though prisoners are supposed to remain at DVI for a limited time, prison overcrowding prevents inmates from being moved in a timely fashion. Some inmates remain at DVI as long as three months before being moved to another facility, says Upland. According to department of corrections statistics, DVI is designed to hold 1,681 inmates. Instead, it holds 3,748. No one can enter the prison with Upland. She is locked in along with the prisoners. For all the obvious reasons, security is tight at DVI. But at 10 p.m., when her shift is over, Upland talks about her night. The only things she won't talk about are details of prison security and the specific stories that would violate patient confidentiality. Once inside the first door, says Upland, there are other security checkpoints. "They're called grill gates," she says. Visitors enter the same way employees do, then diverge to other parts of the facility. Upland continues on through several more buildings and grill gates, where she says guards have to "pop the locks and let me in." Finally she enters a long hallway that runs the length of the prison. Housing units line both sides of the hall. She walks down the center of the hall toward the main office and punches her time card. The floor is marked with orange lines. When inmates are moved from one part of the prison to another, a complex arrangement of signals by guards are used to announce their movement, none of which Upland is allowed to describe. Within the prison, movement of inmates, some of whom are in rival gangs, is a complex operation. She continues between the lines to the clinic where she has been placed as extra staff to assist with intake exams. This afternoon, Upland will be doing blood pressure readings and paperwork. Routine stuff, though she says nothing is ever routine in correctional nursing. On other days she is assigned to do triage assessments and devise care plans for inmates. Triage refers to a system of assessing and prioritizing care that is common to nurses in acute care settings, but is fairly new to the prison medical system. plish positive change." He cut costs of contracting out more in line with University of tension between custody and pharmacy system only and not describes a deeply entrenched nursing services. Sillen also California medical centers. medical staff." actually delivering services). system mired in complex announces plans to build 5,000 bureaucracy. He also additional medical beds. Fail- third report to Judge Hender- he will contract with Amarillo, announces salary increases for announces an intensive ure by the state Legislature to son, Sillen clarifies his goal Texas-based Maxor National physicians working in Califor- 90-day project at San Quentin produce a plan to address of providing a "nurse-driven" Pharmacy Services Corp. to nia's 33 adult prisons, in a move where he hopes to "gain prison overcrowding provokes medical system where nurses manage the state's prison he hopes will "better compen- insight into how to address Sillen's response that he will take on their appropriate role pharmacies, leading to con- sate qualified doctors, aid in systemic problems that affect "move forward to build beds in as the central coordinators of cerns from some prison rights recruitment efforts, and pro- every individual prison." any event." patient care. In this report he activists that the receiver will vide improved access to quality outlines his plan to eliminate privatize prison healthcare care for the state's nearly September 2006: Sillen October 2006: Judge Hen- December 2006: In his Sillen also announces that February 2007: Sillen submits a request to Judge derson grants Sillen's request the medical technical assistant operations. (In a 2007 inter- 173,000 inmate patients." Henderson to grant sweeping to waive California state law, (MTA) classification. Sillen calls view Sillen states that he is He cites as his motivation the salary increases to prison med- allowing the receiver to raise the MTA "a hybrid nurse/peace aware of the concerns, that pri- fact that California prisons ical staff in an effort to attract medical staff salaries in Cali- office" whose role, he says, vatization is "not part of his have a 20 percent vacancy and retain quality care fornia prisons from 5 to 64 "has contributed to an envi- plan," and that Maxor will rate statewide for primary providers and to dramatically percent and brining them ronment of unnecessary be designing a workable care providers. M AY 2 0 0 7 W W W. C A L N U R S E S . O R G REGISTERED NURSE 15

• Cover