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ed with multiple and intentional violations of the Nursing Practice Act. RNs are still subjected as individuals and as RNs to harsh treatment in the security environ- ment no matter what the law states. There is still a lack of enforcement and support for RNs to function as competent healthcare providers within the correc- tional industry at large. Access to Healthcare: Although in- mates have a right to healthcare, they are generally forced to litigate access to care. There is a severe lack of safe, therapeutic, and effective patient care for incarcerat- ed patients in California's correctional fa- cilities. Delivery of nursing care for incarcerated patients has reached crisis proportions in California due to lack of po- litical solutions and failure to retain qual- ified RNs to work in a chaotic and violent environment fueled further by the nurs- ing shortage. There is however one addi- tional hurdle to access since the state prison system has elevated the role of the medical technical assistant (MTA) as a gatekeeper to accessing competent care provided by legally-authorized healthcare professionals. Competency: There is a critical need for training, education, and support specific to the unique problems of the correction- al practice setting which hinders the de- livery of patient care that is qualified, ethical, and competent. Competent, educated RNs have a dif- ficult time struggling against this environ- ment. Educators and leaders in the field are not recognized as those setting the standard of care and their expertise is being lost in a field that needs the nursing torch passed on directly from their hands. Recommendations Inmate patients will greatly benefit from access to competent RNs at all levels of care. Correctional RNs will need strong purposeful direction to define themselves as unique in their service to inmate pa- tients. There is a great need for them to acquire a basic legal education due to the complexities of this practice setting. Cor- rectional RNs seldom define their mission and goals of patient care specific to their practice environment. The scope of prac- tice of the correctional RN must recog- nize a need for autonomy distinctively different from other healthcare disci- plines in order to promote safe, therapeu- tic, and effective patient care, including patient advocacy Major Cases in Correctional Healthcare Impacting the CDCR Healthcare System Armstrong v. Davis 275 F.3d 849. Armstrong v. Wilson 942 F. Supp. 1252 (N.D. Cal. 1996) Clark v. California 123 F. 3d 1267 (9th Cir. 1997). Coleman v. Wilson 912 F. Supp. 1282 (E.D. Cal. 1995). Estelle v. Gamble, 429 U.S. 97 (1976). Farmer v. Brennan 511 U.S. 825, 114 S. Ct. 1970. Gates v. Deukmejian 987 F. 2d 1392 (9th Cir. 1993). In re Rosenkrantz (2000) 80 Cal. App. 4th 409. Madrid v. Gomez 889 F. Supp. 1146 (N.D. Cal. 1995) Marin v. Rushen, settlement agreement. (1983) Pennsylvania Dept. of Corrections v. Yeskey (1998) 524 U.S. 206 Plata v. Davis, Settlement of Class Ac- tion—Medical Care, U.S. District Court. N.D.Cal.No C-01-1351 TEH. (2002) Schumate v. Davis, a settlement agree- ment. (1995) Thompson v. Enomoto, consent decree. Toussaint v. McCarthy 597 F. Supp. 1388 (N.D. Cal. 1984). Wilson v. Deukmejian, injunction. C A L I F O R N I A N U R S E W W W . C A L N U R S E S . O R G M A R C H 2 0 0 6 23