Jail Healthcare Staffing in the US Southeast: a Cross-Sectional Survey

Abstract

Background: Jails annually incarcerate millions of people with health problems, yet jail healthcare services have not been well described.

Objective: To describe jail healthcare staffing.

Design: Phone-administered survey conducted October 2020 to May 2021.

Setting: County jails in North Carolina, South Carolina, Georgia, and Alabama.

Participants: Jail personnel "most knowledgeable" about jail healthcare.

Main measures: Weekly on-site healthcare coverage rate (hours per 100 incarcerated person-weeks [IPWs]) by personnel type; telemedicine rates and detention officers' healthcare duties.

Key results: Survey response rate was 73% (254/346). Among surveyed jails, 71% had on-site non-psychiatric providers (e.g., physicians, physician assistants) (median of 3.3 h per 100 IPWs); 90% had on-site nursing (median of 57.0 h per 100 IPWs) including 50% with on-site registered nurses (median of 25 h per 100 IPWs) and 70% with on-site licensed practical nurses (median of 52 h per 100 IPWs); 9% had on-site psychiatric providers (median of 1.6 h per 100 PWs). Telemedicine was used for primary care in 13% of jails (median 2.1 h per 100 IPW); for mental healthcare in 55% (median 2.1 h per 100 IPW); and for other specialties in 5% (median 1.0 h per 100 IPW). In 81% of jails, officers conducted medical intake and in 58% assessed urgency of medical requests (i.e., "sick call"). The number of officers' healthcare responsibilities increased inversely with weekly nursing coverage.

Conclusions: Nearly 30% of surveyed jails routinely lacked on-site healthcare providers and in most other jails providers' on-site presence was modest. Jails relied heavily on LPNs and officers for care, resulting in missed opportunities for care and potentially endangering incarcerated persons.