The CEO of one of the nation’s major correctional healthcare providers says the “lack of clear guidance” from federal and state authorities—including when staff and incarcerees will receive the projected anti-COVID vaccine—is hampering efforts to cope with the pandemic.
Repeated shifts in recommended protocols over precautionary steps like mask-wearing have made it harder to settle on consistent and appropriate forms of protection for those who are confined behind bars or who work inside the facilities, Thomas Weber, CEO of PrimeCare Medical, said in keynote remarks to a webinar Wednesday.
“Perhaps the most significant hurdle (we face) is the lack of clear guidance about how we’re supposed to deal with this pandemic,” said Weber, whose company provides correctional health services in 80 facilities across five states.
“I’m not here to make political statements, but the lack of clarity has produced a division in our population.”
A worrying uncertainty now is whether America’s prisons, jails and detention facilities will be on the list of priority targets to receive the vaccines expected to be approved for use as early as this year, the webinar was told.
Some state health departments have already reached out to correctional health care providers to request the names of staff who might be included in the early phase of a rollout of a new vaccine, once it receives federal approval, said Dr. John P. May, chief medical officer for Centurion Correctional Healthcare Services, another national provider.
“We’ve had some states reach out to us to say we’re going to include your health workers in our phase one (of vaccine distribution), and we’re going to be shipping vaccines to your prison; there are other states that have not had that call yet.
“It’s a hodge-podge.”
There is still no guarantee that incarcerated individuals—considered among the most medically vulnerable populations in the U.S.—will be able to get the vaccine at an early stage, the webinar was told.
Leading specialists in the field have recommended classifying correctional staff as “essential workers” like First Responders, thus making them eligible to receive the first batch of vaccines—on the grounds that they are not only at higher risk of contracting the virus, but of spreading it to the wider community.
A recent report by the National Academy of Sciences also recommended including incarcerees, particularly aging or medically compromised inmates and those earmarked for compassionate release during the pandemic, for the same reason.
“It was recognized that those who are incarcerated and those who work (in those facilities) ought to be prioritized for vaccine distribution,” said Dr. Emily Wang, the director of Yale University’s SEICHE Center for Health and Justice and one of the authors of the report.
“There’s a growing notion within the public health community that if we’re thinking about all our health, we have to focus on correctional health; but the devil is in the details.”
Currently, correctional facilities are included in “phase two” of the vaccine rollout, but health care professionals and prisoner advocates argue that they should be given a higher priority.
“We’re hearing promising news that we are one of the targeted areas to get the first dosage—at least our staff is in the first group, and then our patients with higher risk factors would be next,” said Weber.
“However, we have a concern about the availability of enough vaccines and how they’re going to distribute them.”
Weber and Dr. Wang were among the speakers in the first of a series of webinars for journalists exploring the impact of COVID-19 on the justice system, organized by the Center on Media, Crime and Justice at John Jay College, publisher of The Crime Report.
The series is supported by the Jacob & Valeria Langeloth Foundation.
The debate over how to prioritize vaccine distribution in correctional settings underlines the lack of a uniform strategy for tackling the pandemic in the nation’s estimated 5,000 prisons and jails, the majority of which are under the jurisdiction of state or local authorities, the webinar was told.
The challenges posed by COVID-19 have also put into sharper relief the disconnect between public health policy and correctional healthcare.
“Correctional healthcare systems are deeply siloed…compromising those who work there, and those who live there, as well as our communities,” said Dr. Wang.
“One of our primary recommendations is that correctional facilities ought to be integrated within the public health infrastructure as part and parcel of public health preparedness planning.”
A single health infrastructure administered at either the state or federal level, depending on the healthcare system, would also help returning citizens bridge medical and counselling needs between prison and community, and ensure greater transparency in data reporting, she said.
Meanwhile, developing a vaccination campaign for the nation’s incarcerated populations is also complicated by uncertainty about how the vaccinations would be paid for.
For instance, one of the vaccines now being considered for use, developed by Pfizer, requires two separate doses weeks apart. If an inmate is vaccinated and then released, there’s no guarantee the second dose would be available to her.
Incarcerees are not eligible for Medicaid until they are released, but enrolling in the system (or re-enrolling) can take a month or longer—thereby putting them and their families at risk while they are still unprotected.
The proposed Medicaid Reentry Act, which would short-circuit the process by allowing inmates to apply for health coverage before release, has received bipartisan support in the House as well as being backed by the National Association of Counties and the National Sheriffs Association. But it remains unclear whether the Senate will take it up during the lame duck session.
One further complication: There are already signs that many incarcerees would be unwilling to accept a vaccine, even if it is available to them early.
“Inmates don’t frequently avail themselves of current vaccines that are available, and there needs to be techniques developed to help them get over the paranoia of vaccination,” said Dr. David Thomas, former Deputy Secretary of Health in Florida, who now teaches correctional medicine at Nova Southeastern College of Osteopathic Medicine.
“They have good reasons to be paranoid,” Dr. Thomas added, alluding to controversial experiments in the last century in which prisoners and especially minority populations were subjected to questionable medical experiments.
Thomas said one way of tackling inmate reluctance was “having your correctional staff and your medical staff taking their vaccines in front of the inmates to demonstrate that this is a positive thing to do.”
Demoralization and Burnout
The uncertainty over vaccine distribution has added to the frustration of correctional health providers around the country in tackling the pandemic.
“We feel like we’ve lost control—this is an unprecedented stressful time in corrections, for those who live in jails and prisons and for those who work there,” said Dr. May, noting that facilities were hampered not just by “staff burnout, demoralization and absenteeism,” but by growing criticism from the public and authorities.
“The public perception is that, rather than (recognize) the effort that goes into caring for folks inside, …things are falling apart.”
Since the onset of the pandemic earlier this year, prisons and jails have emerged as critical “hot zones.”
Some 90 out of the 100 worst clusters of viral outbreaks in the U.S. occurred in correctional facilities, and correctional staff are three to five times more at risk of contracting COVID-19 than the general population, speakers said.
Comprehensive national figures are hard to obtain because of variations in reporting and testing across the country, but the webinar was told that, according to the most recent database, 196,127 inmates and 42, 805 correctional staff have contracted COVID-19.
An estimated 1,500 inmates have died.
Early hopes that the infection rate had begun to abate, however, as more facilities adopted stricter regulations on visits, mask-wearing and testing, have been dashed, admitted PrimeCare Medical CEO Thomas Weber.
“We were relatively successful in addressing the pandemic in the spring, and everyone was in a rush to get back to normal,” he said.
“What that means in a correctional setting is you incarcerate more people, and as you open up more, you allow visitation from attorneys and family members—which is certainly necessary for the patients and their well-being.”
But the result, he noted, was a “spike [in COVID infections] over the last several months, as the steps that were put in place were reversed.”
Public Health, Justice and COVID-19: A Tragedy Foretold by James Doyle, The Crime Report, April 8, 2020
Stephen Handelman is editor of The Crime Report