I've written before how after every disgusting and filthy cell cleanup that our inmate workers scrubbed...
I would drive to a local fast-food joint or pizza palace to buy those workers a much-deserved meal, a treat, if you will. If you asked any one of them, they would tell you that the task was worthy of the reward. But for us, they provided a much-needed service.
We use inmate workers for various tasks all over our facilities. In our last article, we discussed how we assign them to our kitchens, offices, warehouses, commissaries, outdoor space maintenance, and medical areas. We also discussed medical surveillance of the inmate worker, as well as verifying they have the necessary tools and training to perform those duties.
In this article, we focus on the use of inmate workers in the health services area and what they can and cannot do. But to set the stage, I want to know if you have experienced some of the same incidents that I have. Inmate workers mopping the health clinic? Inmate workers wiping down medical equipment? Inmate workers emptying the red biohazard waste baskets? Inmate workers filing medical charts?
Stop! I hope not! Inmate workers should not be anywhere near medical charts; however, I’ve witnessed it. The NCCHC Standard for Inmate Workers specifically says that workers cannot be used for specific tasks. Filing medical charts is one of them, but inmates can still perform other jobs.
During my visits to a few of your facilities, I’ve seen some remarkable programs that teach the incarcerated on how to be successful when they return to their community. Some of these included peer health-related programs that develop partnerships with community agencies. These programs teach the incarcerated health care-related skills that can serve inmates when they are released.
In my own home state of Indiana, there was a partnership between a prison and a university, offering a peer education program that trained the incarcerated to become peer health educators. Graduates of the program passed on their knowledge to their peers about common health conditions affecting prison populations.
The key is to ensure that inmate workers are not making treatment decisions or providing patient care. Unfortunately, I’ve seen that as well. Inmate workers should never be substitutes for health staff! It is not very common to see hospice-type programs in a short-term jail setting, but they could. More likely, we see inmate workers participating in a buddy system for non-acutely suicidal inmates. The key here is to ensure the inmate worker is trained and, again, they are not serving as a substitute for staff.
We invite you to look at the purpose of our standard and think about how you are employing your workforce. A robust inmate worker program can be vital to our facilities, especially now. But, before you do, ensure you are following the proper, recognized, national standards.
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JIM MARTIN, MPSA, CCHP Vice President, Program Development jamesmartin@ncchc.org
AMY PANAGOPOULOS, MBA, BSN, RN Vice President, Accreditation National Commission on Correctional Health Care amyp@ncchc.org
NCCHC Jail Commander Conversations: Utilization of Inmate Workers
This standard defines when and how an inmate worker can provide assistance in the health services area. It clearly stipulates that inmate works cannot be substitutes for qualified health staff even in times when the correctional facility is understaffed.
Why Is This Important? Understaffed correctional facilities may be tempted to use inmates in health care delivery to perform services for which civilian health staff are not available. Studies have shown that when inmate workers are used as adjunct health staff, there is an increased risk to both the patient and the facility. Their assignment to health services for direct patient care frequently and unknowingly violates state laws, invites litigation, discredits the health staff’s expertise, breaches patient confidentiality, and gives inmates unwarranted power over their peers who may be in a vulnerable state.
Now, in some circumstances, inmates may be appropriately assigned to help the health staff with routine tasks. For example, provided there is sufficient supervision, inmates may be employed to clean the health services unit, assemble charts, assemble health record forms, work in a laboratory that makes prosthetic devices, or handle biohazardous waste (only after proper training).
Because there is a growing need to develop job skills in the inmate population, properly established reentry health care training programs can be a useful endeavor. If the facility has such training programs, special care should be given to maintain patient’s privacy and access to care.
Standards and Indicators of Compliance Inmate workers assigned to the health services area cannot provide direct patient care, unless they are enrolled in a health care training program. To assist with developing and implementing an inmate worker program or a reentry health training program, the following are the recommended best practices to follow:
• The policy must stipulate when, where, and in what the inmate worker can participate. In the policy, remind staff that inmates are not substitutes for health staff and that they cannot provide direct patient care.
• Other than those in a reentry training program, inmates are not permitted to: — Distribute or collect sick calls. — Schedule appointments. — Transport or view medical records. — Handle or administer medications. — Handle surgical instruments and sharps.
• For inmates in a peer health-related/health care training or reentry program, they are permitted to: — Assist in activities of daily living. — Participate in a buddy system for non-acutely suicidal inmates after documented training. — Participate in hospice programs after documented training (see F-07 standards for Care for Terminally Ill).
NCCHC Sample Survey Observations from Surveyors Not in Compliance Observations
• Inmate workers not enrolled in the health care training program are working with minimal to no supervision in medical areas.
• Inmates were assigned to collect sick-call slips, which is not supported by the standards.
• Inmates are utilized for constant observation for acutely suicidal inmates with no other constant observation process in place. This is not acceptable or supported by the standards.
• The facility has not developed a comprehensive policy and procedure for the use of inmate workers in clinical areas. During the survey, it was observed the inmate was providing direct patient care, which is beyond what is allowable in the standard.
• The facility has inmates participate in medication passes, which is not supported by the standard due to patient safety issues.
• There is no formal program or policy that describes what inmates enrolled in the reentry program are allowed and not allowed to do.
• The policy and procedure for inmate workers enrolled in the reentry program did not describe a patient’s right to refuse care delivered by inmates in the health care training program (dental assistant, nursing assistant).
Potential Contributing Factors
• Facility staff did not understand all the components involved with developing and implementing an inmate worker program.
• Facility did not understand all the components involved in developing a reentry health care training program.
• Policies and procedures were not complete and lacked clear documentation on what an inmate worker who is not enrolled in the health care training program can perform.
• Facility did not have a process that supports an inmate’s right to refuse care delivered by inmates in the reentry health care training program (e.g., dental assistant, nursing assistant).
• Policies and procedures are not in alignment with all NCCHC compliance indicators in the standards.
• Facility expanded the scope of inmate workers to include direct patient care without consulting the standards or understanding state laws and regulations that frequently prohibit the use of inmates in care delivery processes.