Health care in Illinois prisons is deficient: Report

An aerial view of Stateville prison in Illinois, with brown vacant land all around it.

Rw2 at English Wikipedia / Creative Commons BY-SA 2.0

Stateville Correctional Center

More than a decade has passed since incarcerated people filed a class action lawsuit accusing the Illinois Department of Corrections of failing to provide adequate medical care to people in custody. But health care in the state’s prisons still falls short, and the department isn’t moving quickly enough to fix the myriad problems, according to a new report from an independent monitor.

The monitor found that prison medical units are understaffed, patient intake screenings do not fully address patients’ medical problems or create a care plan, and the department does not review deaths in custody to identify opportunities for medical care improvement, among dozens of other issues. These deficiencies have led to delays in medical treatment and even caused preventable deaths, the monitor wrote.

The report is the fourth filed by the monitor, Dr. John Raba, since November 2019 as part of the ongoing lawsuit over the quality of health care in Illinois prisons. A federal judge approved a consent decree in 2019 and appointed Raba, a former chief medical officer for the Cook County Health and Hospitals System, to oversee implementation of a complete overhaul of health care in the state’s prison system.

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But two years later, the “IDOC does not yet have a comprehensive plan to address this consent decree; instead, it seems to primarily respond to crises and threats of legal action,” Raba wrote in his report.

Illinois Department of Corrections spokesperson Lindsey Hess said she could not comment on ongoing litigation.

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But in a written response to the report filed in court, attorneys for the corrections department said the impact of the Covid-19 pandemic took away time from addressing the consent decree requirements, but the department “has experienced major achievements since the last monitoring report” and “will continue to work collaboratively with the monitor.”

More than 11,000 incarcerated people in Illinois, about one-third of the prison population, have been infected by Covid-19, and 88 people have died, according to the report. But the problems with health care in Illinois’ prisons have long predated the current crisis.

Alan Mills, executive director of the Uptown People’s Law Center, which filed the initial lawsuit against the IDOC for inadequate health care in 2010, said the report shows that the entire system needs an “overhaul from bottom up” to “actually provide good care, rather than just responding to whatever the crisis of the moment is.”

“Prisoners throughout the department of corrections, throughout all prisons in Illinois, continue to suffer from serious medical needs, which are not being met,” Mills said. “So while bureaucrats dither, people are suffering.”

Raba said the department has only fully or partially addressed 11 of the 235 recommendations that he made in his last report in February, which included creating an electronic medical record system, improving nutrition and timing of meals for people in custody with special dietary needs, and implementing standardized initial health intake screenings for all incarcerated people. The monitor found issues with practically all aspects of medical care in the state’s prisons, including daily sick calls, infirmary care, urgent and emergency care, dental care, medication administration, and medical record-keeping.

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In one of dozens of specific examples of substandard care outlined in the report, Raba describes a 82-year-old patient with dementia, arthritis, high cholesterol, gastric reflux, hypothyroidism, and chronic obstructive lung disease. The patient was losing weight, but providers never evaluated what the patient was eating or referred him to a dietitian, according to the monitor. Eventually, the patient died of small bowel obstruction, without ever having a nutritional analysis done, the report said.

In another case, a patient with severe asthma and nasal polyps that caused difficulty breathing waited more than seven months before being seen by an ear nose and throat specialist, according to the report. The specialist ordered a CT scan and requested a follow-up visit, but weeks passed before the appointment was scheduled. The patient died two months later — days before his scheduled follow-up appointment with the specialist. The monitor said his death was “preventable.”

Lack of staff and data collection plague health care system

Many of the issues with medical care stem from a lack of qualified medical staff, a problem that has actually gotten worse in the past two years, according to the report. In August, there were 11 fewer physicians, three fewer physician assistants, and two fewer optometrists than in November 2019, according to the report. There are more than 340 vacant medical staff positions, up from 236 in November 2019.

“The department of corrections has not even come up with a plan to hire people, but perhaps even more importantly, they haven’t actually started hiring people they admit they need,” Mills said.

Raba said some of the medical personnel the department has hired do not have the proper qualifications. For example, the department reported in May 2020 that it had hired a communicable and infectious disease coordinator, but the person it hired had no training in infection control and only eight months of relevant work experience, according to the report. Six current physicians do not have the proper credentials, and one former physician had his license permanently revoked by the state licensing board before the corrections department took action.

A different independent monitor in a separate lawsuit over mental health care in Illinois prisons found similar issues with staffing levels in a report filed in that case earlier this year.

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The department has also stonewalled Raba’s efforts to collect data and documents that would help him determine their level of compliance with the consent decree, Raba wrote in the report. In addition, the department has pushed back against Raba’s recommendations for an implementation plan, arguing that he is going beyond what is required by the consent decree.

“It appears that IDOC is willing to let the monitor develop a plan for them but only if they can reject any of the monitor’s suggestions,” Raba wrote. “If this doesn’t change, the implementation plan will continue to remain unfinished for the foreseeable future.”

Attorneys for the department countered that they have “engaged in ongoing discussions regarding the implementation plan” with Raba for the past two years.

U.S. District Court Judge Jorge L. Alonso, who oversees the consent decree, has ordered the department of corrections to file an implementation plan by Nov. 10. So far, the department has failed to meet the deadlines for staffing and implementation plans, Mills said. The next hearing in the case is scheduled for Dec. 3., when the judge will determine whether the latest implementation plan submitted by the department is sufficient.

Read the full report on health care in Illinois prisons:

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