Inmate population
up, care down
at Halawa
Health services are
By Debra Barayuga
straining to keep up
Star-BulletinAlleviating overcrowding at Halawa Correctional Center is essential to improving delivery of health care and regaining accreditation, says Hawaii's state prison director. Last October, the National Commission on Correctional Health Care denied Halawa accreditation, citing at least 20 areas where improvement was needed.
Keith Kaneshiro: "We do intend
to comply and seek accreditation."
"Now we are more crowded. It makes it more difficult for us to address these concerns," said Public Safety Director Keith Kaneshiro. He added, however, "We do intend to comply and seek accreditation."Medical staff who were seeing four or five inmates per day may now have 10 to 20 requests for treatment. It places an even greater burden on the short-staffed medical unit, Kaneshiro said. "It's more demanding on medical services and use of supplies," he said.
Although health care services continue to be provided, overcrowding and inadequate staffing "will affect the quality of care we give," acknowledged Ted Sakai, corrections chief.
Dan Foley: "If anything,
conditions at Halawa . . .
have moved further
backward, not forward."
With 600 more inmates entering the prisons in the last 1 1/2 years since 300 inmates were transferred to Texas, Halawa is bursting. The latest count was 1,400. At the time of the accreditation survey, 1,234 male inmates were housed at Halawa.
Lack of accreditation does not mean inmates are getting substandard care, Sakai said. What is accreditation?
Unlike hospitals, which lose funding if not accredited, prison health care accreditation is not required and the department will not lose its license or funding, he said.
The standards were adopted by the National Commission on Corrections Health Care, which has a board of directors made up of 37 major professional associations in health care, law or corrections.
"Being credited by us shows you are a facility following these standards determined by us as to what constitutes minimally acceptable levels of health care services in correctional institutions," said Edward A. Harrison, commission president.
Some institutions become accredited as a matter of pride, while others do it as a quality improvement program, he said.
The commission has accredited 400 jails and prisons throughout the country.
In Hawaii, Oahu Community Correctional Center, the Women's Community Correctional Center, Waiawa Correctional Facility and the Kauai Community Correctional Center are accredited. Harrison said others may be working on accreditation, but he declined to reveal which facilities.
Civil rights attorney Dan Foley, who has represented inmates in lawsuits against the state, said the lack of accreditation is "indicative that conditions aren't what they should be." A critic's view
"If anything, conditions at Halawa as well as other prisons have moved further backward, not forward."
Inmate access to medical treatment is significantly affected by inadequate staffing, Foley said.
"The higher the inmate ratio to medical staff, the less access and less treatment."
One of his clients, a Halawa inmate, had difficulty getting care for a severe dental problem.
"The staff couldn't get through the cleaning process - too many inmates and too few medical staff."
One recurring complaint he hears from Halawa inmates is that staff is becoming "jaded and cynical" because of the number of inmates who make unjustified complaints.
"That can lead to people not being diagnosed and treated in a timely fashion," he said.
Because standards for accreditation are higher than constitutional standards, "if you lose it, it doesn't mean conditions are unconstitutional, but it may be slipping down to where courts find it unacceptable," Foley said.
"If you have accreditation, there is no need to worry about lawsuits."
Since Halawa lost its accreditation, he has seen no significant improvements in health care services, he said.
The accreditation report cited seven "essential" standards and 13 "important" health care standards that were not met when the accreditation team surveyed Halawa in December 1995. Getting accredited
To be accredited, the facility must comply with 100 percent of 34 essential standards and 85 percent of 34 important standards, Harrison said.
The "important" standards represent recognized, acceptable practices for health care providers, Harrison said.
"Essential" standards are directly related to the health, safety and welfare of prison inmates and other critical components of a health care system, he said.
Dr. Alan Taniguchi, the full-time medical director hired last August, will develop a plan to improve areas that need work, and officials will review the plan to ensure all standards are met, Sakai said. Developing a plan
Legislation passed this year failed to address the medical staff shortage, Foley said. Although lawmakers agreed to more beds at Halawa, Waiawa, OCCC and WCCC, there were no provisions for more doctors, nurses or support staff.
One of the standards cited in the report was insufficient physician-to-inmate ratio. Since the report was filed, however, another full-time doctor and a few mental health positions have been filled, Sakai said.
Also, an administrative nurse and two other nurses who left because of internal conflicts with staff have returned to the medical unit.
Officials are continuing to recruit to fill vacancies, Kaneshiro said.
Despite threats of cutbacks during the legislative session, no positions at Halawa were cut.
The problem lies in finding people willing to work in a prison, Kaneshiro said.
"The people working at Halawa are very, very dedicated, and the fact that they're still working there is evidence of that."
Thorburn doesn't like
By Helen Altonn
what she sees at Halawa
Star-BulletinDr. Kim Thorburn, former medical director for the state prison system, has left Hawaii to direct the Spokane Regional Health District in Washington state starting June 1. She just earned a master's degree in public health from the University of Hawaii.
"What I always did in prison health was public health," she said. "That was one of the aspects I really enjoyed about it. I wanted to explore public health in another setting."
Thorburn resigned as corrections medical director last year in a conflict with public safety officials over medical autonomy.
George Iranon, then public safety director, said he preferred having a medical director answerable to his office. Dr. Alan M. Taniguchi succeeded Thorburn as the first health care administrator hired as a public safety employee.
She and three other former female public safety employees have filed suit against former and current supervisors, accusing them of sexual discrimination and harassment.
Thorburn was recruited from California in 1987 under an arrangement between the University of Hawaii and Public Safety Department to obtain a qualified corrections medical director.
Improvements in prison health care were ordered by federal court in a 1985 consent decree settling an American Civil Liberties Union lawsuit against the state.
Thorburn taught courses as a UH School of Medicine faculty member and managed health care in the eight prisons under a state contract.
Improvements under her leadership drew praise from national consultants monitoring the prisons, and the medical area was the first released from court oversight under the consent decree.
She continued her faculty position and has been coordinating and overseeing medical students rotating through Queen's Medical Center.
She remains concerned about health care for inmates and lack of state follow-up into alleged inmate abuses by guards two years ago at Halawa Correctional Facility. "I think there will be no consequences," she said.
Halawa has lost accreditation by the National Commission on Correctional Health Care, although it was granted or continued to four other facilities in the state.
"I know what's going on. I'm still contacted frequently. ... It's really heartbreaking to have worked hard and to feel things have backslid."
The deterioration of medical autonomy also is a big concern, she said. "Medical autonomy is the foundation for standards for prison health. When it involves medical issues, the doctor has to have final say. All correctional health standards, national and international, say that."
Thorburn has received numerous honors, including the Distinguished Service Award of the American Correctional Health Services Association.
She was cited for significant contributions to prison health care and public service by the National Commission on Correctional Health Care and the Hawaii Chapter of the American Society of Public Administration.
She formerly was medical director of the California Institution for Men at Chino, Calif.
She left Wednesday with an Amnesty International delegation to testify before a judicial commission in Johannesburg, South Africa. The commission is investigating whether South African police and the military should adopt nonlethal stun guns and other shock weapons, she said.
Thorburn said she will give the medical side of Amnesty's position, which opposes use of such weapons because their safety isn't proven.
Medical deficiencies
ESSENTIAL
Submitting monthly statistical and administrative meeting reports
IMPORTANT
