Allegheny County Jail can’t fill 48 open medical positions

By Bethel Habte, Spring 2017 intern, ACLU of Pennsylvania

Allegheny County Jail needs medical staff — and it’s having trouble filling open positions.

In a recent meeting of the Allegheny County Jail Oversight Board, it was revealed that ACJ has been unable to fill 48 medical staff vacancies at the jail, relying instead on temporary workers hired through staffing agencies.

The news of short staffing comes in the wake of relative progress at the jail.

On May 21, 2015, after two ACJ inmates died of unexplained causes on the same day, the county announced that it would not renew its contract with Tennessee-based private correctional healthcare provider Corizon, Inc. It then partnered with Allegheny Health Network to rebuild the jail’s troubled healthcare system.

In the most basic sense, the results have been favorable since then: During Corizon’s contract — which began in September 2013, and ended in August 2015 — a total of 11 inmates died. Under the new ACJ-AHN partnership, which began in September 2015, only two inmates have died, both suicides.

Healthcare issues remain at the jail, however. The American Civil Liberties Union of Pennsylvania, the Abolitionist Law Center (ALC), the Pennsylvania Institutional Law Project (PILP), and Reed Smith LLP recently filed a lawsuit, Seitz v. Allegheny County, on behalf of five pregnant women. Despite evidence of serious risks of mental and physical harm, the pregnant women were routinely placed in solitary confinement for minor rule violations, and provided poor medical care, according to the lawsuit. The women received an inadequate diet, and were often deprived of heat and the means to shower or exercise, the lawsuit alleged.

”Individuals in prison have a right to receive treatment for serious medical needs,” said Sara Rose, a Senior Staff Attorney with ACLU-PA. “Although there is no right to healthcare generally, individuals who are incarcerated cannot be denied access to medical treatment. Prisons and jails have an obligation under the Eighth Amendment to provide care to prisoners to ensure that they do not experience unnecessary pain and suffering, disability or death while they are in prison.”

According to ACLU-PA Legal Director Vic Walczak, the medical staffing shortage “may explain the [medical care] interruptions our pregnant clients experienced after placement in solitary.”

While officials claim to be working on addressing the medical staffing issue, vacancies have increased. According to a jail healthcare staff vacancies report that was submitted at the most recent Jail Oversight Board meeting, 40 medical staff vacancies were noted in a November 29 report. The number of vacancies had increased by eight by the December 29 report.

Allegheny County Jail employs 162 people on its medical staff. Of these, 140 are directly employed by the county (94 of whom are full-time), and 22 are contracted through an arrangement with AHN (10 of whom are full-time). Of the vacancies at the jail, 20 are full-time and 23 are part-time county positions. The remaining five vacancies are AHN-contracted positions.

In 2015, under Corizon, Allegheny County Jails employed 83 full-time and 60 part-time individuals as part of their treatment staff, for a total of 143 positions, according to the Pennsylvania Department of Correction’s 2015 County Statistics and General Information.

When asked about the medical care shortages, Allegheny County Jail Warden Orlando Harper said the salary offerings are competitive, but that the jail is unable to match other incentives job-seeking nurses might receive elsewhere.

“We base our salaries on the county nursing salaries, so they are competitive to the nursing salaries around the area,” Harper told the oversight board on January 5. “I think one of the difficulties we are encountering is that, even though our salaries are competitive … a lot of people have free parking and stuff like that. We’re working on trying to come up with some different ways to try to bring people on board.”

County Controller Chelsa Wagner released an audit in 2014 criticizing Corizon for maintaining unsafe staffing levels, providing inmates with insufficient clinical care, following unfair labor practices, keeping poor medical records, and generally failing to comply with the terms of their contract.

Brad Korinski, the controller office’s chief legal counsel, said that the current staffing issue is a matter of public health.

“We know that the people who come into the jail are addicted, have mental health issues, have not really been effectively treated by a lot of our healthcare delivery system,” Korinski said. “You would think that you would devote resources to that because it’s worthwhile.”

According to the Allegheny County Jail Healthcare Services Oversight Report, there have been 325 emergency room visits and 681 referrals to off-site specialists in 2016, which could allude to the effects of the medical staffing shortage.

“While there are vacancies, the shifts are not uncovered,” Dr. Aolysius Joseph, Health Services Administrator of Allegheny County Jails said in an email to ACLU-PA. “We do so through overtime, staff nurses and by having the directors of nursing provide such staffing when needed and appropriate.”

While it’s difficult to ascertain the direct effects of the shortages on inmate care, Korinski worried about the potential long-term effects it could have on inmate health.

“I don’t know that people are there necessarily long enough that what we’re not finding or not treating necessarily becomes a problem at the jail,” Korinski said. “It may well be, if you have chronic conditions that perhaps aren’t being treated because you don’t have enough healthcare staff and you’re only treating acute conditions. Maybe it becomes a problem when they’re out of the jail, in which case we never know about it. That still becomes an Allegheny County problem.”

Mental health issues, which are prevalent, are a big concern in light of the unfilled vacancies. About 57 percent of the inmates in Allegheny County Jail are diagnosed with a mental illness, according to an internal survey. In 2016, two inmates committed suicide, and 14 attempted suicide, according to the Allegheny County Jail Healthcare Services Oversight Report.

In failing to meet it obligations to address inmate care, the county is falling short of its progressive objectives, Korinski asserted.

“On the one hand, you have a county where we have a lot of progressive rhetoric and we speak on national issues, and we say that we stand with the poor and unfortunate, and the less well off, and women, and a whole host of marginalized groups; but when it meets the rubber of the road of reality, we haven’t acted in accordance with our rhetoric — and this would seem to be a perfect example.”