Jail Healthcare Staffing in the US Southeast: a Cross-Sectional Survey

Abstract

Abstract Background Jails annually incarcerate millions of people with health problems, yet jail healthcare services have not been well described. Objective To describe jail healthcare staffing. Design Phone-administered survey conducted October 2020 to May 2021. Setting County jails in North Carolina, South Carolina, Georgia, and Alabama. Participants Jail personnel “most knowledgeable” about jail healthcare. Main Measures Weekly on-site healthcare coverage rate (hours per 100 incarcerated person-weeks [IPWs]) by personnel type; telemedicine rates and detention officers’ healthcare duties. Key Results Survey response rate was 73% (254/346). Among surveyed jails, 71% had on-site non-psychiatric providers (e.g., physicians, physician assistants) (median of 3.3 h per 100 IPWs); 90% had on-site nursing (median of 57.0 h per 100 IPWs) including 50% with on-site registered nurses (median of 25 h per 100 IPWs) and 70% with on-site licensed practical nurses (median of 52 h per 100 IPWs); 9% had on-site psychiatric providers (median of 1.6 h per 100 PWs). Telemedicine was used for primary care in 13% of jails (median 2.1 h per 100 IPW); for mental healthcare in 55% (median 2.1 h per 100 IPW); and for other specialties in 5% (median 1.0 h per 100 IPW). In 81% of jails, officers conducted medical intake and in 58% assessed urgency of medical requests (i.e., “sick call”). The number of officers’ healthcare responsibilities increased inversely with weekly nursing coverage. Conclusions Nearly 30% of surveyed jails routinely lacked on-site healthcare providers and in most other jails providers’ on-site presence was modest. Jails relied heavily on LPNs and officers for care, resulting in missed opportunities for care and potentially endangering incarcerated persons.