Healthcare in
New York
Prisons
2004-2007
A Report by
the Correctional Association
of New York

2009

February

The Correctional Association of New York
“Because the dangers of abuse inherent in the penitentiary are always present, the work of
the Correctional Association—an organization of knowledgeable experts unaffected by
political forces—is so important.”
Judge Morris E. Lasker, Former U.S. District Court Judge, Southern District of New York
The Correctional Association of New York (CA) was formed in 1844 by citizens concerned
about prison conditions and the lack of services for inmates returning to their communities. In
1846, the New York State Legislature granted the CA authority to inspect prisons and report on
its findings. Through four projects — Juvenile Justice, Prison Visiting, Public Policy/Drug Law
Repeal, and Women in Prison — the CA advocates for a more humane prison system and a more
safe and just society.
The Prison Visiting Project is the arm of the Correctional Association that carries out this
unique legislative authority for the male prisons. Each year, the Project visits seven to ten of
New York’s 70 state correctional facilities, branching out to all corners of the prison including
cellblocks and dormitories, classrooms and industry shops, psychiatric units, medical clinics,
protective custody and disciplinary housing. The Project interviews inmates, correction officers,
teachers, counselors and medical staff. In addition, the Project collects data about the facility
from prison officials and hundreds of surveys from inmates. After evaluating this information,
the Project prepares a comprehensive report focusing on such areas as medical and mental health
care, educational, vocational and re-entry programs, inmate jobs, relations among inmates and
staff, the physical state of a facility, and other issues of concern to the individuals who live and
work behind the prison wall. The Project presents its findings and recommendations in these
reports to prison officials, the Commissioner of the Department of Correctional Services
(DOCS), high-level state policymakers and the public. All the prison reports prepared by the
Project since 2004 are available on the Correctional Association web page.
For more information about the Prison Visiting Project, please call 212-254-5700 or visit
http://www.correctionalassociation.org/PVP/index.htm

Healthcare in New York Prisons, 2004-2007
Copyright © 2009, The Correctional Association of New York
All Rights Reserved
The Correctional Association of New York
2090 Adam Clayton Powell, Jr. Blvd
Suite 200
New York, New York 10027
(212) 254-5700
(212) 473-2807 (Fax)

HEALTHCARE IN NEW YORK PRISONS
2004–2007

A Report by the
Correctional Association of New York

FEBRUARY 2009

Acknowledgements

Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

ACKNOWLEDGEMENTS
Healthcare in New York Prisons, 2004-2007 was authored by Jack Beck, Director of the
Prison Visiting Project, with significant editorial assistance from Shayna Kessler, former Associate
of the Prison Visiting Project, and Amber Norris, Associate of the Prison Visiting Project. Robert
Gangi, Executive Director of the Correctional Association, guided the project from inception to
completion. Correctional Association Board members Gail Allen, M.D., Nereida Ferran, M.D. and
Ralph Brown, Jr., Chair of the Prison Visiting Committee, provided invaluable editorial input and
review.
We thank Assemblymember Jeffrion Aubry, Chair of the Assembly Standing Committee on
Correction, and Assemblymember Richard Gottfried, Chair of the Assembly Committee on Health,
for their dedication to improving prison healthcare and their support for the Project’s efforts to
investigate and report on prison medical care.
We extend our appreciation to the following officials at the New York State Department of
Correctional Services: Commissioner Brian Fischer, Deputy Commissioner Dr. Lester Wright, and
Deputy Counsel William Gonzalez for arranging research visits, supplying department-wide
information on DOCS’s healthcare system and providing helpful comments on a draft of the report.
We hope this document lends support and guidance to state officials in their efforts to enhance
prison healthcare.
Above all, we wish to thank the many prisoners, medical staff, correction officers and
superintendents for generously sharing their experiences and observations with us. We are deeply
grateful for their participation and hope that this report gives adequate expression to their concerns
and recommendations for improvements.
This report was made possible by support from The Prospect Hill Foundation and The New York
City AIDS Fund. We also express our appreciation to Ropes & Gray, LLP for printing the report.

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Table of Contents

Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

Table of Contents
Healthcare in New York Prisons, 2004-2007
INTRODUCTION .......................................................................................................................... 1
EXECUTIVE SUMMARY ............................................................................................................ 2
SYSTEM OVERVIEW ................................................................................................................ 17
PRISON VISITS AND MONITORING OF PRISON HEALTHCARE ................................
INMATE MEDICAL GRIEVANCES .......................................................................................
MEDICAL STAFFING ...............................................................................................................
Vacancies .............................................................................................................................
Staff Vacancies – Nurses ..............................................................................................
Staff Vacancies – Pharmacists ....................................................................................
Staff Vacancies – Physicians ........................................................................................
Continuing Problems Filling Vacancies .....................................................................
Additional Medical Staffing Needs ...................................................................................
Nursing Staff Needs .......................................................................................................
Physician and PA/NP Staff Needs ................................................................................
MEDICAL STAFF TRAINING .................................................................................................
ACCESS TO AND QUALITY OF CARE AT ROUTINE MEDICAL APPOINTMENTS .
Sick Call ..............................................................................................................................
Clinic Call-Outs – Access to Physicians, Physician Assistants and
Nurse Practitioners ............................................................................................................
CHRONIC DISEASES: HIV, HEPATITIS C AND OTHER ILLNESSES............................
Recent Improvements in Healthcare Systems and Chronic Care .................................
Problems in Identification and Treatment of Inmates with HIV and/or HCV .............
HIV Infection in the Male and Female Prison Populations ...........................................
Identification of HIV-Infected Male Inmates ..................................................................
Identification of HIV-Infected Female Inmates ..............................................................
HIV Testing of DOCS Inmates .........................................................................................
Access to Infectious Disease (IDF) Specialists .................................................................
Access to IFD Specialists at Male Prisons ...................................................................
Access to IFD Specialists at Female Prisons ...............................................................
DOCS HIV Specialists .......................................................................................................
Treatment of HIV-Infected Inmates .................................................................................
DOH Criminal Justice Initiative .......................................................................................
Inmate-Led HIV Support and Education Programs ......................................................
DOCS HIV Quality Improvement Program ....................................................................
Hepatitis C Care in DOCS .................................................................................................
Progress in Identifying More HCV-Infected Inmates ....................................................
Treatment of HCV Disease ................................................................................................
Access to HCV Specialty Services – Gastroenterologists and Liver Biopsies ...............
ii

17
17
19
19
20
22
24
24
25
25
26
26
27
27
28
30
30
31
31
33
35
35
37
37
39
39
40
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The Correctional Association of New York

HCV Therapy ..................................................................................................................... 51
Effectiveness of HCV Therapy ........................................................................................... 53
DOCS HCV Quality Improvement Initiatives .................................................................. 54
OTHER DISEASES: ASTHMA, HYPERTENSION, DIABETES AND CHRONIC
HEPATITIS B ............................................................................................................................... 55
CHRONIC CARE SYSTEM ........................................................................................................ 56
SPECIALTY CARE ..................................................................................................................... 57
DOCS System-wide Specialty Care Utilization ................................................................ 58
Hub Utilization of Specialty Care ...................................................................................... 59
Specialty Care Utilization at Specific Prisons .................................................................. 60
Specialty Care at Female Prisons ..................................................................................... 62
PHARMACY SERVICES ........................................................................................................... 63
Vacancies and Centralized Services .................................................................................. 63
Medication Monitoring and Problems with Medication Distribution ............................ 64
QUALITY IMPROVEMENT PROGRAMS .............................................................................. 65
MEDICAL SERVICES FOR INMATES WITH LIMITED ENGLISH SKILLS .................. 69
CONTINUITY OF CARE ............................................................................................................ 69
CONFIDENTIALITY IN MEDICAL ENCOUNTERS ............................................................ 70
CARE FOR THE AGING INMATE POPULATION ............................................................... 71
INMATE DEATHS ....................................................................................................................... 72
PATIENT EDUCATION AND ACCESS TO HEALTH MATERIALS ................................. 74
WOMEN-SPECIFIC HEALTHCARE NEEDS ........................................................................ 75
EXTERNAL OVERSIGHT OF PRISON HEALTHCARE ..................................................... 77
RECOMMENDATIONS .............................................................................................................. 78
TABLES
TABLE 1 - Most Grieved Issues by Percentage Filed 2001-2006 ............................................. 18
TABLE 2 - Summary of May 2007 DOCS Medical Staffing ..................................................... 20
TABLE 3 - Medical Staff at Time of CA Visit to Prisons in 2004-07 ....................................... 21
TABLE 4 - Summary of 2007 Medical Staff for CA Visited Prisons ....................................... 23
TABLE 5 - HIV and Hepatitis C in CA Visited Prisons in 2004-07 .......................................... 32
TABLE 6 - Summary of HIV Testing by CJI Contractors and DOH Staff ............................. 36
TABLE 7 - AIDS Institute’s CJI HIV Prevention Services – 7/1/06 – 6/30/07 ........................ 41
TABLE 8 - Prisons Served by AIDS Institute’s CJI Contractors – 2007 ................................ 41
TABLE 9 - DOCS HCV Pegasys Treatment – Completion and Reasons Discontinued ......... 53
TABLE 10 – DOCS Quality Assessment Tools Manual ............................................................ 67
TABLE 11 – Summary of Older Population in DOCS 1996-2006 ............................................ 71
TABLE 12 – Cause of Death for DOCS Inmates 2001-2006 ..................................................... 73
EXHIBITS ...................................................................................................................................... 87
EXHIBIT A – Map of New York State Department of Correctional Services Facilities
EXHIBIT B – 2004 and 2005 Medical Grievances at CA Visited Prisons - 2004-07
EXHIBIT C – CORC Appeals of Medical Grievances at CA Visited Prisons - 2004-07

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

EXHIBIT D – DOCS Male HIV Rates and Infectious Disease Access - FY 2006-07
EXHIBIT E – DOCS Male Hepatitis C Rates and HCV Care by Hub - FY 2006-07
EXHIBIT F – DOCS HCV Care at Male Class One Prisons by Treatment Rates - FY 2006-07
EXHIBIT G – DOCS HIV Care at Female Prisons - FY 2005-06 and FY 2006-07
EXHIBIT H – DOCS Female Hepatitis C Rates and HCV Care - FY 2006-07
EXHIBIT I – DOCS Specialty Care for Male Prisons - FY 2006-07 (Parts 1-3)
EXHIBIT J – DOCS Specialty Care Utilization Rates at Male Prisons - FY 2006-07
EXHIBIT K – Hub Specialty Care at Male Prisons - FY 2006-07
EXHIBIT L – DOCS Specialty Care at Female Prisons - FY 2006-07
EXHIBIT M – DOCS Female Specialty Care Utilization Rates - FY 2006-07
EXHIBIT N – DOCS Specialty Care at CA Visited Prisons - FY 2006-07

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Introduction

Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

HEALTHCARE IN NEW YORK PRISONS, 2004-2007
INTRODUCTION
The New York State Assembly has requested that the Correctional Association (CA) provide its
Health and Corrections Committees with an assessment of healthcare in New York State prisons.
The CA has statutory authority to visit state prisons and report to the public and policymakers
about the conditions it observes and its recommendations for improvements. Correctional
Association staff last testified about healthcare before these committees in December 2003.
As part of its current analysis, the CA has developed a new series of recommendations for the
governor, the New York State Department of Correctional Services (DOCS), the New York State
Department of Health (DOH) and the legislature to address the status of medical care provided to
state inmates.
As of April 2008, DOCS confined 62,070 inmates in 69 correctional facilities and the Willard
Drug Treatment Center. Between September 2004 and May 2007, the CA conducted general
monitoring visits to 17 state prisons and obtained medical data from two additional prisons that
were visited for a limited inspection concerning prison violence. These 19 facilities confine
28,250 inmates, representing approximately 45% of the state’s total inmate population.
Much of the analysis in this document is based on information from the on-site monitoring visits.
(See page 17 for an explanation of the CA visit procedure.) In addition, the CA reviewed
DOCS’s computer records, documents and reports about the entire prison system concerning
medical staffing, inmate grievances, specialty care services and DOCS’s Division of Health
Services medical quality improvement program. The CA also analyzed system-wide information
concerning appeals of medical grievances to the DOCS Central Office. The CA has based its
observations and recommendations for improvements in the delivery of medical services on both
the prison visits and the system-wide information.1
The CA has also published an Addendum to this report, provided under separate cover,
containing excerpts from the medical sections of CA prison reports issued after 24 prison
monitoring visits during the period September 2004 through June 2008.

1

Due to time and resource constraints, this report does not include a full analysis of health services for women in
the state’s correctional facilities. Evaluating these services is a critical part of assessing DOCS’s ability to meet
women’s specific healthcare needs, and the CA plans to issue a separate report in the future with more in-depth
analysis.

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

EXECUTIVE SUMMARY
Each of the 69 state prisons run by the New York State Department of Correctional Services
(hereinafter referred to as “DOCS” or “the Department”), as well as the Willard Drug Treatment
Center, has a medical department in which DOCS medical personnel provide healthcare.2
DOCS also runs approximately 45 prison infirmaries and five Regional Medical Units and
provides tens of thousands of in-house and external specialty care consultations per year. DOCS
had a budget of $356 million in Fiscal Year 2008-09 for prison health services and employed
more than 1,950 medical personnel to care for the 62,070 inmates (as of April 2008) in state
prisons. (See Table 2, page 20, for a summary of DOCS medical staffing as of May 2007 and
Table 4, page 23, for medical staffing as of the date the CA visited the 19 prisons whose services
are analyzed in this report.)
Providing quality medical care in prison is good public health policy because prisons provide an
opportunity to diagnose and treat patients with chronic medical conditions who will return to
communities throughout the state. Educating inmates about proper health care and enrolling
them in a care system benefits them, as well as their families and communities.
Currently, there are an estimated 4,000 state inmates with HIV. Thus, New York prisons remain
the epicenter of this disease within the U.S. prison system, representing 20% of all HIV-infected
state inmates in the country.3 DOCS is the largest provider of HIV services in New York State.
New York State prisons also have 8,400 inmates infected with hepatitis C, and many others
suffering from other chronic diseases such as hypertension (6,500), diabetes (2,500) and asthma
(9,000).
DOCS faces significant challenges in providing care to so many patients with serious illnesses,
many of whom received inadequate care even before becoming incarcerated. These challenges
include: limited resources; an annual turnover rate of inmates whereby nearly 40% of the prison
population changes (27,000 to 28,000 inmates are admitted or released each year); and civil
service guidelines that restrict salary levels and negatively affect the ability to recruit and retain
qualified care providers. While many medical staff in the prisons are dedicated individuals
striving to provide appropriate care to people suffering from serious medical conditions, certain
prisons cannot meet the needs of their patients because resources and support systems are
insufficient to provide proper care to all inmates and/or because the medical staff lack the skill,
expertise or motivation to provide appropriate care. Thus, the quality of healthcare varies
throughout the state prison system, with some facilities providing timely access to care that
meets community standards and others providing substandard care.
In the nine years since the CA last issued a report on healthcare, DOCS has made some
significant improvements in the provision of medical care. For example:

2

Each prison is given a medical classification indicating the level of medical care that can be provided at the
facility, ranging from class one to class three. Class one prisons have the highest level of care, including a physician
on-site or on-call 24 hours a day, a 24-hour nurse presence on site and an on-site infirmary.
3
Maruschak, L., HIV in Prisons, 2006, U.S. Department of Justice, Bureau of Justice Statistics, Table 1 (April
2008). http://www.ojp.usdoj.gov/bjs/pub/html/hivp/2006/hivp06.htm.

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Executive Summary

•

•

•
•

Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

The DOCS Division of Health Services (DHS) has promulgated several clinical
practice guidelines on conditions such as hepatitis B, hepatitis C, asthma and men’s
health. It has also updated existing practice guidelines on HIV, hypertension,
diabetes and female health appraisal.
DHS has substantially enhanced its efforts to monitor the care provided in the
prisons by implementing a meaningful Continuing Quality Improvement (CQI)
program that includes development of audit instruments used by DHS and prison
medical staff to assess compliance with the practice guidelines at each prison.
The Department reduced some of the chronic medical staffing vacancies that have
persisted for several years and increased some staffing levels even while the prison
population declined.
There are fewer AIDS deaths due to more effective treatments, and the Department
has identified and is treating substantially more inmates who are infected with
hepatitis C.

However, in spite of these improvements, significant problems persist. Among the most
significant themes emerging from the CA’s investigation were the wide variation in the quality
of healthcare among prisons and often among hubs 4 and inmate dissatisfaction with care. At
some prisons, there are delays in the delivery of care and the treatment provided is inadequate.
At most prisons the CA visited, healthcare accounted for more inmate grievances than any other
issue. In fact, during the last few years, medical grievances have become the most highly
grieved issue in the entire system.
During CA prison visits and in DOCS’s formal grievance process, inmates repeatedly expressed
concerns about:
•
denials of and delays in access to healthcare;
•
inadequate examinations by nurses and physicians;
•
failures to treat chronic medical problems expeditiously;
•
delays in access to specialists and inadequate follow-up by prison providers to
specialists’ recommendations; and
•
problems receiving medications and the health education needed to comply with
complex medication regimens.
Concerning inconsistency of care, it is essential to describe healthcare in the Department not
only from a system-wide perspective but at the level of individual facilities, because each prison
operates, to a substantial degree, independently. Consequently, the level of staffing, utilization
of services and quality of patient care vary greatly from one prison to another. The challenge is
to identify those prisons where care is not meeting community standards of care and DOCS’s
own standards, and to assess why such deficiencies exist. At some prisons, the barrier to
effective care is partially a question of resources (e.g., inadequate staffing or insufficient access
to specialists) where the remedy will likely require the governor and legislature to authorize
additional funding for DOCS. At other prisons, certain providers are unable (due to inadequate
4

The Department has divided the state prisons into nine hubs, each of which is a group of neighboring prisons that
share administrative support and program services. Exhibit A contains a map of the hub system and the location of
each state prison.

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

training or expertise) or unwilling to respond fully to inmates’ medical needs or to promptly
follow-up on their patients’ medical problems. At these institutions, the poor quality of the
medical personnel compromises the delivery of healthcare. Better scrutiny of care and an
effective system of accountability will help identify where changes in policies, practices or staff
are needed at a system-wide or facility level.
The Department appears committed to providing medical care consistent with that in the
community. Although DOCS has not fully achieved this objective, it can realize this goal if it
continues to improve services and if the state adopts the measures suggested in the CA’s
recommendations.

Key Findings
Medical Grievances
Medical care is the most highly grieved issue in the Department, representing about 8,300
medical grievances a year and 18% of all grievances filed by inmates during the last six years.
The CA generally observed the most significant healthcare problems at those facilities with the
greatest percentage of medical grievances.
Medical Staffing and Staff Training
During the period 2004 to 2007, the Department has reduced system-wide vacancies for nurses
from 14% to 8% and doctors’ vacancies to 3%. Despite this progress, at some prisons, the
number of medical staff is insufficient to perform the complex tasks needed to serve the large
number of patients with chronic illnesses and serious medical problems. Moreover, high
vacancy rates still exist for physician assistants (14%) and pharmacists (13%).
♦ For example, Great Meadow is missing 40% of its physicians, half of its physician
assistants, and nearly 30% of its nurses; Bedford Hills has a 40% nursing vacancy rate;
and Attica is missing two of its three physician assistants and three of its 17 nurses.
Some medical positions have remained unfilled for a year or more due in part to applicants’
unwillingness to face the challenges in providing care in the prisons and because the state
provides noncompetitive salaries for certain medical positions.
♦ Great Meadow reported during a CA visit in 2006 that it had nurse vacancies for more
than two years, and Eastern reported in 2005 that it had an open nurse position for more
than a year. Both of these prisons still had nurse vacancies as of May 2007.
Even at full staffing levels, some prisons do not have enough medical personnel to meet the
needs of their inmate-patients. The number of nurses and clinic provider staff—including
physicians, physician assistants and nurse practitioners—varies greatly among the prisons.
These significant staff discrepancies are not justified by differences in the medical needs of the
inmate populations at different prisons. In analyzing the adequacy of medical staffing, the CA
determined the ratio of nurses and clinic providers to inmates at each prison and compared ratios
among prisons.
♦ The CA identified prisons (such as Clinton and Auburn) with insufficient numbers of
nurses (i.e., one nurse for every 120 to 150 inmates). At other facilities (such as Green

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

Haven and Fishkill), CA found substantially better ratios, such as one nurse for every 70
to 80 inmates.
♦ The CA found that at several prisons (such as Clinton, Elmira, Coxsackie and
Wyoming), there were insufficient clinic staff (e.g., one clinic provider for every 600 to
850 inmates). At other prisons (such as Fishkill, Green Haven, Oneida, Sing Sing and
Sullivan), there was one clinic provider for every 400 or fewer inmate-patients.
In conjunction with outside health agencies, the Department has offered voluntary medical
training to its staff on specific medical topics, with a focus on HIV and hepatitis C care. Some of
these programs, including the HIV-related presentations coordinated by Albany Medical Center,
are nationally recognized and offer the up-to-date information crucial to providing expert care in
the prisons. However, because this training is not mandatory, the Department cannot ensure that
all of its providers participate in these programs and does not appear to monitor their
participation. At some prisons, medical staff members are so overburdened that they often
cannot attend continuing medical education programs. And while medical staff are required to
participate in annual general DOCS training, there is no medical training requirement addressing
the treatment of chronic diseases, even though rates for many chronic diseases are five to ten
times greater among inmates than among the general public.
Routine Healthcare
At some prisons the CA visited, inmates raised numerous complaints about inadequate access to
sick call—the time when inmates are seen by a nurse who determines whether further care is
required (see page 27). They also made complaints about receiving improper care when they are
seen. Again, there are wide discrepancies among the various prisons.
♦ Clinton only sees 20-40 inmates at sick call for a population of 2,000. Other prisons,
such as Attica and Eastern, see inmates at twice that rate.
♦ At Coxsackie, the sick call nurse averages only two minutes per patient—insufficient
time to adequately assess and document a patient’s condition.
♦ Patients at many prisons complained that some sick call nurses were disrespectful and
failed to refer patients to a doctor when needed.
♦ Fifty percent or more of inmates at Great Meadow and Wyoming rated sick call as
poor.
Due to understaffed medical departments, delays in access to clinic providers are commonplace
at some facilities. These delays are a direct result of the insufficient number of clinic providers
at these prisons.
♦ At several prisons (such as Attica, Auburn and Great Meadow), inmates reported that it
can take several weeks to a few months to be seen for routine care.
♦ Medical providers at some prisons (such as Elmira) admitted to backlogs for routine
appointments of 30 to 45 days.
♦ When the CA visited Attica, the facility had an 11-page list of inmates waiting to be
seen in the clinic.
Some inmates complained that providers were dismissive of their medical problems, failed to
conduct thorough exams or adequately evaluate their complaints or symptoms, and delayed
addressing their serious medical problems.

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

♦ Sixty percent of the Auburn inmates rated healthcare as poor; two-thirds of the inmates
at Upstate rated the doctors as poor, and half of the inmates at Wyoming said the
physicians provided poor care.
By contrast, at prisons with adequate staffing (such as Oneida and Green Haven), inmates had
prompt access to providers and their medical complaints were generally addressed in a timely
manner.
♦ Two-thirds of Oneida’s inmates rated the physicians as good or fair.
Chronic Disease Care
The care provided to inmates with chronic diseases (e.g., HIV, hepatitis B and C, asthma,
diabetes, hypertension, etc.) varies greatly within the Department. DOCS’s Division of Health
Services has made significant efforts to standardize policies and develop monitoring protocols,
but some prisons are unable to fully conform to these clinical standards, and some prisons do not
assign a specific provider to treat each inmate with a chronic condition.
Identification and Care of HIV-infected Inmates
Although DOCS estimates that there are 4,000 inmates with HIV in its prisons, representing HIV
infection rates of 6% for men and 12% for women, it has identified only about 1,700 HIVinfected inmates—45% of the potential pool of HIV-infected inmates. There are significant
unexplained differences among prisons in the percentage of identified HIV-infected inmates.
There is also greater variation among prisons in HIV rates than in hepatitis C (HCV) rates and
significant differences between HIV and HCV rates at the same prisons.
♦ In certain prisons, less than 2% of their population is identified as HIV-infected,
whereas in other prisons with the same medical classification, the known HIV-infected
populations represents twice that rate.
♦ One in four state inmates with HCV have not been tested for HIV.
Although DOCS, Department of Health (DOH) and outside community-based agencies are
performing 12,000-14,000 HIV tests per year, these entities are not able to identify many HIVinfected inmates. DOCS and DOH must increase their use of peer educators to encourage more
at-risk inmates to get tested and to motivate inmates who know they are HIV-infected, but are
not identified as such by prison medical staff, to seek care.
♦ In 2006, DOH and the community-based agencies tested more than 8,000 inmates, but
identified fewer than 30 patients as HIV-infected.
♦ It appears that inmates who are not ill and are about to be discharged (also known as
the “worried well”) request HIV testing, but few of the estimated 2,000 unidentified
inmates with HIV seek testing and treatment.
DOCS and community standards require that HIV-infected patients who are receiving treatment
but are unable to fully repress the virus should be evaluated by an HIV specialist to determine
whether adjustments to their treatment regimen should be made. Unfortunately, these
evaluations may not be occurring in all appropriate cases. There is significant variation, with no
identifiable reason, in the use of infectious disease (IFD) specialists by the state prisons.
♦ Prisons in the Watertown hub had a utilization rate of IFD specialists that was onetenth the rate in prisons in the southern region of the state.

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

♦ Use of IFD specialists also varied greatly among individual prisons within the same
hub, with some prisons in a hub frequently utilizing IFD specialists, while other prisons
rarely refer patients outside the prison for such services. For example, the ten male
prisons with the greatest utilization of IFD services are located in five of the nine hubs.
This IFD utilization rate was ten times the rate in the 14 prisons (spread throughout seven
of the nine hubs) with the lowest rate. (See Exhibit D.) These wide disparities in IFD
utilization cannot be explained by the medical classification of these prisons or
differences in their patient population.
♦ Access to IFD specialists also varied greatly in the female prisons. Albion had only
eight IFD appointments in Fiscal Year (FY) 2006-07, while Bedford Hills had 537
appointments.
DOCS’s effort to implement a program to certify its physicians as HIV specialists is laudable.
As of June 2007, 17 of DOCS’s 150 physicians, physician assistants and nurse practitioners were
certified at 16 prisons. Unfortunately, this figure has remained relatively constant for several
years, and most prisons do not have a clinic provider with HIV expertise.
DOH AIDS Institute’s Criminal Justice Initiative (CJI) contracts with 15 outside agencies to
provide services to HIV-infected inmates throughout the system. These services include HIV
prevention, HIV training of peer educators, HIV counseling and testing, HIV support services
and HIV discharge planning. This important program provides some services at 60 of the state’s
70 facilities. However, the peer training program exists at only half the prisons, and HIV support
groups occur at approximately 40% of the prisons. Moreover, some CJI services, such as
discharge planning, are not sufficient to meet the needs of all HIV-infected inmates going home;
less than 60% of discharged inmates with HIV were involved in discharge planning efforts in a
recent one-year period. To meet the needs of the HIV prison population and educate all inmates
about the importance of HIV testing and care, the state must allocate greater resources for this
impressive program.
In addition, independent peer-led HIV support programs in the prisons—such as AIDS
Counseling and Education (ACE) in the female prisons and Prisoners for AIDS Counseling and
Education (PACE) in the male prisons—provide effective education and support programs that
should be expanded.
DOCS implemented an HIV Continuous Quality Improvement program that will assist DHS
officials in monitoring the care provided in the prisons and help prison providers to identify
issues that may impede the delivery of HIV care. While this represents a positive step, DHS
should demand more of the prisons in meeting the audit standards and require more
comprehensive corrective plans to address areas where the prisons do not fully comply with
DOCS’s HIV practice guidelines.
Identification and Care of Inmates Infected with Hepatitis C
Based on several DOH studies of hepatitis C (HCV) infection in newly admitted inmates, an
estimated 8,400 HCV-infected inmates currently reside in the prisons, constituting approximately
13% of the male population and 22% of the female population. DOCS has improved its efforts
to identify HCV-infected inmates in the last few years, resulting in an approximately 40%

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

increase in the number known to DOCS. But 30% of the estimated male HCV-infected
population and 35% of the female HCV-infected population have still not been identified by
DOCS and are consequently not being treated for this serious disease.
♦ At most of the male prisons, 8-10% of the population has been identified as HCVinfected, but at several prisons the rate is much lower. The reasons for these disparities
should be investigated.
♦ The rate of known HCV-infected women in the prisons ranges from 12.25% at
Bedford Hills to 17% at Albion. The Albion rate is nearly 40% higher than Bedford
Hills. Department officials should investigate why Bedford Hills has the lowest HCVinfection rate of any female prison, particularly since it has the only female Regional
Medical Unit and the largest female medical program.
In the community, approximately 70% of patients with HCV eventually become chronically
infected. DOCS is not doing an adequate job of identifying those with chronic infection,
reporting only 41% of its known male HCV-infected population as chronically infected and a
surprisingly low 20% of its known female HCV-infected population as such. Since diagnosis of
chronic HCV infection is the first step in evaluating a patient for treatment, the failure to
diagnose such infections can result in the failure to provide life-saving therapy.
Ordinarily, HCV-infected inmates must be evaluated by a gastroenterologist (GI specialist) and
receive a liver biopsy to determine whether they should receive therapy. There were significant
variations among the prisons in access to GI specialists and in the frequency of liver biopsies.
♦ For example, Five Points, Cayuga, Great Meadow and Bare Hill have a combined
population of 5,784 inmates, 524 of whom are known to be infected with HCV. But
these facilities had only 12 HCV-infected patients on therapy and ordered only 23 liver
biopsies during FY 2006-07—one-third the system-wide average rate. In contrast,
Livingston, Marcy, Mid-State and Sing Sing, with a combined population of 5,366
inmates, 576 of whom are known to be HCV-infected, treated 52 HCV-infected inmates
and ordered 125 liver biopsies. The rate of HCV therapy for Livingston group is four
times the rate of the Five Points group (spread through three hubs). Similarly, the rate of
liver biopsies for the Livingston group is six times the Five Point group rate. (See
Exhibit E.) There are no significant patient differences to justify such variation in the
use of specialty services and the number of treated inmates.
Although not all chronically infected HCV-infected inmates require treatment, inmates with
serious liver fibrosis need therapy to avoid liver failure. As of September 2007, DOCS had
initiated treatment for 2,078 inmates since the start of its treatment for this disease. As of May
2007, 383 inmates were receiving HCV therapy, more than twice the number in 2003. However,
there were significant variations among prisons in the percentage of HCV-infected inmates on
therapy, disparities not explained by differences in prison populations. While access to specialty
services is essential to evaluate the need for treatment, low treatment rates may also be
influenced by a failure to educate patients about the risks and benefits of treatment or to provide
sufficient support to enable patients to complete the difficult course of therapy.
♦ The prisons in three hubs (Clinton, Great Meadow and Wende) are treating HCVinfected inmates at half the treatment rate of prisons in the Watertown, Sullivan and New
York City hubs.

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Executive Summary

Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

♦ Setting aside the analysis by hub, there are even more significant variations in
treatment rates among prisons. The 15 prisons providing the most HCV care are treating
known HCV-infected inmates at five times the rate of the 15 prisons with the lowest
percentage of HCV treatment. (See Exhibit F.)
Disparities in HCV treatment effectiveness within DOCS is similar to that in communities
outside of DOCS, but DOCS’s plan to stop monitoring the outcomes of HCV treatment on a
system-wide basis is ill-advised, since it is extremely useful in assessing the HCV treatment
program. This decision should be reconsidered.
♦ Therapy is deemed successful if a patient no longer has the HCV virus six months after
the one-year treatment regimen is completed. In a group of 411 DOCS inmates who have
undergone HCV therapy and have been tracked by DOCS, 58% of the Caucasian HCVinfected inmates, 37% of the Hispanic inmates, and only 19% of the African American
inmates reached sustained suppression of the virus. These figures reflect the lower
response rates experienced by African American patients in the community.
DOCS’s efforts to assess compliance with its Hepatitis C Practice Guidelines through a quality
improvement program are commendable. The initial results of the HCV audit revealed that
prisons have a few areas of noncompliance with the audit’s 12 indicators, including
documentation of patient education and refusal of treatment, and several other areas that could
use improvement. DOCS is developing a new HCV Case Management Review Form that has
the potential to significantly improve the data retrieved in the HCV audits. These changes are
necessary to accurately assess HCV care in the prisons.
Other Chronic Conditions
DOCS has implemented practice guidelines concerning asthma, hypertension and chronic
Hepatitis B. The 2007 audit of asthma care revealed that state prisons had several areas of
noncompliance with the audit indicators and that more should be done to implement the new
asthma guidelines. Similarly, the prisons should improve compliance with the hepatitis B
guidelines. DHS’s efforts to improve care for these chronic conditions and to make practices
uniform throughout the Department are commendable, but prisons should also enhance their
efforts to ensure that all patients with these illnesses are receiving adequate care.
Chronic Care System
The Department has undertaken meaningful efforts to implement a chronic care system with
practice guidelines and quality improvement programs, but more progress is needed. Practice
guidelines do not exist for several chronic conditions, such as high blood cholesterol. More
training is necessary to ensure that providers are adequately skilled in treating chronic medical
problems. Prison-based chronic care coordinators and computer-based tracking systems are not
used in all prisons to manage the care of chronically ill inmates. Patients with chronic conditions
are not consistently assigned to one clinic provider responsible for managing patient progress
and coordinating specialty care services.
Specialty Care
When prison providers need expert assistance in diagnosing or treating their patients, they can
request a consultation with a specialist. Specialists see patients in the prisons, Regional Medical

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Executive Summary

Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

Units, outside hospitals or other outside medical facilities. DOCS utilizes a Department-wide,
computer-based system to schedule specialist appointments and monitor requests for specialty
care to ensure that only needed services are provided. After specialty care appointments, the
specialists document their findings and recommendations, which are then presented to the prison
provider who is responsible for determining what follow-up action to take. Access to specialists
and follow-up to specialists’ recommendations vary greatly throughout the Department without
apparent justification.
♦ For example, 80% or more of Great Meadow and Sullivan inmates reported
experiencing delays in access to specialists, and approximately 70% of inmates from
these facilities stated that follow-up to specialists’ recommendations was inadequate.
Inmates at these prisons reported delays of three to four months in scheduling some
appointments.
♦ Analysis of DOCS data for FY 2006-07 confirms low utilization of specialty services
in certain hubs; the prisons in the Watertown hub use essential specialty care services at
only one-third the rate of prisons in the Green Haven hub. There is even greater variation
among prisons in access to certain specialty services; some prisons use services such as
cardiology, dermatology and neurology at only 10% to 30% of the system-wide rates.
Albion uses several specialty care services for its women inmates at rates that are four to
nine times less than the rates for Bedford Hills inmates.
Prisons do not routinely monitor whether their providers adequately follow up on specialists’
recommendations and/or schedule follow-up appointments in a timely manner. The Department
must improve its monitoring of the use and outcomes of the specialty care system.
Pharmacy Operation
DOCS operates prison pharmacies that serve approximately 50 prisons in New York State. Since
DOCS has experienced problems hiring pharmacists to work in many facilities, 20 prisons are
using outside pharmacy services that are 27% more expensive than if the medications were
provided by DOCS’s Central Pharmacy. This practice results in additional yearly costs of
approximately $3.8 million for the Department. Although DOCS is developing plans for its
Central Pharmacy to take over this operation, the new system will take years to implement.
Inmates reported several problems with the medication system at certain prisons, including:
delays in renewing and/or refilling prescriptions; running out of essential medications for chronic
conditions; failures to provide inmates with sufficient information about medications they are
taking and their potential side effects; and failures to provide medications in a confidential
manner. Although DOCS is making significant efforts to improve its pharmacy services with a
new computer system and more staff, the state must implement additional measures to ensure
that all patients receive their medications in a timely and appropriate manner.
DOCS Quality Improvement Program
DOCS’s Division of Health Services has implemented a meaningful Continuing Quality
Improvement (CQI) Program that attempts to standardize clinical protocols and monitor their
implementation. Despite these efforts, the quality improvement programs at some prisons are
inadequate. The CQI program should enhance its efforts to compel prisons to develop remedial
plans to address areas in which facilities are not fully complying with clinical standards.

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Executive Summary

Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

Medical Services for Inmates with Limited English Skills
Most prisons have very few or no medical staff members who speak a foreign language, even
though 5% to 10% or more of the inmates do not speak sufficient English to communicate
effectively with medical staff about their health problems. Almost all the prisons use inmates,
and sometimes security staff, as translators for most of the medical encounters, raising troubling
issues surrounding patient confidentiality.
Continuity of Care
Inmates are regularly transferred from one prison to another, and 27,000 to 28,000 are released
back to the community each year. Inmates at some prisons assert that they are not promptly seen
and evaluated when transferred. Many inmates are being discharged from custody leave without
adequate documentation of their medical status and without appropriate medication or a medical
discharge plan.
Legislation passed in 2007 requires the Department of Health to suspend, rather than terminate,
the Medicaid benefits of inmates enrolled at the time of incarceration. Unfortunately, this
provision will only apply to the approximately 20% to 25% of the prison population who meet
this criterion. For the vast majority of other inmates, no application for Medicaid is made while
they are in custody, and when they apply for Medicaid eligibility after they return home, they
must wait 45 days to several months before receiving Medicaid benefits. The FY 2008-2009
budget allocated funds for DOCS, the Department of Health and the Division of Parole to
undertake a pilot project to develop a method to file and process Medicaid applications for a
small number of soon-to-be-released inmates who were not on Medicaid when incarcerated; the
relevant state agencies need to do much work, however, to initiate this pilot.
Care for the Aging Inmate Population
The percentage of state inmates who are 50 years or older has more than doubled (from 4.8% to
10.3%) in the ten-year period from 1996 to 2006. With this increase, it was inevitable that there
would be a commensurate increase in medical conditions associated with an elderly population.
A US Department of Justice report demonstrated that inmates 45 years or older are four times
more likely to have cancer; three times more likely to have diabetes; and two times likely to have
heart problems, hypertension or liver problems than younger inmates. DOCS must assess its
medical staff and medical facilities to ensure that it can meet the needs of its increasingly aged
population.
We commend DOCS for opening a 30-bed Unit for the Cognitively Impaired, which houses
inmates who are suffering from Alzheimer’s, AIDS, Parkinson’s or Huntington’s diseases at
Fishkill. This unit opened in 2006 and the Department should periodically evaluate its entire
prison population to determine whether the unit’s capacity is sufficient to meet the needs of
DOCS’s cognitively impaired inmates.
Inmate Deaths
The annual number of DOCS deaths has consistently declined since the 1990s, when many HIVinfected inmates died in prison. In 1995, AIDS-related deaths peaked at 257 but rapidly declined
to just 10 by 2000. This dramatic reduction was due to the development of effective treatments

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Executive Summary

Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

for HIV which have been provided to the HIV-infected population in prison. However, the
number of DOCS deaths during 2001-2004 was the fourth highest among U.S. prisons, and the
average rate of death due to illness for New York inmates was the third highest for all states
excluding the southern region of the country, where much higher mortality rates generally exist.
Given these data, the state should do more to reduce inmates’ deaths by augmenting medical
training and quality improvement activities focused on illnesses (such as heart disease and
cancer) that are most likely to result in inmate mortalities.
Approximately 170 inmates have died each year in DOCS custody since 2001, yet only about a
dozen inmates have been released each year on Medical Parole. In order to expand the number
of compassionate releases of seriously ill or incapacitated inmates, the state should expand the
Medical Parole Law consistent with proposals in the Department’s FY 2008-09 budget, that were
not included in the budget enacted by the Legislature. An Assembly Bill (A10863), with
provisions similar to the Department’s proposals is currently pending before the Legislature but
does not have a Senate sponsor.
Women-Specific Healthcare Needs
In addition to particular gynecological, reproductive, nutritional and other health requirements,
women’s specific life experiences and circumstances have significant implications for their
healthcare needs. An overwhelming majority of women in New York prisons are survivors of
violence and trauma. Approximately 72% of incarcerated women are parents; incarcerated
mothers frequently note that separation from their children causes depression, anxiety and low
self-esteem. Incarcerated women also suffer from serious mental illness at considerably higher
rates than male inmates. Training providers on the concept of women-centered healthcare
(which views the complex circumstances of women’s lives as integral to their treatment plans) is
an important step toward enhancing providers’ ability to communicate with, assess and treat
female patients. We are unaware of any such training for DOCS medical staff.
Most state facilities for women provide gynecological care through on-site specialty clinics. As
a result of this system, incarcerated women (unlike incarcerated men) require routine access to
and follow-up from specialists, whether or not they are ill. Women also need at least yearly Pap
smear tests and mammograms after they reach a certain age and have specific needs related to
personal hygiene items and nutrition. Some inmates reported delays in getting abnormal
gynecological test results and in receiving adequate follow-up care for gynecological issues. The
Department seems to lack a comprehensive quality improvement program to monitor these and
other women-specific health services.
Monitoring of Healthcare Within DOCS
Although the New York State Department of Health monitors the quality of medical care at
private hospitals and clinics throughout the state pursuant to Article 28 of the Public Health Law,
neither DOH nor any other state agency outside of DOCS assesses the quality of care provided
within the prisons. The DOH’s AIDS Institute has played a limited role in advising DOCS about
protocols for prison HIV and hepatitis C care, but DOH has not interpreted the Public Health law
as authorizing it to evaluate the adequacy of prison medical services.

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Executive Summary

Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

The State Commission of Correction (SCOC) has an inmate mortality review panel, but in recent
years this panel’s reviews of DOCS inmate deaths due to natural causes have generally been pro
forma statements, and the panel’s efforts have never included any assessment of the overall
quality of healthcare in DOCS. Moreover, these reviews are often delayed and generally do not
require any response from DOCS. The SCOC is not monitoring DOCS medical care and would
not be an effective agency to be assigned this task due to its limited resources and lack of
relevant expertise.
RECOMMENDATIONS
To ensure that all inmates in DOCS custody receive appropriate healthcare, regardless of where
they are confined, state policymakers should take steps to address deficiencies within the
Department’s healthcare system. These efforts should include regular monitoring at each prison
to identify deficiencies and the development and implementation of targeted remedial plans.
Corrective plans will require additional resources. The governor and the legislature should make
policy decisions that enable the Department to provide healthcare conforming to community
standards and consistent among all prisons in the system.
Pursuant to deficiencies identified in this report, the CA recommends that DOCS, the governor,
other state agencies and the legislature implement the following recommendations with
appropriate additional resources (See the full list of recommendations beginning on page 78):
Enhance Medical Staffing
●
Promptly fill DOCS medical staff vacancies and increase state salaries for medical
positions that are difficult to fill, bringing compensation rates in line with those for comparable
providers in the community.
●
Perform a staffing analysis of medical positions at each prison to determine where
augmented staff is most needed and allocate additional resources for these new positions.
●
Enhance medical staff skills by requiring training for providers with limited background
in the care of frequently encountered medical problems and those found through reviews to need
improvement. Facilitate the participation of all medical staff in training programs through
incentives and by other means. Enhance training of nurses and clinicians to ensure that they are
receptive to and respectful of their patients and that they provide appropriate care during all
medical exams.
Improve Access to and Quality of Routine Care
●
Improve the monitoring of the quality of both sick call and clinic call-outs to ensure that
(1) inmates have timely access to providers, (2) medical staff provide adequate evaluation and
timely and respectful treatment, and (3) these encounters occur in locations that permit
confidential conversations between medical staff and inmates.
Improve Care of the Chronically Ill
●
Assign each patient with a chronic illness to a single provider who is responsible for
overseeing his/her care.

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Executive Summary

Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

●
Develop a chronic care system that includes chronic care coordinator positions at each
prison and a computer-based record-keeping system to manage and monitor this complex care.
●
Improve care provided to HIV-infected inmates and ensure that this care meets
community standards at each prison. Take more aggressive measures to identify HIV-infected
inmates by: increasing the use of paid peer educators; enhancing counseling, testing, and
education by the community-based providers, AIDS Institute and DOCS; providing patient
education about HIV at optimal times; and investigating prisons with low rates of known HIVinfected inmates to determine how to persuade more inmates to be tested and persuade those who
are HIV-positive to seek care. Improve monitoring of HIV care to ensure that HIV-infected
inmates are periodically evaluated by HIV specialists and that such specialists are consulted
when a patient is failing on his/her current medications. Investigate prisons with low usage of
HIV specialists and monitor whether prisons are promptly following up on specialists’
recommendations. Use CQI results to ensure adherence to practice guidelines and provide
effective treatment to all HIV-infected inmates.
•
Improve care provided to inmates infected with hepatitis C (HCV) and ensure that such
care meets community standards at each prison. Enhance efforts to identify more HCV-infected
inmates by screening all inmates and testing those at risk. Ensure that all inmates chronically
infected with HCV are properly diagnosed and that treatment is provided to those needing
therapy. Investigate prisons with low rates of known HCV-infected inmates, inmates with HCV
disease and inmates on therapy. Review practices at prisons that have low utilization rates of
gastroenterology and liver biopsy services. Abandon the plan to stop monitoring the response of
HCV-infected inmates receiving treatment. Improve the HCV quality improvement program by
requiring more rigorous compliance with the HCV Practice Guidelines.
•
Increase funding for the AIDS Institute’s Criminal Justice Initiative to enhance its HIV
prevention activities, especially peer training, support services and discharge planning.
Enhance Access to Specialty Care Services
●
Enhance access to specialty care services by monitoring the utilization of specialty
services by the prisons, ensuring that inmates needing these services are promptly referred to a
specialist and improving the timeliness of specialty care appointments.
●
Ensure that prison providers follow up on specialists’ recommendations appropriately by
promptly implementing the recommended care or by clearly documenting the reasons for
rejecting the specialists’ suggestions in the patient’s chart.
Improve Pharmacy Services
●
Increase the salary authorized for DOCS pharmacists and fill vacant pharmacy positions.
●
Expedite implementation of the computerized pharmacy program and the plan for
DOCS’s Central Pharmacy to provide medications directly to patients at prisons that do not have
a pharmacy in order to improve care, expedite treatment and save money.

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Executive Summary

Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

Enhance DOCS’s Quality Improvement Program
●
Ensure that all prisons have a fully operational quality improvement committee that
analyzes medical grievances, performs chart reviews at least four times a year and routinely
assesses healthcare staff and systems utilizing DOCS’s Quality Assessment Tools Manual.
●
Conduct regular meetings at each prison with the Inmate Liaison Committee, Inmate
Grievance Representatives, prison medical staff and prison executive team to discuss inmates’
concerns about prison healthcare.
●
Increase the activities of the DOCS Division of Health Services’ Continuous Quality
Improvement Committee, which oversees the reviews of prison healthcare by DHS Central
Office medical personnel, and require prison medical administrators to develop action plans to
address deficiencies. Document any failure to meet specific quality indicators and increase the
threshold for compliance to 80% or higher.
Improve Services for Inmates with Limited English Skills
●
Improve translation services for medical encounters with inmates who have limited
English skills by providing incentives (e.g., pay differentials) for bilingual (especially Spanishspeaking) medical personnel to join DOCS and by utilizing appropriate translation services, such
as the AT&T translation phone line.
•
Provide medical documentation and educational materials to patients in their native
language.
Improve Continuity of Care for Inmates with Medical Problems
●
Improve the continuity of care for inmates transferred among DOCS facilities to prevent
delays in care or interruptions in treatment.
●
Develop a medical discharge plan for all inmates with serious or chronic medical
problems being released from prison, including information about their condition and treatment,
adequate medication, and help in scheduling an appointment with a community provider.
Implement a pilot program to be coordinated among DOCS, DOH and the Division of Parole (as
funded in the FY 2008-09 budget) to ensure that inmates nearing release are enrolled in
Medicaid. Enact regulations and/or legislation to require that a Medicaid application be filed and
processed for all eligible inmates being released from custody so they can access healthcare
immediately upon returning to the community.
Improve Care for the Aging Inmate Population
●
Enhance the training of medical staff concerning illnesses frequently encountered by
patients over 50 and assess medical staff and facilities to ensure that adequate resources are
available to treat this expanding inmate population.
Improve the Care of Seriously Ill Inmates and Expand Medical Parole
●
Enhance medical training and quality improvement activities for medical conditions
(such as heart disease and cancer) that are likely to result in inmate mortalities.

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Executive Summary

Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

●
Expand the Medical Parole Law to allow parole of inmates who, even if they are not
dying, are so physically or cognitively incapacitated that they are no longer a danger to society.
Improve Healthcare Services for Women Inmates
●
Require medical providers working in women’s facilities to be trained in concepts of
women-centered healthcare, including issues of trauma, domestic violence and the physical and
mental health implications of abuse.
●
Enhance quality improvement mechanisms intended to monitor women-specific health
services. Develop more comprehensive policies and standards for women-specific health care.
Initiate External Monitoring of Prison Healthcare by DOH and Enhance that by SCOC
●
Enact legislation to require the New York State Department of Health to monitor and
evaluate prison medical care. Alternatively, accomplish this goal through a directive from the
governor, who could, without additional statutory authority, order DOH to act pursuant to its
authority under Public Health Law, Article 28.
●
Improve monitoring of prison healthcare by the New York State Commission of
Correction and encourage more rigorous reviews of state inmate deaths through the SCOC’s
mortality review committee.

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System Overview

Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

SYSTEM OVERVIEW
PRISON VISITS AND MONITORING OF PRISON HEALTHCARE
A general monitoring visit to a prison by Correctional Association (CA) representatives to
evaluate medical care consists of: visits to the healthcare unit at the prison; interviews of senior
healthcare officials, generally the Facility Health Services Director (FHSD) or the Nurse
Administrator; interviews of Inmate Liaison Committee members and inmate staff assigned to
the Inmate Grievance Review Committee; oral surveys of inmates throughout the prison with a
detailed instrument and collection of written survey responses from inmates contacted during the
visit; and meetings with prison administrators and staff, including members of the Public
Employees Federation representing healthcare workers, to discuss conditions and services in the
prison, including medical care. Prior to each visit, the CA obtains information about the prison’s
medical staffing, healthcare services and the number of patients suffering from chronic diseases.
Following the visit, CA staff prepares a detailed report of observations and recommendations.5
INMATE MEDICAL GRIEVANCES
Inmates can file a grievance with administrators to complain about prison conditions and/or
treatment by staff. For the past six years, New York prisoners annually filed approximately
45,000 grievances system-wide. DOCS gives each grievance one of 55 codes signifying the
primary issue raised by that grievance. For health services, there are three codes: 21-dental, 22medical and 22.1-HIPAA (relating to the federal law concerning privacy of medical records).
Formal inmate complaints about conditions or treatment at a prison are reviewed by the prison
grievance committee, which includes inmate representatives and DOCS grievance staff. The
grievance can be disposed of through an “informal resolution” to which the inmate must consent,
or it is sent for a hearing before the prison grievance committee. The decision of the grievance
committee can be appealed to the prison superintendent and then to the Central Office Review
Committee (CORC) in DOCS’s central office. Of the 44,484 grievances filed in 2006,
approximately 11% were informally resolved, 71% went to a grievance hearing, 57% were sent
to the prison superintendent for review and approximately one-third were appealed to CORC.
Instead of filing a grievance, an inmate can initiate a “non-calendared contact” with the
grievance office to seek information or informal help with a problem. In 2006, there were
29,536 non-calendared inmate contacts with the prison grievance offices.
Over the past six years, medical care has become the most highly grieved topic in the
Department. Table 1 lists the five most highly grieved issues during 2001–2006.

5

The CA has issued reports on Albion (female), Attica, Auburn, Bedford Hills (female), Clinton, Coxsackie,
Eastern, Elmira, Fishkill, Gowanda, Great Meadow, Green Haven, Mid-Orange, Oneida, Sullivan, Upstate and
Wyoming Correctional Facilities. The CA has also compiled data on medical staffing and grievances for two other
prisons, Arthur Kill and Sing Sing. There are no medical reports on these two prisons because the visits focused on
assessing prison violence and did not include inspection of the medical area, interviews with medical staff or
surveys of inmates about healthcare. An Addendum to this report contains excerpts from prison reports describing
the CA’s assessment of medical care at 24 prisons visited during the period September 2004 through June 2008.

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System Overview

Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

TABLE 1 - MOST GRIEVED ISSUES BY PERCENTAGE FILED 2001-2006
Year

2006
2005
2004
2003
2002
2001

Total
Griev
#
44,484
45,345
44,587
45,226
44,405
45,624

Medical
#
8,193
8,303
8,360
8,377
8,003
7,631

%
18.42%
18.31%
18.75%
18.52%
18.02%
16.73%

Staff Conduct
#
7,142
7,116
7,439
7,437
7,385
8,219

%
16.06%
15.69%
16.68%
16.44%
16.63%
18.01%

Housing
#
2,913
3,206
3,652
3,742
3,868
3,524

%
6.55%
7.07%
8.19%
8.27%
8.71%
7.72%

Package
Room
#
%
2,252 5.06%
2,360 5.20%
2,027 4.55%
2,099 4.64%
2,042 4.60%
2,201 4.82%

Special
Housing Unit
#
%
2,045 4.60%
1,826 4.03%
1,511 3.39%
1,471 3.25%
1,542 3.47%
1,748 3.83%

Starting in 2002, medical complaints became the most grieved issue in DOCS and represent
almost one-fifth of all grievances. The total number of grievances has remained very high, but
the number varies significantly among prisons, both in percentage of healthcare grievances and
in absolute number filed per 100 inmates.
Exhibit B summarizes the grievance data for the 19 prisons visited in 2004 through 2007. The
CA found a general correlation between the number of inmate grievances and medical problems
identified during visits through observations and interviews with inmates.6
Data from DOCS’s computer records summarizing grievances appealed from all state prisons to
DOCS’s Central Office Review Committee (CORC) reveal that between January 2003 and May
2006, a total of 10,975 medical grievances were appealed, representing 39% of all medical
grievances filed in the prisons during that period.7 CORC appeals of medical grievances were
four times greater than appeals for any other issue. These appeals focus on the denial of
treatment, failure to provide care and specialty care, problems obtaining medications, and many
other areas of concern.
Exhibit C contains an analysis of the computer summaries of CORC medical appeals for the 19
prisons the CA visited. In addition to listing the total number of medical grievance appeals for
each prison, Exhibit C contains a compilation of the number of grievance appeals related to
medications, specialty care and denial of treatment. From January 2003 through May 2006,
there were 5,647 medical care grievance appeals to CORC from these prisons, representing half
of the total CORC medical grievances. Observations and information gathered during visits
indicate more serious problems with healthcare at most of the facilities with higher numbers of
grievance appeals and fewer problems with medical care at most of the prisons with lower
numbers of appeals.8
6

Rates of medical grievances contained in Exhibit B are very high at Arthur Kill, Auburn, Elmira, Great Meadow,
Green Haven, Mid-Orange and Upstate Correctional Facilities. Conversely, grievances were relatively low at
Coxsackie, Eastern, Gowanda, Oneida and Wyoming Correctional Facilities.
7
The summary contains the date of the grievance, the prison in which the grievance arose, a code indicating the
major issue raised in the grievance and a brief summary of what the grievance alleges.
8
Facilities that recorded particularly high numbers of grievance appeals were: Upstate (1,270); Clinton (526);
Auburn (501); Green Haven (472); Elmira (448); Great Meadow (450); and Fishkill (354). Prisons with

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System Overview

Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

In its annual report on grievances, DOCS found that 36% of all grievance appeals in 2006 were
“meritorious or have merit in part.”9 The Department did not provide information on the number
of medical grievances substantiated by CORC. Nevertheless, it is of concern that such a high
percentage of the grievances denied at the prison level were subsequently determined to be at
least partially meritorious upon Central Office review two to three months later. The fact that
inmates appealed nearly 40% of their medical grievances to Central Office and that a significant
number of appealed grievances were determined to have some merit indicate that inmates’
concerns about their healthcare (including access to treatment and quality of care) are of a very
serious nature and lend substantial support to inmates’ claims of inadequate care.
Although medical grievances are a useful barometer of the level of inmate dissatisfaction with
healthcare and can indicate systemic problems at an institution, it is unclear to what degree
DOCS’s Division of Health Services uses them to identify and remedy systemic problems.
Similarly, it seems that individual facilities do not consistently analyze grievances as a tool to
identify and resolve recurrent medical problems.
Moreover, grievances represent only a partial representation of inmate complaints. Many
inmates have reported that they have little faith in the grievance system and have therefore
declined to file a legitimate grievance.
Conversely, there are prisons with a responsive grievance program where the grievance
mechanism can be an effective tool to promptly address inmate complaints. When the grievance
officer contacts medical staff about an inmate’s concerns gathered during the informal grievance
resolution procedure or a non-calendared contact, issues can promptly be resolved, resulting in
improved care and reduced treatment delays.
MEDICAL STAFFING
Vacancies
The CA visits identified several prisons that had numerous medical staff vacancies and/or
appeared to have insufficient staff to meet patient needs. Filling vacancies in nursing, physician
assistant and pharmacy staff has frequently been very difficult for DOCS in several regions of
the state because of inadequate compensation rates for these positions.
Table 3 (page 21) contains a summary of medical staffing at 19 prisons at the time of the CA
visits. These data reveal vacancy rates of 14% for nurses, 12% for physicians, 5% for physician
assistants (PAs) and nurse practitioners (NPs), and 16% for pharmacists.

significantly fewer medical appeals included Eastern (167), Sullivan (149), Wyoming (131), Coxsackie (100),
Oneida (81), and Gowanda (74).
9
See Inmate Grievance Program, Annual Report 2006, DOCS (2007). Comparable, but slightly lower, numbers of
meritorious appeals were noted in annual reports for 2003–2005. Inmate Grievance Program, Annual Report 2005,
DOCS (2006); Inmate Grievance Program, Annual Report 2004, DOCS (2005); Inmate Grievance Program,
Annual Report 2003, DOCS (2004).

- 19 -

System Overview

Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

Recently, the Department has made progress in filling some positions and has managed to
increase some staffing levels. An analysis of DOCS’s May 2007 system-wide medical staffing
data provided by DOCS Division of Health Services indicates that the Department has reduced
its nursing shortages overall by more than 40% in the last few years from about 14% to 8%. The
reduction in the vacancy rate for physicians to 3% indicates that the Department apparently no
longer has a systemic problem filling these positions.
Table 2 contains a list of recommended and filled positions as of May 2007 for all prisons for:
(1) physicians, (2) PAs and NPs, (3) registered nurses and (4) pharmacists.
TABLE 2 - SUMMARY OF MAY 2007 DOCS MEDICAL STAFFING
Recommended Staff
Actually Filled Items
Number of Vacancies
Percent Vacant

Physicians
114.08
110.33
3.75
3.3%

PAs/NPs
48
41.3
6.7
14.0%

Registered Nurses
799
735.8
63.2
7.9%

Pharmacists
54.5
47.4
7.1
13.0%

The CA hopes this progress will continue and urges DHS to undertake an analysis to identify
prisons where inadequate staffing has an adverse effect on healthcare. Despite some systemwide progress, problems still persist in filling PA/NP and pharmacist positions. Moreover, as
detailed at pages 20-24, vacancies still exist at several prisons throughout the state. Table 4
(page 23) contains May 2007 staffing levels for the 19 prisons visited by the CA.
Staff Vacancies - Nurses
The Department has experienced chronic nursing shortages for several years. The overall nurse
vacancy rate reported by DOCS Chief Medical Officer Dr. Lester Wright at the Assembly
hearing conducted by the Corrections and Health Committees in March 2004 was 14%; the
Department reported comparable nurse vacancy rates for several years prior to Dr. Wright’s
testimony. Similarly, there was a 14% overall nurse vacancy rate at the time of CA visits to the
19 prisons in 2004-2007. Nine of these prisons had nursing vacancies of greater than 15%, with
some vacancy rates higher than 40%. At Bedford Hills, for example, 10 of the facility’s 23
registered nurse positions were vacant.
Some vacancies persist for months (and sometimes years), because there are few candidates in
the community willing to work in the prisons at the compensation rates offered. Eastern, for
example, was missing 6.5 nurses, 23% of nursing staff; some of these vacancies had existed for
one year prior to the February 2005 CA visit. Great Meadow was missing nearly 30% of its
nursing staff at the June 2006 CA visit; some of these vacancies had existed for more than two
years.
Further, vacancy rates do not indicate all the missing staff. Some positions are technically
“filled” with individuals who are not working because they are out on extended sick leave,
workers’ compensation or are otherwise unavailable to work. Other individuals cannot fill their
positions, so no one is performing their duties. For example, of seven nursing positions at MidOrange in October 2004, only two permanent staff were present at the facility; two positions

- 20 -

12/19/2005

3/17/2005 2,204

7/19/2005 1,767

7/15/2005

12/14/2004 2,890

9/30/2004

5/25/2005 1,175

5/4/2005

1

1

1

1

1

1

1

1

Arthur Kill

Attica

Auburn

Bedford Hills

Clinton

Coxsackie

Eastern

Elmira

- 21 -

6/20/2006 1,681

5/24/2006 2,149

10/19/2004

3/8/2007

12/2/2005 1,737

7/20/2006

12/13/2004 1,162

5/21/2007 1,707

1

1

1

1

1

1

1

1

Great Meadow

Green Haven

Mid-Orange

Oneida

Sing Sing

Sullivan

Upstate

Wyoming

2

1.5

1

4

2

1.17

1.29

1.34

2.30

1.68

1.39

3.26

1.78

1.43

2.33

1.69

1.70

1.43

1.38

9.90

1.13

0.91

2.11

1.74

0.0%

0.0%

0.0%

0.0%

14.3%

0.0%

20.0%

0.0%

0.0%

0.0%

0.0%

12.5%

25.0%

0.0%

50.0%

50.0%

0.0%

0

0.0%

0.25 16.7%

0

0

0

0

1

0

0.5

0

0

0

0

0.5

2

0

1

1

0

%
Vac

2

1

3

1

0.4

2

1

1

2

1

1.5

1

2

1.5

1

0

0

0

0

0

0

0

0

1

0

0

0

0

0

0

PA/ PA
NP Vac

28,253 54.4 1.93 6.25 11.5% 20.4

746

1,191

1

7

3

2.5

4

3

2

1.4

4

8

2

2

2

2

MD
Vac

4.9%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

50.0%

0.0%

0.0%

0.0%

0.0%

0.0%

2.65

3.01

2.68

4.03

2.52

1.94

4.19

2.38

2.01

3.49

2.25

1.90

1.70

1.81

3.04

%
Rate
Vac
#2

314

11

26

10.5

21

12

7

29

14

16

28.5

16

11

11

19

23

14.5

17

9

18

18.2%

3.8%

0.0%

19.0%

0.0%

28.6%

3.4%

28.6%

0.0%

22.8%

0.0%

13.6%

27.3%

0.0%

43.5%

17.2%

11.8%

22.2%

11.1%

0

0

0

1

0

0

3

0

0

4

0

0

0

1

15

0

0

1

0

13

0

0

1

0

0

1

1

0

3

0

0

0

0

7

0

0

0

0

1.198

0.64

2.24

1.41

1.27

1.01

0.97

1.49

0.83

0.92

1.89

0.90

0.94

1.12

0.69

4.70

0.82

0.77

1.06

1.57

33.5

0

0

2.5

6

1.5

2

2

4

2

2

3

2

2

3

1.5

5.5

0

0

0

0

1

0

1

0

1

1

1

0

0.5

16.4%

0.0%

0.0%

0.0%

0.0%

50.0%

0.0%

50.0%

0.0%

33.3%

50.0%

50.0%

0.0%

33.3%

% LPN LPN Rate Pharm Pharm %
Vac
Vac
#3
Vac Vac

43.5 13.9% 25

2

1

0

4

0

2

1

4

0

6.5

0

1.5

3

0

10

2.5

2

2

2

RN RN
Vac

Rate 1: # of authorized Physician per 1000 inmates.Rate 2: # of MDs, PAs and NPs per 1000 inmates.Rate 3: # of RNs and LPNs per 100 inmates.

TOTALS

6/28/2005 1,743

2

Gowanda

721

2/15/2005 1,718

1

Fishkill

1,779

978

808

947

12/1/2005 1,150

1

Med PVP Visit Pop MD Rate
Cls
2006 Staff #1

Albion

Prison

Table 3 - Medical Staff at Time of CA Visit to Prisons in 2004-07

System Overview
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

System Overview

Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

were vacant, two nurses were on extended sick leave, and one nurse was out on workers’
compensation. In some cases, including at Mid-Orange, temporary per diem items are
authorized to replace absent employees, but even these temporary positions may, at times, be
vacant.
Per diem nurses are hired from the community or through state contracts with outside nursing
agencies. Alternatively, when positions are vacant, the prison must supplement the nursing
personnel with extensive overtime by existing staff and/or extra service nurses from other state
agencies. Compulsory overtime and a lack of permanent staff lead to excessive stress and high
rates of staff turnover which in turn threaten quality of care by disrupting continuity of care and
undermining provider-patient relations. Under these circumstances, essential tasks (e.g., quality
assurance activities, chart reviews, routine preventive care, etc.) are often discontinued or
delayed.
As noted above, the Department has made progress in reducing the overall vacancy rate for
nurses. But the problem has not been solved. Many of the prisons visited in 2005-2007
continued to experience difficulties in hiring nurses. The May 2007 staffing data listed in Table
4 reveal that Bedford Hills still had a 40% nurse vacancy rate: 11 of 28 positions were unfilled.
Elmira was missing 14% of its 18 regular nurses. Arthur Kill, Attica, Great Meadow and Sing
Sing also had multiple nursing positions unfilled. Additional resources are needed to attract staff
to these facilities to remedy these longstanding staffing problems.
Staff Vacancies - Pharmacists
Pharmacy staffing has also been a chronic problem. Thirteen of the 19 prisons the CA visited
(Table 3) had pharmacists authorized for the facility, but there were a number of vacancies. Of
the 33.5 pharmacist positions at the 13 prison pharmacies, 5.5 positions (16%) were vacant at the
time of the CA visit. At four prisons, only one of two authorized pharmacists was working.
The six prisons without onsite pharmacists relied on outside pharmacy services. Four of these
obtained medications from regional pharmacies at other prisons. The other two (Mid-Orange
and Upstate) that relied on an outside community pharmacy had medication costs that were
significantly higher than they would have been had the medications been provided by the DOCS
Central Pharmacy.10
Most pharmacy vacancies have existed for many months or years. The staff shortages and the
reliance on expensive outside providers have persisted primarily due to the state’s failure to
compensate pharmacists at rates comparable to community salaries. As the May 2007 data
(Tables 2 and 4) demonstrate, the problems in pharmacy vacancies still persist system-wide with
an overall vacancy rate of 13% and a vacancy rate of 15% at the 19 prisons visited by the CA. It
appears that greater compensation rates are needed to attract sufficient applicants to fill the many
vacant positions; this increase in wages will require action by officials outside DOCS.

10

See pages 58-61 for a more comprehensive description of pharmacy services and the impact of vacancies on
pharmacy services in the Department.

- 22 -

- 23 -

2
2
3
6.15
2.5
1.5
2
2
5
2
2.5
7.5
1.5
2
3
1
1.5
2

968

2,210

1,772

812

2,833

1,032

1,175

1,779

1,679

1,758

1,654

2,131

717

1,180

1,713

770

1,255

1,705

Arthur Kill

Attica

Auburn

Bedford Hills

Clinton

Coxsackie

Eastern

Elmira

Fishkill

Gowanda

Great Meadow

Green Haven

Mid-Orange

Oneida

Sing Sing

Sullivan

Upstate

Wyoming

0.0%

0.0%

0.0%

16.7%

0.0%

0.0%

0.0%

0.0%

0

0

0

0

0

0

0.25

1

0.5%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

3.3%

40.0%

-0.5 -25.0%

-0.5 -10.0%

0

-0.5 -25.0%

0

0

0

0.5

0

0

0

26

2

1

4

1

3

2

1

2

1

3

1

1

3

1

0.0%

0.0%

25.0%

0.0%

0.0%

50.0%

0.0%

10.0%

0.0%

33.3%

0.0%

0.0%

66.7%

4.7 18.1%

0

0

0

1

0

0

0

1

0

0.2

0

0

1

0

0

2

0

-0.5 -50.0%

367

853

359

385

245

393

478

203

368

586

240

593

588

688

515

114

443

442

484

387

17.6%

25.0%

9.1%

0.0%

5.3%

3.2%

4.9%

0.0%

1

2

0

9.1%

7.7%

0.0%

4.5 22.5%

0

-0.5 -6.3%

5.5 18.3%

4.3 30.7%

0.5

2

2.5 13.9%

1

0

1

11.3 40.4%

1.5 10.3%

3

2

-0.7 -4.7%

331.5 40.9 12.3%

11

26

12.5

20

11

8

30

14

15.5

40.5

18

11

12.5

19

28

14.5

17

8

15

85

155

48

62

86

107

90

71

118

113

41

99

107

83

149

29

122

130

121

77

40

2.5

7

1.5

2

3

3.5

2

2.5

3

2

4

3

1

3

6.1

0

0

1

1.1

0

0

1

1

-0.5

0

0

-0.5

0

0

1

0

1

1

15.3%

40.0%

15.7%

0.0%

50.0%

33.3%

-14.3%

0.0%

-20.0%

0.0%

0.0%

25.0%

0.0%

100.0%

33.3%

MD % MD PA/NP PA/NP % PA Inmates/ RN RN % RN Inmates Pharm Pharm % Pharm
Vac Vacant Staff Vac
Vac MD/PA/NP Staff Vac Vacant per RN Staff Vac
Vacant

28,304 51.15 0.25

2

1,161

Albion

Totals

MD
Staff

Pop
2007

Prison

Table 4 - 2007 Medical Staffing for Prisons Visited by CA in 2004-07

System Overview
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

System Overview

Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

Staff Vacancies - Physicians
Physician staffing had been problematic, but recently, the Department has made significant
progress in filling many of these positions. Overall, for the 19 visited prisons, 12% of the
physician items were vacant at the time of the CA visit (Table 3), including seven prisons that
had at least a part-time physician vacancy. Two prisons were missing half their physicians, one
prison was missing a quarter of its doctors and another had a 20% vacancy rate. Some of these
prisons had had physician vacancies for extended periods of time. Gowanda, for example, had
not filled a half-time physician position for 18 months prior to the CA visit in 2005. Attica’s
FHSD position had been vacant for six months at the time of the 2005 visit. As discussed in
greater detail later in this report, these vacancies had a harmful effect on healthcare, with many
inmates reporting long delays to see a provider and inadequate examinations.
As noted above, the Department has reduced the overall physician vacancy rate to 3% as of May
2007. At the 19 prisons visited by the CA, the 2007 data (Table 4) indicates that only three
prisons were missing physician staff. Auburn had increased its physician staff to three doctors as
of 2007 from the two positions authorized in 2005, but the prison had been unable to fill a halftime physician position. Great Meadow was missing one physician of its 2.5 doctor items.
Unfortunately, both these large prisons have had consistent problems with the quality of the
medical care provided, and these vacancies will only exacerbate their difficulties. The
Department should be commended for its efforts to hire doctors, but it must remain vigilant in
expeditiously filling physician positions, because any absence of such providers negatively
affects the prisons’ ability to provide quality care.
Continuing Problems Filling Vacancies
Despite the progress made with the nurses and physicians, the Department continues to have
high levels of vacancies for pharmacists (13%) and PA/NP positions (14%), apparently due to
the low civil service salaries available for these jobs. The Department should renew discussions
with the Division of the Budget and Civil Service Commission concerning the chronic staffing
shortages in these positions and request additional salary increases for them.
Significant problems that require prompt attention still exist at individual prisons. Table 4,
containing a summary of May 2007 staffing levels, indicates two visited prisons with serious
staffing problems. As noted above, Great Meadow had several critical vacancies: one of 2.5
physician positions (40%), one of two PAs, and 4.3 positions of 14 nursing items (31%) were
vacant. It is unreasonable to expect Great Meadow, a prison of nearly 1,700 inmates, to function
effectively with these shortages, and the staff there may soon experience burn-out from the
burden. It is notable that several nurses at Great Meadow had been hired within one year of the
May 2007 data, suggesting that the prison has difficulties retaining its nursing staff.
Attica had several shortages: it was missing two of three PAs and three of 17 regular nurses. The
prison was also authorized to fill two additional temporary nursing positions, but as of May
2007, both of these positions were vacant, as was a temporary pharmacist position. As a result of
provider vacancies, Attica had only three clinicians for more than 2,200 patients. Given the
chronic problems in staffing at the prison, responsible state officials should make greater efforts
to recruit new staff and provide incentives for existing staff to remain in their positions.

- 24 -

System Overview

Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

Additional Medical Staffing Needs
Even if all the 2007 authorized medical positions were filled, deficiencies in care at some prisons
would persist because the authorized number at some prisons is not sufficient to meet the health
needs of the inmate population. Moreover, there is no apparent consistent staffing plan for each
prison to ensure that comparable services are available throughout the Department.
Nursing Staff Needs
Many prisons do not have sufficient nursing staff to meet the needs of their patients, and
substantially different nurse-patient ratios exist throughout the Department. For example, as of
May 2007, Auburn, with 1,770 inmates and a prison infirmary, was authorized to employ only
14.5 nurses, representing one nurse for every 122 inmates. (See Table 4.) It was not surprising
that a majority of inmates the CA surveyed rated the healthcare at Auburn as poor and that it has
the second highest rate of medical grievances of the facilities the CA visited. At Clinton, there
are only 19 nurses for almost 2,900 inmates in the Main and Annex buildings, a ratio of one
nurse for 152 inmates. At Clinton, many fewer inmates go to sick call than at other prisons, the
number of medical grievances is high, and inmates reported significant delays in access to care.
Wyoming has only 11 nurses for more than 1,700 inmates, representing one nurse for every 155
inmates. Wyoming inmates were particularly critical of the quality of sick call, which is run by
nurses, with half the inmates rating it as poor and only 6% assessing it as good. Other prisons
had similar staffing problems.11
In contrast, Green Haven, bound by a federal court order requiring specific medical staff levels,
has a population of 2,139 inmates and employs 32 nurses, a ratio of one nurse for every 67
inmates, twice the rate at Clinton and Auburn. Fishkill, with 1,730 inmates, has one nurse for
approximately 80 inmates,12 and Sing Sing has one nurse for every 82 inmates.
There is no apparent medical justification for the significant differences in the allocation of
nursing staff at these downstate facilities in comparison to the staffing levels at Auburn, Clinton
and Great Meadow, which are prisons that have the highest prison medical classification level
and operate a medical infirmary.
Some prisons have augmented nursing staff since the CA visits in 2004 and 2005. When the CA
visited Elmira in May 2005, the prison had 16 nurses and no nurse vacancies, but, to provide
essential services, the prison regularly utilized per diem nurses and significant staff overtime. At
that time, the staff had requested two more nurses, but DOCS had not approved any additional
positions. Since then, two additional nurses have been authorized for the prison. Unfortunately,
the prison now has 2.5 nurse vacancies, so it has not realized the benefit of this increase in
nursing staff. During the CA visit to Mid-Orange in 2004, the staff informed the Visiting
Committee that the prison had requested two additional nurse items beyond its then-current level
of seven, but the prison was only authorized to hire one additional nurse to work 16 hours per
11

At Attica and Great Meadow, the inmate-nurse ratios are 130 and 120, respectively, and inmates at these prisons
had significant complaints about healthcare.
12
Fishkill, with a total of 40.5 nurses, has a 30-bed Regional Medical Unit (RMU) and a 30-bed Cognitively
Disabled Unit (CDU) for inmates with severe dementia and other cognitive impairments. The RMU and CDU have
11 and 8.5 nurses, respectively; consequently, to serve the remaining prison population, there is one nurse for
approximately 80 inmates.

- 25 -

System Overview

Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

week. Since our prison report, Mid-Orange was authorized to increase it nursing staff to eight
nurses and as of May 2007, the prison employed 8.5 nurses, exceeding its regular staff
allocation.
Physician and PA/NP Staff Needs
Similar discrepancies exist for the authorized levels of physician staff at many prisons, leaving
some facilities with insufficient personnel to meet the healthcare needs of inmates. At 17 prisons
visited by the CA (excluding Green Haven and Bedford Hills, prisons where litigation required
augmented staffing), there were only 37.5 authorized doctors for 25,300 inmates, a ratio of one
physician for every 675 inmates. These May 2007 figures include a Facility Health Services
Director (FHSD) at each prison who often must spend a significant portion of their time on
administrative matters.
If the authorized levels of physician assistants (PAs) and nurse practitioners (NPs) are added to
the physician staffing, there is one clinician for every 425 inmates at the other 17 prisons visited
by the CA. For the entire system, the ratio of authorized clinicians (physician, PA and NP) to
inmates is one provider for every 392 patients.
Table 4, which contains a summary of physician, PA and NP staff as of May 2007 at the 19
visited prisons, demonstrates a continuing problem with staff allocations.
Clinton has only 2.5 physicians and three PAs authorized for 2,833 inmates, a ratio of one
clinician for every 515 patients (a rate one-third higher than the system average). With one PA
vacancy, the ratio at Clinton rises to one clinician for 630 patients. Elmira has only two doctors
and one PA for 1,779 inmates, a ratio of one clinician for 593 patients. Gowanda has a ratio of
one clinician for every 586 patients, Coxsackie has one clinician for 688 patients and Wyoming
has a clinician for every 853 inmates. In contrast, the clinician to inmate ratios at Fishkill, Green
Haven, Oneida, Sing Sing, and Sullivan are one clinician for fewer than 400 patients.13
There is no justification for clinician-patient ratios that are 25% to 50% higher at some prisons
than others. During prison visits, the CA requested that the Department evaluate the adequacy of
staffing at Clinton, Coxsackie and Elmira and noted delays in care at Gowanda and Wyoming.
The 2007 staffing data illustrate that there have not been any significant improvements in
staffing at Coxsackie, Elmira, Gowanda or Wyoming. At Clinton, the PA staff allocation has
been increased by one, but the position is unfilled. More importantly, the significant
discrepancies in staffing patterns at the 19 visited facilities persisted in 2007.
MEDICAL STAFF TRAINING
The medical training of DOCS providers is insufficient because there is no mandatory continuing
medical education (CME) program for DOCS healthcare staff, and because at many prisons,
medical personnel are so busy with their care duties, they do not have sufficient time to
participate in voluntary CME programs. DOCS requires all its employees, including medical
staff, to annually attend 40 hours of general Department training, but there is no health-specific
13

The ratio of clinician to inmates at Fishkill and Green Haven is below 400, even when the clinicians authorized
for the special units are deducted from the prison total.

- 26 -

System Overview

Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

curriculum in this program that is mandated for medical staff. DOCS’s lack of mandatory
training in chronic diseases proves problematic for the many providers who are required to treat
inmates with chronic conditions (e.g., HIV, hepatitis C, etc.) but who lack extensive experience
in treating these diseases. It is inappropriate to require providers to care for patients with
conditions that medical staff has not been sufficiently trained to treat.
Effective CME is available for prison providers who elect to participate in voluntary programs.
For several years, DOCS has offered an excellent training program coordinated through Albany
Medical Center that focuses on infectious diseases (particularly HIV and hepatitis C) and
includes two national videoconference sessions each year and written training materials for
prison providers. But DOCS clinicians are not required to attend the teleconferences, and it does
not appear that the Department makes an effort to closely monitor CME participation of its staff.
Prison health administrators have reported that when prisons experience staff shortages, they
cannot assign personnel to the Department’s training sessions. Rather, individuals must pursue
training on their own time and/or take tapes of training sessions home to view during non-work
hours. This practice is an unacceptable alternative to a meaningful CME program.
ACCESS TO AND QUALITY OF CARE AT ROUTINE MEDICAL APPOINTMENTS
Prison medical care is provided through a triage system in which inmates initiate requests for
care and are screened by nurses who determine whether a patient requires additional examination
and treatment by a prison provider. This process is called “sick call” and occurs in most prisons
four to five days a week. If at sick call the nurse decides that additional care is needed, the
patient must wait for an appointment with a DOCS provider who will examine the patient in the
medical clinic area, an encounter that could happen the same day if it is urgent or could take
weeks or months if it involves routine care. Prison clinic medical care is provided by doctors,
physician assistants or nurse practitioners, most of whom are DOCS employees. Many inmates
complain about delays in accessing the medical system and the quality of the care they receive.
As with other aspects of the prison healthcare systems, access to routine services and the quality
of the medical examinations vary greatly among the prisons.
Sick Call
During CA visits, inmates expressed mixed opinions about sick call. At some prisons, there was
adequate access, and inmate-patients offered positive statements about the quality of
examinations performed by sick call nurses. For example, at Gowanda, with a population of
approximately 1,750 inmates and no nurse vacancies, the prison assigned two or three nurses to
sick call each day, and the inmates generally had favorable comments about healthcare and the
nurses. At Green Haven, more than three-quarters of the inmates stated that they could access
sick call when needed.
At other prisons, inmates complained of delayed access to sick call and reported that some nurses
dismissed their medical concerns. The sick call system sometimes appeared to discourage
inmate participation.
For example, at Clinton’s main building, which houses more than 2,000 inmates, the prison
conducted sick call only four times per week, and only 20 to 40 inmates were seen each day.

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

This rate is less than half that documented at other prisons this size. Clinton inmates said that
some security staff discourage them from requesting sick call. At Auburn, sick call is conducted
in the housing areas from 5:30 a.m. to 7:00 a.m.; inmates complained that the early hour
discourages their participation. At Coxsackie, sick call nurses saw 30 to 50 patients in 1.5 to two
hours, an average of only about two minutes per patient. Coxsackie inmates complained that
nurses sometimes refused to refer them to the prison doctor when needed. The shortage in
nursing staff at this prison very likely contributed to the limited sick call time. Other prisons had
similar access and quality of care problems.14
Since sick call is the entry point for most of prison healthcare, it is essential that the process
function well, in terms of access and the quality of medical encounters. When the process fails,
inmates experience delays in treatment and serious conditions can worsen. An essential purpose
of sick call is for nurses to refer patients for follow-up care. Some delays in clinic access can be
attributed to a breakdown in that process. The quality of the sick call encounters should be
carefully scrutinized to determine if this vital function is operating effectively.
In November 2007, the Department issued a Quality Assessment Tools Manual containing,
among other tools, a sick call instrument that will be useful in evaluating some aspects of sick
call process by monitoring the availability of sick call for general population and disciplinary
inmates, and in assessing whether the encounters were adequately documented. But the data
from this tool is not sufficient to comprehensively evaluate the quality of the services provided
and does not include any input from patients in assessing the sick call nurses’ attitude and
demeanor. Sick call nurses should receive additional training on how to properly conduct sick
call and how to effectively and respectfully communicate with the inmates so that patients feel
comfortable disclosing important medical information and are encouraged to cooperate in their
own medical care. All of this will contribute to the ability of these nurses to properly assess
patients’ medical needs.
Clinic Call-Outs – Access to Physicians, Physician Assistants and Nurse Practitioners
Once an inmate has been screened by a nurse at sick call, he/she can be referred to a doctor,
physician assistant (PA) or nurse practitioner (NP) in the clinic area for further evaluation and
treatment. Most clinic providers are physicians; PAs and NPs represent approximately onequarter of the clinic staff at visited prisons. Except in emergencies, inmates are generally seen
by a clinician several days, weeks or even months after their sick call screening.
Inmates expressed a mixed, but somewhat negative, review of the clinic call-out system. The
most frequent complaints were about the significant delays in accessing prison doctors and the
cursory, disrespectful and/or inadequate care that some providers rendered.
14

At Eastern, with a population of 1,000 inmates, only one nurse conducted sick call for the approximately 40
inmates attending daily; consequently, inmates waited hours to be seen. Again, chronic nursing shortages probably
contributed to this situation. At Great Meadow, 52% of the population rated sick call as poor. At Wyoming, 50% of
survey participants rated sick call as poor, and only 6% reported it as good; the inmates’ greatest concern was that
the sick call nurses did not promptly refer inmates with serious medical problems to physicians for treatment. At
Mid-Orange, where only two of the seven authorized nurses were actively working, inmates complained of delays in
access to care and the failure of nursing staff to screen newly admitted inmates properly or to perform routine
physicals. At Upstate (a prison primarily housing inmates in disciplinary confinement), the majority of inmates
surveyed reported problems accessing sick call at their cells, and three-quarters rated sick call services as poor.

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

At prisons with a higher ratio of medical providers, inmates reported they had adequate access to
physicians. For example, at Oneida, with one clinician for every 400 inmates, inmates reported
that it takes only two weeks to see a clinic provider for routine care, and two-thirds of the
inmates rated the physicians as good or fair. At Sullivan, with one provider for every 370
patients, inmates estimated that they can see a clinician within three weeks, and the medical staff
reported it generally takes only two weeks for a clinic appointment. At Bedford Hills, where
healthcare was monitored for more than two decades following a consent decree that resulted in
more providers per inmate at this prison than at most facilities, inmates said they generally see a
physician within two weeks for routine care.15
At many other prisons, particularly those with fewer providers and/or more physician vacancies,
problems persisted. For example, at Great Meadow, which had one clinician for every 560
patients, more than three-quarters of the surveyed inmates reported delays in access to clinic
providers, estimating that it took 45 days on average to see a clinician for routine care. The
medical staff admitted to delays of a month. Of greater concern was inmates’ assessment of the
quality of care provided. Sixty-five percent of surveyed inmates rated physician care as poor;
only 7.5% considered it good. There were complaints about care provided by some, but not all,
of the providers, including poor attitude and lack of respect when dealing with inmates and
failure to address problems in a timely manner and to provide treatment for longstanding medical
problems.
At Elmira, staff admitted that it could take up to 30 days for an inmate to be seen for routine
care. A majority of Elmira inmates interviewed said they did not have adequate access to
medical providers and rated overall healthcare as poor. At Attica, where the FHSD position was
vacant when the CA visited, inmates reported delays of six weeks or more in accessing a
provider, and the medical staff admitted they had an 11-page list of inmates waiting to be seen by
clinic staff.
At Auburn, inmates reported that it could take a month or more to see a clinic provider, and more
than 60% of the interviewed inmates rated healthcare as poor. Inmates surveyed at several other
prison reported similar problems.16
The Department’s Quality Assessment Tools Manual contains a clinician chart review tool,
issued in October 2007, to evaluate the documentation of clinic encounters with primary care
providers. This tool could be an important component in monitoring the performance of DOCS
providers by focusing on the adequacy of the notations made in the patient’s chart and by
assessing whether the primary care provider has reviewed laboratory results and other tests,
documented continuity between the provider and the specialists and documented follow-up to
any previous plan of care. No results from the use of this tool were available for CA review, but
15

At Fishkill, inmates had mixed reviews of healthcare depending on which provider they were seeing. The
recently hired FHSD was praised as attentive and helpful, medical screening had become more comprehensive, and
medical grievances had declined.
16
At Clinton, inmates complained that some providers were dismissive or disrespectful during medical encounters,
but they praised the new PA and the care she provided. At Gowanda, where there was a long-term physician
vacancy, inmates reported delays in access to care. At Upstate, a majority of disciplinary inmates reported frequent
delays in access to a physician; two-thirds rated the doctors as poor, and not one inmate rated healthcare as good. At
Wyoming, almost 50% of survey participants rated physician care as poor, and only 9% assessed it as good. At
Albion, about half the female inmates surveyed reported that it can take one month or more to be seen by a provider.

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

this instrument could substantially enhance the Department’s effort to monitor the quality of
clinic encounters. Beyond this, additional efforts are needed to ensure that clinicians are
adequately responding to patients’ medical concerns and are conducting these encounters in a
respectful and sensitive manner.
Serious medical consequences can occur when prison providers do not see inmates in a timely
manner, do not respond appropriately to medical complaints, or fail to manage complex medical
cases. Inadequate clinic care can result in problems with specialty care, since prison clinicians
are responsible for referring inmates with serious conditions to a specialist and for following up
on specialists’ recommendations when the patient returns to prison. A review of CORC
grievance reports concerning inadequate treatment (see Exhibit C) reveals higher rates of such
grievances at Auburn, Clinton, Great Meadow and Upstate—the same prisons where the CA
noted significant complaints about medical care.
CHRONIC DISEASES: HIV, HEPATITIS C AND OTHER ILLNESSES
New York State inmates suffer from high rates of chronic diseases, and a significant portion of
DOCS’s healthcare system is devoted to providing medical services for them. Recent data on
HIV and hepatitis C (HCV) infection rates released by the New York State Department of
Health, along with DOCS’s estimates, indicate that approximately 4,000 DOCS inmates are
HIV-infected and 8,400 inmates are infected with HCV.
Recent Improvements in Healthcare Systems and Chronic Care
DOCS’s Division of Health Services (DHS) has promulgated separate Practice Guidelines for
HIV and HCV treatment that provide instructions to prison staff concerning accepted protocols
for examining and treating patients with these diseases and documentation that prison medical
staff are expected to complete during treatment. The CA commends DHS for developing these
guidelines along with routine amendments to attempt to keep DOCS’s practices consistent with
community standards of care. The challenge is to ensure that prison practices conform to these
standards. Some prisons are apparently doing an effective job, while others are falling short.
The Department has made progress over the last few years in the diagnosis and treatment of HIV
and HCV. HIV care has improved with the development of new antiretroviral medications that
are readily available in all state prisons; as a result, fewer inmates are dying from AIDS. DHS
has adopted a policy that HIV-infected inmates experiencing problems on their current regimen
must be evaluated by an HIV specialist. Most importantly, DHS has now fully implemented an
HIV quality improvement program to better monitor HIV care in the prisons.
More inmates infected with hepatitis C receive medications than did a few years ago, and it
appears that many patients are responding well to treatment. DHS expanded the population that
can qualify for HCV treatment by no longer requiring inmates to enroll in a substance abuse
treatment program before initiating HCV treatment and by implementing a program to develop
discharge treatment plans for inmates who will be released to the community before their
treatment is completed. DHS also expanded its quality improvement activities concerning other
chronic diseases and is developing more comprehensive instruments to assess prisons’

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

compliance with the hepatitis C Treatment Practice Guidelines. These steps have resulted in
improvements in care and better monitoring of prison operations.
Problems in Identification and Treatment of Inmates with HIV and/or HCV
There is still more that must be accomplished to consistently meet community standards of care
for all inmates with HIV and/or HCV. Persistent problems include the following: (1) the
Department has not been successful in identifying a significant portion of inmates with these
chronic diseases; (2) not all prisons are implementing policies requiring access to expert care for
those identified as having a chronic disease; and (3) not all prisons are aggressively treating their
HIV- or HCV-infected populations.
The CA obtained data during each prison visit about the number of inmates infected with HIV
and HCV in the prison, as well as the number of patients with these illnesses on active treatment.
Table 5 (page 32) lists this information. More recent system-wide data from the Department on
the number of HIV- and HCV-infected inmates at every prison, along with data for FY 2006-07
detailing specialty care services accessed by DOCS inmates, were evaluated and are reported in
Exhibit D and Exhibit E for male prisons. Comparable data for the female prisons are
presented in Exhibit G and Exhibit H. Both at the time of CA visits and into 2007, there were
greatly varying levels of disease identification and treatment, particularly for HCV.
HIV Infection in the Male and Female Prison Populations
Since 1988 (and approximately every two years thereafter), the Department of Health (DOH) has
tested a sample of inmates newly admitted to DOCS custody to determine the number of HIVinfected inmates.
The most recent DOH data available from tests in 2005 show that the rate of HIV infection for
newly admitted male inmates was 4.0%, a slight decrease from the 2003 rate. Based upon these
data and previous DOH studies, the estimated current male HIV population is approximately
3,700 inmates, representing an overall male HIV infection rate of approximately 6.1%.
The HIV infection rate for women is twice the rate for the men. The 2005 DOH study of newly
admitted female inmates found an HIV infection rate of 10.6%, a small decrease compared to
2003. Based on DOH’s studies, an estimated 12% of female inmates (approximately 340
women) are HIV-infected. At an AIDS Institute Conference in October 2007, DOCS officials
stated that the system housed approximately 4,000 HIV-infected male and female inmates, an
estimate consistent with CA’s projections.
The HIV infection rate in state prisons has consistently decreased in the last 20 years, although
the rate of decline for men has slowed during the past few years. The DOH studies of newly
admitted DOCS inmates illustrate these declines. In 1992, 11.5% of newly admitted men and
20.3% of the women were HIV-infected, rates that declined to 4.7% for men and 13.9% for
women admitted in 2000-01 and to 4% for men and 10.6% for women admitted in 2005.
However, these figures do not represent the actual HIV infection rate in the prisons because
DOH tests only a sample of the nearly 27,000 newly admitted inmates and not the entire prison

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

Table 5 - HIV and Hepatitis C in CA Visited Prisons in 2004-07
Prison

%
HIV
HIV on % HIV+ HCV
positive HIV + Treatment on Tx Positive

%
HCV on
Treatment HCV+

Visit
Date

Pop
2005

Albion

12/1/2005

1,184

66

5.57%

36

54.55%

171

1

14.44%

Arthur Kill

12/19/2005

947

34

3.59%

27

79.41%

70

8

7.39%

Attica

3/17/2005

2,181

100

4.59%

Auburn

7/19/2005

1,765

56

3.17%

28

50.00%

53

6

3.00%

Bedford Hills

7/15/2005

792

56

7.07%

50

89.29%

43

4

5.43%

Clinton

12/14/2004

2,843

300

10.55%

142

12

4.99%

Coxsackie

9/30/2004

1,033

20

1.94%

12

60.00%

60

6

5.81%

Eastern

5/25/2005

1,168

34

2.91%

31

91.18%

30

7

2.57%

Elmira

5/4/2005

1,782

24

1.35%

Fishkill

2/15/2005

1,719

100

5.82%

70

70.00%

100

17

5.82%

Gowanda

6/28/2005

1,746

34

1.95%

16

47.06%

57

3

3.26%

Great Meadow

6/20/2006

1,642

65

3.96%

45

69.23%

350

2

21.32%

Green Haven

5/24/2006

2,145

67

3.12%

44

65.67%

232

11

10.82%

Mid-Orange

10/19/2004

727

40

5.50%

Oneida

3/8/2007

1,199

32

2.67%

27

84.38%

99

4

8.26%

Sing Sing

12/2/2005

1,744

56

3.21%

34

60.71%

94

19

5.39%

Sullivan

7/20/2006

718

23

3.20%

23

100.00%

53

10

7.38%

Upstate

12/13/2004

1,251

29

2.32%

20

68.97%

46

4

3.68%

Wyoming

5/21/2007

1,672

34

2.03%

26

76.47%

114

7

6.82%

1,714

142

TOTALS

28,258

1,170 4.14%

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6

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7

489

System Overview

Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

population, and the DOH samples from intake prisons do not mirror the actual prison
population.17 Still, based upon the 2003 DOH data, DOCS estimated that as of year-end 2005,
there were approximately 4,440 HIV-infected inmates in its system (4,040 male and 400
female).18 DOCS’s latest estimate (2007) represents a 10% decline in the infection rate during
the last two years.
Despite the slow decline in the HIV infection rate, with more than 4,000 DOCS inmates HIVinfected, New York prisons still remain the epicenter of this disease for the U.S. prison system,
representing 20% of all HIV state prisoners in the country as of year-end 2006.19 DOCS is also
the largest provider of HIV services in New York State.
Identification of HIV-Infected Male Inmates
Although the number of HIV-infected male inmates has declined, most prisons have identified
less than one-half of their estimated HIV-infected population. Documents provided by DOCS in
2007 indicate that the Department is aware of approximately 1,550 male HIV-infected inmates.20
This number means that only 2.5% of the male inmate population is known to be HIV-infected.
Thus, DOCS has identified only 42% of the estimated HIV-infected male inmates in the system.
Exhibit D provides a summary for each male prison of the number of: (a) inmates at the prison;
(b) HIV-infected inmates as identified in DOCS’s computerized medical problems list (recorded
in a document from a January 2007 DHS Continuous Quality Improvement Meeting); and (c)
infectious disease appointments for FY 2006-07. Based upon these figures, the CA has
computed for each prison: the HIV infection rate, rates of infectious disease (IFD) appointments
for all inmates in each prison, and rate of IFD appointments for those with HIV. 21 These data
demonstrate that the prisons vary greatly in the percentage of identified HIV-infected inmates
and the number of annual IFD appointments per HIV-infected inmate.
The number and rate of male inmates known by DOCS to be infected with HIV vary greatly
among hubs and among prisons within the hubs. The Attica hub had the lowest rate of known
HIV-positive inmates (2.0%), followed by the Great Meadow Hub (2.32%) and the Sullivan Hub
17

The DOH protocol for testing newly admitted inmates seeks approximately equal number of samples from each
of the male reception centers. However, the actual admission rates are lower at reception centers in the western
region of the state where the HCV and HIV infection rates are lower than among inmates entering the eastern
reception centers. The CA analysis has attempted to adjust for these differences in the estimates of HIV and HCV
rates for the current DOCS population. In addition, the entire prison population contains inmates admitted in the
earlier years when there was a higher HIV infection rate. DOCS has developed a model to account for these
differences in computing estimated HIV infection rates. Our estimate is based upon the current inmate population
and the HIV infection rates that existed at the time inmates were incarcerated.
18
Maruschak, L., HIV in Prisons, 2005, U.S. Department of Justice, Bureau of Justice Statistics, 10 (2007). This
estimate is based upon a New York State Department of Health study of newly admitted inmates to DOCS custody
performed in 2003.
19
Maruschak, L., HIV in Prisons, 2006, U.S. Department of Justice, Bureau of Justice Statistics, Table 1 (April
2008). This recently released report states that New York’s prison HIV population is 4,000 as of year-end 2006.
20
Data provided from a January 2007 Quality Improvement Meeting contained a chart listing 1,514 male inmates
and 163 female inmates as HIV-infected. Another document from May 2007 stated that 1,739 DOCS inmates,
including women, had a medical problem indicating they were infected with HIV; given the January 2007 figure for
female HIV-infected inmates, the May 2007 data would indicate about 1,575 male inmates were HIV infected.
21
Although infectious disease consultations are used both for patients who are HIV-infected and those who are not,
the bulk of these appointments are used for patients with HIV.

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System Overview

Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

(2.35%). The highest rates of identified HIV-infected inmates were in the Watertown Hub
(3.05%), New York City Hub (3.02%) and Oneida Hub (2.98%). These latter hubs have a rate of
identified HIV-infected men almost 40% higher than that of the three hubs with the lowest rates.
Since it does not appear that DOCS is concentrating HIV-infected inmates in any particular
locations or hubs, these variations suggest that several hubs have problems identifying inmates
with HIV infection.
More importantly, there are significant differences in the ability of various prisons to identify
their HIV-infected populations. Focusing on 43 maximum and medium security prisons that are
classified as capable of providing the highest level of medical care (medical class one prisons),
ten prisons distributed among seven different hubs had an identified HIV infection rate over
3.0%, and eight prisons in four hubs had a known HIV infection rate below 2.0%.22
These differences are substantial, representing rates of identified HIV cases in some “higher
rate” facilities that are two to three times greater than those in some “lower rate” prisons. The
prisons with high and low rates are scattered throughout the Department; none are facilities with
specialized units that would either draw or exclude HIV-infected inmates. Therefore, it would
appear that action or inaction by prison medical staff or others is having an effect on each
prison’s ability to identify HIV-infected inmates. DOCS’s Division of Health Services officials
should review the number of HIV-infected inmates at each prison to determine how facilities
with low HIV rates can take steps both to encourage inmates to be tested and to persuade inmates
who know they are HIV-positive to come forward and seek treatment.
The information on the number of known HIV-infected inmates gathered during the CA visits
(Table 5) generally was similar to the 2007 data from DOCS’s Division of Health Services
(Exhibit D), although the figures from visits were slightly higher than those from DHS. One
notable exception to this congruency was the HIV-infection figure for Clinton; in this case, the
CA figures greatly exceeded the DHS data. In 2004, during a CA visit to Clinton, the FHSD
estimated that there were 300 HIV-infected inmates in the prison; however, the 2007 DHS data
indicated only 60 HIV-infected Clinton inmates. It is doubtful that the known HIV-infected
population at Clinton could have declined so drastically during this period; the prison may be
aware of more inmates with HIV than it is reporting to DHS officials and/or the FHSD may have
overestimated the prison’s HIV-positive population. Smaller discrepancies at two other prisons
may also be due to inaccurate estimates by prison officials.23

22

Prisons with low HIV infection rates included: Otisville (1.3%), Livingston (1.5%), Eastern (1.6%), Wyoming
(1.7%), Elmira (1.7%) and Five Points (1.8%). Prisons that have been much more successful in identifying HIVpositive inmates included Mid-State (4.5%), Ogdensburg (4.5%), Southport (3.9%), Mt. McGregor (3.8%), Franklin
(3.6%), Sullivan (3.5%), Auburn (3.2%), Bare Hill (3.2%), Sing Sing (3.2%) and Watertown (3.1%).
23
There are differences between figures received during visits to Fishkill and Attica and the 2007 data. During the
2005 Fishkill visit, medical staff said there were approximately 100 HIV-infected inmates in the prison, whereas the
2007 DHS data indicate only 42 known HIV-infected inmates. During a 2005 CA visit, Attica medical staff
estimated that the prison had about 100 HIV-infected inmates, whereas the 2007 DHS data indicate 64 known HIVinfected inmates there in 2007. The 2005 Attica and Fishkill figures were oral statements by staff without reference
to Department records. The differences between the 2005 numbers and the 2007 data probably reflect rough
estimates by staff and not a change in the number of identified HIV-infected inmates at these facilities.

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System Overview

Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

It is important that DHS has an accurate picture of the disease burden within its prisons so that it
can appropriately allocate resources and estimate funding needs. DHS should investigate the
potential discrepancies between its data and prison reports to determine whether prison medical
personnel are aware of a greater number of HIV-infected inmates than are reflected in DHS
records. Better reporting may be necessary to gauge the true HIV case rate in each prison.
Regardless of the estimates used, it is clear that approximately half or more of the inmates who
are HIV-infected in the prison population either do not know their HIV status or are reluctant to
disclose it to DOCS. The Department has not successfully persuaded all inmates at risk for HIV
to be tested or to convince those who know their status to seek treatment.
Identification of HIV-Infected Female Inmates
Currently, there are approximately 340 HIV-infected women in custody, representing 12% of the
female population. Based upon the earlier DOH studies of newly admitted women from 2000
and 2003, DOCS estimated as of year-end 2005 that 14.2% of the female inmates were HIVinfected. At Bedford Hills and Albion, which house approximately 70% of the entire female
prison population, prison staff informed the CA during visits in 2005 that they had identified 122
HIV-infected inmates of the total prison population of 1,976. (See Table 5.) This figure
represents an infection rate of 6.17%, or only 43% of the 2005 estimated HIV-infected female
population.
Exhibit G contains a summary of more recent DHS data on HIV infection and infectious disease
specialist access for all female facilities. These data indicate that only 6.0% of the female
population is known to be HIV-positive,24 half the total estimated to be infected. Greater efforts
must be made to encourage women at risk for HIV to get tested and begin treatment while
incarcerated.
HIV Testing of DOCS Inmates
In order to increase the number of identified HIV-infected inmates, more inmates must agree to
be tested. There are several ways to initiate testing. Inmates can request a test by DOCS
medical staff or the medical staff can request HIV testing if they believe a patient is at risk for
the disease. Inmates can seek testing from outside contractors who provide services to the prison
through the AIDS Institute’s Criminal Justice Initiative (CJI), or they can be tested by staff
working for the State Department of Health, Bureau of Direct Program Operations, who visit
several prisons and perform HIV testing. These latter two groups conduct anonymous testing,
enabling inmates to receive their HIV test results but make their own determination as to whether
or not to disclose their HIV status to DOCS. HIV-infected inmates identified through these
outside sources are encouraged to inform DOCS of their status, but are not required to do so.
As Table 6 (page 36) illustrates, the CJI contractors and DOH officials perform many HIV tests
on inmates, but identify very few HIV-infected inmates.

24

The DHS data did not indicate the number of women at Lakeview or Willard who are HIV-infected, since these
institutions confine both men and women. Therefore, in computing the rate of identified HIV-infected women, the
CA also excluded these facilities.

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System Overview

Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

TABLE 6 - SUMMARY OF HIV TESTING BY CJI CONTRACTORS AND DOH STAFF

Dates
# HIV Tested
# HIV Positive
% HIV +

CJI Contractors
Jan – Dec 2006 Jan – June 2007
3,487
1,651
9
4
0.26%
0.24%

DOH Bureau of Direct Program
Jan – Dec 2006 Jan – June 2007
4,787
2,404
20
6
0.42%
0.25%

These results are discouraging; they indicate that of the estimated 2,000 inmates who are HIV
infected but unknown to DOCS, the outside agencies identified only 30 HIV-infected inmates in
2006 and only 10 in the first half of 2007. In other words, DOH and the CJI contractors were
able to newly identify only 1.5% of the pool of unknown HIV-infected inmates. These testing
programs are making genuine efforts to reach the infected population, but have not been
successful in convincing those most at risk to come forward and be tested. Rather, it appears that
inmates who are at low risk for HIV infection and soon to be released from prison utilize these
services to confirm that they will not expose their families to the disease when they return home.
Although testing is certainly advisable for soon-to-be-released inmates, DOH and CJI efforts
should focus on reaching higher-risk inmates.
Along with the programs mentioned above, DOCS offers HIV testing as well. In 2002, DOCS
conducted 4,444 tests, of which 2.1% were HIV positive. Given that some of these tests were
requested by medical staff who suspected the patient might be HIV-infected, it is not surprising
that DOCS testing would result in a higher rate of infected inmates. Yet even at this higher rate,
DOCS was only able to identify 92 HIV-infected patients in 2002. In 2003, DOCS tested
approximately 5,000 inmates. It appears that since 2003, HIV testing by DOCS has continued at
nearly the same rate.
During the last six years, the total annual number of HIV tests of DOCS inmates by the
Department, DOH and CJI contractors processed by the state laboratory has ranged from 14,000
in 2001 and 2002 to slightly less than 12,000 in 2006. Although there has been a slight decrease
in the number of HIV tests performed in state prisons, testing in the county jails during this
period increased by nearly 3,000, suggesting that the overall testing rate for inmates in the state
system has remained nearly constant.
Many inmates coming into DOCS already know their HIV status or have been tested at some
point prior to their incarceration in state custody. At a 2007 AIDS Institute conference on
infectious diseases in the prisons, DOH officials disclosed that 80% of all newly admitted
inmates tested in its 2005 prison study had previously been tested for HIV. However, a prior
negative HIV test does not mean that the inmate is still negative at intake or thereafter. During
DOH’s 2000-01 prison study of newly admitted inmates, investigators obtained a detailed survey
of participants. The study found that of 260 inmates identified as HIV-infected, 95% reported
having had a previous HIV test. However, 18.5% of those previously tested reported that they
were HIV-negative at their last test. These data demonstrate that many inmates are aware of
their risk, but some are unwilling or unable to curtail their risk behaviors. But few of the
inmates found to be HIV-infected during this study were newly infected; less than 4% of HIV-

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System Overview

Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

infected inmates in the 2000-01 DOH study had been infected in the six months prior to
incarceration.
Assessment of these testing programs leads to the conclusion that current practices are
ineffective in identifying cases of HIV among inmates. This failure is not due to a lack of testing
options, but to an inability to convince inmates at risk that they should seek testing. More
extensive HIV education, peer counseling and outreach to the at-risk population are needed to
motivate inmates to seek information about the disease and learn their HIV status.
For inmates who already know their HIV status, a primary obstacle to accessing appropriate HIV
care is reticence about disclosing their infection to prison medical staff. Skepticism about the
quality of prison healthcare and concerns about confidentiality appear to be the main reasons
HIV-infected inmates refuse to disclose their status. To reach these inmates, more peer
educators are needed to educate inmates about effective treatment. Prison medical staff must
also demonstrate that they can provide timely and effective care to inmates with chronic
diseases, which at some prisons will be a challenging task given the many grievances about
healthcare. Consequently, to encourage at-risk inmates to seek care, some prisons will have to
substantially improve their medical services.
Access to Infectious Disease (IFD) Specialists
There is reason for concern about the quality of the care offered to known HIV-positive inmates
at some prisons. Although the CA does not have access to inmates’ medical records, and
therefore cannot assess whether individual inmates receive appropriate HIV care, it is known that
DOCS has not implemented a system to ensure delivery of effective care to every inmate with a
chronic disease at all prisons. Recent actions by DHS, detailed below, indicate that DOCS has
taken steps to improve its monitoring of prison healthcare and has undertaken positive measures
to monitor HIV care. But it is not yet known whether these monitoring activities will lead to
improvements in care.
Of greatest concern is whether HIV-infected inmates receive timely access to infectious disease
specialists required to manage the complex care needed to control HIV. National and DOCS
policies require that patients who are not adequately suppressing their HIV infection with
combination drug therapy should be evaluated by an HIV specialist to determine the appropriate
treatment regimen. It does not appear that all prisons follow this practice.
Access to IFD Specialists at Male Prisons
The CA analyzed data on access to infectious disease specialists for each prison for FY 2006-07.
Exhibit D contains a summary of the number of IFD appointments completed at each male
prison during that fiscal year, indicating greatly varying rates of IFD appointments compared to
the total inmate population and the HIV-infected population.
There is significant variation in the use of IFD specialists among the hubs. The IFD utilization
rate in the Green Haven Hub is more than three times the system-wide average, and the New
York City Hub’s rate is twice the system-wide average. In contrast, the Watertown Hub, with

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

one of the highest rates of identified HIV-infected inmates,25 has a utilization rate only one-tenth
the system-wide rate. Other hubs with low IFD specialist utilization rates are Oneida, Wende
and Elmira. The utilization rate in the remaining five hubs is nearly four times the rate in these
three hubs. There is no known justification for such a discrepancy in access to HIV experts.
There is also significant variation in the use of IFD specialists among the prisons, even those
within the same hub. In 10 male prisons distributed in five of the nine hubs and containing
almost 10% of the HIV-infected male population, HIV-infected inmates have regular access to
HIV specialists.26 In these prisons, there are many more IFD appointments than HIV-infected
inmates, resulting in utilization rates that are ten times the rate of access to HIV specialists in
prisons infrequently using IFD specialists.
In contrast, there are 14 medical class one prisons in seven of the nine hubs that have very low
utilization rates of outside IFD specialists.27 These prisons contain more than 10% of all HIVinfected men in the system, and none of these prisons has a certified HIV specialist on staff.
Most of these prisons have fewer infectious disease appointments in a year than the number of
HIV-infected inmates at the prison.
Although it is not known whether inmates at prisons with low IFD utilization rates received
inadequate care, it is likely that some patients did not have appropriate monitoring of their
condition by a provider with sufficient expertise to determine whether the patient is on the most
effective HIV regimen.
Low IFD utilization rates cannot be attributed to less demand for services. The rate of identified
HIV-infected inmates in the low utilization prisons (2.4%) is nearly identical to the rate in the
high use prisons (2.5%). There is nothing about the patients in these prisons that would justify
such a discrepancy in access to HIV experts. Several high utilization prisons are in the southern
region of the state, where it may be easier to identify IFD specialists willing to treat HIVinfected inmates, but some prisons providing frequent access to HIV specialists are in the same
hubs in which low utilization prisons are also located.
DHS officials should investigate the differences in IFD service utilization for the male prisons to
determine whether appropriate access to HIV experts is consistently provided to HIV-infected
men throughout the Department.

25

It could be that some prison providers in the Watertown Hub are experienced with HIV care, and one provider at
Riverview is qualified as an HIV specialist. However, it is important to note that other hubs with high utilization
rates also have prison staff members who are HIV specialists, and it is unlikely that the Watertown physician could
provide the bulk of HIV care for the entire hub. Consequently, there is nothing about the medical staff in the
Watertown Hub that would justify the extreme low utilization of infectious disease specialists.
26
The prisons with the highest rates of access to an infectious disease specialist include: Adirondack and Clinton in
the Clinton Hub; Eastern, Mid-Orange and Woodbourne in the Sullivan Hub; Fishkill and Green Haven in the Green
Haven Hub; Coxsackie and Washington in the Great Meadow Hub; and Sing Sing in the Sing Sing Hub.
27
The low IFD-use prisons are Marcy in the Oneida Hub; Cape Vincent, Gouverneur, Ogdensburg and Watertown
in the Watertown Hub; Franklin in the Clinton Hub; Otisville in the Sullivan Hub; Great Meadow in the Great
Meadow Hub; Groveland, Livingston and Wyoming in the Wende Hub; and Elmira, Five Points and Southport in
the Elmira Hub.

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

Access to IFD Specialists at Female Prisons
Although women have a higher rate of access to infectious disease specialists in the prisons than
men, there are significant variations in the use of IFD specialists among the female facilities.
Exhibit G summarizes the number and rate of infectious disease consultations for women during
FY 2005-06 and FY 2006-07. It illustrates questionable variations in IFD utilization during both
time spans.
Albion had only eight IFD appointments in FY 2006-07. Although one of Albion’s providers is
certified as an HIV specialist and is therefore less likely to make referrals to an outside IFD
consultant, Albion had 129 IFD appointments in FY 2005-06 while the same HIV specialist
physician was on staff. It seems that the change in IFD utilization occurred because the outside
infectious disease specialist who provided consultations for the Albion HIV-infected population
in FY 2005-06 retired prior to or early in FY 2006-07. Access to infectious disease specialists
should be determined by the needs of the patients, not the availability of a specialist. At
Bayview, there were only seven IFD appointments in FY 2005-06, whereas during the next fiscal
year, there were 39. It is of concern that there was such a significant change from one year to the
next. In contrast to Albion and Bayview, Bedford Hills had 636 and 537 IFD appointments in
the last two fiscal years, an IFD utilization rate eight to ten times greater than that of the other
prisons.
Department officials should explore why there has been such variation in IFD utilization among
the female prisons and determine whether each female prison is providing sufficient specialty
resources for its HIV-infected population.
DOCS HIV Specialists
In assessing the need for expert assistance in caring for HIV-infected patients, it is important not
to limit the analysis to only considering access to outside IFD specialists. DOCS has developed
a policy stating that it will certify a DOCS physician, nurse practitioner or physician assistant as
an HIV specialist if the provider has completed sufficient training, has experience treating HIVinfected patients and participates in a continuing medical education program.
As of June 2007, according to DOCS records, there were 17 DOCS providers certified as HIV
specialists of the 150 DOCS providers. Exhibit D indicates the prisons where these providers
are employed and the number of HIV specialists on each prison staff. At many prisons with HIV
specialists, a somewhat greater percentage of the population has been identified as HIV-infected.
It appears that some of the staff HIV specialists are managing the care of inmates with HIV
without much outside assistance; consequently, at these facilities there are very few IFD
appointments.28
For example, Mid-State, which has 68 identified HIV-infected inmates and the highest HIV rate
in the state, had only two IFD appointments in FY 2006-07. One of Mid-State’s providers is a
Nurse Practitioner who is certified as an HIV specialist. It is notable that Mid-State seems more
28

It should be noted that none of the prisons with a staff HIV specialist were included in the analysis of prisons
with low IFD utilization described on page 34.

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The Correctional Association of New York

effective than other prisons at identifying its HIV population, and CA commends the prison for
having a certified HIV specialist on staff.
However, even with a staff HIV specialist, a prison could still benefit from the assistance of an
infectious disease specialist. In fact, several prisons, including Eastern, Coxsackie, Hudson and
Upstate, have HIV specialists on staff but still used infectious disease specialists at rates
substantially higher than the system-wide average.
The CA commends the Department for encouraging its medical staff to develop expertise in the
treatment of HIV and supports DOCS’s certification program for staff HIV specialists.
However, some patients managed by these prison HIV specialists probably would still require
consultation with an outside infectious disease specialist in certain situations, particularly when a
patient is failing on a particular medication regimen. DHS officials should monitor the care
provided by its HIV specialists to ensure it is comparable to that available in the community.
Treatment of HIV-Infected Inmates
During prison visits, the CA obtained data on the number of HIV-infected inmates who were on
therapy. This information is summarized in Table 5 (page 32).29
Several observations can be made concerning the 13 male prisons for which the CA has
treatment data. The percentage of HIV-infected inmates on treatment varied significantly from
47% at Gowanda to 100% at Sullivan. Most prisons had 60-80% of their HIV-infected inmates
on therapy. The situation at Gowanda is problematic; the prison was treating less than half of its
known HIV-infected population, even though it had identified significantly fewer inmates with
HIV than the system-wide average. Gowanda’s HIV rate is below 2%, whereas the average rate
of known HIV-infected inmates at the visited prisons was more than 3.2%, almost 40% higher.30
Gowanda also had lower rates of access to IFD specialists, and there is concern that it may not
aggressively evaluate its population for HIV treatment.
There are also questions about the adequacy of care provided to female inmates known to have
HIV. Treatment data for HIV-infected women at Albion and Bedford, presented in Table 5, was
somewhat discouraging. There were only 86 women on HIV medication, representing about
one-third of the estimated HIV-infected population. Bedford Hills had substantially more of its
known HIV-infected inmates on treatment (89%) compared to Albion (55%). As previously
noted, Albion refers far fewer of its HIV-infected inmates to an IFD specialist; there is concern
that Albion may not aggressively pursue treatment for its HIV-infected population.
DOH AIDS Institute’s Criminal Justice Initiative
In addition to offering the testing services discussed above, the DOH AIDS Institute’s Criminal
Justice Initiative contracts with 15 agencies throughout the state that provide the following
services system-wide to HIV-infected inmates: (1) HIV prevention education; (2) HIV training
29

The CA did not receive any system-wide data concerning the number of inmates on HIV therapy and therefore
cannot compare the treatment rates at the visited prisons to other facilities.
30
The male HIV-infection rate at the visited prisons (3.2%) is computed from the data contained in Table 5, but
data from Clinton was excluded since, as noted on page 31, data provided during the visit on the number of HIVinfected at Clinton was significantly different from the figure provided by DHS.

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

of peer educators; (3) HIV counseling and testing; (4) HIV support services; and (5) HIV/AIDS
transitional planning. Table 7 contains a summary of the services provided by the CJI
contractors during the period July 1, 2006 through June 30, 2007.
TABLE 7 – AIDS INSTITUTE’S CJI HIV PREVENTION SERVICES - 7/1/06-6/30/07
Activities
Outreach
Health Information/Public Info.
Individual Interventions
Group Interventions
Support Groups
Peer Educator Training
Transitional Services
Prison Hotline
Transitional CM

# of Agencies
12
12
8
8
8
12
9
1
2

# of Sessions
231
802
2,424
14,116
2,114
4,708
1,648
n/a
2,093

# of Participants
2,813
11,051
1,898
3,744
430
845
350
629
153

Table 8 summarizes the number of prisons receiving these important services as of September
2007.
TABLE 8 - PRISONS SERVED BY AIDS INSTITUTE’S CJI CONTRACTORS – 2007
Hub

# of
Prisons
in Hub
1
8
2
5
3
9
4
8
5
6
6
8
7
12
8
7
9
7
Total
70
% of Prisons
with Services

Prisons
with HIV
Prevention
7
5
9
7
6
6
11
4
6
61

Prisons
with Peer
Training
4
5
4
6
4
0
8
4
1
36

Prisons
with HIV
Testing
6
5
6
6
6
6
7
3
6
51

Prisons
with HIV
Support
4
5
5
0
1
2
8
3
1
29

Prisons with
Transitional
Planning
7
5
9
7
4
6
10
3
7
58

87%

51%

73%

41%

83%

The CA strongly endorses the use of outside contractors to provide support services to the HIVinfected inmate population. Table 8 demonstrates that HIV prevention education, transitional
services and testing exist at most prisons. Peer training, however, is in only half the prisons, and
HIV support activities exist in only 41% of the facilities. These are also important services. The
CA recommends that the state authorize sufficient funding to permit all five services at each
maximum and medium security prison and appropriate prevention education, HIV testing and

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

transitional planning at every minimum security prison from which many inmates return to their
communities.
It is important to note that the services provided at each prison vary greatly in frequency. At
some prisons, the CJI contractor is present one or more days a week, enabling frequent and
intense interactions with the HIV-infected population and more opportunity for general
education programs for inmates and staff. At other facilities the contractor provides services
only one or two days a month.
Support programs. HIV support programs are needed in many male prisons, and current CJI
initiatives are not sufficient to reach many of the infected patients. These programs, however,
must be conducted in a manner that will preserve confidentiality. There is still significant stigma
associated with HIV, and many HIV-infected inmates are reluctant to participate in an activity
that will reveal their status to staff and inmates who are not enrolled in the program.
Officials must take creative measures to provide support to HIV-infected inmates without
placing them at risk of public disclosure. While some CJI contractors have made significant
efforts to protect their clients’ status, DOCS officials and CJI contractors must consult with
inmates in designing programs that provide services in a setting that affords appropriate
confidentiality.
Peer educators. Although the CJI providers conduct peer educator training, many prisons do not
fully utilize these peer educators to encourage inmates to seek testing and care. Peer educators
must have access to the inmate population in formal and informal forums and locations, with
HIV education integrated into all prison activities. Some inmates may not attend a voluntary
educational session focused on HIV education and testing because it may lead others to assume
that the attendee is infected. Consequently, HIV education must occur frequently in routine
prison activities that most inmates attend and that are not focused solely on HIV.
One-on-one discussions in the yard or at other activities are often the most effective means to
reach individuals who are at risk. In contrast to current practice at some prisons, peer educators
must have access to these areas and be authorized to conduct such discussions without violating
prison rules. Also, the timeframes in which HIV education is offered affect whether inmates will
act upon the information they receive. HIV education is often provided when an inmate first
enters the system, is transferred to a new facility or is about to be released. Although these
sessions are useful, these time periods are often stressful for the inmate and not conducive to
follow-up requests for testing. It is best for the system to provide HIV information to inmates
and to encourage them to seek HIV testing and care once they are established at a prison, but still
early in their sentence.
Additional funding is essential to implement a peer-training program in the 50% of prisons that
currently do not have it. The Memorandum of Understanding between DOCS and DOH should
include a requirement that DOCS appropriately utilize the services of peer educators. Moreover,
the state should allocate additional funds to permit DOCS to pay peer educators for their
services.

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

Transitional planning. Resources for transitional planning at some prisons may not be adequate
to perform the multiple tasks needed to develop a comprehensive plan for all HIV-infected
inmates leaving the facility. Approximately 40% of the known HIV-infected population is
discharged each year, totaling about 620 inmates. Table 7 indicates that only 350 inmates were
involved in transitional planning with CJI contractors during the period July 2006 through June
2007. It is likely that many of these inmates were not able to complete their discharge plans,
given the limited availability of CJI providers at their prisons and delays in referring HIVinfected inmates to the discharge planners.
CJI discharge planners need additional resources to provide these services. The system should
give contractors access to every identified HIV-infected inmate in sufficient time to prepare a
comprehensive discharge plan prior to the inmate’s release. To assist in that process, DOCS,
DOH and Parole should enter into a memorandum of understanding that will clearly indicate
each agency’s obligation in the discharge planning process and ensure that CJI contractors have
full and timely access to all necessary information and records.
Inmate-Led HIV Support and Education Programs
For many years, certain facilities have had inmate-run HIV support and education programs,
such as the AIDS Counseling and Education (ACE) program at Bedford Hills and the Prisoners
for AIDS Counseling and Education (PACE) programs at several male prisons.31 These
programs run support groups for HIV-infected inmates and provide HIV education for the
general prison population. The CA commends the Department for supporting these programs
and, more importantly, the inmates who run them. Although the inmate staff of these programs
are not necessarily HIV-infected, the programs provide a location for participants to interact with
inmates living with HIV who are role models and who help other HIV-infected inmates learn
about their illness and empower them to stay as healthy as possible despite the difficulties of
living with HIV. By providing positive examples of inmates who have been tested, disclosed
their HIV status and received medical treatment in prison, these programs benefit the entire
prison population, encouraging inmates at risk for HIV but unsure of their status to get tested and
seek treatment. The Department could do even more to use peer educators in this way. But HIV
support programs must also be sensitive to the privacy concerns of participants. Given the
barriers to real confidentiality in prison, DOCS officials must be creative in organizing support
activities that do not inadvertently breach patient confidentiality.
DOCS HIV Quality Improvement Program
For several years, the Department had been developing an assessment tool to monitor HIV care
in the prisons based upon DOH’s computer-based quality improvement (QI) program known as
HIVQUAL. Using the HIVQUAL tool as a model, in 2006 DOCS implemented a system-wide
HIV Continuing Quality Improvement (CQI) program, which requires that a sample of medical
records of HIV-infected inmates at each prison is reviewed by prison staff to assess whether the
prison is in compliance with 20 quality indicators that address: HIV testing; antiretroviral
therapy management; CD4 and HIV viral load measurements; access to HIV specialist care when
the patient is unstable or in end stage; routine screening for lipids, tuberculosis and syphilis, and

31

PACE programs exist at Eastern, Fishkill, Green Haven, Marcy, Mid-Orange, Otisville, Shawangunk, Sullivan,
Wallkill and Woodbourne.

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

Pap smears for women; prophylaxis care for opportunistic infections associated with HIV/AIDS;
Pneumovax vaccine; HCV screening; and Hepatitis A screening and vaccination.
The CA commends the Department for undertaking this program and believes that it will assist
DHS officials in monitoring the care provided in the prisons and in helping providers identify
barriers or problems delivering care consistent with community standards. As part of a
December 2006 settlement of federal class action litigation concerning HIV care in prisons, the
Department committed to performing these audits annually at each prison. Current DOCS
practice, however, goes beyond the settlement requirements. The DHS protocol is to review 10
medical charts or those from 25% of the prison’s known HIV population, whichever is higher,
each quarter year and provide feedback to the prisons based upon these assessments.
DOCS did not provide the results of its HIV CQI audits, so the CA cannot assess whether the
prisons are conforming to the DHS HIV Practice Guidelines. But, based upon a meeting agenda
of the DHS central office CQI Committee provided to the CA, it appears that results from the
prisons have been documented and reviewed by DHS central office personnel. There are
indications in the DHS CQI Committee minutes that some facilities have had difficulty
performing the audits, primarily due to inadequate staff. The CA urges DHS to evaluate whether
the state should enhance staffing allocations at these prisons to ensure that essential services are
being provided.
The CA also commends the DHS CQI Committee for focusing on HIV care, but is concerned
that the committee records very few references to: (1) the overall state of compliance by the
system; (2) whether specific prisons have difficulties in meeting all the audit indicators; and (3)
whether there are any systemic problems in providing HIV care. Although reference is made to
the process of feedback to the prisons and the possibility of prison-based action plans to correct
noncompliance, nothing is included in the DHS CQI Committee records that indicate whether
there are any specific problems with HIV care at any facility. In the HIV CQI program, a prison
is considered compliant if 70% of the medical charts meet the quality indicator. A prison must
develop an action plan to address a deficiency only if an indicator falls below this 70% threshold,
which is too low. DHS and its CQI Committee should set a more sensitive threshold for
developing an action plan, thereby encouraging prisons to implement systemic remedies to
frequently encountered problems and motivating them to improve services. The Department
should also substantially increase the threshold level for acceptable compliance to 80% for
several parameters. (See page 66 for further discussion of thresholds for audit indicators.)
Currently, chart reviews are performed by facility staff or by infection control nurses; however,
some facilities are having difficulties performing the reviews with existing prison staff. To make
assessments required by the audit and report the results, chart reviewers must have sufficient
expertise in assessing medical records to identify problems in care and to develop
recommendations for systematic improvements. Moreover, prisons should fully document any
corrective plans, and the Regional Medical Director should carefully review them.
Implementation must be monitored to determine whether actions taken have corrected
deficiencies. The CA did not receive any documentation verifying this process, although the
policy requires such measures. Finally, the new HIV CQI program should be integrated into the

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

monitoring and quality improvements activities of each prison. The CA will explore how the
CQI system is functioning during future visits.
Hepatitis C Care in DOCS
The Department has made significant efforts to enhance the process of identifying inmates with
hepatitis C (HCV) and to increase the number of HCV-infected inmates receiving treatment. In
addition, in response to increased access by patients in the community to HCV care, litigation on
behalf of HCV-infected inmates, and advocates’ and legislators’ concerns about barriers to HCV
treatment, the Department has changed its protocol for determining who should receive HCV
therapy and expanded the number of inmate-patients who are eligible for treatment. (See pages
47-48 for discussion of medical evaluation for HCV treatment.)
In the past, DHS required that an inmate have at least 15 months remaining on his/her sentence
before therapy could be approved so that the one-year treatment regimen could be completed
before release. DOCS removed this barrier in 2005 when DHS initiated a protocol for DOCS
providers to arrange for continuity of HCV care in the community for inmate-patients who were
receiving HCV therapy at the time of their release. Although, based on information obtained
during prison visits, it seemed that few HCV-inmates have participated in this continuity of care
program, the CA expects that the prisons will accelerate their use of this program now that AIDS
Institute personnel are actively supporting it. The CA commends DOCS for undertaking this
initiative and understands that to date 60 inmates have been enrolled in the program. The CA
urges DHS to reinforce with prison providers the option of starting qualified HCV-infected
inmates on treatment even if they are nearing release and to monitor whether the prisons are
aggressively recruiting these patients for therapy.
A second change in the HCV protocol occurred in 2007 when DHS eliminated the requirement
that HCV-infected inmates with a history of substance abuse at any time in their past had to be
enrolled in a substance abuse treatment program prior to initiating HCV therapy. DOCS
removed this requirement following a consent agreement with inmates who challenged this
restriction in a federal class action suit. The CA applauds DHS for making this change.
Although it is advisable for inmates with a history of substance abuse to receive substance abuse
treatment, care of their HCV infection should be pursued independently, especially considering
that it takes significant time to complete the HCV evaluation process and treatment regimen.
The CA urges the Department to do more to further expand the diagnostic and treatment services
for HCV. Many of the same concerns about the care of inmates with HIV pertain to those with
HCV: (1) identification of inmates who are HCV-infected; (2) timely and adequate treatment of
known HCV-infected inmates; (3) timely access to specialty services, particularly for
gastroenterologist appointments and liver biopsies; and (4) assistance to inmates in complying
with their HCV medication regimen and treatment of side effects.
Progress in Identifying More HCV-Infected Inmates
New York State Department of Health testing of newly admitted inmates to DOCS custody in
2000 and 2003 revealed that 13.6% and 13.3%, respectively, of male and 23% and 24%,
respectively, of female inmates were infected with HCV. In 2005, the infection rates declined,
and DOH reported that 10.4% of the men and 19.4% of the women were HCV-infected. Using a

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

weighted distribution of the infection rates from these three studies and making adjustments for
the difference between the study population and the current DOCS population,32 the CA
estimates the HCV infection rate at year-end 2006 was approximately 12.8% for men and 22.1%
for women. These estimates would mean that about 7,780 men and 640 women in DOCS
custody at the beginning of 2007 were HCV-infected.
HCV-infected people may or may not exhibit symptoms, develop chronic infection, progress to
liver disease, and/or require treatment. Careful medical monitoring and evaluation is needed to
determine the appropriate level of care. Several documents received from DOCS in 2007
summarize: (1) the number of inmates at each facility included on the DHS computerized
problem list as infected with HCV as of August 2006; (2) the number of DOCS inmates who
were determined to have HCV disease33; (3) the number of DOCS inmates on HCV therapy as of
January 2007; and (4) the number of appointments in FY 2006-07 for gastroenterology and liver
biopsies. Data for 2006-07 from these documents are listed in Exhibit E for the male prisons
and Exhibit H for the female facilities.
It is clear from these data that many HCV-infected inmates are not known to DOCS and that
only a small percentage of those infected is receiving treatment. An analysis of these data
demonstrates that DOCS is identifying about 70% of its HCV-infected population. Moreover,
the 5,884 male and female inmates identified in the August 2006 list are significantly more than
the 4,250 HCV-infected inmates reported by DOCS in 2003, representing an increase of almost
40% in three years. The CA commends the Department for its efforts to reach a greater
percentage of the HCV-infected population and notes that DOCS is having greater success
identifying HCV-infected inmates than those who are HIV-infected. However, 30% of those
infected with HCV are not being identified. Efforts should be made to reach them, and such
outreach should be sustained consistently by prison providers, since 27,000 to 28,000 inmates are
admitted to DOCS each year, representing more than 40% of the population. The Department
should screen all new inmates for HCV.
Table 5 (page 32) illustrates data received from 13 male prisons and 2 female prisons visited by
the CA from 2004 through 2007 concerning the number of inmates infected with HCV and those
receiving therapy. At the male prisons, only 6.1% of the population is known to be HCVpositive, less than half of the estimated HCV population. The percentage of the inmate
population identified as HCV-infected varies greatly, from low infection rates of 2% to 3% at
Auburn, Eastern, Gowanda and Upstate, to 6% to 10% at Arthur Kill, Green Haven, Oneida,
Sullivan and Wyoming. There is no apparent reason why some prisons should be able to identify
HCV-infected inmates at rates two to four times higher than others. The CA urges DHS to
investigate these discrepancies.

32

The DOH protocol seeks approximately equal number of samples from each of the male reception centers.
However, the actual admission rates are less at reception centers in the western region of the state where the HCV
infection rate is less than that for inmates entering the eastern reception centers. The CA attempted to adjust for
these differences in estimates of the HCV rate for the current DOCS population.
33
DOCS lists an inmate with HCV disease if the patient is chronically infected (i.e., based upon blood test it is
determined the patient currently has the HCV virus is his/her system). A patient with HCV disease may or may not
have any symptoms.

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

Several observations are apparent from examining the male HCV-infection rates in Table 5 and
Exhibit E. First, there is greater consistency in 2007 in the percentage of identified male HCVinfected inmates at each prison (Exhibit E) than was reported by the prisons during CA visits in
2004-06 (Table 5). Second, the 2007 HCV-infection rates are more uniform among prisons than
the more variable HIV rates shown in Exhibit D. There is no apparent reason why rates of
HCV and HIV should differ so significantly among prisons, particularly since the risk behaviors
for both infections are similar. Third, while hubs generally have an overall HCV infection rate
of 8% to 10%, a few facilities have lower than expected rates.
For example, in maximum and medium security prisons with a medical class one designation, the
highest medical classification, most prisons are within the 8-10% range with the exception of:
Upstate (6.9%), Eastern (6.5%), Greene (4.3%), Gowanda (6.6%), Lakeview (3.0%) and
Wyoming (6.1%). These prisons have rates that are 30-50% lower than the system-wide average
of 9.01%. There is no apparent reason why these facilities, other than Lakeview and Greene,34
should have rates of known HCV-infected inmates lower than those found elsewhere in the
Department. The CA urges DHS to investigate the practices at these prisons to determine if they
can implement measures to identify a greater percentage of HCV-infected inmates.
Exhibit H contains a summary of data received from DOCS in 2007 concerning the number of
women with HCV-infection, with HCV disease and on HCV treatment, as well as the number of
appointments for gastroenterology and liver biopsies during FY 2006-07. Overall, the female
prisons have identified 14.3% of their population as HCV-infected. Given the estimate of 22%
of female inmates with HCV, the prisons have identified only 65% of the potential pool of
infected women. The percentage of known HCV-infected women at each prison is between
12.25% and 17.04%. It is of some concern, however, that Bedford Hills has the lowest rate, even
though it is the only female prison with a Regional Medical Unit and has the most
comprehensive healthcare system of the women’s prisons.
During the past two years, the female prisons have made progress in increasing the number of
identified HCV-infected women. Table 5 contains the information received from female prisons
during CA visits. In July 2005, Bedford Hills had identified only 43 women as HCV-infected,
just over 5% of its total population. Since DOCS and DOH data suggest that 22% of women
system-wide are HCV-infected, Bedford Hills had identified less than one-quarter of them.
However, by 2007, Bedford Hills had more than doubled the number of identified HCV-infected
women to 99 (Exhibit H). At Albion in December 2005, 171 women were diagnosed with
HCV, representing two-thirds of the estimated number. By 2007, Albion had increased its
identified HCV-infected population by 15% to 196. Greater efforts are needed, however, to
reach more HCV-infected women.
Treatment of HCV Disease
A series of steps are required to determine whether an HCV-infected patient requires treatment.
(See also page 45 for discussion of DOCS eligibility criteria for HCV treatment.) First, a blood
test for HCV antibodies reveals whether the patient was ever infected with the hepatitis C virus.
If the test is positive, an HCV viral load test is then used to determine whether the patient
34

Since Lakeview and Greene confine a greater percentage of young inmates, it is likely these institutions would
have lower HCV infection rates than the other male prisons.

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

currently has the virus (a condition referred to as “chronic infection”). National figures suggest
that 50% to 85% of patients infected with HCV become chronically infected.35 Of these, 5% to
20% will develop cirrhosis (scarring of the liver), depending upon age at infection, alcohol
intake, co-infection with Hepatitis B and sexual practices. Liver cancer develops in 1% to 5% of
persons with chronic HCV.
Patients with chronic infections do not necessarily suffer any symptoms and may not experience
liver inflammation or damage, which can take decades to develop. A test for elevated liver
enzymes determines if a chronically infected patient’s liver is inflamed. If these enzymes are
sufficiently elevated, the patient is referred to a gastroenterologist (GI) for evaluation. If the GI
specialist believes the patient may have liver damage, he or she will order a liver biopsy to
determine the extent of inflammation and whether fibroids or liver scarring has occurred. If the
level of liver damage is significant but not severe enough to cause scarring, the patient may be
offered therapy, which generally consists of multiple medications prescribed for up to a year to
eradicate the virus.
The National Institutes of Health Consensus Development Conference Panel recommends that
therapy for HCV be offered to those patients with fibrosis or moderate to severe degrees of
inflammation and necrosis on liver biopsy and that patients with less severe liver disease be
managed on an individual basis. Clearly, not all inmates with HCV need to be treated, but
reasonable efforts must be made to identify and assess patients with liver damage to determine
the best candidates for treatment.
Exhibit E contains data obtained from DOCS concerning the number of male inmates in the
system that have HCV disease, indicating DOCS confirmation that they are chronically infected.
Exhibit H provides data for women. As of January 2007, 2,303 inmates (2,223 males and 80
females) were designated in the DHS computerized medical problem list as having HCV disease.
Just 285 of the known HCV-infected population (270 males and 15 females) were receiving
therapy.
Exhibit E compares the number of known HCV-infected male patients to those with HCV
disease, i.e., chronic infection. System-wide, 41% of the known HCV-infected male inmates had
HCV disease. This figure appears low because, as the Department recognizes in its HCV
Practice Guidelines, approximately 70% of HCV-infected persons develop a chronic infection.
This discrepancy may reflect a failure by medical staff to aggressively evaluate patients for
potential treatment, and/or a failure to properly document the testing and evaluation of patients in
medical records. Moreover, in data from medical class one prisons, the percentage of known
HCV-infected inmates classified with HCV disease varied widely from 8% to 100%. Nine of the
45 medical class one prisons had HCV disease rates under 30%.
Exhibit H contains similar HCV infection and HCV disease data for women. The reported rate
of HCV disease within the known female HCV-infected population is under 20%—half the rate

35

Chronic infection develops among 75%–85% of persons infected as older adults (aged >45 years) and among
50%–60% of persons infected as juveniles or young adults. Centers for Disease Control and Prevention, Prevention
and Control of Infections with Hepatitis Viruses in Correctional Settings, MMWR 2003; 52 (No. RR-1), p. 6.

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

found among males and substantially lower than the 70% chronic infection rate found in the
community at large. There is no apparent medical reason to support this finding.
The overall low reported rates of HCV disease, and particularly the very low rates among
women, are of concern. Moreover, there is no apparent medical reason for HCV disease rates in
certain prisons to be significantly lower than the system-wide average. The CA urges DHS
officials to review the practices at prisons with low HCV disease statistics to assess whether the
facilities are conducting adequate and timely evaluations of patients and are appropriate
documenting these results in patients’ medical records. Since the diagnosis of HCV disease is
the first step to treatment, it is crucial that the prison provider make an HCV disease diagnosis
for every inmate infected with HCV.
Access to HCV Specialty Services – Gastroenterologists and Liver Biopsies
The evaluation of patients for potential HCV treatment generally entails multiple appointments
with specialists. Patients have an initial evaluation by a GI specialist, followed by a liver biopsy,
and are then rescheduled for the GI specialists to determine if treatment should be provided.
Once on treatment, patients are seen by the GI specialist to determine whether the therapy is
working or should be discontinued. Consequently, timely access to GI services is crucial to
effective HCV treatment.
However, access to a specialist does not automatically mean that patients will be treated, since
the prison provider must act upon the specialist’s recommendation, and the complex diagnostic
procedure must be completed in a timely manner to initiate therapy. Effective HCV care
requires vigilance and coordination by prison providers, plus timely access to specialty services.
Exhibit E contains a summary of the number of gastroenterology appointments and liver biopsy
procedures for each male prison, along with the rates of those services in the entire prison
population and in the HCV-infected population. Certain hubs and prisons apparently
underutilize these services. Other locations provide better access. For example, the Elmira Hub
(#8) had significantly lower rates of utilization of both GI specialists and liver biopsies than the
system-wide average. Not surprisingly, it had a lower rate of identified HCV-infected patients
and inmates diagnosed with HCV disease. More problematic, this hub had lower rates of
patients receiving HCV therapy, both as a percentage of the hub’s known HCV-infected
population and the entire hub prison population, percentages that were about 20% below systemwide rates. In this hub, Five Points (with 1,367 inmates and 121 HCV-infected patients) and
Cayuga (with 1,016 inmates and 78 HCV-infected patients) each had only two inmates receiving
therapy. Both prisons had liver biopsy rates more than three times lower than the system-wide
average.
The Great Meadow Hub (#6) had low utilization of liver biopsy procedures and, potentially as a
consequence of this underutilization, an overall lower rate of identified HCV-infected inmates
and lower rate of HCV therapy than the system-wide averages. For example, Coxsackie (with
1,034 inmates and 87 HCV-infected patients) ordered 10 liver biopsies during FY 2006-07 and
had only two inmates on therapy. Great Meadow (with 1,681 inmates and 148 HCV-infected
patients) ordered only five liver biopsies during the year and had five inmates receiving

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

treatment. The CA also noted lower rates for liver biopsies and/or GI specialists in the Sullivan
and Watertown hubs. 36
Within other hubs, there were also some prisons with low utilization of GI specialists and/or liver
biopsies, including Bare Hill and Franklin in the Clinton Hub (#3) and Gowanda in the Wende
Hub (#7). These prisons all had fewer inmates receiving therapy.
In contrast, several male prisons had greater access to GI and/or liver biopsy services and
consequently identified more inmates with HCV and/or treated more patients than the systemwide averages. Many of these prisons identified 10% or more of their population as HCVinfected and/or treated 7% or more of identified HCV-infected inmates, or close to 1% of the
entire population, treatment rates that were often twice the rate of the system-wide average.
These prisons include Arthur Kill, Eastern, Fishkill, Livingston, Marcy, Mid-Orange, Mid-State,
Mt. McGregor, Ogdensburg and Sing Sing. These prisons come from nearly every hub in the
Department, demonstrating that a more effective HCV identification and treatment program can
be implemented anywhere in DOCS.
The figures on women’s access to GI and liver biopsy services, presented in Exhibit H, also
raise some concerns. Despite the substantially higher HCV infection rate for women compared
to men, the utilization rates of GI and liver biopsy appointments in FY 2006-07 for women were
relatively lower than for the male population, particularly for liver biopsies. Moreover, the rates
for access to GI and liver biopsy services for women varied significantly from prison to prison.
At Bedford Hills, the GI utilization rate was more than double the rate at Albion. In contrast, the
rate for liver biopsies at Albion was significantly higher than for Bedford Hills. With so few
women receiving HCV treatment, the Department should examine whether prison providers are
referring female HCV-infected inmates to specialists for evaluation and potential treatment.
Overall, there is a loose correlation between access to GI and liver biopsy services and the
numbers of identified HCV-infected inmates or HCV-infected inmates on therapy. For example,
of the ten medical class one prisons with the lowest treatment rates, six had lower than average
rates of liver biopsy procedures, and one of the remaining four had below average GI access.37
In contrast, of the 15 medical class one prisons with treatment rates greater than the system
average, 12 had average or higher liver biopsy rates and one of the remaining three had a high
rate of GI services. A few prisons with high HCV treatment rates, such as Woodbourne and
36

The Sullivan Hub (#4) had lower utilization rates of liver biopsy procedures than the system-wide average, but
its rate for use of GI specialists was somewhat above the system-wide average. Within this hub, Otisville, with 602
inmates, had only four liver biopsies and only two patients were on therapy of the 58 known HCV+ inmates.
Similarly, Wallkill, with 599 inmates, ordered five liver biopsies and had only one patient on treatment. Finally,
Shawangunk, with 539 inmates, performed seven liver biopsies, but had no patients on therapy even though there
were 50 HCV-infected inmates in the prison. The Watertown Hub (#2) had the lowest utilization rate for GI
specialists, but most of the prisons in the hub exceeded the system-wide average for access to liver biopsies for both
the entire prison population and HCV-infected patients. Overall, the percentages of inmates in this hub who were
diagnosed with HCV or were receiving therapy were above system-wide averages, with the exception of the prison
in Watertown, where significantly fewer liver biopsies were performed and no patients were on therapy even though
60 inmates were HCV-infected and 26 had HCV disease.
37
The CA excludes the reception centers and short-term prisons, like Willard Drug Treatment and Lakeview, from
the low treatment rate prisons because many inmates are not at these facilities long enough to initiate therapy.

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

Cape Vincent, had low usage of these specialty services but had identified a significant
percentage of its population with HCV. And a few prisons with low treatment rates, such as
Groveland and Shawangunk, had above-average usage of these services, but were treating only
one HCV-infected patient. This analysis demonstrates that adequate access to specialty services
is generally necessary, but not sufficient, to ensure proper HCV care.
HCV Therapy
As explained above, therapy is not recommended for all HCV-infected patients, only those with
significant liver fibrosis as demonstrated by a liver biopsy, and even patients with significant
liver damage generally do not have symptoms. In contrast, the year-long therapy required for the
most common genotype of HCV involves multi-drug therapy that frequently causes significant
adverse psychological and physical side effects. Determining whether an HCV-infected patient
is eligible for therapy requires a complex analysis of his/her condition, and the CA is concerned
as to whether all the state’s facilities are aggressively evaluating HCV-infected inmates for
treatment. Inmates deemed eligible for therapy must then decide whether to undergo this
arduous treatment. Patients often need care for the side effects in order to complete the full yearlong regimen. It is unclear whether HCV-infected inmates who are contemplating therapy or
who have undertaken treatment receive adequate education and support from the prison medical
staff.
As of September 2007, 2,078 DOCS inmates had initiated HCV treatment since the Department
started providing it.38 During the past few years, the Department has significantly increased the
number of HCV-infected inmates receiving treatment. In 2003, 160 inmates were on HCV
therapy, but that number increased to 383 as of May 2007.
DOCS has established an HCV continuity of care program that provides services for inmates in
treatment who are about to be released to the community.39 The program, coordinated among
DOCS medical providers, Division of Parole officers, AIDS Institute staff and community-based
Criminal Justice Initiative contractors, develops discharge plans that identify providers in the
community who will continue HCV therapy, arranges initial appointments with these community
providers and ensures thato HCV medications are given to inmates upon release. At an October
2007 AIDS Institute Conference, program staff announced that 60 formerly incarcerated
individuals had been enrolled in the program. This program represents an impressive model that
should be replicated for inmates with other chronic conditions who are being released.
Table 5, which records data received during CA prison visits, shows that 7.1% of known HCVinfected inmates were receiving treatment at that time. Analysis of the data reveals significant
variations in treatment at different prisons. For example, at Great Meadow, with an estimated
350 HCV-infected inmates, only two patients were on therapy. Great Meadow inmates reported
that many had complained to medical staff about the lack of HCV care and filed grievances, but
the vast majority had not been successful getting HCV treatment. At Gowanda and Auburn,
prisons with nearly 1,800 inmates, only six inmates were receiving therapy, even though the
38

Presentation of C. Flanigan & J. Cooper, “Hepatitis C: Solutions for Optimal Treatment Outcomes,” AIDS
Institute Conference: HIV and Corrections: Building Partnerships Inside and Out, October 10, 2007.
39
Klein, S. et al., Promoting HCV Treatment Completion for Prison Inmates: New York State’s Hepatitis C
Continuity Program, Health Reports, 122: 83-88 (2007).

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

estimated HCV-infected population was about 230. In contrast, at Green Haven, Fishkill and
Sing Sing, 16, 17 and 19 inmates, respectively, were on HCV therapy.
Exhibit E indicates the number of patients receiving HCV therapy at each male prison as of
January 2007 and their proportion relative to the number of HCV-infected patients and the total
prison population. There is significant variation in these percentages, even among medical class
one prisons. Low rates of treatment could be due to a failure to: evaluate patients for therapy,
recommend treatment for eligible patients, educate patients about the benefits and risks of
therapy and/or support patients on therapy so they will complete their treatment.
Three hubs, Clinton (#3), Great Meadow (#6) and Wende (#7), had lower rates of treatment than
the system-wide average and just half the rate of treatment in the hubs with the highest treatment
rates, Watertown (#2), Sullivan (#4) and New York City (#9).
However, differences in treatment rates are even starker among individual male prisons. Exhibit
F lists medical class one male prisons by percent of inmates receiving HCV treatment (column
headed: % Tx/HCV+). The average rate of treatment for known HCV-infected inmates at the top
15 facilities (Eastern through Ogdensburg) are more than five times the average rate of the 15
facilities at the bottom of the list (Oneida through Watertown). The prisons in the group
providing greater treatment come from eight different hubs and include four maximum and
eleven medium security prisons. There is nothing about any of the high or low treatment prisons
to justify such significant differences in the patient populations or the need for HCV treatment.
The “high treatment” prisons identified only 13% more HCV-infected inmates than the “low
treatment” group. It appears that medical staff at the top group of prisons are aggressively
evaluating patients for potential HCV treatment and encouraging patients to accept therapy.
The Department should carefully assess prisons in the low treatment category to determine
whether these prisons are adequately evaluating inmate treatment eligibility. Focus should be
placed on Great Meadow (5 treated), Wyoming (5), Washington (3), Oneida (3), Wende (2),
Altona (1), Clinton (6), Coxsackie (2), Cayuga (2), Adirondack (1), Bare Hill (3), Five Points
(2), Groveland (1), Shawangunk (0) and Watertown (0).
The low rate of women who are receiving HCV therapy is also problematic. As of January 2007,
only 15 women were on treatment out of a population of 407 known HCV-infected female
inmates. The rate of treatment for HCV-infected women is 25% less than that for men. Bedford
Hills is treating five women (one greater than the four noted in 2005). Albion is now treating 10
women, which represents significant progress since December 2005 when only one Albion
patient was receiving treatment. Of greatest concern is that no women were in treatment at
Taconic, Beacon and Bayview, which have a combined population of approximately 750
women, 110 of whom were known to be HCV-infected.40 The CA urges DHS to investigate this
situation. It appears that more liver biopsies are needed to identify female patients with liver

40

One possible explanation for the lack of treatment at these three prisons is that women who are eligible for HCV
therapy are transferred to Bedford Hills or Albion. If this is the policy, the prospect of transfer to another prison may
deter many women at these three prisons from seeking HCV testing and therapy. If there is no transfer policy, it is
unclear how such a large group of female inmates did not yield even one candidate for treatment.

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

damage, and greater efforts are necessary to convince HCV-infected women to seek and accept
HCV treatment.
Effectiveness of HCV Therapy
The combination therapy now provided to HCV-infected inmates appears to be working. The
CA was pleased to see that as part of DHS quality improvement efforts, the Department has
performed an evaluation of outcomes on 411 patients who received the drugs Pegasys and
Ribavirin. In that study, 27% of the participants were African American, 39% Hispanic and 34%
Caucasian. This demographic breakdown is notable in that the inmate population is 50% African
American, 27% Hispanic and 20% Caucasian. Clearly, African Americans are significantly
underrepresented in the treatment group. The Department should investigate this situation, but,
as discussed below, treatment outcome data suggest that African Americans seem to respond less
well than other racial/ethnic groups to this treatment.
To assess the effectiveness of HCV therapy, patients are tested for the presence of the HCV virus
during treatment and after completion of therapy. While patients are on treatment, they are
tested at 12-, 24- and 48-weeks to determine if the amount of HCV virus in their blood is
diminishing. If it is, the patient is considered a “responder.” If after 24 weeks on therapy, the
virus is still detectable, in most cases the treatment will be stopped because the patient is not
expected to benefit further from treatment. Patients who have completed the full 48-weeks of
treatment are tested again six months after completion to determine whether they are still free of
the HCV virus. Inmates who are virus-free are deemed to have a Sustained Virological
Response (SVR); in such cases, it is generally anticipated that the virus will not reappear, and
they are essentially considered cured. Based on the somewhat limited data on SVR testing in the
411 inmates evaluated, 58% of Caucasian HCV-infected inmates, 37% of Hispanics and only
19% of African American inmates reached SVR. Low rates of response to this regimen in
African American patients in the community have also been documented. Table 9 summarizes
the completion rates for each racial/ethnic group.
Table 9 DOCS HCV Pegasys Treatment – Completion and Reasons Discontinued
African Am.
2006 Data
Completed Treatment
48
Nonresponder
21
Refused
16
Noncompliant
1
Provider discontinued
14
Released
8
Other
2
TOTAL
110
Percent of Total
27%

Hispanic
85
34
16
1
13
11
2
162
39%

Caucasian
90
7
17
1
11
7
6
139
34%

Total
223
62
49
3
38
26
10
411

Percent
54.3%
15.1%
11.9%
0.7%
9.2%
6.3%
2.4%

Several observations are evident from these data. First, inmates for the most part attempt to
complete the treatment. Refusal and noncompliance with the medications are together less than
13%. Second, completion of therapy has substantially improved in the last five years. In 2003,
DOCS reported at a hearing held by the Corrections and Health Committees of the Assembly
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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

that only 14% of the 350 inmates who had started HCV therapy in 2002-03 had completed the
full course of treatment. The CA commends the Department for its efforts to nearly quadruple
that rate to 54% by 2006.
DOCS HCV Quality Improvement Initiatives
The CA is pleased to report that DHS has undertaken an effort to assess prison compliance with
the Department’s Hepatitis C Practice Guidelines through a quality improvement program. The
Department has made significant efforts since 2005 to develop quality improvement instruments
to assess quality of care through review of the medical records of HCV-infected inmates. In
2007, the DHS CQI Committee updated the HCV Case Management Audit to collect more
information and increase the number of charts reviewed. This new tool will provide a more
comprehensive assessment of HCV care and generate better information so that prisons can
identify potential problems in their HCV care system.
The CA received data from a report submitted to DOCS Regional Medical Directors in March
2007 containing results from the 2005 HCV audit of the entire system. Three medical charts
from each prison each quarter year (totaling 724 charts) were reviewed to collect this data. As
with the HIV CQI program, DHS required prisons to develop remedial action plans only when an
indicator fell below a 70% compliance rate. At this threshold, two of the 12 indicators used to
assess HCV-related care were identified as needing attention: documentation of patient education
on HCV in the medical chart and a signed refusal form for patients who declined HCV treatment.
A CA review of the data, however, raises concerns about other indicators that had
noncompliance rates of 20-30%, including: failure to order follow-up labs in a timely manner for
patients with elevated liver functions; failure to document in the medical chart the discussion of
HCV treatment with the patient; and failure to order genotype testing of the virus (an essential
test to identify the appropriate course of therapy). If the Department used a more sensitive
threshold to trigger prison remedial plans, each of these important procedures in HCV care could
receive increased attention.
The CA does not believe the data reflected in the HCV audit demonstrate lack of system-wide
attention to HCV care. Rather, they show the fully anticipated result that many prisons and
providers are following the HCV Practice Guidelines and that others need to improve their
performance. Since a CQI process should strive to continuously improve care, the problem is
setting a 70% compliance threshold that suggests that prison staff should be satisfied with results
indicating significant noncompliance with established treatment standards.
A part of this HCV audit included recording the HIV status of the patients involved. This data
was recorded for 572 (79%) of the medical records reviewed. Of this group, 326 (57%) were
HCV-infected and HIV-negative, 104 (18%) were both HIV- and HCV-infected and 142 (25%)
were HCV-infected but of unknown HIV status. Given the high rate of HIV infection typically
found in HCV-infected populations, it is unfortunate that one-quarter of this high risk group had
not been tested for HIV. This data reinforces concern that the Department is not successful in
convincing a significant portion of its at-risk population to be tested for HIV.
The Department is developing a new HCV Case Management Review Form, which has the
potential to significantly improve the data that will be retrieved in the HCV audits. Specific

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

improvements will include: (1) more detailed attention to the diagnostic evaluation process; (2)
data about liver biopsies; and (3) information about why treatment was refused or inappropriate.
Given the problems noted above with access to liver biopsies, the new audit will likely assist
DHS and the prisons in evaluating this crucial component of the care process. The CA looks
forward to the Department’s results and urges DHS to consider additional indicators addressing
the issue of access to gastroenterologists.
A second aspect of the monitoring of HCV care by DHS was the HCV Treatment Review form.
Data from this form were used to compile the information reported above concerning the
outcomes for patients who have received HCV treatment. This information is crucial to
assessing the effectiveness of HCV therapy and evaluating how DOCS can improve HCV care.
Unfortunately, in March 2007, the DHS committee developing HCV policies decided to
terminate the collection of this data, except for recording the outcomes for inmates who had
already been included in the study. It was left to the discretion of the infection control nurses
whether or not to use the form. The CA strongly urges DHS to reconsider its decision and to
recommence the systemic collection and recording of this data.
OTHER DISEASES: ASTHMA, HYPERTENSION, DIABETES AND CHRONIC
HEPATITIS B
DOCS inmates suffer from many other chronic diseases, including asthma, hypertension and
diabetes. The CA received data reporting the number of inmates at each prison who have these
illnesses designated in the computerized problem list contained in their DOCS medical record:
asthma (9,253 patients), hypertension (6,496) and diabetes (2,472). There is incomplete
information about the care provided to patients with these conditions, but it is possible to make
some observations from the documents received.
DOCS has a very large asthma population requiring care. In the last three years, DHS has
attempted to improve asthma care by issuing revised Asthma Practice Guidelines. These
guidelines promulgate new medical problem list indicators to better distinguish different levels
of the disease and provide more refined protocols for each level. They also include
implementation of an asthma audit. However, records of the DHS CQI Committee indicate that
prisons have not completely implemented the new problem list indicators for all asthma patients,
and final results of the asthma audit issued in March 2007 show that four of the six audit
indicators are below even the 70% compliance standard. Although DHS and the prisons are
making a substantial effort to improve asthma practices, it is clear that more work is needed to
bring asthma care up to community standards.
The Department issued Hepatitis B Practice Guidelines in 2004 and subsequently developed an
audit instrument to monitor patients with this illness. As of April 2007, 46 medical charts had
been audited. Results presented to the DHS CQI Committee showed that several of the audit
indicators had noncompliance rates well in excess of the 30% rate considered unacceptable.
Implementing this audit instrument is the first step in a process which, with attentive monitoring,
should result in improvements in patient care. The CA anticipates that DHS officials will take
action to correct deficiencies and that prisons will expeditiously implement remedial plans to
address problems noted in the audit.

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The Correctional Association of New York

DHS has also issued practices guidelines and audit instruments for diabetes and hypertension,
but the CA has not received any documentation concerning recent audits of these illnesses, and
therefore, cannot comment on the state of care. As discussed below in the section on specialty
care, there is significant variation in access to cardiology services throughout the Department.
The CA urges DHS to perform system-wide audits of these conditions and consider including
CQI indicators that provide for assessment of patients’ access to specialty services as a
component of this care when needed.
CHRONIC CARE SYSTEM
Six components are required for effective chronic care.
First, the Department should have policies for the treatment of chronic diseases so that patients
will receive the same quality of care regardless of where they are confined. The CA commends
DHS for promulgating practice guidelines for seven of the more common chronic diseases
(asthma, diabetes, chronic hepatitis B, hepatitis C, HIV, hypertension and tuberculosis). DHS
should consider issuing additional practice guidelines for conditions such as epilepsy and high
blood cholesterol, as recommended by the National Commission on Correctional Health Care, as
well as for other respiratory and digestive diseases.
Second, prison providers must be adequately trained in the care of patients with chronic illnesses.
As previously noted, DOCS does not mandate such training, and it is doubtful that all providers
treating inmates with chronic diseases have the required expertise.
Third, chronic care patients must have one knowledgeable provider managing all of their care.
The practice of assigning a chronic care patient to a single prison provider is not followed at all
prisons.
Fourth, a chronic care system should ensure that the many appointments, tests and procedures
ordered for a patient with a chronic illness are performed in a timely manner. This system
should also ensure that inmates are kept apprised of their care and ways to improve treatment
compliance. Patient education is essential to ensure that individuals with chronic illnesses are
knowledgeable about their disease, committed to their treatment protocol and vigilant in
monitoring their condition and response to therapy. A chronic care coordinator, usually a nurse
with special training, should be responsible for this coordination of care, as well as for
communication with and education of patients. Many prisons do not have staff to perform these
functions for all patients with chronic diseases.
Fifth, patients must have timely access to specialists whose recommendations should be
implemented by the prison provider unless the provider documents in the medical chart that the
suggested treatment is not necessary or appropriate. As discussed above, it appears that many
inmates with chronic illnesses are not receiving timely attention from specialists and
recommended care is not promptly implemented. These delays in treatment result in care that is
not consistent with community standards. Finally, consistent monitoring by DHS personnel
should ensure that chronic care throughout all facilities is consistent with community standards.

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The Correctional Association of New York

The DHS practice guidelines, new CQI programs and greater attention from DHS to these
illnesses are steps in the right direction. But the CA is concerned that practices within the
prisons are not sufficiently consistent with practice guidelines or community standards so that all
patients, regardless of where they are housed, receive appropriate care. The CA urges DHS to
continue its efforts to monitor prison care for inmates with chronic conditions and to require
prisons exhibiting problems to implement remedial measures to address deficiencies.
SPECIALTY CARE
When facility providers determine that their patients would benefit from an evaluation by an
medical expert and/or need treatment recommendations from a specialist, these providers issue
specialty care requests describing the patients’ conditions, designating the specialty services
needed and specifying the level of urgency for the medical appointment. These requests are
entered into DOCS’s department-wide computer system and processed by DHS staff who
determine whether the requested services are necessary and, if appropriate, schedule the specialty
appointments. The specialists may come to a specific prison to provide services, hold specialty
clinics for several prisons at the Regional Medical Centers or see inmates at outside hospitals or
other outside medical facilities. Following all specialty appointments, the specialists document
their findings and recommendations, which are returned to the prison providers for consideration.
It is the responsibility of the prison providers to act upon these recommendations and request any
follow-up evaluations and treatments.
Inmates repeatedly expressed concerns during CA prison visits about timely access to specialists
and inadequate follow-up of their recommendations by prison providers. In addition, according
to inmates and medical staff, certain specialty services, particularly orthopedic and neurology
services, were difficult to arrange in some prisons at the frequency required to meet inmate
needs. Other prisons seem to offer substantially more specialty care services, suggesting that the
Department and specialists are willing to provide services when the prison medical staff seeks
them.
The Department has made substantial efforts to develop systems to facilitate and coordinate
access to specialists, while also monitoring use to ensure that only necessary appointments are
scheduled. To coordinate services among the prisons and between the prisons and specialists,
the Department has developed a computerized scheduling system that incorporates a
sophisticated utilization review process and the management of appointments by regional
medical staff so that appointments can be prioritized and scheduled efficiently. However, as
with other components of the Department’s healthcare system, although policies are in place to
facilitate specialty care, prison practices do not necessarily conform to these policies. An
additional apparent deficiency is the lack of any ongoing quality improvement effort to monitor
the use of specialty services by prisons and assess responses to specialists’ recommendations.
In some instances, delayed or denied access to specialty care seems due to the lack of sufficient
specialists available to see inmates in a timely manner, while other delays/denials can be
attributed to an unwillingness or reluctance of prison providers to request specialty consultations.
In addition, failures to act upon specialists’ recommendations may result from prison providers’

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The Correctional Association of New York

inattention to the consultants’ reports or failure to document in medical charts their
determination that the recommendations are not necessary to properly treat their patients.
An analysis of CORC appeal grievances during the three-and-a-half-year period of 2003 through
mid-2006, reveals 1,459 appeals relating to specialty care at all the prisons. There were 753 such
appeals from the prisons the CA visited. (See Exhibit C.) The rates of specialty care complaints
were significantly higher than the rate for the whole prison system at the following prisons:
Arthur Kill, Elmira, Great Meadow, Mid-Orange, Sullivan and Upstate. Inmate surveys
confirmed that many inmates at these prisons had problems with specialty services. Since the
CA received only brief titles for each grievance appeal, rather than a detailed description, it is
likely that many more grievances also raised the issue of specialty care, because many short titles
include a general description, such as, “denial of treatment” or “needs treatment.”
During prison visits, the CA noted problems with specialty services at several prisons. For
example, at Great Meadow, 82% of medical care survey respondents stated that they encountered
delays at least some of the time in accessing specialty clinics. Moreover, 72% of the respondents
said that there was not adequate follow-up by the prison staff to specialists’ recommendations.
At Sullivan, 80% of survey participants stated that they experienced delays in access to specialty
care, and nearly 70% reported inadequate follow-up to specialists’ recommendations. Inmates at
other male prisons also expressed concerns with specialty care.41
At Albion, many female inmates reported that they had to wait for months to see outside
specialists, even for serious medical problems. One woman told us of repeatedly complaining of
uterine pain; the medical staff initially provided Tylenol and then prescribed antibiotics, but her
pain did not abate. After filing two grievances, she was eventually sent for an ultrasound, which
revealed an abnormal growth in her ovaries. At the time of our visit, she was still waiting for
further follow-up, nine months after her initial complaint.
In a few prisons, however, inmates reported that they had adequate access to specialty care
services, including Eastern, as well as Coxsackie and Fishkill, both of which have a Regional
Medical Unit providing outpatient specialty care.
DHS should perform a systemic review of specialty care to determine whether inmates are seen
in a timely manner consistent with the urgency priorities set for each specialty consultation. In
addition, DHS should assess whether prisons are implementing recommendations for care from
the specialists in a timely manner or recording in the patient’s medical chart the reasons for
rejecting the specialists’ recommendations.
DOCS System-Wide Specialty Care Utilization
Evaluation of specialty care services throughout the Department and at specific facilities
confirms observations during prison visits that significant variations in the utilization of specialty
care services exist among hubs and prisons within certain hubs.

41

At Green Haven, more than half the respondents reported that the prison provider did not do a good job of
following up on specialists’ recommendations. At Mid-Orange, Attica, Gowanda and Auburn, the majority of
survey respondents complained about delays in access to specialists.

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The CA obtained data from the Department summarizing the specialty care services provided at
each prison for FY 2005-06 and FY 2006-07. The CA analyzed the data from FY 2006-07 and
summarized the results in Exhibit I, which lists the number of all specialty care appointments at
each male prison and the number and rate of consultations for 11 specialty services.42 Rates
represent the number of specialty care appointments per 100 inmates at each prison. The female
population has historically more frequently used specialty care services, but the female
institutions are not equally distributed throughout the hubs. Consequently, in order to compare
service utilization among hubs, this analysis excluded the female prisons from Exhibit I and
listed them separately in Exhibit L.
Exhibit J lists rates for each specialty service for each male prison compared (as a percent) to
the overall average; Exhibit M is a similar exhibit for the female prisons. Exhibit K is a
summary chart listing the overall rate of specialty care and the rates for the 11 specialty services
per hub. (Hub totals are also available within Exhibit I.) Exhibit N contains specialty care
utilization rates for the 19 prisons visited for this report.
Hub Utilization of Specialty Care
These data demonstrate some troubling trends concerning specialty care services. Exhibit K, for
example, shows significant differences in the use of specialty care in different regions of the
state. (A DOCS map of the prisons and hubs is included as Exhibit A.) The Watertown Hub
(#2) has the lowest utilization rate of specialty services, just one-third the rate of specialty care in
the Green Haven Hub (#5) and a little more than half the rate in the Sullivan Hub (#4). The rate
in the Great Meadow Hub (#6) is less than half the rate in the Green Haven Hub and less than
three-quarters of the rate in the Sullivan Hub. The rate in the Elmira Hub (#8) is approximately
half the rate of the Green Haven Hub and 20% less than the Sullivan Hub.
Based upon the inmate populations in these prisons, there is no apparent justification for the
differences in utilization among the hubs. The most likely explanation for the underutilization of
specialty care in certain hubs is the unavailability of specialists in these regions (as in the
Watertown Hub) or the reluctance of prison providers to refer patients for specialty care.
DOCS’s DHS should evaluate these rates and determine whether patients in need of specialty
care are receiving timely access to services, and/or whether DOCS providers are delaying or
refusing to order specialty care. If a DHS review determines that in certain locations there is an
inability to identify specialists willing to provide sufficient services to meet the needs of the
prison population, the Department should make an effort to find specialists in that location or
implement a referral system for inmates to get these services via telemedicine or transport to
locations where such services are readily available. If unavailability of outside specialists is not
the problem, DHS officials should review a representative sample of charts of patients with
medical conditions that could potentially justify referral to specialty care to determine whether
patients have received timely access to specialists. The CA urges the Department to enlist the
aid of specialists not providing services in the region under review to assist in assessing the
quality of care provided to DOCS patients.

42

The specialty care services summarized in Exhibit I are: cardiology, dermatology, gastroenterology, infectious
diseases, liver biopsies, nephrology, neurology, ophthalmology, orthopedics (other), physical therapy and urology.

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Review of specialty care appointments for the 11 services analyzed in each hub (Exhibit I and
Exhibit J) reveals underutilization of several specialty services in certain regions of the state.
Overall, the Watertown Hub (#2) had significantly less utilization of several critical services
compared to average rates throughout the system for male prisons. Specialty care per 100
inmates were one-third the average rate for cardiology, 30% for gastroenterology, one-tenth for
infectious disease, 16% for nephrology, 46% for neurology, 27% for physical therapy and 45%
for urology. The Elmira Hub (#8) also had significantly less utilization for selective specialty
services, with utilization rates that were 54% of average for gastroenterology, 40% for infectious
disease, 64% for liver biopsies and 26% for nephrology. Other hubs had low rates for some
services.43
Again, it is difficult to determine any justification for this kind of underutilization of specialty
services, other than difficulties identifying and accessing specialists willing to provide services
to an inmate population or reluctance by prison providers to refer their patients outside for
specialty services.
Specialty Care Utilization at Specific Prisons
The CA also observed significant differences in the utilization of specialty services among male
prisons within the same hub (Exhibit J and Exhibit K). For example, in the Oneida Hub,
overall specialty care was consistent with system-wide utilization, with the exception of
infectious disease. However, at Marcy, the utilization of specialty care services overall was only
55% of the system-wide rate, and certain services were significantly underutilized.44 Rates for
many services were much lower than those at nearby Oneida, where for many of these same
specialty services utilization rates were near or above the system-wide average. The comparison
indicates that providers for these specialty services must be available to DOCS facilities in that
region, but Marcy either has no need for, or is not referring its patients to, these services.
Nothing about Marcy inmates would suggest a significantly different patient population than at
other medium security prisons. It should be noted that in 2005, Marcy had one of the highest
proportions of medical care grievances out of all types of grievances filed by Marcy inmates—a
rate three times the system-wide average. Moreover, the rate of complaints about specialty care
appealed to CORC by Marcy inmates was three times the system-wide rate.
Bare Hill is another prison with a low utilization of specialty care, just 64% of the system-wide
average.45 In contrast, Franklin, which is literally across the street from Bare Hill, had an overall
specialty care utilization rate that exceeded the system-wide average and had utilization rates that

43

The Oneida Hub (#1) had only 40% of the average rate for infectious disease and 73% of the average rate for
gastroenterology, even though utilization rates of other specialty care services were near or close to the system-wide
averages. The Clinton Hub (#3) had a 60% rate for neurology and 44% for dermatology, although it generally
exceeded the utilization rates for other specialty services. The Sullivan Hub exceeded the system-wide utilization
rates for all services except liver biopsies, which was only 65% of the system-wide average. The Great Meadow
Hub (#6) had a 71% utilization rate for liver biopsies, 51% for orthopedics and 56% for physical therapy.
44
Marcy had low utilization rates for: dermatology (30%), infectious disease (9.5%), nephrology (15%),
orthopedics (63%), physical therapy (38%) and urology (56%).
45
Bare Hill had very low rates for certain specialty services, including: cardiology (27%), dermatology (30%),
gastroenterology (37%), liver biopsies (33%), neurology (38%), physical therapy (39%) and urology (39%).

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were near or above average for gastroenterology, physical therapy and urology.46 The utilization
rates at Bare Hill were significantly below the hub average,47 and DHS should assess its use of
specialty care to determine whether it is inappropriately restricting access to outside specialists.
The FY 2006-07 specialty care data presented in Exhibit N confirms inmates’ concerns about
specialty care heard during the CA’s visits to 19 prisons. Great Meadow and Wyoming had the
two lowest utilization rates of the visited prisons, and inmates at these facilities overwhelmingly
reported problems with access to specialty care and inadequate follow-up to specialists’
recommendations.
Great Meadow’s overall utilization rate for specialty care was slightly more than half of the
system-wide average.48 (See inmate survey results discussed on page 58.) Given that Great
Meadow has an 18-bed infirmary, which is slightly larger than many prison infirmaries, and is
only 70 miles from Albany Medical Center and within two hours of the Coxsackie Regional
Medical Unit, it is surprising that it had such low utilization rates for these essential services.
Elmira had a 76% utilization rate of specialty care overall and very low rates for several
important services.49 The Elmira Hub (#8) had chronic underutilization of gastroenterology,
infectious disease, liver biopsies and nephrology services, and the Elmira prison was generally
well below even these low hub averages. The high number of Elmira grievance appeals about
specialty care, discussed above and included in Exhibit C, confirms inmates’ dissatisfaction with
these services. Given that Elmira contains an infirmary and confines many long-term inmates,
DHS should carefully scrutinize these low utilization rates.
The CA visited three male prisons in the Attica Hub (#7): Attica, Gowanda and Wyoming. All
three had low utilization rates for specialists in FY 2006-07. Wyoming’s overall utilization of
specialty care was only two-thirds the system-wide average.50 Its low rates for several important
services may account for responses to the CA survey in which 65% of Wyoming inmate
respondents reported delays in access to specialty care, and 72% stated that the follow-up to the
specialists’ recommendations was inadequate. Gowanda had an overall utilization rate of
specialty care that was approximately three-quarters the system-wide average with particularly
low use of several specialists.51 Gowanda medical staff admitted that they had experienced some
problems locating neurology services. Attica had an overall utilization rate comparable to
system-wide averages, but it underutilized several specialty services, with particularly low rates
for cardiology (44%), gastroenterology (41%), neurology (64%) and urology (62%).
46

Franklin, however, had low rates of utilization for cardiology (47%), dermatology (39%), liver biopsies (33%)
and neurology (32%).
47
The Clinton Hub, which includes Bare Hill, generally used specialty care consistent with the overall system
average, but the hub exhibited low rates of use for cardiology (73%), dermatology (44%), neurology (60%) and
urology (80%).
48
Great Meadow had particularly low use of the following services: dermatology (27%), infectious disease (36%),
liver biopsies (25%), ophthalmology (52%) and physical therapy (34%).
49
Elmira had low utilization rates for: cardiology (57%), dermatology (41%), gastroenterology (19%), infectious
disease (14%), liver biopsies (64%), nephrology (15%) and physical therapy (51%).
50
Wyoming had very low rates for cardiology (35%), dermatology (37%), infectious disease (17%), neurology
(26%) and physical therapy (55%).
51
Gowanda had low use of dermatology (38%), gastroenterology (29%), infectious disease (15%), nephrology
(32%), neurology (40%) and urology (44%) services.

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The CA also visited several facilities that provide specialty care at rates substantially higher than
the system-wide averages. It appears that at these prisons, the medical providers have ready
access to the services needed for their patients with chronic or acute medical problems, and that
the providers are willing to consult medical experts to assist them in diagnosing medical
problems and determining appropriate treatment modalities.
For example, Fishkill used specialty care services at more than twice the average overall and at
three to seven times the rate for cardiology, dermatology, infectious disease, nephrology and
neurology. Similarly, Green Haven had an overall rate substantially higher than the system-wide
average and utilized cardiology and dermatology services at nearly twice the rate of other
prisons, infectious disease services at four times the system-wide rate and physical therapy
services at two-and-a-half times the system-wide average. Arthur Kill, Coxsackie, Eastern, MidOrange and Sing Sing had high utilization rates for most of the specialty services examined,
often using certain services one-and-a-half to three times more than the system average.
The CA’s analysis supports the recommendation that utilization of specialty care must be more
closely evaluated and the medical charts of patients with serious and/or chronic problems must
be carefully monitored. Qualified medical evaluators from outside the Department should assess
whether specialty care is being requested when needed and determine whether specialists’
recommendations are being appropriately considered and promptly implemented.
Specialty Care at Female Prisons
The female population utilizes specialty care at rates that are nearly three times greater than
those for the male population. Exhibit L contains a summary of the number of specialty care
visits and rates of utilization for each female prison, and Exhibit M lists the utilization rates for
each specialty service compared to the system-wide average for female prisons.
Services that women used substantially more than men included cardiology, dermatology,
gastroenterology, infectious disease, neurology, ophthalmology, orthopedics and physical
therapy. Clearly some of the higher utilization rates for these services are due to higher rates of
infection with hepatitis C and HIV among women.
However, there are also significant differences in utilization rates among prisons. For example,
Albion (the largest female prison) had substantially fewer specialty appointments than the
average for all female prisons. In particular, it had utilization rates that were between four and
ten times lower than those for Bedford Hills for the following specialty services: cardiology (four
times less); dermatology (almost five times less); infectious disease (nine times less); nephrology
(nine times less) and neurology (seven times less). Although Bedford Hills has a Regional
Medical Unit (RMU), the RMU consultations were excluded from these comparisons. Taconic,
a medium security prison, also had utilization rates that were substantially higher (often on the
order of two to ten times) than Albion for many specialty services.
DOCS officials should evaluate the use of specialty care services at the female prisons, with a
particular focus on Albion, to determine whether women have appropriate access to specialty
care.

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The Correctional Association of New York

PHARMACY SERVICES
DOCS is clearly in the process of upgrading its pharmacy operation, both at its Central Pharmacy
and at the prison pharmacies serving 49 of the prisons. The CA applauds the Department’s
efforts, but in view of immediate problems, the CA urges DOCS and other state officials to take
interim steps to ensure that inmates at each prison have timely access to the medications they
need.
Vacancies and Centralized Services
As noted previously in this report, one of the primary obstacles to effective pharmacy services is
the lack of prison pharmacists. For years, the state has not authorized adequate compensation
rates to attract pharmacists to the prisons. Consequently, as of May 2007, there was a 13%
pharmacist vacancy rate in prisons with a DOCS pharmacy. Many prisons have abandoned their
effort to have a pharmacy and rely on a DOCS regional pharmacy or outside pharmacy services
to supply medications. As noted at the 2003-04 New York State Assembly hearings held by the
Corrections and Health Committees on prison healthcare, the cost of medication from the outside
pharmacies is 27% greater than DOCS Central Pharmacy costs. During FY 2006-07, DOCS
spent $17 million on medications provided by outside pharmacy services, which included
approximately $3.8 million more than what DOCS would have spent for the same medications if
purchased through its Central Pharmacy. Twenty prisons are currently using contract pharmacy
services through a new provider (Kinney Drugs) whose contract with DOCS became fully
operational as of April 2007. DOCS will have to rely on this expensive system at these prisons
until it can implement an alternative system.
The DOCS Central Pharmacy staff reported that the Department does have a long-term plan to
take over the outside pharmacy services by expanding the Central Pharmacy and adding 17 new
pharmacy positions, which were authorized in last year’s budget. Under this plan, in addition to
distributing bulk medications to prison pharmacies throughout the state, the Central Pharmacy
will begin dispensing individual prescriptions to inmates at prisons currently served by an
outside contractor. It appears, however, that it will take several years to implement this plan.
This proposal represents significant progress in addressing the longstanding issue of inadequate
staffing of prison pharmacies, but it will probably not fully address the need for more prison
pharmacies. Consequently, the CA urges the state to make state pharmacists’ salaries
competitive with community rates, eliminating the ongoing challenge of staffing prison
pharmacies throughout the state.
The CA recognizes that DOCS cannot control the salary levels for civil service employees and
that the approval of a geographic pay differential in 2005 increased civil service salaries for
pharmacists by $11,000 per year. Although this increase enabled some prisons to fill pharmacy
positions, numerous pharmacy vacancies still exist and many prison pharmacies remain closed.
The CA visited DOCS’s Central Pharmacy at Oneida during a visit to the prison in March 2007
and was impressed by the facility and the staff. The CA also observed the new computerized
pharmacy software. DOCS is currently in the process of installing this system at a number of
prisons and training pharmacy staff on its operation. The CA anticipates the new pharmacy
computer system will allow for better analysis of medications and other quality assurance

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measures by the prison medical staff, including monitoring of contraindicated drugs, utilization
of costly medications, and identification of inmates on chronic medications who are not filling
their prescriptions.
Medication Monitoring and Problems with Medication Distribution
The Department spends substantial sums annually to provide medications to treat chronic
diseases. During FY 2006-07, DOCS spent $26.2 million for HIV medications, $16.2 million for
psychotropic medications and $3.6 million for hepatitis C drugs, in total representing more than
60% of its medication budget. Given these expenditures and those for other chronic diseases like
asthma, hypertension and diabetes, it is essential that the Department conduct effective quality
assurance of the medical care provided to the chronically ill to ensure that the drugs are used
appropriately and that the treatment is effective.
Distributing medications from DOCS pharmacies should enable better tracking of inmate
medications using the new DOCS pharmacy computer system. However, there currently is no
mechanism to integrate the computerized medication records of inmates receiving prescriptions
from outside contractors with DOCS’s computerized pharmacy records. Consequently, when an
inmate is transferred from one prison receiving outside pharmacy services to a prison serviced by
DOCS’s Central Pharmacy, or vice versa, the receiving facility is unable to access any computer
records about the inmate’s prior medication history. This gap makes it much more difficult to
appropriately monitor inmates on complex medication regimens, to assess inmate compliance
with their medications, or to gauge the impact of alterations in medication regimens for patients
with chronic conditions.
In addition, inadequate staffing also compromises DOCS’s pharmacy operations. Inmates’
medication regimens cannot be closely monitored for contraindicated prescriptions or the failure
to renew chronic medications at appropriate intervals. Since strict compliance with complex
regimens is crucial for effective treatment of many chronic illnesses and the pharmacy can be an
invaluable source of information for providers monitoring patients’ treatment, inadequate
pharmacy staff and systems can significantly compromise the prison’s ability to provide effective
chronic care.
Inmates have reported many other problems concerning medications, including the periodic
failure of prisons to: (1) renew medications in a timely fashion; (2) maintain an adequate supply
of some medications for chronic conditions, resulting in shortages of essential drugs; (3) provide
inmates with sufficient information about the medications they are taking and possible side
effects; and (4) deliver medications in a confidential manner to prevent disclosure of the nature
of inmates’ illnesses to staff and other inmates. Even at prisons with a full pharmacy staff,
inmates report problems with their medications. For example, at Great Meadow and Sullivan,
more than 60% of the inmates on medications stated that they sometimes have problems
obtaining their prescriptions. At Green Haven more than 50% of medication users complained
of problems with drug access.
CORC grievance appeal data confirm survey results, revealing numerous complaints about
access to medications. From January 2003 through May 2006, there were a total of 1,599
medical grievance appeals system-wide which raised the issue of inmate medications. This

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figure represents 15% of all medical grievance appeals. Prisons in which inmates filed
significantly more grievances about medications than the system-wide average include Upstate,
Auburn, Great Meadow, Fishkill and Sullivan. In contrast, Coxsackie, Gowanda and Sing Sing
had far fewer medication grievances.
QUALITY IMPROVEMENT PROGRAMS
During the past two decades, the Department has attempted to develop several different quality
improvement programs in the prisons and in DHS to monitor healthcare. Until recently, these
efforts were unsuccessful in that: (1) the prisons have not consistently collected information,
analyzed systemic trends or developed remedial plans to address problems; (2) there has been
little coordination between DHS and the prisons concerning monitoring of the quality
improvement program; and (3) there has been minimal follow-up by DHS and the prisons to
ensure that identified problems have been corrected. However, since 2000, DHS has made
significant progress in reinvigorating its quality improvement activities and has issued a mandate
that prisons develop prison-based quality improvement efforts.
One component of the Department’s quality improvement program is the development of clinical
guidelines for prison providers to follow. Starting in the 1990s, DHS promulgated eight sets of
guidelines covering asthma (latest version in 11/04), diabetes (8/99), female health appraisal
protocol (3/00), hepatitis B (5/04), hepatitis C (7/04), HIV (9/05), hypertension (2/01) and men’s
health (6/03). DHS also issued assessment tools to determine whether prisons are following the
guidelines.
In October 2000, DHS issued Health Services Policy Manual Item #7.19, which directed that a
prison quality improvement program should address seven primary care areas to be reviewed by
Senior Utilization Review Nurses (SURNs) during site visits. The SURNs were to report
deficiencies to a DHS Central Office Continuous Quality Improvement (CQI) Committee, which
would then issue reports to the prison superintendent and Facility Health Services Director about
areas in need of improvement. The prison medical administration had to provide the Central
Office CQI Committee with an action plan to address noted deficiencies. The Regional Medical
Director (RMD) and the Regional Health Services Administrator (RHSA) for the prison were
responsible for ensuring compliance with the action plan.
In February 2007, Item #7.19 was replaced by a draft protocol creating a DHS Continuous
Quality Improvement (CQI) Program directed by a CQI Committee consisting of directors and
assistant directors from several departments of DHS, Regional Medical Directors and other
health professionals in DHS, facility staff and regional staff. The policy specified that a Quality
Assessment Tools (QAT) Manual would be distributed to the prisons for use by prison staff in
conducting self-evaluation audits. The important changes from the previous policy are that
prison staff will conduct the audits and that the QAT Manual, rather than Policy 7.19, will
specify the procedures and tools to be used in CQI activities.
The Department provided the CA with DHS materials concerning its quality improvement
efforts, including records from all DHS CQI Committee meetings, for the period January 2005
through early 2007. Several observations are evident from reviewing these documents and their

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attachments. First, the CQI Committee has been very active in developing new tools to assess
several chronic conditions, including HIV, Hepatitis B, hepatitis C and asthma. In addition, the
Committee has focused on routine medical procedures such as documentation of medical
histories, physicals and periodic health appraisals for men and women.
Second, the CQI Committee has obtained system-wide data from several audits revealing that the
prisons are complying with some indicators but not meeting all the required audit indicators.
Results of the audits for HIV, hepatitis B, hepatitis C and asthma are discussed in the chronic
care section of this report.
Third, the new CQI Program requires prison staff to be more involved in the auditing process,
mandating that the prisons complete many of the audits. However, it appears some prisons are
having difficulties performing these tasks. Of particular concern are indications that prisons
have been unable to meet their CQI duties due to staffing deficiencies. For example, in 2006, ten
prisons were identified as encountering barriers to performing an HIV audit. Staff shortages
were noted at Arthur Kill, Five Points, Great Meadow, Greene, Mid-Orange, Oneida, Southport
and Taconic. Meaningful CQI efforts are time-consuming, yet very important for a prison
medical staff. DHS should include the CQI activities in determining staff requirements at all
prisons.
Fourth, the CQI Committee considers a prison to have satisfied an audit indicator if 70% of the
medical charts reviewed at the prison are determined to be in compliance. Only when a prison
falls below the 70% threshold is the medical staff required to develop a remedial plan. As
discussed in the chronic care section, this threshold represents too low a bar for acceptable
performance. Noncompliance with an essential component of care in 20%, or even 10%, of the
cases reviewed at a prison could indicate that there may be systemic problems and that
improvements could be realized with closer attention to the policy requirements. Continuous
quality improvement is not intended to find fault or blame, but rather to motivate medical staff to
continuously find ways of improving services, just as a remedial plan does not necessarily
signify the delivery of poor care, but only that there may be ways to improve care. The reviewed
audit data includes many indicators that fall in the 10-30% noncompliance range. Prisons would
be better served if they were encouraged to address these areas. The CA urges the CQI
Committee to re-examine its criteria for acceptable compliance, particularly for indicators that
measure critical elements of patient evaluation and care.
Fifth, documentation received from the CQI Committee included no indications about: (1)
whether the Department now requires prisons to develop remedial plans for areas that need
improvement; (2) what measures have been implemented in any such plans and whether they
could be instructive to other prisons and DHS for improving care; and (3) the extent to which
DHS or the Regional Medical Directors have followed up at prisons where audits have
established noncompliance. It appears that the remedial steps of the CQI Program have been left
to the Regional Medical Directors and/or the prison staff with little or no oversight by the DHS
CQI Committee. By failing to generate and distribute remedial plans, DOCS is losing the
opportunity for other prisons to learn from the experiences of prisons struggling with compliance
and for the CQI Program to foster greater accountability from its prison medical programs.

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The Department recently provided the CA with its Quality Assessment Tools Manual, which was
issued in November 2007. The Manual is a significant addition to the Department’s QI
documentation, containing several additional tools to assess medical services at the prisons. It
contains 18 tools to assess primary care, a dental care tool, a pharmacy tool, a mental health tool
and five miscellaneous tools. Table 10 identifies the primary care and miscellaneous tools. The
primary care tools include an assessment instrument that evaluates continuity between the prison
clinician and specialty care services and appropriate clinician follow-up to a patient’s previous
plan of care. Similarly, there is a tool concerning consultation to specialty providers that
examines not only the consultation request, but also whether the prison primary care provider has
reviewed the consultant’s recommendations and taken appropriate action. In the miscellaneous
section there is a tool to evaluate the prison provider’s response and follow-up to specialist’s
recommendations.
Table 10 – DOCS Quality Assessment Tools Manual
Category
Primary Care
Tools

Tools
Asthma, Clinician Chart Review, Consultation to Specialty Provider, Diabetes,
Emergency Medical Equipment/Response, Emergency Room Referral, Health
Care During Transfer, Hepatitis B, Hepatitis C, HIV, Hypertension, Infirmary
Nursing Assessment and Documentation, Infirmary Primary Care Provider
Documentation, Latent TB Infection, Periodic Men’s Health Appraisal, Periodic
Women’s Health Appraisal, Reception Health Screening, Sick Call (Nursing)
Miscellaneous Fit Test N95 Audit, HIV Rapid Test Audit, Hospital Admission and Discharge
Tools
Review, Post Specialty Consultation Review, Quality Improvement Reporting
The Manual defines each indicator in the tools and generally specifies that an inmate must be at a
facility at least 90 days for his/her chart to be included in the assessment process. However, the
Manual does not specify the frequency with which these tools should be employed by the prison
medical department. Moreover, the Manual maintains the 70% compliance rate for determining
whether an indicator has been satisfied.
Overall, the CA is impressed with the efforts of the DHS CQI Program, as it reflects a clear
intent to specify standards of care for all prisons and to monitor prison practices through
objective assessments. Nevertheless, the CA urges the committee to expand the areas it is
investigating to include specialty care and other chronic conditions and to enhance the
component of the program that mandates the development of remedial plans and dissemination
of those plans to DHS officials and prison providers.
The Department has also improved individual prison-based QI programs, but it should augment
those efforts. Health Policy Manual Item #7.19a, issued in September 2003, requires each prison
to create a facility-based Quality Improvement Committee (QIC) and to conduct at least
quarterly meetings. The protocol notes that “[t]imely and periodic assessment of healthcare
outcome measure values will help to assure compliance with American Correctional Association
performance standards and will serve as an internal system for assessing achievement.” The
program “is designed to keep healthcare professionals continually involved in the monitoring and
improvement of the quality of health services provided to the inmate population.” For a system-

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wide QI program to be effective, prison staff must regularly be engaged in QI activities at their
prison.
At several prisons, the CA found that the facility-based quality improvement (QI) program was
not fully operational or did not meet the goals stated in Policy Item #7.19a. At Attica, Great
Meadow and Mid-Orange, the QI program was hampered by a lack of staff to perform essential
tasks. Without an FHSD or a Nurse Administrator to organize the program, or adequate nursing
staff to perform chart reviews, a QI program cannot function. At some prisons, such as Eastern
and Gowanda, officials said there were quarterly meetings, but the CA did not have an
opportunity to review program documentation. Auburn officials reported that monthly QI
meetings are held and that medical chart reviews and mortality assessments are performed by
prison medical staff.
While efforts to conduct regular QI activities at the prisons represent a positive step, DHS staff
must be more involved to ensure that these programs are comprehensive and effective in
addressing deficiencies in the prison healthcare systems. As long as staff shortages exist at
certain prisons, it is unrealistic to expect these facilities to support an effective QI program while
also performing necessary medical care. In determining the level of medical staff required at a
prison, the Department should include a realistic allocation of time for medical administrative
staff to perform QI duties.
A component of reviewing the quality of prison healthcare involves assessment of the medical
staff. As noted in the section on routine care, inmate-patients frequently complain to the CA
about the attitude, thoroughness, responsiveness and demeanor of the prison staff during medical
encounters. There appears to be limited DOCS oversight concerning this aspect of care. The
quality assessment tools of clinicians consist primarily of chart reviews of medical encounters. It
is unlikely that these records will contain data about these aspects of patient-staff relations.
When the CA inquired whether the Department performs overall reviews of medical staff, DHS
personnel asserted that individual evaluations are conducted. As evidence of these reviews,
DOCS shared with the CA a few examples of redacted evaluations by a Regional Medical
Director of a prison provider. These documents were completed Performance Evaluation
Program Forms prepared pursuant to the contract between the New York State Public Employees
Federation (the union representing all medical staff) and the State of New York. It appears these
evaluations are required for an individual to receive payment for performance advances under
the contract. Although the Regional Medical Director assesses whether the provider’s
performance is satisfactory or unsatisfactory in this evaluation, the following issues are unclear:
(1) what records were reviewed or process employed (e.g., chart reviews, interviews with staff
and patients, and evaluation of grievances) to determine satisfactory performance; (2) what
record is created of specific areas in which performance could be improved; (3) whether a
written plan is required specifying what the employee should do to enhance his/her performance;
and (4) how these evaluations are used in assigning medical personnel and determining medical
operations. It appears a more comprehensive, better documented staff review process is needed
to adequately assess the performance of medical personnel.

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MEDICAL SERVICES FOR INMATES WITH LIMITED ENGLISH SKILLS
Most prisons the CA visited had very few or no medical staff members who spoke Spanish, even
though 5% to 10% or more of the inmate population at these prisons did not speak sufficient
English to communicate effectively with medical staff about their health problems. At almost all
of these prisons, inmates, and sometimes security staff, are used as translators for these medical
encounters. It is inappropriate and ineffective to use untrained translators in this way; it
compromises confidentiality, and inmate-patients will understandably be reluctant to talk about
sensitive medical issues when their peers or security staff can learn about their health conditions.
Additionally, ineffective communication occurs when untrained individuals, sometimes with
limited English skills themselves, try to translate medical terminology and concepts to nonEnglish speaking patients.
Telephone services, such as one offered by AT&T, provide translations for a modest cost. They
are available for dozens of languages. At a few prisons, medical staff had access to telephone
translation services, but no prison was consistently using them. The Department has recently
agreed to implement this program in all its prisons and to inform medical, correction and civilian
staff and inmates of its availability. The CA urges the Department to monitor the system to
ensure that the prisons are using the system when communicating with inmates with limited
English-language skills.
Prisons also fail to consistently provide information in Spanish or other inmates’ native
languages about medication descriptions, instructions for dosage and warnings about potential
side effects. Department officials informed the CA that DOCS pharmacy system has the
capability to provide information about medication in Spanish. It is unclear whether the
Department provides other medical documentation in the patient’s native language, such as
laboratory test results, inmate medical refusals, patient instructions following discharge from a
hospital or instructions for medical tests and procedures. The CA urges DHS to conduct a
system-wide assessment of prison practices concerning the provision of medical instructions and
documentation comprehensible to non-English speaking patients.
CONTINUITY OF CARE
Inmates are regularly transferred from one prison to another, and 27,000 to 28,000 are released
each year to the community. For inmates with chronic medical conditions, there are problems
ensuring adequate continuity of care during these transitions.
Inmates at several prisons asserted that they had not been seen by a provider until several months
after they arrived at a prison, even though they had chronic medical problems. Some had
interruptions in their medications when they were transferred to a new facility, and in some cases
medical charts did not arrive promptly. These difficulties would not occur if prisons carefully
reviewed medical records of all incoming inmates and assigned chronically ill inmates to a
designated provider who conducted evaluations of patients soon after their arrival at the facility.
In addition, many inmates being discharged from custody leave without adequate documentation
of their medical status. Some do not receive the required two-week supply of medications upon

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discharge or the 30-day supply required for discharged HIV-infected patients. Very few receive
a referral to a clinic in their community for follow-up care for existing medical conditions that
require treatment. Almost none of the patients with serious illnesses leave prison with a
Medicaid card or with a pending application for health benefits. Inevitably, many formerly
incarcerated individuals face numerous difficulties in promptly accessing healthcare in their
communities. The prison medical staff generally do not provide any discharge planning services
for them, and the transitional services units and parole staff in the prisons are unable or illequipped to perform discharge planning for essential medical care.
In 2007, the state enacted legislation requiring the Department of Health to suspend, rather than
terminate, the Medicaid benefits of inmates enrolled at the time of their incarceration, so that
benefits can promptly be restored when they are discharged. The CA applauds this action and
commends the governor and New York State Legislature for supporting this measure. Yet more
needs to be done. It is estimated by DOCS that only 20-25% of the inmate population will be
affected by this law, which went into effect on April 1, 2008. In order for other inmates to have
Medicaid benefits at discharge, some form of facilitated enrollment of Medicaid applications
must occur while inmates are incarcerated. This service is now being provided for a very limited
number of inmates, including those on dialysis for kidney disease and inmates being discharged
from Queensboro. In the recently enacted FY 2008-2009 budget, funds have been allocated for
DOCS, the Department of Health and the Division of Parole to undertake a pilot project to
develop a method to fill and process Medicaid applications for soon-to-be-released inmates. We
commend this initiative and hope that the pilot can be promptly developed and implemented.
The CA also commends the Department for starting a pilot project at Orleans in the western part
of the state to facilitate reentry for inmates returning to Erie County. This project includes
assistance in filing benefit applications while the inmates are still incarcerated. Moreover,
DOCS’s Chief Medical Officer, Dr. Lester Wright, has assembled a Medical Reentry Task Force
that includes representatives of the relevant state agencies and outside advocates, including the
CA, to develop recommendations for improving the reentry of inmates with medical problems.
These efforts clearly demonstrate a commitment by DOCS to enhance discharge planning for
inmates with medical needs and a desire to coordinate with other state and private entities to
facilitate prisoner reentry. Legislation, additional resources including staffing, and changes in
DOCS and parole policies must occur to make discharge planning effective for inmates with
medical problems.
CONFIDENTIALITY IN MEDICAL ENCOUNTERS
At some prisons, inmates complain that their medical encounters, particularly during sick call,
are not conducted in a confidential manner. Since correctional staff must be in the area where
sick call occurs to provide security for the medical staff, the Department should implement
measures to ensure that officers do not overhear confidential medical information.
Unfortunately, Auburn conducts sick call in the housing areas where it is even more difficult to
maintain privacy, and inmates reported that correctional staff could hear medical conversations.
The CA also observed problems with confidentiality at Mid-Orange, which holds medical call-

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outs in the clinic area in a hallway behind a cloth screen. It was clear that inmates and security
staff could overhear conversations in this area.
For inmates who are in disciplinary segregation, the problem is even more severe. In these units,
sick call staff interview inmates through the cell door. At Upstate there are solid doors with
small holes through which inmates and staff attempt to communicate. The CA has conducted
interviews on these units and can verify that it is very difficult to communicate with an inmate
without talking at a high volume. Since correctional officers follow sick call nurses during their
rounds on these units, it is inevitable that security staff will overhear these medical exchanges.
Inmates also complain about the lack of privacy in the distribution of medications. At many
prisons, pharmacy staff distribute medications at a window where inmates must line up at
specific times of the day. At some prisons, there is insufficient space between inmates on the
medication line and the patient receiving his/her prescription to allow for a private interaction.
Inmates also complain that non-medical staff are sometimes given medications to distribute to
inmates in their housing area and that the drugs are not adequately packaged to shield the nature
of the contents from staff.
CARE FOR THE AGING INMATE POPULATION
The overall inmate population has gotten older during the last several decades, resulting in a
substantial increase in the number of inmates 50 years or older, amounting to a percentage of
older inmates that more than doubled between 1996 and 2006. Table 11 contains a summary of
this aging DOCS population for these years.
TABLE 11 - SUMMARY OF OLDER POPULATION IN DOCS 1996-2006
AGE

1996

1997

1998

1999

2000

2001

2002

2003

2005

2006

50-54
55-59
60-64
65 and older

1,750
871
398
282

1,836
988
431
323

2,030
1,054
446
368

1,895
1,010
401
306

2,518
1,241
538
408

2,722
1,354
606
429

2,772
1,378
702
484

2,787
1,507
746
526

2,887
1,539
756
555

3,103
1,601
795
625

3,245
1,724
848
651

50 and older 3,301 3,578 3,898 3,612 4,705 5,111 5,336 5,566
% of
4.82% 5.14% 5.64% 5.16% 6.58% 7.29% 7.92% 8.34%
Population
55 and older 1,551 1,742 1,868 1,717 2,187 2,389 2,564 2,779
% of
2.26% 2.50% 2.70% 2.45% 3.06% 3.41% 3.80% 4.16%
Population

5,737

6,124

6,468

Total
Population

68,484 69,646 69,099 70,004 71,466 70,153 67,394 66,745

2004

8.80% 9.61% 10.31%
2,850

3,021

3,223

4.37% 4.74%

5.14%

65,197 63,698 62,732

Consequently, there has been a commensurate increase in the percentage of inmates with medical
problems and in the prevalence of specific medical conditions associated with older patients. A
recent Bureau of Justice Statistics analysis of 2004 data obtained during its survey of all state and
federal inmates concerning medical problems reported that 69% of all state inmates 45 years or

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The Correctional Association of New York

older had a current medical problem, compared to only 34% and 50%, respectively, of inmates
aged 25-34 and 35-44.52 This study also reported that certain medical conditions were much
more prevalent in the 45 and older population than in the 35-44 age group: cancer was four times
higher; diabetes nearly three times higher; heart problems more than twice as high; and
hypertension and liver problems twice as high.53 The study found that the 45 and older state
inmates were two to five times more likely to require surgery while incarcerated than groups of
younger inmates. These older inmates were also three to six times more likely to have
disabilities related to hearing, vision or mobility than younger inmates groups.54 Finally, the
older inmate population also accounts for a disproportionate share of inmate deaths. A separate
Bureau of Justice Statistics report, Medical Causes of Death in State Prisons, 2001-2004,
reported that two-thirds of all inmate deaths involved individuals age 45 or older and that 40% of
all state inmate deaths occur in five states, including New York.55
With the increase in the older population in prison, it is inevitable that the Department will use
more medical resources to serve aging inmates and that the prevalence of common medical
problems of elderly inmates will increase in the prisons. There will also be additional costs for
medications for chronic conditions, more extensive infirmary and skilled nursing care utilization
and more frequent and lengthy hospitalizations. Older patients with chronic conditions also may
require more intense nursing care when they are in an infirmary or Regional Medical Unit, and
therefore, additional nurses and medical aides may be required for these units. It is important
that the Department closely monitor the increasing needs of this expanding population and
ensure that it has the resources, in terms of both medical staff and residential facilities, to meet
the growing demand.
The CA commends the Department for creating a 30-bed Unit for the Cognitively Impaired at
Fishkill in October 2006. Inmates with dementia due to Alzheimer’s, AIDS, Parkinson’s or
Huntington’s diseases are placed there. As of May 2007, the average age of the patients on this
unit was 62 years old. Staff for the unit, including nurses, correction officers and housekeepers,
go through a 40-hour training to learn how to interact effectively with this patient population.
The unit had 20 patients as of May 2007, but it is reasonable to suspect that many more
vulnerable inmates with cognitive impairments could benefit from placement on this unit.
INMATE DEATHS
The number of deaths in the Department has consistently declined since the 1990s when many
HIV-infected inmates died in custody. In 1995, AIDS-related deaths peaked at 257, and a total
of 396 state inmates died that year while incarcerated. In the late 1990s, the number of AIDSrelated deaths declined rapidly so that in 2000 there were only ten AIDS-related deaths and a
total of 172 deaths, a more than 50% reduction in all DOCS deaths from just five years earlier.
The reduction in AIDS-related deaths in the 1990s was primarily due to the effectiveness of
52

Maruschak, L., Medical Problems of Prisoners, US Dept of Justice, Bureau of Justice Statistics, Table 1, April
2007 (http://www.ojp.usdoj.gov/bjs/pub/html/mpp/mpp.htm).
53
Ibid. at Table 2.
54
Ibid. at Table 4.
55
Mumola, C., Medical Causes of Death in State Prisons, 2001-2004, US Dept of Justice, Bureau of Justice
Statistics, at 1 (2007).

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available treatment for HIV disease and the fact that many inmates were on therapy when they
entered custody. Since then, the decline in inmate mortalities has been much less significant.
Table 12 details the total number and causes of death for DOCS inmates during the period 2001
through 2006.56
TABLE 12 – CAUSE OF DEATH FOR DOCS INMATES 2001-2006
Year
2001
2002
2003
2004
Homicide
3
5
2
2
Suicide
8
14
14
8
Accident
2
1
1
1
Other Causes
4
3
4
5
Natural Causes
134
149
164
125
AIDS
28
18
15
13
179
190
200
154
TOTAL
* Data is not available on AIDS-related deaths for these years.

2005
1
19
0
3
149
*
172

2006
0
8
0
5
118
*
131

The Bureau of Justice Statistics report on deaths in all state prisons, Medical Causes of Death in
State Prisons, 2001-2004, analyzed the prevalence of specific causes of death and provided data
for each state.57 In New York, the number of deaths due to natural causes other than AIDS has
remained relatively constant throughout the period. The number of DOCS deaths for 2001-04
was the fourth highest in the country, behind California, Texas and Florida, which all have
substantially larger inmate populations. The average rate of death due to illnesses for New York
inmates was also the third highest for all state prisons outside the southern region of the country,
where much higher mortality rates generally exist.58 The most important causes of death for
DOCS inmates were heart disease, cancer, AIDS and liver disease. Nationally, cancer of the
lung was the most common site for inmate cancer deaths. For female inmates nationally, breast,
ovarian, cervical and uterine cancers accounted for 24% of all female inmate cancer deaths.59
Given the relatively high incidence of death for DOCS inmates, it is important for the
Department to have an aggressive program to identify and treat the illnesses most likely to cause
inmate mortality. It is not clear that DHS has intensely focused on heart disease or cancer, and
the CA is not aware of any quality improvement activities evaluating care of patients with these
illnesses. The CA is also concerned that the mortality reviews conducted by the Commission of
Correction are not rigorous for inmates dying of natural causes and that these reviews are not
issued in a timely manner. The CA believes that legislation requiring DOH oversight should
include a renewed focus on inmate mortalities to determine if measures can be taken to reduce
the number of these deaths.

56

See Inmate Mortality Report, 2001-2004, DOCS (2005); Unusual Incident Reports 2005, DOCS (2006); Unusual
Incident Reports 2006, DOCS (2007).
57
Mumola, C., Medical Causes of Death in State Prisons, 2001-2004, US Dept. of Justice, Bureau of Justice
Statistics (2007).
58
Ibid. at Appendix table 9.
59
Ibid. at 2.

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For inmates who are seriously ill, one option to enhance their end-of-life experiences and to
reduce the cost of care for the Department is to release them early to the community when they
no longer pose any risk to society due to their deteriorated condition. New York’s Medical
Parole Law has been in place since 1992 and provides for the early release of inmates who are
“suffering from a terminal condition, disease or syndrome” and who are “so debilitated or
incapacitated as to create a reasonable probability” that they are “physically incapable of
presenting any danger to society.”60 The Medical Parole Law permits inmates to be released
before they reach their minimum sentences and requires DOCS to make an assessment of the
inmates’ medical condition and the Division of Parole to make the final determination whether to
release the individual. Since 1992, Parole has released 289 individuals on medical parole. An
additional 61 inmates, who had already been before the Parole Board and been denied parole,
have received an expedited reconsideration of parole when their medical condition deteriorated.61
During the early years of the Medical Parole Law, many inmates were regularly released, but
during the last several years, only about 12 inmates have been released annually through Medical
Parole and Full Board Case Review procedures. This figure represents less than 10% of the
inmates dying in custody.
In 2008, then-Governor Eliot Spitzer and DOCS proposed an amendment to the Medical Parole
Law during the budget process which would have expanded the law to cover inmates who are so
physically or cognitively incapacitated that they no longer present any danger to society, even if
they do not have a terminal condition. Unfortunately, the Senate opposed the provision and
during negotiations over the budget, this measure was withdrawn. The CA strongly supports the
expansion of the Medical Parole Law and urges state officials to pass pending legislation such as
Assembly Bill A10863, which is similar to the executive’s budget proposal, broadening the
scope of the Medical Parole Law.
PATIENT EDUCATION AND ACCESS TO HEALTH MATERIALS
Access to comprehensive, user-friendly health materials can empower patients with basic health
information such as which questions to ask medical providers, what to expect during medical
exams and tests, and how to take steps toward building healthy and safe lives after release.
Informed patients can more actively contribute to their own health and build effective
relationships with their providers. Greater efforts are needed throughout the Department to
improve patient education during all medical encounters. Moreover, patients with chronic
medical conditions need ongoing education about their condition, treatment and prognosis so that
they can fully participate in their treatment and recovery.
In February 2008, the CA was pleased to work with DOCS to establish a women’s health section
in the general library of each of New York’s seven correctional facilities that house women. The
CA decided to initiate this project after hearing comments from women during prison visits that
library health materials were often inaccessible, scarce and outdated. The CA collaborated with
60

Executive Law, § 259-r (McKinney’s Conn. Laws of NY).
When inmates have already passed their minimum sentence and been denied parole, they are no longer eligible
for Medical Parole, but they can be considered for parole on an expedited basis in a process known as Full Board
Case Review (FBCR). Sixty-one terminally ill inmates have been released since 1992 utilizing this FBCR process
during which DOCS and Parole apply the medical standards for eligibility similar to the Medical Parole Law.

61

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medical professionals, DOCS librarians and community librarians, currently and formerly
incarcerated women and other advocates to compile a comprehensive list of resources addressing
the most common health issues facing incarcerated women. The CA then secured donations
from publishers and individual donors to gather the materials.
The male prison population could also benefit from better patient education and access to healthrelated materials. Much of the information contained in the collection of health materials
provided to the women facilities would be useful to men. We urge the Department to review that
collection, identify what materials would be informative for men and seek funding for the
purchase of these materials.
Educating the inmate population about how to access healthcare systems in the community upon
release is an important component of discharge planning. The CA commends the Department
for initiating the Health Reentry Taskforce, coordinated by the New York Academy of Medicine,
which, in addition to other efforts described earlier concerning Medicaid eligibility, is
investigating ways to provide inmates with crucial information about how they can obtain
healthcare for themselves and their families once they are discharged. Moreover, the AIDS
Institute’s Criminal Justice Initiative will be including this type of information in its training of
peer educators. We urge the Department to continue its efforts with the Reentry Taskforce and
the CJI providers to explore ways to include this information in the health training that occurs in
the prisons, particularly in phases II and III of the transitional services programs provided to
inmates about to be released from prison.
WOMEN-SPECIFIC HEALTHCARE NEEDS
This report does not include a full analysis of health services for women in the state’s
correctional facilities. Evaluating these services is a critical part of assessing DOCS ability to
meet the healthcare needs of individuals in its custody, and the CA plans to issue a separate
report in the future with more in-depth analysis of medical care provided to incarcerated women.
What follows are general comments about women-specific health care and an overview of
various aspects of CA findings and observations about healthcare for women in DOCS custody.
In addition to gynecological, reproductive, nutritional and other health requirements, women’s
individual life experiences and circumstances significantly impact their health care issues and
needs. Multiple studies have shown that a disproportionately high percentage of incarcerated
women, including those in New York’s prisons, are survivors of trauma and/or physical and
sexual abuse, both as children and as adults.62 DOCS estimates that 88% of female inmates had
62

A study conducted in 1999 found that 82% of women incarcerated at Bedford Hills had a childhood history of
severe physical and/or sexual abuse, that more than 90% had endured physical or sexual violence in their lifetimes
and that 75% had experienced severe physical violence by an intimate partner during adulthood. Browne, Miller
and Maguin, “Prevalence and Severity of Lifetime Physical and Sexual Victimization Among Incarcerated Women,”
International Journal of Law & Psychiatry 22(3-4) (1999). Nationwide, more than 57% of women in state prisons
and 55% of women in local jails report having been physically and/or sexually abused in the past. More than 37%
of women in state prisons report having been raped at some point before their incarceration. Prior Abuse Reported
by Inmates and Probationers, Bureau of Justice Statistics, U.S. Department of Justice (April 1999), at 2, and Doris J.
James, Profile of Jail Inmates, 2002, Bureau of Justice Statistics, U.S. Department of Justice (July 2004), at 10.

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a substance abuse problem before their arrest, compared with 71% of male inmates. Many
women have engaged in sex work before their incarceration, thereby increasing their exposure to
sexually transmitted diseases. Approximately 72% of women in New York State prison report
being parents, compared to nearly 58% of incarcerated men. Women are more likely than men to
have been the primary caretakers of their children prior to arrest, and incarcerated mothers
frequently note that being separated from their children contributes to feelings of depression,
anxiety and low self-esteem. Incarcerated women also suffer from serious mental illness at
considerably higher rates than male inmates.
Most state facilities for women provide gynecological (GYN) care through on-site specialty
clinics. As a result of these arrangements, incarcerated women require routine access to and
follow-up from GYN specialists, whether or not they are ill. Women also need at least yearly
Pap smear tests and mammograms after they reach a certain age. During CA visits to Bedford
Hills and Albion in 2005, most women inmates reported that they did not have serious problems
accessing routine GYN care, and most praised the quality of the gynecologists. Many, however,
reported difficulty obtaining abnormal gynecological test outcomes in a timely fashion and
delays in accessing consistent and adequate follow-up care for abnormal test results and other
gynecological issues that necessitated treatment from specialists other than on-site providers.
Additionally, although most women reported that they had been given a Pap test and a
mammogram (if they were over 40 years old) at some point in last 12 months, some indicated
that they had not received either procedure in the past year.
During past CA visits, most women inmates reported that the number of sanitary napkins and rolls
of toilet paper they received each month was not sufficient for their needs. Many women reported
that if they needed more sanitary napkins or toilet paper, they had to request it from their housing
officer, often an uncomfortable and humiliating situation, particularly if the officer was male. On
a positive note, after working with DOCS recently-created Women’s Task Force on this issue, the
CA has received reports since these initial visits that the situation has improved at certain
facilities. Unfortunately, more work needs to be done, as the CA continues to receive reports that
women in certain facilities continue to encounter difficulty accessing adequate supplies.
Women consistently identified food and nutrition as areas of concern. They explained that meals
were disproportionately composed of starches and fats and described the food as “disgusting”
and “bland.” Many women explained that prison food had led to skin problems, deteriorating
nail quality and general feelings of depression. Some women noted that the prison diet,
combined with limited opportunities for exercise, made it difficult for them to stay fit and
maintain proper body weight.
Women also reported that certain medical providers, especially sick call nurses, sometimes
refused to take seriously certain women-specific health issues and minimized problems like
menstrual and menopausal symptoms as not “real enough” to warrant consideration and
treatment. Women noted that some medical providers seemed predisposed to believing that
female inmates complain merely to get attention or medication.
In March 2000, DOCS issued a 12-page document entitled Female Health Appraisal Primary
Care Guidelines. This document seems to be the Department’s main tool for instructing medical

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staff about its standards for providing women-specific health care. Though it is a positive sign
that DOCS maintains this document, the practice guidelines do not seem comprehensive and
contain information from sources that are a decade old.
Additionally, the CA is not aware of: (1) any specific quality improvement mechanism used by
DOCS to conduct consistent and comprehensive assessments of its women’s health care services
or (2) any women-centered healthcare training that DOCS requires its doctors to undergo.
Training providers in concepts of women-centered healthcare would significantly enhance
DOCS’s ability to ensure that providers are communicating with, assessing and treating the
female patients in its custody in the most effective way possible. Without such training and
perspective, a provider may:
•
•
•
•
•

inadvertently traumatize female patients who have histories of abuse or trauma, or
depression and/or other mental health issues (e.g., by conducting a physical exam
without sufficient warning or explanation);
dismiss health concerns specific to female patients, such as symptoms related to
menstruation and menopause;
misdiagnose female patients or fail to diagnose patients as early as possible
because of illness symptoms unique to women;
fail to effectively empower female patients to comply with treatment plans and to
be active participants in their own health, especially women with low self-esteem,
who may not believe that they are “worthy” or deserving of good treatment; and
miss the opportunity to refer patients to other supportive services (e.g., domestic
violence counseling, mental health services, support groups, and parenting and
family services) that promote well-being and may help patients make positive
choices about their health and that of their children and families after release.

DOCS could improve its health services for women by requiring medical providers to adopt a
women-centered approach and integrate into their practice an understanding of women’s specific
health needs and symptoms, the complex circumstances of incarcerated women’s lives, and the
varied ways in which those circumstances affect female patients’ health, behavior and
communication style.
EXTERNAL OVERSIGHT OF PRISON HEALTHCARE
DOCS spends approximately $324 million on prison healthcare annually for more than 62,000
inmates in its custody. It is providing HIV care to the largest population of HIV-infected
patients in the state and the largest HIV prison population in the country. With more than 1,900
DOCS medical personnel, 45 prison infirmaries, five Regional Medical Units and tens of
thousands of specialty care consultations per year, the prison healthcare system is extremely
complex and cumbersome. Such a dispersed system must be externally monitored to ensure that
its many parts are functioning adequately and efficiently. Such independent oversight currently
does not occur.
The New York State Department of Health has had very limited involvement in the provision of
healthcare to state inmates. Specifically, DOH does not exercise any general oversight function
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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

concerning care at prison clinics, infirmaries or Regional Medical Units. An exception is the
efforts by administrators at the DOH AIDS Institute (AI) who hold periodic meetings with DHS
administrators and assist DOCS in developing and implementing AI’s HIV Quality of Care
Program (HIVQUAL) throughout the system. After nearly ten years of planning, the program
was finally implemented at all prisons in 2006 as part of the resolution of litigation about HIV
care. However, external oversight of HIV care or other medical care in the prisons by DOH, or
any other outside agency, is nonexistent.
The State Commission of Correction (SCOC) is authorized to monitor prison operations,
including healthcare, and performs reviews of all inmate deaths occurring in DOCS custody.
This oversight appears minimal, however, and in the last several years, the death reviews of
inmates who have died of natural causes have been mostly pro forma. The SCOC budget is
insufficient to support a rigorous review of DOCS medical practices. The agency lacks the
resources and expertise to undertake external oversight of the prison medical care system, and it
does not perform any regular monitoring of healthcare practices at the prisons.
The CA has statutory authority to visit the prisons and report to state officials concerning its
observations and recommendations. For external oversight to be effective, it is crucial that the
reviewed agency actively participate in the review process and in developing and implementing a
corrective plan. Recently, the CA has had constructive exchanges with the new DOCS
administration about prison issues, and the CA expects to have a lively and positive dialogue
with DOCS and DOH officials about the CA’s concerns regarding prison healthcare.
DOH is best suited to perform external monitoring of DOCS healthcare system. With additional
resources allocated in the state budget, DOH could regularly visit each prison, review systemwide data on the important components of the medical care system, inspect sample medical
records of patients with specific conditions and speak with inmates and staff about their concerns
about the healthcare system.

RECOMMENDATIONS
1. ENHANCE DOCS MEDICAL STAFF
A. Fill Vacant Medical Positions Expeditiously - State policymakers must take action to ensure
that authorized DOCS medical positions are promptly filled. This step will require increased
compensation for certain job titles (e.g., pharmacists, physician assistants and nurses) and/or
geographical pay increases in parts of the state where it is difficult to recruit competent
personnel. Prison administrators should more aggressively recruit staff, and DOCS’s Division of
Health Services (DHS) should assist prisons in identifying qualified applicants and should better
supervise local efforts to hire replacement personnel.
B. Assess Medical Staff Needs and Add Staff to Prisons with the Most Serious Deficiencies Even if all medical positions were filled, some prisons need additional positions. DOCS should
perform a detailed staffing analysis, and, once this needs assessment is completed, the state
should approve funding to permit DOCS to add personnel at the prisons with the greatest need.

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The Correctional Association of New York

C. Enhance Reviews of Medical Staff Performance - Although DOCS performs limited
reviews of the medical staff in accordance with the union contract with medical staff, some
providers appear to have minimal qualifications and poor performance records. DOCS should
more closely monitor the job performance of medical personnel and require that staff identified
as needing improvement participate in mandatory training.
D. Augment Training of Medical Staff - Although some DOCS medical providers are highly
qualified and skilled practitioners, others could benefit from more rigorous training and updated
education on medical conditions and DOCS medical protocols. Training of nurses and clinic
providers should include instruction on how to be receptive and respectful to patients during all
medical encounters. DHS should more closely monitor the continuing education of providers
and facilitate greater participation in training by providing monetary support, approved absences
for training and other incentives to enhance the skills of prison medical staff.
2. IMPROVE ROUTINE CARE WITHIN THE PRISONS
A. Enhance Sick Call Services - As part of DOCS’s Quality Improvement (QI) program, prison
health administrators and DHS QI personnel should routinely assess the quality of the sick call
process at all DOCS facilities. This assessment should include a determination of the: adequacy
of the staff assigned to sick call, timeliness of sick call services, quality of interactions between
the sick call nurses and patients, and degree to which timely follow-up occurs in response to sick
call examinations.
B. Ensure that Inmates Have Timely Access to Clinic Providers and Adequate Care During
Clinic Call-outs - As part of DOCS’s Quality Improvement program, prison health
administrators and DHS QI staff should routinely assess each prison to determine whether
adequate personnel is assigned to clinic call-outs and to evaluate the adequacy of clinic
encounters. At prisons where it is determined that inmates do not have timely access to
providers for routine care, the Department should assign additional personnel. At prisons where
it is determined that clinic examinations and treatment are deficient, the Department should
implement a corrective plan, including staff training and close monitoring, to improve these
medical services.
3. IMPROVE CARE OF THE CHRONICALLY ILL
A. Assign Every Chronically Ill Inmate to a Regular Primary Care Provider - DOCS should
assign each inmate with a chronic disease to a specific provider at the prison where the inmate is
confined. Thereafter, that provider should be responsible for regularly monitoring the patient
and overseeing all medical care to ensure the timely and appropriate provision of treatment.
B. Develop a Chronic Care System that includes a Chronic Care Coordinator and a
Computer-based System to Schedule and Monitor Chronic Care - The complicated nature of
caring for patients with chronic illnesses requires a system to organize the many aspects of
effective healthcare. The system should facilitate the coordination of laboratory tests, diagnostic
procedures, specialty care consultations and medical treatments. It should also include a chronic
care coordinator who is assigned to performing these functions. This coordinator should be

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

responsible for communicating with relevant medical staff and with the patient about how to
optimize care by improving patient adherence to treatment and minimizing delays in care and
adverse side effects of treatment. To assist the chronic care coordinator, the prisons should have
a computer-based scheduling system and other computerized records to manage patient care.
Finally, DHS should continue to issue clinical practice guidelines for medical conditions
frequently experienced by inmates, as recommended by the National Commission on
Correctional Health Care for epilepsy and high blood cholesterol, as well as for respiratory and
digestive diseases.
C. Enhance Efforts to Identify Inmates Infected with HIV and Ensure that Identified
Patients are Provided Care Comparable to Community Standards for HIV Treatment DOCS should augment its efforts to identify a greater percentage of the HIV-infected inmate
population at the time inmates are admitted to prison and throughout their incarceration, by
enhancing the HIV education, counseling and testing services provided by the DOH AIDS
Institute’s Criminal Justice Initiative and HIV testing and counseling performed by DOCS and
Department of Health personnel. Peer education should be an essential component of this
outreach process. The Department should investigate why there are significant variations in the
percentages of known HIV-infected inmates at different prisons and enhance efforts at
problematic prisons to identify more inmates with HIV. Medical staff at each prison should
ensure that identified HIV-infected inmates are periodically evaluated by an HIV specialist based
upon their health status and that such specialists are consulted when it is determined that a
patient is failing on his/her current medication regimen. The Department should investigate
prisons with low usage of IFD specialists to ensure that all HIV-infected inmates have prompt
access to a specialist when needed. To evaluate the quality of HIV care, DOCS’s Continuous
Quality Improvement Committee should more closely scrutinize the results from the HIV
Continuous Quality Improvement audits to ensure that each prison is adhering to DOCS’s HIV
Practice Guidelines. In particular, officials should pay close attention to whether there is prompt
access to HIV experts and appropriate follow-up to their recommendations.
D. Enhance Efforts to Identify Inmates Infected with Hepatitis C and Ensure that HCVinfected Inmates Receive Timely Care Comparable to Community Standards for HCV
Treatment - DOCS must enhance its efforts to identify inmates infected with HCV at the time
they are admitted to the prison system and throughout their incarceration. All newly admitted
inmates should be screened for HCV. DOCS should also eliminate delays in testing inmates for
HCV and determining whether they are appropriate candidates for treatment. The Department
should investigate variations among the prisons in the percentage of HCV-infected inmates, in
the percentage of HCV-infected inmates diagnosed as chronically infected, in the use of
gastroenterology and liver biopsy services and in the number of HCV-infected patients being
treated. Prisons found to be lax in their efforts to evaluate inmates for this disease or to evaluate
and treat patients with liver damage should have to implement a remedial plan to address care
deficiencies. DHS should continue to maintain records of the number of patients receiving HCV
therapy and monitor their response to such treatment to assess whether HCV therapy has been
successful in the prison setting. DOCS Continuous Quality Improvement Committee should
more vigorously monitor the results of the HCV audit process to ensure that each prison
aggressively pursues identification of its HCV-infected population and treatment of those
patients who would benefit from therapy.

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

E. Increase Funding for the DOH AIDS Institute’s Criminal Justice Initiative to Enhance
its HIV Prevention Activities - The Criminal Justice Initiative (CJI) has provided essential
services to the HIV-infected inmate population. The state should provide additional funds so
that the CJI can offer all the HIV prevention services needed at each prison, particularly peer
training, support services and comprehensive transitional services for all HIV-infected inmates
being discharged. DOCS and DOH should coordinate efforts so HIV peer educators trained by
the CJI contractors can engage more fully in patient education and efforts to encourage the
prison population to get tested and enter treatment.
4. ENHANCE ACCESS TO SPECIALTY CARE SERVICES
A. Ensure Timely Access to Specialists - DHS and prison medical administrators should more
closely monitor the timeliness of specialty care services to ensure that inmates are seen in
accordance with the priorities established for the medical consultation by the prison provider. In
addition, the Facility Health Services Director (FHSD) should regularly review medical charts to
determine whether providers are referring patients to specialists when their conditions warrant.
The Department should investigate the significant variations among prisons in their use of
specialty services and require a remediation plan at any prison found to be underutilizing
specialty services. The Department should evaluate the effectiveness of the recently
implemented Quality Assessment tools being used by the prisons to monitor specialty care.
DHS’s Continuous Quality Improvement Committee should closely monitor prisons’ utilization
of specialty services to ensure that all inmates have timely access to specialists when needed.
B. Monitor Prison Provider Follow-up to Specialists’ Recommendations to Ensure
Appropriate Treatment - Inmates frequently complain that prison providers are not promptly
acting on recommendations of specialists for additional evaluation, treatment and follow-up
services. DHS and prison medical administrators should evaluate whether the recently
implemented Quality Assurance tools developed to monitor specialty care are effective in
routinely assessing whether the prison providers are following up promptly on specialists’
recommendations. In addition, DHS and prison medical staff should utilize the specialty care
computer system to evaluate whether appropriate follow-up care is occurring as requested by
specialists. Prisons identified as failing to provide timely follow-up on specialists’
recommendations should be required to implement a remediation plan monitored by DHS
officials.
5. IMPROVE PHARMACY SERVICES
A. Increase Pharmacist Salaries and Expeditiously Fill Vacant Pharmacy Positions - To fill
the many pharmacy vacancies and to open closed prison pharmacies, the state will need to
authorize increased salaries for prison pharmacists. Once appropriate salary levels are approved,
DOCS and prison administrators should enhance their efforts to fill vacant pharmacy positions.
B. Expedite Implementation of the Computerized Pharmacy Program - DHS should
expedite the implementation of the new computer system for pharmacy services. The system
should be utilized to prevent medication shortages at prisons and the prescription of
inappropriate therapies. Once the system is fully operational, DHS should use it to monitor

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

medical treatment adherence by inmates with chronic conditions. Finally, DHS should employ
the computer system in other quality assurance tasks, such as evaluating the effectiveness of
therapies used to treat various chronic conditions and identifying individuals for chart review to
aid in this process.
C. Expedite Efforts to Replace Contract Pharmacy Services with DOCS Supplied
Medications - DOCS should accelerate its efforts to develop the capability of its Central
Pharmacy to directly dispense medications to individual inmates at prisons that currently do not
have a pharmacy. This step would represent a welcome advancement toward discontinuing the
costly use of contract pharmacy services. In addition, DOCS should enhance efforts to recruit
pharmacists to prisons that have closed their pharmacy, so that more prisons will be able to have
a pharmacy in their medical unit.
6. ENHANCE DOCS’S QUALITY IMPROVEMENT PROGRAM
A. Ensure that All Prisons Have an Active Prison-Based Quality Improvement Program DHS and prison administrators should ensure that each prison is fully implementing DOCS’s
policy concerning prison-based QI activities, including quarterly QI meetings. These activities
should include regular performance of random chart reviews of the care provided to inmates
infected with chronic diseases, as well as assessing the routine care processes (e.g., sick call,
physicals, call-outs and specialty care services) utilizing the instruments contained in DOCS’s
Quality Assessment Tools Manual. The prison QI team should develop written action plans to
address identified deficiencies and communicate this information to the Regional Medical
Directors (RMDs) and DHS CQI Committee. The implementation of these plans should be
closely monitored by the RMDs, the Regional Health Services Administrators (RHSDs) and the
DHS CQI Committee.
B. Conduct Regular Meetings in Each Prison with Medical Personnel, Prison Executive
Staff, the Inmate Liaison Committee and Inmate Grievance Representatives to Discuss
Prison Healthcare – Each prison should conduct routine meetings with the Inmate Liaison
Committee, Inmate Grievance Representatives, prison medical staff and the prison executive
staff to discuss inmate concerns about prison medical care. These meetings should be used to
assess inmates’ satisfaction with the medical care, to identify recurrent medical problems and to
communicate with inmates about updated medical procedures and policies.
C. Increase DHS’ Quality Improvement Committee Activities - The DHS CQI Committee
should review the medical services at each prison at least once per year through audits conducted
by prison medical staff and the DOCS senior utilization review nurses with the instruments
developed as part of DOCS CQI policies, including those contained in DOCS’s Quality
Assessment Tools Manual. The DHS CQI Committee should specify how frequently each
quality assessment tool should be used at the prisons as part of their QI efforts. The DHS CQI
Committee should issue written instructions for development of a remediation plan and followup monitoring at each prison where deficiencies are noted. The DHS CQI Program should set a
more rigorous threshold for noncompliance than is currently applied. Prisons where a QI audit
reveals that the care in more than 10% or 20% of the medical charts is inconsistent with an audit
indicator should have to develop a remedial plan. The prisons’ FHSD and Nurse Administrator

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

should develop these remedial plans, and the RMDs and RHSDs should monitor them. The DHS
CQI Committee should develop additional assessment tools, including measures to assess the
care for chronic diseases not already covered by DOCS’s Clinical Practice Guidelines.
7. IMPROVE SERVICES FOR INMATES WITH LIMITED ENGLISH SKILLS
A. Implement Telephone Translation Services at Facilities that Do Not Already Have
Them, and Direct Prisons to Utilize These Services When Bilingual Medical Staff Are Not
Available for Exchanges with Patients with Limited English Skills - Medical staff should use
translation services even if a patient has some English proficiency because understanding
medical conditions, treatment recommendations and related information requires more
sophisticated language skills than many inmates with poor English-speaking skills possess.
B. Provide Pay Differentials to Medical Staff Who are Bilingual and Actively Recruit
Bilingual Medical Staff - Given that 8% or more of the inmate population has limited English
proficiency, a greater percentage of the medical staff should be bilingual. In order to recruit such
staff, the state should provide a pay differential to medical staff who perform translation duties.
Such staff should also receive specific training in the proper translation of medical information.
C. Provide Medical Information for Inmates with Limited English Skills in Inmates’ Native
Languages - Healthcare staff at each prison should provide inmates with limited English skills
access to medical documents (e.g., patient educational materials, medication instructions,
discharge summaries from medical units containing patient instructions, medical refusal forms,
etc.) in their native language. In this way, inmates can better understand their care, comply with
their treatment protocols and alert the medical department if they experience adverse effects
from their treatment.
8. IMPROVE CONTINUITY OF CARE FOR INMATES WITH MEDICAL PROBLEMS
A. Improve Continuity of Care for Inmates Transferred Among DOCS Prisons - DOCS
should enhance the continuity of care for transferred inmates by ensuring that for each inmate
with a medical problem or receiving medical treatment who is admitted to a prison, the medical
department performs the following tasks: (1) the patient’s medical chart is promptly reviewed;
(2) the patient is assigned to a primary care provider; (3) the patient is promptly seen by that
provider; and (4) there is no interruption in the patient’s medications or care plan.
B. Provide Enhanced Discharge Planning Services for Inmates with Chronic Illnesses DOCS should provide all inmates with a chronic illness who are about to be discharged from
prison with appropriate documentation of their condition and treatment, along with an adequate
supply of medications and prescriptions to continue treatment until care can be arranged in the
community. In addition, corrections and parole staff should assist soon-to-be-released inmates in
identifying a provider in the community to continue necessary care and in scheduling an
appointment for care following release. This effort will require coordination among the prison
medical department, transitional services and parole.

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

C. Undertake Efforts to Expedite Inmates’ Enrollment in Health Insurance Upon Their
Release - The vast majority of the 28,000 inmates being released each year must wait between
six weeks and several months to qualify for medical benefits under programs such as Medicaid
because no Medicaid application is filed or processed while they are incarcerated. DOCS, the
Department of Health and the Division of Parole should implement the pilot program funded in
the FY 2008-09 budget to ensure that inmates nearing release are enrolled in Medicaid.
Following this pilot program, the governor and legislature should enact regulations and/or
legislation to require that Medicaid applications be filed and processed for all eligible inmates
prior to their release from custody so that they can access healthcare immediately upon returning
to the community.
9. CONFIDENTIALITY IN MEDICAL ENCOUNTERS
A. Require Medical Services to be Provided in a Setting that Ensures Patient
Confidentiality - Review medical procedures and the settings in which medical services are
provided to ensure that conversations between patients and their providers are conducted in a
confidential manner. In Special Housing Units, when confidential medical information will be
discussed during a medical encounter, require medical staff to request that inmates are removed
from their cells and taken to an area where confidential conversations can occur.
10. CARE FOR THE AGING INMATE POPULATION
A. Evaluate Medical Staffing, Training and Care Facilities to Determine if Adequate
Resources are Available to Treat the Increasing Numbers of Aging Patients - Given the
significant growth in the percentage of inmates 50 years and older and the resulting increase in
illnesses experienced by these inmates, the Department should assess whether it has sufficient
medical staff and physical resources to care for this population. In addition, DOCS should
provide mandatory continuing medical education on conditions common to an older population.
B. Regularly Reassess the Demand within the DOCS Population for Care Similar to that
Available in the Fishkill Unit for the Cognitively Impaired and Provide Sufficient Capacity
to Meet the Need - The Fishkill Unit for the Cognitively Impaired, opened in 2006, is an
important addition to DOCS’s medical capacity. The Department should regularly reassess the
need for these services throughout its inmate population to determine whether this Unit is
adequate to meet the demand for such services.
11. INMATE DEATHS
A. Enhance the Department’s Medical Training and Quality Improvement Activities for
Conditions Likely to Result in Inmate Deaths - DOCS should perform a systemic analysis of
the causes of inmate deaths. Once it has identified the most common causes, it should institute
more intense medical training and a quality improvement program to enhance care provided for
conditions (e.g., heart disease, cancer, liver disease, etc.) that are more likely to result in inmate
mortalities.

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

B. Expand the Medical Parole Law to Include Inmates Who are so Physically or
Cognitively Incapacitated that They No Longer Present Any Danger to Society - The state
should enact legislation supported by DOCS to expand the Medical Parole Law, which currently
permits the early release of dying inmates who are physically incapacitated and no longer present
a danger to society, to include individuals whose condition may not be terminal, but who are so
physically or cognitively incapacitated that they present no danger to society.
12. PATIENT EDUCATION AND ACCESS TO HEALTH MATERIALS
A. Enhance Patient Education during Medical Encounters - In order for patients to
participate more effectively in their own care, it is essential that they be educated about their
illness and treatment. DOCS should enhance its patient education efforts at all levels of care.
For patients with chronic conditions, continuous patient involvement is crucial to successful
treatment. All soon-to-be-released inmates also need education about how to access health
services in the communities to which they will be returning.
B. Expand Health Materials Available to all DOCS Inmates in Prison Libraries - Building
upon the successful introduction of a comprehensive health section in the women’s libraries
resulting from a CA initiative to provide these materials for all female institutions, DOCS should
develop a comparable collection of health materials for all male facilities in the prisons’ libraries.
13. IMPROVE SERVICES FOR INCARCERATED WOMEN
A. Require Medical Providers Working in Women’s Facilities to be Trained in Concepts of
Women-Centered Healthcare - DOCS medical providers should be trained to recognize and
incorporate into treatment plans the complex and specific circumstances of the lives of
incarcerated women, including issues of trauma, domestic violence and the physical and mental
health implications of abuse. Such training would enhance the quality of care for women
prisoners and reduce the likelihood that women-specific health issues such as yeast infections
and menstrual cramps will be dismissed by providers as “not serious enough” to warrant
attention and treatment.
B. Enhance Quality Improvement Activities Monitoring Women-specific Healthcare and
Develop More Comprehensive Policies that Outline Standards for Women’s Healthcare,
Including Gynecological and Reproductive Healthcare - To ensure that women in state
custody receive quality health services, DOCS should: (1) develop more comprehensive written
policies that clearly outline women’s healthcare standards; (2) require gynecologists to
participate in DOCS’s Division of Health Services and facility-based Quality Improvement
Committees; (3) require Quality Improvement Committees to conduct consistent and
comprehensive assessments of women-specific healthcare at each women’s correctional facility;
and (4) require Quality Improvement Committees to issue corrective action plans to improve
women-specific healthcare when necessary and monitor the implementation of those plans.
C. Provide Women with an Adequate Supply of Hygiene Items and Proper Nutrition DOCS should ensure that each woman in state custody has an adequate number of sanitary

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

napkins and rolls of toilet paper. DOCS should also review its cook-chill menu to ensure that it
meets the particular nutritional requirements of women.
14. ENHANCE EXTERNAL OVERSIGHT OF PRISON HEALTHCARE BY DOH AND SCOC
A. Mandate Department of Health Oversight of Prison Healthcare - To improve prison
healthcare, DOH oversight is necessary. The legislature should adopt several legislative
measures, including bills like A.3787 (Gottfried) and A.3849 (Gottfried)/S.2819 (Duane),
requiring DOH to monitor medical care in the prisons. Alternatively, the governor, without
legislative mandate, could direct DOH to monitor prison healthcare, consistent with DOH’s
general duties under Article 28 of the Public Health Law. For the process to be effective, it is
essential that DOH make public the results of its monitoring activities and include public input
into the monitoring process. In performing this oversight, DOH should also examine carefully
inmate mortalities to determine if measures can be taken to reduce the number of inmate deaths.
B. Revitalize Mortality Reviews by the State Commission of Correction (SCOC) - SCOC
performs mortality reviews of all inmate deaths in New York’s prisons and jails. However, in
recent years, the reviews of deaths of state inmates due to illnesses have been less substantive.
SCOC should conduct more rigorous, timely and comprehensive reviews of prison deaths and
make public the findings of the SCOC mortality review committee.

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Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

EXHIBITS

- 87 -

EXHIBIT A

EXHIBIT B
73.4

1,737 1,275

Sing Sing

1,707

Wyoming

90.8 446
23

28,253 25,663

1,351

8

92

11

12

7

1

10

60

7

46

73

3

13

57

1

14

26

2

3

6.3% 3.4

229

4,349

15.4

72 19.0% 4.2

790 22.4% 68.0

94 15.9% 12.6

205 16.1% 11.8

42 10.1% 3.5

137 39.4% 19.0

421 14.4% 19.6

444 18.8% 26.4

60

241 16.6% 14.0

355 18.6% 20.0

118 13.2% 10.0

103 11.7% 10.5

348 19.1% 12.0

63 14.4% 7.8

355 15.0% 20.1

222 12.3% 10.1

253 24.0% 26.7

6

113

0

20

1

5

3

3

2

13

2

7

1

9

0

13

3

17

6

8

0

#/100 HIPAA

26 10.2% 2.3

%
Med

443

3830

516

1560

307

499

2397

2130

1271

1127

1841

674

699

1115

491

2700

1860

1051

286

Griev
2004

1,305

28,258 24,797

1672

1251

718

1744

1199

727

2145

1642

1746

1719

1782

1168

1033

2843

792

1765

2181

947

1184

Pop
2005

87.8

26.5

306.2

71.9

89.4

25.6

68.6

111.7

129.7

72.8

65.6

103.3

57.7

67.7

39.2

62.0

153.0

85.3

111.0

24.2

20

389

24

97

5

22

3

6

3

33

23

23

34

0

8

26

3

27

38

7

7

#/100 Dental

229

4,344

86

858

75

231

45

133

295

509

108

228

384

118

79

244

57

474

236

141

43

Med
#22

19.4%

22.4%

14.5%

14.8%

14.7%

26.7%

12.3%

23.9%

8.5%

20.2%

20.9%

17.5%

11.3%

21.9%

11.6%

17.6%

12.7%

13.4%

15.0%

15.4

5.1

68.6

10.4

13.2

3.8

18.3

13.8

31.0

6.2

13.3

21.5

10.1

7.6

8.6

7.2

26.9

10.8

14.9

3.6

EXHIBIT B

7

135

0

34

0

9

1

0

11

3

5

22

2

6

2

10

2

17

6

5

0

% Med #/100 HIPAA

Med # 22-Medical grievances code #22; % Med-% of medical grievances compared to all grievances; HIPPA-Grievances re confidentiality

Averages

Totals

22.2

303.9

1,162 3,531

Upstate

379

79.4

592

Sullivan

746

34.9

416

1,191

Mid-Orange

Oneida

136.1

2,149 2,925

Green Haven
48.3

140.6

1,681 2,364

Great Meadow

348

54.8

956

1,743

Gowanda

721

84.3

1,718 1,448

Fishkill

76.2
107.5

895

1,175

90.3

1,779 1,913

883

978

63.1

2,890 1,823

Elmira

Eastern

Coxsackie

Clinton

Bedford Hills

54.2

133.8

1,767 2,364

Auburn

438

81.9

2,204 1,805

Attica

808

111.2

947 1,053

Arthur Kill

22.2

255

1,150

Albion

#/100 Dental Med
# 22

Griev
2005

Pop
2006

Prison

Exhibit B - 2004 and 2005 Medical Grievances at CA Visited Prisons - 2004-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

4,349
229

1,805
2,364
438
1,823
883
895
1,913
1,448
956
2,364
2,925
348
416
1,275
592
3,531
379
25,663
1,351

2,204

1,767

808

2,890

978

1,175

1,779

1,718

1,743

1,681

2,149

721

1,191

1,737

746

1,162

1,707

28,253

Attica

Auburn

Eastern

Elmira

Fishkill

Gowanda

Great Meadow

Green Haven

Mid-Orange

Oneida

Sing Sing

Sullivan

Upstate

Wyoming

Totals

EXHIBIT C
72

790

94

205

42

137

421

444

60

241

355

118

103

348

63

19.0%

22.4%

15.9%

16.1%

10.1%

39.4%

14.4%

18.8%

6.3%

16.6%

18.6%

13.2%

11.7%

19.1%

14.4%

15.0%

12.3%

24.0%

10.2%

15.4

4.2

68.0

12.6

11.8

3.5

19.0

19.6

26.4

3.4

14.0

20.0

10.0

10.5

12.0

7.8

20.1

10.1

26.7

2.3

297

5,647

131

1,270

149

227

81

171

472

450

74

354

448

167

100

464

57

501

293

175

63

20.0

7.67

109.29

19.97

13.07

6.80

23.72

21.96

26.77

4.25

20.61

25.18

14.21

10.22

16.06

7.05

28.35

13.29

18.48

5.48

48

910

24

264

23

30

8

18

55

74

14

59

61

31

10

65

6

82

48

30

8

3.2

1.41

22.72

3.08

1.73

0.67

2.50

2.56

4.40

0.80

3.43

3.43

2.64

1.02

2.25

0.74

4.64

2.18

3.17

0.70

39

748

28

123

33

28

19

41

59

57

14

53

78

23

14

64

2

41

23

36

12

CORC* #/100 Meds* #/100 Spec*

2.6

1.64

10.59

4.42

1.61

1.60

5.69

2.75

3.39

0.80

3.08

4.38

1.96

1.43

2.21

0.25

2.32

1.04

3.80

1.04

82

1,564

43

377

25

81

20

28

127

136

14

110

118

36

32

143

17

119

73

41

24

5.5

2.52

32.44

3.35

4.66

1.68

3.88

5.91

8.09

0.80

6.40

6.63

3.06

3.27

4.95

2.10

6.73

3.31

4.33

2.09

#/100 Treatment* #/100

EXHIBIT C

* - Data refers to CORC appeals for the period January 2003 through May 2006. "Meds" refers to only such appeals concerning
medications or prescriptions. "Spec" refers only to appeals about specialty care services. "Treatment" refers to appeals about
general claims of inadequate care or treatment.

Averages

Coxsackie

Clinton

Bedford Hills

355

222

253

1,053

26

947

Arthur Kill

Albion

255

Pop 2006 Griev 05 Med-22 % Med #/100

1,150

Prison

Exhibit C - CORC Appeals of Medical Grievances at CA Visited Prisons - 2004-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

1,503

1,297

1,191

141

Mid-State

Mohawk

Oneida

Pharsalia

EXHIBIT D

876

637

4,005

Riverview

Watertown

2

552

477

1,720

219

2,890

Adirondack

Altona

Bare Hill

Chateaugay

Clinton

Totals

605

Ogdensburg

Hub

1,021

6,212

Gouverneur

Totals

866

1

Cape Vincent

Hub

111

1,255

Marcy

Walsh Medical

390

Hale Creek

173

151

Georgetown

Summit

Pop
2006

Prison

1

3

1

1

1

1

1

1

1

1

1

3

3

1

2

1

1

3

3

3

3

3

3

3

2

2

2

2

2

1

1

1

1

1

1

1

1

1

Med Hub
Class

Maximum

Medium

Medium

Medium

Medium

Medium

Medium

Medium

Medium

Medium

Maximum

Minimum

Minimum

Medium

Medium

Medium

Medium

Medium

Minimum

Security

183.67

201.83

122.44

189.52

211.41

115.06

153.85

107.31

106.45

113.61

102.08

178.49

1910.81

67.05

126.24

184.13

196.53

148.57

104.54

62.05

95.36

Page 1 of 4

5,308

442

2,106

904

1,167

4,608

980

940

644

1,160

884

11,088

2,121

116

178

2,193

2,549

2,233

1,312

242

144

262

3

145

39

79

31

14

4

3

10

0

189

100

0

0

64

10

2

9

3

1

Totl Spec # of IFD
Tot #
Apts
Rate
Spec Apt

EXHIBIT D

1

1

2

1

1

HIV
Spec

9.07

1.37

8.43

8.18

14.31

0.77

2.20

0.46

0.50

0.98

0.00

3.04

90.09

0.00

0.00

5.37

0.77

0.13

0.72

0.77

0.66

IFD
Rate

60

1

55

14

16

122

20

21

27

29

25

185

17

1

1

30

28

68

29

11

HIV+
Pts

2.08%

0.46%

3.20%

2.94%

2.90%

3.05%

3.14%

2.40%

4.46%

2.84%

2.89%

2.98%

15.32%

0.58%

0.71%

2.52%

2.16%

4.52%

2.31%

2.82%

Rate
HIV+

4.37

3.00

2.64

2.79

4.94

0.25

0.70

0.19

0.11

0.34

0.00

1.02

5.88

0.00

0.00

2.13

0.36

0.03

0.31

0.27

IFD per
HIV+

Exhibit D-DOCS Male HIV Rates and Infectious Disease Access-FY 2006-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

EXHIBIT D

746

599

793

Ulster

Wallkill

Woodbourne

2,149

Green Haven

5,096

128

Camp Mt. McGrego

Hub

Totals

5

29

1,689

Fishkill

Fishkill RMU

1,229

Downstate

5,921

746

Sullivan

Totals

539

Shawangunk

4

602

Otisville

Hub

721

1,175

9,032

Mid-Orange

Eastern

Totals

1,162

Upstate

3

135

Lyon Mountain

Hub

165

Gabriel

3

1

1

1

1

1

2

1

1

1

1

1

1

1

3

3

1

1,712

Franklin

6

5

5

5

5

4

4

4

4

4

4

4

4

3

3

3

3

3

Med Hub
Class
1

Pop
2006

Clinton Annex

Prison

Minimum

Maximum

Maximum

Medium

Maximum

Medium

Medium

Medium

Maximum

Maximum

Medium

Medium

Maximum

Maximum

Minimum

Minimum

Medium

Medium

Security

4

3.13

335.66

356.21

2979.31

409.59

135.72

234.22

324.59

127.38

13.54

267.02

327.27

176.41

334.12

272.60

194.71

217.99

170.37

177.58

212.97

Page 2 of 4

17,105

7,655

864

6,918

1,668

13,868

2,574

763

101

1,992

1,764

1,062

2,409

3,203

17,586

2,533

230

293

3,646

957

1

1,398

692

38

635

33

449

85

48

0

63

52

14

107

80

813

94

16

5

94

76

Totl Spec # of IFD
Tot #
Apts
Rate
Spec Apt

EXHIBIT D

1

1

1

1

HIV
Spec

0.78

27.43

32.20

131.03

37.60

2.69

7.58

10.72

8.01

0.00

8.45

9.65

2.33

14.84

6.81

9.00

8.09

11.85

3.03

5.49

IFD
Rate

134

61

42

31

139

21

13

17

26

14

8

21

19

246

28

6

5

61

HIV+
Pts

2.63%

2.84%

2.49%

2.52%

2.35%

2.65%

2.17%

2.28%

3.49%

2.60%

1.33%

2.91%

1.62%

2.72%

2.41%

4.44%

3.03%

3.56%

Rate
HIV+

10.43

11.34

15.12

1.06

3.23

4.05

3.69

0.00

2.42

3.71

1.75

5.10

4.21

3.30

3.36

2.67

1.00

1.54

IFD per
HIV+

Exhibit D-DOCS Male HIV Rates and Infectious Disease Access-FY 2006-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

978

56

1,681

1,756

506

200

526

Coxsackie

Coxsackie RMU

Great Meadow

Greene

Hudson

Moriah

Mt. McGregor

6,868

6

EXHIBIT D

1,222

1,005

871

996

51

940

1,707

Groveland

Lakeview (male)

Livingston

Orleans

Rochester

Wende

Wyoming

12,013

1,743

Gowanda

Totals

1,165

Collins

7

109

Buffalo

Hub

2,204

Attica

Hub

1,037

Washington

Totals

Pop
2006

Prison

1

1

3

1

1

1

1

2

1

2

1

1

1

3

2

1

1

1

1

7

7

7

7

7

7

7

7

7

7

7

6

6

6

6

6

6

6

6

Med Hub
Class

Medium

Maximum

Minimum

Medium

Medium

Minimum

Medium

Medium

Medium

Minimum

Maximum

Medium

Medium

Minimum

Medium

Medium

Maximum

Maximum

Maximum

Security

193.93

129.00

579.15

262.05

164.18

58.81

239.44

146.36

109.36

4.59

193.47

155.29

133.17

139.92

73.00

135.97

113.84

107.14

2776.79

240.80

Page 3 of 4

23,297

2,202

5,444

2,610

1,430

591

2,926

2,551

1,274

5

4,264

10,665

1,381

736

146

688

1,999

1,801

1,555

2,355

433

22

72

71

19

17

36

19

46

0

131

505

101

26

4

50

106

45

64

108

Totl Spec # of IFD
Tot #
Apts
Rate
Spec Apt

EXHIBIT D

1

1

1

1

HIV
Spec

3.60

1.29

7.66

7.13

2.18

1.69

2.95

1.09

3.95

0.00

5.94

7.35

9.74

4.94

2.00

9.88

6.04

2.68

114.29

11.04

IFD
Rate

240

29

25

0

27

13

9

30

18

25

64

159

20

20

13

33

48

25

HIV+
Pts

2.00%

1.70%

2.66%

0.00%

2.71%

1.49%

0.90%

2.45%

1.03%

2.15%

2.90%

2.32%

1.93%

3.80%

2.57%

1.88%

2.86%

2.56%

Rate
HIV+

1.80

0.76

2.88

2.63

1.46

1.89

1.20

1.06

1.84

2.05

3.18

5.05

1.30

3.85

3.21

0.94

4.32

IFD per
HIV+

Exhibit D-DOCS Male HIV Rates and Infectious Disease Access-FY 2006-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

1,767

172

183

1,016

1,779

1,367

177

Auburn

Butler

Butler ASACTC

Cayuga

Elmira

Five Points

Monterey

7,274

8

EXHIBIT D

186

94

151

394

1,737

Edgecombe

Fulton

Lincoln

Queensboro

Sing Sing

867

867

Willard DTC (male)

Hub 99 Totals

1

1

3

3

3

3

1

1

3

1

1

1

3

3

1

Maximum

Minimum

Minimum

Minimum

Minimum

Medium

Maximum

Minimum

Maximum

Maximum

Medium

Medium

Minimum

Maximum

Security

99 Medium

9

9

9

9

9

9

8

8

8

8

8

8

8

8

Med Hub
Class

IFD Rate - Rate of IFD Appts per total prison population

Department Totals

60,797

3,509

Hub

Totals

9

947

Arthur Kill

Hub

813

Southport

Totals

Pop
2006

Prison

193.45

54.09

54.09

191.28

234.89

36.04

262.94

167.93

200.49

66.67

234.31

145.92

180.12

34.43

85.47

148.73

Page 4 of 4

117,613

469

469

6,712

4,080

142

2,490

12,215

1,630

118

3,203

2,596

1,830

63

147

2,628

4,582

1

1

544

463

8

73

219

20

0

4

19

49

0

0

127

Totl Spec # of IFD
Tot #
Apts
Rate
Spec Apt

EXHIBIT D

1

1

HIV
Spec

7.54

0.12

0.12

15.50

26.66

2.03

7.71

3.01

2.46

0.00

0.29

1.07

4.82

0.00

0.00

7.19

IFD
Rate

1,514

11

11

106

55

16

2

3

2

28

172

32

1

25

31

23

4

56

HIV+
Pts

2.49%

1.27%

1.27%

3.02%

3.17%

4.06%

1.32%

3.19%

1.08%

2.96%

2.36%

3.94%

0.56%

1.83%

1.74%

2.26%

2.33%

3.17%

Rate
HIV+

3.03

0.09

0.09

5.13

8.42

0.50

2.61

1.27

0.63

0.00

0.16

0.61

2.13

0.00

2.27

IFD per
HIV+

Exhibit D-DOCS Male HIV Rates and Infectious Disease Access-FY 2006-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

1,191

141

173

111

Oneida

Pharsalia

Summit

Walsh Medical

EXHIBIT E

876

637

Riverview

Watertown

552

477

1,720

219

2,890

Adirondack

Altona

Bare Hill

Chateaugay

Clinton

4,005

605

Ogdensburg

2 Totals

1,021

Gouverneur

Hub

866

Cape Vincent

6,212

1,297

Mohawk

1 Totals

1,503

Mid-State

Hub

1,255

1

3

1

1

1

1

1

1

1

1

1

3

3

1

2

1

1

3

3

3

3

3

2

2

2

2

2

1

1

1

1

1

1

1

1

Max

Med

Med

Med

Med

Med

Med

Med

Med

Med

Max

Min

Min

Med

Med

Med

Med

Med

257

7

28

43

18

53

16

11

2

15

9

199

49

0

5

52

20

25

39

7

38

18

8

16

17

64

6

14

16

16

12

138

3

0

0

21

41

36

33

4

0

1.31

8.22

0.47

3.35

3.08

1.60

0.94

1.60

2.64

1.57

1.39

2.22

2.70

0.00

0.00

1.76

3.16

2.40

2.63

1.03

0.00

9.93%

3

2.89%

7.80%

8.06%

5

4

41

9.40%

9.70%

34

19

26

34

231 7.99%

29 13.24%

102

8

177 10.29% 62

57 11.95% 10

9

9.86% 146

9.42%

8.90%

66 11.96%

395

60

78

77 12.73% 33

96

84

666 10.72% 287

25 22.52% 13

5

11

96

136 10.49% 65

212 14.11% 94

127 10.12% 39

39 10.00% 23

15

Liver Rate HCV+ HCV+ HCV
Biopsy Liv Bx Pts
%
Dis

EXHIBIT E Page 1 of 4

8.89

3.20

1.63

9.01

3.26

1.32

2.51

1.26

0.33

1.47

1.04

3.20

44.14

0.00

3.55

4.37

1.54

1.66

3.11

1.79

1.32

Marcy

3

2

390

Min

Hale Creek

1

151

Georgetown

3

Pop Med Hub Secur- GI Rate
2006 Class
ity
Care
GI

Prison

44.16%

27.59%

35.03%

17.54%

13.64%

36.96%

43.33%

43.59%

42.86%

35.42%

22.62%

43.09%

52.00%

100.00%

36.36%

42.71%

47.79%

44.34%

30.71%

58.97%

20.00%

6

0

3

1

1

32

0

9

5

7

11

38

1

0

0

3

5

16

12

1

0

2.60% 0.21%

0.00% 0.00%

1.69% 0.17%

1.75% 0.21%

1.52% 0.18%

8.10% 0.80%

0.00% 0.00%

11.54% 1.03%

6.49% 0.83%

7.29% 0.69%

13.10% 1.27%

5.71% 0.61%

4.00% 0.90%

0.00% 0.00%

0.00% 0.00%

3.13% 0.25%

3.68% 0.39%

7.55% 1.06%

9.45% 0.96%

2.56% 0.26%

0.00% 0.00%

1.11

0.24

0.16

0.75

0.27

0.13

0.27

0.14

0.03

0.16

0.11

0.30

1.96

0.00

0.45

0.54

0.15

0.12

0.31

0.18

0.13

0.16

0.62

0.05

0.28

0.26

0.16

0.10

0.18

0.21

0.17

0.14

0.21

0.12

0.00

0.00

0.22

0.30

0.17

0.26

0.10

0.00

HCV HCV % Tx/ % Tx/ GI per Liv Bx/
Dis %
Tx HCV+ Pop HCV+ HCV+

Exhibit E - DOCS Male Hepatitis C Rates and HCV Care by Hub - FY 2006-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

1,162

Upstate

EXHIBIT E

539

746

746

599

793

Shawangunk

Sullivan

Ulster

Wallkill

Woodbourne

Camp Mt. McGreg

5 Totals

128

5,125

2,149

Green Haven

Hub

29

1,718

Fishkill

Fishkill RMU

1,229

Downstate

5,921

602

Otisville

4 Totals

721

Mid-Orange

Hub

1,175

Eastern

9,032

135

Lyon Mountain

3 Totals

165

Gabriel

Hub

1

1,712

Franklin

3

1

1

1

1

1

2

1

1

1

1

1

1

1

3

3

1

6

5

5

5

5

4

4

4

4

4

4

4

4

3

3

3

3

3

Min

Max

Max

Med

Max

Med

Med

Med

Max

Max

Med

Med

Max

Max

Min

Min

Med

Med

2

235

97

19

102

17

373

39

59

1

44

80

39

48

63

453

11

3

1

65

20

4

44

20

1

21

2

54

7

5

1

5

7

4

11

14

123

10

5

0

8

3

3.13

0.86

0.93

3.45

1.22

0.16

0.91

0.88

0.83

0.13

0.67

1.30

0.66

1.53

1.19

1.36

0.86

3.70

0.00

0.47
8.48%

30

9.02%

7.51%

8.71%

9.28%

9.63%

9.43%

6.47%

25

22

38

4

24

43

31

9.43% 283

6.88%

7

5

6.67%

35

8.87% 211

534 10.42% 243

231 10.75% 113

221 12.86% 95

82

525

98 12.36% 24

54

56

65

50

58

68

76

852

80

14 10.37%

14

184 10.75% 50

Liver Rate HCV+ HCV+ HCV
Biopsy Liv Bx Pts
%
Dis

EXHIBIT E Page 2 of 4

1.56

4.59

4.51

65.52

5.94

1.38

6.30

4.92

9.85

0.13

5.90

14.84

6.48

6.66

5.36

5.02

0.95

2.22

0.61

3.80

Pop Med Hub Secur- GI Rate
2006 Class
ity
Care
GI

Clinton Annex

Prison

45.51%

48.92%

42.99%

42.68%

40.19%

24.49%

46.30%

39.29%

58.46%

8.00%

41.38%

63.24%

40.79%

33.22%

37.50%

50.00%

35.71%

27.17%

32

13

18

1

34

7

1

0

4

0

2

8

12

29

11

0

0

7

5.99% 0.62%

5.63% 0.60%

8.14% 1.05%

1.22% 0.08%

6.48% 0.57%

7.14% 0.88%

1.85% 0.17%

0.00% 0.00%

6.15% 0.54%

0.00% 0.00%

3.45% 0.33%

11.76% 1.11%

15.79% 1.02%

3.40% 0.32%

13.75% 0.95%

0.00% 0.00%

0.00% 0.00%

3.80% 0.41%

0.44

0.42

0.46

0.21

0.71

0.40

1.09

0.02

0.68

1.60

0.67

0.71

0.83

0.53

0.14

0.21

0.07

0.35

0.08

0.09

0.10

0.02

0.10

0.07

0.09

0.02

0.08

0.14

0.07

0.16

0.18

0.14

0.13

0.36

0.00

0.04

HCV HCV % Tx/ % Tx/ GI per Liv Bx/
Dis %
Tx HCV+ Pop HCV+ HCV+

Exhibit E - DOCS Male Hepatitis C Rates and HCV Care by Hub - FY 2006-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

200

526

1,037

Moriah

Mt. McGregor

Washington

EXHIBIT E

1,743

1,222

1,005

871

996

51

940

1,707

Gowanda

Groveland

Lakeview (male)

Livingston

Orleans

Rochester

Wende

Wyoming

12,013

1,165

Collins

7 Totals

109

Buffalo

Hub

2,204

Attica

6,868

506

Hudson

6 Totals

1,756

Greene

Hub

1,681

1

1

3

1

1

1

1

2

1

2

1

1

1

3

2

1

1

7

7

7

7

7

7

7

7

7

7

7

6

6

6

6

6

6

6

Med

Max

Min

Med

Med

Min

Med

Med

Med

Min

Max

Med

Med

Min

Med

Med

Max

Max

471

87

69

65

57

3

98

22

31

0

39

471

45

39

0

31

80

77

46

246

38

20

34

24

10

51

23

21

0

25

69

12

20

0

3

13

6

1

10

2.05

2.23

2.13

3.41

2.76

1.00

4.17

1.32

1.80

0.00

1.13

1.00

1.16

3.80

0.00

0.59

0.74

0.36

1.79

1.02

8.90%

4.33%

34

59

36

3.50%

5

4.59%

64

37

5

68

9.68%

3.92%

7.33%

8.84%

2.99%

949

86

33

2

41

28

10

7.90% 438

104 6.09%

91

2

73

77

30

147 12.03% 64

115 6.60%

112 9.61%

5

20

7.76% 206

7.23%

193 8.76%

533

75

86 16.35% 33

7

54 10.67% 19

76

148 8.80%

87

Liver Rate HCV+ HCV+ HCV
Biopsy Liv Bx Pts
%
Dis

EXHIBIT E Page 3 of 4

3.92

5.10

7.34

6.53

6.54

0.30

8.02

1.26

2.66

0.00

1.77

6.86

4.34

7.41

0.00

6.13

4.56

4.58

82.14

15.44

Great Meadow

1

151

56

Max

Coxsackie RMU

6

978

Coxsackie

1

Pop Med Hub Secur- GI Rate
2006 Class
ity
Care
GI

Prison

46.15%

82.69%

36.26%

100.00%

56.16%

36.36%

33.33%

43.54%

55.65%

33.04%

100.00%

35.23%

38.65%

26.67%

38.37%

71.43%

35.19%

44.74%

39.86%

41.38%

37

5

2

0

4

7

1

1

3

4

1

9

18

3

5

0

0

3

5

2

3.90% 0.31%

4.81% 0.29%

2.20% 0.21%

0.00% 0.00%

5.48% 0.40%

9.09% 0.80%

3.33% 0.10%

0.68% 0.08%

2.61% 0.17%

3.57% 0.34%

20.00% 0.92%

4.66% 0.41%

3.38% 0.26%

4.00% 0.29%

5.81% 0.95%

0.00% 0.00%

0.00% 0.00%

3.95% 0.17%

3.38% 0.30%

2.30% 0.20%

0.50

0.84

0.76

0.89

0.74

0.10

0.67

0.19

0.28

0.00

0.20

0.88

0.60

0.45

0.00

0.57

1.05

0.52

1.74

0.26

0.37

0.22

0.47

0.31

0.33

0.35

0.20

0.19

0.00

0.13

0.13

0.16

0.23

0.00

0.06

0.17

0.04

0.11

HCV HCV % Tx/ % Tx/ GI per Liv Bx/
Dis %
Tx HCV+ Pop HCV+ HCV+

Exhibit E - DOCS Male Hepatitis C Rates and HCV Care by Hub - FY 2006-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

1,367

177

813

Five Points

Monterey

Southport

EXHIBIT E

151

394

1,737

Lincoln

Queensboro

Sing Sing

15
2,652

60,826

Department Totals

Hub

15

212

121

1

90

170

7

0

31

15

33

1

867

Med

Max

Min

Min

Min

Min

Med

Max

Min

Max

Max

Med

Med

99 Totals

99

9

9

9

9

9

9

8

8

8

8

8

8

2

867

1

1

3

3

3

3

1

1

3

1

1

1

3

Min

Willard DTC (male

3,509

94

Fulton

9 Totals

186

Edgecombe

Hub

947

Arthur Kill

7,274

1,779

Elmira

8 Totals

1,016

Cayuga

Hub

183

8

856

0

0

52

32

0

20

66

21

0

5

16

4

0

0

20

1.41

0.00

0.00

1.48

1.84

0.00

2.11

0.91

2.58

0.00

0.37

0.90

0.39

0.00

0.00

1.13

63

7.68%

4.30%

8.98%

4.64%

3

8

4

50

9.03% 151

68

10.27% 32

35.96%

35.96%

47.63%

42.50%

38.30%

42.86%

80.00%

50.00%

58.82%

36.63%

24.05%

0.00%

32.23%

46.15%

26.92%

44.44%

41.45%

1

1

24

17

1

0

0

0

6

25

7

0

2

7

2

0

7

4.93% 0.44%

1.12% 0.12%

1.12% 0.12%

7.57% 0.68%

10.63% 0.98%

2.13% 0.25%

0.00% 0.00%

0.00% 0.00%

0.00% 0.00%

7.06% 0.63%

4.05% 0.34%

8.86% 0.86%

0.00% 0.00%

1.65% 0.15%

4.49% 0.39%

2.56% 0.20%

0.00% 0.00%

4.61% 0.40%

0.48

0.17

0.17

0.67

0.76

0.02

1.06

0.28

0.09

0.00

0.26

0.10

0.42

0.07

0.53

0.16

0.00

0.00

0.16

0.20

0.00

0.24

0.11

0.27

0.00

0.04

0.10

0.05

0.00

0.13

HCV HCV % Tx/ % Tx/ GI per Liv Bx/
Dis %
Tx HCV+ Pop HCV+ HCV+

5,477 9.00% 2,223 40.59% 270

89

89 10.27% 32

317

160 9.21%

47 11.93% 18

7

19

0

39

72

21

8.48% 226

9.72%

2.26%

10 10.64%

8

85

617

79

4

121 8.85%

156 8.77%

78

27 15.70% 12

152 8.60%

Liver Rate HCV+ HCV+ HCV
Biopsy Liv Bx Pts
%
Dis

EXHIBIT E Page 4 of 4

4.36

1.73

1.73

6.04

6.97

0.25

9.50

2.34

0.86

0.00

2.27

0.84

3.25

0.55

1.16

4.58

Butler ASACTC

3

81

172

Max

Butler

8

1,767

Auburn

1

Pop Med Hub Secur- GI Rate
2006 Class
ity
Care
GI

Prison

Exhibit E - DOCS Male Hepatitis C Rates and HCV Care by Hub - FY 2006-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

866

721

876

1,737

1,255

871

813

1,718

1,503

1,021

793

947

605

746

526

2,149

996

1,707

2,204

Cape Vincent

Mid-Orange

Riverview

Sing Sing

Marcy

Livingston

Southport

Fishkill

Mid-State

Gouverneur

EXHIBIT F

Woodbourne

Arthur Kill

Ogdensburg

Sullivan

Mt. McGregor

Green Haven

Orleans

Wyoming

Attica

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

7 Max

7 Med

7 Med

5 Max

6 Med

4 Max

2 Med

9 Med

4 Med

2 Med

1 Med

5 Med

8 Max

7 Med

1 Med

9 Max

2 Med

4 Med

2 Med

3 Max

39

87

65

97

39

44

2

90

39

15

25

102

7

57

39

121

11

48

9

11

25

38

34

20

20

5

16

20

7

16

36

21

21

24

33

32

14

11

12

10

14

1.13

2.23

3.41

0.93

3.80

0.67

2.64

2.11

0.88

1.57

2.40

1.22

2.58

2.76

2.63

1.84

1.60

1.53

1.39

0.86

1.19

Page 1 of 3

0.20

0.84

0.89

0.42

0.45

0.68

0.03

1.06

0.40

0.16

0.12

0.46

0.09

0.74

0.31

0.76

0.14

0.71

0.11

0.14

0.83

0.13

0.37

0.47

0.09

0.23

0.08

0.21

0.24

0.07

0.17

0.17

0.10

0.27

0.31

0.26

0.20

0.18

0.16

0.14

0.13

0.18

8.90%

9.43%

9.70%

6.88%

6.47%

9

8

1.03% 11.54%

1.11% 11.76%

68 42.50% 17 0.98% 10.63%

34 43.59%

43 63.24%

19 22.62% 11 1.27% 13.10%

30 37.50% 11 0.95% 13.75%

31 40.79% 12 1.02% 15.79%

9.72%

8.84%

7

7

0.86% 8.86%

0.80% 9.09%

95 42.99% 18 1.05% 8.14%

19 24.05%

28 36.36%

9.40%

34 35.42%

8.98%

8.71%

38 58.46%

33 42.86%

50 58.82%

5

4

5

6

7

7

0.95% 5.81%

0.54% 6.15%

0.83% 6.49%

0.63% 7.06%

0.88% 7.14%

0.69% 7.29%

7.33%

193 8.76%

104 6.09%

73

68 35.23%

86 82.69%

41 56.16%

9

5

4

0.41% 4.66%

0.29% 4.81%

0.40% 5.48%

231 10.75% 113 48.92% 13 0.60% 5.63%

86 16.35% 33 38.37%

65

77 12.73%

85

98 12.36% 24 24.49%

96

212 14.11% 94 44.34% 16 1.06% 7.55%

221 12.86%

79

77

127 10.12% 39 30.71% 12 0.96% 9.45%

160 9.21%

78

68

84

80

76

Liver Rate GI per Liv Bx/ HCV+ HCV+ HCV HCV HCV % Tx/ % Tx/
Biopsy Liv Bx HCV+ HCV+
Pts
%
Dis Dis % Tx Pop HCV+

EXHIBIT F

1.77

5.10

6.53

4.51

7.41

5.90

0.33

9.50

4.92

1.47

1.66

5.94

0.86

6.54

3.11

6.97

1.26

6.66

1.04

0.95

5.36

1,162

63

Upstate

4 Max

1,175

Eastern

1

Pop Med Hub Security GI Rate
2006 Class
Care
GI

Prison

Exhibit F - HCV Care at Male Class One Prisons by Treatment Rates - FY 2006-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

111

1,037

1,756

1,712

1,165

602

1,681

1,005

1,191

2,890

1,016

978

940

477

1,720

1,367

552

1,229

867

Walsh Medical

Washington

Greene

Franklin

Collins

Otisville

Great Meadow

Lakeview (male)

Oneida

Clinton

EXHIBIT F

Cayuga

Coxsackie

Wende

Altona

Bare Hill

Five Points

Adirondack

Downstate

Willard DTC (male

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

99 Med

5 Max

3 Med

8 Max

3 Med

3 Med

7 Max

6 Max

8 Med

3 Max

1 Med

7 Min

6 Max

4 Med

7 Med

3 Med

6 Med

6 Med

1 Max

8 Max

15

17

18

31

28

43

69

151

33

257

52

3

77

39

31

65

80

45

49

15

0

2

17

5

8

16

20

10

4

38

21

10

6

4

21

8

13

12

3

16

20

0.00

0.16

3.08

0.37

0.47

3.35

2.13

1.02

0.39

1.31

1.76

1.00

0.36

0.66

1.80

0.47

0.74

1.16

2.70

0.90

1.13

Page 2 of 3

0.17

0.21

0.27

0.26

0.16

0.75

0.76

1.74

0.42

1.11

0.54

0.10

0.52

0.67

0.28

0.35

1.05

0.60

1.96

0.10

0.53

0.00

0.02

0.26

0.04

0.05

0.28

0.22

0.11

0.05

0.16

0.22

0.33

0.04

0.07

0.19

0.04

0.17

0.16

0.12

0.10

0.13
72 46.15%

63 41.45%

4.33%

7.23%

34 44.74%

20 26.67%

9.63%

8.06%

2.99%

41 42.71%

10 33.33%

59 39.86%

24 41.38%

37 33.04%

9.68%

8.90%

7.68%

33 36.26%

36 41.38%

21 26.92%

6.67%

13.64%
35 42.68%

9

39 32.23%

89 10.27% 32 35.96%

82

66 11.96%

121 8.85%

177 10.29% 62 35.03%

57 11.95% 10 17.54%

91

87

78

231 7.99% 102 44.16%

96

30

148 8.80%

58

112 9.61%

184 10.75% 50 27.17%

76

75

25 22.52% 13 52.00%

156 8.77%

152 8.60%

1

1

1

2

3

1

2

2

2

6

3

1

5

2

4

7

3

3

1

7

7

0.12% 1.12%

0.08% 1.22%

0.18% 1.52%

0.15% 1.65%

0.17% 1.69%

0.21% 1.75%

0.21% 2.20%

0.20% 2.30%

0.20% 2.56%

0.21% 2.60%

0.25% 3.13%

0.10% 3.33%

0.30% 3.38%

0.33% 3.45%

0.34% 3.57%

0.41% 3.80%

0.17% 3.95%

0.29% 4.00%

0.90% 4.00%

0.39% 4.49%

0.40% 4.61%

Liver Rate GI per Liv Bx/ HCV+ HCV+ HCV HCV HCV % Tx/ % Tx/
Biopsy Liv Bx HCV+ HCV+
Pts
%
Dis Dis % Tx Pop HCV+

EXHIBIT F

1.73

1.38

3.26

2.27

1.63

9.01

7.34

15.44

3.25

8.89

4.37

0.30

4.58

6.48

2.66

3.80

4.56

4.34

44.14

0.84

4.58

1,779

81

Elmira

8 Max

1,767

Auburn

1

Pop Med Hub Security GI Rate
2006 Class
Care
GI

Prison

Exhibit F - HCV Care at Male Class One Prisons by Treatment Rates - FY 2006-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

539

637

53,377

Shawangunk

Watertown

Department Totals

1

1

1

2 Med

4 Max

4 Med

2,404

16

80

1

748

6

7

1

51

1.40

0.94

1.30

0.13

4.17

Page 3 of 3

0.49

0.27

1.60

0.02

0.67

0.15

0.10

0.14

0.02

0.35

9.42%

9.28%

7.51%
8.00%

26 43.33%

4

22 39.29%

0

0

0

1

0.00% 0.00%

0.00% 0.00%

0.00% 0.00%

0.08% 0.68%

4,874 9.13% 1,938 39.76% 258 0.48% 5.29%

60

50

56

147 12.03% 64 43.54%

Liver Rate GI per Liv Bx/ HCV+ HCV+ HCV HCV HCV % Tx/ % Tx/
Biopsy Liv Bx HCV+ HCV+
Pts
%
Dis Dis % Tx Pop HCV+

EXHIBIT F

4.50

2.51

14.84

0.13

8.02

746

98

Ulster

7 Med

1,222

Groveland

1

Pop Med Hub Security GI Rate
2006 Class
Care
GI

Prison

Exhibit F - HCV Care at Male Class One Prisons by Treatment Rates - FY 2006-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

EXHIBIT F

18
305

Bedford Hills RMU

Taconic

EXHIBIT G
51

Hub Totals
2,871

51

Willard DTC female

Department Totals

215

215

1,246

96

1,150

Hub Totals

Bayview

Hub Totals

Lakeview (female)

Albion

808

Bedford Hills

1,359

228

Beacon

Hub Totals

Pop
2006

Prison

1

1

99

9

7

7

5

5

5

5

Med Hub
Class

Medium

Medium

Minimum

Medium

Medium

Maximum

Maximum

Minimum

Security

1

873.02

521.05

Spec
Rate

605.68

131.37

131.37

433.49

433.49

443.26

84.38

473.22

799.63

687.21

2938.89

EXHIBIT G

17,389

67

67

932

932

5,523

81

5,442

10,867

2,096

529

7,054

1,188

HIV
Tot #
Spec Spec Apt

8.37%

8.37%

4.65%

5.04%

6.40%

9.18%

4.83%

8.77%

0

0

920

0

39

7
0

39

11

131
7

3

2

8

870

953
129

210

28

509

123

32.04

0.00

0.00

18.14

18.14

0.88

3.13

0.70

64.02

68.85

155.56

63.00

53.95

2006 IFD 06
IFD
Rate

209

20

616

108

163 5.68% 1,091

18

18

58

58

87

28

39

20

HIV+ Rate 2005
Pts HIV+ IFD

6.69

0.39

0.39

2.26

2.22

10.95

7.46

15.79

5.40

5.64

2.17

2.17

0.19

0.14

10.00

7.50

13.05

6.15

IFD05/ IFD06/
HIV+
HIV+

Exhibit G - DOCS HIV Care at Female Prisons - FY 2005-06 and FY 2006-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

EXHIBIT H

9 Totals

7 Totals

99 Totals

Department Totals

Hub

Willard DTC female

Hub

Bayview

Hub

Lakeview (female)

Albion

5 Totals

210

3

24

24

51

0

51

132

29

4

2,871

99 Med

9 Med

7 Min

7 Med

5 Med

5 Max

82

3

1

1

1

1

2

1

5 Max

51

51

215

215

1,246

96

1,150

1,359

305

Taconic

Hub

18

Bedford Hills RMU

1

7.31

5.88

5.88

11.16

11.16

4.09

0.00

4.43

9.71

9.51

22.22

10.15

7.46

808

17

Bedford Hills

5 Min

228

Beacon

3

Pop Med Hub Security GI Rate
2006 Cls
Care GI

Prison

1.85

0.00

0.00

2.33

2.33

2.25

0.00

2.43

1.47

1.64

5.56

1.11

2.19

EXHIBIT H

53

0

0

5

5

28

0

28

20

5

1

9

5

8

6

3

3

407 14.18% 80

29 13.49%

29 13.49%

196 15.73% 38

196 17.04% 38

182 13.39% 39

51 16.72%

99 12.25% 25

32 14.04%

Liver Rate HCV+ HCV+ HCV
Biopsy Liv Bx Pts
%
Dis

10

5

0

5

0

0

0

19.66% 15

10.34%

10.34%

19.39% 10

19.39%

21.43%

11.76%

25.25%

25.00%

3.69% 0.52%

0.00% 0.00%

0.00% 0.00%

5.10% 0.80%

5.10% 0.87%

2.75% 0.37%

0.00% 0.00%

5.05% 0.62%

0.00% 0.00%

0.52

0.83

0.83

0.26

0.26

0.73

0.57

0.83

0.53

0.13

0.17

0.17

0.14

0.14

0.11

0.10

0.09

0.16

HCV HCV % Tx/ % Tx/ GI per Liv Bx/
Dis % Tx HCV+ Pop HCV+ HCV+

Exhibit H - DOCS Female Hepatitis C Rates and HCV Care - FY 2006-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

1,255
1,503
1,297
1,191
141
173
111

Marcy

Mid-State

Mohawk

Oneida

Pharsalia

Summit

Walsh Medical

EXHIBIT I - Part 1
605
876
637

Ogdensburg

Riverview

Watertown

477
1,720
219
2,890

Altona

Bare Hill

Chateaugay

Clinton

Clinton Annex

552

Adirondack

4,005

1,021

Gouverneur

Hub 2 Totals

866

Cape Vincent

6,212

390

Hale Creek

Hub 1 Totals

151

1

1

3

1

1

1

1

1

1

1

1

1

3

3

1

2

1

1

3

3

3

3

3

3

3

3

2

2

2

2

2

1

1

1

1

1

1

1

1

1

957

5,308

442

2,106

904

1,167

4,608

980

940

644

1,160

884

11,088

2,121

116

178

2,193

2,549

2,233

1,312

242

144

183.67

201.83

122.44

189.52

211.41

115.06

153.85

107.31

106.45

113.61

102.08

178.49

1910.81

67.05

126.24

184.13

196.53

148.57

104.54

62.05

95.36

11

103

2

11

3

5

35

11

6

5

9

4

141

26

0

2

32

26

28

22

4

1

3.56

0.91

0.64

0.63

0.91

0.87

1.73

0.68

0.83

0.88

0.46

2.27

23.42

0.00

1.42

2.69

2.00

1.86

1.75

1.03

0.66

6

26

3

16

9

21

104

24

32

2

32

14

171

27

0

9

36

45

35

12

1

6

0.90

1.37

0.93

1.89

3.80

2.60

3.77

3.65

0.33

3.13

1.62

2.75

24.32

0.00

6.38

3.02

3.47

2.33

0.96

0.26

3.97

Rate Spec Cardiology Rate Card Dermatology Rate Derm

Page 1 of 4

Totl # Spec

EXHIBIT I - Part 1

Medium

Maximum

Medium

Medium

Medium

Medium

Medium

Medium

Medium

Medium

Medium

Maximum

Minimum

Minimum

Medium

Medium

Medium

Medium

Medium

Minimum

Pop 2006 Med Cl Hub Security

Georgetown

Prison

Exhibit I - DOCS Specialty Care for Male Prisons - FY 2006-07 (Part 1)

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

135
1,162

Lyon Mountain

Upstate

EXHIBIT I - Part 1

602
539
746
746
599
793

Otisville

Shawangunk

Sullivan

Ulster

Wallkill

Woodbourne

5,125
128
978
56

Camp Mt. McGregor

Coxsackie

Coxsackie RMU

2,149

Green Haven

Hub 5 Totals

29

1,718

Fishkill

Fishkill RMU

1,229

Downstate

5,921

721

Mid-Orange

Hub 4 Totals

1,175

Eastern

9,032

165

Gabriel

Hub 3 Totals

1,712

1

1

3

1

1

1

1

1

2

1

1

1

1

1

1

1

3

3

1

6

6

6

5

5

5

5

4

4

4

4

4

4

4

4

3

3

3

3

1,555

2,355

4

17,105

7,655

864

6,918

1,668

13,868

2,574

763

101

1,992

1,764

1,062

2,409

3,203

17,586

2,533

230

293

3,646

2776.79

240.80

3.13

333.76

356.21

2979.31

402.68

135.72

234.22

324.59

127.38

13.54

267.02

327.27

176.41

334.12

272.60

194.71

217.99

170.37

177.58

212.97

56

36

0

209

31

21

146

11

211

52

12

1

16

27

18

55

30

154

0

0

0

19

100.00

3.68

0.00

4.08

1.44

72.41

8.50

0.90

3.56

6.56

2.00

0.13

2.14

5.01

2.99

7.63

2.55

1.71

0.00

0.00

0.00

1.11

17

61

0

456

138

27

261

30

242

37

9

1

12

29

27

93

34

125

16

1

6

21

30.36

6.24

0.00

8.90

6.42

93.10

15.19

2.44

4.09

4.67

1.50

0.13

1.61

5.38

4.49

12.90

2.89

1.38

1.38

0.74

3.64

1.23

Rate Spec Cardiology Rate Card Dermatology Rate Derm

Page 2 of 4

Totl # Spec

EXHIBIT I - Part 1

Maximum

Maximum

Minimum

Maximum

Maximum

Medium

Maximum

Medium

Medium

Medium

Maximum

Maximum

Medium

Medium

Maximum

Maximum

Minimum

Minimum

Medium

Pop 2006 Med Cl Hub Security

Franklin

Prison

Exhibit I - DOCS Specialty Care for Male Prisons - FY 2006-07 (Part 1)

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

506
200
526
1,037

Hudson

Moriah

Mt. McGregor

Washington

EXHIBIT I - Part 1
1,165
1,743
1,222
1,005
871
996
51
940
1,707

Collins

Gowanda

Groveland

Lakeview (male)

Livingston

Orleans

Rochester

Wende

Wyoming

1,767
172
183

Auburn

Butler

Butler ASACTC

12,013

109

Buffalo

Hub 7 Totals

2,204

Attica

6,868

1,756

Greene

Hub 6 Totals

1,681

3

3

1

1

1

3

1

1

1

1

2

1

2

1

1

1

3

2

1

1

8

8

8

7

7

7

7

7

7

7

7

7

7

7

6

6

6

6

6

6

63

147

2,628

23,297

2,202

5,444

2,610

1,430

591

2,926

2,551

1,274

5

4,264

10,665

1,381

736

146

688

1,999

1,801

34.43

85.47

148.73

193.93

129.00

579.15

262.05

164.18

58.81

239.44

146.36

109.36

4.59

193.47

155.29

133.17

139.92

73.00

135.97

113.84

107.14

1

0

39

206

14

45

40

9

0

46

22

7

0

23

198

10

4

0

17

42

33

0.55

0.00

2.21

1.71

0.82

4.79

4.02

1.03

0.00

3.76

1.26

0.60

0.00

1.04

2.88

0.96

0.76

0.00

3.36

2.39

1.96

2

5

50

354

20

107

51

34

10

25

21

36

0

50

196

35

18

4

20

27

14

1.09

2.91

2.83

2.95

1.17

11.38

5.12

3.90

1.00

2.05

1.20

3.09

0.00

2.27

2.85

3.38

3.42

2.00

3.95

1.54

0.83

Rate Spec Cardiology Rate Card Dermatology Rate Derm

Page 3 of 4

Totl # Spec

EXHIBIT I - Part 1

Medium

Minimum

Maximum

Medium

Maximum

Minimum

Medium

Medium

Minimum

Medium

Medium

Medium

Minimum

Maximum

Medium

Medium

Minimum

Medium

Medium

Maximum

Pop 2006 Med Cl Hub Security

Great Meadow

Prison

Exhibit I - DOCS Specialty Care for Male Prisons - FY 2006-07 (Part 1)

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

1,367
177
813

Five Points

Monterey

Southport

EXHIBIT I - Part 1
117,613

60,826

EXHIBIT I - Part 1

469

6,712

4,080

142

Department Totals

Maximum

99 Medium

9

Minimum

469

1

1

9

Minimum

867

1,737

Sing Sing

3

9

Minimum

Hub 99 Totals

394

Queensboro

3

9

Minimum

2,490

12,215

1,630

118

3,203

2,596

1,830

867

151

Lincoln

3

9

Medium

Maximum

Minimum

Maximum

Maximum

Medium

Willard DTC (male)

94

Fulton

3

9

8

8

8

8

8

3,509

186

Edgecombe

1

1

3

1

1

1

193.36

54.09

54.09

191.28

234.89

36.04

262.94

167.93

200.49

66.67

234.31

145.92

180.12

1,429

4

4

121

66

2

53

150

5

0

12

24

69

2.35

0.46

0.46

3.45

3.80

0.51

5.60

2.06

0.62

0.00

0.88

1.35

6.79

1,910

6

6

91

56

3

32

165

6

0

37

23

42

3.14

0.69

0.69

2.59

3.22

0.76

3.38

2.27

0.74

0.00

2.71

1.29

4.13

Rate Spec Cardiology Rate Card Dermatology Rate Derm

Page 4 of 4

Totl # Spec

Hub 9 Totals

947

Arthur Kill

7,274

1,779

Elmira

Hub 8 Totals

1,016

Pop 2006 Med Cl Hub Security

Cayuga

Prison

Exhibit I - DOCS Specialty Care for Male Prisons - FY 2006-07 (Part 1)

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

1,297

1,191
141

Mohawk

Oneida

Pharsalia

EXHIBIT I - Part 2
605
876
637

Ogdensburg

Riverview

Watertown

552
477

1,720
219

2,890

Adirondack

Altona

Bare Hill

Chateaugay

Clinton

4,005

1,021

Gouverneur

Hub Totals

866

6,212

Cape Vincent

Hub Totals

111

1,503

Mid-State

Walsh Medical

1,255

Marcy

173

390

Hale Creek

Summit

151

1

3

1

1

1

1

1

1

1

1

1

3

3

1

2

1

1

3

3

3

3

3

3

3

2

2

2

2

2

1

1

1

1

1

1

1

1

1

8.89

3.20

1.63

9.01

3.26

1.32

2.51

1.26

0.33

1.47

1.04

3.20

44.14

0.00

3.55

4.37

1.54

1.66

3.11

1.79

1.32

EXHIBIT I - Part 2

257

7

28

43

18

53

16

11

2

15

9

199

49

0

5

52

20

25

39

7

2

Pop 2006 Med Cl Hub Gastroent. Rate GI

Georgetown

Prison

9.07

1.37

8.43

8.18

14.31

0.77

2.20

0.46

0.50

0.98

0.00

3.04

90.09

0.00

0.00

5.37

0.77

0.13

0.72

0.77

0.66

Rate IFD

Page 1 of 4

262

3

145

39

79

31

14

4

3

10

0

189

100

0

0

64

10

2

9

3

1

Inf. Dis.

38

18

8

16

17

64

6

14

16

16

12

138

3

0

0

21

41

36

33

4

0

1.31

8.22

0.47

3.35

3.08

1.60

0.94

1.60

2.64

1.57

1.39

2.22

2.70

0.00

0.00

1.76

3.16

2.40

2.63

1.03

0.00

23

2

16

7

17

7

4

0

1

2

0

98

15

0

3

37

16

20

2

5

0

0.80

0.91

0.93

1.47

3.08

0.17

0.63

0.00

0.17

0.20

0.00

1.58

13.51

0.00

2.13

3.11

1.23

1.33

0.16

1.28

0.00

Liver Bx Rate LvBx Nephrology Rate Neph

Exhibit I - DOCS Specialty Care for Male Prisons - FY 2006-07 (Part 2)

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

1,162

Upstate

EXHIBIT I - Part 2
539
746
746
599
793

Shawangunk

Sullivan

Ulster

Wallkill

Woodbourne

5,125
128

Camp Mt. McGregor

2,149

Green Haven

Hub Totals

29

1,718

Fishkill

Fishkill RMU

1,229

Downstate

5,921

602

Otisville

Hub Totals

721

1,175

Mid-Orange

Eastern

135

Lyon Mountain

9,032

165

Gabriel

Hub Totals

1

1,712

Franklin

3

1

1

1

1

1

2

1

1

1

1

1

1

1

3

3

1

6

5

5

5

5

4

4

4

4

4

4

4

4

3

3

3

3

3

1.56

4.59

4.51

65.52

5.94

1.38

6.30

4.92

9.85

0.13

5.90

14.84

6.48

6.66

5.36

5.02

0.95

2.22

0.61

3.80

EXHIBIT I - Part 2

2

235

97

19

102

17

373

39

59

1

44

80

39

48

63

453

11

3

1

65

20

Pop 2006 Med Cl Hub Gastroent. Rate GI

Clinton Annex

Prison

1

0.78

27.28

32.20

131.03

36.96

2.69

7.58

10.72

8.01

0.00

8.45

9.65

2.33

14.84

6.81

9.00

8.09

11.85

3.03

5.49

Rate IFD

Page 2 of 4

1,398

692

38

635

33

449

85

48

0

63

52

14

107

80

813

94

16

5

94

76

Inf. Dis.

4

44

20

1

21

2

54

7

5

1

5

7

4

11

14

123

10

5

0

8

3

3.13

0.86

0.93

3.45

1.22

0.16

0.91

0.88

0.83

0.13

0.67

1.30

0.66

1.53

1.19

1.36

0.86

3.70

0.00

0.47

0

176

43

11

122

0

104

20

3

5

10

13

18

23

12

86

6

2

1

10

2

0.00

3.43

2.00

37.93

7.10

0.00

1.76

2.52

0.50

0.67

1.34

2.41

2.99

3.19

1.02

0.95

0.52

1.48

0.61

0.58

Liver Bx Rate LvBx Nephrology Rate Neph

Exhibit I - DOCS Specialty Care for Male Prisons - FY 2006-07 (Part 2)

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

1,681

1,756
506
200
526

Great Meadow

Greene

Hudson

Moriah

Mt. McGregor

EXHIBIT I - Part 2

1,165

1,743

1,222

1,005
871
996
51
940

1,707

Collins

Gowanda

Groveland

Lakeview (male)

Livingston

Orleans

Rochester

Wende

Wyoming

12,013

109

Buffalo

Hub Totals

2,204

6,868

Attica

Hub Totals

1,037

56

Coxsackie RMU

Washington

978

1

1

3

1

1

1

1

2

1

2

1

1

1

3

2

1

1

1

1

7

7

7

7

7

7

7

7

7

7

7

6

6

6

6

6

6

6

6

3.92

5.10

7.34

6.53

6.54

0.30

8.02

1.26

2.66

0.00

1.77

6.86

4.34

7.41

0.00

6.13

4.56

4.58

82.14

15.44

EXHIBIT I - Part 2

471

87

69

65

57

3

98

22

31

0

39

471

45

39

0

31

80

77

46

151

Pop 2006 Med Cl Hub Gastroent. Rate GI

Coxsackie

Prison

3.60

1.29

7.66

7.13

2.18

1.69

2.95

1.09

3.95

0.00

5.94

7.35

9.74

4.94

2.00

9.88

6.04

2.68

114.29

11.04

Rate IFD

Page 3 of 4

433

22

72

71

19

17

36

19

46

0

131

505

101

26

4

50

106

45

64

108

Inf. Dis.

246

38

20

34

24

10

51

23

21

0

25

69

12

20

0

3

13

6

1

10

2.05

2.23

2.13

3.41

2.76

1.00

4.17

1.32

1.80

0.00

1.13

1.00

1.16

3.80

0.00

0.59

0.74

0.36

1.79

1.02

86

12

25

0

10

0

11

6

5

0

17

68

9

3

2

3

13

6

20

12

0.72

0.70

2.66

0.00

1.15

0.00

0.90

0.34

0.43

0.00

0.77

0.99

0.87

0.57

1.00

0.59

0.74

0.36

35.71

1.23

Liver Bx Rate LvBx Nephrology Rate Neph

Exhibit I - DOCS Specialty Care for Male Prisons - FY 2006-07 (Part 2)

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

183

1,016

1,779

1,367
177

Butler ASACTC

Cayuga

Elmira

Five Points

Monterey

EXHIBIT I - Part 2
2,652

4.36

1.73

1.73

6.04

6.97

0.25

9.50

2.34

0.86

0.00

2.27

0.84

3.25

0.55

1.16

4.58

EXHIBIT I - Part 2

15

212

121

60,826

Department Totals

99

9

1

15

1

1

9

867

1,737

Sing Sing

3

9

Hub Totals

394

Queensboro

3

9

867

151

Lincoln

3

9

90

170

7

0

31

15

33

1

2

81

Willard DTC (male)

94

Fulton

3

9

8

8

8

8

8

8

8

8

3,509

186

Edgecombe

1

1

3

1

1

1

3

3

1

Hub Totals

947

7,274

Arthur Kill

Hub Totals

813

172

Butler

Southport

1,767

Pop 2006 Med Cl Hub Gastroent. Rate GI

Auburn

Prison

7.53

0.12

0.12

15.50

26.66

2.03

7.71

3.01

2.46

0.00

0.29

1.07

4.82

0.00

0.00

7.19

Rate IFD

Page 4 of 4

4,582

1

1

544

463

8

73

219

20

0

4

19

49

0

0

127

Inf. Dis.

856

0

0

52

32

0

20

66

21

0

5

16

4

0

0

20

1.41

0.00

0.00

1.48

1.84

0.00

2.11

0.91

2.58

0.00

0.37

0.90

0.39

0.00

0.00

1.13

665

0

0

19

19

0

0

21

0

0

4

3

5

0

0

9

1.09

0.00

0.00

0.54

1.09

0.00

0.00

0.29

0.00

0.00

0.29

0.17

0.49

0.00

0.00

0.51

Liver Bx Rate LvBx Nephrology Rate Neph

Exhibit I - DOCS Specialty Care for Male Prisons - FY 2006-07 (Part 2)

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

1,297
1,191
141
173
111

Mohawk

Oneida

Pharsalia

Summit

Walsh Medical

EXHIBIT I - Part 3
605
876
637

Ogdensburg

Riverview

Watertown

477
1,720
219
2,890

Altona

Bare Hill

Chateaugay

Clinton

Clinton Annex

552

Adirondack

4,005

1,021

Gouverneur

Totals for Hub

866

Cape Vincent

2

1,503

Mid-State

6,212

1,255

Marcy

1

390

Hale Creek

Totals for Hub

151

1

1

3

1

1

1

1

1

1

1

1

1

3

3

1

2

1

1

3

3

3

3

3

3

3

3

2

2

2

2

2

1

1

1

1

1

1

1

1

1

1.25

0.00

0.76

1.05

3.08

0.92

1.41

1.14

1.32

0.49

0.58

2.64

36.94

0.00

1.42

1.85

2.08

3.06

1.83

0.26

1.32

EXHIBIT I - Part 3

9

36

0

13

5

17

37

9

10

8

5

5

164

41

0

2

22

27

46

23

1

2

54

11.25

8.68

11.92

8.60

12.14

15.83

19.00

15.41

20.99

15.08

11.20

11.24

64.86

5.78

7.80

11.34

12.64

10.51

8.76

6.15

9.27

Page 1 of 4

325

19

205

41

67

634

121

135

127

154

97

698

72

10

11

135

164

158

110

24

14

34

215

19

174

40

67

381

85

104

13

94

85

635

35

0

22

127

204

138

87

4

18

7.44

8.68

10.12

8.39

12.14

9.51

13.34

11.87

2.15

9.21

9.82

10.22

31.53

0.00

15.60

10.66

15.73

9.18

6.93

1.03

11.92

15

103

10

31

36

13

85

15

7

8

29

26

270

24

0

4

73

66

64

33

5

1

Pop 2006 Med Cl Hub Neurology Rate Neuro Ophthal. Rate Ophth Orthopedics Rate Ortho Urology

Georgetown

Prison

Exhibit I - DOCS Specialty Care for Male Prisons - FY 2006-07 (Part 3)

3.56

4.57

1.80

7.55

2.36

2.12

2.35

0.80

1.32

2.84

3.00

4.35

21.62

0.00

2.84

6.13

5.09

4.26

2.63

1.28

0.66

Rate Uro

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

EXHIBIT I - Part 3
539
746
746
599
793

Shawangunk

Sullivan

Ulster

Wallkill

Woodbourne

128
978
56

Camp Mt. McGregor

Coxsackie

Coxsackie RMU

5,125

2,149

Green Haven

Totals for Hub

29

1,718

Fishkill

Fishkill RMU

1,229

Downstate

5

602

Otisville

5,921

721

Mid-Orange

Totals for Hub

1,175

Eastern

4

1,162

Upstate
9,032

135

Lyon Mountain

3

165

Gabriel

Totals for Hub

1,712

1

1

3

1

1

1

1

1

2

1

1

1

1

1

1

1

3

3

1

6

6

6

5

5

5

5

4

4

4

4

4

4

4

4

3

3

3

3

55.36

3.27

0.00

3.43

1.68

75.86

6.05

1.14

1.81

2.77

1.34

0.13

1.07

2.23

0.17

3.05

2.81

1.21

1.55

0.00

0.00

0.64

EXHIBIT I - Part 3

31

32

0

176

36

22

104

14

107

22

8

1

8

12

1

22

33

109

18

0

0

11

43

76.79

10.33

3.13

9.39

9.87

62.07

11.87

3.82

9.90

14.63

6.18

0.54

10.46

14.84

10.63

11.79

10.38

12.93

9.04

12.59

22.42

17.41

Page 2 of 4

101

4

481

212

18

204

47

586

116

37

4

78

80

64

85

122

1,168

105

17

37

298

19

69

2

769

273

34

412

50

773

184

39

8

84

136

41

108

173

1,085

232

14

18

272

33.93

7.06

1.56

15.00

12.70

117.24

23.98

4.07

13.06

23.20

6.51

1.07

11.26

25.23

6.81

14.98

14.72

12.01

19.97

10.37

10.91

15.89

48

106

0

300

124

22

124

30

406

79

13

2

59

37

39

76

101

340

42

3

9

78

Pop 2006 Med Cl Hub Neurology Rate Neuro Ophthal. Rate Ophth Orthopedics Rate Ortho Urology

Franklin

Prison

Exhibit I - DOCS Specialty Care for Male Prisons - FY 2006-07 (Part 3)

85.71

10.84

0.00

5.85

5.77

75.86

7.22

2.44

6.86

9.96

2.17

0.27

7.91

6.86

6.48

10.54

8.60

3.76

3.61

2.22

5.45

4.56

Rate Uro

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

526
1,037

Mt. McGregor

Washington

EXHIBIT I - Part 3
1,165
1,743
1,222
1,005
871
996
51
940
1,707

Collins

Gowanda

Groveland

Lakeview (male)

Livingston

Orleans

Rochester

Wende

Wyoming

1,767
172
183

Auburn

Butler

Butler ASACTC

12,013

109

Buffalo

Totals for Hub

2,204

Attica

7

200

Moriah

6,868

506

Hudson

6

1,756

Greene

Totals for Hub

1,681

3

3

1

1

1

3

1

1

1

1

2

1

2

1

1

1

3

2

1

1

8

8

8

7

7

7

7

7

7

7

7

7

7

7

6

6

6

6

6

6

0.00

0.58

2.89

1.86

0.53

8.09

3.31

2.18

0.30

2.95

0.80

0.43

0.00

1.27

1.89

1.74

0.19

1.00

0.79

1.31

1.13

EXHIBIT I - Part 3

0

1

51

223

9

76

33

19

3

36

14

5

0

28

130

18

1

2

4

23

19

3

14

1.64

8.14

7.64

8.87

8.67

25.96

7.03

7.92

3.38

9.98

5.97

5.67

0.92

9.44

7.50

8.20

11.03

0.50

9.49

5.18

5.00

Page 3 of 4

135

1,066

148

244

70

69

34

122

104

66

1

208

515

85

58

1

48

91

84

5

6

172

1,489

169

236

187

129

23

253

144

89

0

259

384

69

33

1

20

81

90

2.73

3.49

9.73

12.39

9.90

25.11

18.78

14.81

2.29

20.70

8.26

7.64

0.00

11.75

5.59

6.65

6.27

0.50

3.95

4.61

5.35

2

4

67

476

59

80

69

25

13

72

36

57

1

64

387

51

20

0

36

60

66

Pop 2006 Med Cl Hub Neurology Rate Neuro Ophthal. Rate Ophth Orthopedics Rate Ortho Urology

Great Meadow

Prison

Exhibit I - DOCS Specialty Care for Male Prisons - FY 2006-07 (Part 3)

1.09

2.33

3.79

3.96

3.46

8.51

6.93

2.87

1.29

5.89

2.07

4.89

0.92

2.90

5.63

4.92

3.80

0.00

7.11

3.42

3.93

Rate Uro

Exhibits
Healthcare
Healthcare in
in New
New York
York Prisons
Prisons 2004-2007
2004-2007
The
Correctional
Association
of
The Correctional Association of New
New York
York

813

Southport

EXHIBIT I - Part 3
94
151
394
1,737

Fulton

Lincoln

Queensboro

Sing Sing

Totals

Totals for Hub

99

Willard DTC (male)

60,826

867

867

3,509

186

Edgecombe

Totals for Hub

947

Arthur Kill

9

177

Monterey

7,274

1,367

Five Points

8

1,779

Elmira

Totals for Hub

1,016

1

1

3

3

3

3

1

1

3

1

1

1

99

9

9

9

9

9

9

8

8

8

8

8

2.00

0.23

0.23

1.28

0.98

0.00

2.96

3.05

1.35

0.00

3.44

4.05

3.94

EXHIBIT I - Part 3

1,215

2

2

45

17

0

28

222

11

0

47

72

40

9.67

3.23

3.23

5.02

5.30

1.27

8.34

7.26

9.10

0.56

7.02

6.41

8.96

Page 4 of 4

5,880

28

28

176

92

5

79

528

74

1

96

114

91

6,702

27

27

336

205

24

107

823

182

1

139

192

126

11.02

3.11

3.11

9.58

11.80

6.09

11.30

11.31

22.39

0.56

10.17

10.79

12.40

2,846

17

17

217

133

3

81

348

43

0

65

123

44

Pop 2006 Med Cl Hub Neurology Rate Neuro Ophthal. Rate Ophth Orthopedics Rate Ortho Urology

Cayuga

Prison

Exhibit I - DOCS Specialty Care for Male Prisons - FY 2006-07 (Part 3)

4.68

1.96

1.96

6.18

7.66

0.76

8.55

4.78

5.29

0.00

4.75

6.91

4.33

Rate Uro

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

EXHIBIT J

1,191

141

173

111

Oneida

Pharsalia

Summit

Walsh Medical

Cape Vincent

866

6,212

1,297

Mohawk

1

1,503

Mid-State

Totals for Hub

1,255

Marcy

1

1

3

3

1

2

1

1

3

2

1

1

1

1

1

1

1

1

Med

Max

Min

Min

Med

Med

Med

Med

Med

2.00

3.47

1.54

2.69

3.02

4.37

1.03

0.0%

0.00

Rate
Liv Bx

1.28

0.0%

0.00

Rate
Neph

0.26

6.15

2.63

0.16

2.40

1.33

8.76

6.93

3.06

10.51

9.18

91.7% 90.6% 62.9%

1.83

3.16

1.23

2.08

12.64

15.73

0.0%

34.7%

3.55

24.32

0.0%

0.00

44.14

0.0%

0.00

4.26
68.08

5.09

83.7% 91.0%

40.25

5.37

1.76

3.11

1.85

11.34

10.66

90.09

0.0%

0.00

0.0%

0.00

2.13

1.42

7.80

15.60

2.70

0.0%

0.00

13.51

0.0%

0.00

36.94

0.0%

0.00

64.86

59.8%

5.78

31.53

0.0%

0.00

0.0% 194.5% 71.0% 80.7% 141.5%

0.00

6.13

676.58

0.0%

0.00

1.5%

0.71

21.62

0.0%

0.00

60.6%

2.84

74.7% 131.0%

35.94

52.8%

102.08

92.3%

178.49

2.75

3.20
1.62

1.04

EXHIBIT J

2.22

1.58

2.64

11.24

10.22

0.0%

0.00

98.4%

1.39

0.0%

0.00

11.20

9.82
28.9% 115.8% 89.0%

0.58

40.4% 157.8% 144.2% 132.1% 116.2% 92.7%

3.04

Page 1 of 8

19.7% 51.5% 23.8%

0.46

96.6% 87.6% 73.4%

2.27

4.35
3.00
30.0% 64.2%

14.43

97.1% 92.9%

46.70

987.7% 996.6% 774.3%1012.0%1195.4%192.0%1235.5%1848.2%670.7% 286.0% 1406.5%462.0%

23.42

0.00

1910.81

6.38

60.3% 203.2% 81.3%

1.42

67.05

65.3%

126.24

2.63

27.4%

1.28

14.2%

38.4% 56.2%

18.49

0.5%

0.26

0.0%

10.2% 224.5% 112.8% 104.2% 130.7% 142.7% 141.5% 108.7%

0.77

1.8% 170.1% 121.7% 153.1% 108.7% 83.3%

0.13

9.5% 186.8% 14.6%

0.72

9.3%

1.03

66.3% 95.9% 108.1%

Rate
Rate
Rate Rate PT Rate
Neuro Ophtha Ortho
Urol
l
1.32
9.27
11.92
0.00
0.66

10.2% 72.8% 117.2% 12.8% 63.6%

0.77

8.8%

0.66

Rate
IFD

95.2% 114.3% 96.2% 100.1% 71.3% 125.2% 284.0% 92.4% 117.2% 96.7%

184.13

101.6% 85.3% 110.4% 35.4%

196.53

79.3% 74.1% 38.1%

1.66

76.8%

2.33

1.86

148.57

74.6% 30.4% 71.2%

3.11

41.1%

54.0%

0.96

8.2%

1.79

1.75

43.6%

32.1%

0.26

104.54

1.03

62.05

28.2% 126.5% 30.4%

1.32

Rate
Gastro

49.3%

3.97

Rate
Derm

0.66

Rate
Card

95.36

390

Min

Hale Creek

1

151

Georgetown

3

Pop Med Hub Security Rate All
2006 Cl
Spec

Prison

Exhibit J - DOCS Specialty Care Utilization Rates at Male Prisons - FY 2006-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

EXHIBIT J

477

1,720

219

2,890

Altona

Bare Hill

Chateaugay

Clinton

Clinton Annex

552

4,005

Adirondack

2

637

Watertown

Totals for Hub

876

Riverview

1

1

3

1

1

1

1

1

1

3

3

3

3

3

3

2

2

2

Med

Max

Med

Med

Med

Med

Med

Med

Med

0.33
3.65

1.26

7.6%

0.33

3.77

2.51

2.60

1.32

0.91

3.80

3.26

37.2% 82.7% 30.3%

0.87

73.5% 119.9% 57.6%

1.73

29.1% 116.3% 28.8%

0.68

35.2% 10.5%

0.83

1.57

Rate
Liv Bx
0.20

Rate
Neph

2.64

0.17

1.60

0.00

0.94

0.63

1.60

0.17

14.31

3.08

3.08

10.3% 113.5% 16.0%

0.77

29.2% 66.9% 57.4%

2.20

6.1% 113.5% 0.0%

0.46

6.6% 187.8% 15.1%

0.50

13.0% 111.3% 17.9%

0.98

Rate
IFD

20.99

2.15

15.41

11.87

1.32
17.12

0.80

10.7% 28.3%

5.12

26.7% 60.7%

19.00

13.34

13.50

2.35
15.83

9.51
3.08

12.14

12.14

46.2% 163.7% 86.3%

0.92

2.12
61.96

2.36

27.1% 45.4%

13.06

70.7% 196.4% 121.0% 28.1% 50.3%

1.41

57.1% 159.3% 107.7% 35.6% 17.1%

1.14

66.2% 217.0% 19.5%

1.32

24.5% 156.0% 83.5%

Rate
Rate
Rate Rate PT Rate
Neuro Ophtha Ortho
Urol
l
0.49
15.08
9.21
12.83
2.84

1.89

9.01

8.18

3.35

1.47

1.37

3.20

3.56

0.90

8.89

8.22

0.91

0.93

9.07

1.31

0.80

18.2% 583.7% 83.5%

1.37

0.47

EXHIBIT J

Page 2 of 8

94.9% 151.6% 28.6% 203.9% 120.3% 93.4% 72.8%

183.67

104.3% 38.9% 43.6% 73.3%

0.91

8.43

27.2% 29.6% 37.3% 111.9% 33.0% 85.0%

1.63

63.3%

0.93

0.64

201.83

1.05

8.60

8.39

48.85

7.55
11.92

10.12
8.68
11.25

7.44

89.7% 78.7%

8.68

1.80
4.57
62.35

3.56

38.0% 97.6%

18.26

39.2% 38.5%

18.84

62.3% 116.3% 67.5% 129.6% 76.2%

1.25

0.0%

0.00

37.8% 123.2% 91.8%

0.76

26.8% 60.1% 206.7% 108.5% 238.2% 134.2% 52.5% 88.9% 76.1% 101.5% 161.3%

0.63

122.44

98.0%

189.52

109.3% 38.5% 121.1% 74.8% 189.9% 218.7% 281.6% 154.1% 125.5% 110.1% 128.8% 50.3%

211.41

59.5%

115.06

79.5%

153.85

55.5%

107.31

55.0%

106.45

37.5% 99.8% 33.7%

1.47

Rate
Gastro

58.7%

3.13

Rate
Derm

0.88

Rate
Card

113.61

605

Med

Ogdensburg

2

1,021

Gouverneur

1

Pop Med Hub Security Rate All
2006 Cl
Spec

Prison

Exhibit J - DOCS Specialty Care Utilization Rates at Male Prisons - FY 2006-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

1,175

721

602

539

746

746

Mid-Orange

Otisville

Shawangunk

Sullivan

Ulster

9,032

Eastern

3

1,162

Upstate

Totals for Hub

135

Lyon Mountain

EXHIBIT J
1

1

1

1

1

1

1

3

3

4

4

4

4

4

4

3

3

3

Med

Max

Max

Med

Med

Max

Max

Min

Min

1.11

Rate
Card
1.23

Rate
Derm
3.80

Rate
Gastro

0.0%
1.71

112.7%
194.71

2.22

0.58

Rate
Neph

11.85

40.2%

3.03
3.70

0.0%

0.00
1.48

55.4%

0.61

0.95

8.09

0.86

0.52

1.38

5.02

9.00

1.36

0.95

43.8% 21.7% 107.3% 61.1% 47.2%

1.38

23.6% 50.9% 157.3% 263.0% 135.4%

0.74

0.47

Rate
Liv Bx

72.9% 33.2% 53.4%

5.49

Rate
IFD

2.55

2.89

5.36

6.81

1.19

1.02

22.42

10.91

52.12

5.45

12.59

10.37
9.04

19.97

2.22
100.86

3.61

84.7% 47.5%

40.74

12.93

12.01

59.88

3.76
2.81

10.38

14.72

82.55

8.60

60.4% 133.7% 109.0% 124.5% 80.4%

1.21

77.5% 93.4% 181.1% 209.7% 77.2%

1.55

0.0% 130.2% 94.1%

0.00

0.0% 231.9% 99.0% 108.4% 116.6%

0.00

32.2% 180.0% 144.1% 130.2% 97.4%

Rate
Rate
Rate Rate PT Rate
Neuro Ophtha Ortho
Urol
l
0.64
17.41 15.89
62.62
4.56

7.63

12.90

6.66

14.84

1.53

3.19

3.05

11.79

14.98

94.17

10.54

2.99

4.49

6.48

2.33

0.66

2.99

5.01

5.38

14.84

9.65

1.30

2.41

10.63

6.81
2.23

14.84

25.23

8.3% 109.9% 61.8%

0.17

6.48
90.72

6.86

47.7% 138.4%

22.92

2.14

1.61

5.90

8.45

0.67

1.34

1.07

10.46

11.26

89.28

7.91

5.7%

7.0%

4.3%

0.13

EXHIBIT J

0.13

13.54

0.0%

0.00

Page 3 of 8

3.1%

0.13

9.5%

0.13

61.3%

0.67

6.7%

0.13

5.5%

0.54

9.7%

1.07

0.0%

0.00

5.7%

0.27

138.0% 91.3% 51.2% 135.2% 112.1% 47.6% 122.6% 53.7% 108.1% 102.1% 185.6% 169.0%

267.02

169.2% 213.1% 171.3% 340.3% 128.0% 92.2% 220.5% 111.4% 153.5% 228.9% 188.6% 146.7%

327.27

91.2% 127.2% 142.8% 148.5% 30.9% 47.2% 273.4%

176.41

172.7% 324.6% 410.6% 152.6% 196.9% 108.4% 291.6% 152.7% 121.9% 135.9% 195.8% 225.3%

334.12

140.9% 108.6% 92.1% 122.9% 90.3% 84.6% 93.4% 140.5% 107.4% 133.6% 171.6% 183.7%

272.60

100.6% 72.5% 44.1% 115.0% 119.4% 96.7% 87.1%

0.00

0.0%

88.1%
217.99

0.00

170.37

0.0% 115.7% 13.9%

0.61

91.8%

3.64

0.00

177.58

110.1% 47.2% 39.0% 87.0%

212.97

165

Med

Gabriel

3

1,712

Franklin

1

Pop Med Hub Security Rate All
2006 Cl
Spec

Prison

Exhibit J - DOCS Specialty Care Utilization Rates at Male Prisons - FY 2006-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

EXHIBIT J

5

128

978

56

Camp Mt. McGregor

Coxsackie

Coxsackie RMU

5,096

2,149

Green Haven

Totals for Hub

29

Fishkill RMU

1,689

Fishkill

5,921

1,229

4

Downstate

Totals for Hub

1

1

3

1

1

1

1

1

6

6

6

5

5

5

5

4

Max

Max

Min

Max

Max

Med

Max

Med

1.50

Rate
Derm
9.85

Rate
Gastro
8.01

Rate
IFD
0.83

Rate
Liv Bx
0.50

Rate
Neph

6.56

4.67

4.92

10.72

0.88

2.52

85.2% 47.8% 225.8% 106.3% 59.3% 45.8%

2.00

Rate
Card

2.77

14.63

23.20

66.8% 63.9% 59.1%

61.79

9.96

44.4% 46.4%

Rate
Rate
Rate Rate PT Rate
Neuro Ophtha Ortho
Urol
l
1.34
6.18
6.51
21.37
2.17

3.56

4.09

6.30

7.58

0.91

1.76

1.81

9.90

13.06

60.12

6.86

8.64

15.45

6.04

0.16

37.60

1.24

35.6% 11.6%

2.69
7.22

0.0%

0.00

3.82

4.07
6.16

12.08

24.39

57.0% 39.5% 36.9%

1.14

2.44
88.87

7.34

10.1% 52.2%

4.88

72.41

93.10

65.52

131.03

3.45

37.93

75.86

62.07

117.24

510.34

75.86

1.44

6.42

4.51

32.20

0.93

2.00

1.68

9.87

12.70

119.22

5.77

4.10

8.95

4.61

27.43

0.86

3.45

3.45

9.44

15.09

83.81

5.89

6.24

0.0%

0.00

15.44

35.8%

1.56

3.13

0.00
11.04

1.02

1.23

10.4% 221.9% 0.0%

0.78

3.27

0.0%

0.00

1.56
10.33

7.06

32.3% 14.2%

3.13

52.97

0.0%

0.00

10.84

0.0%

0.00

30.36

82.14

114.29

1.79

35.71

55.36

76.79

33.93

905.36

85.71

EXHIBIT J

Page 4 of 8

1435.4% 4254.6%966.3%1883.1%1516.4%126.8%3265.2%2769.9%793.9% 307.8% 1882.1%1831.7%

2776.79 100.00

124.5% 156.6% 198.5% 354.0% 146.5% 72.6% 112.2% 163.7% 106.8% 64.0% 110.1% 231.6%

3.68

0.0%

1.6%
240.80

0.00

3.13

173.5% 174.5% 284.8% 105.7% 364.0% 61.3% 315.8% 172.8% 97.6% 136.9% 174.2% 125.8%

335.66

184.1% 61.4% 204.4% 103.5% 427.3% 66.1% 182.9% 83.8% 102.0% 115.2% 247.8% 123.3%

356.21

1540.1% 3080.9%2963.6%1502.0%1738.6%244.9%3467.8%3796.0%641.8%1063.5%1060.9%1621.2%

2979.31

211.7% 367.8% 491.9% 138.4% 498.8% 88.3% 660.4% 308.1% 124.9% 221.3% 184.7% 156.9%

409.59

38.1% 77.7% 31.7%

1.38

70.2%

2.44

0.90

135.72

121.1% 151.6% 130.1% 144.4% 100.6% 64.8% 160.6% 90.4% 102.3% 118.4% 125.0% 146.5%

234.22

167.8% 279.0% 148.5% 112.7% 142.2% 62.7% 230.6% 138.8% 151.2% 210.5% 128.5% 212.9%

324.59

65.8%

127.38

793

Med

Woodbourne

4

599

Wallkill

2

Pop Med Hub Security Rate All
2006 Cl
Spec

Prison

Exhibit J - DOCS Specialty Care Utilization Rates at Male Prisons - FY 2006-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

EXHIBIT J

1,037

Washington

2,204

109

1,165

1,743

Attica

Buffalo

Collins

Gowanda

6,868

526

Mt. McGregor

6

200

Moriah

Totals for Hub

506

Hudson

2

1

2

1

1

1

3

2

1

7

7

7

7

6

6

6

6

6

Med

Med

Min

Max

Med

Med

Min

Med

Med

2.39

1.54

4.56

6.04

0.74

0.36

Rate
Liv Bx

0.74

0.36

Rate
Neph

3.36

3.95

6.13

9.88

0.59

0.59

7.41

0.0%

0.00
4.94

26.5%

2.00
3.80

0.0%

0.00
0.57

91.4%

1.00

2.88

2.85

6.86

7.35

1.00

1.16

0.99

0.87

1.04

2.27

1.77

EXHIBIT J

1.13

0.77

1.80

0.0%

0.00

0.43

0.0%

0.00

1.32

0.34
14.5% 93.7% 31.5%

1.09

52.4% 128.0% 39.2%

3.95

0.0%

0.00

78.9% 80.6% 70.5%

5.94

Page 5 of 8

53.7% 38.4% 28.9%

1.26

75.7%

1.20

1.26

146.36

25.6% 98.4% 61.0%

2.66

0.0%

56.5%

3.09

0.0%

0.00

0.60

0.0%

2.4%

0.00

109.36

0.00

4.59

100.0% 44.4% 72.2% 40.6%

193.47

80.3% 122.7% 90.8% 157.2% 97.6% 71.4% 90.5%

155.29

9.74

41.0% 107.4% 99.5% 129.2% 82.2% 79.3%

4.34

68.8%

3.38

0.96

32.4% 108.9% 170.0% 65.6% 270.0% 52.1%

3.42

63.7%

2.00

133.17

72.3%

0.76

0.0%

37.7%
139.92

0.00

73.00

70.3% 142.9% 125.8% 140.4% 131.1% 42.1% 54.2%

135.97

58.8% 101.8% 48.9% 104.4% 80.1% 52.6% 67.7%

113.84

2.68

Rate
IFD

83.5% 26.5% 105.0% 35.5% 25.4% 32.6%

4.58

Rate
Gastro

55.4%

0.83

Rate
Derm

1.96

Rate
Card

107.14

1,756

Max

Greene

6

1,681

Great Meadow

1

Pop Med Hub Security Rate All
2006 Cl
Spec

Prison

5.18

4.61

9.49

3.95

11.03

5.2%

0.50

6.27

4.5%

0.50

8.20

6.65
7.50

5.59
9.44

11.75

3.42
7.11

3.80

0.0%

0.00

4.92
5.63
65.29

2.90

56.3% 120.4%

27.07

36.5% 105.1%

17.55

28.1% 81.3%

13.50

0.0%

0.00

43.5% 152.0%

20.95

23.7% 73.0%

11.39

34.0% 83.9%

5.67

9.5%

0.92

7.64

0.0%

0.00

5.97

8.26
40.2% 61.7% 74.9%

0.80

21.5% 58.6% 69.3%

0.43

0.0%

0.00

4.89

19.6%

0.92

2.07
76.6% 44.1%

36.83

23.4% 104.6%

11.24

0.0%

0.00

63.6% 97.6% 106.6% 135.7% 62.1%

1.27

94.7% 77.5% 50.7%

1.89

86.9% 84.8% 60.4%

1.74

9.5% 114.0% 56.9%

0.19

50.0%

1.00

39.6% 98.1% 35.9%

0.79

65.5% 53.6% 41.8%

1.31

56.6% 51.7% 48.6%

Rate
Rate
Rate Rate PT Rate
Neuro Ophtha Ortho
Urol
l
1.13
5.00
5.35
16.36
3.93

Exhibit J - DOCS Specialty Care Utilization Rates at Male Prisons - FY 2006-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

EXHIBIT J

940

1,707

Wende

Wyoming

1,767

172

183

Auburn

Butler

Butler ASACTC

12,013

51

Rochester

7

996

Orleans

Totals for Hub

871

Livingston

3

3

1

1

1

3

1

1

1

8

8

8

7

7

7

7

7

7

Med

Min

Max

Med

Max

Min

Med

Med

Min

3.76

Rate
Card
2.05

Rate
Derm
8.02

Rate
Gastro
2.95

Rate
IFD
4.17

Rate
Liv Bx
0.90

Rate
Neph

Rate
Rate
Rate Rate PT Rate
Neuro Ophtha Ortho
Urol
l
2.95
9.98
20.70
50.25
5.89

6.54

6.8%

0.30

1.00

2.18

2.76

22.4% 70.7%

1.69
1.15

0.0%

0.00

2.29

2.18

7.92

14.81

28.36

6.4%

3.08

2.87

27.6%

1.29

4.02

5.12

6.53

7.13

3.41

0.00

4.79

11.38

7.34

7.66

2.13

2.66

7.03

18.78

42.37

6.93

8.09

25.96

25.11

192.45

8.51

165.8% 72.7% 170.3% 88.1% 148.0%

3.31

1.71

2.95

3.92

EXHIBIT J

0.0%

0.00

0.0%

0.00

Page 6 of 8

23.2% 34.8% 12.5%

0.55

17.8%

1.09

92.5% 26.7%

1.16
0.55

0.0%

44.2%

2.91

34.43

0.00

85.47

0.0%

0.00

0.0%

0.00

1.13

0.0%

0.00

0.0%

0.00

0.51

8.87

12.39

3.46
48.16

3.96

54.9% 73.9%

26.42

8.14

7.64

3.49

9.73

0.0%

0.00

2.73
17.0% 24.8%

1.64

29.1% 84.2% 31.6%

0.58

2.89

3.79
2.33

1.1%

0.55

23.4%

1.09

12.1% 49.7%

5.81

81.2% 81.0%

39.05

92.9% 91.8% 112.4% 100.1% 84.7%

1.86

93.9% 90.1% 105.1% 95.4% 80.4% 46.6% 144.4% 79.0% 88.3%

7.19

9.90

76.9%

4.58

0.72

8.67

26.4% 89.6% 89.8%

0.53

2.21

2.83

2.05

0.70

47.8% 145.4% 65.4%

3.60

2.23

148.73

100.2% 73.0% 93.8% 89.9%

193.93

1.29

34.9% 37.3% 116.8% 17.1% 158.1% 64.3%

5.10

66.7%

1.17

0.82

129.00

299.4% 203.7% 362.3% 168.3% 101.6% 151.1% 243.1% 404.6% 268.4% 227.8% 400.1% 181.9%

579.15

3.38

14.9% 35.0% 20.8%

0.30

44.0% 124.3% 150.0% 28.9% 195.7% 105.0% 109.2% 81.9% 134.4% 59.0% 61.3%

3.90

31.7%

1.00

135.5% 170.9% 163.0% 149.6% 94.6% 242.4% 0.0%

262.05

84.9%

1.03

0.0%

30.4%
164.18

0.00

58.81

123.8% 160.2% 65.1% 183.8% 39.1% 296.4% 82.3% 147.4% 103.2% 187.8% 104.5% 125.9%

239.44

1,005

Med

Lakeview (male)

7

1,222

Groveland

1

Pop Med Hub Security Rate All
2006 Cl
Spec

Prison

Exhibit J - DOCS Specialty Care Utilization Rates at Male Prisons - FY 2006-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

EXHIBIT J

947

186

94

151

394

Arthur Kill

Edgecombe

Fulton

Lincoln

Queensboro

7,274

813

Southport

8

177

Monterey

Totals for Hub

1,367

Five Points

3

3

3

3

1

1

3

1

1

9

9

9

9

9

8

8

8

8

Min

Min

Min

Min

Med

Max

Min

Max

Max

6.79

Rate
Card
4.13

Rate
Derm
3.25

Rate
Gastro

0.74

0.0%

0.00
0.86

0.0%

0.00

2.27

2.34

5.60

3.38

9.50

87.7% 72.2% 53.6%

2.06

0.90

0.17

EXHIBIT J

21.6% 24.2%

18.6%

0.76

0.51

36.04

0.29

2.58

0.0%

0.00
0.00

0.0%

0.00

4.05

6.41

10.79

3.44

7.02

10.17

6.91
107.24

4.75

51.3% 147.8%

24.68

0.91

0.29

9.10

5.8%

0.56

22.39

5.1%

0.56

64.94

0.0%

0.00

5.29

0.0%

0.00

3.05

7.26

11.31

48.34

4.78

67.7% 94.1% 203.1% 135.0% 113.0%

1.35

0.0%

0.00

7.71

2.11

0.00

26.9%

2.03

0.0%

0.00

0.0%

0.00

8.34

11.30

52.80

8.55

0.0%

0.00

6.09
13.1% 55.3%

1.27

2.6%

1.27

16.3%

0.76

147.9% 86.3% 102.5% 109.8% 182.8%

2.96

39.9% 64.4% 26.4% 152.7% 75.1% 102.6% 100.5% 102.2%

3.01

32.6% 183.5% 0.0%

2.46

0.0%

0.00

Page 7 of 8

5.8%

0.25

Rate
Rate
Rate Rate PT Rate
Neuro Ophtha Ortho
Urol
l
3.94
8.96
12.40
37.60
4.33

26.0% 26.8% 172.0% 72.6% 92.2% 222.9% 101.6%

0.37

135.9% 238.1% 107.6% 217.9% 102.3% 150.0% 0.0%

262.94

86.8%

167.93

103.6% 26.2% 23.5% 19.7%

0.62

0.0%

34.5%
200.49

0.00

66.67

3.9%

121.1% 37.3% 86.2% 52.0%

2.71

0.49

Rate
Neph

14.2% 63.9% 15.4% 202.5% 66.3% 97.9%

1.07
0.29

0.88

0.39

Rate
Liv Bx

64.0% 28.0% 45.0% 197.0% 92.6% 112.5% 78.2% 92.5%

4.82

Rate
IFD

2.27

234.31

57.4% 41.2% 19.3%

0.84

75.4%

1.29

1.35

145.92

93.1% 288.9% 131.6% 74.5%

180.12

1,779

Med

Elmira

8

1,016

Cayuga

1

Pop Med Hub Security Rate All
2006 Cl
Spec

Prison

Exhibit J - DOCS Specialty Care Utilization Rates at Male Prisons - FY 2006-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

867

867

Willard DTC (male)

99

Department Totals

Totals for Hub

60,797

3,509

9

Totals for Hub
1

Max

99 Med

9

3.80

Rate
Card
3.22

Rate
Derm
6.97

Rate
Gastro
26.66

Rate
IFD
1.84

Rate
Liv Bx
1.09

Rate
Neph

Rate
Rate
Rate Rate PT Rate
Neuro Ophtha Ortho
Urol
l
0.98
5.30
11.80
55.04
7.66

3.45

2.59

6.04

15.50

1.48

0.54

193.45

28.0%

54.09

28.0%

54.09

0.69

1.73

0.69

1.73

EXHIBIT J

3.14

EXHIBIT J

2.35

7.54

1.5%

0.12

1.5%

0.12

Page 8 of 8

4.36

19.6% 22.0% 39.7%

0.46

19.6% 22.0% 39.7%

0.46

1.41

0.0%

0.00

0.0%

0.00

1.09

0.0%

0.00

0.0%

0.00

98.9% 146.7% 82.5% 138.5% 205.7% 105.2% 49.5%

191.28

5.02

9.58

3.23

3.11
3.23

3.11
2.00

9.67

11.02

11.5% 33.4% 28.3%

0.23

11.5% 33.4% 28.3%

0.23

64.2% 51.9% 86.9%

1.28

6.18

48.17

0.5%

0.23

0.5%

0.23

4.68

41.9%

1.96

41.9%

1.96

86.6% 132.2%

41.64

121.4% 161.7% 102.6% 159.7% 353.7% 130.8% 100.0% 49.0% 54.8% 107.1% 114.4% 163.6%

234.89

1,737

Sing Sing

1

Pop Med Hub Security Rate All
2006 Cl
Spec

Prison

Exhibit J - DOCS Specialty Care Utilization Rates at Male Prisons - FY 2006-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

EXHIBIT K

9

8

3

8

11

8

6

3 Clinton

4 Sullivan

5 Green Haven

6 Great Meadow

7 Wende

8 Elmira

9 New York City

TOTALS

5

2 Watertown

191.28
195.47

59,930

167.93

193.93

155.29

335.66

234.22

194.71

115.06

178.49

3,509

7,274

12,013

6,868

5,096

5,921

9,032

4,005

6,212

2.38

3.45

2.06

1.71

2.88

4.10

3.56

1.71

0.87

2.27

4.40

6.04

2.34

3.92

6.86

4.61

6.30

5.02

1.32

3.20

Gastro
Rate

EXHIBIT K

3.18

2.59

2.27

2.95

2.85

8.95

4.09

1.38

2.60

2.75

# Male Male Pop Spec Care Cardio Derm
Prisons 2006
Rate
Rate
Rate

8

Hub Name

1 Oneida

Hub

7.50

15.50

3.01

3.60

7.35

27.43

7.58

9.00

0.77

1.61

IFD
Rate

1.43

1.48

0.91

2.05

1.00

0.86

0.91

1.36

1.60

2.22

1.11

0.54

0.29

0.72

0.99

3.45

1.76

0.95

0.17

1.58

2.02

1.28

3.05

1.86

1.89

3.45

1.81

1.21

0.92

2.64

9.76

5.02

7.26

8.87

7.50

9.44

9.86

12.93

15.83

11.24

11.14

9.58

11.31

12.39

5.59

15.09

13.06

12.01

9.51

10.22

48.80

41.64

48.34

48.16

27.07

82.99

60.12

59.88

13.06

46.70

4.72

6.18

4.78

3.96

5.63

5.87

6.86

3.76

2.12

4.35

Liv Bx Nephro Neuro Ophthal Ortho PT Rate Urol
Rate
Rate
Rate
Rate
Rate
Rate

Exhibit K - Hub Specialty Care at Male Prisons - FY 2006-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

1,150
215
228
808
18
96
305
51

2,871

Bayview

Bedford Hills

Bedford Hills RMU

Lakeview (female)

Taconic

Willard DTC female

Totals

Beacon

Pop
2006

Albion

Prison

1

2

1

1

1

3

1

1

Security

EXHIBIT L
17,389

67

2,096

81

7,583

1,188

932

5,442

Totl #
Spec

EXHIBIT L

99 Medium

5 Medium

7 Minimum

5 Maximum

5 Maximum

5 Minimum

9 Medium

7 Medium

Med Hub
Class

3,400

0

218

0

277

1,698

227

89

891

Physical
Therapy

Page 1 of 3

605.68

131.37

687.21

84.38

938.49

521.05

433.49

473.22

Rate
Spec

118.43

0.00

71.48

0.00

1538.89

210.15

99.56

41.40

77.48

Rate
PT

138

0

26

0

7

69

3

9

24

Cardiology

4.81

0.00

8.52

0.00

38.89

8.54

1.32

4.19

2.09

Rate
Card

368

0

29

0

16

206

33

21

63

12.82

0.00

9.51

0.00

88.89

25.50

14.47

9.77

5.48

Dermatology Rate
Derm

Exhibit L - DOCS Specialty Care at Female Prisons - FY 2006-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

228

808
18
96

305

Beacon

Bedford Hills

Bedford Hills RMU

Lakeview (female)

Taconic

Totals

2,871

51

215

Bayview

Willard DTC female

1,150

1

2

1

1

1

3

1

1

99

5

7

5

5

5

9

7

210

3

29

0

4

82

17

24

51

EXHIBIT L
EXHIBIT L

7.31

5.88

9.51

0.00

22.22

10.15

7.46

11.16

4.43

Pop 2006 Med Cl Hub Gastroent. Rate GI

Albion

Prison

32.04

0.00

68.85

3.13

155.56

63.00

53.95

18.14

0.70

Rate IFD

Page 2 of 3

920

0

210

3

28

509

123

39

8

Inf. Dis.

53

0

5

0

1

9

5

5

28

1.85

0.00

1.64

0.00

5.56

1.11

2.19

2.33

2.43

49

0

9

0

2

31

2

0

5

1.71

0.00

2.95

0.00

11.11

3.84

0.88

0.00

0.43

Liver Bx Rate LvBx Nephrology Rate Neph

Exhibit L - DOCS Specialty Care at Female Prisons - FY 2006-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

228

808
18
96

305

Beacon

Bedford Hills

Bedford Hills RMU

Lakeview (female)

Taconic

Totals

2,871

51

215

Bayview

Willard DTC female

1,150

1

2

1

1

1

3

1

1

99

5

7

5

5

5

9

7

221

2

33

1

6

121

12

20

26

EXHIBIT L
EXHIBIT L

7.70

3.92

10.82

1.04

33.33

14.98

5.26

9.30

2.26

Page 3 of 3

310

7

20

2

6

141

20

14

100

10.80

13.73

6.56

2.08

33.33

17.45

8.77

6.51

8.70

671

3

61

1

9

258

38

28

273

23.37

5.88

20.00

1.04

50.00

31.93

16.67

13.02

23.74

124

0

18

0

4

43

7

7

45

Pop 2006 Med Cl Hub Neurology Rate Neuro Ophthal. Rate Ophth Orthopedics Rate Ortho Urology

Albion

Prison

4.32

0.00

5.90

0.00

22.22

5.32

3.07

3.26

3.91

Rate Uro

Exhibit L - DOCS Specialty Care Services for Female Prisons - FY 2006-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

EXHIBIT M

Totals for Hub

Bayview

Totals for Hub

9

7

Lakeview (female)

Albion

5

215

215

1,246

96

1,150

1,359

305

Taconic

Totals for Hub

18

Bedford Hills RMU

1

1

808

9

7

7

5

5

5

Med

Min

Med

Med

Max

Max

Rate
Card

Rate
Derm

Rate
Gastro

Rate
IFD

Rate
Rate
Liv Bx Neph

Rate
Rate
Neuro Ophth

7.73

20.90

9.71

64.02

1.47

3.24

12.66

13.76

26.93

178.07

5.30

71.48
5.90
60.4% 136.6%

1.93

443.26

5.06

0.00
0.0%
4.09

0.00
0.0%

2.25

0.00
0.0%

0.40

0.00
0.0%

2.17

8.19

1.04
2.08
13.5% 19.3%

21.99

1.04
4.5%

3.61

0.00
0.0%

11.16

18.14

2.33

0.00

9.30

6.51

13.02

EXHIBIT M

Page 1 of 2

71.6% 87.0% 76.2% 152.7% 56.6% 125.7% 0.0% 120.8% 60.3% 55.7%

9.77

35.0% 75.4%

3.26

41.40

4.19

433.49

60.4% 83.6%

71.51

0.00
0.0%

41.40
3.26
35.0% 75.4%

2.8% 121.5% 23.5% 28.1% 75.8% 94.1%

0.88

3.13
9.8%

0.70
2.43
0.43
2.26
8.70
23.74
77.48
3.91
2.2% 131.6% 25.4% 29.4% 80.5% 101.6% 65.4% 90.6%

433.49 4.19
9.77
11.16
18.14
2.33
0.00
9.30
6.51
13.02
71.6% 87.0% 76.2% 152.7% 56.6% 125.7% 0.0% 120.8% 60.3% 55.7%

73.2% 40.0% 39.4% 56.0%

0.00
0.0%

84.38
13.9%

473.22 2.09
5.48
4.43
78.1% 43.4% 42.7% 60.7%

132.0% 160.6% 163.0%132.9% 199.8% 79.5% 189.3% 164.4% 127.4% 115.2% 150.4% 122.6%

799.63

687.21 8.52
9.51
9.51
68.85
1.64
2.95
10.82
6.56
20.00
113.5% 177.2% 74.2% 130.1% 214.9% 88.6% 172.6% 140.5% 60.7% 85.6%

2938.89 38.89 88.89 22.22 155.56 5.56 11.11 33.33 33.33 50.00 1538.89 22.22
485.2% 808.5% 693.4% 304.0% 485.5% 300.3% 649.8% 432.9% 308.6% 213.9% 1299.4%514.4%

873.02 8.54 25.50 10.15
63.00
1.11
3.84
14.98 17.45 31.93 210.15 5.32
144.1% 177.5% 198.9% 138.8% 196.6% 60.2% 224.4% 194.5% 161.6% 136.6% 177.4% 123.2%

99.56
3.07
84.1% 71.1%

Rate Rate PT Rate
Ortho
Urol

521.05 1.32 14.47
7.46
53.95
2.19
0.88
5.26
8.77
16.67
86.0% 27.4% 112.9% 102.0% 168.4% 118.5% 51.3% 68.4% 81.2% 71.3%

Bedford Hills

Min

228

Beacon

5

Pop Med Hub Security Rate Ttl
2006 Cl
Spec

Prison

Exhibit M - DOCS Female Specialty Care Utilization Rates - FY 2006-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

51

2,871

Totals for Hub 99

Department Totals

99

Med

0.0%

21.7%
4.81

0.00

131.37
605.68

0.00
0.0%

131.37
21.7%

Rate
Card

Rate
Gastro

5.88

12.82

7.31

0.0% 80.5%

0.00

0.00
5.88
0.0% 80.5%

Rate
Derm

32.04

0.0%

0.00

0.00
0.0%

Rate
IFD

1.85

0.0%

0.00

0.00
0.0%

1.71

0.0%

0.00

0.00
0.0%

Rate
Rate
Liv Bx Neph

13.73

5.88

7.70

10.80

23.37

50.9% 127.1% 25.2%

3.92

EXHIBIT M

Page 2 of 2

118.43

0.0%

0.00

0.00
0.0%

4.32

0.0%

0.00

0.00
0.0%

Rate Rate PT Rate
Ortho
Urol

3.92
13.73
5.88
50.9% 127.1% 25.2%

Rate
Rate
Neuro Ophth

Note: The percentages contained in the second line for each facility represents the percentage of the prison's utilization rate in
comparison to the system-wide average utilization rate for women for each specialty care service.

51

Pop Med Hub Security Rate Ttl
2006 Cl
Spec

Willard DTC female

Prison

Exhibit M - DOCS Female Specialty Care Utilization Rates - FY 2006-07

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York

EXHIBIT N
M
EXHIBIT M

EXHIBIT N

2,149

721

1,191

1,737

746

1,162

1,707

Green Haven

Mid-Orange

Oneida

Sing Sing

Sullivan

Upstate

Wyoming

28,253

1,681

Great Meadow

Totals

1,743

978

Coxsackie

Gowanda

2,890

Clinton

1,718

808

Bedford Hills

Fishkill

1,767

Auburn

1,779

2,204

Attica

Elmira

947

Arthur Kill

1,175

1,150

Albion

Eastern

Pop
2006

Prison

1

1

1

1

1

1

1

1

2

1

1

1

1

1

1

1

1

1

1

7

3

4

9

1

4

5

6

7

5

8

4

6

3

5

8

7

9

7

Med

Max

Max

Max

Med

Med

Max

Max

Med

Med

Max

Max

Max

Max

Max

Max

Max

Med

Med

248.48

129.00

217.99

267.02

234.89

184.13

334.12

356.21

107.14

146.36

402.68

145.92

272.60

240.80

183.67

938.49

148.73

193.47

262.94

473.22

Med Hub Security Rate All
Cl
Spec

2.89

0.82

0.00

2.14

3.80

2.69

7.63

1.44

1.96

1.26

8.50

1.35

2.55

3.68

3.56

8.54

2.21

1.04

5.60

2.09

Rate
Card

4.58

1.77

9.50

4.43

5.27

5.10

0.95

5.90

6.97

4.37

6.66

4.51

4.58

1.26

5.94

0.84

5.36

15.44

8.89

EXHIBIT N

4.29

1.17

1.38

1.61

3.22

3.02

12.90

6.42

0.83

1.20

15.19

1.29

2.89

6.24

0.90

25.50 10.15

2.83

2.27

3.38

5.48

12.46

1.29

8.09

8.45

26.66

5.37

14.84

32.20

2.68

1.09

36.96

1.07

6.81

11.04

9.07

63.00

7.19

5.94

7.71

0.70

Rate Rate Rate
Derm Gastro IFD

1.30

2.23

0.86

0.67

1.84

1.76

1.53

0.93

0.36

1.32

1.22

0.90

1.19

1.02

1.31

1.11

1.13

1.13

2.11

2.43

1.40

0.70

0.52

1.34

1.09

3.11

3.19

2.00

0.36

0.34

7.10

0.17

1.02

1.23

0.80

3.84

0.51

0.77

0.00

0.43

7.64

9.44

8.34

8.70

9.73

11.75

11.30

23.74

39.05

65.29

52.80

77.48

Rate
PT

2.46

0.53

1.55

1.07

0.98

1.85

3.05

1.68

1.13

0.80

6.05

4.05

2.81

3.27

1.25

7.06

7.44

10.79

9.10

8.67

9.04

89.28

55.04

35.94

94.17

12.61

9.90

64.70

26.42

19.97 100.86

10.46 11.26

11.80

11.34 10.66
5.30

16.36

36.83

87.37

24.68

82.55

52.97

62.35

12.70 119.22

5.35

8.26

11.79 14.98

9.87

5.00

5.97

11.87 23.98

6.41

10.38 14.72

10.33

11.25

14.98 17.45 31.93 210.15

2.89

1.27

2.96

2.26

Rate Rate Rate Rate Rate
Liv Bx Neph Neuro Ophth Ortho

Exhibit N - DOCS Specialty Care at CA Visited Prisons - FY 2006-07

5.40

3.46

3.61

7.91

7.66

6.13

10.54

5.77

3.93

2.07

7.22

6.91

8.60

10.84

3.56

5.32

3.79

2.90

8.55

3.91

Rate
Urol

Exhibits
Healthcare in New York Prisons 2004-2007
The Correctional Association of New York