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The doctor is out
By Ann Coppola, News Reporter
Published: 06/02/2008

Safe There’s a good chance that on any given day, at any number of hospitals across the United States, an inmate is receiving care from a non-correctional nurse or doctor. In these situations, the ultimate objective of hospital administrators – saving lives – can sometimes clash with the ultimate objective of corrections officials – security. Even worse, like so many other seemingly routine corrections procedures, outside medical appointments have the potential to turn into deadly incidents.

“Across corrections in this country if you look at the most serious, bad outcomes over the past few years, they’ve all been transport related,” says South Carolina Department of Corrections Director Jon Ozmint, who chairs the American Correctional Association’s staff safety issues committee. “Transports used to be routine, but we can’t treat them like they’re routine anymore.”

Most states follow similar procedures to transport inmates to outside medical appointments, which can be at a doctor’s office, hospital or clinic. Generally, two officers transport an inmate. The “close contact” officer, the one who has direct contact with the inmate and applies and removes restraints, is not armed. The other officer not in close contact is armed.

“One thing South Carolina started about four years ago is we now require all transport officers to wear a bullet proof vest,” Ozmint says. “If you look around the country more and more states are requiring this. It’s recognition of the new dangerousness and the increased reality of outside threats.”

The presence and availability of cell phones inside facilities is just one factor adding to this increasing danger. Access to them may allow an inmate to coordinate escape attempts with the outside world. As more inmates serve longer sentences, they tend to become more reckless, feeling as if they have nothing to lose.

Hospital transports can be even more dangerous than other transports, such as court appointments, because there is a greater chance the inmate will know about the transport ahead of time. Having this knowledge can give him the opportunity to plan an escape.

“In so many cases it is impossible to keep that information, like the timing of a medical appointment, from an inmate,” Ozmint explains. “We have a system where we won’t let those inmates know about their outside medical appointment until the morning of. But, for example, if it’s for some kind of testing procedure that the inmate has to go on a fast for, then we obviously have to let him know. It can put you at great risk.”

Last January, risks such as these proved to be too much for one Maryland hospital to take. A Maryland Department of Public Safety and Correctional Services inmate was shot and killed after he escaped from a regional hospital. It was the second prisoner escape from that hospital in three months. In response to the incident, Dimensions Healthcare System, the group overseeing the hospital, announced it would no longer admit inmates as patients in non-emergencies until security procedures were tightened.

"We have always been willing to do our part in treating state and county prisoners who are brought to us," wrote Dimensions president G.T. Dunlop Ecker in a letter to Corrections Secretary Gary Maynard. "We need to be assured, however, that this will be done in a safe manner for all concerned."

Hospitals are required by law to provide treatment to all patients in emergency cases, and since the January incident, Laurel has continued to treat inmates. The dialogue in the following months between MDPSCS and Dimensions has led to improvements in security procedures.

“We have done some things to enhance our security,” says MDPSCS Assistant Commissioner of Security Operations James Peguese. “We have adjusted our positioning inside of hospital rooms, and we now work more closely with the hospital security in terms of advising them of who is in the hospital, and giving them data about the person that is there. Just being able to know whether or not this person is a flight risk helps the hospital officials to make different decisions about their own security.”

MDPSCS also changed how its officers are armed during the transport.

“Before, depending on the security level each officer would be armed,” Peguese says. “Now, depending on the security level, only one officer is armed, and the hands-on officer actually dealing directly with the inmate is no longer armed.”

There are several reasons why a transport can go wrong, but the main ones are pretty straightforward.

“I would say that incidents tend to stem from staff error, incomplete procedures, improper training, and inspection or the lack thereof,” adds Peguese. “It’s that old adage - ‘it’s not what you expect, it’s what you inspect.’”

MDPSCS continues to send its supervisors to hospitals around the state for security inspections to ensure the hospitals can safely treat inmates. It has the ability to send its inmates to any of the state hospitals, but that approach could change in the near future.

“We are actively involved in trying to increase our telemedicine capabilities and we’re also trying to generalize our medical care providers,” Peguese explains. “As far as secondary medical care that requires an outside institution, we’re trying to nail down and work out a partnership with a single entity where all of our admissions take place at one hospital, regardless of geographical location. If the inmate’s condition is not life threatening, we could have everything take place in one spot.”

A single state corrections hospital would allow corrections officials to continuously work with hospital staff to train them in security procedures.

“Hospitals are in the business to save lives, and most hospitals are not equipped to handle inmates on a daily basis,” says Peguese. “You have to enter into some kind of partnership where there’s an ability to provide additional training to hospital staff that come in contact with your inmates on a daily basis, so they know some of the things they should be looking out for, like some of the games that are played and so forth. Then you also can minimize the general exposure an inmate would have to the general public.”

No matter what methods are chosen, the goal to cut down on the overall number of outside appointment transports seems common.

“I think the reality is going to drive people more and more towards technological solutions to eliminate as many transports as possible,” Ozmint says. “Video conferencing for court parole hearings, telemedicine - we do all of these things in South Carolina, but if you really want to see legislators talk about their importance, unfortunately, you have to wait for something to go wrong. I think eventually technology will provide the means, and we may even already be there, so that hopefully many transports won’t be necessary.”

“We look forward to cutting down on the number of transports and most importantly the number of places that we have to transport to,” Peguese adds.

As long as the dialogue between the medical and corrections communities remains open, there’s no stopping the progress towards the best balance of security and saving lives.

Related Resources:

Corrections.com columnist Gene Nardi discusses transports

Washington Post article on the Laurel incident


  1. Gene Atherton on 05/29/2008:

    Great call to bring attention to this issue. Probably the highest risk condition in corrections today. There are numerous war stories across the US about corrections transports gone wrong. I agree, part of the solution is medical technology. Also, there are some fine examples of hospitals and corrections working together to shape future expansion of facilities to include a secure, forensic intake unit at the hospital. Reamins very high risk. Gene Atherton

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