After years of working as a registered nurse, surveyor and a health services administrator, Betty Hron knows good health care when she sees it.

“People, for the most part, are trying to provide adequate health care for inmates,” Hron says. “When you think about it, it's the only population that has health care provided to them [by law]. Despite the obvious budget crunches, I think people are doing their best.”

Hron, a lead surveyor for the National Commission on Correctional Health Care (NCCHC), has always focused on improving inmate health care and evaluates correctional health care situations on a daily basis. As a surveyor, Hron visits corrections facilities to make sure that inmates are being offered adequate health care, and grants accreditation by the NCCHC when the facility meets the organizations' requirements.

The Corrections Connection recently spoke with Hron about corrections health care standards and her career in health services.

Q: How did you get into the field of corrections health care?

Hron: Let me put it like this – when I first went into corrections, it was because someone told me that I couldn't. It started out as a job, but then it became my career. I liked finding ways to make things appropriate in a setting that was totally opposed to the provision of health care.

I actually started out as a Health Service Administrator for 23 years, and then I retired. I have been doing surveys for the National Commission sine 80's. Doing these surveys has given me a chance to share what I've learned to help provide adequate care = not necessarily what the inmates thought they needed, but what they really needed. It's a labor of love.

Q: What do you look for when you enter a facility?

Hron: We look at the level of care they provide, and the staff. Generally, bad health care is health care that isn't provided in an appropriate time frame.

Q: What's the biggest problem facing health care in corrections?

Hron: The biggest problem that exists right now is the financial issue. There is a discrepancy in the pay scale in the community versus the pay scale in a corrections community, whether it's nurses, officers or doctors. Corrections cannot meet the same pay criteria for the staff – it's like a wage ware for health care staff. This results in corrections trying to find ways to provide health care with less staff.

You know, money is the root of all evil. If we all had as much money as we wanted, we would be able to provide these things easier. It doesn't matter where you're going or what you're doing – money drives the world.

Q: What should officers and staff be aware of when it comes to inmate health care?

Hron: I think everyone is really aware that the biggest liability is in health care. Inmates are notorious for filing lawsuits – they'll sue you quicker than anything, so that creates your biggest liability. 

Also, if you apply the standards and do the things required by the standards, you're going to have an appropriate medical program and care. It all totally depends on the individuals who are providing and exercising the care. The people who execute the standards, put them in place, all of that – those people are the important ones. You can take something very simple and make it difficult or you can take something very difficult and make it very simple depending on how you approach it.

One of the things that I remember telling [officers] once was ‘You're dealing with these people every day, and so the diseases they have, you can take home. If we can treat them and make them healthy – if they aren't carrying TB and hepatitis – then it's safer for you.' The inmate population, depending on where you are, if you're not screening, testing and treating – you're exposing your entire staff to these diseases – and then they get taken home to families.

Q: What can facilities do to address the issue of staff exposure to disease?

Hron: Our NCCHC standards make it mandatory for staff screening across the board – they need to be tested appropriately so that if someone did catch something, we can treat it early. The standards require that the inmate be tested on an annual basis – why not the officers that are exposed to the same thing?

Q: How do you help facilities that do not meet NCCHC standards?

Hron: We talk about things they can do to meet the standards. Part of my job is also to be a mentor and help these facilities find methods and ways to help them meet the standards. That's not only my philosophy – that's also the commissions' philosophy. It's kind of a given thing with us. The NCCHC decides on a timeline and decides whether they do or do not meet the standards.

If the compliance issues are bad, they will be given time to fix their health care. If the commission is concerned that there will be a problem with fixing the health care, we will go back to make sure they comply.

Q: Do you have any recommendations for corrections staff about health care?

Hron: Even if a facility isn't applying for accreditation from the commission for their health care – if facilities take those standards and apply them, they are going to be applying an appropriate level of health care. I don't say that it's going to be grand, but it will be appropriate. You can have the “Cadillac” program, or the appropriate program. If you apply the standards and do the things required by the standards, you're going to have an appropriate medical program. It all totally depends on the individuals who are providing the care too.

Also, there are inmates that are chronically ill because the prison system is become a catch-all for a lot of chronic diseases and mental illness. You have to be aware of that, because for a while, I wasn't. I went into the jail wearing rose-colored glasses. I lost those a long time ago. But I think the ability to make health care work is the reward. And every once in awhile, you're going to see an inmate that turns himself around, that makes a change – that says ‘thank you'. And it doesn't take much to keep you going once you see that.