New York inmate health care needs pose treatment, design challenges.
Many correctional agencies, including the New York State Department of Correctional Services (DOCS), have created their own health-care networks. These networks use smaller, localized primary care clinics and larger, centralized regional medical facilities to deliver more cost-effective and labor-efficient health care services to their populations. The following article discusses how New York's DOCS is addressing the needs of its inmate population and how it uses facility design to enhance health care services.
The DOCS operates 68 correctional facilities, including 15 maximum security facilities, 37 medium security facilities and a number of minimum security facilities and work release centers. Two factors affecting the health care services provided by the DOCS are recent increases in the number of women inmates and the rise of communicable diseases among the offender population.
The numbers and proportion of women in the system have increased steadily in the last decade, rising from 2,450 women inmates, or 4.4 percent of the general population, in 1990 to 3,479 women inmates, or more than 6 percent of the total population, in 1993. The DOCS projects that by 1998, these figures will rise to 5,600 women, or 8 percent of a projected total population of well over 70,000.
Many women enter the system with medical problems, with an estimated 60 percent requiring secondary care follow-up services, especially for high-risk conditions. All this has heightened the need for the DOCS to address women inmates' health issues.
Among the most pressing problems among both men and women inmates are TB and AIDS. According to Dr. Robert Greifinger, deputy commissioner and chief medical officer, the demographics of the incarcerated population make it a prime target for the spread of TB. Communicable diseases among inmates are high, especially among those who are HIV-positive.
In 1992, among the state's incoming male inmates, 1.2 percent had hepatitis B, 8 percent had symptoms of syphilis, 13 percent were HIV-positive and 27 percent showed skin-tests positive for TB. For incoming women inmates, the rates were even higher: 25 percent had symptoms of syphilis and 20 percent were HIV-positive.
Plan of Action
In 1991 the DOCS and the New York State Office of General Services responded to these health care needs by developing the Health Care Plan of Action, a five-volume, 4,000-page plan evaluating medical services at all 68 correctional facilities. The plan presented regional- and facility-based solutions for addressing this issue over the next decade, in the form of new construction and renovations.
The DOCS began seeking cost-saving measures on a system-wide basis. Regionalization would enable the DOCS to combine certain activities and provide increased services to a larger inmate population more economically. The object was to move inmates in need of health care to where services and staff exist.
Based on a detailed analysis of demand for inpatient and outpatient services and staff availability, the Health Care Plan of Action called for creating four regional medical units--three for men and one for women--to be located within existing correctional facilities. According to the plan, each unit would have certain standard components and services, but the size and quantities of these elements, such as examination rooms and numbers of beds per nursing unit, would be based on regional need and available services.
The DOCS used the plan to develop architectural programs for new prototype facilities. The four regional units feature primary care clinics, infirmaries ranging in capacity from 12 to 30 beds, secondary care clinics, long-term care nursing units, medical/psychiatric units, pharmacies, dialysis units, support spaces and administrative areas. In addition, the women's regional unit has a mother-infant housing unit.
When the regionalization plan is fully implemented, maximum security facilities will have an infirmary and a primary care clinic. All medium security facilities will have primary care clinics and most will have infirmaries. Minimum security facilities will have primary care clinics as well.
Inmates will be treated at primary care clinics for medical and dental services. Those inmates requiring more specialized, secondary care services will be referred by their facility physician to the regional unit. Regional units offer several benefits:
* Scheduling of visits. Visits involving similar medical
problems may be scheduled at the same time, resulting
in a predictable number of appointments. This
enables planning for the required number of vehicles,
correctional officers and medical staff.
* Availability of services. Many local providers do not
accept inmates in community outpatient clinics. Often,
when they do agree to see inmates, there is a considerable
waiting time and overtime costs for correctional
officers. The regional unit system eliminates this
* Security concerns. Scheduling appointments at a
regional unit ensures that security requirements are
met in terms of correctional officer staffing, coverage
and physical space needs.
* Staff recruitment and retention. Regional units provide
the opportunity to consolidate those inmates who
require more intensive medical and nursing care. This,
in turn, aids in staff recruitment and retention by providing
a work environment for health care professionals
that offers development opportunities similar to
those in the community.
Many prison infirmary buildings in New York are more than 50 years old and were not designed to meet current health, building or accessibility codes or to serve a prison population of more than 64,000 inmates. These buildings generally contain mechanical ventilation systems designed to meet minimal comfort levels; they were not intended to reduce the spread of contagious diseases.
To fight the spread of TB among inmates and staff and to improve medical services, the DOCS has initiated a $350 million program for designing and building prison health care facilities over the next decade.
The first phase of this program has begun. It includes new construction and renovation of clinics and infirmaries at 11 correctional facilities and the construction of 135 isolation rooms at several infirmaries.
Because the isolation rooms are to be replicated by various design consultants, the DOCS and the Office of General Services wanted the design consultants to use standardized criteria. According to Program Manager John O'Donnell, at least 50 isolation room layouts were produced before one was chosen. The selection, O'Donnell said, was based on concerns for durability, security, maintenance and inmate accessibility to bathing areas. In 1993, the DOCS built a full-scale prototype at one of its facilities.
The prototype enabled designers and DOCS staff to test how accessible the space would be for wheelchairs and stretchers, determine the best placement for air supply and return registers, and select the most appropriate finishes and details for infection control, security and maintenance factors.
Several design features emerged:
* Visibility. In the model, the staff can see the inmate in
the isolation room bed from the corridor, through
vision panels in the anteroom.
* Ventilation. Anterooms will have 20 air changes per
hour, with positive pressure. Isolation rooms will have
12 air changes per hour, with negative pressure.
Isolation rooms have an air supply register on each
side of the bed, with perforated diffusers, and an
exhaust register is located at each side at the head of
the bed, close to floor level. A unique feature of the
isolation rooms is the redundant mechanical air system.
According to O'Donnell, this includes true standby
supply and exhaust air moving units. "State-of-the-art
controls detect deviation from specified
performance," he said. "If deviation occurs, modulating
controls are used. If specified conditions cannot be
obtained, the appropriate standby equipment is energized."
* ADA compliance. The new health care facilities were
designed to comply with the Americans with
Disabilities Act. Staff and patient areas will be completely
accessible. All patient rooms were designed to
accommodate non-ambulatory patients with respect to
toilet fixtures, mirror heights, sinks, showers and
* Flooring. After extensive investigation, and based on
a 40-year life cycle for pricing materials, terrazzo
flooring was selected for the isolation rooms, because
it is easy to maintain and highly durable.
Under the direction of Commissioner Thomas A. Coughlin III, the New York DOCS has developed a strategy for health-care services delivery in its facilities. It involves physical plant enhancement, standardized health care, regionalization of services, and responsiveness to issues that affect the inmates, staff and the general public. Over the next decade, these factors will be the driving forces behind the policies and goals of New York state's prison system.
Barbara A. Nadel, AIA, is principal of Barbara Nadel Architect, a firm specializing in correctional and healthcare facilities design and planning based in New York City. Kevin M. Travis is associate commissioner for the New York State Department of Correctional Services.
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|Title Annotation:||Architecture, Construction & Design; New York State|
|Author:||Nadel, Barbara A.; Travis, Kevin M.|
|Date:||Apr 1, 1994|
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