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Prisons and Jails
Corrections Typology and Definitions
Jails and prisons differ in the type of inmates they hold, their daily and annual population, and the manner in which they are operated. People with all types of medical conditions and at all levels of ambulatory ability are arrested and incarcerated in jails and prisons.
Typology of Jails and Prisons
Criminal Justice Status of Inmates
Pretrial (not sentenced)
Sentenced (up to 2 years)
Sentenced (2 or more years)
Operated by the Sheriff or County
Autonomous units, not part of larger
structure (there are regional and national Sheriffs' Associations, but they
do not have authority over Sheriffs.)
Each State Department of Corrections
(DOC) operates the prisons, sets policies and has authority over the
prisons. However, each facility has a degree of autonomy and many policies
and practices are at the discretion of the Warden.
Average Daily Population (ADP) and Annual
Jails have high inmate turnover and many
short stay (a few hours to 14 days) inmates. As a result ADP is much lower
than the number of inmates that pass through annually.
Stable inmate population with much less
turnover than jails.
Inmates with Serious Medical Conditions
Typically not held, transferred to
medical facility or other supervision option. Most facilities have medical
units where inmates go for acute conditions.
Some States have one or more facility for
inmates with serious medical conditions, but they are often held at regular
facilities, sometimes in special units.
All facilities have medical units where
inmates go for acute conditions.
Medical and Other Programs
Less common due to the short length of
Medical services and other programs are
more common, but vary by system and facility.
* The Federal Bureau of Prisons (FBOP) operates Federal prisons and several private companies operate private prison facilities around the country. This report
does not address the needs or readiness of private prisons.
Correctional Health Care. Correctional health
care is increasingly provided by private companies who contract with
corrections systems, often in a managed care arrangement. There are a few major
private health care contractors and numerous smaller ones. This trend may have
consequences for a national patient tracking system as the contracts for health
care are regularly renewed and change hands; agreements with one contractor may
not be agreeable to or even known about by the next contractor. Even if
agreements are made with the correctional facility/system, the medical
department (or contractor) would be responsible for ensuring that medical
information can and will be provided to the proposed system. (Abt recently
conducted a survey of correctional medical departments for the U.S. Department
of Justice and found that when there had been recent turnover in private
contractors, the new health care vendor often did not have access to inmate medical
data from their predecessor.)
Inmate Health Care Needs. Correctional
facilities house a large number of inmates with infectious diseases, including
conditions such as HIV and hepatitis C that require regular medication, as well
as an increasing number of inmates with chronic diseases. They also often
house a large number of inmates with mental health conditions. Inmates with
mental health conditions cannot be evacuated without continuous medication and
supervision, to assure that evacuation is safe for them and those around them.
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Existing Corrections Information Systems
The different segments of the criminal justice system
(police, court, DA, jails, prisons) almost never use the same information technology (IT) systems. In
some cases the police operate or maintain the electronic administrative systems
for their local jail, but this does not guarantee that it is an integrated
system. Data, whether administrative or medical, are maintained and accessed
at the "department" level (e.g., individual jail, county department of
corrections). In addition, medical and administrative data are usually in two
separate systems, and administrative records are more likely to be in
electronic form than are medical records.
Corrections Administrative Records. IT
systems to manage corrections administration are almost universal (very small
facilities may still have paper systems) and track the exact location of each
inmate inside the facility, at all times. These tracking data are checked
several times a day through inmate "head counts". Most administrative record
systems are homegrown or modified off-the-shelf systems, and do not connect to
any other system in the criminal justice system or at the State or Federal
level (except of course for the Federal Bureau of Prisons institutions). One
jail respondent explained that their emergency plan included printing out this
database hourly when they are on alert for an evacuation, in case the computers go down.
Corrections Electronic Medical Records (EMRs).
There is no comprehensive information on how widespread EMRs are in jails or
prisons. But there are some data from a variety of sources, including a 2005
Abt Survey of Infectious Diseases in Correctional Facilities that included
questions on the use of EMRs and, more broadly access to computers and the
Internet. The survey included the Federal BoP, the 50 State departments of
corrections, and the 50 largest jails in the country. Survey results show that
correctional systems that have an EMR may not be able to connect to the Internet
(to upload data to a national evacuation tracking system) and that many
correctional institutions lack computers and/or Internet access.
Access to Computers and the Internet and Use Or Planned Implementation of EMRs
| Correctional Facility
Access to Computers in
Access to Internet in
Currently Uses EMR
Plans EMR in next 12 months
33 of 50 Largest Jails
46 of 50 State Prisons and the
Federal Bureau of Prisons
Data from Abt Associates Inc. 2005
Survey of Infectious Diseases in Correctional Facilities.
Corrections officials interviewed about evacuation tracking also reported that:
- Only about 10% of the jails that apply for certification from
NCCHC (an accrediting body for correctional health care) use EMRs.
Most large jails have EMRs.
- In many departments of corrections, a minority of facilities have
EMRs; moreover they are not always connected to each other or the central
office for data sharing.
Home grown systems that have evolved over time are very
common for both administrative and medical data. However there are many
vendors for each type of system and few facilities have "enterprise" solutions
that contain both administrative and medical data.
Unique IDs: Each facility/system may assign
multiple ID numbers to each inmate for different purposes, and State prison
systems will have at least one shared ID across facilities. There is no shared
ID number across criminal justice entities (e.g., courts, jails, prisons). EMR
IDs are probably be even less standardized.
Demographic Information: No standard administrative
or medical data elements are required to be reported to an outside body.
Presumably many systems collect a relatively similar core data set in terms of
client demographics and criminal justice involvement, but the manner in which
it is captured, the field names and the data formats vary widely.
Overall Health Status: There is generally no
medical information in the administrative record. No correctional system that
we spoke to had an EMR that can identify inmates with certain needs (e.g.
wheelchairs, special medications), and none have a mechanism for easily
identifying inmates who would need assistance evacuating. Detailed health
information is available in the EMR in individual records, but as with hospital
EMRs these systems probably cannot generate lists of persons in wheelchairs,
persons requiring specific medications, etc.
The administrative and the facility census data are very
accurate. The completeness and accessibility of medical data will vary by
system, when there is any EMR at all. A major concern is that many
correctional systems do not have remote backup for their systems so if the
facility's computers are down they cannot access records and may never be able to retrieve them.
Some prisons have explored alternative methods for
tracking inmate movements. One we spoke with priced an RFID (radio frequency
identification) system with handheld devices to scan each inmate's ID#,
demographics, security level and medical data. The estimated cost for one large
jail was $1.8M for RFID, software and hand-held devices.
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Special Evacuation Issues in Jails and Prisons
Three themes came up in the discussion of advanced planning
for emergencies that highlighted some of the difficulties in planning for an
inmate evacuation. First, it is difficult to set up agreements for
transportation, housing, and other resources for inmates prior to an emergency
because other correctional facilities are concerned about the liability and
payment issues that might arise if they agree to accept inmates from another
facility during an emergency. Private companies that could provide
transportation, housing, etc., generally have reservations about aligning
themselves with correctional systems. Second, during an emergency mutual aid
agreements and emergency orders will be put in place that will either make
other systems/companies more willing to cooperate or will require them to do
so. Third, inmates and correctional facilities will be the lowest priority for
public resources and the correctional facilities assume that they will have
little access to community resources or transportation.
Corrections Evacuation Plans and Strategies.
Some correctional facilities told us that they would not evacuate, even under
an evacuation order. A concern with this strategy is that inmates will be at
risk if there is loss of power or damage to the building. Inmates in segregation may be more at risk.
Others plan to evacuate vertically (or within the
facility/complex) by moving only inmates in affected areas of the facility to
other parts of the facility/complex. Since the Katrina experience, many
facilities have revisited this concept and now realize that much depends on the
nature and extent of the disaster. For example, in the event of flooding some
degree of vertical evacuation may be possible; in an earthquake where the
entire facility is damaged or destroyed, the building would have to be
evacuated. One jail's plan includes cordoning off a city block outside the
facility and holding inmates there until they can be moved elsewhere.
Evacuating to other (safe) correctional facilities is now
being considered by more officials. In some cases, tents could be set up in
the yard of another facility that has insufficient cell space to house the
evacuees. If a correctional facility in another State is the closest
alternative, more complex arrangements would be needed, as well as payment between the two States.
Some officials are considering use of large unused
buildings, armories, National Guard facilities or fairgrounds that are
reasonably close but out of harm's way. Concerns include security, who will pay,
and liability—all of which are partially resolved when an Emergency Operations Center is established and issues an executive order requiring sharing of resources (mutual aide).
Some low risk inmates could safely be released to
self-evacuate. One jail reported that they have used this strategy on three
previous occasions and each time all but one of the released inmates returned
to the jail after the emergency. (Prisons do not have this option.)
Experts from the National Institute of Corrections advised
us that emergency preparedness is not currently a major concern for jails and
prisons. Few correctional systems have any type of emergency plan, and
existing plans are generally out of date and have not been recently reviewed.
Correctional staff receive very little training on emergency preparedness, and
few use drills to practice for evacuation. Given the expense and security
needs of moving inmates for a drill (within or out of the facility), they are
rarely done. The task is so daunting that many facilities have not developed any evacuation plan at all.
The emergency preparedness plans that do exist in corrections can address a variety of emergencies and take a variety of forms:
- Plans for mass escape or hostage taking incidents.
- Plans for fire (required for some accreditations).
- Some plans for specific disasters (e.g. hurricane, earthquake, bioterrorism).
- Some generic plans that are adapted for each type of emergency (corrections is moving towards generic as this simplifies staff training).
- Plans for on-site evacuations (if part of the facility becomes uninhabitable).
- Plans for off-site evacuations, for situations that affect just the facility and also for those that affect the entire community.
National Incident Management System (NIMS), coordinated by the Federal
Emergency Management Administration (FEMA). It was developed for fire departments and
adopted by police departments, and is used in corrections but considered a "poor fit."
Transportation Resources in Correctional Facilities. Under normal circumstances, inmates are transported "outside the walls" in
specially secured vehicles with specific officer-to-inmate ratios depending on
the security status of the inmate (minimum, medium or maximum security).
Facilities generally have only a few transports to handle each week and even
the largest do not have sufficient vehicles, fuel and staff to evacuate an
entire jail or prison. In addition, inmates will need to be supervised by
correctional officers in the required ratios at the evacuation destination; the
officers will not be able to return to the facility to move more inmates out.
Virtually all available officers would be used in the "first wave" of the transport,
leaving none for subsequent roundtrips to and from the facility.
Jail systems vary in the extent to which they own buses to
transport inmates. Jails that are attached or located in close proximity to
the courts may not have buses because inmates are walked back and forth to
court. More remote jails have many vehicles to transport inmates. When
inmates are moved from jail to prison (to serve longer sentences) the prison
system is responsible for transportation. Some jails have formal or informal agreements
with municipal agencies to use city or school buses in an evacuation, however
most officials we spoke with were not optimistic that inmates would have
priority in the event of a community-wide disaster. Most divisions of
corrections do have a fleet of buses and vans for moving inmates between
facilities, which they could deploy in an emergency, but not enough to evacuate
all threatened facilities in an area the size of that affected by Katrina.
(Note that in the New Orleans evacuation, many staff members transported inmates in their private cars.)
Inmate Identification During and After Evacuation. The most common plan for identifying inmates during an evacuation is to issue plastic bracelets marked with an ID number. This ID number would not associated with any of the administrative or EMR Ids; it would be recorded and linked with the inmate's name (and could become the unique ID number that is uploaded to a
national tracking system). In some jails, inmates already wear a bracelet
throughout their incarceration printed, with the following data elements (not a
barcode): picture from booking, jail and criminal ID numbers and name. No
medical information or emergency alerts are included (e.g., diabetes).
Bracelets may be a poor identification strategy for
inmates. When the New Orleans Parish Prison was evacuated, inmates were issued
bracelets that were color-coded based on security level. Almost all the
inmates, except the lowest level of security, cut or chewed the bracelets off
before the buses deposited them at the prison that was used as their evacuation
site. This meant that there was no way to identify any of the inmates for
either security purposes or to treat them for medical conditions.
Medications. In facilities with "keep on
person" (KOP) medication policies where inmates control their own supply of
medication, each inmate could bring their current supply of medication with
them during an evacuation. Some inmates, and some medications, must be
controlled and administered by trained medical personnel. Medication might
need to be dispensed in-transit during an evacuation as well as afterwards.
Correctional staff will need to be responsible for assuring that inmates
continue to receive necessary medication throughout an evacuation.
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Privacy and Confidentiality in Corrections
Prison records contain information about inmates' crimes,
sentences, medical records, and other potentially sensitive information. Many States
post information on all sentenced inmates on their Web sites, so this
information is not considered private or protected, but for people being held
prior to trial, there would be confidentiality concerns. Correctional officials
have concerns about information security and who will have access to each type
of data. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is relevant for prisons, but the special security considerations raise additional issues. There are also concerns about legal issues and a general sense that the legal department would have to approve their participation in the proposed system.
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Correctional Staff Perceptions: Benefits of Evacuation Tracking
Corrections officials were interested in an evacuation
tracking system. For those that have electronic data but no backups (or whose
systems are too damaged to access), the national system could be a temporary
back-up—assuming data are uploaded quickly enough before the facility's own system fails.
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Data for Other People Needing Evacuation Assistance
In addition to the institutional records described above, there are other databases that could be used to "pre-populate" a database of persons who need to be assisted—and tracked—during an evacuation. Some of these other databases may be electronic, but some may be print or written lists that cannot be as readily accessed. The need for evacuation assistance and
tracking of non-institutionalized persons could be substantial; an official
from the Department on Disability in Los Angeles estimates that 25 to 30
percent of the general population will need evacuation assistance.74
- Hotel and resort guests. During hurricanes in
tourist areas, hotels become temporary shelters for any of their guests who
cannot secure evacuation transportation, and for others whose homes are unsafe.
Hotels have accurate lists of all registered guests; these lists are often maintained
in a central database for hotel chains. Most hotel guests need little more than
transportation to a safe airport, but it might take several days before that is
- Evacuation Pre-registration. Florida counties
offer residents the opportunity to pre-register for evacuation assistance.
People who know that they will require this assistance can pre-register for
help. During an evacuation, emergency managers will attempt to verify whether
help is indeed needed, and send emergency responders to assist. Ventilator-dependent
(and other electricity-dependent) patients, those who are bed-bound or
wheelchair-bound and without any transportation assistance, and anyone else who
knows that they will not be able to self-evacuate safely, can pre-register. Miami-Dade County has such as system; its registration form is at http://www.co.miami-dade.fl.us/oem/pdfs/EEAP.pdf. In addition to identifying and location information, the form asks for the applicant's health status
(there are check boxes for 15 different conditions), whether they use medical
equipment requiring electricity, whether a companion will accompany them to a
shelter, and whether they use a wheelchair, walker, guide dog, or crutches. According
to a county emergency manager in Florida, most of these registries are small—many people prefer not to be on such a list for reasons of privacy. Recent hurricanes have heightened awareness of the need to pre-register and the voluntary registries are expanding gradually.75
- Local Special Assistance Lists. Many fire
departments offer disabled persons who might need to be rescued (e.g. in a
fire) the opportunity to be listed, so that responders are aware that a
disabled person lives in a house. In addition to those who are mobility
impaired, persons with communication impairment (deaf, mute) may voluntarily
add their names to such a list.
- MedicAlert and other emergency pager systems have lists of clients who might require assistance, especially in a rapid evacuation.
- Vocational rehabilitation and independent living centers
have lists of persons receiving personal home aide (not home health) services and will likely know which require mobility assistance.
74. 2006 personal communication with Angela Kaufman, Project Coordinator, Los Angeles Department on Disability.
75. 2006 personal communication with David Freeman, Orange County, FL.
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