New research from economists at Harvard University shows that county jails may be able to improve health care and reduce deaths within prisons through health care certification, but the process still leaves inmates frustrated by subpar care.
The study, shared by Harvard University with The Times, surveyed 44 medium-sized prisons across the country and found that those accredited by the nonprofit National Commission on Correctional Health Care had 93 lower monthly death rates than those without certification. %. The reduction likely saved about 15 lives over the course of the study, the researchers said in a preliminary draft of their work, which has not yet been peer-reviewed.
Prisons seeking NCCHC approval tend to better educate staff on how to refer inmates for treatment, said Crystal Yang, a professor at Harvard Law School and one of the study’s co-authors. She told The Times the aim was to “ensure that processes and procedures for triaging and managing prisoner patients are up to standard”.
Obtaining certification takes several months, typically costs $5,000 to $10,000, and often requires an inspection of the facility by NCCHC experts, Harvard researchers said. The prisons in the study did not hire more staff, change health care providers or purchase new equipment, but still had lower death rates than facilities that did not seek accreditation.
“They are able to use the capital and labor on hand to better deliver services,” said another study co-author, Marcela Arsan, a professor of public policy at the Harvard Kennedy School.
The researchers did not examine whether certification led to doctors visiting inmates more frequently and said it did not lead to facilities providing a wider range of services. But they said their findings suggest some health care services, such as medical and mental health screenings for new inmates, are provided more frequently and in a more timely manner in accredited facilities.
Alsan said the certification process also promotes better communication between health care workers and correctional officers, improves compliance with safety and training standards and increases job satisfaction.
The study comes amid rising death tolls and fatalities in prisons across the country, including those in Los Angeles. Criticism of prison conditions grows. In 2023, 45 people died in Los Angeles County jails; Leading to increase in county jail death rate That’s more than double what it was ten years ago.
The study does not include the names or counties of the prisons involved in the study because they guarantee anonymity for participation. Nine of the prisons are located in California, but the average daily population is between 100 and 3,000, which means that the Los Angeles prison – An average of about 12,800 prisoners per day ——Not included. The Los Angeles County Sheriff’s Department said in an email that its facilities are not NCCHC certified.
Harvard research suggests accreditation is not a panacea for the prison health system’s problems.
Staff at accredited prisons included in the study self-reported that they had less respect for inmates than their counterparts at non-accredited prisons. Regardless of the prison’s accreditation status, inmates interviewed for this study were pessimistic about the treatment they received.
“The medical staff think you’re lying. [about health issues],” one prisoner told researchers. The prisoner, who asked not to be named, added that they believed the poor treatment they received in the prison, one of the accredited prisons, was “impossible in this country”. Likewise, one inmate at an unaccredited facility told researchers they were treated like “animals.”
In 2021, researchers identified dozens of prisons interested in participating in a study and then paid for them to become certified. Over the next few years, the Harvard team interviewed staff and inmates and surveyed the facility throughout the process.
Two prisons that originally participated in the study dropped out early—in one case, because someone on the facility’s medical leadership team suffered a heart attack, and in the other, because someone on the facility’s detention leadership team suffered a heart attack. Sued for sexual harassment. Of the remaining 44 prisons, half were designated for certification and the other half were not certified. Eleven were successful and two more are on the verge of completion. About 15% to 20% of the country’s prisons recognizedthe researchers said.
Researchers found that the 13 prisons that had completed or were about to complete accreditation had an 18% increase in compliance with safety and prevention standards and a 25% increase in compliance with staff training standards. While three deaths occurred at 13 certified facilities, 27 deaths occurred at 22 noncertified facilities during the same time period.
As for why they found such large improvements in health care adherence and outcomes, the researchers said in a draft report that the bar was low to begin with: “It appears that the size of our effect is due to the fact that there was a considerable Big room for improvement Conditions in U.S. prisons, where information friction and coordination problems are severe, and where health conditions are much worse than generally thought, are improving.
Los Angeles County inmates have died in recent years from jumping bars, banging their heads against walls and injecting drugs with makeshift needles. The Times previously reported. At least three prisoners had paper, tampons or other objects stuffed down their throats and suffocated to death before anyone could intervene. one Man dies after being beaten He bled for four hours before the guards noticed. Era analysis State and county data last year found that natural deaths, homicides and drug overdoses were all up in Los Angeles jails compared with a decade ago.
But in the end it turned out that there were fewer deaths last year than the year before. As of the end of 2024, the Sheriff’s Department reported that 32 people had died in its custody, the lowest death toll at the jail since 2019.
