How Poor Pay and Bad Planning Has Led to Diminished Medical Care for Federal Prisoners

Jerry-Rainey /

Medical care provided by the government to inmates at federal prisons is suffering due to poor planning and insufficient compensation, according to a new report.

The Bureau of Prisons has massive shortfalls in its medical staff at facilities across the country, the Justice Department’s inspector found in an audit released Monday, and has yet to develop an adequate strategy to address the problem. The staffing issues not only affect inmates’ care, but waste money on contracted medical care and diminish employee morale.

BoP facilities are required to have at least 90 percent of their medical positions filled in any 18-month period, but 80 percent of the bureau’s 121 institutions failed to meet that target as of September 2014. At some facilities, medical positions were more than 40 percent vacant.

As the bureau has spent more on recruitment and retention bonuses, student loan repayments, temporary duty assignments and contracted care, its total budget on medical care has increased more than 20 percent from fiscal years 2010 to 2014 to $1.1 billion. The shortages have only been exacerbated in that period, however, the IG said. The auditors said local competition, pay limits and geographic locations limited the agency’s ability to recruit and retain medical professionals.

The 2,300 civil servant medical staffers at the bureau receive pay according to the General Schedule, which the IG said lags behind similar jobs in private sector. In some cases -- using the Physicians and Dentists Comparability Allowance programs -- some medical employees can earn up to 25 percent more than their GS position allows in exchange for a two-year commitment to the agency. Some doctors in nearby private sector jobs still earn double their federal counterparts in comparable positions. BoP nurses, meanwhile, are topped out at the GS-5 level. This has led would-be applicants to take positions at more prestigious and higher paying hospitals and facilities, and results in employees leaving federal service quickly for better options.

The bureau has discussed adjusting the job listings and corresponding pay caps with the Office of Personnel Management, the IG said, but those discussions have yielded no results. The agency increased the number of employees receiving some sort of incentive pay by 74 percent between fiscal years 2010 and 2014, but that process is often cumbersome and not immediately available for hiring managers when negotiating with applicants. BoP has considered automating certain incentive procedures, but has yet to do so.

On top of those issues, the auditors noted BoP pay is not factoring in the “inherent security risks associated with working in a correctional setting,” further deterring potential employees. Additionally, many of the prisons are located in remote locations, making recruiting difficult.

The bureau has failed to develop a comprehensive plan to assess its biggest needs, making it harder for the agency to prioritize its hiring and relocating efforts. It employs around 800 U.S. Public Health Service commissioned officers to fill medical positions, but its lack of a national plan focusing on the largest gaps inhibits its ability to deploy them in the most efficient way. The bureau has also declined to regularly use mandatory reassignments for PHS employees -- designed to be standard practice for the corps, as in the military -- to relocate them to the most needy areas.

BoP has instead relied on temporary duty assignments, which the IG found to be more expensive than hiring full-time employees in the areas in need. Spending on inmate care outside of bureau facilities has also increased 23 percent from fiscal 2010 to fiscal 2014, while the agency is spending more money on overtime for its employees who transport the inmates to local hospitals and treatment centers.

The staffing issues are taking their toll BoP employees and inmates alike.

“We found that staffing shortages lower staff morale, increase staff workload, and ultimately can reduce inmates’ access to routine medical care,” the auditors wrote.

Employees are taking mandatory overtime and working double shifts, the IG said. When the staff is drained, some employees said, routine care becomes a lower priority.

Workforce morale has also been damaged by the joint use of GS employees and the commissioned PHS corps, who deploy from the Health and Human Services Department and receive more generous pay and benefits. Once installed at the prisons, BoP and PHS staff perform the same duties.

“We did note that several BOP officials described the inevitable tensions that can arise in a workforce where staff members share the same jobs, workplace and mission, yet can receive meaningfully different compensation and benefits,” the IG wrote.

The report is only the latest among a litany of longstanding staffing complaints directed at the bureau; the American Federation of Government Employees’ Council on Prison Locals has for years sounded the alarm on too few employees across the agency.

“BoP has not been operating under its full complement since I've been employed,” the council’s president E.O. Young told Government Executive earlier this year. “I believe it currently operates in the low 90 percent of its current staffing levels.”

The steps the bureau has taken so far have done little to solve the problem, the IG said, often just placing a Band-Aid on a wound requiring a much more serious solution.

“The BoP’s actions to address its recruiting challenges tend to involve reactively addressing specific problems faced by individual institutions rather than proactively identifying, prioritizing, and responding to regional or national trends in a coordinated fashion across all of its institutions,” the auditors wrote.

The agency agreed with auditors on the need to establish a more far-reaching and standardized approach to meeting its challenges, including through the more effective use of PHS staff. 

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