County jails can improve access to health care and reduce mortality rates behind bars through health care accreditation, according to new research by Harvard University economists, but the process still leaves inmates frustrated by low standards of care.
The Harvard study shared with The Times analyzed 44 midsize prisons across the country and found that those that earned accreditation from the nonprofit National Commission on Correctional Health Care had a 93% lower monthly mortality rate than those who did not obtain it. Over the course of the study, that reduction could have saved about 15 lives, the researchers said in a preliminary draft of their work, which has not yet been peer-reviewed.
Crystal Yang, a professor at Harvard Law School and one of the study's co-authors, said prisons seeking the NCCHC seal of approval tend to better educate staff on how to refer inmates for treatment. The goal is “to ensure that processes and procedures for classifying and managing inmate patients meet standards,” he told The Times.
Obtaining accreditation takes several months, typically costs between $5,000 and $10,000, the Harvard researchers said, and typically involves an inspection of the facilities by NCCHC experts. The prisons in the study did not hire more staff, change health care providers or purchase new equipment, but they still recorded lower mortality rates than facilities that did not seek accreditation.
“They were able to provide better services with the capital and labor they had on hand,” said another co-author of the study, Marcella Alsan, a professor of public policy at the Harvard Kennedy School.
Researchers did not examine whether accreditation resulted in doctors seeing inmates more frequently and said it did not result in facilities offering a broader range of services. But they said their findings suggest that some health care services were offered more frequently and in a more timely manner at accredited facilities, such as intake medical exams and mental health screenings for new inmates.
Alsan said the accreditation process also drove better communication between medical and correctional staff, improved compliance with safety and training standards and increased job satisfaction.
The investigation comes as prisons across the country, including those in Los Angeles, have seen a rise in deaths and Growing criticism of conditions behind bars.. In 2023, 45 people died in Los Angeles County jails. driving death rate in county jails more than double what it had been a decade earlier.
The research does not include the names or counties of the prisons that were included in the study, as they were guaranteed anonymity to participate. Nine of the prisons were in California, but all had an average daily population of between 100 and 3,000, i.e. the Los Angeles prisons, which average around 12,800 inmates per day – were not included. The Los Angeles County Sheriff's Department said in an email that its facilities are not accredited by the NCCHC.
The Harvard study contained some indications that accreditation is not a panacea for troubled prison health systems.
Staff at accredited facilities included in the research reported lower levels of respect toward inmates than their peers at non-certified prisons. Inmates interviewed for the study offered bleak opinions about the treatment they received regardless of their prison's accreditation status.
“Medical staff assume you are lying.” [about health issues]“one inmate told investigators. The anonymous inmate added that he did not believe that the poor level of treatment they had received in prison (one of the accredited ones) “was possible in this country.” Similarly, an inmate at an unaccredited facility told investigators they were treated like “animals.”
In 2021, researchers identified several dozen prisons interested in participating in a study and then paid the costs to obtain accreditation. Over the next few years, the Harvard team interviewed staff and inmates, and examined the facilities as they moved through the process.
Two of the prisons that initially 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 case because someone on the facility's custody leadership team was sued for sexual harassment. . Of the remaining 44 prisons, half were assigned accreditation and the other half were not. Eleven made it and two others are on their way to finishing it. Nationally, about 15 to 20% of prisons are accreditedthe researchers said.
Researchers found that the 13 jails that completed or will complete accreditation had an 18% higher compliance rate with safety and prevention standards, and a 25% higher compliance rate with staff training standards. And while three people died at the 13 facilities undergoing accreditation, their 22 unaccredited counterparts suffered 27 deaths in the same time period.
As to why they found such improvements in compliance and health care outcomes, the researchers suggested in a draft of their report that the bar is low to begin with: “It appears that the magnitude of our effects is due to the fact that there is considerable room for improvement among US prisons, where information frictions and coordination problems are severe and where health outcomes are much worse than widely believed.”
In recent years, Los Angeles County inmates have died by jumping off railings, hitting their heads on a wall and injecting drugs with makeshift needles. The Times previously reported. At least three inmates died after putting paper, sanitary pads or other items down their throats, suffocating before anyone intervened. One man died after being beaten and they left him bleeding for four hours before the guards noticed. A Times analysis An investigation of state and county data last year found that in Los Angeles jails, natural deaths, murders and overdoses were up compared to 10 years ago.
But ultimately, last year turned out to be less deadly than the year before; As of the end of 2024, the Sheriff's Department reported that 32 people died in its custody, marking the lowest number of deaths in jails since 2019.
