Psychiatry Shortage Grows 50%
Merritt Hawkins & Associates, one of the country's biggest physician search companies, reports that in 2005 there was a 48% increase in requests for psychiatrist searches. They attributed this to a "growing demand for behavioral health services and a diminishing supply of psychiatrists." (Duh.) But here's the interesting part:
"A growing number of facilities, many of them state funded mental health facilities or correctional facilities, are unable to recruit the psychiatrists they need and are reliant on temporary (i.e., locum tenens) practitioners to fill gaps in their staffs. We project that psychiatrists will become increasingly difficult to recruit and that the need for additional psychiatrists will become acute in the next five to 10 years."
Apparently when it comes to "fill order", public institutions are the last places to get physicians.
Free Society Sees Longer Waiting Times
According to a story in today's Los Angelos Times, the waiting time to see a physician has grown. Here are the delays they report:
- dermatologist: 24 days
- gynecologist: 23 days
- cardiologist: 19 days
- orthopedic surgeon: 17 days
I think this is interesting because some correctional systems require that inmates with positive intake medical screens see a physician within seven days---at least twice as fast as the waiting time in free society. And these are systems with the highest patient loads and the most difficult recruitment issues. Why are correctional facilities held to higher standards than free society?
My suspicion is that Corrections patients are significantly more likely to seek "relief" by litigation than free society. Each CA prison is required, by law, to maintain a law library available to prisoners. Having reviewed inmates' Central Files (i.e. containing everything but medical informations), they are often six inches thick, or in multiple volumes, filled with hand-written law suits. Filing fees are waived by the courts, and I'm thinking that Corrections chooses to "settle" many cases like everyone else. I am not aware of an "arbitration system" in CA Corrections.
If you go the website of the CA Dept. of Corrections, there is a large add stating that Corrections is "now hiring healthcare professionals." This should read begging for healthcare professionals. As you well know, these are certainly the more difficult, and dangerous patients you are ever going to see, all in a highly charged, suspicious, adversarial environment. One apparently must be of a special breed (notice I didn't say crazy) to work with this population.
I was once sitting with staff in the clinic of a prison when an elderly gentleman passed by, bent over and slowly making his way to his destination. When I inquired I was told, "He's one of the new psychiatrists." Yikes!
I vaguely recall reading somewhere that nearly a third of all Federal litigation is correctional litigation. The Prison Litigation Reform Act passed in 1996 set limits on this. Inmates are required to pursue & exhaust state remedies prior to seeking relief in the Federal courts. Inmates must pay filing fees and any settlements must go to pay restitution or court fees. If there is a constitutional issue that the Feds will address, the remedy must be narrowly drawn. There's also some limits imposed on attorney's fees, but it's been a while since I've read it so I don't remember specifics.
Some states have used the PLRA to lift monitoring of systems that have been in place for years. For details on the PLRA's affect on numbers of filings, see the Department of Justice report.
Seems like a no-brainer, if not a cliche. Why do prisoners get shelter and three-square daily while "free" homeless people go hungry and die of exposure? That's our free market system. We make more or less everybody pay for more or less everything so the competion for our dollars will make everything we want cheap and plentiful. If you're committed to a free market, you don't care about what people buy on average, only that with enough money you can buy anything, including speedy treatment, which I have no doubt one can do (albeit perhaps at the additional cost of taxi fare to take you uptown). So the destitute can't sue the state for the pain and suffering they experience because of the cost of living. They get to vote, is what they get to do.
Prisoners can sue as a matter of simple fairness (i.e. our society's concept of fairness). No amount of money is supposed to be able to buy a prisoner something that isn't in the program or isn't allowed by the rules, and he or she can make special requests, keepers approve or deny at their discretion. If such decisions weren't subject to appeal in the courts, they wouldn't be prisoners of the state but beholden to their keepers, which I think would be hard to square with the constitutional ammendment banning slavery. Of course, these days we don't our government hewing so closely to the Constitution.
Ah, you just mentioned a very interesting amendment. Passed in 1865, it abolished slavery. However, it had no effect on prisoners. In full reading, it states:
"Neither slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States, or any place subject to their jurisdiction."
In other words, 'we still gotcha'. Later in Ruffin v. Commonwealth (62 VA 790, 1870) an inmate tried to say he should be freed based on the 13th Amendment, but it didn't work. The court's opinion stated: "A convicted felon is one whom the law in its humanity punishes by confinement in the penitentiary instead of death...for the time being, during his term of service in the penitentiary, he is a slave of penal servitude to the State...for the time being, the slave of the State." In correctional history, this marked the beginning of the era known as 'civil slavery' during which anyone convicted of a crime literally became the property of the state---the Bill of Rights did not apply to them.
Earlier on, when Congress was debating the passage of the Eighth Amendment, a senator from Virginia argued against it stating: "Brigands deserve to be whipped, or perhaps to have their ears cut off."
We've come a long way.
Oops, here's the correct link for the 13th Amendment.
I know that aspect of the ammendment. My point was that ONLY the state can own slaves, and so if you can't appeal beyond the authority of a privately run prison, you are like a slave on a plantation. I suppose there are agents of the state in every prison, but being able to appeal to a single unelected executive isn't very "constitutiony."
The psychiatric manpower needs of Alabama have been significantly under scrutinized over the last decade. Alabama has two potential sources of psychiatrists; in-state trainees, and out-of-state recruits. The University of Alabama at Birmingham and the University of South Alabama (USA) have each experienced difficulties in training the maximum number of psychiatrists; many of whom may remain in Alabama. The University of South Alabama suffered from management issues and the program at UAB suffered from a shortage of funding to support the maximum number of candidates. Statistics provided by the Substance Abuse and Mental Health Services Administration (SAMHSA) and other federal agencies determine that Alabama has 7.1 practicing psychiatrists per hundred thousand persons with the southeast region demonstrating a ratio of 8.2 as compared to the New England region which demonstrates ratio of 26.9.
Alabama has 7.1 psychiatrists per 100,000 populations while other neighboring states have 8.1 and the nation has 13.7. Alabama is below Tennessee, Georgia, and Florida with only Mississippi below our levels
Alabama has shortages of psychologists, social workers, and nurses who specialize in mental health in comparison to our neighbors and the nation
The psychiatric workforce is rapidly aging with most over the age of 50 and many (24%) over the age of 69 The national rate of growth in training of psychiatrists is declining while the rate of growth for demand of services is rising.
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