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Private healthcare enters five prisons due to the lack of prison doctors | Society

Archive image of one of the inner courtyards of the A Lama Penitentiary Center (Pontevedra).
Archive image of one of the inner courtyards of the A Lama Penitentiary Center (Pontevedra).Carlos Puga

In the last year and a half, the lack of prison doctors has led the directors of at least five prisons to put out tenders to hire private services for the primary care of their prisoners. These are the prisons of Cuenca, Cáceres, A Lama (Pontevedra), Teixeiro (A Coruña) and Mallorca, which together house just over 3,300 inmates and who will pay a total of 200,000 euros for these contracts. “Currently, the staff available are three doctors, of which one is on medical leave due to pregnancy and the other two retire on September 15 and October 4 of the present, so it cannot be covered with a minimum of guarantees the necessary attention in this penitentiary center ”, warned last October, in the tender documentation, the director of the Cáceres prison to justify this contract.

This Extremadura prison currently has 340 inmates and until 2019 had a staff of five doctors, who retired without being replaced. After a few months without a doctor, the prison director chose to hire an external professional, to whom he later added another similar contract. “They can attend to emergencies, the mandatory check-ups for each new inmate and little else. It has nothing to do with the medicine that has always been done, which had an important part of preventive medicine for a very vulnerable group, ”laments Carmen Hoyos, spokesperson for the professional prison health union and doctor of the Extremaduran prison until she retired. . In the tender specifications, which was awarded last December, a maximum amount of 58,482 euros was set for nine months of service and it was estimated that the successful bidder should attend 604 ordinary consultations per month in the center (at seven euros each) , 32 medical examinations (10 euros) and 163 emergencies (another 10 euros).

The problem is repeated in the other four centers, according to the documentation of the contests. In the Mallorca prison, with just over 1,000 inmates, only two of the eight places are filled. “Due to this emergency situation and the impossibility of the Penitentiary Administration to provide these professionals to peripheral establishments, the need to resort to other types of channels so that the health care of the inmates is minimally covered” is objectified. points to a document dated June 21 to justify an expense of 29,900 euros. In similar terms, the management of the A Lama prison expressed itself weeks before, which has awarded the company Acció Salut a contract for 40,506 euros to cover 1,080 hours of medical care for its 860 inmates with this system until the end of the year. The Teixeiro prison, after acknowledging that “Prison Health is going through difficult times”, will spend around 29,900 euros in the same period to “provide continuous and permanent health care” to its 990 inmates. And the one in Cuenca, which has 100 inmates, tendered a first contract in December 2020 and a second last November, this one for 27,000 euros. The first was won by Quirón Prevention and the second by CMD Salud Integral, well-known companies.

Although these bids to cover primary care are new, the problem is not. The Ombudsman has repeatedly denounced the lack of penitentiary doctors for primary care (specialized care is provided in the hospitals closest to the prisons) and demanded solutions from the administrations, since the public competitions to fill these positions remain year after year “virtually deserted”. The main reason, highlights the institution, is that salaries are lower than in the whole of public health. According to the statistics of Penitentiary Institutions, in 2018 35 places were offered and only 11 were filled. The following year there were 40 and only six were awarded. Figures that were repeated in 2020. For 2021 and 2022, Interior has taken out a total of 80 places. It has also offered 40 temporary positions. The forecast is that a good part of them remain uncovered again.

Prison sources insist that primary care for inmates is guaranteed, as was shown during the pandemic, when the incidence of covid was lower than among the rest of the population. However, they admit that the problem exists and that they are looking for solutions, sometimes with initiatives that go beyond job offers. Thus, Penitentiary Institutions launched in November a system of telematic guards in the smaller centers so that penitentiary doctors who have finished their shifts in other prisons attend telephone consultations that cannot wait in those.

Transferred skills

The problem is not only of Prisons, but also of the autonomous communities. The Law of Cohesion and Quality of the National Health System, of 2003, ordered that the penitentiary health services be integrated into the National Health System, which implied transferring to the communities the competences on primary care for prisoners. They are on their way to completing 20 years and only Navarra (which did so a year ago) and the two communities that have transferred the management of the prisons, Catalonia (which took over medical care in 2010) and the Basque Country (in 2011) , have assumed these powers. The doctors who work in the prisons of the rest of the country continue to be integrated into the Ministry of the Interior. In 2019, the Secretary General of Penitentiary Institutions, Ángel Luis Ortiz, sent a letter to the Health Councilors of the rest of the communities to start negotiations and comply with “the legal mandate”. At present, only some, which Prisons declines to specify, have agreed to initiate contacts.

Meanwhile, the toilets took this situation to court in 2020 after the department of Fernando Grande-Marlaska rejected their request to match the salaries of the doctors of the national health service. The National High Court, in a ruling issued in May, admits the breach of the law, “since the term indicated for the legislator has elapsed without the planned integration having been carried out.” However, it has rejected their claims, understanding that the responsibility for their situation does not lie with the Interior (against whom the lawsuit was directed), but with the Council of Ministers (the transfer must be made via royal decree) and the autonomous communities (to which that the law entrusted him to set the steps for the transfer of competences).

The prison doctors and nurses who signed the lawsuit have announced that they will appeal to the Supreme Court. According to data provided by the prison health platform, 296 doctors currently work in prisons, of which 97 are over 60 years old; 165, between 50 and 60; 24, between 40 and 50; and only 10, less than 40, which means that in the coming years there will be dozens of retirements that will leave vacancies that will be added to those that have occurred in recent years. “The problem of the lack of doctors is very serious. And it had been known for a long time what was going to happen for the retirement forecasts, ”warns the spokeswoman for the prison health union. Added to the retirements is the voluntary departure of doctors who in recent years have chosen to work in the public health service or in private health, even though they lose their status as career civil servants due to the refusal of Prisons to grant them a leave of absence, According to the collective complaint. From 2008 to 2017, 125 doctors stopped working in Penitentiary Institutions, according to this union.

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