The problem of the lack of doctors in public health it reaches the prisons. A third of the places of doctors of prisons (184 of 491) of Spain are not covered, as explained this morning Carmen Hoyos, coordinator of Penitentiary Health of the Medical College Organization (OMC). They are responsible for covering the equivalent of primary care in 72 prisons (all but those in Catalonia) with some 50,000 inmates.
Apart from the characteristics of the position, for Hoyos there is a key cause: the salary. "Although we are required to be specialists in Family Medicine as primary doctors, we charge an average of 1,450 euros less gross per month," he said at a conference organized by the State HIV / AIDS Coordinator (Cesida). Nurses and pharmacists are also paid by the Ministry of the Interior, and they charge less than their health colleagues.
And the situation does not seem to be solved. In 2018 they left 15 places of prison doctor, Hoyos said, and two were covered. And the problem comes from far: in 2008 they were 5 out of 16.
It is not just a work problem. The prison population has special features in health issues. For example, José Antonio Martín, of the Spanish Penitentiary Health Society (SESP), has exposed the highest prevalence of mental health problems. Not only in the income. In addition, we must "analyze how the prison affects the process of loss of mental health, and also how from within the prison environment, you can help the recovery of this type of patient," says the SESP.
Carmen Hoyos, Head of Prison Health of the Collegiate Medical Organization, this week has given several examples of problems caused by lack of health personnel in prisons.
Ibiza From October 20 to January 8, he was without a doctor.
Picassent (Valencia). The largest in Spain. It has a project of 21 doctors, but there are only 2, and one of them is a deputy director who should not be dedicated to the attention, but to the management.
The Port 1. He was without a doctor from July 26 to September 10 of last year.
Daroca The doctors make localized guards 80 kilometers away.
Navalcarnero "It has been a reference." Of 11 projected doctors, it has 6.
Algeciras It processes 4,000 admissions every year with only three doctors, who have the obligation to see the prisoners in the first 24 hours.
Attention the first 24 hours. It is the inmate's first contact with the system. Your mental health is evaluated if it affects your guilt or if you are at risk of suicide. Also if you have an infectious disease, something especially serious in a "hyper-contaminated" environment such as prisons. It is observed if they present lesions.
Drug use is also frequent among the prison population, and, related to this, last aspect there is also a higher proportion of people with HIV and Hepatitis C in prisons. In addition, other situations, such as transsexuals who need medication continuously to control their levels of hormones.
"With the cuts we can only do emergency medicine," said Hoyos. And he gave as an example that before, patients were periodically checked to make sure, for example, that they met their treatment for HIV or other factors, and that now they are only seen when there is an emergency. "The system was a reference, and it is not," he said.
"Insufficient and unsupportive"
For the WTO, both professionals and inmates lose out with non-compliance with the law that obliges communities to take charge of health care of the prison population. "The penitentiary health systems are characterized by being of a condition (in all aspects) inferior to the existing out of prison. It is also noteworthy that the assistance provided in this type of institution is often mediated by circumstances and interests outside of the strictly health, generating deontologically debatable situations ", and gives as an example that the doctor-patient relationship becomes that of official-inmate . "The system is, therefore, insufficient, unsupportive or not equitable and inadequate", summarizes the WTO.
In fact, the legal model is that penitentiary health is integrated into the primary system of each community with some extras (dental consultations or gynecology in jail to avoid transfers), but only Catalonia and the Basque Country have assumed the transfer of prison care. Navarra was scheduled to be the next, but the political situation may delay it, admitted Alfredo Martínez Larrera, director of Patient Assistance for the regional community.
Carmen Martínez Aznar, deputy director general of Coordination of Prison Health of the Ministry of the Interior, has indicated that the transfers of this competence, which are mandatory since 2003 by the law of cohesion of the health system, can only be carried out if both parties agree . He said he had conversations with all the communities to activate them, but that the process is technically complex. You have to start by integrating the systems of electronic medical records, and then you have to finance it. The first part is much more feasible than the second, and more so in the current political situation.