The lack of doctors to attend to the inmates of prisons is leading Penitentiary Institutions to pull the Private sanity to pay attention to the more than 48,000 inmates of the Spanish centers. Of the more than 500 physician positions available, half are unfilled, according to the unions. The situation is so precarious that in prisons like those of Basin they are doctors from the private group Quirón who consult. The leakage of toilets is constant: they earn less than their peers and are getting older. They have been waiting for 18 years for the transfer of sanitary powers to the autonomous communities. More and more hopeless.
In the centers of Cuenca and Burgos, medical care is complemented with temporary contract private health groups admit ‘The Newspaper of Spain’ from the General Secretariat of Penitentiary Institutions (II.PP.). Also that they are not the only prisons where has it been done this type of contracts although they do not detail in which other centers they have resorted to private health groups.
“Penitentiary Institutions admit that, on a temporary and occasional basis, private companies are hired”
The general secretariat recognizes that prison health is under minimum and that there are serious problems to fill the positions of doctors. The centers, they assure from the institution, have their corresponding doctors, but if support is considered necessary, in a temporary and punctualThey specify that the resource of contracting with other external private companies is used.
It’s a usual system, recognize, to provide medical care to the 48,191 people held in Spanish prisons, of which 3,522 are women, with data from last August. From that figure, we would have to subtract the 1,387 inmates of the three prisons basques. This October, the Basque Government has assumed the management of its prisons.
A contract of almost 35,000 euros with Chiron
In the case of the medical service contracted for the Cuenca Penitentiary Center, the amount of the award granted to Quirón Prevention, one of the divisions of the private health group Chiron Health, has an estimated value of 34,581.40 euros. The estimate has been calculated as the sum of the amount of the basic tender budget (six months duration) amounting to 17,290.70 euros; to which is added a three-month extension for the amount of 8,645.35 euros and another for three months for 8,645.35 euros.
The contract awarded to provide assistance to prison inmates Castilian-Manchega was awarded on February 16, 2021 with a budget of 17,290.70 euros. It remains in effect until next February. In other words, it lasts for one year. Therefore it is not a one-off contract.
This newspaper has asked Quirón Salud if they provide health services general medicine in other prisons, but has not received a response. It is not the first time that the company takes care of the inmates of Cuenca. Before, by minor contracts, the same group had been awarded the service for months.
In Burgos, by the hour
At Burgos Penitentiary Center, on September 20, there was a doctor from Claris Medical Services, a private company based in Barcelona, working four days a week, for three hours. Before, prison sources consulted by this newspaper indicate, that same service was provided for more days. This same company had also provided medical services in the same Castilian-Leonese center previously. From October to December 2020 was awarded a minor contract, lasting two months, for the amount of 9,600 euros.
“According to II.PP. in prisons there are 304 doctors and 90 places to fill”
The data provided by II.PP. to this newspaper are that, currently, in penitentiary centers -including the two psychiatric centers: Seville and Foncalent (Alicante) – there are 304 doctors and 90 positions pending to be filled. The figures that they contribute from the union organizations vary with respect to these statistics. According to data -of June 2021- provided by the Grouping of the Corps of the Administration of Penitentiary Institutions (Acaip), the list of jobs (RTP) of doctors in prisons is 515 places, of which 251 (48.74% of the total) are vacant and 264 are occupied.
In the case of nursing, the situation improves. Out of a total of 623 spaces, 93 are vacant with the data provided by Acaip. But also from nursing they have been demanding for years an improvement in their conditions. There are centers where, in the absence of doctors, they treat all patients who need assistance and, when necessary, refer to the specialist. This is technically called nursing demand management. In several centers they have signed up for the telemedicine– The professional visits the inmate remotely via a high resolution video conferencing device.
Doctors want to retire
Of the total number of doctors, according to data provided to The Newspaper of Spain from the State Confederation of Medical Unions (CESM), 10% retire next year; 44% are over 60 years old (which means that they can retire whenever they want) and there is 15% who are over 55 years old. There are prisons where doctors continue to consult with about 70 years. This union organization numbers 223 doctors currently in prisons
“From the General Secretariat they admit that there are serious problems to fill the positions of doctors”
Another 250 professionals would be missing to have all the consultations of the prisons covered, they detail. Those 18 years of delay in the transfer of health competencies to the communities, only aggravate, day by day, a situation already unsustainable. Among the doctors available are those who have a place, the interim and the medical deputy directors who, although they do not go through consultations, can do shifts.
The General Secretariat admits that prison health is Under minimum and that there are serious problems to fill the positions of doctors. The delay of almost twenty years in this transfer of health care from prisons to regional health systems, they argue, is behind so much precariousness. Navarra was the last community, last summer, to assume the powers. The rest of the regions are slow and, for now, there are no steps forward. In a timely manner and when it is considered necessary, they insist from Prisons, it is necessary to pull private health in the face of the lack of professionals.
Centers without doctors or with assistance by the hour
The panorama turns out bleak. There are centers without a doctor during days, weekends, afternoons or shifts, as described by the doctors. The portrait that is made of health care in prisons happens because, in order to see the admissions, isolations and other regimental situations that have nothing to do with health care, external doctors are hired by the hour, in some cases; for one hour three days a week and two on weekends without guards; in others, three hours four days without guards; another four hours from Monday to Friday with localized guards and without anyone on the weekends …
This is how Pedro Antonio Martínez Sánchez, head of the CESM Prisons section, describes it to this newspaper. Martínez, a doctor at the Ocaña II prison (Toledo), assures that any situation can occur. “Any modality is possible, there are other cases in which it is the 112 the one who provides service. In some places you pay almost 300 euros per hour to an intervening company; in others to medical examination clinics; in others to freelancers … it is not known very well with what criteria. Chaos, “he denounces.
The figures provided by ACAIP support so much pessimism. There are 44 prisons with a deficit equal to or greater than 50% of physicians in the consultations. They cite the examples of prisons such as:
Daroca (Zaragoza): has only 2 doctors with 8 places.
Dueñas (Cantabria): with 2 out of a total of 9.
Murcia I or Seville II: with 3 decks with 9 seats available.
Madrid VII (Estremera): 4 doctors with 9 places.
Teixeiro (A Coruña) or Tenerife: with 2 of 9 covered seats.
Picassent (Valencia): 5 doctors when it should be 22.
From Toledo, Pedro Antonio Martínez, one of the two doctors at the Ocaña II Penitentiary Center, explains that both in his center and in Ocaña I, the list of jobs is five places, but less than half are covered.
An eternal handover
From CESM Prisons, Pedro Antonio Martínez points to several possibilities for which “Let die” sanitation within prisons. The first, he lists, the lack of political will to comply with the law. The General Council of the College of Physicians of Spain (CGCOM) has once again come to the rescue of its colleagues. The Spanish Society of Penitentiary Health holds a congress on October 28, 29 and 30 and its president, José Joaquín Antón Basanta, warns that the future is increasingly catastrophic. Augurates that prison health is doomed to its disappearanceOne of the claims of the prison physicians is the salary. They are part of the public health system, but the difference in remuneration with their colleagues, they denounce, is enormous. It happens, they point out, both in ordinary salaries, which can vary by about a thousand euros, and in guards.
“Many doctors have retired early and feel disappointed to see that their conditions are increasingly distancing themselves from their colleagues in public health”
They also criticize that it does not exist career, so that the work done for many years is not recognized or paid. In these years, many doctors have retired early and feel disappointed to see how their working conditions are increasingly distancing themselves from their colleagues in health centers.
CESM has appealed the last two public offers of employment of interns of the facultative body of penitentiary health because they did not request title of family doctorexplains Martínez. “It seems the army of Pancho Villa and all for not facing the real problem, the integration of prison health and, until then, the salary equalization that allows avoiding the escape of prison doctors and that makes it attractive to appear for the oppositions,” he says. the prison doctor Ocana II.
“The solution is that the law be followed”, Sonsoles Castro, national representative of the Office of Physicians of Public Administrations of the CGCOM, abundantly emphatically. “It is one of the main topics of the vocal work because it does not conform to the law since 2003. It is not one of the government priorities. The situation is dramatic for professionals and for the people they serve, “Castro concludes.