Nearly half of all medical positions inside Illinois prisons are currently unfilled, according to a new report from a court-appointed monitor that found the staffing shortages are a “crisis” that “threatens the safety” of people locked up.

The monitor was assigned to evaluate prison conditions as part of a court settlement. Attorney Harold Hirshman, who worked on the lawsuit over prison health care, said the monitor’s report was “terrible, as usual” and undercuts the state’s positive rhetoric.

“Why when the governor proudly proclaims that health care in prisons is improving, does the court’s monitor report on a continuing, deadly, disastrous system?” Hirshman asked.

The damning report comes more than a decade after a federal lawsuit alleged medical care in Illinois prisons was so poor it violated the constitution. The lawsuit settled in 2019, but the monitor says at least some aspects of the prison health care system are actually worse than they were then.

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Illinois Department of Corrections spokesperson Naomi Puzzello said the department is working to comply with the terms of the settlement agreement. She said they disagree with some of the monitor’s findings but will respond in court.

Meanwhile, the private company in charge of providing medical care inside Illinois prisons recently saw its contract expire, and the state is now soliciting bids for a new health care contract.

Private contractor behind Illinois medical care

The company, Wexford Health Sources, has a long history of failing to provide good medical care in Illinois prisons, going back more than a decade. Those problems include dangerously inadequate mental health services and numerous preventable deaths.

Wexford has routinely refused to answer WBEZ’s questions about medical care in Illinois prisons, including its failure to properly staff facilities. When WBEZ filed a public records request to learn the number and type of open positions at each prison, Wexford refused to provide the information. The company claimed it was not required to comply with the request because the levels of medical staffing are a trade secret that, if public, would make it difficult for them to compete with other private prison health care companies.

Department officials provided a list of vacant positions, but said it did not include temporary staff employed by Wexford, so was not an accurate reflection of the number of medical staff working day to day.

Puzzello said the department is struggling with “recruitment of medical and mental health professionals in the midst of an unprecedented workforce shortage in the U.S. health care industry.”

Dixon

The monitor highlighted particularly acute health care problems at Dixon Correctional Center on the west side of the state, where many of the oldest and sickest patients in the Illinois Department of Corrections are housed.

Dixon includes a geriatric unit, but of the 21 people living there, the monitor said 16 had needs that exceeded what the unit actually provided. The unit was in poor condition and the showers and toilets were not ADA compliant when the monitor visited the prison.

According to the monitor’s report, one incarcerated man “used a wheelchair to wheel a patient with brain damage and a mobility disorder to a sink down the hall so he could wash daily as he felt unsafe trying to get into the shower.”

Dixon has a program that allows incarcerated people to work as aides for patients who need help. The monitor strongly supported the program, but said staffing was so short that these workers were actually providing clinical care that should have been done by trained health care workers.

The staffing shortages were not just in the medical unit — of the 536 correctional officer positions at Dixon, 200 were unfilled. That meant there was not enough security staff to transport people to outside appointments for specialty care. While IDOC does not specifically track referrals for specialty care, one state staffer quoted in the report estimated about 15% of patients at Dixon never get their outside specialty appointments.

An aging prison population

Alan Mills, executive director of the Uptown People’s Law Center and a civil rights lawyer who worked on the lawsuit over prison health care, said the fundamental issue is that the state has an aging and sick prison population it is not equipped to properly care for.

He said the issues highlighted by the monitor “should not obscure the real problem — the ‘banality of evil’ issue: Why does Illinois have so many people who are terminally ill, who have profound disabilities and who suffer from advanced dementia in prison in the first place?”

Advocates argue reducing the number of elderly and sick people behind bars would improve health care by reducing the burden placed on the strained system.

About 32% of the IDOC population is over 55 and incarcerated people tend to have worse health conditions than the general public because of the harsh conditions behind bars. The state passed a law to allow easier release of some people with serious medical problems. The law went into effect last year, but the Prisoner Review Board, which oversees release decisions, has not yet said how many people were released under the new procedures.

In many cases, people incarcerated in Illinois would need to secure suitable housing before release.

Puzello, the corrections department spokesperson, said they work to identify nursing homes and specialized housing for elderly and sick people, but that’s difficult.

“There are challenges with many placements’ willingness to accept individuals releasing from IDOC custody, largely due to criminal history and the stigma or perceived risk associated with incarceration,” she said.

Mills said placing people in the community is a civil rights issue.

“Prisons are not, and should never be, advanced care nursing homes. That we are using them as such is a gross human rights violation,” Mills said.

Shannon Heffernan is a reporter on WBEZ’s Criminal Justice Desk. Follow her at @shannon_h. Email her at sheffernan@wbez.org.

Editor’s Note: This story has been updated with comments from the Illinois Department of Corrections.