Spanish prisons have a significant lack of doctors. It is not a new situation, but it has worsened over the years to an unprecedented scenario: of the 488 places planned for the primary care system in prisons, only 251 are covered, just over half. Some centers, such as those in Cuenca, Cáceres or Alicante II, have recently resorted to private contracts with mutual insurance companies or self-employed doctors to make up for this lack of personnel.
At the beginning of 2021, the Cuenca prison awarded the private mutual fund Quirón a six-month contract for an external medical service worth 14,560 euros and at the beginning of this year it did the same again, but this time with the Grupo CMD Salud and an agreement for twelve months and a value of 27,116 euros.
Other prisons, such as Cáceres and Villena (Alicante II) have also resorted in the last two years to specific private contracts, although in this case with autonomous doctors. The Extremaduran prison awarded one of these contracts in December 2021 and for a period of six months to a doctor to cover the morning and afternoon shifts from Monday to Friday and emergency shifts on weekends. In the justification provided in the tender, the director of that center argued that they had three doctors at that time –one of them on medical leave due to pregnancy and the other two about to retire–, for which, he considered, “there is no can cover the necessary care with a minimum of guarantees”.
These contracts appear in the contracting portal, although Penitentiary Institutions recognize that there could be more, given that the contracts are signed by each prison and there is no centralized count. The country newspaper reported a few weeks ago that the prisons of A Lama, in Pontevedra, have also resorted to contracts of this type; of Teixeiro, in A Coruña; and from Majorca.
“Different formulas are being made, but they are patches. More than half of the medical positions are vacant. We have an aging staff and more people leave than enter, ”summarizes Silvia Fernández, general secretary of Prisons of Workers’ Commissions (CCOO), who warns that the situation is very worrying.
According to official data updated up to August, in the prisons that depend on the Ministry of the Interior (Euskadi, Catalonia and recently Navarra have taken over the management of their prisons), the active medical staff is 251 workers, including doctors, interim doctors, deputy medical directors and service chiefs. The number of places provided for the total number of centers managed by the central State is 488. Therefore, only 51.4% of the positions available for doctors are covered. All this for a total of 46,787 inmates, which leaves a ratio of one doctor to 186 inmates.
This figure, however, is an average. In photography by centers there are striking cases. According to the CCOO, there is no doctor in Fontwarming, in Alicante; in León, the staff is not enough to cover 24 hours and in Burgos there is only one doctor for the entire center. The problem, they insist, is not new: in 2019, the union warned in a statement that the right to health “cannot be guaranteed in Spanish prisons”, although then the data they handled was not so alarming, there were vacancies almost 30% of the places destined for physicians and 23% in general of the positions for health personnel.
In its 2021 report on the situation in prisons, the Ombudsman also referred to the problem of “insufficiency of doctors and other health personnel”, a “recurring and well-known” problem. In the document, the defender warned of the special vulnerability of the prisoners in terms of health due to their particular ailments, especially psychiatric ones, and included specific complaints from some prisons: “In the Badajoz Penitentiary Center there should be eight places occupied by medical personnel and there were five, and eight nursing and there were six (…). Specialized assistance is generally provided abroad, as opposed to the legal provision of doing it inside prisons. This determines a greater difficulty in accessing specialists, both because of the complexity of organizing outings and because of the loss of constant medical appointments due to the lack of police lines.”
The problem, according to the unions and the Ombudsman, is not the lack of places. “The selective processes are practically deserted, due, without a doubt, to the fact that the remuneration offered is not competitive,” explains the report. According to data from Penitentiary Institutions, in 2018 35 places were opened, of which 11 were initially awarded; in 2019, 40, but only six were granted, a situation that was repeated the following year. For 2021 and 2022 there are another 80 called in total, but the forecast, says Fernández, from CCOO, is that a good part of them will remain uncovered again. “Salaries for doctors are not attractive. There is up to 1,500 euros of difference [en comparación con los del Sistema Nacional de Salud]. Although places are offered, no one comes, ”she laments.
From Prisons they admit that the situation is far from ideal. The priority of the General Secretariat is to implement the law of cohesion and quality of the National Health System, which established that all health competencies should be transferred to the autonomous communities in 2004, including those of prisons. Despite the fact that the law is almost twenty years old, only Euskadi, Catalonia and recently Navarra –which agreed to the transfer last year– manage these powers. At the beginning of his administration, the current Secretary General of Penitentiary Institutions, Ángel Luis Ortiz, sent a letter to the directors of the branch to initiate a round of negotiations on the subject. Sources from the department affirm that there are conversations with some autonomies, but they do not specify which ones.
Meanwhile, the short-term measures that have been put in place to try to alleviate the situation stand out. In addition to the contracts with private mutual insurance companies or autonomous doctors to which the prisons can resort, the department managed to open vacancies in 2020, during the pandemic, for interns who, with or without the MIR, could work in the centers. Although some of the places offered every year since then have been deserted, from Prisons they affirm that the percentage is lower than with fixed places. Another of the initiatives that they have launched is a pilot telemedicine system, so that volunteer doctors, outside of their conventional working hours, assist the nursing staff who are in the prison from a distance, through a video screen. with the patient. The program is in an initial phase, only in ten prisons at the moment and with eleven doctors, although this figure may vary.
This latest initiative, however, does not convince the unions. Fernández describes it as an “occurrence” and believes that this method ends up burdening the nursing staff with a series of decisions that exceed their functions. “If you do it through telecare, the nurse has to do the physical examination to tell the doctor what she understands or interprets how the area has. A review is one thing, but here responsibilities are generated if someone dies due to the damages that may occur, ”he comments.
What the unions do agree on is the global solution. “We defend the transfer of skills, this is the priority. But while that is not resolved, it is necessary to improve the remuneration of doctors. Collaboration agreements can be established with medical centers, that prisons be places where the MIR can be done, for example, ”proposes the unionist.
The Ombudsman concluded in his report on the state of the prisons that, in short, “the fundamental thing in defense of human rights is not who has the competence but how they exercise it.” “Policies can have an impact either on improving budgets (…) or on the autonomous communities definitively assuming the powers of prison health, planned so many years ago.”
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