Prison health system severely understaffed, lacking in multiple areas - comptroller report

Half of all Israeli Prison Service medical clinics have been determined as inaccessible for people with disabilities.

 Prisoners at the Maasiyahu jail in Ramla cast their votes at the prison polling station on elections day for the 20th Knesset, March 17, 2015.  (photo credit: HADAS PARUSH/FLASH90)
Prisoners at the Maasiyahu jail in Ramla cast their votes at the prison polling station on elections day for the 20th Knesset, March 17, 2015.
(photo credit: HADAS PARUSH/FLASH90)

The internal healthcare system of the Israel Prison Services (IPS) has been found lacking in several key areas, including inpatient psychiatric care and the number of medical staff employed by the IPS, a new report from State Comptroller Matanyahu Englman has found. 

The IPS medical system is responsible for providing healthcare to all inmates across the country, and operates clinics in 32 different detention facilities and five medical centers, including centers for specialist medical services. Additionally, the Maasiyahu Prison Complex in Raml houses both an inpatient medical facility for inmates, and a psychiatric inpatient facility for inmates which operates under the responsibility of the Health Ministry.

The new State Comptroller audit, carried out from March-June 2021, serves as a follow-up to an audit from 2015 in which many deficiencies were found in the IPS healthcare system, such as a lack of doctors made available to inmates, a lack of ongoing access to up-to-date medical information and defects in the accessibility of buildings and medical clinics.

Medical staff shortages

The 2015 comptroller report found that seven different medical services within the IPS were not being offered to patients as there was no doctor hired to fill the necessary positions. The new audit found that not only had this not been corrected, but the staff shortages had actually worsened. At the time of the inspection, 23% of all required medical positions were not filled.

 Israel Prison Services (IPS) head Kati Perry is seen testifying to the committee investigating the escape of six Palestinian security prisoners from Gilboa Prison, on January 12, 2022. (credit: Bruno Sharvit/GPO) Israel Prison Services (IPS) head Kati Perry is seen testifying to the committee investigating the escape of six Palestinian security prisoners from Gilboa Prison, on January 12, 2022. (credit: Bruno Sharvit/GPO)

The shortage of doctors is only expected to worsen in the coming years as 50% of IPS doctors are over the age of 57, the customary retirement age within the IPS. 

However, one area in which improvement was seen compared to the previous report was the training of clinic managers. In 2015, it was found that those managing the clinics were not required to undergo any management training, neither general management training nor training specifically related to managing a medical clinic. The 2022 comptroller report notes that this has been entirely corrected and that clinic managers are now required to take a management course and participate in annual training sessions.

Specialist patient care

One glaring issue found in the report is the fact that there is not currently a separate hospital department for women and adolescents who require psychiatric hospitalization. Instead, should the need arise, they are hospitalized externally.

The report recommends that the IPS, together with the Health Ministry, work to calculate the number of women and adolescents currently imprisoned who have needed psychiatric hospitalization in recent years and then, based on the findings, examine the best way in which to address and meet the specific needs of these populations.

As of 2020, 17 psychiatric doctors were employed by the IPS. The psychiatrists visit the hospitals between one to two times every week, and during their visits, they meet with all their assigned patients. Around 29% of all IPS inmates in 2020 were classified as having medical conditions relating to mental health, and this number has been on the rise for the last several years.

According to IPS data, between the years 2017-2020, 15 inmates committed suicide - three in 2017, one in 2018, five in 2019 and six in 2020.

Commenting on the changes made between 2015 and 2021, the report states that “for about 15 years, the mental health system at the IPS has not been adapted to increase the number of inmates and the number of inmates in need of psychiatric treatment.” 

When it came to meeting the needs of prisoners with disabilities, the IPS has also failed to meet the required standards, the report has found.

Half of all IPS clinics (16 out of 32) have been determined as inaccessible for people with disabilities. Several of these clinics were already noted to be inaccessible in 2015, and no changes were made in the years following the audit. The lack of accessibility for inmates with disabilities is inconsistent with the requirements of Israel’s accessibility laws, the comptroller notes. 

The report also noted a lack of specialized care when it came to both elderly and chronically ill inmates. In 2020, 38% of IPS inmates (5,369 out of 14,000) were classified as being chronically ill, and a further 2% of inmates were over the age of 65 (297 inmates). 90% of all elderly inmates are also classified as chronically ill. 

In the previous comptroller report, it was found that no systematic plan existed within the IPS for elderly and chronically ill inmates and that the conditions within the Maasiyahu Prison Medical Center were often poor, and unsuitable for a prolonged stay of elderly and chronically ill people.

It was also determined that there was a lack of manpower and equipment for treating chronically ill inmates who were not being held in inpatient facilities.

Many of these issues were found to still be present at the time of the new audit, and little work had been done to correct them.

At the time in 2015, the State Comptroller’s recommendation was for the Maasiyahy medical facility to undergo extensive renovations, as well as the prison division for eldery inmates. While the elderly inmate division did undergo renovations in 2016 which made it more accessible, the 2022 report found it to still be lacking.

According to the report, “it was found that the prison clinic is far from the [eldery inmate] wing, the passages in the clinic are narrow and the doctor’s room is not accessible to inmates who use a wheelchair.”

Despite the recommendation for the hospital renovation having been issued in 2015, it was only in 2021 that the IPS began the renovations, and as of June 2021 they were still underway. However, the report notes, that as part of the renovation, the errors from the 2016 renovation will be corrected and the clinic will be made accessible to patients in wheelchairs.

Additionally, 16% of all formal complaints filed by inmates over the last year were filed in relation to the IPS medical system, the comptroller report notes. 

Summarizing the findings of the audit in comparison to 2015, the report states that “The follow-up audit revealed that some of the defects have not yet been repaired: there are still clinics that have not been renovated or are inaccessible to inmates with disabilities; And the gap between the number of physicians and the number of jobs has not been reduced and has even deepened, compared to the gap found in the previous audit.”

“The right to health derives from the system of human dignity and the constitutional umbrella of the Basic Law: Human Dignity and Liberty. The Prison Service holds inmates in its facilities, and as a result, it must also provide them with the medical care they need, in accordance with the standard of medicine in the community,” the report concludes. 

“The Prison Service must continue to work to strengthen and improve the medical service provided to inmates, maintain the fitness of medical staff, adapt medical services to the needs of elderly inmates and chronically ill, and work to make all clinics accessible and renovated.”