Colorado State Penitentiary in Canon City. (Getty Images)
With Colorado prisons continuously struggling to recruit and retain staff, medical personnel in particular are running low, leading to burnout for those who are filling those positions and delayed care for those who are incarcerated.
Dan Meyer is an attorney at the Spero Justice Center, which focuses on decarceration and ending extreme sentencing practices in Colorado. He said his organization regularly hears “extremely disturbing stories” about medical care within the system.
“You can’t believe either on the medical care side of things, or the release side of things, that this system is working or just,” Meyer said.
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While vacancy rates fluctuate, the Colorado Department of Corrections’ overall clinical staff vacancy rate is about 30%. For certain clinical positions, such as physicians and social workers, the vacancy rate closes in on 50%. Colorado has 21 prisons, which manage more than over 17,000 incarcerated people.
CDOC works with several contract staffing agencies to fill in positions when possible, and spokesperson Alondra Gonzalez-Garcia said the department has onboarded about 50 new hires since a March report to the Colorado Legislature highlighted vacancies.
Meyer has seen the result of those vacancies. Delayed care and a lack of preventative care can “turn moderate or treatable problems or injuries or conditions into disasters,” he said. One client received MRI results that indicated he likely had cancer, but he wasn’t able to get a biopsy until six months later, Meyer said.
“If you have cancer that goes untreated and you’re elderly, in six months of delay it can go from a treatable stage to a terminal stage,” Meyer said, “and that’s just one example of a pattern I see over and over and over again.”
Meyer said his organization learned through an open records request last year that the average age of death within CDOC is 56. He said sentencing practices in Colorado keep people in prison longer, and as more incarcerated people age, the more incarcerated people require medical care.
“What elderly means in prison is just different from the free world,” Meyer said. “Somebody who we might think of as middle-aged, if they’re incarcerated they’re really better viewed as geriatric.”
David Maxted is the founder of Maxted Law, a Denver-based civil rights law firm that opened in 2020. The firm represents people who are incarcerated who have experienced a civil rights violation, which includes denial of medical care or delayed medical care.
Maxted said most of what his firm takes on is severe cases such as untreated infections that lead to amputations and deaths that resulted from treatable, preventable conditions or infections. While staff shortages aren’t the sole reason those kinds of cases occur, limited staffing can lead to longer wait times before seeing a provider, he said.
“I think a lot of the run-of-the-mill medical care that people are used to in the community — like you need to go to the doctor, you need some medication, you need something kind of simple, but it’s not life threatening — you’re going to see a lot of delays in getting that kind of care when you’re in prison because the staffing, because of the way it works,” he said.
Burnout and compassion fatigue
Danielle Tye is a mental health clinician at the Colorado Territorial Correctional Facility in Cañon City and a union steward for Colorado WINS, the union representing over 27,000 state workers. She is responsible for overseeing the mental well-being of 700-800 people who are incarcerated, providing services such as individual and group therapy, as well as crisis response and intervention.
Tye said Colorado WINS wants to see the state use its funding “responsibly to help reduce our turnover rate, attract new hires and keep us all on the job,” instead of on contractors.
“When you hire someone and the state spends money to train that person and then they don’t stay or they find a better opportunity elsewhere, that costs money to constantly rehire and train people,” she said. “People want to be able to keep a career in the long-term.”
It’s hard to compare how much a state clinical worker makes to what a contract worker makes, because the pay structures are different. Contract agencies set the pay rate for their staff members, and CDOC pays the agency directly.
“This approach allows us to efficiently manage and distribute funds in line with our contractual agreements,” Gonzalez-Garcia said. “In contrast, state employees, including CDOC clinical staff, are paid in alignment with our state compensation plan.”
Gonzalez-Garcia said the department “is committed to providing high-quality clinical care to those we serve” and has implemented “aggressive incentives to ensure we can recruit and retain talent,” including tuition reimbursement and a $25,000 sign-on bonus for certain positions.
In Tye’s team of three mental health clinicians, she is the only state employee. At certain facilities, Tye said contractors make up half or up to 75% of the mental health staff. Many other state employees have told her about how short staffing affects their work-life balance.
“I hear reports of people in facilities every day, they’re having managers asking them to work double shifts to fill in for call-offs, and just the general lack of filled positions,” Tye said. “What I see as a steward is this impacts employee morale. When people are working double shifts, they’re missing out on time with their family and work life balance becomes skewed — there is no balance in those situations.”
Working too much leads to burnout as well as compassion fatigue, which Tye said makes it harder to effectively respond to the situations mental health clinicians in corrections see.
Tye said the main drawback with contract workers is that they are temporary, which is particularly difficult in mental health care. She said rotating through several therapists during treatment can alter someone’s perception of mental health care.
“In a clinical role especially with mental health, building those long-term relationships and establishing rapport with clients is essential to that therapeutic relationship,” Tye said. “So if someone’s only there for a short amount of time, they’re not going to be able to forge that lasting connection with that client to do that effective work.”
CDOC has contracts with 12 medical and dental agencies and nine mental health agencies, with some overlap depending on the agency.
The department funds clinical staffing contracts through a designated clinical contract fund, as well as some of its general clinical staffing fund. Gonzalez-Garcia estimated the department spent $24.7 million on medical and mental health contracts with staffing agencies in the 2023-2024 fiscal year, and $23.4 million in the 2022-2023 fiscal year.
“All contracted clinical staff must adhere to CDOC policies and clinical standards,” Gonzalez-Garcia said.
Special needs parole as a ‘release valve’
Maxted said the best solution to improving care in prison is reducing the prison population. One mechanism to do so is through special needs parole, a process the Colorado Legislature approved that allows someone who is elderly, sick or disabled to be released if they no longer present a threat to the public.
Caring for people who are really sick or have terminal illnesses while in prison costs “tons of money,” Maxted said, and if they get released, “that burden is not on the system anymore” and can free up resources to improve standard medical care.
“It’s not just humanitarian and the right thing to do for people who deserve to be released, but it also should improve care for that reason as well,” Maxted said. “So it should be good for the system.”
Meyer said special needs parole is intended to be a “release valve” to keep people who do not present a risk of harm out of prison. He said the risk of someone committing a serious or violent crime greatly decreases with age and disability.
Between July 1, 2023, and June 30, six people were approved for special needs parole, two applications were tabled because they did not have an approved place to live outside of prison, and seven were denied. Compared to a prison population of over 17,000, Meyer said six people is “pretty paltry.”
On days when she is the only mental health employee at her facility, Tye said she’s “reduced to providing the most basic essential services,” which is mostly crisis intervention. She said consistent programming is proven to help reduce crisis situations among prison populations because it gives people who are incarcerated purpose and will “help them to be successful when they get back out to the community.”
Tye said she’s able to run programming with a full mental health team right now. But because the two other members of her team are contract workers, she said they can make the decision to leave the position at any time.
If that were to happen, she said her work would shift primarily to crisis intervention “all day every day.”
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