The Truth About The Federal Bureau of Prisons and Medical Care

There are many myths associated with the type of care that a federal inmate receives while they are incarcerated in the Federal Bureau of Prisons. Medical care is a major issue in the federal system. The B.O.P is responsible for the care of every inmate, ranging from the common cold to an inmate with disabilities or chronic illnesses. It is no mystery that prisons are overcrowded. The problem of overcrowding brings along with it several other logistical issues. The ratio of staff to inmates has plummeted in the last 20 years, this includes medical staff. When the Bureau of prisons faces high operations cost due to overcrowding, one of the first departments to incur budget cuts is the medical department.

The honest truth is that the healthcare system and services in the BOP has fallen way below the standard of your average clinic or hospital in the “free world”. Just as state prisons all over the nation have experienced budget cuts for medical care, overcrowding has become the primary stumbling block to receiving decent medical care for the inmate population in the federal prison system. Simply put, if you are sick, prison is not the place to be!

As an inmate you have the right to receive medical care, but you will need to follow certain procedures in order to have the treatment started. This is a rough outline of what that process looks like from an inmate who has been to several facilities and has spent over 20 years in the federal prison system. The one thing that has remained a constant throughout my time at several prisons is that the medical care being provided has always been inadequate and sometimes dangerous.

The first step to receiving medical care at the BOP starts with an early-morning trip to the medical building to attend what is referred to as, “sick call”. Sick call is where you are to make your illness known to a medical staff member who will document your issue, and depending on what institution you are at, they may take your vitals and give you an appointment to see the physician’s assistant. The procedures vary from institution to institution, so familiarize yourself with it before you get sick. The one thing that is true for sick calls at every institution is that it is always very early in the morning and inconvenient. If you are too sick to go, then most times the institution staff will wait until it is an actual emergency before someone will come see you. If you are slightly incapacitated, dizzy, injured or handicapped, you may get a wheelchair or you may not. The bottom line is you are responsible for getting yourself to sick call or you will not be seen.

Sick call is usually open for one hour and if you do not make it in that time you must try your luck again the next morning. Once again, the most important thing to remember about sick call is that no matter your condition, the weather, or any other unforeseen circumstance you will have to make sick call for you will not receive medical care. After sick call you will only be treated if your condition is critical and staff can get to you in the appropriate time.

Not only will you have to contend with the ungodly morning our and your medical ailment but you will also have to contend with usually obnoxious, rude and grumpy attitude of the overworked staff member who is documenting your condition. You will also have to deal with a large number of fellow inmates who are seeking the same treatment. If it is flu season, you may want to request a mask while you are waiting in the sick call lobby as many people have no respect or manners and will not cover their mouth when coughing. In order to prevent the situation from escalating it is best to just wear the mask yourself so you don’t have to worry about breathing in other people’s germs.

To make your visit even more memorable there will be a two dollar copayment deduction from your account, this for perhaps nothing. In other words, whether you are referred to a doctor or not referred at all you will be charged $2.00 for coming sick call.

If you are lucky you will be scheduled to see the physician’s assistant or a doctor within a few days. Most times this is not the case. Chances are that you will be seen within two weeks depending on your condition. Especially for the more minor conditions, the BOP hopes that your condition will take a turn for the better and you will no longer need medical treatment when your appointment time comes. The number one goal is to save money and the less people that need to be treated the more money is saved. Many times the medical staff will tell you that there is no medication that needs to be prescribed to you and will direct you to the commissary to buy over-the-counter pain relievers.

For the chronic care inmate, they will also have to make sick call- but because the inmate has been documented as having a chronic condition, their complaint will be examined somewhat more seriously. The BOP has a system in place that designates inmates with different levels of care. These designations are based on chronic conditions, terminal illnesses and special needs. Each institution is labeled under its ability to provide for particular care level; I, II, or III. The Bureau of prisons attempts to match inmates in their continuing medical needs with an institution that can provide for those needs. Once that institution is found that is likely where a particular inmate will reside.

Many times the system will fail and the inmate will not be matched with the appropriate institution. That is a whole other issue is something that will be covered later in the section called, “Health Care Grievances”.

It really doesn’t matter the level of care institution that you are place at. In my experience at every care level, inmates are receiving substandard care. For many inmates this becomes critical and sometimes a life or death situation. Often times the medical staff begins to think much like the correctional officers of the institution. For example, medical staff will experience many inmates trying to manipulate the system by embellishing or faking certain illnesses or injuries. After some time of course, the medical staff becomes very sarcastic, skeptical and jaded and they tend to forget that every case is different and every inmate is a person that deserves a chance.

I have witnessed on countless occasions where an inmate’s complaints of pain or illnesses were disregarded and taken as an attempt to once again manipulate the system and the actual chance to treat the emergency is lost. Sometimes a little care and attention is all that is needed to prevent an inmate from becoming dangerously ill. It seems like the BOP has a subculture that encourages skepticism when inmates complain of pain or illness. This general attitude is not completely the fault of the medical staff. Mass incarceration has affected the way the system is supposed to work. Many times medical staff find themselves overworked, underpaid, and unappreciated by their superiors. All of these things are contributing factors to poor medical care in prison. There is a corporate focus on cost savings within the medical services departments at every institution and this attitude is detrimental to both inmates and staff. Spending any amount of time at a BOP institution will make these truths obvious. Im sure the state prison is the same or worse.

Other factors that exist are the lack of adequate medication, delayed medications and sometimes the rejection of needed medical procedures. There’s often misdiagnosis due to the fast pace and high-volume of patients. All this is not to say that there are no good medical staff members at many of these institutions. There are many good hearted staff members who truly care about people. However, they are very few and far between and my best advice is to pray that you meet one wherever you will be doing your time.


A few quick comments about dental services: Dental services and staff tend to be better than medical staff in general. For you to receive dental care you must still make the dreaded sick call and deal with the wait unless you have an emergency, then hopefully they will see you the same day. You can count on having your teeth cleaned on an annual basis and if there is a tooth that needs to be pulled then that is a procedure that is done immediately. Before the explosion in the inmate population there were certain dental cosmetic procedures that were approved. Actually better dental and medical treatment were commonplace in the BOP. Once again, overcrowding and budget cuts have made adequate medical and dental care very rare.