A health care facility that cares for the most challenging physically and mentally ill patients is dangerously understaffed. How do you fix it?
The answer for most private sector administrators would probably not be to cut the remaining workers’ pay.
Yet that is what the federal government is doing at the Devens prison, part of a nationwide budget cut.
Federal Medical Center Devens, in Ayer, is one of only seven prisons in the country equipped to care for the most severely ill incarcerated people. It is the only prison with a specialized dementia unit, one of four to offer dialysis, and the first with an organ transplant unit.
It tends to house aging mafiosos and killers with walkers. In April 2024, 171 inmates had the highest classification of medical need, which encompasses conditions like cancer, quadriplegia, end-stage renal failure, or a need for major surgery. There were 122 patients with mental health needs severe enough to require psychiatric hospitalization, according to a December 2024 report by the Office of the Inspector General.
Yet shockingly, last fall, just one physician was working at the prison, responsible for caring for 941 inmates, the OIG reported.
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Devens was supposed to have six doctors, but during the April 2024 audit, three positions were vacant and two doctors were on extended leave, leaving one physician and a clinical director (also a physician). In June, the clinical director retired.
A letter that members of the American Federation of Government Employees Council of Prison Locals sent Congress this month said after the OIG audit, a Devens physician died by suicide. “The entire institution was run independently by [physician assistants] and [nurse practitioners] without any physicians for several months,” the union members wrote. It’s worth noting that under Massachusetts law, a physician assistant can only practice under a licensed physician’s supervision.
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Of 149 positions authorized in Devens’s Health Services Department during the OIG audit, 36 were vacant. There was no chief dental officer or deputy chief psychologist, and after the audit occurred but before the report was released, the chief pharmacist, chief psychiatrist, and nursing director retired. Also vacant were 10 of 42 nursing positions and five of 11 pharmacist positions, the report said.
Michael Wilson, legislative coordinator for the Council of Prison Locals’ northeast region, told the editorial board Devens now has two physicians. As of March 20, Devens had 1,122 inmates, according to the Federal Bureau of Prisons. Wilson said staffing is “absolutely not” sufficient.
Unsurprisingly, given the understaffing, the OIG report found myriad problems with Devens’s health care. Inmates taking medicines for substance use disorders are supposed to be supervised while consuming them but weren’t. Services like ophthalmology and radiology are obtained at nearby hospitals, and at the time of the audit, 57 medical appointments that had been ordered hadn’t been scheduled and were overdue by, on average, 53 days. Prisoners had difficulty accessing care for routine conditions and weren’t getting preventative health screenings.
The Biden administration in December said in response to the audit that it was seeking funding from Congress to increase salaries and hire more employees across the federal prison system. As the report notes, salaries at Devens are lower than at nearby hospitals. A prison physician earns approximately $282,480 annually, while a physician at a nearby hospital emergency department earns around $415,300.
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But under President Trump, the Bureau of Prisons is cutting salaries. Many prisons, including Devens, had been giving workers retention pay. On March 23, the Bureau of Prisons reduced that pay, citing budget constraints. “This decision was not made lightly, and we recognize the financial hardship this may cause for employees who rely on those incentives. However, the current financial challenges necessitate this action to ensure the long-term stability of the agency and to maintain operations across the board,” Bureau of Prisons spokesperson Randilee Giamusso said.
At Devens, physician assistants and nurse practitioners will lose around $15,000 a year, according to the letter union members sent to Congress. “We risk increased turnover and vacancies, leading to diminished inmate health care services,” they wrote.
A group of US senators, led by Illinois Democrat Dick Durbin, the ranking member of the Judiciary Committee, wrote to the US attorney general expressing concern that the pay cut will exacerbate staffing shortages. Representative Lori Trahan, whose Massachusetts district includes the Devens prison, is spearheading a House letter urging the Federal Bureau of Prisons to reverse the cuts.
To be clear, the problem of Devens staffing isn’t new and persisted through the Biden administration. But it’s now the Trump administration’s responsibility to fix.
Government is obligated to provide medical care for people it incarcerates. Reversing the pay cuts for Devens’s health care workers is a first step.
If government can’t adequately provide health care in prison, that raises the question of whether prison is the right place to provide this care.
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The federal government has a compassionate release program, which grants early release to inmates suffering from terminal illness, debilitating medical conditions, or other extenuating circumstances. Judges granted 2,900 petitions for compassionate release in fiscal 2024. There are reasons to argue that imprisoning a frail elderly person with dementia — who can’t hurt anyone or recall their crimes — doesn’t serve any useful purpose.
If a specialized medical center like Devens can’t retain enough clinicians to care for patients, the federal government and judges should consider releasing those who can be safely released to community-based facilities that can.
Editorials represent the views of the Boston Globe Editorial Board. Follow us @GlobeOpinion.
