COVID-19, Prison Health Care

Public Health Nurses play vital role inside California’s prisons during COVID‑19

California Correctional Center aerial view.
California Correctional Center

By Office of Public and Employee Communications staff

Prior to the coronavirus pandemic, the scope of the Public Health Nurse (PHN) inside California’s prisons was primarily focused on identifying those in the incarcerated population with communicable diseases such as tuberculosis, hepatitis, influenza, and/or sexually transmitted diseases. Today, the role of the PHN has never been more critical.

The PHN is well versed on the importance and effectiveness of immediate isolation and quarantine, physical distancing, proper hygiene, and hand-washing, some of which was largely unknown to the public until the COVID-19 pandemic hit our community.

Heather Horsley, PHN at California Correctional Center (CCC) in Susanville, has spent 17 years with the department and has been on the front line of the fight to stop the spread of COVID-19 within the institution.

CCC experienced an outbreak in mid-June after several of the institution’s dormitories reported incarcerated persons positive for COVID-19. CCC has worked closely with the Lassen County Department of Public Health to respond to the COVID-19 outbreak through mass testing of both staff and the population.

“There are a massive amount of decisions that need to be made when facing an outbreak, from testing, isolation and quarantine housing and notifications, to educating patients on medications and how they can keep themselves and those around them safe,” Horsley said. “Our primary focus is to protect the incarcerated population, our coworkers, and our community because our decisions impact everyone.”

Immediately identifying those who have the virus, isolating them from others, and quarantining those who have been in contact with the positive patient, are all critical steps to mitigating the spread of any communicable disease.

“Nursing is pivotal in the management of diseases not just for patients but for staff and communities that impact our patients,” said Barbara Barney-Knox, Deputy Director of Nursing Services and Statewide Director of Nursing (A).

In the event an incarcerated person develops symptoms, nursing staff at the institution immediately isolate the patient and conduct a COVID-19 test. If the result is positive, or is suspected of being positive, CCHCS nursing and public health staff begin the process of contact tracing within the institution.

The clock ticks for the institution’s team of operations, health care, and public health experts to make critical housing, quarantine, isolation, and testing decisions based on the results of those contact investigations, which determine what potential exposure, if any, may have occurred to others in the incarcerated population and/or staff.

At California Institution for Men (CIM) in Chino, PHN Angela Olatubosun was part of the first of California’s prisons to experience a COVID-19 outbreak, which occurred in late April. While state and national guidance on COVID-19 shifted daily as health care and public health experts learned more about how this new virus spread, Olatubosun was a part of the team that has helped lay the groundwork for contact tracing and COVID-19 response efforts within California’s prisons.

“It was very challenging in the beginning because this was all uncharted and information was changing daily,” Olatubosun said. “(CIM) worked as a team to develop contact tracing guidance that will hopefully help other institutions be able to quickly respond to a positive COVID-19 case.”

Those in the incarcerated population identified during the contact investigation as being potentially exposed to the positive case are placed on mandatory 14-day quarantine with health care screenings by nursing staff occurring multiple times a day, movement limited to essential moves only, testing offered, and personal protective equipment provided to help mitigate spread. The required quarantine period may be extended if other positive cases are identified within the unit and additional exposure suspected.

The PHN also plays a vital role in collaboration with county departments of public health to keep them informed of outbreaks within the institution, but also to keep them informed of the health care status of patients being released to their counties of residence.

For COVID-19, an added role for the PHN is educating the incarcerated population on the availability of Project Hope, a voluntary state initiative that allows people releasing from prison to finish their medically directed quarantine/isolation in a hotel room at no cost to their participant, including food and safe transportation to the hotel. This is vitally important not only for the health and safety of the formerly incarcerated person, but the community at-large.

“We are providing education to those being released from state prison on ways they can help protect themselves and stay safe in the community,” PHN Horsley said. “We focus on providing them information on what to do upon their release, how to protect their family, and how they can receive medical care in the community if they need it.”

CDCR and CCHCS are made up of people, and are in turn part of the larger community, and what happens outside of prison walls directly impacts what happens inside of them.

CDCR and CCHCS have implemented multiple strategies since mid-March to control the spread of the virus within our institutions.

They include suspending intake from jails and halting non-essential transfers, exponentially increasing testing for inmates and staff, implementing early release programs for eligible inmates and those deemed medically high-risk for complications, limiting movement within institutions, and mandating all inmates and staff wear masks.

More efforts are underway as CDCR and CCHCS work tirelessly to address this public health emergency.