One inmate with an abscess was not treated for two months. Another went toothless for more than two years while he waited for dentures. He filed paperwork to get them 18 times and experienced mouth pain, swelling of mouth tissue known as mucositis and digestive issues while on a soft food diet. Another said the dental team at Goose Creek Correctional Center would do no dental work except to pull teeth.
These complaints prompted Kate Burkhart to investigate systemic issues with dental care within the state’s Department of Corrections. Burkhart is the state ombudsman, whose office is an independent agency that investigates complaints about state government.
“It’s probably easy for some folks to be like, ‘Well, it’s just their teeth,’ but it’s indicative of larger problems meeting the health needs of folks in custody,” she said.
The Department of Corrections has a legal obligation to provide health care to Alaskans in custody, but the investigation by the ombudsman’s office found the agency failed to provide adequate or timely dental care to inmates at Goose Creek Correctional Center for quite some time. The office released a public report on Monday after sharing its findings with the department.
Burkhart called it a “persistent problem”; it is her office’s second investigation related to dental services within the Department of Corrections; the first began in 2019 and ended with a report in January 2021.
“The finding that they weren’t meeting a legal obligation is pretty serious. It also creates implications related to the rights of folks in custody. The department has been sued before for not meeting those obligations,” Burkhart said.
Her office investigated six allegations at Goose Creek Correctional Center, from inordinate delays in treatment to improper handling of grievances, and found all of them justified.
The report found that “serious dental treatment needs are not being met.”
“Resources currently allow the GCCC Dental Program to extract teeth and fight infection. Routine exams, cleanings, fillings and making dentures are not currently performed,” the report said. It also said inmates were routinely put on waitlists for services unavailable at GCCC.
At one point at the end of 2022, the GCCC dentist had neither an assistant or hygienist. “The dentist saw eight (8) patients over three (3) days in this roughly six-week period,” the report said.
The report also found that the prison’s dentist was reviewing dental grievances and that medical staff “reasonably believed that the dentist had asked them not to notify inmates of their right to grieve dental decisions, and on at least two occasions, the dentist communicated the undesirability of dental grievances to medical staff.”
The ombudsman’s office made 12 recommendations to the department, which include hiring another dental team and increasing oversight of the dental program.
DOC has begun to contract with two dentists to alleviate the burden on its current dental staff while it works to secure funding to hire an additional three-person dental team for Goose Creek.
Dr. Robert Lawrence, the chief medical officer for the Department of Corrections, said there were no surprises in the report and that the agency has fully accepted the findings and is working to address its issues, most of which are due to lack of critical staff.
“The real resource we need here is people. Because the heart is there, the motivation is there, the commitment is there. We just need the people who can help provide that care,” he said.
He said the department aims to have each inmate leave the system better than when they entered, and that includes access to dental care.
“That is very hard for us to do, because we don’t have the resources to do it and do it well — and we feel that burden,” he said.
Inadequate care
The issues identified at Goose Creek Correctional Center stem from three main points: the ongoing lack of a dental hygienist, a large volume of inmates who need care compared to the number of staff capable of providing it and a slowdown in dental care at another nearby facility which often transfers inmates to GCCC.
The ombudsman’s office found that more than 20% of inmates at Goose Creek Correctional Center are on the waitlist for dental care. In the report, officials say they have only the resources to pull teeth and fight infection with antibiotics — the facility does not provide routine dental exams, cleanings, fillings or denture fittings.
Notably, the report said the facility has gone without a dental hygienist for more than two years, which has significantly hindered its response to dental needs among inmates.
Lawrence said the position is hard to fill because of how little the department is allowed to pay compared to what a hygienist could make in the private sector. The position has been posted five times since the end of 2021 and no posting has resulted in more than two referred applicants, according to the ombudsman’s report.
“The dental hygienist role, or that position, is only paid at somewhere between 50% and at the most 60% of what the same person could make in the community right now,” he said. “The cost of the dental hygienist now is so high that even in the community dentists are having trouble retaining the dental hygienist, but they’re so crucial to a well-functioning dental program.”
The department said it is asking for an exception to be able to pay a hygienist more money in order to attract more applicants. It is working to get an emergency contract for a hygienist.
“If we could get that in place, that would address 90% of the allegations made by the ombudsman — as well as meet most of the recommendations,” he said.
Delays
Of the nearly 350 inmates on the waitlist for dental care at Goose Creek Correctional Center, 35 need dentures, 130 need urgent treatment, 36 need routine care, 55 need an exam and 86 need a cleaning, according to the ombudsman’s report.
Goose Creek was built to house two dental teams, but it has only one partially staffed team. There are four dentist’s chairs in the facility. “We’ve started to pencil out and make plans for bringing in another dental team,” Lawrence said.
He said the department is not budgeted to pay for an additional team and would have to request more money from the state.
Goose Creek houses a large proportion of unsentenced inmates, which means the population changes frequently. The result is that many inmates come in needing care, but may only be in the facility for a short period of time. Many of them come from Anchorage Correctional Complex, where one dental clinic is closed and needs to be renovated. DOC has a request for funds to do that in the administration’s current capital budget proposal.
The result is a backup in care that often sends inmates with only routine needs to the back of the line as new inmates with more urgent issues come in.
Lawrence said the state’s inmate population has higher needs for care than the state’s population as a whole.
“Prisons are not just warehouses where we put people. These are neighborhoods within the larger community. And one of the things that we recognize about this unique neighborhood that is a correctional institution is that it tends to have a concentrating effect, meaning that any of the issues that we’re dealing with in the community get concentrated within this prison environment,” he said.
He said that in the population at large, about a quarter of people will have a tooth that needs attention. In the prison population, he said, about 90% of inmates have multiple teeth that need attention.
“It’s important to recognize the burden of disease that is concentrated in this neighborhood of Goose Creek,” he said. “There’s around 1,200 inmates who live there at any given time and we only have one dentist.”
The ombudsman’s report also found that some medical staff at Goose Creek were discouraged from informing inmates about their right to file grievances. Others said they were asked not to inform inmates of staffing issues for fear that it would lead to a “surge” in dental requests. The ombudsman’s office considers these allegations resolved, however, after Lawrence provided staff with coaching and supervision at the end of last year.
Next steps
Since the investigation, the Department of Corrections has been working with the ombudsman’s office. The agency’s first step was to hire the contractors, and Lawrence identified that hiring a dental hygienist would come next. The additional dental team at Goose Creek and renovations at Anchorage Correctional Complex will take more time.
He said DOC is also working to update its dental policy, so that all staff can communicate better with inmates about their care. He said that is critical, especially while the hygienist position, which usually takes on a lot of the scheduling and interfacing with inmates before appointments, is unfilled at Goose Creek.
And the inmate who went without teeth for more than two years was fitted for dentures this month — about two weeks after the ombudsman sent DOC an initial draft of its report.
