DEPARTMENT OF CORRECTIONS
2017-19 Biennial Budget
Issue Paper
Topic: DIN 5701 - CCI HSU Expansion
Request
The Department of Corrections (DOC) requests $773,200 GPR and 5.00 GPR FTE in FY19 in order to staff
and operate the new Health Services Unit (HSU) at Columbia Correctional Institution (CCI) and treat CCI’s
large population of chronically and mentally ill inmate patients.
Problem Description
CCI’s current HSU is located in the Administration building and was constructed in 1985 to serve 450 adult
male offenders. There are currently 829 inmates housed at CCI. 4 There are a significant number of inmate
patients housed at CCI that have complex healthcare needs.
There are a high proportion of chronically ill inmates, mentally ill inmates, and a large number of inmates in
restrictive housing that create scheduling challenges and complicate health services at the institution. Once
the expansion is complete, CCI would like to be able to expand and extend on-site health services and
service hours and be able to operate 24 hours per day/7 days per week. Additional HSU health care staff are
required to meet those operational objectives, and additional officer overtime will be necessary.
Background
CCI’s new HSU was enumerated in 2013 Act 20 (the 2013-15 Biennial Budget). The project expands CCI’s
HSU capacity by building a new 14,300 square foot HSU to replace the original 4,300 square foot facility.
The expansion includes a secure waiting area; examination rooms, offices for medical and psychiatry health
care professionals, medical and clinical record storage areas; secure medication and supply rooms; a dental
suite; multi-purpose therapy rooms; a radiology room; lab space; and an officer station.
Construction is estimated to begin in October 2016 and be completed in November 2018. CCI will not need
new staff until October 2018 at the earliest. Due to the aging population and the large number of inmates
with complex healthcare needs, DOC believes that there is benefit to expanding hours of operation to meet
health care needs, improve inmate patient outcomes, and decrease liability.

4

Friday Report 8/26/2016

 Analysis
Health Care Challenges with CCI’s Population
CCI’s inmate population is aging and has a variety of complex healthcare needs. Appendix 1 shows that
from FY10 to FY15, CCI’s population over 50 years of age increased by 2% while the younger age groups
generally decreased. Moreover, inmates at CCI have approximately 638 chronic illnesses among the
population, as shown in Table 1.
Table 1: Chronic Illnesses
Human Immunodeficiency Virus (HIV)
Seizures
Hepatitis C
Hypertension
Diabetes
Dyslipidemia (high cholesterol)
Asthma
Total

5
29
52
176
58
182
136
638

Delivery of health care is complicated by mental health issues in restrictive housing and within the Special
Management Unit (SMU). Of 630 maximum security inmates on May 31, 2016, 330 (52%) have been
identified with a mental health code of MH-1 or higher.
Moreover, 57% of CCI’s restrictive housing population has been identified with a code of MH-1 or higher.
Table 2 shows a complete breakout of mental health codes by security level as of May 31, 2016 and
Appendix 2 shows a description of each mental health code. 5
Table 2: Mental Health Codes at CCI

Maximum
Medium
Minimum
(Barracks)
*As of May 31, 2016

Unknown
0
1
1

MH-0 MH-1
300
250
21
10
113

13

MH2A
75
1
0

MH2B
5
0
0

Existing HSU Staffing:
CCI’s HSU is currently staffed by 8.80 FTE health positions and a 1.00 FTE Correctional Officer. The
existing HSU is open seven days per week and operates between 6:00am and 10:30pm on weekdays and
between 6:00am and 6:00pm on weekends. A nurse and DAI physician are on-call during overnight hours.
In May 2016, the existing HSU had 896 appointments.
5

The medium security inmates have been reduced from maximum to medium security levels, and are awaiting transfer to beds at
other DAI sites.

 DOC wishes to increase CCI’s health care staffing to a 24/7 operation so that there are better responses to
emergencies, restraint checks, and clinical monitoring (continuity of care through ongoing clinical
assessments) as well as being able to provide round-the-clock vital sign checks, triage, follow-up care, and
medication administration.
In addition to permanent employees, CCI currently utilizes contracted agency medical staff to supplement
their full time staff in order to meet care needs. Presently, there are three contracted agency Licensed
Practical Nurses (LPN), one agency Registered Nurse (RN) 6, one agency Medical Assistant and one agency
office support staff.
CCI has also experienced an increase in overtime (OT) hours of FTE NC2 staff. In FY14, 428 OT hours
were used; in FY15, 745 OT hours were used, and in FY16 as of pay period 12, 1,306 hours were used. In
all, CCI has experienced a 4% increase in total healthcare hours spread between FTE, LTE, OT, and agency
staff. Table 2 shows how the total number of hours across all classifications has increased by a total of 4%.
Table 3: Total Nursing Hours
(FTE, LTE, and Agency Combined)
FY16
FY14 FY15 (Forecast)
12,243 12,104
15,440
RN
4,268
7,039
5,158
LPN
60
57
0
APNP
2,128
0
0
CNA
0
605
481
MA
1,743
0
MPAA 1,652
Total
20,351 21,548
21,079
Staffing Request:
DOC is requesting an additional 5.00 FTE positions to staff the expanded space when it opens in FY19.
With the substantial increase in treatment capacity, CCI estimates that it will be able to accommodate an
increased number of appointments each week, which is why they are requesting additional health positions.
DOC is requesting:
-

Overtime funds to add a 24/7 correctional officer post due to the increased size of the unit;
4.00 FTE NC2 positions to fully staff three new posts. One post will add seven day per week 3rd
shift (overnight) coverage and the two additional posts will provide five day per week coverage to
accommodate additional appointments and medication administration; and;
1.00 FTE Advanced Practice Nurse Prescriber (APNP).

Delivering health services to CCI inmate patients is complicated by mental health issues and an aging
inmate population. A combination of an APNP and NC2 positions will ensure inmate patients’ access to
medical care. The scope of practice for an APNP allows them to assess and treat patients, order and perform
6

An agency RN is equivalent to an FTE Nurse Clinician 2 position.

 medical testing, and prescribe medications. With the increased number of visits, having an APNP will
improve CCI’s ability to manage and treat its entire population.
The NC2s perform a multitude of tasks including: sick calls, HSU appointments, physical assessments and
treatments within scope of practice and established nursing protocols, bi-weekly segregation rounds, lab
draws/processing, procedures (EKG’s, spirometry set-up for in-house sleep studies, etc), injections,
emergency triage, continuity of care from offsite providers, medical monitoring, medication administration,
patient education, medication education, transcription of medication orders, and medication control changes.
With this staffing request, CCI will have the resources necessary to provide ambulatory health care services
for all CCI inmates, utilizing a multi-discipline approach (physical and mental health wellness) in an
environment that is safe for caregivers, security staff, and inmates. Moreover, CCI will have the ability to
reduce the use of hospital trips for observational purposes, since they will have the space to place inmate
patients within the institutions.
CCI will experience cost avoidance by utilizing their own facilities for patients under observational status as
well as reduced overtime associated with officer vigils. CCI is currently able to accommodate medical and
Psychological Services Unit (PSU) visits based only on the availability of treatment and exam space and
only during normal business hours.
Adding 24 hour coverage would make access to the HSU comparable to two DAI male maximum security
institutions. Both Waupun Correctional Institution (WCI) and Green Bay Correctional Institution (GBCI)
provide 24 hour coverage Sunday through Thursday and weekend coverage on first and second shift.
Wisconsin Secure Program Facility (WSPF) is seven days per week but not 24 hours per day. Dodge
Correctional Institution (DCI) has 24 hour coverage only in the infirmary. Outside of WCI and GBCI,
Taycheedah Correctional Institution (TCI), the female medium/maximum institution and Milwaukee Secure
Detention Facility (MSDF), a medium security facility, provide 24/7 staffing in their HSUs.
Summary
GPR
TOTAL

FY 18
Funding
FTE
$0
00.00
$0
00.00

Prepared by: Peter James, Budget and Policy Analyst
240-5422

FY 19
Funding
FTE
$773,200
5.00
$773,200
5.00