How are doctors treated in prison?

Even if it is about people who have broken the law, they are ultimately people, writes Silvio S. in a letter. Black ballpoint pen, white A4 paper, beautiful writing. S. writes from the cell. He is a prisoner in the Dresden JVA, this large brown block that was built out of the ground in the early 2000s on a former barracks site on the edge of the Outer Neustadt. In this unbearably hot summer, 705 convicted male offenders are waiting behind bars for the daily round of the court.

But S. still has to show more patience. The last full-time doctor left the prison over a year ago. Since then, the institute has been employing physicians on a fee basis who, in addition to their main activities, take on basic care. S., who, by his own admission, has been plagued by skin problems for a long time, has to struggle with severe itching and the resulting open wounds. But the quick help he wants doesn't come. “I was barely able to sleep for three weeks. When I was finally allowed to go to the doctor, I was dispatched within a minute. "

Although he was prescribed an antibiotic, the itching persists. A new appointment? In a few weeks at the earliest. “That is inhumane. I am not alone in my opinion, ”said S. Civil servants and medical assistants also suffered from the medical care situation.

Health of the inmates endangered?

S. attorney, the Dresden defense attorney Martin Boine, shares his client's assessment. "Since there are no more permanent doctors working there, I've also been hearing more complaints from other prisoners," says Boine. The problem is known. Even a public prosecutor had advised a prisoner to file a criminal complaint in the presence of the lawyer.

Of course, Jörn Goeckenjan does not want to accept the accusation that the Dresden JVA would endanger the health of the inmates. "Emergency care is always guaranteed," says the 49-year-old director, an experienced man who was previously in charge of the Waldheim and Chemnitz prisons.

But even he does not hide the fact that good medical care would look different. “We employ 15 fee doctors in Dresden. Three of them are general practitioners and twelve are specialists such as an internist, a diabetologist and a radiologist, ”he says. From Monday to Friday one of the family doctors comes to the institution for a few hours in the mornings. "An average of 60 patients register every day," says Goeckenjan. Doctors are overwhelmed by the great demand, and there is little time left for treatment. Appointments are also made “not as quickly as desired”. Because this cannot be permanent, Goeckenjan and his team are urgently looking for new prison doctors - two and a half posts are waiting to be filled.

Dresden is not alone in this. Nationwide, around every fourth doctor's post in prisons remains vacant. In Saxony there are currently eleven prison doctors working in ten penal institutions. "It would be appropriate if at least one prison doctor was available for every 400 inmates in every prison," explains Jörg Herold, press spokesman in the Saxon Ministry of Justice. The reality is different. Instead of filling vacancies, people are increasingly helping themselves with fee-based doctors. Their number in the Saxon prison has risen from 50 in 2009 to 75 now.

But why does hardly any doctor want to work permanently in prison? "First of all, this goes hand in hand with the general shortage of doctors," believes Dr. Michael Schulte-Westenberg, General Manager of the Saxon Medical Association. At the same time, the public service does not have the best reputation among medical professionals. "It is assumed that the remuneration is not as good as in other areas." However, the medical association does not have any valid figures on this.

Christian Wolfram is a medical student in Leipzig and represents the interests of young junior doctors in the Hartmannbund medical association. "Most students and interns know little about prisons, the option is hardly considered," says the 24-year-old. In his view, inhibitions and prejudices about working in prison are also widespread. “You ask yourself: What is the tone and approach there? Are the patients aggressive, do they become violent? ”The widespread belief is that the payment is significantly worse than in a practice or clinic.

That there is an exception in the public health service for prisons is hardly known, according to Goeckenjan, head of the prison. In the meantime, prison doctors in all Saxon prisons are paid according to the collective agreement for doctors at university hospitals. “We even group them two levels higher than at the university clinic. When they have reached the highest tariff level, they receive another monthly allowance of around 1,325 euros, ”explains Goeckenjan. In addition, the doctors are offered the possibility of civil service.

Institution takes on further training

Christian Wolfram also sees many advantages in working as a prison doctor: “Prisons usually offer family-friendly working hours. You don't have to worry about bills either. ”According to studies by the Hartmannbund, it is precisely these points that are at the top of the wish lists of young doctors, says Wolfram. “We don't have shift, weekend or on-call duty,” Goeckenjan explains. Core working hours are from 9 a.m. to 3:30 p.m. The institution would also take over further training in its entirety.

Wolfram finds offers that are attractive. "It would have to be advertised a lot more," says the medical student. In his opinion, prejudices regarding security should also be reduced through education. "Since I started as a director in Dresden in 2017, there has not been a single attack on medical staff," says Goeckenjan. The doctors are never alone and always have a radio with an emergency button with them. "The prisoners are grateful and happy about medical help." This is also confirmed by Silvio S .: "The step into public is necessary for something to change."