Planning health services for a city jail: impact of contractual services on men's sick call.

A nonviolent protest by prisoners began a 2-year planning process leading to the implementation of contractual medical services at Baltimore City Jail. This study was conducted in order to assess the impact of contractual services on the process of men's sick call. The contractual program was associated with a decrease in utilization of men's sick call: 62.9 patient visits per day per 1,000 prisoners in 1975 versus 27.4 patient visits per day per 1,000 prisoners in 1978; an increased duration of encounter; 2.8 minutes in 1975 versus 10.9 minutes in 1978; and with changes in prescribing patterns and in categories of patients' complaints. Baltimore City Jail spent about $588 per prisoner-year during fiscal year 1977, and about $670 per prisoner-year during fiscal year 1978, the first year of contractual services. We conclude that a system of health services for a large, urban jail can allow time for humane and professional encounters between providers and patients.