Thursday, August 12, 2010

Privatizing jail healthcare

Nueces County outsourced their jail healthcare to a private company out of Alabama that issued a bid $1 million per year lower than their closest competitor, reports the Corpus Christi Caller Times. Presumably this includes mental health, judging from Naphcare's list of services covered on its website.

Naphcare also runs jail healthcare in Beaumont (Jefferson County) and quite a few other local jails and federal Bureau of Prisons facilities around the country, though it no longer performs any work in its home state after Alabama changed providers in the wake of widespread litigation. A quick search also identified a recent lawsuit out of Beaumont alleging a "Naphcare employee mistakenly gave [an inmate] an anti-psychotic drug instead of his usual blood pressure medication."

I've never comprehensively examined how jail healthcare is delivered around the state, but my sense is it's all over the map. Some counties have contracts with local hospitals, some provide it themselves, UTMB used to provide it at the Dallas County Jail (as it does at 80% of Texas prisons), and I don't know how many have privatized it as they've done in Corpus and Beaumont. Especially as it regards mental healthcare, I would fear privatizing might limit flexibility because the availability of mental health services influences so many inmate classification and housing decisions.

Earlier this year I read some remarkable horror stories published in the San Francisco Bay Guardian regarding privatized medical care at county jails in California that one hopes won't be replicated in Texas. Here's a notable excerpt:
The U.S. Supreme Court recently agreed to a hear an appeal by the state of California to the federal court ruling that substandard medical care in California prisons constitutes cruel and unusual punishment and necessitates the early release of about 40,000 prisoners. At the May 26 hearing, healthcare workers familiar with the interiors of county jails and state penitentiaries came forward with horror stories.

"Every week I receive at least one inmate who has an open gunshot wound. They have not seen medical care in the county jails," Dr. Elena Tootell, chief medical officer at San Quentin state prison, told committee members. "It's quite surprising to me that they send inmates with gunshot wounds to prison. They just walk off the bus. They often have paper towels stuck to their bodies, seeping the blood. And then we are obligated to take care of them. This does not happen from San Francisco County, I'm going to tell you that right now."

Tootell said she'd observed a significant difference between those counties using private firms and those using public health care. "They will have a fracture — they've never been splinted, they've never seen a doctor. They're on anticoagulation [medication], but haven't had their blood checked in weeks and have bruises all over their body."

Connolly echoed similar concerns. For example, she told the Guardian, she's found herself asking questions like, "You were on AIDS medication before you got arrested and now you're not?"

Susanne Paradis, a healthcare research contractor with SEIU Local 1021, rejects the premise that the same services could be provided at a lower price. Under a private model, she says, the priority is to keep costs low — and that means doing less.

A key issue, Paradis said, is that private firms tend to rely more heavily on licensed vocational nurses (LVNs) — lower-paid medical staffers who aren't trained to assess patient's medical needs and cannot administer the same care that registered nurses (RNs) can. Using PHS data, Paradis found that in Alameda, there is one RN for every 92 inmates, compared with one RN per 32 inmates in San Francisco.

"An RN has the ability to assess, observe, and determine if there's emergency care needed," Paradis explained. "An LVN does not have the ability to do that."

John Poh, a nurse practitioner stationed at a jail in San Francisco's Hall of Justice, explained the difference this way: "The more RNs you have working for you, the fewer deaths you have."
The story about county jails leaving gunshot wounds untreated bespeaks of jawdropping negligence of a scope I've ever heard of in Texas. But of course, the trend of reducing the number of RNs isn't limited to either California or private companies: UTMB recently did the same thing at the Texas state prisons where they provide care.

In any event, this is an area where there are no good solutions - inmate healthcare is costly and if it's not provided at adequate levels, litigation and a few expensive cases could quickly outdistance the $700K Nueces County will save on the Naphcare contract.

The Supreme Court has dictated that whenever the state chooses to take someone's liberty, it's obligated to provide healthcare. Bottom line: If counties can't afford to provide healthcare for all the inmates in their county jail, the best solution isn't to cut corners on medical services but simply incarcerate fewer people in the first place.


Anonymous said...

Gee, I have zero medical training and even I can tell you that a gunshot wound or a fracture needs treatment immediately, and just from watching TV drug ads I know that someone on anticoagulants can suffer all sorts of complications if not monitored properly. Where do they get these LVN's from?

Prison Doc said...

With my screen name I can't resist commenting on this one. I have worked in both private for-profit facilities (GEO) as well as a mid-sized TDCJ prison with UTMB Correctional Managed Care. In neither private nor public sector have I ever seen anyone denied MEDICALLY NECESSARY care, although elective care, which would be nice but not required, is frequently denied in both sectors, mostly the state.

Private companies are convenient whipping boys, but can be low bidders and save on costs in many ways other than giving bad medical care--mostly in the area of lower pay to employees. UTMB, conversely, has an enormous and well compensated staff even after recent layoffs.
Inmates at prison facilities, both state and Federal at least in Texas receive a higher level of medical care than do the working poor or other free persons with inferior insurance coverage.

The RN--LVN disparity is a false argument, arising more from state nursing politics than medical need. Texas is particularly brutal to LVNs. LVNs are extremely well suited for 95% of the duties required in regular prisons.

If any deficiences arise in Nueces county with Naphcare, I'd predict itwill be more likely the result of our country's dysfunctional healthcare system--like medications that cost too much or procedures that are 'way too expensive.

Anonymous said...


It seems that dental care is not part of what is considered health care. I just received a letter from a dear friend who is incarcerated in Texas and they just got the news that the only dental care that will be given from now on is to pull any tooth that needs care. No fillings. No other care, just pulls no matter what the condition of the tooth or if a simple filling would solve the problem.

So I would guess this to mean a number of things like unless they start serving a lot of protein shakes instead of chewable food, a number of inmates will be having great difficulty eating. If you have pain from your teeth you're going to just have to live with it or lose the teeth and I don't even want to think of the general health issues that would go along with whatever wait one would have to go through for the pull if a tooth abscesses.

It's bad enough that the prison will administer the cheapest drug for a problem as opposed to the most effective one, but now I'm wondering if they will even give the inmates the proper antibiotics to go along with tooth removal or just wait for them to die of unnecessary infections.

No, it's not a gunshot wound, but a simple tooth abscess can become a life threatening issue if left too long especially if it complicates other medical conditions that are left untreated.

Anonymous said...

Anon 6:25...your friend must not have understood. I work in one of the dental depts and I can assure you that we are just not pulling teeth as the only care option! Maybe your friends tooth could not be filled because it was too decayed? If an inmate needs their arm stiched up do they just decided to amputate it?!? NO. Before people jump to conclusions they should be a little more informed!

jdgalt said...

This post betrays the same wrong assumption that has led you to oppose privatizing jails themselves.

There aren't any fewer abuses when prisons are publicly run than when they're privately run; the real difference is that the abuses are much less likely to see the light of day, because the bad guys have badges and aren't accountable to anybody. Their unions see to that. But when prisons are privatized, state prison authorities make sure even the slightest misstep is broadcast to the world, so that they can spend more of our tax money to create bigger personal empires for themselves.

Why would that picture be any different when the medical personnel in the prison are the ones whose jobs are being privatized?

Get government corrections officers stripped of their immunity to liability when they abuse their powers, and you'll soon see whose record is the cleaner. Until then, you don't know.

Anonymous said...

Prison Doc must be a senior leader at UTMB CMC. What unit are you on ? The recent RIF has put a strain on every UTMB CMC employee and the LVNs who practice outside of their scope. YOU KNOW that is true.