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.