States, in an attempt to cut costs, are increasingly outsourcing health care for inmates to for-profit companies, but the trend is raising concerns among unions and prisoners’ rights groups.
About 20 states, including Arizona, Illinois and Maryland, have shifted all or portions of their prison health care operations to private firms. Officials in these states maintain that the companies, which provide physical, dental, mental and pharmaceutical services, are less expensive than employing state workers — partially because using the companies saves benefits and pension costs.
"We believe that contracting out for inmate medical services is the best use of taxpayer money," said Aurora Sanchez, deputy secretary of administration for the department of corrections in New Mexico. "It is state law to provide quality healthcare to inmates, and we are positive that inmates are getting professional healthcare at a reasonable cost."
One of the most recent states to make that decision was Florida, but that attempt became mired in a legal battle. Labor unions filed suit in May, urging a judge to block the proposal, which threatened the jobs of 900 state employees, said Jeanie Demshar, director of professional practice advocacy and labor relations for the Florida Nurses Association. The state planned to use two of the nation's largest vendors, Corizon and Wexford Health Sources Inc., but the court refused to rule on the case this month after determining that the suit was moot since the 2011 budget had expired and the 2012 budget did not include the plan.
"The reason that privatization is a better model is that when you look at state departments of corrections and local facilities, their core mission is safety, security and rehabilitation of the inmates," said Mark Hale, Wexford’s president and CEO. "Health care is required by the Constitution but is not a core competency of those agencies."
Human rights groups, however, say that private services are not always providing care that is as good or better than what the state could. Joel Thompson, co-chair of the Health Care Project at Prisoners' Legal Services in Massachusetts, said using private services can carry its own set of problems. "As with anything privatized or contracted out, you worry about whether the incentive to cut costs becomes too great," he said.
Public employees see the move as yet another attack on unions, and question the delivery of care.
"Private correctional health care companies have a track record of cost cutting that put both inmates and staff at risk," said Kerry Korpi, director of research for the American Federation of State, County and Municipal Employees. "These companies' goal is profit, not public safety."
Complaints About Public And Private Care
Both states and private companies have been the targets of numerous lawsuits during the past two decades, alleging negligent or inadequate care.
"I'm not aware of any correctional system that thinks it's where it needs to be," said Jesse Jannetta, senior research associate at the Urban Institute’s Justice Policy Center. "I've noticed the same challenges and problems despite how things are structured or who is responsible for what aspect of care."
Under the Eighth Amendment directive against cruel and unusual punishment, prisoners are guaranteed adequate health care.
But managing prisoners' health care is difficult. Infectious disease, mental illness and addiction are common problems for inmates, according to the Center for Prisoner Health and Human Rights. Furthermore, a January report by Human Rights Watch detailed the growing number of aging inmates, who incur costs that are nine times higher than those for younger inmates.
Wexford and Corizon have faced criticism about delivery of care. A March report prepared for a federal judge accused Corizon of poor medical care and neglect at one of Idaho’s prisons, alleging serious nursing mistakes and inadequate care for prisoners with terminal illnesses.
Corizon responded to the accusations in a press release, saying the report was "incomplete, misleading and erroneous" and cited an audit by the National Commission on Correctional Health Care, which stated Corizon met all required standards.
"Corizon has a dedicated staff that works hard every day to provide care to a patient population that is sometimes difficult to treat, and at the same time be mindful that they are stewards of the taxpayer's money," a spokesman said.
In response, the Idaho corrections department agreed in May to increase its staff and medical oversight, while the court continues to review the system during the next two years.
Wexford's longest-standing contract is with Illinois. John Maki, executive director of the John Howard Association of Illinois, a prison-reform group, says inmates often tell him they are receiving insufficient responses to care.
"It's hard to untangle what's true, and whether it's the fault of the department of corrections or Wexford," Maki said. When the state handles the prisons and the health care is outsourced, there may be coordination issues, he said.
But Wexford is also working on providing computerized health records and increasing its use of telemedicine, moves Maki says have been invaluable, particularly in rural areas.
To be sure, complaints about prison health care are also raised when the state provides it. In California, inmates' health care has been under federal court supervision for the past six years after a judge found that the state failed to provide inmates with adequate medical treatment. The state’s department of corrections tried in May to re-gain the right to oversee the system but was refused by a federal judge, who said the department must first demonstrate it is able to provide adequate medical treatment.
Don Specter, director of the Prison Law Office
, the legal advocacy group that set the lawsuits in motion to call for oversight of California’s prison health system, said care has improved but is still inadequate.