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鈥� 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 鈥� partially because using the companies saves benefits and pension costs.
鈥淲e believe that contracting out for inmate medical services is the best use of taxpayer money,鈥� said Aurora Sanchez, deputy secretary of administration for the department of corrections in New Mexico. 鈥淚t is state law to provide quality healthcare to inmates, and we are positive that inmates are getting professional healthcare at a reasonable cost.鈥�
One of the most recent states to make that decision was Florida, but that attempt became mired in a . 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聽to use two of the nation鈥檚 largest vendors, Corizon and Wexford Health Sources Inc.,聽 but the 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.
鈥淭he 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,鈥� said , Wexford鈥檚 president and CEO. 鈥淗ealth care is required by the Constitution but is not a core competency of those agencies.鈥�
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聽 in Massachusetts, said using private services can carry its own set of problems. 鈥淎s with anything privatized or contracted out, you worry about whether the incentive to cut costs becomes too great,鈥� he said.
Public employees see the move as yet another attack on unions, and question the delivery of care.
鈥淧rivate correctional health care companies have a track record of cost cutting that put both inmates and staff at risk,鈥� said Kerry Korpi, director of research for the American Federation of State, County and Municipal Employees. 鈥淭hese companies鈥� goal is profit, not public safety.鈥�
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.
鈥淚鈥檓 not aware of any correctional system that thinks it鈥檚 where it needs to be,鈥� said Jesse Jannetta, senior research associate at the Urban Institute鈥檚 Justice Policy Center. 鈥淚鈥檝e noticed the same challenges and problems despite how things are structured or who is responsible for what aspect of care.鈥�
Under the Eighth Amendment directive against cruel and unusual punishment, .
But managing prisoners鈥� health care is difficult. Infectious disease, mental illness and addiction are common problems for inmates, according to the . Furthermore, a聽 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聽 prepared for a federal judge accused Corizon of poor medical care and neglect at one of Idaho鈥檚 prisons, alleging serious nursing mistakes and inadequate care for prisoners with terminal illnesses.
Corizon responded to the accusations in a , saying the report was 鈥渋ncomplete, misleading and erroneous鈥� and cited an audit by the , which stated Corizon met all required standards.
鈥淐orizon 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鈥檚 money,鈥� 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鈥檚 longest-standing contract is with Illinois. , 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.
鈥淚t鈥檚 hard to untangle what鈥檚 true, and whether it鈥檚 the fault of the department of corrections or Wexford,鈥� 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鈥� health care has been聽 for the past six years after a judge found that the state failed to provide inmates with adequate medical treatment. The state鈥檚 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 , the legal advocacy group that set the lawsuits in motion to call for oversight of California鈥檚 prison health system, said care has improved but is still inadequate.