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Private Health Care Services in County Jails Comes at High Price
The 1976 U.S. Supreme Court decision ruling that deliberate indifference to a jail detainee’s health care constituted “unnecessary and wanton infliction of pain,” violating the Eighth Amendment’s protection against cruel and unusual punishment and opened the door for those in the jails’ care to file suit and hold the jails accountable. Subsequently, the 1980s saw the birth of the private health-care industry to help cover costs and shoulder this responsibility.
Next, the deinstitutionalization of the mentally ill in the 2000s saw the closure of mental health hospitals and ensuing growth of county jail populations and therefore, the private health care industry. By 2010, 62% of the nation’s jails had privatized medical care.
But Reuters points out that utilization of the health care industry may have an unforeseen price. There are no regulations governing private health care so certain standards such as staffing levels and intake evaluations are contractual and can vary from organization to organization. Decisions are primarily profit-driven, employees are pressured into cost-cutting procedures. And as a result, general health care of the jails’ occupants was lacking.
The Reuters analysis stated that no large-scale studies had ever been conducted of the results of privatization of the country’s jails concerning their death rates. So they surveyed 523 jails in the U.S. between 2008 and 2019 to compare the industry’s mortality rate to that of jails whose health care is run in-house. They filed over 1,500 public records requests from all the jails with an average daily population of 750 or more, as well as the 10 largest jails in nearly every state. They calculated the death rates of prisoners and detainees whose cause of death was listed as a medical condition, drug and alcohol overdose or withdrawal, illness or suicide. A jail’s health care was said to be privatized only if the contractor was fully responsible for managing and staffing services.
The article stated it found that the death rates for the two groups were similar between 2010 and 2015. But between 2016 and 2018, publicly managed health care mortality rates in jails ran approximately 12.8 deaths to every 10,000 detainees while the top five privatized health-care companies averaged anywhere between 15.1 and 20.2 deaths for every 10,000 detainees.
These results were submitted to two independent statisticians, American Institutes for Research principal researcher Ryan Willimas and University of Alabama’s Culverhouse College of Business Associate Research Dean Jim Cochran. The two concluded that the news organization’s survey was reasonable and accurate and that these results were statistically significant.
The article said that out of the top five private health-care companies, NaphCare had the largest disparity, carrying 20.2 deaths per 10,000 patients, followed by Armor at 18.8, Corizon at 16.0, Wellpath at 15.9 and PrimeCare at 15.1. It said smaller jurisdictions were more likely to privatize health care and hire one of these organizations because of tighter budgets.
NaphCare Chief Executive Officer (CEO) Brad McLane said his family-owned company “never compromised patient care for profit and never will.”
Armor claimed that its health care services met or exceeded all industry standards.
Corizon CEO James Hyman stated that statisticians employed by Corizon disputed Reuters’ methodology and results. Variances between Corizon death rate and publicly managed health care was not statistically significant and death rate alone was not a valid indicator of the quality of the company’s performance.
Wellpath President Kip Hallman said jails often hire contractors after they hit a crisis and that comparing the two death rates would therefore be like “comparing apples to oranges.”
PrimeCare CEO Thomas Weber claimed the company improved every jail they were contracted to serve. “In every one we have been informed that we provide a more comprehensive and better healthcare system,” he said.
Prison Health Services (another private health-care company) served Chatham County Detention Center (CCDC) in Savannah, Georgia in 2011. It spent $1.3 million that year on ambulance fees and hospitalizations. After Corizon took the contract over the following year, those costs dropped to $.7 million. The Reuters article said that sending fewer detainees and prisoners for needed hospital visits increased Corizon’s profit margin by 6.9% in 2011. It stated that reported profit margins went from 14.6% in 2011 to 21.5% in 2012 and then to 24.2% in 2013.
Savannah lawyer Will Claiborne, representing families in wrongful death lawsuits against the county jail, said private companies have an incentive to cut costs. “It’s a one to one, dollar to dollar, relationship between denying care and profit.” He just settled a lawsuit last year for the family of Matthew Loflin who died at CCDC April 24, 2014 after being denied the necessary hospitalization for a blood clot in his chest by a senior manager at Corizon.
Corizon has been in the headlines consistently for a number of years. From 2014 to 2016 allegations persisted of missing drugs, denial of hospitalizations, untreated mentally ill patients, falsification of records, lack of active doctors on site, and inadequate staff coverage.
A 2014 incident had Dr. Charles Pugh, nurse Betty Riner and nurse Lynne Williams approach Sheriff Al St. Lawrence about accusations of corruption and unethical practices. Riner and Williams were later fired for going outside Corizon’s chain of command and Pugh for failing to work scheduled hours.
In 2015, the Medical Association of Georgia investigated Corizon due to a lawsuit filed in a wrongful death claim at CCDC. In August 2015, its contract with CCDC was reviewed and Corizon was removed as the jail’s health-care provider.
Lawsuits abounded for the company, and it lost contracts successively with Alameda County, California, the Indiana Department of Corrections and the Arizona Department of Corrections. The Arizona contract alone was worth $189 million annually.
The organization changed its executive officers in 2015 and financial officers in 2016. It was acquired by a holding company, Flaks Group, in 2108 and its $100 million debt was restructured.
Corizon’s problems were not unique in the health care industry. The Savannah jail breakdown and nationwide mortality rates were indicative of a potential trend in all private health care services. Reuters reported that the current system resulted in the loss of more lives in our nation’s county jails and prisons than in-house health care services.