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Prescription for Recovery, SC DOC Health Care

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Keeping South Carolina’s Prison Health Care
Public and Making It Better
Marguerite G. Rosenthal, Ph.D.

Grassroots Leadership
400 Clarice Avenue
Suite 400
P.O. Box 36006
Charlotte, NC 28236

June 10, 2004

South Carolina Fair Share
1338 Main Street
Suite 301
P.O. Box 8888
Columbia, SC 29203

Keeping South Carolina’s Prison Health Care Public
And Making It Better
Executive Summary
As a follow-up to our earlier Prescription for Disaster: Commercializing Prison Health Services
in South Carolina, this report is focused on important issues that the South Carolina Budget and
Control Board should consider as it fulfils its legislated mandate to complete a study comparing
the current public prison health care system with privatization before the South Carolina
Department of Corrections [SCDC] awards any contract. We are very concerned that SCDC
proposed privatization apparently before conducting any objective study of its own and seemingly
proceeded on ideological convictions rather than on objective realities. Prison health care is
fundamentally a public responsibility both legally and morally, and we maintain that SCDC
should retain it.
There are ongoing reports of deplorable health care provided by the three commercial entities that
have submitted bids for SCDC’s health care system. For example, the State Auditor in Vermont
has just released a report that states that Correctional Medical Services has over-billed the state for
non-existent staff and off-formulary psychotropic drugs; the state’s losses amount to almost
$830,000. The Idaho Department of Corrections has launched three different investigations into
the activities of its contractor, Prison Health Services. The third company, Wexford Health
Sources, cancelled a 5-year contract with Pennsylvania last year, hoping to extract more money
from that state.
Two studies that have compared prison health care costs among different states show clearly that
South Carolina’s costs are already lower than most and that public systems are less costly than
privatized ones. A 2003 study by PriceWaterhouseCoopers found that South Carolina’s
expenditures were over $1,000 (or 1/3) less expensive than the average of six southern states. In
general the second study, conducted by Jacqueline Moore and Associates, demonstrates the
financial advantages of public systems, though the author is associated with private prison health
The current SCDC health care system has both strengths and weaknesses. Its principal strength is
its cadre of dedicated and loyal medical staff, its state-run laboratory and its own, efficient
pharmacy. However, because of job freezes and cumbersome hiring practices, the Department has
left many positions unfilled, and the system is under great stress. Proactive hiring policies,
creative approaches to filling positions in underserved prisons and streamlining bureaucratic
regulations will ease these difficulties. Some of these will save money by making the system more
efficient. Prison health care is a public responsibility and needs sufficient support to ensure the
health and safety of prisoners and, ultimately, the public.

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Keeping South Carolina’s Prison Health Care Public
And Making It Better
Introduction and Update
This report is a follow-up to our earlier one, Prescription for Disaster: Commercializing Prison
Health Services in South Carolina.1 Governor Mark Sanford and his Corrections Department
Director, Jon Ozmint, have advocated privatizing prison health services in South Carolina.
Prescription for Disaster documented the dangerous and expensive prison health care services
provided by for-profit, private corporations in South Carolina from 1986-2000 and elsewhere.
This report is being written as the South Carolina General Assembly has required the Budget and
Control Board to complete a study comparing the current public prison health care system with
privatization before the South Carolina Department of Corrections awards any contract.
We are writing this report in large part because the South Carolina Department of Corrections
[hereafter SCDC] apparently conducted no thorough study of its own before making the decision
to privatize its prison health care system to a private company. Especially in light of the fact that
SCDC had a troubled experience with its partially privatized health system in the past, we are
convinced that an objective examination of the many complex components of any prison health
care system must be conducted before a major decision such as privatization goes forward. Part of
this needed examination must include the experiences of the State of South Carolina and other
states and localities that have or have not privatized their prison medical services.
Prescription for Disaster reported numerous examples of deplorable health care provided by the
three commercial health care companies that have submitted bids for South Carolina’s prison
health care contract award, Correctional Medical Services [hereafter, CMS], Prison Health
Services [hereafter, PHS] and the smaller Wexford Health Sources. Since the first report was
written, we have found other, recent examples of private prison health care companies’ failures.
In several cases, states and counties have had to bear expensive financial costs as a consequence
of both contract non-compliances and medical malpractice. News articles, official reports, and
lawsuits against these companies are easily located on the internet. We cite only a few, but
egregious, examples below:
Correctional Medical Services
In 2003, the Philadelphia Inquirer published a report that charged that CMS was
failing to inform and treat prisoners suffering from hepatitis C in New Jersey’s
prisons. A class action suit against CMS and the NJ Department of Corrections on
these same grounds was filed, and the state was forced to pick up the costs for
treating the hepatitis epidemic, estimated to cost between $4.5 and $8 million in

Vermont’s State Auditor has just released a review of that state’s
Department of Corrections’ contracts, including one with CMS. CMS was
12 2


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criticized for billing for non-existent staff, needless expenses for off-formulary
psychotropic drug costs and failure to submit required quarterly and annual
financial reports. The state’s losses amounted to almost $830,000.3 The
Vermont report’s serious charges concerning CMS’ practices echo those of South
Carolina’s 2000 Legislative Audit Report. 4
" The U.S. Justice Department’s Civil Rights Division, along with the American
Civil Liberties Union of Eastern Missouri, is currently investigating CMS for
alleged inadequate medical attention and care that may have led to the premature
death of several prisoners at the state’s Vandalia women’s prison.5
" Sister Frances Buschell, prison coordinator for the Jefferson City Roman Catholic
Diocese and a regular presence in the Vandalia prison, reports that CMS routinely
imposes obstacles to care. She has observed the following problems: women
must line up in the early morning just to fill out a request to be seen by medical
personnel, and only a fraction of them actually complete the necessary forms
because the time allotted for this task is much too short; women wait 4-6 months
for cancer treatment, at which point their cancers have worsened and may have
become terminal; two women have lost sight because their meningitis was
misdiagnosed as a psychiatric problem; pain medication has been denied when
needed; and records have been falsified. Buschell states that there is frequent
turnover of medical staff and that the doctors are inept.6
Prison Health Services
" PHS, which has contracts with many county jails as well as a few states,
apparently ignored the obvious serious health problems of several Lee County,
Florida prisoners. A December 2002 article reported that several prisoners died
either in the jail or very shortly after being released. A lawsuit was filed in US
District Court on a claim of one former prisoner who was paralyzed from
“botched medical care.” 7
" The same Florida newspaper report also cited the New York City Comptroller
who, in expressing grave concerns over the medical care being provided at the
infamous prison on Rikers Island, noted nation-wide criticism of PHS and
questioned whether PHS should be permitted to provide services in New York
State.8 Nurses at Rikers Island have claimed that PHS had so reduced staff that
employees and prisoners were both at risk.9
" A nurse who once worked for PHS in St. Lucie County, Florida claimed that she
was fired for refusing to participate in illegal and unethical practices, including
ignoring a request for medication, verbal abuse of prisoners, antagonizing
mentally ill prisoners and falsifying medical records.10
" In 2002, the ACLU filed a class action against Clark County, Nevada and PHS for
dreadful conditions in the jail’s medical unit and inadequate medical care that
caused “widespread harm.” Mental health treatment was called “atrocious and

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uncivilized” and the jail was said to have no protocols for treating chronic
" In April, 2004, Idaho’s Corrections Director expressed dissatisfaction with PHS,
its contractor. The Department has launched three different investigations, and the
Director was quoted as saying: “We have employee management issues,
communication issues and accountability issues.”12
Wexford Health Sources
" In June, 2003, Wexford cancelled a 5-year contract with Pennsylvania after only a
little over one year, hoping to renegotiate for more money.13
" There are recent allegations that seven deaths in Florida’s jails—including one of
a 56-year-old minister and Purple Heart Vietnam veteran who died when he did
not receive dialysis on time—are attributed to poor medical treatment by
" An article in an Illinois paper reported that Wexford obtained a $114 million
contract with the Illinois Department of Corrections after the company contributed
$10,000 to Governor Rod Blagojevich’s campaign. Wexford had the lowest bid
but also did not have the highest score in the Department’s evaluation.15
What Should the Budget and Control Board Study?
We applaud the General Assembly’s requirement that privatization should not be entered into
headlong and without an objective evaluation of its true costs. At the same time, we have
concerns that the focus of the Legislature’s mandate to the Budget and Control Board is on costs
alone. South Carolina’s prison health care system is already among the least expensive in the
country, and it is hard to imagine that any more financial reductions can be extracted from the
system without harm.
Indeed, because of frozen positions within the SCDC health care system, the current costs are
below what they should be. Further, what commercial companies promise is often not what they
deliver, as our earlier report documented. Private companies have a record of promising to reduce
costs and then wangling for increases once they have gotten their contracts. They have avoided or
refused to provide needed health care services such as diagnosing and treating hepatitis C, and
they have reloaded onto the public systems health services that they consider too costly.
Comprehensiveness and quality of services should, in other words, be important foci of any
comparison, difficult as such a detailed study might prove to be.
We are concerned that SCDC’s decision to privatize its prison health care system is based upon
the ideological assumption that privatization must be more efficient and cheaper rather than upon
an evidence-based analysis. In this regard, we are very concerned that SCDC did not carefully
study the needs of its prison health care system as well as the serious problems and financial
losses associated with its previous CMS contract before launching into another privatization


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There are fundamental services that are the duty of the public sector to provide. Purchasing
automobiles and copying machines from commercial dealers is one thing; states do not
manufacture and supply themselves with these sorts of items. Running prisons, on the other hand,
is an age-old function of the state. Caring for those in prison is a public obligation stemming from
the consequences of prisoners’ losing their liberty. Selling this obligation raises the specter of
incompetent care, profits to corporate executives and shareholders—most of whom live and spend
out of state—paid for by South Carolina taxpayers, and exploitation of prisoner-patients.
SCDC is fortunate to have many dedicated health care professionals. Some of them have thought
carefully about needed changes to improve the delivery and efficiency of the prison health care
system. These improvements would result in reducing bureaucratic functions so that more time
can be spent in direct care. At the same time, these professionals recognize the difficulty the
Department has had in attracting and employing personnel in some of the more remote parts of the
state and they have suggestions to remedy these difficulties.
This report will briefly review of what is known about several prison health systems. It will then
relate some of the suggestions that have come from current SCDC personnel.

The SCDC Prison Health Care System in Comparative Perspective
South Carolina’s Prison Health Care Costs are Comparatively Low Already
In January, 2003, the accounting consultant firm, PriceWaterhouseCoopers, issued a report,
Interstate Survey of Health Care Costs for Inmates, commissioned by the Georgia Department of
Corrections. This report, which compared prison health costs for Alabama, California, Florida,
Georgia, Mississippi, South Carolina, Texas and Virginia, found that the average cost per
prisoner in these states in FY02 was $3,523. In South Carolina, the cost was nearly one-third
less: $2,280. Only Alabama and Mississippi spent less than South Carolina that year. Alabama’s
system was a troubled privatized one that has since switched providers, but Mississippi’s was
public at that time.16
Another study was conducted by the firm, Jacqueline Moore and Associates, in 2003. Moore was
a co-founder of Prison Health Services (PHS) but currently has ties to Corrections Medical
Services [CMS].17 PHS and CMS are the two biggest for-profit prison medical companies, and
both have submitted bids to the SC Budget and Control Board. Moore’s study compared FY 2002
per prisoner health costs for 8 states. A comparison of average costs as published in this report is
reproduced on the following page.

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Comparison of Average Healthcare Cost Per Inmate FY 200218





Idaho (PHS)



Cat Limits $25K/


Delaware (First Correctional Medical)





Wyoming (CMS)



Aggregate Cap


Maine (CMS)





Vermont (CMS)





North Dakota
(Self Op)



No Exclusions


South Dakota
(Hospital Based)



No Exclusions


Utah (Self Op)



No Exclusions





Budget Minus
Amount Returned to


Note that Vermont, Maine and Wyoming contracted with CMS and paid between $4,318 (without
pharmacy charges) and $6,420 (capped) per prisoner per year. The chart above also shows that
Utah, a publicly provided system, had lower per prisoner costs than the privatized systems, $2,998
(after funds allocated for clinical services but used for other purposes were returned to the
Department of Corrections). Although Moore’s report made some recommendations for further
efficiencies, it concluded that Utah had a cost-effective and comprehensive system that should not
be privatized. This report, available online at, could well be useful to those reviewing
South Carolina’s prison health care system.
Another cost comparison is contained in the following: In FY 2004, CMS was charging Missouri
$7.84 per day per prisoner or $2,861.50 annually. This amount exceeds South Carolina’s costs and
is more than double the charges of $3.70 per prisoner per day originally contracted for in 1992.19


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These cost analyses demonstrate that, on its face, public prison health care is less expensive than
privatized prison health care. There may, of course, be some unique situations in each state’s
system. Nonetheless, these studies certainly suggest that South Carolina will not save money by
contracting with for-profit prison health companies.
We suggest that privatizing will not save money because a commercialized system necessarily
adds costs since it must reward its investors with profits and its executives with salaries much
higher than public sector compensation. To make up for these added costs and charge the state
less, commercial companies must reduce the quantity and quality of services, as the many stories
of inadequate care cited above attest, and/or they must substantially reduce the compensation of
those actually providing the services. In the latter case, dollars are removed from South
Carolina’s economy.
If costs can be saved by better management, as private companies often claim, there is no reason
that the SCDC cannot itself become more efficient (see below for some suggestions). We suspect,
however, that having already suffered several severe budget cuts, there is very little else that can
be cut out of the SCDC prison health system. Except as an initial loss leader (as has happened
elsewhere), how can a commercial company possibly save dollars and reward its investors and
executives except by improperly rationing services?
South Carolina’s Prison Health Care Costs Have Been Dropping
Not only is South Carolina’s prison health system relatively inexpensive, it has also been reducing
its average costs per prisoner. While most of the states in the Southeast region saw increases of
between 3% and 16% between FY01 and 02, South Carolina’s costs dropped by 14.7%, nearly 3
times more than the only other state to see reductions, Tennessee.20 We note that CMS pulled out
of its contract with SCDC during FY 2001. In other words, when South Carolina took its prison
health care system back from a private company, its costs went down significantly. We urge future
investigators to look carefully into these reductions to determine their causes and evaluate their
promises for the future.
We observe that South Carolina’s total payments to outside medical providers such as general
hospitals (presumably for emergency services and complex health services) was nearly 1/3 of its
prison health care budget in both FY01 and FY02.20 Perhaps this significant expenditure is related
to the fact that SCDC continues to contract with Columbia Care, run by Just Care, Inc. of
Alabama, a private health care corporation, for some of its prisoner patients. According to
SCDC’s chief accountant, private care was estimated to cost the state $20,000 more per prisoner
per year than care in the prison system’s infirmary.22 Continued use of this facility and its
associated costs is certainly an area that should be examined further.
Can SCDC’s Prison Health Care System Improve?
As noted above, personnel in the current, public SCDC prison health system have hands-on
knowledge of their system and have offered this writer some suggestions for greater efficiency and
cost savings. Some of these suggestions are presented below, but—again—we urge that future
investigators consult with a variety of medical and mental health care givers, pharmacists and
laboratory technicians, particularly those currently working within the SCDC system, to gain a

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more detailed description of their work while also gaining important information and
recommendations for improving the system.
To begin with strengths, SCDC medical personnel point to several important factors:
" Dedicated and loyal employees;
" A system of medical directives that has functioned well in the past (but may be slipping
" A state-run pharmacy that runs efficiently and in a cost-cutting manner;
" A state-run laboratory which, similarly, is cost-efficient since testing is done in-house; and
" Strong specialty clinics.
There are a number of weaknesses, however, that are frequently mentioned. These include (and
will be further elaborated on, below):
" Insufficient direct medical personnel, including doctors, nurses, nurse practitioners and
" Cumbersome hiring practices that dissuade applicants from seeking positions at SCDC;
" Hiring freezes that have left clinics understaffed, creating tremendous burdens on the loyal
staff remaining and costing SCDC substantial financial outlays for per diem hiring;
" Few medical protocols in place, resulting in wasted effort and time in getting approvals for
prisoner care;
" Quality of care that is not always up to standard;
" An inadequate administrative structure with poor linkage and communication between the
Central Office and individual clinics; and
" An overly bureaucratic system that wastes time and effort that could better be spent on
patient care.
Suggested Solutions
Staffing problems appear to be at the core of the various challenges facing SCDC’s medical
services and, indeed, have provided at least one of the rationales for seeking to commercialize the
system. These problems fall into two categories: staffing qualifications and appropriate levels of
responsibility; and hiring protocols to attract new personnel. Specifically, the following
recommendations have been suggested by current SCDC health staff:
1) Staffing the clinics: Currently, there appears to be an over-emphasis on having physicians
in each clinic. Since nurse practitioners are licensed to prescribe medication, having a
nurse practitioner in each clinic would be cost effective and is more likely to result in
eliminating the large number of physician vacancies.
2) Hiring medical and mental health specialists: Staffing all the prisons, particularly those in
rural areas, is admittedly a difficult challenge. However, scholarship or loan/payback
arrangements for students attending South Carolina’s public institutions of higher
education who are training for relevant specialties, such as psychiatrists, psychologists,
psychiatric nurses and social workers, could assist in filling some positions. Under this
arrangement, students receiving scholarships would be obligated to work for the SCDC for
a fixed amount of time after they receive their advanced training. Some may, of course,


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choose to remain in the prison health system after they have fulfilled their mandatory
obligations. A related suggestion is that SCDC partner with the University of South
Carolina’s Medical School and its public universities to arrange for internships. Under
appropriate supervision, interns can greatly augment SCDC’s medical and mental health
3) Recruitment methods: More aggressive outreach, particularly through active use of the
internet, is needed. Commercial prison health care companies use the internet for
recruitment; SCDC should use the same techniques. We note that North Carolina’s
Department of Corrections, which contracted with CMS to staff its prisons in remote, rural
areas, found that the private company was no more successful than it had been and
therefore terminated the contract.2 3
4) Hiring incentives: SCDC should consider instituting sign-on bonuses to recruit medical
and mental health personnel who agree to work in hard-to-staff prisons.
5) Streamlining the hiring process: The current hiring process takes too long and is overly
bureaucratic. Especially since there is a nursing shortage in South Carolina, the red tape
involved in hiring must be cut so that appropriate applicants receive job offers quickly and
are rapidly moved into their SCDC positions. Allowing medical personnel in each facility
to hire staff would greatly shorten the lag time and administrative costs currently involved
in employing new personnel.
6) Unfreezing medical records personnel positions: Nurses currently have responsibility for
medical records, taking time away from nursing. Shifting responsibility for medical
records duties to other personnel might make sense since they are often not fully occupied
with their primary responsibilities.
7) Developing a pool of nurses: Instead of hiring per diem nurses from a private and
expensive nursing agency, SCDC could develop its own pool of nurses to fill in as needed
in several institutions.
8) Allowing positions to be filled before a resigning employee leaves: Being proactive about
replacing personnel would assure that positions are filled in a timely fashion.
9) Filling vacant pharmacist positions with technicians: Licensing requirements allow for 3
technicians for each pharmacist; hiring technicians this way would be cost-effective.
Streamlining the bureaucracy to make medical care more efficient would allow medical
personnel to attend to patient care instead of filling out request forms and waiting for approvals
from central office. A key to achieving more efficiency involves having nurses use existing
Medicare protocols, thus eliminating the need for a physician’s having to review and approve
consultations and treatment regimens.
A specific recommendation offered by a current nursing supervisor is to purchase the
computerized version of McMillan, Robertson Utilization Review and to make it available to all

Prescription For Recovery


SCDC clinic physicians and nurse practitioners to save time on routine cases. Another suggestion
is to revamp the nursing hierarchy, eliminating a supervising nurse at each location and allowing
the head nurse to serve in that capacity with, perhaps, 3 or 4 nursing supervisors for the whole
system to whom the head nurses would report. In general, there needs to be an evaluation of the
true staffing needs to determine how many supervising staff are actually needed in order to reduce
costs associated with higher ranking medical personnel.
Mental health screening and appropriate placement are crucially important to the functioning
of the prisons. Mental health professionals such as social workers and psychiatric nurses can
conduct mental health screenings, considered very important in light of the large numbers of
mentally ill and substance-dependent prisoners. These professionals can be hired at less cost than
psychiatrists and clinical psychologists who are currently required to perform these functions.
Re-instituting the accreditation process would assure that medical services conform to
standards. Assuring objectivity in evaluations is crucial. With oversight to insure that they
remain objective, using available SCDC medical staff for audits is cost-effective, particularly
because they can establish appropriate policies and procedures as part of this function. There
needs to be more accountability in the system; currently too many decisions pertaining to health
care are left to each warden.
Establishing an independent medical services review body that can receive, investigate and
respond to questions and complaints related to prison health care services raised by prisoners, their
families, employees and advocates is vitally important to improve the prison health care system
and assure that health care is properly delivered and crises are avoided
Hidden Costs of Inadequate Prison Health Care Systems
States are obligated by a U.S. Supreme Court decision to provide prisoners with adequate health
care.24 Even when prison health care systems are privatized, the states continue to bear this legal
responsibility. Prison health care is not just a matter of personnel, physical facilities and
medications. There are the costs of attorney and legal fees, insurance and settlement payouts
associated with malpractice claims and lawsuits. If the prison health care system is under-funded
and under-staffed, lawsuits will abound, and the state will have costly damage awards. While the
current costs to the State of South Carolina are not known to us, it should be cautionary that
officials in one New York County suggested doubling their insurance protection when it
privatized its jail’s health program.25
And then there is the matter of public health. Nearly every prisoner will be returning to his or her
community someday. Thus, prison health care is truly a public health concern. Because of the
crowded conditions of their confinement and their poor health status, prisoners are particularly
susceptible to communicable diseases such as tuberculosis, hepatitis C and HIV/AIDS. It is
therefore critical that they get appropriate treatment. If they do not, these illnesses will spread to
the general population. To save lives and to protect public health, health care should be efficiently
but also adequately provided. These are all important factors to consider when evaluating who
should be delivering prison health services.


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The current SCDC prison health care system is not expensive when compared to other state
systems. Privatizing does not save money. Indeed, giving state money away to out-of-state
executives and shareholders results in further squeezing the health care system.
SCDC has a cadre of dedicated and thoughtful personnel, many of whom have devoted much of
their professional lives to caring for the state’s incarcerated population. The system appears to be
functioning fairly well, but, as should be clear from the briefly outlined suggestions above, there
are many areas that can be greatly improved. These suggestions, if explored in greater detail and
implemented appropriately, may result in financial savings to the state. At the same time, we
caution that the system appears to be seriously understaffed, particularly in the area of primary
caregivers. Reducing bureaucratic functions will make more current personnel available to
perform caring functions, but more personnel are clearly needed.
The changes outlined above have been suggested by current SCDC medical staff. These
professionals are in the best position to provide details about their current ideas as well as to
provide additional suggestions for improvements in the system in which they work. Establishing a
task force composed of current staff representing different specialties and geographical areas of
the state and outside medical experts familiar with institutional health care is, we feel, the best
way to evaluate how to improve the SCDC health care system both to make it more cost-efficient
and to enhance the quality of care it provides.

ABOUT THE AUTHOR: Marguerite G. Rosenthal is a Professor of Social Work at Salem State
College in Salem, Massachusetts. She holds a Ph.D. in Social Work and Social Welfare from
Rutgers University. She has received awards and grants from the National Institute of Mental
Health, the National Association of Social Workers and the U.S. Department of Health and
Human Services. Early in her career, she served as a juvenile probation officer with the
Onondaga County Probation Department in Syracuse, New York and as supervisor of field staff at
the State of New Jersey’s Department of the Public Advocate. She has published and presented
widely on issues of social policy, privatization, managed care, welfare reform, residential care,
juvenile corrections and faith-based initiatives. She is currently serving as Senior Research
Fellow for Grassroots Leadership while on sabbatical from Salem State College.

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1. Rosenthal, M.G. (2004). Prescription for Disaster: Commercializing prison health care in
South Carolina. Grassroots Leadership/South Carolina Fair Share.
2. Fazloliah, M. and Lin, J. (2003). Hepatitis C treatment may cost N.J. millions. Philadelphia
Inquirer (Jan. 12); Selan, E. (2003). HepC class action suit filed in U.S. NJ District Court,
retrieved at on 5/31/04.
3. Ready, E.M., (2004). Keys to Success: Improving accountability, contract management and
fiscal oversight at the Department of Corrections. (May 26).
4. South Carolina General Assembly, Legislative Audit Council (2000). A review of the
medical services at the SC Department of Corrections. (LAC/SCDC-98-7), retrieved at on 4/1/2004.
5. Dreiling, G. L. (2003). Some inmates tell horror stories about healthcare at the women’s
prison in Vandalia. Some didn’t live to tell their tales. Riverfront Times (Oct. 15); Denise
Lieberman, Legal Director, ACLU of Eastern Missouri (personal communication, May 24,
6. Sr. Frances Buschell (personal communication, June 1, 2004).
7. Hoyem, M. (2002). Dying in Lee County Jail. News Press (Dec. 22).
8. Ibid.
9. Service Employees Union Local 1199 (2001). Bad to worse at Rikers (June).
10. Pollio, M. (2002). Ex-jail nurse sues healthcare company. Retrieved at
forums/showthread.php?postied=168051 on 5/28/04.
11. Geer Thevenot, C. (2002). Class-action lawsuit: Jail’s care deficient, ACLU says. Las
Vegas Review-Journal (May 26).
12. n.a. (2004). The Idaho Statesman (April 6). Retrieved at
rap_phs.html on 6/1/04.
13. Ransom, L. (2003). Wexford ends inmates’ health care contract. Pittsburgh Tribune-Review.
(June 7) Retrieved at
print_138547.html on 3/9/2004.
14. Barg, J. (2002). Scandals r us: Seems the city can’t find a prison health care provider
without a troubling past. Philadelphia Weekly (Sept. 4). Retrieved at http:// on 5/28/04.


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15. O’Connor, J. (2004). State awards prison contracts to Blagojevich contributor. State
Journal Register (March 9).
16. PriceWaterhouseCoopers (2003). Georgia Department of Corrections: Interstate Survey of
Health Care Costs for Inmates. (January 21), p. 4.
17. Broughton, A. (2003). Privatization study advisor under scrutiny. The Salt Lake Tribune
(July 16). Retrieved at on May 28, 2004.
18. Moore, J. and Associates (2003). Analysis of cost and service within the Utah Department
of Corrections Bureau of Clinical Services. “Discussion Draft” prepared at the request of the
Office of Legislative Fiscal Analyst (November 18). Table 10. p. 37.
19. Dreiling, G. L. (2003). Some inmates tell horror stories about healthcare at the women’s
prison in Vandalia. Some didn’t live to tell their tales. Riverfront Times (Oct. 15).
20. PriceWaterhouseCoopers (2003). Georgia Department of Corrections: Interestate Survey of
Health Care Costs for Inmates. (January 21), p. 7.
21. PriceWaterhouseCoopers (2003). Georgia Department of Corrections: Interestate Survey of
Health Care Costs for Inmates. (January 21), p. 8.
22. The Post and Courier (Jan. 27, 2003). Corrections closes 5 prison infirmaries. Retrieved at on March 31, 2004.
23. Keith Acree, Public Information Officer, North Carolina Department of Corrections
(personal communication, April 5, 2004).
24. Estelle v. Gamble, 429 U.S. 97, 103 (1976).
25. Martineu, K. (1999). Privatization of jail infirmary advances.
The Times Union (November 24).

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Prescription For Recovery