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Grand Jury Faults State for Health Care at City Jail

On September 19, 2005, a Grand Jury of the Baltimore City Circuit Court issued its report on health conditions at the Baltimore City Detention Center.  This investigation began last May in response to concerns raised by Public Justice Center staff, who provided evidence to the Grand Jury of persistent failure to provide health care to pre-trial detainees at the City jail.
 
The Grand Jury's report found that the flat-fee contractual health care provider, Prison Health Services (PHS), had in fact failed to provide necessary care, and "made it more and more difficult for [detainees] to receive prescription medications, hospital procedures, and laboratory tests."  Moreover, the report concluded that the State intentionally turned a blind eye toward PHS's performance "in an attempt to foster better working relations with the contractor. . . ."  After legislative hearings last spring, and the release of the PJC's film "Infected: the Baltimore City Detention Center's Hidden Health Crisis," the State did not renew its contract with PHS, as urged by the PJC.
 
However, the State then divided inmate health services (medical, mental health, dental, pharmacy, utilization review) into five separate contracts, and awarded them to a consortium of for-profit health providers. The Grand Jury report's author expressed optimism that this change would resolve the health conditions at the jail.  The PJC, however, is skeptical.  The following article in the Baltimore Sun quotes PJC attorney Sally Dworak-Fisher as reporting that:
 
detainees, in interviews, are currently reporting many of the same kinds of problems as in the past, with few signs of improvement since the new contracts took effect July 1. She noted that the company that holds the $125.6 million, two-year contract for primary care services [Correctional Medical Services], by far the largest segment of the work, has fallen short of supplying the number of staff it agreed to provide. The grand jury report also said that St. Louis-based Correctional Medical Services 'has a history of troubled performance in other states, as well as in Maryland."
 
The State's new fragmented approach to inmate health care is unprecendented and untested.  The PJC is concerned that the new contract scheme creates problems of accountability and will lead to finger-pointing.  Moreover, the State's decision to hire Correctional Medical Services -- a company that it previously fired after an auditing dispute over $7 million dollars -- is particularly problematic.
 
The Public Justice Center continues to represent inmates at the Baltimore City Detention Center and, with the ACLU's National Prison Project, is proceeding with a class action lawsuit concerning the unconstitutional health care conditions at the jail.
 
The article in the Baltimore Sun follows.

STATE FAULTED FOR INMATE CARE
CONTRACT PROVIDED INADEQUATE HEALTH SERVICES, GRAND JURY SAYS

By Greg Garland, Sun reporter
September 20, 2005
 
The state did a poor job of providing medical care to prisoners at Baltimore's downtown prison over much of the past five years because of a flawed and underfunded contract with a private company that took effect in 2000, according to a grand jury report released yesterday.
 
But the report, which supports findings of a Sun investigation published this year, credits the Ehrlich administration for its efforts to come up with an innovative solution to the problems through a new set of medical care contracts that state officials signed in June.
 
The new system divides responsibility for different segments of health care - such as primary physician services, pharmaceuticals, mental health and dental treatment - among different vendors. It also removes incentives for private providers to deny needed hospitalization and other services as a way to save money.
 
The changes come at sizable cost. The state spent $68 million on health care services for its 27,000 prisoners last year but expects to spend as much as $110 million annually under the new contracts.
 
The grand jury report came out of a review of prison conditions that are part of the routine of grand juries in Maryland. Circuit Court Judge Stuart R. Berger ordered the Baltimore grand jury in May to examine health care services at the state-run detention center in Baltimore.
 
The grand jury identified what it said were serious problems with the flat-fee contract the state held with Tennessee-based Prison Health Services Inc. Under the contract, which expired June 30, Prison Health was responsible for all health care needs for most Maryland inmates. "Putting one organization in charge of all aspects of offender health care was a serious mistake at the outset," the report states.
 
In addition, it said, the documents the state sent out inviting companies to bid on health care services for inmates in 2000 were poorly written. And the state's monitoring for compliance in the initial years after the contracts were signed was inadequate, jurors found.
 
Money-losing deal. 
More importantly, jurors said, the long-term, fixed-price contract locked Prison Health into what turned out to be a money-losing deal that affected services provided to inmates. "This resulted in enormous pressure from PHS management to economize on operations," the report says. "Instead of looking for efficiencies, PHS made it more and more difficult for offenders to receive prescription medications, hospital procedures or laboratory tests."
 
The report said that detainees often did not receive prescribed medication for weeks after they were booked into the city's jail, and it listed a series of other problems that The Sun had also discovered in its investigation.
 
PHS officials have consistently denied that economic factors influenced decisions on medical care. They say the company lost $15 million on the Maryland contract, which generated $260 million in revenues over five years.
"The suggestion that PHS puts business and economic interests ahead of patients' needs is blatantly false," said company President Trey Hartman. "PHS practitioners are empowered to exercise their independent, professional, medical judgment to act in the best interest of their patients."
 
Optimism.
Avraham Sonenthal, the grand juror assigned to write the report, said in an interview yesterday that he is optimistic the new contracts the state approved this year will solve many of the problems.
 
He credited the Ehrlich administration with bringing in experienced people to deal with the problem. "They could have left things as they were, but they rolled up their sleeves," said Sonenthal, a computer network engineer from upper Park Heights.
 
A spokesman for Department of Public Safety and Correctional Services Secretary Mary Ann Saar said Saar made improving inmate health care one of her top priorities after taking office in 2003 and put an assistant secretary with a background in both law and prison health care in charge of it.
 
But advocates for inmates say that the grand jury's optimism may be misplaced given what they see as a long history of the state shortchanging the medical needs of its prisoners. "We hope the report will be helpful, but their tone is a little more hopeful than we think the current situation calls for," said Sally Dworak-Fisher, a lawyer with the Public Justice Center in Baltimore.
 
Her group and the American Civil Liberties Union's National Prisons Project have a long-standing lawsuit against the state to improve conditions at the detention center and central booking facility in Baltimore.
 
Dworak-Fisher said that detainees, in interviews, are currently reporting many of the same kinds of problems as in the past, with few signs of improvement since the new contracts took effect July 1.
 
She noted that the company that holds the $125.6 million, two-year contract for primary care services, by far the largest segment of the work, has fallen short of supplying the number of staff it agreed to provide. The grand jury report also said that St. Louis-based Correctional Medical Services "has a history of troubled performance in other states, as well as in Maryland."
 
A CMS spokesman said yesterday the firm is aggressively recruiting and hiring staff, and that Maryland selected it after careful review of its performance.
 
The grand jury report's recommendations include adding more staff to the state's Office of Inmate Health Care to insure the performance of contractors is adequately monitored.
 
It also calls for opening an infirmary at the detention center. Prisoners at the jail who need supervised nursing care currently are transferred to the nearby Metropolitan Transition Center, tying up staff and resources, the report says.
 
The report also recommends a review of sick-call procedures and calls for establishing an external oversight committee to independently monitor inmate health care in city jails.
 
greg.garland@baltsun.com
Copyright (c) 2005, The Baltimore Sun

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