Arizona prisons in health-care quandary

by Bob Ortega - Feb. 16, 2012
The Republic

The Arizona Department of Corrections, under orders to privatize its troubled prison health-care system, faces a questionable choice.

The department is expected shortly to award a three-year contract to provide medical and mental-health care for the nearly 34,000 inmates in Arizona's 10 state-run prisons.

Lawmakers adopted legislation two years ago and revised it last year, requiring Corrections to privatize the health-care system regardless of whether it saves money. But the choices are between two companies with checkered records and a third company that has no track record in correctional health care.

Corizon Inc. of Brentwood, Tenn., a privately held company, is the country's largest provider of correctional medical care, operating at 400 prisons and jails in 31 states, with a total prison population of about 400,000. Corizon formed last June out of the merger of the parent companies of Correctional Medical Services and PHS Correctional Health Care, previously fierce rivals. Both Corizon's CMS and PHS sides have repeatedly run into problems providing adequate health care in other states.

Last November, the Maine Legislature's Office of Program Evaluation and Government Accountability issued a study blasting Corizon's CMS unit, saying that more than 50 percent of inmates' medical records checked by auditors had errors and that there were no records for more than 10 percent of inmates treated.

The Maine study also reported CMS failed to respond to sick calls, provide dental services and physicals in a timely manner, had persistent problems issuing prescribed medicines properly and hadn't trained staff properly, among other problems.

Over 12 months ending in June, Idaho fined Corizon's CMS unit more than $270,000 for a wide range of medical- and mental-health-care shortfalls, including staffing shortages. Public documents released to the Associated Press said CMS, though it was supposed to fill vacancies within 60 days, left the South Boise Women's Correctional Center without an Ob/Gyn for more than two years and left another maximum-security prison without a staff psychologist for more than eight months.

Since 2005, Corizon's CMS or PHS have lost contracts or failed to win renewals with prison systems in four states, each with seven to 24 prisons: Vermont (2005), Alabama (2007), Delaware (2010) and Maryland (2010). Additionally, Corizon's units also lost contracts at individual county jails in Galveston County, Texas (2007), Pima County, Ariz. (2008), and Monroe County, N.Y. (2010).

In almost every case, the contract losses followed allegations by correctional or county officials that the company failed to provide adequate health care. Pima County officials withheld $1.3 million in payments over staffing and health-care problems.

"I have huge issues with the quality of the staff, the quality of the care. ... Their whole goal is how not to do any work," Pima County Superior Court Judge Nanette Warner said of the company during a court hearing in 2008, according to the Arizona Daily Star.

Corizon officials declined to respond to specific questions about these issues or allegations. Spokeswoman Courtney Eller said that "Corizon has a strong track record of quality care, and we are committed to continuously working to improve and get better at what we do."

Wexford Health Sources Inc. of Pittsburgh, also privately held, contracts with 100 prisons and jails, holding about 91,000 inmates in 10 states. That includes a contract with Yavapai County in Arizona to provide medical services at the county jail. Yavapai County also has contracted with Wexford since 2010 to run a small program to restore mental competency for defendants awaiting trial.

Assistant Yavapai County Administrator Dave Hunt said officials have been satisfied with both programs.

Wexford doesn't have as long a record as Corizon of losing contracts, but there are issues. Wexford was implicated in a 2008 payoff scandal in which the former corrections director for Illinois, Donald Snyder, was sentenced to two years in federal prison after he admitted taking a $30,000 bribe from Wexford's lobbyist, Larry Sims, to steer business to Wexford.

No Wexford official was charged in the case. The company declined to comment on the scandal. However, in 2008, a spokeswoman denied to the Chicago Tribune, any company involvement in the bribe.

Wexford also lost a contract in New Mexico in 2007, after an audit by that state's Legislative Finance Committee reported shortages of physicians, dentists and optometrists on staff and noted that the company had failed to issue timely reports on 14 inmates who died at correctional facilities in 2006. That same year, a Mississippi legislative committee reported that Wexford wasn't complying with its contract and had not filled 13 percent of the positions it was required to by contract at three prisons. Wexford officials also declined to comment on the staffing and care issues in those reports, or to respond to questions from The Republic in any manner.

The third bidder, Centurion LLC, was incorporated in Arizona in December, shortly before its bid was submitted. Centurion is a unit of Centene Corp. of Clayton, Mo., a publicly traded Fortune 500 company and the country's fourth-largest Medicaid-claims manager. Centene reported $111 million in profits on $5.2 billion in revenue last year. Centene also filed incorporation papers for Centurion in recent months in Georgia and North Carolina. Centene officials declined to comment on their bids or on their entry into correctional health care.

It isn't clear whether Centene's Centurion unit can meet Arizona's contract requirement that the successful bidder must have five years or more of experience in the past 10 years providing medical- or mental-health services to at least 10,000 daily patients in a correctional or custodial setting.

Arizona Department of Corrections officials declined to comment on when the department may award a contract. But there are just as many questions about the caliber of care the department currently offers. As soon as next week, a legal coalition representing Arizona inmates is expected to file suit in federal court alleging that the department has systematically and unconstitutionally denied medical care to inmates for weeks or months even for severe, life-threatening conditions.

The Prison Law Office, a California legal-advocacy group, outlined allegations in a letter to the department last October, demanding changes in medical care. In November, Corrections officials signed an agreement with the group that delayed legal action and gave the state until Friday to investigate and respond to scores of medical claims.

With that deadline approaching, Corrections spokesman Bill Lamoreaux would comment only that "we are still looking at this matter." Director Charles Ryan said in early December that he didn't see any evidence of systemic problems in the state's medical- or mental-health care for prisoners.

However, as The Republic previously reported, scores of inmates from prisons both public and private around the state have provided letters alleging weeks and months of waiting for even basic health-care services, difficulties getting prescribed medications and other problems.

Also, last fiscal year Arizona's per capita prison suicide rate was more than double the national average, a problem that advocates say reflects inadequate mental-health-care services; and in recent months, suicides appear to be continuing at a similar pace, with three reported in the past month. Since June 1, the department has reported six suicides and nine other deaths that remain under investigation.

Corrections officials have not complied with public-information requests by The Republic for results of the preliminary investigations into any of these deaths.

Nationally, there have been few studies of the impact of privatizing prison medical care. "Part of the problem is that good data is really hard to come by," said Kelly Bedard, an economist at the University of California-Santa Barbara who co-authored a 2007 study analyzing privatization outcomes in 32 states.

She concluded that inmate deaths rose 2 percent for every 20 percent increase in medical-care privatization. "Our results were very clear," she said. But Bedard cautioned that, "theoretically, it could go either way ... just like insurance companies, private providers always have an incentive to say 'no' because they're trying to save money." But she said, at least theoretically, a well-written contract with tough oversight and enforcement could improve care.