Paying attention to prisoners: “Can I see a doctor?”

When a prisoner dies, sometimes people pay attention to the issue of medical care in Minnesota prisons. Otherwise — not so much. Prisoners can’t vote. Their access to the press is limited, and their credibility doubted.

Two recent developments should focus more attention on Minnesota’s prison healthcare system:

• In January, the state canceled its contract with for-profit Corizon, after 15 years, switching to Centurion Managed Care, another for-profit provider.
• On February 20, the Minnesota legislative auditor issued a 134-page report on Minnesota prison health services, which found “considerable room for improvement.”

For-profit prison health care: What happened with Corizon?

Prison health care is big business. Minnesota spent about $68 million on prison health services in 2013, amounting to about 20 percent of its prison budget. That amount includes both its contract with a private, for-profit company and expenditures for state employees, including nurses and mental health therapists. In switching to Centurion for contracted services, the state passed over Corizon’s low bid, while carefully not saying anything negative about Corizon.

Since Corizon is the nation’s largest prison health care contractor, the decision got national attention. Modern Healthcare reported:

“The Minnesota contract had come under scrutiny in recent years after allegations of care mismanagement. In May, for instance, the state paid $400,000 to settle a lawsuit over the death of a 27-year-old inmate who had suffered at least seven seizures while in his prison cell in 2010.”

That would be Xavier Scullark-Johnson, who died in his Rush City prison cell just months before his scheduled release from prison, after a nurse turned away an ambulance that had been called to take him to an outside hospital for treatment. According to a 2012 Star Tribune article on the case:

“No doctors, who are all Corizon employees, work in the state’s prisons after 4 p.m. or on weekends. Corrections nurses, who are state employees, work seven days a week, but their last shifts end at 10:30 p.m. The last time the Rush City prison had 24-hour medical coverage was in 2002.

“Additionally, services such as ambulance runs are strictly monitored by Corizon and the department in an effort to cut costs, according to department medical staff.”

In its article on the contract change, the Star Tribune noted “at least nine inmate deaths and numerous injuries related to poor and delayed care” since 2000.

The Modern Healthcare article said that privatization of prison healthcare has drawn criticism because “the capitated contracts invite vendors to cut costs at the expense of quality of care.” A 2013 Tampa Bay Tribune article details some of that criticism:

“In Louisville, Ky., six Corizon workers resigned and a series of lawsuits followed the deaths of two inmates in the county jail last year. One inmate suffered a drug overdose and the other had diabetes and heart disease and county officials said it took too long for them to get medical attention.

“In Idaho, a court-appointed expert said Corizon’s care for inmates at the state prison near Boise was inhumane. The company countered that a national accrediting agency said conditions were satisfactory.

“Corizon agreed last year to pay a $1.85 million fine to Philadelphia after an investigation revealed the use of a phony subcontractor to meet city rules for minority-owned vendors.”

Will Centurion be a better healthcare provider? It’s too soon to tell, but the system of rewarding cost-cutting rather than rewarding good care does not inspire confidence.

“Considerable room for improvement”

The legislative auditor’s report deserves careful reading and attention by lawmakers. Prison health care is costly, so that’s one reason for the legislature to pay attention. Prisoners are completely at the mercy of the health care providers chosen by the state — they can’t select another doctor or dentist or therapist, and they can only get the medical attention that the state-paid providers dole out. That should be an even more compelling reason to make sure that the medical care provided is competent and adequate.

The letter transmitting the report to the legislature found “considerable room for improvement in the coordination of services to chronically ill inmates, the adequacy of mental health services, and DOC’s compliance with generally accepted professional standards for correctional health care.” The letter recommended increased external oversight and accountability.

Some of the other highlights of the report:

• Inmates are less healthy than people in the general population, having more infectious diseases, substance abuse and psychiatric illnesses, as well as more chronic conditions such as hyptertension and diabetes. Moreover, “the prison setting can have adverse physical and mental impacts on inmates.”

• Minnesota’s prison population is aging, which also adds to health problems. “The percentage of Minnesota inmates over age 50 grew from 5.6 percent in 1998 to 13.5 percent in 2013.”

• “About 28 percent of offenders incarcerated as of mid-2013 were receiving mental health services.” That’s less than the 65 percent who had been ordered to complete chemical dependence treatment.

• It’s “hard to assess” responsiveness to prisoner requests to see a doctor. Many of those requests go through security guards. Records of requests are not consistently kept. “Urgent requests for off-site care” were also not sufficiently documented, but it appeared that many were not handled in a timely manner.

• Emergency and after-hours care is not governed by consistent policies, and the Department of Corrections needs to develop a system-wide policy for 24-hour emergency coverage.

• The DOC needs to develop “a coordinated, comprehensive approach to care for individuals with chronic conditions.”

• Mental health services are a particular area of concern, including the use of segregation as punishment for prisoners with mental illness.

• Currently, no licensing, inspection or accreditation is required — this should change.

Prisoners — those most affected by the policies — will not have an opportunity to read the report. They can’t vote, so they can’t command the attention of elected officials.

There’s more — you can read the report. You can also contact your legislators, and ask them to read the report and act on its recommendations.