Prisons' new health firm short on staffing

ACLU reports poor care

Md. had retooled contract system to address woes

August 27, 2005|By Greg Garland | Greg Garland,SUN STAFF

A for-profit company the state brought in to provide medical care to Maryland prison inmates has hired far fewer staff than required, and advocates for prisoners say that they have compiled dozens of cases of poor and inadequate care since the new contract took effect July 1.

St. Louis-based Correctional Medical Services Inc. serves as primary medical care provider for Maryland's 27,000 prisoners and is required under its contract to have 603 full-time staff. State officials acknowledge that the company currently has a staff of only 425.

The new contract with CMS was part of a comprehensive restructuring of the way Maryland delivers medical care to inmates. The objective was to resolve complaints that have been voiced for several years about inadequate care for prisoners.

But Elizabeth Alexander, director of the American Civil Liberties Union's National Prison Project, said she has seen no signs of improvement. She said her group has taken sworn statements since late last month from more than two dozen prisoners in the state-run Baltimore City jails about lengthy delays in getting access to doctors, poor treatment and medication mix-ups.

"I see no evidence of any improvement in medical care," she said. "The quantity and quality of these complaints are just what we got before."

Service defended

Correctional Medical Services disputes the ACLU's characterization of its performance. Ken Fields, a spokesman, said the company is providing medical care to inmates in a responsible manner and is taking steps to hire more staff.

"CMS takes very seriously the mission of delivering effective, quality health care," he said. "Each patient receives hands-on attention from quality health care professionals who make decisions about the best course of treatment for each patient."

The Sun reported in June that, over the previous five years, the state's prison health care system was underfunded, understaffed and poorly run. The company that had provided most health care services lost the contract to CMS.

Alexander's group, which with the Baltimore-based Public Justice Center has a long-standing lawsuit against the state over jail conditions in Baltimore, says medical care for inmates remains far from satisfactory.

Inmate complaints

Recent complaints, Alexander said, include an inmate who broke his jaw in a fight and was merely given aspirin. It was a month before any X-rays were taken, she said. She recounted another case in which a man with a hernia "the size of a racquetball" was given Tylenol but no other treatment.

Prisoners with high blood pressure, asthma and other ailments have reported lengthy delays in getting access to physicians and said they sometimes did not receive their medications for weeks, Alexander said.

Fields, the CMS spokesman, conceded that the company has fewer full-time workers than the contract calls for but said it is working diligently to hire more people. He pointed out that the 603 positions CMS is required to fill are a substantial increase from the 468 positions the state required under the previous contract, which was held by Tennessee-based Prison Health Services.

"There is a nationwide nursing shortage that has been going on for years now, which gives health care workers lots of flexibility in the choice of places where they can work," he said.

Fields said the company has kept many of the employees who formerly worked for Prison Health and has hired some staff through placement agencies. "We're also using overtime ... to meet inmate medical needs as we continue to increase staffing," he said.

The state completely restructured the way it handles medical care for inmates when it rebid the services this year.

Impetus for reform

Prison Health had locked itself into a five-year, flat-fee contract to provide comprehensive medical services. The deal turned out to be a money loser for the company. Prison Health was paid about $260 million over the five years but says it lost about $15 million.

The new contract that took effect July 1 carved medical services into segments - such as primary medical care, dental care and mental health services. They were put out for bid, and contracts were awarded to different vendors.

CMS won the largest contract, a $125.6 million, two-year deal to serve as primary medical care provider to state prisons and Baltimore's state-run jails.

The complicated contract has several unique provisions. For example, the state is responsible for paying the costs when inmates are sent to outside hospitals for specialized treatment. To keep these costs down, a private company was hired to review and screen such cases.

Richard Rosenblatt, who oversees medical treatment for the Maryland Department of Public Safety and Correctional Services, said the new system is working well. He defended CMS' performance.

"We are confident that CMS is making a good-faith effort to recruit and live up to the contract," Rosenblatt said in an e-mail response to questions posed by The Sun.

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