Privatization. The wave of the future:
Even within the troubled Alabama penal system, this state compound near Huntsville was notorious for cruel punishment and medical neglect. In one drafty, rat-infested warehouse once reserved for chain gangs, the state quarantined its male prisoners with H.I.V. and AIDS, until the extraordinary death toll – 36 inmates from 1999 to 2002 – moved inmates to sue and the government to promise change.
Alabama’s solution was to fire the local company in charge of medical care and hire Prison Health Services, the nation’s largest commercial provider of health care behind bars. Prison Health’s solution was to recruit Dr. Valda M. Chijide, an infectious-disease specialist who arrived last November with a lofty title: statewide coordinator of inmate H.I.V. care.
She was an unlikely candidate for the job in one sense, having never stepped inside a prison. But it did not take her long to conclude that the chaos was continuing, and that much of the problem was Prison Health itself.
Though the company had promised the help of other doctors, she said, she was left alone to care for not only the 230 men in the H.I.V. unit, but the 1,800 other prisoners, too. Nurses were so poorly trained, Dr. Chijide said, that they neglected to hand out life-sustaining drugs or gave the wrong ones. Medical charts were a mess, she said, and often it was impossible to find such basic items as a thermometer, or even soap.
Dr. Chijide lasted barely three months. After she complained in writing, Prison Health suspended her for reasons it would not disclose, and she quit.
Her short, frantic stint – battling for drugs, hospitalizations and extra food for skeletal inmates, she said – was not unusual in the world of Prison Health Services, which has had a turbulent record in many of the 33 states where it has provided jail or prison medicine. But her story, a rare firsthand account of a doctor in charge of a prison’s health care, offers an intimate glimpse of the company’s work at a moment when the need for change could not have been more pressing, and the spotlight on Prison Health could hardly have been more intense.
Even then, interviews and the reports of a federal court monitor show, the state and the company made promises they did not keep, settling for care that jeopardized inmates’ health. And Prison Health, which often laments the difficulty of finding qualified doctors to work in jails and prisons, searched nationwide for a specialist, only to question her integrity.
“If you bring up a problem that they don’t want to hear about, they will attack you,” said Dr. Chijide, 45. “I felt better resigning than staying on and bending my principles to their principles.”
Around the nation, the company has drawn criticism from judges, government overseers, and whistle-blowers, and has paid millions of dollars in fines and settlements. In New York, state regulators have faulted Prison Health in several deaths, and are investigating whether it is even operating legally in the state. Yet the company has continued to grow, absorbing rivals and winning new contracts; its largest, serving New York City’s jails, was renewed in January, as Dr. Chijide was lodging her complaints.
There is, of course, a higher authority that Prison Health must answer to: the state official charged with making sure it lives up to its contract. That person is Ruth Naglich, who as associate commissioner of the Alabama Corrections Department is supposed to review the company’s work.
Three years ago, Ms. Naglich was a Prison Health executive, vice president for sales and marketing, at the company’s headquarters outside Nashville.
Ms. Naglich said her connections to the company helped her coax it to improve care. And though her department has moved to fine Prison Health $580,000 over the last year for failing to meet certain performance standards – the company is fighting the fines – she said, “I’m pleased with the progress they’ve made.”
Hmmmm. Failure to provide promised services, stalling to avoid paying fines, rank incomptence, slagging whistleblowers, a former executive in high places overseeing the work that they’re supposed to be doing.
I think we’ve seen this movie before.