Andrew Pallito, commissioner of the Department of Corrections. Photo by Terry J. Allen
Not long after, the Vermont Department of Corrections decided not to renew its contract with Prison Health Services, Inc., the corporation that has been responsible for inmate medical care in the state since 2005, and invited other companies to bid for the contract.
The company that rose to the top of the list and has been in negotiations with the state since October, Correct Care Solutions, is relatively new.
Unlike Prison Health Services, which has a long track record nationally of racking up lawsuits, settlements and complaints of poor inmate care, Correct Care appears to be somewhat less plagued so far by reports of substandard care, though two families filed lawsuits against the company in 2009 for the deaths of inmates in Virginia and Illinois.
The two corporations, Prison Health Services and Correct Care, have several similarities and a key connection. They are both for-profit, out-of-state providers based in Tennessee, and both have been led by the same CEO, Gerald (Jerry) Boyle, according to a previous Vtdigger.org report by Terry J. Allen.
Before founding Correct Care in 2003, Boyle headed Prison Health Services for a five-year period. He was also a vice president for EMSA, which held the first contract with the Vermont Department of Corrections from 1996 to 2000.
Andrew Pallito, Vermont’s Corrections commissioner, is optimistic that Correct Care will provide better medical services to inmates. He says the company’s local management team will be comprised of Vermonters. Pallito says he is also impressed that Correct Care “came to the table with a lot of new ideas” and vetted local Prison Health employees in a rehiring process. Most of Correct Care’s staff and local management team members will be Vermonters, Pallito says.
“I really have high hopes for this company,” Pallito says. “They’re new; they’re small. In the end, though, it’s our responsibility to manage this company and make sure that they do what they say they’re going to do.”
Correct Care is set to provide not only medical care but also mental health services to Vermont inmates as of Feb. 1.
Until now, the state has held a separate contract for psychiatric care with MHM Correctional Services Inc., of Vienna, Va., at a cost of roughly $2 million per year, according to a 2005 article by Louis Porter in the Rutland Herald.
Though the state is still negotiating the final contract with Correct Care, Pallito says they will take over both mental and medical care for less than the $16.4 million the state is currently paying Prison Health Services for medical services alone.
Prison reform advocates say they anticipate health care for inmates won’t change much under the new company.
Ed Paquin, of Disability Rights Vermont, says the idea of consolidating mental and medical services is sound, “if the leadership is right.” But, “if you’re trying to do something this complex on the cheap, you could be looking for trouble,” Paquin says.
Matthew Valerio, defender general, also appears to have doubts.
“Fundamentally, we’re going to end up with more of the same,” Valerio says. “But it’ll be a new face in the crowd, and hopefully they’ll do better. I don’t have any hope that there’s going to be any fundamental change here.”
From January 2008 to May 2009, PHS reported 169 sick-call and pharmacy violations system-wide, and Corrections imposed $19,200 in fines, according to Terry Allen’s December Vtdigger.org article. From August — the month Ellis died — through October, Northwest alone racked up 43 additional penalties, Allen reported.
Disabilities Rights Vermont, Inc., has investigated four inmate deaths since 2005 (in addition to Ellis’), all under PHS care and all related to drug withdrawals, according to Paquin, executive director of the nonprofit group. Under federal law, Paquin’s organization is authorized to probe complaints of abuse, neglect and civil rights violations.
Recently, Disability Rights created a memorandum of agreement with Corrections that requires new standards of care for intoxicated prisoners.
“We’ve looked into about four deaths in the last four years that would indicate there was a problem in identifying a need, monitoring the need or delivering (appropriate) services,” Paquin says.
Can Correct Care Solutions offer Vermont inmates more services for $2 million less and provide better care?
Sen. Dick Sears, longtime chairman of the Senate Judiciary Committee says, “There’s nowhere to go but up as far as I’m concerned.”
Seth Lipschutz, supervisory attorney for the Prisoners’ Rights Office, is less sanguine about the notion of hiring a for-profit outfit to provide services for inmates. He advocates for a community health care program for inmates, similar to the one offered in Hampden County, Massachusetts, in which prisoners receive services from local community health centers.
“I guess what I have to say about it is stupid cliché kind of stuff, like alright so you put together a prison and an HMO; like what kind of health care do you think you’re going to get?” Lipschutz says. “Just like
the HMOs in the community, they’re running a profit, so the less care they provide, the more money they make. You’ve heard all the horror stories, care is denied, so you add the element of the most despised people in America, right, having an HMO, and of course you’re going to have stuff like this happen (the death of Ashley Ellis). Duh.”
The contract: details, details
The Department of Corrections’ contract with Correct Care, which according to state officials runs to 500 pages, has not been finalized yet, and officials are reluctant to talk about specifics.
Dr. Delores Burroughs-Biron, chief medical officer for the Department of Corrections, says hiring a single contractor that provides comprehensive services will ensure that mental health care is better integrated into the medical system for inmates. This, she says, will improve communication and enable the contractor to “see our population holistically.”
According to the Department of Corrections’ bid proposal, the contract would run for three years, with an opportunity for two one-year extensions. Correct Care would be responsible for health screening and
routine care for inmates in the state’s eight prison facilities, along with chronic disease management. The corporation would also run two infirmaries, two hospice care units, a medical housing unit and intermediate care and secure mental health units at Southern State Correctional Facility in Springfield.
Under the state’s contract with Prison Health Services, inmates could wait two to three days for non-emergency medication. In Ashley Ellis’ case, although she was eligible to receive medication because of her anorexic condition, a series of problems led to a delay, and ultimately, her death.
Less than two days after Ellis was incarcerated on a misdemeanor offense, she died in jail of a potassium deficiency induced cardiac arrhythmia because she didn’t receive the medication she needed, according to the Vermont Defender General’s investigation.
“In the end with Ashley Ellis, there was no reason she shouldn’t have gotten the potassium,” Pallito says. “There was no excuse for it. We have a system in place to make sure all offenders are getting their
medications.”
Terry Allen reported on Vtdigger.org that no one competent to assess Ellis’ health was present at her medical intake. There was no doctor at the facility, and one RN (for a single shift) was available during the two-day period Ellis survived in jail, according to Department of Corrections records. Nursing at Northwest on weekends—5 p.m. Friday to 7 a.m. Monday—by contract is light and assigned to licensed practical nurses, Allen wrote. LPNs are barred by state nursing regulations from assessing patients, Allen reported, and may not have had the training to understand how critically ill Ellis was.
According to Allen’s article, PHS was allowed to staff Northwest and other facilities on weekends (and many weekday shifts) with no one above the level of LPN. From Friday evening to Monday morning, one PHS doctor is on call, by phone, to cover the roughly 1,600 inmates incarcerated in 2009, and many of the 7,000 to 8,000 people who pass through the state’s jails annually.
Allen reported that Dr. John Leppman, a PHS physician, says he typically fields 20 to 30 calls on a weekend. Nurses can work 12-hour shifts. One nurse said she was ordered to work 36 hours straight because no one else was available, Allen reported.
When asked whether more registered nurses will be on duty under the contract with Correct Care, Dr. Burroughs-Biron, who has been involved in the contract negotiations, said, “The hours will be different, yes.”
Though she declined to talk about specific staffing recommendations, she added that the contract includes new “features,” and she talked about how in the Massachusetts system it’s typical for one doctor to be on call for 10,000 inmates, compared with 1,600 in Vermont.
“For us, the bottom line is getting the appropriate management team in that will make sure that what we want done is what is being done,” says Dr. Burroughs-Biron. “It’s a matter of management as well as line staff adhering to policy because I can write fabulous policy, fabulous directives, and if people don’t adhere to those, it really doesn’t matter in the long run.”
It isn’t clear though, whether, under the final contract, Correct Care will be required, for example, to provide medication immediately or to staff facilities with registered nurses on weekends. Lawmakers say they have no authority to require that the Douglas administration incorporate specific rules into its contracts with companies, though Rep. Alice Emmons and Sen. Dick Sears, both members of the Legislature’s Corrections Oversight Committee, say they might introduce legislation that would
address these issues.
More broadly, Sears says, the Legislature has no control over which company the Department of Corrections decides to hire. “It’s really the administration’s decision,” Sears says. “I had serious qualms about the prior one, and I expressed them to the then-commissioner, and they went ahead with them. Unfortunately, that company lived up to our concerns.”
Emmons says the Legislature cannot micromanage the details of the contract.
“We can give general direction in terms of what we’d like to see,” Emmons said, “But in terms of getting into the nitty-gritty and the specifics, that’s all negotiated with the Department of Corrections and the vendor.”
Seth Lipschutz, of the Prisoner’s Rights Office, takes issue with this assessment of the Legislature’s authority. He says if legislators wanted to, they could pass a law that required any contract with a private prison health service in the state of Vermont to include certain elements they deemed necessary. Lipschutz says that instead, legislators provide “theoretical oversight,” and, in effect, allow the Department of Corrections free rein to run the justice system.
“That’s a classic pass-the-buck thing,” Lipschutz says. “They don’t want to do it, so they’re just saying we can’t do it. We can’t make the Department of Corrections do anything. We’re the Legislature; we make
the laws of the state, but the Department of Corrections, they’re above the law. We can’t require them to do anything in their contract. That’s absurd. That’s just the legislator abandoning his or her responsibility.”
A bill requiring that medications be administered immediately would have a direct impact on inmates’ health, Lipschutz says. “What goes on … routinely is that people come in off the streets, and they’re not
allowed to have any of their own medication. We understand the security concerns about this. The inmate says this is penicillin and it’s actually OxyContin; how are we supposed to know, right?”
Lipschutz says the Department of Corrections needs to control possible illegal drug use in prison, but there are other ways to deal with the problem that can create better conditions for inmates. He suggested they could set up a prescription with a pharmacy in advance for patients who are reporting in and create a system for people who come off the street to get their medications the next day.
“If they cared, they could figure this one out,” Lipschutz says.
So far, however, Pallito will not say whether such changes will be a part of the new contract, and legislation hasn’t emerged.
Matthew Valerio, the Defender General, supports a bill to address the issue, but so far lawmakers haven’t taken it up.
“Frankly I’ve had discussions with legislators, but at present I don’t have anybody sponsoring it,” Valerio says. “My guess is they’ll do something. They’ll attach it to something else. This isn’t going to be a
priority for anybody; this is going to be an add-on to an existing bill somewhere along the way.”
Sears suggested that a legislative committee might hold hearings on Ellis’ death to figure out “what we can learn from it.”
Lipshutz said a hearing would be counterproductive at this point. “The whole system is rotten to the core as far as I’m concerned, and holding hearings on it isn’t going to change anything,” he says. “I wouldn’t be opposed to hearings, but am I going to go around advocating you guys should hold hearings on this? Nah, I’m not going to waste my time on that.”
Correct Care will be the fourth for-profit inmate medical company the state has contracted with since 1996, and Pallito hopes it will be the last for a while.
“From my perspective, this is the fourth company we’ve tried — EMSA, CMS to PHS — if this doesn’t work, the next question is, is there any company we can work with?” Pallito says. “We’re starting from scratch with this company, and I have high hopes … so if it doesn’t work, it’s going to be disappointing.”
Why did the state stop providing services in-house? Well, as Rep. Alice Emmons put it, “People felt it was more cost effective.” Is it? “I think the jury’s still out on that,” Emmons says. “I don’t think that people are convinced either way. We had problems, but we also didn’t have the incarcerated population that you do now. You need a medical person, a psychiatrist, on board that’s employed by the DOC when it’s run in-house, and sometimes those positions are hard to fill, because if you have a corrections facility in Newport and St. Albans and Springfield, and you have a well-trained psychiatrist in forensics, they may not be around.”
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