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Jail, Inc.

Budget woes could force Santa Fe County Adult Detention Facility to revisit a horrifying past

July 20, 2011, 2:00 am

Repayment of the high-interest, 30-year bond the county used to build its Adult Detention Facility costs taxpayers $2.3 million annually.
Credits: File Photo

Correctional Healthcare Management, the Colorado-based company courting Santa Fe County for control of its inmate medical care, claims it can solve these problems by dramatically reducing costs. 

CHM already has contracts with San Juan and Bernalillo counties, and Todd Murphy, CHM’s director of business development for New Mexico, says a deal with Taos County is also close to fruition.

CHM’s pitch to Santa Fe County is threefold, Murphy explains: Reduce the number of prisoners transported to other facilities for medical care, control pharmaceutical costs and eliminate “surprises” by charging the county a flat fee.

Murphy says that, because CHM’s contract would assume all liability for prisoner claims, it could be more conservative than the county in choosing whether to transport patients. CHM reduced transports in Wichita County, Texas, by 46 percent after taking over that county’s inmate medical care, Murphy notes. (Santa Fe County has not provided data on its transport numbers.)

Murphy says CHM also reduces pharmaceutical costs by buying in bulk, as it provides medical services and drugs for 80,000 inmates around the country. According to a recommendation letter from Wichita County Jail Administrator Donny Johns, CHM also brought Wichita County approximately $200,000 in savings on pharmaceutical costs. According to Santa Fe County Finance Director Teresa Martinez, that’s roughly equivalent to the total amount the Santa Fe facility spends on pharmaceuticals in a year. (Havel, however, says San Juan opted out of the pharmaceutical component of its contract with CHM out of concern that it would restrict medication choice. San Juan County spends about $140,000 annually on medication.)

Murphy adds that, under a CHM contract, there would be “no surprises” for the county because it would pay a fee up front. Most contracts for jail medical services are designed that way, so that the company receives a lump sum from which it carves out a profit by reducing inmates’ care as much as possible. That incentive to reduce care is at the center of the problems that tend to recur under private medical contracts. In Villanueva’s case, the reluctance to transport him for the specialty care he needed ultimately cost him his life. 

“It’s a frequent problem with private providers of medical care because they have to pay dollar for dollar out of their pocket for the off-site exams,” Donatelli says. “If you were on the street and someone said there was a questionable mass in your chest X-ray, you’d be in tomorrow getting an expert to take a look at it. That didn’t happen in Jimmy’s case.”

CHM is dealing with those same problems. In a pending lawsuit filed against the company late last year, a former inmate at San Juan County Adult Detention Center claims that her transport was delayed for three days after her appendix burst. The woman, who was incarcerated on misdemeanor charges, alleges in the complaint that jail staff ignored her requests for help and provided only the antacid Maalox as a remedy.

It’s the very idea that a private company can somehow save the county money on inmate medical costs while still earning a profit for its shareholders that alarms critics. The only way to reduce costs that dramatically, some say, is to lower the standard of care. 

“How do you provide adequate medical care and reduce the cost?” Santa Fe lawyer Bob Rothstein asks. “It doesn’t work that way…The more they try and cut their costs, they’ll find that more inmates suffer.”

Susan Cave, a psychiatrist who works with the 1st Judicial District Court and frequently visits both the Santa Fe County-run jail and the CHM-run Bernalillo facility, says the Santa Fe facility offers higher-quality health care. In Bernalillo, Cave says, a lack of communication about inmate health conditions persists among medical staff. Cave has had to resort to asking corrections officers to relay critical health information because doctors don’t respond to calls and faxes. At SFCADF, she has direct communication with staff doctors.

“I actually saw people recover from their mental illness in [SFCADF], which is almost unheard of,” she says.

Romero isn’t averse to using a private contract for certain parts of her operation; for instance, a private company provides the facility’s food service. But with medical care, she is afraid that, if she relinquishes control and allows the hand-picked group of medical personnel she put together over the years to dissolve, the quality of care will erode, returning the facility to the poor health standards of the past.

“Medical care is different,” Romero says. “There’s just so much risk associated with that, that’s not where I prefer to save money.”

American Civil Liberties Union National Prison Project Director David Fathi agrees with Romero that jail medical care is fundamentally different from nonmedical services because there is no element of consumer choice. Without competition, Fathi notes, there are limits to how effectively oversight agencies can ensure a decent standard of care. 

“The general rules of market discipline—the idea that, if a business provides bad service, or certainly if it injures or kills people, it will go out of business—those rules don’t really work with private prisons or private prison medical care,” Fathi says. “One obvious reason is they have no consumer choice. If a prisoner doesn’t like the medical care at this prison, thinks it’s dangerous or inadequate, he can’t go down the road to a different prison where it’s better.”

During one of CHM’s numerous meetings with county staff, the company gave Romero a “survey” to fill out about the needs of SFCADF. She has yet to do anything with it, despite facing questioning at subsequent Board of County Commissioners meetings. But the pressure from county officials continues to build. At the BCC’s Feb. 1 special session, Santa Fe County Manager Katherine Miller reported that the county managers in Bernalillo and San Juan “said they were pleased with their contracts and that it was saving them money.” 

Still, Romero says that when county finance department employees make cursory calls to other counties to find out their jail medical expenses, they end up with distorted views. She needs to visit each facility to see what services it’s getting for its buck—and she plans to do that in the upcoming weeks as part of her report back to the county. Romero says she finds the idea of contracting out the medical services distasteful, but she is researching the option just so she has all the information to effectively fire back.

There’s no hard deadline for Romero to report back to the county, but she told the BCC she would visit comparably sized facilities sometime over the next month. Meanwhile, the Santa Fe facility is operating on reduced staff who she says can’t sustain any more cuts; Romero herself was forced to drive prisoners to another facility recently because of the staff shortage. But she would rather do that than risk turning the facility’s medical care back into the private-contract hell she helped reclaim it from in the past.

“The thing with correctional facilities is, it could look like we save a dollar today, but it’ll cost you,” Romero says. “It’ll cost you eventually.”  SFR

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