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US jails are outsourcing medical care — and the death toll is rising

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Matthew Loflin was coughing up blood, struggling to breathe and losing consciousness in his cell while awaiting trial on drug-possession charges in this historic Southern …
Matthew Loflin was coughing up blood, struggling to breathe and losing consciousness in his cell while awaiting trial on drug-possession charges in this historic Southern city. “I need to go to the hospital,” he told his mother in a jailhouse phone call. “I’m gonna die in here.” It was March 28,2014, and his seven weeks at the Chatham County Detention Center had been a blur of blackouts and racing heartbeats. The jail’s senior medical staff – Dr. Charles Pugh and two well-credentialed nurses – agreed he needed hospitalization. But the move was opposed by a senior manager at their employer, Corizon Health Inc, which held a multi-million dollar contract to manage the jail’s healthcare, according to court records and former medical staff. When Loflin’s X-ray showed a suspicious spot in his chest on April 7, Pugh tried another plan: He sent Loflin to a cardiologist, believing the specialist would want him hospitalized. After a quick exam, the cardiologist sent him straight to the hospital, but it was too late. Loflin,32, deteriorated quickly, suffering irreversible brain damage. He died April 24. His death was the second in two months that Pugh and nurses Betty Riner and Lynne Williams considered preventable, internal jail memos and emails produced in litigation show. That August, the trio met with the sheriff and accused Corizon of prioritizing profits over lives. Corizon fired all three, triggering a wrongful termination lawsuit settled on confidential terms. The plaintiffs agreed not to discuss their allegations. Reuters corroborated their claims about faulty care at the jail in this city of antebellum homes and moss-covered oaks. The story of deadly neglect was assembled through previously unreported whistleblower testimony, thousands of court and police documents, interviews with more than a dozen former medical and jail staff, and confidential monitor reports. In the last years of Corizon’s watch from 2014 to 2016, prescription drugs went missing, patients deemed gravely ill by medical staff were denied hospitalization, mentally ill inmates went untreated and records were falsified, Reuters found. Weeks passed with no doctor on site, leaving care to nurses and video calls with doctors. The jail’s 400 mentally ill inmates, nearly a quarter of its population, were treated by a sole psychiatrist. Corizon said it put patient care first and told its staff to hospitalize inmates when needed. Yet an inmate died from a treatable heart condition after his doctor’s requests for hospitalization were denied. A guard was crippled by an inmate who hadn’t gotten her meds. Another inmate died from a blood clot in his leg 32 hours after he crawled across the floor begging to go to the hospital. The Savannah jail’s breakdowns speak to a national trend. More than 60% of America’s top jails now hire private companies to deliver inmates’ medical care, Reuters found, and that shift has taken a toll: more dead. A Reuters review of deaths in more than 500 jails found that, from 2016 to 2018, those relying on one of the five leading jail healthcare contractors had higher death rates than facilities where medical services are run by government agencies. The analysis assessed deaths from illness and medical conditions, suicide, and the acute effects of drugs and alcohol. Jails with publicly managed medical services, usually run by the sheriff’s office or local health department, had an average of 12.8 deaths per 10,000 inmates in that time. Jails with healthcare provided by one of the five companies had an additional 2.3 to 7.4 annual deaths per 10,000 inmates. The death rates were 18% to 58% higher, depending upon the company. The Reuters review is the most definitive examination to date revealing the risks that have emerged as hundreds of jails have embraced the multi-billion dollar correctional healthcare industry and its promises of quality care and controlled costs. It is part of a larger Reuters examination finding that two-thirds of dead inmates, including Loflin, never got their day in court for the alleged offenses on which they were held. Corizon, among the nation’s biggest correctional healthcare companies, now manages care for some 116,000 prisoners in state and county facilities at more than 140 locations in 15 states. In an interview, Corizon Chief Executive James Hyman said jail death rates alone were not a valid indicator of “the quality of performance… in what is a very complex population set.” He said the Reuters findings did not take into account the challenges of providing care to two distinct groups of inmates: Those who stay less than a month in jail and those who cannot afford bail or are serving post-conviction sentences. In Savannah, Corizon was eventually replaced by another contractor amid a series of deaths. Corizon said it never sacrificed care for profits. “I would not have operated in or stayed in that kind of environment,” said Dr. Calvin Johnson, the Tennessee company’s chief medical officer from 2014 to 2016. Hyman said Corizon’s statisticians did not believe the variance in death rates for jails contracting with Corizon was “statistically significant.” While every jail death is “significant,” the company disputed Reuters’ methodology and “resulting assumptions.” Many factors can contribute to a jail’s mortality rate, such as the overall health of its population and the size of its budget, and it is impossible to account for all such variables with publicly available data. But even after adjusting for the size of the jail and the area’s mortality rate, Reuters and two independent statisticians still found statistically significant disparities between jails with publicly provided medical care and those with healthcare managed by one of the top contractors. Until the 1970s, jail healthcare was minimal. Most lockups offered little more than first aid, a 1972 American Medical Association survey found. Then, in 1976, the U.S. Supreme Court ruled that “deliberate indifference” to an inmate’s medical needs amounts to “unnecessary and wanton infliction of pain,” violating the Eighth Amendment. Inmates began suing, and in the 1980s the correctional healthcare industry emerged. The industry expanded through the 1990s and early 2000s as a push to deinstitutionalize the mentally ill spurred the closure of mental health hospitals – sending many former patients to the streets, and then jail. By 2010, nearly half the U.S. jails surveyed by Reuters had turned to privatized medical care. By 2018,62% got privatized services. Today, a handful of companies dominate the jail healthcare business: Wellpath Holdings Inc, NaphCare Inc, Corizon, PrimeCare Medical Inc, and Armor Correctional Health Services Inc. The largest, Wellpath, is owned by a private equity firm. An investment firm owns Corizon. NaphCare, PrimeCare and Armor are privately owned. “It makes sense to have someone whose specialty is to come in and take care of inmates,” said Chatham County Commissioner Helen Stone. “Saving money,” she said, is key. Many sheriffs have embraced the chance to shed the headaches of managing their own medical operations. “It is a package deal and everything is done for you,” said Captain Jessica Pete, whose facility, the St. Louis County Jail in Duluth, Minnesota, hired regional contractor MEnD Correctional Care in 2012. “We are getting fantastic care.” Yet even as the industry’s reach expanded, no large-scale studies have been conducted to assess privatization’s impact on inmate mortality. To answer that question, Reuters surveyed 523 jails for healthcare and death data from 2008 to 2019. It explored all U.S. jails with 750 or more inmates, plus the 10 largest jails in nearly every state. From 2010 to 2015, death rates were generally similar in jails using the big healthcare contractors and those with publicly managed care. But from 2016 to 2018, the most recent year for which comprehensive statistics are available, the death rates diverged. Jails using the major companies had 691 fatalities among an average total population of 138,000 inmates in that three-year span. By contrast, jails using publicly managed care had 587 fatalities while caring for more than 152,000 inmates. To be sure, some publicly run systems suffer high death rates. But on balance, Reuters found, death rates are higher when healthcare is in the hands of private industry. Overall, facilities with care managed by the biggest jail medical providers had 17 deaths per 10,000 inmates, compared to 13 deaths in publicly-run units. Contracts with private providers sometimes lack quantified standards for care, Reuters found, such as staffing requirements or protocols for inmate health evaluations or hospitalizations. Such problems can occur in publicly run systems, but they aren’t locked into contracts or dependent upon profits.

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