Letter Response to Annual Jails Report

District Attorney Schrunk and colleagues,

As is becoming an annual task, we’ve finished reviewing the Multnomah County Corrections Grand Jury Report (PDF).

The Mental Health Association of Portland has advocated since 2003 for persons with mental illness, specifically for their rights and well-being. That in turns necessarily translates into a primary concern for the well being of the mentally ill persons in the county correction system since that system minimally consists of a high percentage of persons with mental illness or addictions.

In the end, the grand jury findings are a budgetary analysis to find savings for the financially strapped County by outsourcing corrections’ health care services for savings. From our advocacy
understanding it is a classic example of privatizing profit and socializing risk and the risk we see is heavily borne by the inmates, with both mental and physical illness, a risk that too often ends in exacerbated health problems, not infrequently death.

An aside worth noting: the outside contracting of health services for correction systems nationwide is a growing industry of more than $2 billion. Their universal marketing mantra is that they offer efficiency, better care and cost reduction compared to government run corrections health services.

The grand jury traveled no further than adjacent Washington County where Prison Health Services, Inc. one of the nation’s largest corrections contractors (serving 200+ facilities) provides service for 50% of Multnomah County’s annual costs. The report commends PHS quality services: the Washington County jail system this year was awarded the NCCHC award for best program in the nation for the delivery of mental health services in jails. We believe that mental health care services are probably the most important health care services in a jail system.

And this understates the significant saving of employing PHS: the Washington County contract for health care in the jail requires the contractor to assume full legal liability for litigation costs and
recoveries against the county in lawsuits arising from health care issues.

Undoubtedly, the 30% or $4 million saving almost sells the plan for outsourcing when the report is claiming the quality of mental health services is surpassing. But the reports highlighting of PHS assuming legal liability is the canary in the mine. The County thereby escapes the cost and damaging publicity of lawsuits resulting from its failures. And for PHS?

A simple search tonight found 1500 news stories about lawsuits PHS has settled for a wide spectrum of wrongdoings to both inmates and their employees. I couldn’t tally just all the wrongful death suits alone but it has to give pause County Board of Commissioners when considering this company’s “exemplary” record. The expenses of these settlements merely are acceptable costs of PHS doing business. One can suppose the ratio of injured is many multiple higher for those not filing suits against PHC.

Our association believes the efficiencies and savings PHS, as well as corrections contractors industry as a whole, are had at the expense of a great number of well documented and all to frequent systemic, egregious instances of unconscionable paucity of quality health care.

We urge caution on two points.

First, the corrections health program at our jails has been both underfunded and under-managed for decades. They “see” more patients annually than almost any other Oregon institution, with fewer resources, tools and staff. We imagine their record, though there have been tremendous mistakes, such as Holly Casey, as statistically high in quality, considering the acuteness and complexity of their clientele.

To offer as a sole solution that the County seek a contract with an out-of-state provider, especially exemplifying a sole provider with a long string of lawsuits, seems to imply an already-present handshake deal. We hope this is not the case.

Because there’s a far more reasonable answer – fund and manage the current program to meet community expectations. This is entirely the responsibility of senior county management and elected officials – who are far easier to bring to compliance than an outside contractor.

Second, we know [senior staff member] and talked with him and his staff prior to the move to centralize the housing and care of persons with mental illness. We haven’t visited the MCDC pod yet, but theoretically it’s better to centralize both the patients, resources and staff in one place rather than try to manage them over several facilities. If costs are a concern, centralization makes more sense.

Thank you,

Roy Silberstein
President, Mental Health Association of Portland

READ – Harsh Medicine: New York Times Exposes How Private Health Care in Jails Can Be a “Death Sentence” for Prisoners, Democracy Now, 3 4 2005
READ – As Health Care in Jails Goes Private, 10 Days Can Be a Death Sentence, NY Times, 2 27 2005