By Naseem S. Miller
Ocala Star-Banner
An elderly man called my editor one day and said his wife was not getting her psychotropic medications at the jail. Her doctor had offered to talk to the psychiatrist at the jail to tell him how badly she needed her medications – but was turned down. He said she was having hallucinations and was in a bad shape. He was mad and desperate and had called us as a last resort.
We thought there might be something bigger than a 20-inch story to this. There had been several other calls with a similar nature, not to mention a few suicides at the jail, and we decided to dig around to see what was going on. The result was a two-part series that:
- Revealed the situation at the jail through stories of three former inmates.
- Shed light on the challenges of correctional health care
- Explained various ways jails run their medical operations, and the pros and cons.
Background
Correctional health care is complex, costly and politicized.
Many jails — mostly run by the sheriff’s office, some by the county — outsource medical operations to private companies, because they come in with the promise of streamlining the services and controlling the costs. Critics say the profit motive that drives these companies leads them to cut corners on inmate care to save money and keep their investors happy.
Meanwhile, medical care is a constitutional right for inmates. They are entitled to “community standard of care,” which means the same quality of care provided to the community. But that doesn’t mean they’re entitled to “Cadillac” services.
Most people in jails and prisons are poor, lack education, have high rates of mental illness and chronic illness and are frequently substance abusers or addicts. Many are uninsured and have not seen a doctor or dentist for years.
The stories
Our first story focused on the current issue at the jail, which we found was lack of appropriate medical care for inmates.
Our second story, however, emerged unexpectedly. Two months after we began our inquiry and investigation, the sheriff’s office decided to end its contract with the private provider Prison Health Services. We were told it did so because of financial reasons. The sheriff decided to create a nonprofit organization with the help of our local medical providers, like the hospital and the mental health center. The model he used is called Community Oriented Correctional Health Services (COCHS), which holds many promises and is slowly gaining popularity among the jails in the United States. The second story will give you insight into how different jails run their medical operations.
How we got started
We began with printing a brief in the paper, asking inmates or their families to share with us their experience with medical care at the county jail. We stressed that they needed to be willing to let us see their medical records. The letters, e-mails and phone calls poured in (Hint: not a good sign).
Most were willing to sign over their medical records. Most had the same complaint: They were taken off their medication, their “sick calls” were ignored, or they were given medications that were not as effective as their original prescription.
Picking inmate stories
We conducted more than a dozen interviews with former inmates, inmates behind bars, or their families. But we chose three at the end, all verified by their medical records, revealing different aspects of the issue:
- A paranoid schizophrenic turned himself in at the jail on a minor charge of driving without a license, and within days was lapsing into insanity in a small concrete cell.
- A woman, arrested on a fraud charge, lost feeling in her legs and became lame. Instead of seeking a medical explanation, staffers called her a faker, refused to treat her and let her lay immobile in her own feces and urine. She was later diagnosed with Guillain-Barre Syndrome.
- A man with severe mental illness died in jail custody, injected with medication that would subdue him, but was never given proper medication for his condition.
Requesting records
Medical records: Prison Health Services, one of the nation’s largest providers of correctional health care, was in charge of our local jail at the time. The lawyers for our company drew up a simple document, which the inmates could sign to give us access to their medical records. We took the signed papers to the jail's medical records office. We decided to choose a less aggressive strategy, because we needed quite a few records. So, if they said they needed two weeks to give us the records, we gave them the time.
Grievances: We asked the sheriff’s office to give us the medical grievances filed by inmates. They can give you an idea about the nature of the inmates’ complaints – and also what was done about them.
Audits and accreditations: We asked the sheriff’s office for those papers, although we knew the jail was accredited by the main accrediting bodies such as the American Correctional Association
Letters: We asked for all the correspondence between Prison Health Services and the sheriff’s office since the beginning of their contract.
Independent oversight: The sheriff had an independent doctor look over all the ambulance transfers and suicides. He also had an independent contract monitor who produced monthly reports. We asked for the documents they produced.
Note: We were lucky, because our sheriff is big on transparency and we faced no resistance in getting the records. We were also allowed to tour the jails medical wing and videotape it for our Web site.
Getting perspective/interviews
Aside from the inmates, their families and their lawyers, we spoke to:
- The medical care provider, Prison Health Services
- Jail’s doctor and psychiatrist
- An independent doctor and psychiatrist who reviewed the medical records
- The sheriff
- A few lawyers who represented inmates with medical issues
- A former employee of PHS at the county jail. No current employees would talk to us.
- An ethicist
We also used the following resources:
For the inmates’ rights and their health care:
- American Civil Liberties Union
- Prison Legal News (Newsmagazine has subscribers in prisons. Editors are former prisoners)
- Private Corrections Institute (The group is against all aspects of correctional privatization)
- Prison Talk Online Community
- Institute for Criminal Justice Health Care
Data, stats and reports:
- National Commission on Correctional Health Care
- Bureau of Justice Statistics
- Commission on Safety and Abuse in America’s Prisons
- Understanding Prison Health Care
- National Institute of Corrections
- The state sheriff's association
- American Jail Association
- American Correctional Health Services Association
- Community Oriented Health Care Services. A quick primer on what’s different about COCHS
Also keep an eye on what the surgeon general might be issuing/saying about correctional health care. The topic has been mentioned off and on, including these remarks to the American Correctional Association in January 2007.
The response
The general population is unsympathetic towards people behind bars, so we were not surprised to find not-so-nice comments following the first story. Also, be prepared for other families and inmates calling you after your story runs to ask you to write a story about them too. Keep their names and numbers for follow-up stories.
Naseem S. Miller is a health writer at the Ocala Star-Banner.
