AHCJ freelancer reveals challenges in Georgia’s inmate health care Date: 04/21/20
By Carolyn Crist
For more than a year, Atlanta-based freelance journalist and AHCJ member Max Blau investigated the troublesome health care delivery in jails across his state. He filed records requests, conducted tough interviews and weaved together a series about his findings — all while reporting and writing other stories at the same time to pay his bills.
The stories appeared in the Atlanta Magazine in January 2020 and The Telegraph in Macon in December 2019 and received national attention, including mentions in Kaiser Health News and Politico’s newsletters. Since then, officials in two areas began re-examining their contracts.
Blau’s reporting was supported by the AHCJ Reporting Fellowship on Health Care Performance, funded by the Commonwealth Fund, and the Fund for Investigative Journalism.
Known for his ability to juggle a freelance career with long-term investigative projects, Blau talks about the reporting process and filing records. He also offers advice to reporters, particularly freelancers, who want to tackle a similar project in their state.
Q: How did you find this story?
Blau: As long as I’ve been a reporter, I’ve covered issues related to criminal justice. As a staff writer at Creative Loafing, I covered the death penalty and the various trials that happened in the early 2010s. That’s the first time Carlo Musso’s name popped up on the radar as the doctor who supervised the lethal injection process. This pre-dated my focus on health care reporting, but I was always interested in the topic.
While freelancing and looking for stories in 2018, I chatted with the Telegraph editor, who was looking for statewide investigative stories. We began talking about Musso and CorrectHealth, which provides medical services to jails in the state. The jail health care space itself is unlike every other facet of health care that involves the government, with strict reporting requirements under Medicare/Medicaid and a clear research-based and evidence-driven approach to measuring care. It’s almost the exact opposite of that, especially in local jails, and to some degree in state prisons. Each county goes its own way, and there is minimal health reporting around deaths and adverse outcomes. Federal law requires health care for inmates but gives no clear standards for what that looks like, and it’s left up to the counties to figure it out.
I was interested in how that played out, especially providing care at a low cost. Every health care reporter knows those two things are often at odds with one other. The way the editor and I envisioned the story was a very records-intensive piece, which would have costs tied to it. I applied for and was fortunate to receive the AHCJ fellowship and FIJ grant, which provided enough to move forward with the story and dig into the documents.
Q: How did you report this story?
Blau: No database shows you which jails have which health care providers. I didn’t know immediately which counties worked with which agencies, so that was the first place to start. I looked RFPs and PACER, which I knew had federal-level cases. It was a time-intensive process to figure out which jails they were in and how many suits had been filed, not just at the federal level but at the state level. I visited individual courthouses, and it was a long process of filing open records requests. I started with the largest counties, and from there, found a proposal that outlined many of the agencies. Even then, some RFPs were outdated and from years ago, so I started a spreadsheet to keep track of the agencies, jails, contracts and payment records. Some counties had reports on medical information and monthly statistical reports that captured quantitative information such as the number of prescriptions filled and the number of patients, but they didn’t track quality.
As part of this, I asked for mortality review documents and ante litem notices that informed counties when they were to be sued, and some of that was denied. Some records laws shield them from being obtained, but I was able to get a sense of what the care was like. It was clear pretty early on that Musso wasn’t going to talk to me, and I was able to find several depositions from different stages in his career that showed an evolution. Through that, I was able to build and find his voice.
In total, I filed about 100 open records requests and had about 25,000 pages to review. It took several months to do this logistically, haggling to get the costs down, but it still cost about $10,000 to get the reports before I even started the interviews or writing. Really, there was no way to do the story otherwise.
Q: What experience did you have with open records requests before this?
Blau: I’d had investigative reporting in my mix of stories for about five years at this point, and over time, I shifted from thinking that it was intimidating to file a records request to knowing how to word a request to get the information. Over time, it became a habit — almost in the same way as pitching — where I do it every week to feel comfortable with it. Even if I’m not working on a story immediately, I go to courthouses to pull records. During this process, you get a sense of why your requests are rejected and if they’re too broad. I’ve learned patience in this time-consuming process that comes with getting records.
Q: How did you approach interviews for this story?
Blau: I first talked to jail health care researchers in a broader sense to understand the history of why private companies had grown such much and the state of the field. After I looked at lawsuits on PACER, I began reaching out to families whose relatives had died, and then talking to family’s lawyers or plaintiff’s attorneys. Some were happy to put me in touch. I also put a call out on social media to help me understand how jail health care works and talked to guards, formerly incarcerated people and family members. I began to understand the stakes of what it means to not receive adequate health care.
It was hard to talk to people in jails and prisons due to access issues. I talked to family members as a first step and, over time, I was able to write emails and letters to incarcerated people. I also talked to sheriffs, who often approve these contracts, because I wanted to understand their thinking and get around the blockade coming from the agencies. A few of the sheriffs let me in, and I was able to talk to some of the company employees without a spokesperson.
Finally, I circled back with Musso and CorrectHealth before filing my final drafts, but I received a statement that didn’t respond to individual incidences or the specific questions I asked. I had to rewrite part of the story when they responded so I could include their perspective in the final days and hours before my deadline.
Q: What obstacles did you face?
Blau: One of the reasons that reporters don’t cover jail health care is that it falls at the intersection of two secretive systems. Jails themselves are closed off due to privacy concerns, and getting access is hard. HIPAA overlaps in many cases, which makes it difficult to report on the vast majority of cases with any kind of documented narrative or specific detail. Ultimately, I had detailed anecdotes and records from loved ones to show what happened.
Beyond that, the time-intensive record-gathering was tough. For every number I had, such as $360 million in government contracts, it required 100 records requests and spreadsheets with year-by-year numbers to understand how it grew over time and see the contours of the company expansion. This kind of reporting would have been impossible without the assistance of funders to provide support.
Q: How did you juggle this as a freelancer?
Blau: I have to set limits on the kinds of stories that I do, and I won’t move forward with investigative projects unless I have the right resources and publications supporting me. You have to know your limitations, and I wouldn’t have pursued this without grant funding.
In a given year, I have two to four investigative projects of varying scopes, and this was my big one for 2019. While reporting and building up my expertise on the topic, I look for news-centric and state policy issues that I can pitch. Gigs that are adjacent to investigative work creates an efficiency that allows me to pay my bills while reporting. I also have a few anchor clients that provide a steady paycheck.
Over time as a freelancer, even when I receive good offers from certain publications, I’ve slowly set a floor for the minimum amount I will accept per word or per day. Writing for 5 cents/word is untenable if you’re trying to create a full-time career. I’m slowly inching that up.
Q: How did you fit this into your schedule?
Blau: Each day is different. I don’t do much breaking news, so I’m able to create my own schedule and make it work. I book days that are reporting days with only calls, days that are writing days, and days that are travel days. Juggling between tasks doesn’t always work for me. You need different mindsets for different tasks.
For this story, I’d book a day to visit seven courthouses for a data-gathering day. For some large projects, I’ve been able to use grant money to hire students to visit courthouses or obtain records, which gives me more time to talk to sources or write. I like that it allows me to do more, and it also helps them to learn. I help them with their stories, too, and it’s nice to have another set of eyes on my reporting.
Q: What’s next for you?
Blau: As a freelancer, I’m still jugging all kinds of short-term assignments, including stories about a rural hospital’s unlikely turnaround and the health consequences of living near coal ash ponds. I’m currently pitching a few long-term feature ideas about jail and prison health care, which I have yet to sell, but I’m hoping someone might be interested in the future. Having had the privilege of studying correctional health care over the past year, I feel compelled to keep reporting on that topic. If any editors are interested in finding ways to cover the topic, I’d encourage them to reach out to me.
Q: What advice do you have for AHCJ members who want to do a story like this?
Blau: I would start by attending a jail health care conference by one of the accrediting organizations. That experience helped me understand the unique complexities of the field and helped me accrue better sourcing. I would also talk to other journalists who have spent time on the topic. It’s challenging given both HIPAA and the secrecy that runs throughout most jails and prisons, but there are ways to get around both barriers to tell important stories about the field.