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HRDC director quoted re privatized prison medical care in Indiana

South Bend Tribune, June 12, 2016.

Profits over prisoners? Indiana's health care for inmates draws anger, anguish

Complaints rise but state officials defend the quality of medical care

A private company hired to provide medical treatment to Indiana's prisoners while saving taxpayer money has come under increasing scrutiny amid a spike in complaints, questions about oversight and allegations that profit often takes priority over critical health services for inmates.

Corizon Health, based in Brentwood, Tenn., is the largest correctional medical company in the country. It provides health care services to jails and prisons in 25 states, including Indiana and Michigan.

A spokesman for Indiana's Department of Correction defended the medical care provided to the state's approximately 26,000 prisoners, saying, “I am confident that our clinical metrics for chronic conditions are better than the free world.”

But in the last few years:

• The number of inmate medical complaints filed with the ombudsman for Indiana's DOC has spiked, from 153 in 2010 to 509 in 2015. The number of prisoner deaths, including suicides, also rose, reaching 86 in 2015.

• Prisoners or their families have filed at least 178 medical-related civil rights lawsuits in federal courts in Indiana against Corizon since 2011 — 46 of those in 2015 alone. The state has settled nearly three dozen of those cases, paying out more than $1.2 million.

The settlements range from $300 for a prisoner whose appeal relating to his cataracts was denied, to $400,000 to the mother of a prisoner who was murdered by a mentally ill cellmate.

A spokesman for the state attorney general's office emphasized that settlements are not admissions of guilt but "avoid the uncertainties of further litigation where taxpayer dollars would be at stake."

• When asked about prescription drugs for inmates, state officials provided two different and varying sets of figures — both of which showed odd patterns.

One showed the number of drugs prescribed to inmates staying exactly the same for a 24-month stretch. This came despite the fact that the number of inmates overall in the state prison system fluctuates.

The second set, meanwhile, showed an oddly consistent pattern of prescribing drugs for inmates that persisted for years. From 2012 to 2015, the numbers of prisoners prescribed drugs climbed steadily for the first half of the year before dipping in the final months, the figures showed.

• A group of federal judges in Indiana, worried about prisoners struggling without proper legal help with medical cases, have pushed to set up a system to recruit attorneys and possibly medical experts to help poor prisoners with those cases.

• Officials across the country, most recently in such states as Florida and New York, have accused Corizon of cutting corners to save money, resulting in inadequate care. Many of those states have ended their contracts with Corizon.

Michael Sutherlin, a civil rights attorney in Indianapolis, calls Corizon's philosophy “a profit model” rather than “a medical model.”

Sutherlin and other attorneys accuse the company of being reluctant to prescribe certain medications or send offenders outside prison walls for specialized testing, diagnoses or treatment as ways to cut costs. The results, they say, are often unnecessary suffering and even deaths.

Corizon's relationship with Indiana extends back to 2005, when it first won a contract with the state for health care under former Gov. Mitch Daniels, who was leading a charge to privatize various state services.

The company has changed its name twice over the last several years after mergers, formerly operating as Prisoner Health Services and Correctional Medical Services.

As it has done so, the company's contract renewals have expanded the range of services it provides in Indiana prisons, now including medical, mental health, rehab, dental and vision. The most recent, three-year contract, which expires at the end of this year, was worth nearly $300 million. As of April, 39 health care providers, including nurse practitioners, worked in 24 state corrections facilities.

Corizon operates its own correctional pharmaceutical company and subcontracts with other companies for some services.

But information about the company, and its work in Indiana, can be hard to find.

Indiana's current deal with Corizon includes requirements for regular reports to the DOC, including staffing shortages and reviews of inmate deaths. But those reports are not made public, with a DOC attorney citing the confidentiality of inmate medical information.

The Tribune was provided lists of prisons and their consistently high scores during inspections from 2011 to 2015. But they did not include details about the inspectors or what they may have found to be deficient. A 2011 directive laying out rules for the DOC's quality assurance program includes a paragraph deeming a "quality assurance product" to be strictly confidential, including "in discovery during lawsuits."

The Human Rights Defense Center filed a lawsuit in March against Corizon and the state of New Mexico demanding a list of settlements in prison health care cases, after Freedom of Information Requests had been denied.

“The reality of it is that generally Americans don't really care what's going on unless it personally and directly affects them,” said Paul Wright, the center's executive director. Yet “every penny (Corizon gets) is a taxpayer dollar.”

Dr. Michael Mitcheff, of Osceola, chief medical officer for Indiana's DOC and a top Corizon official in Indiana for several years before that, agrees the company must make a profit. But he insists that profit does not take priority over health care for prisoners.

“The question is, 'How do you make money in this industry and provide great service?' There is a way, and we did it in Indiana,” Mitcheff said. “That isn't by withholding care, because typically withholding care down the road is going to cost you more money. … The way to be cost-effective and make money in this industry is by providing great-quality preventive care.”

Gov. Mike Pence and DOC Commissioner Bruce Lemmon declined interviews about Corizon and prison health care, referring all questions to Mitcheff.