Sunday, March 18, 2007
Basic Flaws Undermine Health Care
By Mike Gallagher
Copyright © 2007 Albuquerque Journal; Journal Investigative Reporter
Corrections officials are past the point of denying they have problems providing inmates with medical care.
The issue now is how to fix it.
The current medical provider, Wexford Health Sources of Pittsburgh, Pa., was told in December that its contract won't be renewed July 1.
Wexford CEO Mark A. Hale said having the state provide accurate information for companies bidding on the next contract would be a good place to start.
Hale said his company's bid was based on inaccurate data supplied by the state, causing Wexford and other bidders to "substantially underprice the contract."
Corrections Secretary Joe Williams doesn't deny there were problems with that request for proposals.
"I'm putting together an RFP, which hopefully we can tighten up and learn from past failures," Williams said.
One of the biggest problems Wexford faced from the time it started was staffing shortages, according to department correspondence.
Among problems identified by Wexford:
Demand for off-site specialty medical care (such as chemotherapy) was much greater than the RFP indicated.
Salaries were higher than indicated.
There was a smaller-than-expected pool of nurses from which Wexford could recruit.
Administrative requirements of a Hepatitis C program expanded, taking staff away from other duties.
These issues were laid out in e-mails and letters between Wexford and the department.
Hale said Wexford is cooperating with the state in drawing up a new RFP.
Williams said he wants input from the medical community and expects expert help in hiring a new medical director, shaping the RFP and "figuring out a way to get it done right."
"At the lower level, we need to re-engage some of our deputy wardens in making sure the vendor is in compliance," Williams said. "They can't get into particulars in medical files, and stuff like that, but I think we can do a better job."
Litany of problems
Late last summer and into the fall, the Santa Fe Reporter published a series of articles on problems in the prison medical system.
Based primarily on complaints of former employees, the reports got the attention of the Legislative Finance Committee, which began asking questions and decided an audit should be done.
That audit is under way. Based on the Journal's examination of inmate medical care, it should find plenty.
When Wexford took over the contract in 2005, it was the third company to run the prison medical system in four years. The changes in management and management styles caused many nurses to seek higher-paying jobs elsewhere.
Internal department records show Wexford faced problems finding nurses.
Company officials say they were competing in a tough market where hospitals were willing to pay substantially more than Wexford had estimated when it bid on the contract.
Former and current employees say this led to a cycle of bringing in temporary nurses unfamiliar with the prison environment who stayed for short periods.
Eventually, doctors began leaving. That put more stress on nurses who had stayed.
At times, the prison hospital at the Los Lunas prison had two nurses when six were supposed to be on duty.
Other shortages, according to records reviewed by the Journal, show that "med lines" where inmates receive prescription medicines were canceled because of staff shortages.
Devendra Singh, acting Medical Bureau director, has been involved in New Mexico's corrections medical system for 28 years.
He said staff continuity is the key to providing inmates with medical care that will meet standards set by federal courts.
"Any company that comes in, that will be a challenge, recruitment and retention," Singh said.
"The availability of professional staff is getting thinner and thinner. Nurses move from hospital to hospital. It is a very competitive business."
Fighting the system
The Journal interviewed three inmates chosen from letters to the Journal complaining about medical treatment in prison.
The interviews were allowed under the condition that a corrections official was present.
Corrections spokeswoman Tia Bland assured the inmates they would not be subject to retaliation for anything they said. None of the inmates was buying that, and said so.
Bland's presence was dictated by a department policy issued last summer. In the past, inmates were allowed to be interviewed without a department official being present.
The inmates had a variety of ailments, ranging from colon cancer to an injured knee in need of surgery.
Under current federal law, inmates have a more difficult time taking their complaints to federal court.
They must show they have used all administrative appeal procedures before filing in court and then must show that failure to provide proper medical care was done with "deliberate indifference."
Both standards are higher than those faced by New Mexico inmates who filed a civil rights lawsuit in the 1970s that resulted in what became known as the "Duran Decree."
Under Duran, federal judges supervised Corrections Department policy for almost two decades.
Department officials say they have a formal grievance procedure but inmates said grievances about medical care are routinely returned with the advice that the inmate talk with the prison doctor.
Medical services are sort of a "trip wire" in prison systems.
If the Corrections Department can't deliver adequate medical care to its captive population, which system starts breaking down next? Food service? Security?
Twenty-seven years ago, before inmates set fire to the prison south of Santa Fe and killed 33 of their own in the 1980 riot, the state was paying less than $1 million a year for the medical needs of about 2,000 inmates.
Today, that figure is more than $30 million for about 6,500 inmates. The Corrections Department has asked for $38 million in tax dollars for next year.
Williams said the department isn't looking to save money on medical care.
"We're looking at containing costs," he said.
Part of Williams' job is keeping problems in the prison system off the evening news and the front pages of newspapers.
To a degree he has been successful.
"We have done a good job of curbing violence, escapes," Williams said. "It is a prison system, and anything can happen on a given day."