Photo by REUTERS
Above, an inmate at San Quentin receives a visit from the dentist. In 2005, a California judge called health care conditions at San Quentin — which was built for 3,700 inmates and currently houses more than 5,000 — “deplorable,” but few paid attention until April 2006, when Governor Arnold Schwarzenegger committed $600 million to improving mental health facilities in the nation’s prisons. Despite this pledge, problems persist.

Politics and profit trump protection of inmates as states contract health care to private firms

by JULIA DAHL

Robert Boggon died like an animal. He was beaten, scrubbed raw with a rough bristled brush, stunned with a Taser gun while in the shower, bound in a chair with a pillowcase over his head and left to die inside a cold concrete jail cell in Escambia County, Fl. His crime? Boggon, 63, had a schizophrenic episode inside a local Dollar Tree store. On the day he died he’d not been convicted of a thing.

“Around here, getting sent to the Escambia County Jail is like a death sentence,” says Mike LaDoucer, the attorney representing Boggon’s estate.

But it wasn’t Escambia County, or even the state of Florida that was in charge of Boggon’s care while he awaited trail — it was a private company called Prison Health Services.

Private prisons, public problems

As the number of incarcerated individuals rises each year — the Justice Department recently announced that 2.2 million Americans are currently behind bars — the burden of providing them constitutionally guaranteed rights to health care becomes greater. Prisons breed disease. HIV and hepatitis are common, as is rape, assault, and self-injury. According to a September Bureau of Justice Statistics report, as many as half of all inmates suffer from some kind of mental illness.

In an effort to cut costs and avoid liability, in the late 1980s and early 1990s, states began to outsource health care to private, for-profit companies.

“The contract goes to the lowest bidder, and you get what you pay for,” says Dr. Erik Roskes, former chief forensic psychiatrist for the state of Maryland. “I think it’s an abdication of our responsibilities as a state. It’s our job to provide these services. You can’t sell the contract and then just wipe your hands.”

Last year, Prison Health Service’s parent company settled a Florida lawsuit over the death of one of the inmates in its care for $5.2 million. The company provides health care for one in 10 American prisoners.

But that’s exactly what many states have done. This decision–often abetted by campaign donations from the companies who scoop up the new contracts for care–leaves prisoners, specifically mentally ill prisoners, caught in a situation where their welfare has been auctioned off to the company willing to watch over them for the least amount of money. A situation where profit, not protection, is the priority.

“The theory is that these companies can do the job cheaper,” Roskes says. “I’m not an economist, but if some company is making a profit off public funds, I don’t see how that’s saving me, the taxpayer, money. I don’t have a problem with profit. The issue is who it’s being made on. These aren’t widgets, they’re people.”

And the people are proving profitable.

Profits over protection

In 2004, America Service Group (ASG), the company that owns Prison Health Services (PHS), the nation’s largest for-profit prison health care provider, reported earnings of nearly $10 million. According to the company’s 2005 annual report, PHS has contracts with 105 correctional facilities, and provides care for about 218,000 inmates, or one in 10 American prisoners.

But PHS, which was founded in 1978 by a former Philadelphia prison nurse named Doyle Moore, has been dogged by inmate deaths and negligence claims for years.

“PHS does all kinds of things they aren’t supposed to do. They create an atmosphere that allows constitutional violations to occur,” lawyer LaDoucer says. “This is a company that had been put on notice that they needed to do a better job — to basically give a damn about the people they serve.”

Roskes has seen first-hand the damage that understaffing and poor training can cause. From 1999 to 2001, he oversaw PHS mental health employees at the Baltimore City Detention Center, where in the span of just six months, there were five suicides.

“It was pretty bad,” Roskes remembers. “Inmates were given materials they shouldn’t have had and were able to hang themselves. They were left in a cell unsupervised, unmonitored. It was terrible.”

According to a subsequent Attorney General’s report, PHS staff at the jail did not provide timely mental health care or proper access to medications, and “these deficiencies are tied, at least in part, to significant staff shortages.” The same report also cited PHS staff for placing inmates “at risk of serious harm by failing to evaluate serious symptoms at an appropriate level.”

Apparently, however, the report did little to propel changes within the company. In early 2005, the ”New York Times” published a three-part series exposing chronic problems in New York state prisons where PHS provided medical care. More recently, the ”Times ”reported that PHS routinely failed to meet the standards — specifically in their care of mentally ill and HIV-positive inmates — of their $300 million contract with New York City. Since 2005, the city has withheld more than $170,000 in payments to the company.

America Service Group donates thousands of dollars to the campaigns of local lawmakers where they have, or hope to obtain contracts.

When asked if the ”Times” series and other reports of understaffing and negligence had prompted a review of best-practices within the company, spokesperson Susan Morgenstern says that PHS and parent-company America Service Group didn’t think the Times stories were “balanced or fair.”

“We don’t think they gave a clear or accurate picture of our operations,” says Morgenstern.

Yet, according to their 2005 annual report, last year the company incurred penalties of $2.8 million because of various violations, many stemming from understaffing. A search of the federal courts database reveals that the company has been a defendant in 1,909 lawsuits, including the current case of Florida resident Richard Boggon. Last year, ASG settled another Florida lawsuit for $5.2 million.

Friends in high places

So how does a company with so many lawsuits pending and reprimands issued continue to obtain lucrative contracts all over the country?

One reason might be that ASG is well-connected. Half a dozen of its senior officers, including current CEO Michael Catalano, are former high-level employees of Columbia/Hospital Corporation of America (HCA), the hospital management company founded in 1968 by Thomas Frist, father of Senator Bill Frist (R-TN). During the 1990s, HCA was investigated for bookkeeping irregularities and Medicare fraud, and paid a total of $1.7 billion in fines — the largest fraud settlement in U.S. history.

In 1999, ASG formed a political action committee (PAC) and began donating thousands of dollars to the campaigns of lawmakers in states where they wish to obtain or maintain contracts. For example, in 2005 ASG donated $10,000 to Philadelphia mayor John Street’s campaign fund, including $5,000 for an inaugural ball. The company, which provides health care services for all state prisons in Pennsylvania as well as Philadelphia jails, has also donated $15,000 to Pennsylvania Gov. Edward G. Rendell, and $6,000 to other state lawmakers over the past three years.

In May of this year, the company gave $15,000 to the campaign of Greg Ahern, who was running unopposed for Sheriff of Alameda County, California. Two Alameda County detention facilities have contracts with PHS, and according to Ahern, one is up for rebid next year.

Calls to Mayor Street’s office were not returned. Sheriff-elect Ahern confirmed that ASG did give him “some money.”

ASG spokesperson Morgenstern says she had “no information” on the PAC or any of its political donations.

ASG has also been dogged by allegations of financial impropriety. Last year, the company was forced to launch an internal audit, which, according to the 2005 annual report, found that its subsidiary, Secure Pharmacy Plus (SPP), improperly charged customers, failed to issue rebates, and that “members of SPP’s senior management inappropriately established and used certain reserves.” The offending management officials resigned, and on May 15 the company announced it would issue refunds of $3.6 million, plus interest.

“Most people’s attitude is that people in prison are scum and they ought to be thrown away and forgotten about,” says Dr. Erik Roskes.

On May 9, two of the company’s board members, Carol Goldberg and Michael Gallagher, resigned. According to the Associated Press, Gallagher said he “no longer has faith” in CEO Catalano’s leadership.

As a result of the investigation, the refunds, and the defection of the board members ASG’s stock has been threatened with delisting several times this year by the Securities and Exchange Commission, and at least three groups of shareholders have filed class action suits against the company.

An examination of the company’s earnings also shows that the lawsuits, resignations, and penalties have taken a toll. ASG’s stock has fallen, and though the company’s net income doubled between 2003 and 2004, in 2005 it plummeted by more than 50 percent, to pre-2003 levels.

A problem of empathy?

But the problem isn’t just the apparent callousness or incompetence of one company. Prison Health Service’s main competitor, Correctional Medical Services, which took over the Maryland contract from PHS last year, has also a defended against more than 2,000 lawsuits.

“If I were more paranoid, I’d think it was fixed, like they were all in it together,” says Roskes.

And indeed, when PHS lost the contract at the Escambia County Jail in the wake of Boggon’s death, a company called Armor Correctional Services took over. Armor was founded by Doyle Moore, the same man who founded PHS, and the Armor’s CEO, Bruce Teal, was on PHS’s Board of Directors from 1996-2002.

Roskes, now the director of forensic treatment at Maryland’s Springfield Psychiatric Hospital, thinks that irresponsible cost-cutting decisions are, at some level, par for the course with privatization.

Sitting at his desk in a tiny office in the hospital’s Nurses House, Roskes calls up the website www.PreventSuicide.com and points to the front page picture of two disheveled-looking individuals sporting poncho-style blue gowns called “suicide smocks.” These smocks are made of material too thick to tear or braid into a noose, thus keeping suicidal patients safe when there aren’t enough guards or nurses to watch over them.

“It’s cheaper to buy 20 suicide smocks than to add a couple extra staff,” he says, shaking his head.

But a suicide smock would not have saved Robert Boggon, who languished in the Escambia County Jail for 11 days displaying clear signs of mental distress.

“He took off all his clothes, urinated on himself, and was rocking back and forth,” said LaDoucer, who is scheduled to argue Boggon’s case later this year.

According to LaDoucer, the nurse in charge “didn’t think Boggon was faking his symptoms,” which makes the fact that he never once saw a doctor or mental health professional even more baffling.

To Roskes, however, it’s just the same sad, small-minded truth he’s fought against his whole career.

“Most people’s attitude is that people in prison are scum and they ought to be thrown away and forgotten about. Why should we spend good money on them?” he says. “The fact that 98 percent of the people who go in come back out escapes most people’s attention.”