Washington City Paper
July 25, 1997
The District Line
Getting the Treatment
Advocates say privatization has hurt medical care at D.C.'s Correctional Treatment Facility
By Stephanie Mencimer
Early in June, Carol Kosh paid a visit to her aunt, Sheila Morris, an inmate who was working to complete a drug treatment program at the D.C. Correctional Treatment Facility (CTF). During her visit, Morris showed her niece a walnut-size cyst under her left arm that was reddish and bruised looking, and that doctors at D.C. General Hospital had told her in March was malignant and needed to be removed. Kosh knew the cyst was not something to be taken lightly, because Morris is HIV-positive.
Yet when Kosh last saw her at CTF, Morris' stomach was distended and she was barely eating. The CTF nurses had tried to give her liquid vitamin drinks, but Morris told her niece the facility kept running out, so she was subsisting on crackers and Oodles of Noodles. According to Kosh, the doctors at D. C. General had prescribed Percocet for Morris to alleviate the pain from the growing cyst, but when Morris got back to CTF, the medical staff would only give her the over-the-counter remedy, Motrin, which was chewing up her empty stomach. Kosh says Morris had been back and forth to D.C. General for tests, but never for surgery.
Not long after Kosh's visit, Morris' twice-weekly letters suddenly stopped coming, and Kosh suspected immediately that something was wrong. She and her aunt had been corresponding regularly for more than three years. Not long after the mail stream dried up, Kosh got a call from another CTF inmate who told her that Morris was too weak to get out of bed and needed help. Kosh contacted D.C. Prisoners' Legal Services, which began to investigate the case. She also continued to pester the CTF medical staff for updates on her aunt's condition. Kosh says that when she spoke with health administrator James Arieno on June 18, he promised that her aunt would go to D.C. General the next day for emergency surgery.
Despite repeated promises from Arieno, Kosh says CTF medical staff failed to transfer Morris to the hospital for surgery, and when a law clerk paid Morris a visit on July 3, her cyst had grown to fistsize, turned bluish-green, and was suppurating. Two days later, still untreated, Morris went into shock, her body overcome with pain and infection. She was rushed to D.C. General, unconscious, and she's been that way ever since. "Now she's like a vegetable laying there, and all I can do is hold her hand for a few minutes," says Kosh. "I couldn't believe they let her lay there like that. I know they're prisoners, but they're people too. Nobody should be treated like that."
The story sounds like typical District dysfunction: A terminally ill inmate neglected by a government too inept, uncaring, and corrupt to help. But this time, the District wasn't responsible for Morris' suffering - at least not directly. Kosh's aunt was under the care of the Correctional Corp. of America (CCA), a national prison company that was supposed to bring private-sector magic to the District's ailing correctional system.
On March 16, the District handed over the keys to its newest jail to CCA under terms that both parties hailed: CCA bought CTF for $52 million, providing a huge infusion of cash to the strapped city coffers. Then, the city would lease the facility back from CCA for nearly $3 million a year for 20years,at which time the building would revert to District ownership, so the $52 million was essentially an interest-free loan. The city would also pay CCA roughly $20 million a year to manage the facility Proponents of the deal promised city residents that it would save the city millions and improve conditions for inmates as well.
Opened in 1992, CTF was designed as a model treatment center for addicted and mentally ill inmates. While the drug treatment program went off as promised, budget problems forced the city to forgo the planned mental health wing and to house women prisoners there instead. As the corrections budget continued to dwindle, the building began to deteriorate along with work programs and medical services
Like other programs that the city has driven into the ground, CTF became a popular candidate for privatization. Everyone from the D.C. Council to the control board cheered the mayor's proposal to plop the facility in the hands of CCA, a corporate giant with the resources to bring it up to snuff. City Administrator Michael Rogers called the deal "a grand slam for D.C.," according to the Washington Post. Instead, four months after CCA took over, some of the problems at CTF are, unbelievably, even worse than they were under District management, according to doctors and lawyers who work with the corrections system.
Those lawyers and doctors report that the CTF medical service suffers from shortages of medication in the pharmacy, under staffing, and a lack of mental health services - all problems CCA was supposed to be fixing. Brenda Smith who runs the women's prison project at the National Women's Law Center says she is betting disturbing r from clients that HIV-infected pregnant women CTF are not regularly getting the expensive ' therapy" medication that would protect unborn children from the virus. Smith says the situation is dangerous not just for the women and their kids but for public health, because a spore of anti-viral medications can breed a form of infectious diseases resistant to treatment with drugs.
Jonathan Smith, executive director of D. C. prisoners' Legal Services, says one of his clients recently came down with shingles, a form of herpes that causes a painful skin condition. . She was also pregnant and HIV-infected. According to Smith, the inmate went for a week without treatment, until the condition had spread to her face, where it could have threatened her eyesight. Even though shingles is highly treatable with oral therapies in their early stages, the woman ended up an inpatient at D.C. General for intravenous drug therapy to get the problem under control Aurie Hall, a staff attorney at D. C. Prisoners' Legal Services, says an inmate she worked with recently ended up at D. C. General with pneumonia and full blown aids after having several HIV tests at CTF that came back negative.
CTF also appears to be thin on mental health services, a serious liability in a facility loaded with the mentally ill and substance abusers. According to Dr. Andrea Weisman, Director of Mental Health Services at D.C. Jail, which sends patients to the infirmary at CTF, the facility no longer has a psychiatrist on call 24-hours-a-day for emergencies, something it had under District Management. Now, the only psychiatrist at CTF is a doctor from Weisman's staff at D.C. Jail who works at CTF four hours a week, Weisman says.
Weisman says CCA has instructed the CTF psychiatrist not to prescribe certain medications because of their cost. And she says that CCA does not have any policies or procedures in place for moving inmates from one institution to another Weisman says CTF staff had no idea how to transfer an inmate who needed emergency psychiatric hospitalization two weeks ago. "Certainly I think that people are not getting the care that they need," says Weisman. "There are lots of problems".
Advocates suspect that many of CTF's problems stem from understaffing. The medical unit at CTF is a large and crucial hub of the District's correctional health system The facility has the only infirmary in the correctional system, and any inmate too lick to be housed in the general population but not ice enough to need a real hospital is transferred to he 32-bed CTF infirmary from Lorton or D. C. Jail. among CTF's 900 inmates are all the city's pregnant inmates, whose pregnancies are considered high-risk because of the high rate of HIV infection and substance abuse among prisoners. The institution has one of only two units in the system for physically disabled prisoners, and the only special isolation unit for inmates with tuberculosis.
Despite the extensive medical services delivered It CTF, the facility apparently has no full-time medical director. Smith notes that CTF medical director Dr. Vincent Roux is also an associate dean of the Howard University medical school, runs his own private medical practice, and is overseeing the development of a new acute-care mental health unit at D.C. General Smith says Roux's stretched too thin o be giving CTF the close attention it needs.
Dr. Armond Start, a consultant from the University of Wisconsin brought in by the D.C. Department of Corrections to help improve correctional medicine, has confirmed the advocates' suspicions bout CTF's threadbare staffing At the request of he D.C. Department of Corrections, Start and the court-appointed receiver of the D.C. Jail medical services, Ronald Shank vested Clef twice and found its medical services deficient in many areas. Last week, Start briefed the correctional health task force of the Medical Society of D.C. on his findings.
Start said CCA employs the equivalent of only 3.6 doctors (full- and part-time) one for every 250 inmates. CCA employs several specialists to visit for a few hours a week, including an infectious-disease specialist who comes for eight hours a week. However, Start said that the medical facility had only one registered nurse on duty for the entire weekend then he visited—not nearly enough to distribute he cozens of closes of medication to HIV-infected inmates or to administer the intravenous therapies used to fight infection. (IV treatments can only be administered by a doctor or a registered nurse, not the physicians' assistants or LPNs who make up the bulk of CCA's medical staff.)
In his presentation before the medical society committee, Start cited the case of an inmate from Lorton who spent nearly 50 days at D.C. General receiving IV treatments that he could not get at the CTF infirmary. The case was hardly anomalous. Smith says his project's clients have had trouble getting admitted to the CTF infirmary, partly because CCA has no intake or discharge criteria for the facility. As a result, he suspects the facility is filled with inmates who are termed "medically vulnerable," like the blind, but who don't really need 'round-the-clock nursing care. Patients in need of greater attention then end up at D.C. General, courtesy of D.C. taxpayers,whocoughup$1,850a day for prisoners' inpatient care.
D.C. Jail medical receiver Shansky echoed Smith's concerns at an April meeting of the medical society committee, when he reported that the CTF infirmary suffered from bed shortages and that his shop was making far fewer patient transfers there than before CCA took over. The correctional health receivership is the primary user of the CTF infirmary because the jail infirmary was closed about five years ago because of substandard conditions. As a result, most of the infirmary patients from CTF come from the jail clinic.
Roux and Arieno did not return calls for comment. But Joseph Johnson Jr., CEO of the National Corrections and Rehabilitation Corp. (NCRC), which serves as a consultant to the CTF medical services for CCA, says the notion that CTF's medical unit is understaffed is completely ridiculous. "We're overstaffed there," he says. "We have more than the full compliment that was there before. " He says the facility has more nurses than the District employed and * his &6 Human Services. Roux, the medical director than Start found. And as for Weisman's assertion that the facility has no full-time psychiatrist on call, "It's completely untrue. There's a full-dine person there." Johnson could not provide the name of that doctor, however.)
Johnson also disputes Kosh's account of the treatment her aunt received at CTF. While he concedes that scheduling the surgery took longer than it should have, he says Morris was operated on, but when she returned to CTF she had post-operative complications and went right back to the hospital, where she's been ever since. "The medical records will confirm that," he says.
In the end, advocates say it's hard to know what is really happening at CTF because CCA is keeping a tight lid on information. Hall has been unable to obtain Morris medical records from CTF, despite repeated requests. And doctors at CTF have told her that CCA has barred them from talking to anyone from her organization, which was responsible for landing the District's jail medical services in receivership two years ego. Dr. Christopher Fletcher, CCA's corporate medical director at the company's Nashville headquarters, did not return two calls for comment, and Lonnie Moore, the CTF warden, would not comment and referred all calls to CCA spokesperson Susan Hart, who did not return calls either. The secrecy Smith and Hall say they've encountered from CCA is something they'd come to expect from the District government, but not from the vaunted private sector. "It looks awfully shady, but then we don't have one dead corpse," says Hall cynically.
The problems with CTF's medical services shouldn't come as much of a surprise to District officials. Last year, when the city was hellbent on privatizing CTF, witnesses came before the D.C. Council arguing that the contract with CCA was full of deficiencies, particularly in the area of medical services. At a hearing on the privatization last fall, witnesses from the Medical Society of D.C. and D.C. Prisoners' Legal Services pointed out that CCA intended to subcontract the medical services at CTF to Johnson's NCRC, a company that had never run a prison health service.
That company, incidentally, is a coterie of cronies of none other than Mayor Marion Barry NCRC's president is Arthur Graves, a former D.C. corrections official who was criticized for allowing hundreds of criminals to escape from halfway houses without ever being pursued by the department. The company's general counsel is Chalfrantz Perry, a former special assistant to Barry and the lawyer of record in a sexual harassment suit against Barry's longtime associate David Rivers, who was indicted (but never convicted) three times for bribery and conspiracy charges as head of the District's Depart
And Johnson, NCRC's chief operating officer, is a political operator who ran John Ray's 1994 mayoral campaign and worked for late D.C. Council Chairman Dave Clarke in the 1980s. Prior to coming to the District in 1988, Johnson headed the New Mexico state health and environment department. He was forced to resign in 1986 after being charged with seven counts of bribery, as well as fraud, conspiracy, taking illegal kickbacks, and racketeering, after the head of a mental health center pleaded guilty to bribing him. (A judge dismissed the charges for lack of probable cause, and Johnson returned to work as an assistant to the governor of New Mexico.) (See "Let's Make a Deal," 5/9.)
More recently, Johnson's company Healthcare Affiliates was investigated by the U. S. Department of Housing and Urban Development for allegedly mismanaging a troubled charitable hospital in Newport News, Va. Late last year, the HUD inspector general found that Johnson's firm had inappropriately used hospital funds to pay for travel expenses and swank apartments for company staff. CTF's hospital administrator Arieno worked for Johnson as the administrator of Newport News General Hospital until the firm's contract was canceled in late 1995.
In an interview this spring, Roux told Washington City Paper that NCRC would deliver "the best and continue to accept sick inmates from other parts of the corrections system.
According to Dr. Richard Guy, who chairs the medical society's correctional health task force, the contract only required CCA, in the most general of terms, to maintain the same level of service provided by the District. "But we knew the services were substandard to begin with," says Guy, who recognized immediately that upgrading CTF's medical care would require more money, not less, than the District had been spending. Yet in its "cost-saving" proposal, CCA promised that it wouldn't spend more than $9 a day per inmate on medical care—a dump in the bucket compared to the $24 a day spent per inmate under the receivership at D.C. Jail, where medical care is now considered adequate.
Dr. Michael Michaelson, vice chair of the D.C. Medical Society's correctional health task force, testified before the D.C. Council last fall that he and his colleagues were deeply concerned that the contract under consideration made no mention of how CCA would handle treatment of TB, HIV, and prenatal care. He noted that the city was giving CCA sole discretion over deciding how it would fill job categories such as gynecologist, dentist, psychiatrist, and lab technician.
"The failure of the contractor to specify its needs and intentions with respect to these critical jobs is utterly unacceptable, and for the District to sign such a document would be absurd," Michaelson said Yet that's just what happened The National Women's Law Center's Brenda Smith, who also tried to impress on the city and control board members the need for better medical requirements, says, "You couldn't tell them anything This was a quick way out and they took it." City Administrator Rogers, who was a driving force behind the CTF privatization, did not return a call for comment.
The District is now stuck with a 20-year contract that allows all the CTF medical staffing levels to be determined by the profit-driven CCA, which has a huge financial incentive to skimp on medical care. The level of medical services provided at other CCA facilities suggests that running a tightfisted medical operation is part of a corporate strategy. CCA's brand-new prison, built in Youngstown, Ohio, to house District inmates, has only two infirmary beds and a single full-time doctor on staff to treat the nearly 900 inmates shipped there by the District over the past few weeks, according to prisoner advocate Jonathan Smith, who visited the facility two weeks ago. Smith says warden Willis Gibson told him that CCA intends to increase the number of inmates at Youngstown to 2,000 without increasing the number of doctors on staff. Gibson did not return a call for comment.
In her testimony before the D. C. Council last fall on the proposed privatization of CTF, corrections department Director Margaret Moore assured the council that CCA's contract provided a dear provision to assess fines against CCA if the company understates critical functions such as correctional officers and medical services. But Moore's assurances were largely meaningless, since the contract didn't articulate what would constitute a full staffing level. Weisman explains that the city can't enforce contract provisions that don't exist.
Even if the city did have a better contract, it's not likely the corrections department would have a handle on whether CCA was living up to it. Almost immediately after CCA took over CTF, the department of corrections realized it didn't have the internal capacity to monitor CCA's contract with regard to medical services. So, in the spirit of privatization, the department decided to contract out the contract monitoring. Four months later, the city still has not finalized that contract, and Moore has not responded to an offer from the medical society to volunteer to fill in the gap. Moore did not respond to calls for comment or to a faxed list of questions.
Without a decent contract and a contract monitor, the only thing now requiring CCA to care for D.C. prisoners, says Brenda Smith, is the Eighth Amendment, which tears the use of cruel and unusual punishment inside American jails and prisons.UP
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