The Real Cost of Prisons Weblog

The State Department of Education, which regulates the practice of
medicine, is examining the terms of the three-year, $300 million
contract renewal the city signed in December with the corporation,
Prison Health Services. The inquiry will determine whether the contract complies with a state requirement that for-profit corporations providing medical services be owned and controlled by doctors - a law intended to prevent business considerations, like maximizing profits, from influencing medical decisions.

Prison Health executives and the city officials who oversee the
company's work say they believe that the contract is in compliance. But state education officials say the matter of who is in charge is a
serious one, with grave repercussions for the well-being and survival of inmates, as well as the public health.

The investigation, in fact, marks a renewed effort by the Education
Department, which first began to look into the Tennessee-based
corporation in 2001, after several inmate deaths in upstate jails
staffed by Prison Health began to draw stinging criticism from the State Commission of Correction, which monitors jail conditions.

The department's investigators concluded then that Prison Health was
violating the state law, saying that company executives were ultimately responsible for medical decisions and profiting from medical services. The two agencies asked the state attorney general, Eliot Spitzer, to halt the company's operations in New York, but Mr. Spitzer's office has declined to investigate.

Now, however, education officials have decided to look into the
company's largest contract of scores across the country, providing
medical and mental health care at nine city jails on Rikers Island and a 10th in Lower Manhattan.

State officials familiar with the new contract Prison Health signed with the city's Department of Health and Mental Hygiene have said in
interviews that it appears to violate the state law because it makes the doctors who are actually doing the work at Rikers answerable to Prison Health executives in Tennessee for the care they provide. Prison Health hires all doctors at Rikers Island.

On April 20, Education Department investigators met with three state
assemblymen, city health officials and Richard Rifkin, a deputy to Mr. Spitzer, to discuss Prison Health's legal status. The Assembly members at the session were Richard N. Gottfried, chairman of the Assembly's Health Committee; Jeffrion L. Aubry, chairman of the Correction Committee; and Ron Canestrari, chairman of the Higher Education Committee.

Mr. Gottfried said he called the meeting to answer questions raised by a recent series of articles in The New York Times examining Prison
Health's record in New York. Among other things, the series detailed
State Commission of Correction reports that faulted company policies and medical errors in the treatment of 24 inmates who had died in city or upstate jails.

"I and my colleagues are very concerned both about the quality of health care in our jails and prisons, and also concerned about the principal of corporatizing health care," Mr. Gottfried said in an interview last week. "If there is something illegal going on, I would want to work to enforce the law. If medical decisions are being directly or indirectly dictated by nonprofessionals, that's what we don't want."

Assemblyman Canestrari said Prison Health appeared to be in violation of the state law governing for-profit medical services.

"My understanding is their structure doesn't comply with the law," he
said in an interview last week. "There have been attempts to meet the
legal standard, but they have fallen short."

But company officials insist doctors are in charge of medical decisions. In New York City, Prison Health says it provides only administrative services to a doctor-run corporation, P. H. S. Medical Services P. C., that directs all medical care at Rikers.
But that corporation is run by Dr. Trevor Parks, who is a regional
medical director for Prison Health. State education investigators have called Dr. Parks's corporation a sham, and said that when they
questioned him, he had only a vague idea of his role in it.

Several Prison Health employees at Rikers said in interviews that Dr.
Parks recently gathered a group of supervising doctors there and
informed them that they were employees of his corporation. Dr. Parks
declined to comment yesterday.

City Health Department officials believe the Prison Health contract is legal, said Sandra Mullin, a department spokeswoman, in an e-mailed statement. "We welcome any state review that may offer additional information," she said.

Trey Hartman, Prison Health's president, said in a statement yesterday: "The city of New York has said that our structure under the Rikers Island contract is appropriate and in compliance with all legal requirements, and we have received guidance confirming that by widely respected outside legal counsel."

A spokesman for Attorney General Spitzer declined to comment on the
Education Department's new investigation into Prison Health.

City health officials first hired the company in 2001 after competitive bidding, making Prison Health the first for-profit enterprise to deliver medical care in the city's jails. The company beat out three other companies for the new contract.

Assemblyman Canestrari said that as troublesome as the fallout may be, the legal issues must be explored.

"The law is the law," he said, "and it's not going to go away."

http://www.nytimes.com/2005/05/11/nyregion/11jail.html?th&emc=th