Effort to privatize Ga. prison health care draws fear from experts, advocates

An exterior view in 2016 of Pulaski State Prison: the overall crime rate is down, the overall number of prisoners sent to stand prison is down, and the number of black inmates sent to prison is steadily declining as well. (Hyosub Shin / hshin@ajc.com)
An exterior view in 2016 of Pulaski State Prison: the overall crime rate is down, the overall number of prisoners sent to stand prison is down, and the number of black inmates sent to prison is steadily declining as well. (Hyosub Shin / hshin@ajc.com)

Credit: HYOSUB SHIN / AJC

Credit: HYOSUB SHIN / AJC

‘Recipe for disaster,’ one expert says

Georgia Department of Corrections officials hope to save money by privatizing all health care at state prisons, a proposal that alarms experts and people who’d been incarcerated in a system they say already has a rock-bottom medical budget.

GDC is researching how the prisons could have medical services provided by a for-profit firm rather than Georgia Correctional HealthCare, part of the state’s medical school at Augusta University, according to documents obtained through the Open Records Act. The agency has already privatized mental health and dental services. Documents show GDC wants all prison health care to be private by July 2021.

Experts say privatization is unlikely to reduce costs and might result in worse care.

“I think it’s a recipe for disaster," said Madie LaMarre, who provided and oversaw health care in Georgia prisons for more than 20 years. “When the budget is already low and you introduce a profit motive, you introduce the possibility of denied needed health care.”

The department of corrections didn’t respond to a request for comment, but agency staff suggested in documents that the 23-year-old arrangement with Augusta University, negotiated by the late Gov. Zell Miller and other state officials, is outdated.

“The model has remained largely unchanged while healthcare reform, innovation and delivery have significantly evolved,” a staffer wrote. “The cost for providing healthcare services has steadily increased, and GDC has had difficulty forecasting future costs with accuracy.”

State Rep. Alan Powell, R-Hartwell, a member of the House Appropriations Committee, praised GDC Commissioner Timothy Ward earlier this year for researching ways to cut costs.

“In this day of privatization, I’m looking forward to seeing what the consultants come up with,” Powell said. “(We) might find it could save us a tremendous amount of money.”

Past and present prisoners and their advocates routinely report poor, delayed, cheap and, at times, non-existent care.

“They barely spend anything as it is," said Kristy Cope, whose son is incarcerated for armed robbery and has been waiting two months to see a cardiologist. “How can they possibly spend less?”

In recent years, diabetic prisoners have died of alleged neglect. Delayed treatment and misdiagnoses were tied to three deaths. At least 10 women at Pulaski State Prison and Emanuel Women’s Facility died agonizing deaths under the care of one doctor.

Cassandra Gilbert’s pain was thought to be caused by a urinary tract infection until scans found tumors on her colon, liver and lungs.

“They haven’t sent me to an oncologist yet and I have been waiting four months," Gilbert, sentenced to 20 years for racketeering, pimping and other offenses, wrote to her daughter-in-law. “I been complaining for a long time and they just been ignoring me."

She died at 55 in 2019. She was treated mostly with painkillers.

Last month, a federal judge ruled a lawsuit by a prison doctor who said he was fired for exposing dangerous conditions at the state medical prison can move forward.

LaMarre, a correctional health care expert who has consulted across the country, left the department of corrections in 2005. She fears a cut-rate health care contract could lead to more preventable hospitalizations and deaths, and an even tougher time retaining dedicated employees. All of that could add up to the state spending more — not less, she said.

“Good health care is less expensive than bad health care," LaMarre said, "because with bad health care people end up in the hospital.”

The current nonprofit system employs 753 doctors, nurses and other medical professionals whose jobs could be imperiled by privatization. LaMarre predicts many will quit if the state seeks bids for privatization.

She said Georgia already has a bare-bones budget for prison health care. She cited a 2017 report from the Pew Charitable Trusts that showed Georgia spent $3,600 per inmate per year on health care. Only six states spent less.

“How much less money do they want to spend?" she asked. "Do they want to be 50th, is that the goal?”

Documents show the department of corrections intends to roll out a new health care system in phases, the first being the replacement of the pharmacy department. GDC agreed to pay the McKinsey consulting firm $1.5 million to research and help GDC find a private pharmacy provider, records show. The agency solicited bids from contractors but hasn’t said if it received a viable bid.

Dr. Josiah “Jody” Rich, a Brown University professor and the director of the Center for Prisoner Health and Human Rights, said there are some private correctional health care companies that do good work. But generally, private contractors can provide a lower standard of care than a public institution, such as the one that administers medical services to Georgia prisoners, he said.

Hospitals must be accredited and can face stiff consequences, including closure, if they don’t perform well enough. Private correctional health care companies aren’t required to be accredited, Rich said.

“You can with impunity give lousy care,” he said. "The only recourse (for inmates) is litigation.”

Second time’s a charm?

The question of how to provide health care in prisons and jails is complex. Officials must keep costs down while caring for populations that tend to be less healthy than the public. Spend too little and prisoners get sicker, driving costs up. If the budget grows too much, politicians risk a backlash from taxpayers.

In the mid-1990s, GDC let a private company take over. Prison Health Services won a five-year, $60 million contract, which was then said to be the biggest such contract in the country.

Months into the agreement, the company was fined for falling short of staffing requirements. A few months later, the state tore up the agreement. Officials said they terminated the contract to keep “dollars in the state" by turning to Augusta University, then known as the Medical College of Georgia.

LaMarre, who was GDC’s clinical services manager at the time, said the biggest reason to end privatization was this: “It failed completely."

The new arrangement with the state college was successful, LaMarre said, particularly because it offered adequate salaries and made workers eligible for state pensions — a strong incentive to keep skilled medical professionals on staff. She said staff also faced audits to make sure they provided quality care and kept costs down, but the office that controlled oversight was shuttered in 2005, effectively leaving Augusta University to audit itself.

As officials complain, prison health care costs have indeed increased. In 2016, the annual bill was $208 million. In 2019, it was $239 million. But correctional health care professionals note that medical costs are increasing in the public as well and it isn’t clear how the department of corrections could get around that without decreasing the quality of care.

In Mississippi, officials hired Centurion, a prolific political donor in that state and this one, to provide medical care in prisons in 2015. After inmates began a legal battle over what they described as abysmal care and a series of preventable deaths, Centurion notified Mississippi in July that it was ending its contract. The company said it couldn’t improve care because Mississippi officials refused to invest more in staffing and infrastructure.

Centurion runs mental health and dental services for Georgia prisons.

Questions about the process, outcome

Experts are puzzled by the process the state has been following on its path to potential privatization. They questioned the contract with McKinsey, an international corporate consulting firm that has been criticized for its track record in corrections.

In 2014, New York City paid McKinsey $27.5 million to reduce violence at Rikers Island. Three years later, the firm reported violence was down more than 50% in the parts of the jail the consultants focused on. McKinsey and jail officials touted the results until a federal monitor revealed that violence at Rikers had actually risen 50%, according to ProPublica, the nonprofit investigative journalism outlet.

An investigation by ProPublica found that McKinsey consultants and jail officials rigged the process for positive numbers by moving inmates they believed to be less violent into the units McKinsey was managing. McKinsey denied ProPublica’s charge.

Anne Spaulding, a former associate medical director for Georgia Correctional HealthCare, found it odd that McKinsey suggested in documents sent to Georgia officials that it had experience in addressing prison violence.

“They are touting their experience in reducing violence," Spaulding said. "When did they gain this?”

McKinsey faced criticism in 2019 after a separate ProPublica/New York Times investigation found the company proposed significantly cutting food, health care and supervision costs at immigrant detention centers, causing alarm among Immigration and Customs Enforcement employees. McKinsey disputed that report as well.

Spaulding, an Emory University epidemiology associate professor, said the state should be more transparent about the process of planning to privatize.

“We as taxpayers are paying for it," she said. "We should know what we are buying.”

Craig Jones, a Wilkes County attorney who has represented numerous inmates alleging poor medical care, said the motive to turn a profit tends to lead contractors to cut corners.

“They’re doing it for profit and they’re doing it on a fairly thin margin because they want to be the low bidder," he said. "The people who end up suffering are the inmates. The state ends up getting sued. The medical provider ends up getting sued. (The state) may save in one way but end up paying in another.”

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