Private companies such as CMS operate much like HMOs, trimming costs by streamlining and bundling services. CMS saves money, for instance, by having its own "fax and fill" pharmacy: Orders are sent to a central office in Oklahoma and prescriptions are sent from there to sites around the nation. The company also plans to use "telemedicine," a system whereby doctors use digital medical records to treat inmates from remote locations. Sheehan says another big savings will come from the way CMS contracts for hospital stays. In the past, the DoC reserved an entire ward at Regions Hospital for its inmates, an arrangement Sheehan deems "wasteful"--only a few of the 15 beds were occupied at any one time. CMS, on the other hand, has subcontracted for just three beds at Mercy Hospital.
There's more at stake here than dollars, argues Mohamedu Jones, staff attorney with the American Civil Liberties Union's Washington, D.C.-based National Prison Project. "These companies make money three ways: staffing, pharmaceuticals, and care," says Jones. "And the manner in which they do this is contrary to the Hippocratic Oath and the U.S. Constitution." According to Prison Project studies, CMS and other firms cut staff sizes to the bare minimum, limit the quantity, quality, and variety of medications they warehouse and dispense, and employ licensed practical nurses instead of registered nurses, who have more training but command higher salaries. "The big question is whether states actually save money," Jones contends. "What they end up saving often goes to paying for lawsuits."
Of course, Minnesota's prison infirmaries didn't boast spotless records during the period when state employees were running the medical show. In 1994, for example, Stillwater Prison faced a pair of wrongful-death lawsuits after two inmates there died within weeks of one another. (The cases were chronicled in "The Lonesome Death of Gregory Stampley," a February 1994 City Pages cover story.) As a result of the suits, the state agreed to improve protections for inmates with mental illnesses.
Lawsuits are the price of working within the correctional systems, argues Sheehan, who adds that the state has a number of safeguards built into its contract with CMS. "We have final say over the doctors and staff hired by the company, and if staffing falls below 90 percent of the minimum staffing requirements for more than 30 days, the company has to subtract the equivalent of that position's salary," she notes. In addition, Sheehan says CMS must submit weekly and quarterly reports, and its employees are to be monitored for compliance with accepted medical procedures. "We still have an obligation to manage that contract," asserts the prison health-services director.
That's what they all say, counters the ACLU's Jones. "Once a contract is signed, the state will back off and forget about it," he predicts. "That is, until something happens."