Chances are you haven't heard of Correctional Medical Services. When the Minnesota Department of Corrections quietly inked a deal with the private firm in July to provide inmate medical care at prisons throughout the state, the agreement prompted nary a peep from the press. Based in St. Louis, Mo., Correctional Medical Services (CMS) is the leader in the burgeoning prison health-care industry, operating more than 340 sites in 30 states and pulling in more than $400 million per year. According to the DoC, Minnesota's three-year contract with CMS is worth in excess of $8 million annually and is expected to reap yearly savings of $2 million.
Though you might think such a cost-cutting accomplishment would be worthy of headlines, it went virtually unnoticed here. But outside Minnesota, CMS has been drawing a great deal of attention recently. In fact, even as the ink on the state's contract was drying, a team of investigative reporters at the St. Louis Post-Dispatch was putting the finishing touches on a massive story about inmate health care. The 12-page special report, published Sunday, September 27 (and available on the Internet at www.stlnet.com/postnet/news/prisoncare.nsf), revealed a system that is troubled at best, criminally negligent at worst: At least 20 inmates have died in the nation's prisons as a result of negligence, indifference, or cost-cutting techniques, the Post-Dispatch reporters found, and the courts are flooded with scores of medical-malpractice lawsuits filed by inmates.
At the center of the controversy: CMS.
Among the dozen or so incidents cited in the Post's piece was the February 1996 death of an 18-year-old inmate in an Alabama correctional facility. Calvin Moore, who had a history of mental illness, lost 50 pounds in less than a month under CMS's care and died as a result of dehydration and starvation just a few weeks into his two-year sentence for burglary. Three years earlier at another CMS facility, the Post reported, four inmates died after a nurse put the wrong chemicals in a kidney dialysis machine. And in May 1995 an inmate being treated by a CMS physician feigned paralysis, escaped, and murdered a man while free, according to the story.
The Post also documented cases in which the company has hired doctors with dubious pasts. The article described the case of Dr. Gail Williams, a former Michigan physician who had his license revoked in 1985 after engaging in sexual acts with a psychiatric patient and falsely billing the insurance company for the "treatment." Williams received a restricted license that permitted him to practice in prisons or other supervised settings and was hired in 1990 as head of mental services for the Oklahoma Department of Corrections. That license was revoked three years later, when Williams was accused of sexually battering and harassing a nurse and other female staffers. The women won a civil sex-harassment suit against the state's corrections department. CMS hired Williams in 1994 and helped expedite his licensing in the state of Alabama.
Yet another incident cited in the Post-Dispatch story involved Dr. Walter Mauney, a CMS medical director from 1995 to 1997. When Mauney was involved in a wrongful-death lawsuit, attorneys discovered that he had given "misleading statements" on his CMS job application: In reference to a 1979 conviction, Mauney claimed he'd been charged by a Tennessee grand jury for having consensual sex with an 18-year-old male (the age of consent was 19), when the actual charges involved "oral and penetrating" sex with a 16-year-old "mentally defective" boy.
In all, CMS acknowledged to the Post-Dispatch that more than 500 lawsuits are pending against the company, 29 of them involving inmate deaths. CMS also confirmed having paid out more than $4.1 million in indemnity claims between 1981 and 1994. (While this boils down to just $300,000 per year, actuarial tables place far less value on an inmate's life than that of an average citizen.)
Prison officials in Minnesota say they're well aware of CMS's record in and out of the courtroom, and they're confident in the company's ability to run a safe and efficient operation. That's why the company's bid was chosen from among proposals submitted by 58 firms. "I can't comment on the Missouri system," says Carol Sheehan, director of health services for the DoC, "but I can tell you that when we checked CMS's references, the state [of Missouri] and others are very pleased with them." (CMS officials initially consented to an interview for this story, but they failed to follow through with the scheduled interview. Subsequent calls to reschedule were not returned.)
In the past, state employees provided direct nursing care and mental-health and dental services for prisoners in Minnesota, while primary medical care--routine examinations, first aid, the dispensing of over-the-counter medications, etc.--was administered by independent contractors. Any inmate who required inpatient care was sent to Regions Hospital in St. Paul. That system, Sheehan and other DoC officials say, proved both inefficient and costly, earning Minnesota the No. 2 ranking in the nation for prison health-care costs. "At $10.90 we have the second-highest health per diem in the country," she says. Annually, Minnesota spends between $9 million and $10 million on its health-care contracts, Sheehan explains, adding that those figures don't include costs for transporting prisoners to off-site care or staffing clinics in the prisons. "The only state whose inmate medical costs are higher is Alaska," she says.
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."