Special Report: U.S. jails are outsourcing medical care — and the death toll is rising

“A Reuters review of deaths in more than 500 jails found that, from 2016 to 2018, those relying on one of the five leading jail healthcare contractors had higher death rates than facilities where medical services are run by government agencies. The analysis assessed deaths from illness and medical conditions, suicide, and the acute effects of drugs and alcohol.

Jails with publicly managed medical services, usually run by the sheriff’s office or local health department, had an average of 12.8 deaths per 10,000 inmates in that time. Jails with healthcare provided by one of the five companies had an additional 2.3 to 7.4 annual deaths per 10,000 inmates. The death rates were 18% to 58% higher, depending upon the company.

[..] Corizon Chief Executive James Hyman said jail death rates alone were not a valid indicator of “the quality of performance … in what is a very complex population set.” He said the Reuters findings did not take into account the challenges of providing care to two distinct groups of inmates: Those who stay less than a month in jail and those who cannot afford bail or are serving post-conviction sentences.

[..] By 2010, nearly half the U.S. jails surveyed by Reuters had turned to privatized medical care. By 2018, 62% got privatized services.

Today, a handful of companies dominate the jail healthcare business: Wellpath Holdings Inc, NaphCare Inc, Corizon, PrimeCare Medical Inc, and Armor Correctional Health Services Inc. The largest, Wellpath, is owned by a private equity firm. An investment firm owns Corizon. NaphCare, PrimeCare and Armor are privately owned.

[..] no large-scale studies have been conducted to assess privatization’s impact on inmate mortality.

[..] Contracts with private providers sometimes lack quantified standards for care, Reuters found, such as staffing requirements or protocols for inmate health evaluations or hospitalizations. Such problems can occur in publicly run systems, but they aren’t locked into contracts or dependent upon profits.

Size can also play a role. Big jurisdictions are more likely to have publicly managed inmate care under the aegis of a health department, Reuters found. Small to midsize counties, often operating with tight budgets, are more likely to hire private firms.

[..] “What statistics can’t explain, and many in the public do not know, is that the first day ‘behind bars’ for most of our patients is the first time they receive essential medications, medical care, and behavioral healthcare,” Armor wrote. Inmates bring “incomparably unique healthcare challenges.”

Some industry adversaries say companies have an incentive to cut costs. “It is a one to one, dollar to dollar, relationship between denying care and profit,” said Savannah lawyer Will Claiborne, who represented Loflin’s family in a lawsuit against the jail and Corizon that settled last year.”

Full article, Szep J, Parker N, So L et al.