State withholds prison medical payment

5th May, 2005
The Birmingham News
Carla Crowder

Alabama's prison medical provider is losing $1.2 million from the state because it has not provided enough doctors and nurses to state prisons.

Prison Health Services has not fulfilled minimal contract requirements that call for a certain number of doctors, nurses, administrators and support staff. The company is not being fined, Department of Corrections spokesman Brian Corbett said, but DOC will not have to pay $1.2 million of its contract.

The department hired PHS in November 2003. The company's three-year, $143 million contract could see more reductions if the medical staff does not increase.

A new accountant will soon be hired to "assist in the ongoing analysis of all financial aspects of the ADOC health services program," Corbett said.

That includes figuring out how much money the state is owed for empty positions. Corbett referred questions about how many empty slots there have been to PHS; the company could not provide that information Wednesday.

Previously, an outside monitor, Correctional Medical Management of Nashville, tracked staffing and other contract matters, but its contract ended in March.

Tennessee-based Prison Health Services also has come under fire in recent months by physicians who are monitoring two prisons under federal court settlements. A lawsuit alleging inadequate medical care is pending at a third prison, the Hamilton Aged and Infirm facility, where the oldest, sickest men are housed.

Dr. Michael Puisis, court monitor at Tutwiler Prison for Women, said in a March report that prison medical staff provided poor or incomplete care to three inmates who died last year. He suggested that negligence might have led to two of those deaths. The third, a suicide, was likely the result of inadequate care by mental health workers, who are employed by a different company.

Two deaths since then are still under investigation.

Monitor's report:

Dr. Joseph Bick, a California physician and court monitor at Limestone Correctional Facility's HIV Unit, found in February that patients were not getting critical medicines, that doctor turnover was frequent, and that no HIV specialist was on staff as required.

PHS doctors have said they have made improvements, including the addition of two nurses, mandatory training sessions for medical staff, and establishment of a hepatitis C treatment program, all part of a plan to improve conditions.

Still, attorneys for the Limestone inmates have asked the federal courts to hold the state in contempt for failing to abide by the conditions of the settlement.

Last year, the state agreed to dozens of improvements, centering on added medical staff and more humane housing conditions. Doctors keep leaving, some after claiming PHS did not allow them the flexibility and resources to practice medicine as they want to do.

"There are just as many complaints raised after the settlement as before," said Gretchen Rohr, an attorney with the Atlanta-based Southern Center for Human Rights, who represents Alabama prisons in both cases.

Magistrate to visit:

U.S. Magistrate John Ott plans to visit the Limestone prison, in north Alabama, and attend a conference that coincides with Bick's next visit, Rohr said.

"He hasn't been there before," Rohr said. "I think he'll find it quite helpful to have an understanding of plaintiffs' concerns."

There has been at least one recent death at Limestone, that of Willie Woods, 59. There has been no mortality review yet, she said.

PHS Vice President of Ethics Ben Purser said Wednesday that he did not have readily available a list of empty positions at Alabama prisons.

The $1.2 million in unfilled hours of service covers the period from May 2004 to February. There was no deduction the first few months of the contract because of a 180-day grace period to allow PHS to start work. Birmingham-based Naphcare had the contract before PHS.

Rohr said the $1.2 million is a step in the right direction.

"I encourage any creative way of getting PHS to do their job," she said. "We have definitely criticized the DOC for not coming down hard enough on the medical provider. ... They have so many avenues of assuring that PHS lives up to its end of the contract."