Privatization and Deathly Health Care in Prisons                        July 2005
 
Are those who prescribe or advocate privatization as the key to more cost-effective government ethically responsible when their prescriptions and advocacy cause serious harm?
 
Between 2000 and early 2005, there were 23 deaths attributed to inadequate medical care in a state's county jails. The care provider was a for profit firm specializing in prison and jail health care, Professional Medical Health Services (PMHS). The company is a leader in an industry that reaps in $2 billion a year. For profit firms provide about 40 percent of the health care in prisons and jails in the U.S. However, there are only a handful of companies that routinely bid on providing services to county, state, and federal prisons. The competition is so stiff that some health care specialists say companies make bids that require cutting corners. PMHS provides care to over 200,000 inmates in 28 states. Its track record is decidedly mixed. Some counties will not contract with it even if it is the lowest bidder.
 
Here are accounts of three cases.
 
"It's only a matter of time before they kill someone," said Dr. Jane Jones. "I knew there was going to be a death. I could feel it." She quit a few months before Steve Marks Jr. died. He was born prematurely to a 22 year old mother in a maternity cell in a county jail. A nurse found the mother sitting on the toilet crying, with blood everywhere. Assuming that the inmate had miscarried, the nurse tried to console and clean her up. The nurse never looked for the baby. He was found in the toilet by a guard who was instructed, by phone, to look for it by ambulance personnel en route to the jail. The guards, with no experience in birthing babies, did their best to save the boy, who was taken to a hospital only to die three days later. The mother, who had tried to hide a friend's illegal drugs from police during a traffic stop said, "I know what I was doing was wrong, [but] I can't find a reason why a baby had to die." The nurse was placed on a year's probation and fined $500.
 
Richard Smith was confined to a jail cell in another county of the same state. He was struggling with Parkinson's disease and needed 32 pills a day to quell his tremors. The jail's medical director withheld all but a few of these. Over a 10 day period, Smith became unable to move, lost consciousness and was soaked in his own urine and sweat. The jail's nurses believed he was faking. He suffered great pain and died of septic shock.
 
It also took only 10 days for Vanessa Brown to die of a heart attack at age 35 in another of the state's county jails. She told a nurse, "My chest is tight and burns, my arms are numb." She had an EKG, which showed a heart problem. She was given drugs for intestinal problems and Bengay topical ointment. She died a painful death and apparently unnecessary death.
 
I ask once more: “Are those who prescribe or advocate privatization as the key to more cost-effective government ethically responsible when their prescriptions and advocacy cause serious harm?”
 
 
The cases are based on actual occurrences. The names of all parties and entities have been changed.
 
Submitted by: David Rosenbloom, American University (dhrosenbloom@verizon.net)
 
Adapted from Paul von Zielbauer, "Private Health Care in Jails Can Be a Death Sentence," New York Times, nytimes.com, dated February 27, 2005, downloaded March 1, 2005. http://www.nytimes.com/2005/02/27/nyregion/27jail.html