Eye On Boise

MONDAY, JUNE 6, 2011, 8:34 A.M.

Idaho prison health contractor fined $382K for big contract violations

Idaho's prison health care contractor, Correctional Medical Services of Creve Coeur, Mo., has been fined nearly $400,000 by the state for contract violations including leaving the South Boise Women's Correctional Center without an OB/GYN for two years, and leaving the Idaho Maximum Security Institution without a staff psychologist for at least eight months, when the contract with the state required vacancies to be filled within 60 days, the Associated Press reports. Furthermore, the state renewed its contract with CMS last year. The AP uncovered the fines through a series of public records requests; click below to read the full report from AP reporter Rebecca Boone.

Idaho fines prison health care company $382K
By REBECCA BOONE, Associated Press

BOISE, Idaho (AP) — The company responsible for providing medical care to Idaho prison inmates has been fined nearly $400,000 by state officials for failing to meet some of the most basic health care requirements outlined by the state.

The fines against Correctional Medical Services, totaling more than $382,500, were uncovered through a series of public records requests by The Associated Press.

Among the problems detailed in the records: The South Boise Women's Correctional Center was without an OB/GYN for two years, and the Idaho Maximum Security Institution was without a staff psychologist for at least 8 months. Idaho's contract with CMS requires that vacant positions be filled within 60 days.

The Creve Coeur, Mo.-based CMS bills itself as the nation's largest prison health care provider, caring for more than 250,000 inmates in 19 states. The private company, which merged with Prison Health Services on Friday and now goes by the name Corizon, has contracted with Idaho to handle medical care at all of the state-run prisons since 2005. Its new regional director for Idaho, Tom Dolan, says CMS has recently fixed the problems and the fines stopped a couple of weeks ago.

According to the records obtained by the AP, CMS had a long history of failing to meet contract standards. Nevertheless, Idaho officials turned down four other bidders and renewed the state's contract with CMS last year — not without some changes, however.

Idaho Department of Correction Director Brent Reinke said his department had learned that in order to get CMS to pay attention to problems, the state had to hit them in the pocketbook. The new contract steeply increased the amount of fines, called liquidated damages, that could be levied against CMS. More than two-thirds of the fines — $270,201 — have been brought under the new contract, which began July 1, 2010.

"They're bottom-line driven," said Reinke of CMS. "They have shareholders, so we're learning from them and they're learning from us."

Rona Siegert, the head of health care for the Idaho Department of Corrections, said the state's tactics are working.

"The money was racking up, and they've done a really great job of curing these and getting rid of the liquidated damages," Siegert said.

The fact that Idaho renewed CMS's contract after a competitive bidding process shows that the company has done a good job caring for inmates, said CMS spokesman Ken Fields. He said the fines accrued under the new contract were largely for new administrative and paperwork requirements that go beyond the national standard.

He said none of the issues had negatively impacted inmate patients.

Recruiting and retaining health care workers has "been a challenge," Fields said, because of a national shortage of health care workers. But the vacant positions — including the OB/GYN and psychologist vacancies — have since been filled, he said.

Some of the problems found by the state auditors involved the way CMS ran its non-emergency health care services, its infirmaries and extended care units, pharmaceutical operations and mental health services. The company's staff training, diagnostic services, record-keeping, chronic care planning, inmate screening and other services were also found to be deficient enough to warrant fines.

Despite the problems, IDOC officials maintain no inmate's health was damaged and no one went without medical care. Instead, inmates they were transported off-site — usually at the state's cost — or a doctor that worked for the state was brought in to fill the gaps. For instance, when the Idaho State Correctional Institution south of Boise went without a dialysis nurse for two months in 2008, the state had to transport several offenders to an offsite facility daily for several hours each day. The effort cost Idaho nearly $19,000 in personnel costs, an amount that it recovered from CMS through the fines.

The findings of some state audits of CMS's operations suggest that it was at least likely that some inmates had longer waits for care or didn't receive immediate care at all. For example, an audit found that inmates that were sick on the weekends weren't getting their requests for treatment triaged by medical professionals. Siegert said that if inmates were visibly sick, correctional officers probably would have noticed while making their rounds and would probably have gotten the inmates help.

But correctional officers are trained in security issues, not in how to determine if someone is seriously ill.

Inmates at the Idaho State Correctional Institution — where nearly all of Idaho's sickest inmates are housed — have long complained about the quality of medical care. In a class-action lawsuit dating back to the 1980s, ISCI inmates said they were forced to wait too long for medical care and in some cases were denied access to medical treatment.

Though the lawsuit began long before CMS came to Idaho, the inmates have used the testimony of a former CMS worker in an effort to show that the problems with medical care continue today.

Dr. Ralph Heckard, a primary care physician who contracted with CMS to treat inmates at the Idaho State Correctional Institution between June 2009 and January 2010, described several potentially serious problems in a court affidavit filed in the Balla case.

In his affidavit, Heckard said there was just one doctor for every 1,500 inmates, compared to a statewide average of one doctor for every 450 Idaho residents. He said ISCI had no pharmacist, and that often unlicensed and unauthorized staffers handled nursing duties, even giving inmates injections.

Prisoners frequently experienced weeks-long waits for medical care, Heckard said. One inmate had biopsy-confirmed cancer, and Heckard said CMS delayed providing the inmate with the recommended surgery and chemotherapy. Inmates with mental illness were deprived of necessary (and often expensive) medication because there was no psychiatrist to renew their expiring prescriptions and because CMS would not allow primary care doctors like Heckard to prescribe or renew any psychoactive medications, he said.

Fields said that Heckard's characterizations weren't accurate. Few prisons have on-site pharmacists, he said, and he noted that ISCI inmates get prescriptions within 24 hours, or sooner when necessary. During the period where the company didn't have an on-site psychiatric staffer, a psychiatrist from the corporate office and local community mental health professionals met the needs of inmates, he said. He also refuted Heckard's assertion that unlicensed professionals were administering health care.

CMS Regional Manager Tom Dolan addressed the Idaho Board of Correction during a meeting last month, telling the board members that when he took the Idaho job in February, "clearly there were some struggles at ISCI ... there was a lot of work for us to do."

But he reminded the board that CMS's Idaho facilities are beating Medicare and Medicaid standards for some markers of patient health, such as how many diabetic inmates show signs of serious illness.

In fact, he said, for the past two years in a row Idaho has won CMS's award for quality of care and clinical performance.

Copyright 2011 The Associated Press.

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Betsy Z. Russell
Betsy Russell covers Idaho news from the state capitol in Boise and writes the Eye on Boise blog.

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