With contract out to bid, prison health care questioned

TONY WILLIAMS felt his leg snap when he jumped off a top bunk in a Philadelphia prison cell two years ago and landed awkwardly on the concrete floor. But a prison doctor called the injury a sprain and sent him back to his cell.

That misdiagnosis of a broken leg was just the beginning. Williams, incarcerated for a parole violation, was made to wait weeks for treatments, didn't receive rehabilitation after surgery and was repeatedly ignored when he complained of pain, according to a suit he has filed against the city and Corizon, a for-profit private firm that provides health care to the city's roughly 9,047 inmates.

"Trying to see a doctor is like trying to get out," said Williams, 30, who needs a brace and a cane because his leg didn't heal properly. According to a doctor's review ordered by his attorney, Williams' injuries are "both serious and permanent."

Williams is one of many who have filed suit against Corizon - a Tennessee-based firm formerly known as Prison Health Services - over the years. But city officials say they are satisfied with the service. And Corizon is looking to keep its multimillion-dollar contract, which recently expired, with the city.

"We do offer the same range of services someone would get in the community," said Prison Commissioner Louis Giorla, who said he didn't know the particulars of Williams' case. "In correctional health care, the level of complaints is very high."

Corizon last month paid a $1.8 million fine to the city for allegedly skirting minority-participation guidelines, but worked out a deal that preserved the right to bid on contracts. The previous contract expired, but the city granted an extension to Corizon while it seeks bids. Giorla said the new contract will be issued soon.

A spokesman for Corizon declined to make anyone available for an interview, saying in a statement that the firm wanted to stay out of the media during the contracting process and does not comment on pending litigation.

"What we can say is that our caregivers work hard every day to provide quality, compassionate care to our patients in the Philadelphia Prison System," spokesman Brian Fulton said.

Since 1995, the firm has been paid $196 million by the city for providing medical and pharmacy service. That includes hiring doctors and nurses, assessing inmates, doing sick calls and providing medication.

The local complaints over Corizon - which provides prison health care to 345,000 inmates in 29 states - are not unique. A recent court-ordered report in Idaho blasted Corizon, saying a poor quality of care constituted "cruel and unusual punishment" - allegations the company disputed.

Attorney Geoffrey Seay, who represents Williams, said he has seven current or pending suits against Corizon and the city.

"There is a pattern of negligence," he said. "They're not getting the proper evaluation, the proper treatment."

The city has paid out at least $1 million since 1995 to settle suits brought by former inmates over medical care, according to the city law department. Among the biggest settlements was $300,000 paid to a man who never received needed eye surgery while in prison and went blind in one eye. When a suit is settled, Corizon typically pays additional damages to the victim, the city said.

Corizon's contract with Philadelphia was terminated for several months in 2002 after complaints from prison advocates about a diabetic inmate, who died in 2000 after missing insulin treatment. But the city ultimately signed with Corizon again, citing affordability and pledging oversight.

Experts agree that prison health care is a challenge that requires catering to a growing population that often has serious health concerns like chronic illness and drug addiction. Ballooning costs have led many cities and states to outsource health care.

But prison advocates caution that you get what you pay for.

"I think we need to start with the proposition that if it sounds too good to be true it probably is. The private providers say they can do the same job, do as good a job, save money and generate profits for their shareholder," said David Fathi, director of the American Civil Liberties Union National Prison Project. "If they're going to try to do it more cheaply and at the same time generate a profit, they are going to cut corners."

Officials said that outside monitors visit the prisons twice a year and that the facilities meet national accreditation standards. Bruce Herdman, chief of medical operations for the prisons, said the full-time medical staff makes 145,000 sick-call visits every year.

Still, former inmate Lisa Holland says she didn't get adequate treatment during a recent jail stint. Holland, 46, was arrested July 12 on drug charges. Seay, who also represents Holland, said she is innocent but got taken into custody because her son was arrested for drugs.

When Holland was arrested, she wasn't permitted to take a dose of the morphine she needs to manage severe pain she has struggled with since a 2000 car accident damaged her spine and crushed her leg. By the time she got to prison, she was in severe withdrawal, vomiting and defecating. She said it was four days before a doctor sent her to the hospital.

"Every shift, every person I asked to take me to the hospital. I laid on the floor soiling my clothes," said Holland, who plans to sue Corizon and the city. "They treated me like a dog. They made me feel terrible."

Giorla said the prisons deal with a large number of substance-addicted people who experience withdrawal. He said inmates receive a medical evaluation to see if they need medications.

"If it's therapeutic and it's necessary and there's no substitution, we'll provide it. If it's not necessary, we won't provide it," he said.

Civil-rights attorney David Rudovsky said private health care in prisons requires substantial oversight.

"Whether it's Corizon or [Prison Health Services] or a new provider, in my experience, the problems of inadequate medical care [will continue] unless the city provides an adequate amount of money, the provider has some integrity, and there's some very detailed oversight," he said.