Critics Assail UConn’s $98 Million Deal For Prisoner Health Services [Hartford Courant]

March 14, 2011

Some Say Contract Should Be Bid, Services Could Be Better

By Josh Kovner
Hartford Courant
Story as it appeared in the Hartford Courant on March 14, 2011

March 14, 2011— The UConn Health Center for the last 13 years has provided mental-health and medical services to the state prison system under a no-bid agreement with no expiration date — a deal that is now drawing increasing criticism in the face of the state’s projected $3.7 billion deficit.

The program’s cost for this fiscal year will be $98.6 million, up from $92.9 million last year. The health-center division that performs the services, Correctional Managed Health Care, has 807 full- and part-time employees.

The price tag and insular, non-competitive nature of the program have some lawmakers and human-service advocates suggesting that it should be put out to bid or at least opened up to competitive negotiations with other quasi-public or private providers.

The health center’s precarious financial position is also playing into the discussion. Gov. Dannel P. Malloy’s budget chief acknowledged that if UConn were to lose the arrangement with the Department of Correction, the state would have to increase its subsidies to the center in other areas.

The problem, say legislators and human-service advocates, is this: The UConn Health Center may be doing a good job at an acceptable price in a difficult prison environment, as correction officials maintain, but that proposition can never be proven without subjecting the arrangement to competition.

“For nearly $100 million, taxpayers should know what the gold standard is for mental-health services in our prisons,” said Vivien Blackford, a former state human-rights commission member who sits on a newly formed sentencing review board.

The arrangement exists in a murky area of state procurement law. Bids are required under most circumstances when a state agency goes shopping for a private vendor. But in this case, the health center and the Department of Correction are both entities of the government, one providing services to another. They call their arrangement a “memorandum of agreement,” rather than a contract.

“This has been in place since ’97 – there’s no transparency, there’s no bid,” said Republican state Sen. Rob Kane of Watertown, ranking member of the legislature’s appropriations committee. “Is it plausible to have a private, for-profit, provider perform these services?”

A newly proposed bill would wipe out any remaining exceptions to state laws that already ban no-bid contracts in most cases, though it wasn’t immediately clear if the UConn-correction department arrangement would be affected.

Correction department spokesman Brian Garnett said he’ll let the legislature decide the fate of the arrangement.
He said the agreement “has been updated over the years, most recently last fall, with a major re-write currently underway. … It details required mental health services and requires a comprehensive performance audit of the healthcare program at each facility every six months to evaluate compliance.”

UConn Health Center officials referred questions about the program to the correction department.
The health center quietly entered the prison health care business in the late 1990s.
A program overview from 2005 says that a 12-bed inpatient unit for inmates opened at UConn’s John Dempsey Hospital in 1995. Two years later, the report says, “the UConn Health Center assumed all health-service provision from the Department of Correction in November 1997.”

There are roughly 17,900 inmates in state prisons and 4,700 inmates in community-based programs. About 18 percent of the inmate population has mental illness.

Finding acceptable alternatives to the UConn deal may be difficult.
Private providers of prison health care have had their share of problems across the country.
“We’ve got lobbyists [for some of the private providers] marching around the Capitol; some of whom want to introduce themselves to me,” said Ben Barnes, budget chief for Gov. Dannel P. Malloy.

“Their interest is understandable,” said Barnes. “This is a lucrative piece of business that private providers very much want. Any change would have to be done gradually, with great caution.”

And then there’s the health center’s financial problems.
“They’re in horrible financial shape. We already heavily subsidize them. It’s money one way or the other,” said Barnes.

There’s also a larger problem that goes beyond the health center and the correction department. Advocates for people with disabilities and civil-rights lawyers say there are too many people in Connecticut’s prisons who are there because they are mentally ill, not because they are dangerous, violent criminals.

Michael Lawlor, Malloy’s chief of criminal justice planning and policy, said that too often defendants with mental problems who can’t make bail end up at Garner Correctional Institution in Newtown, the treatment center of the prison system.

The Garner inmates range from convicted murderers who are profoundly mentally ill to low-risk inmates with much milder conditions.

A veteran state corrections officer who works at Garner said officers widely believe that the more functional inmates “manipulate the system” by faking symptoms or “hurting themselves” to get to Garner, or to stay there.

“Some inmates are really sick,” the officer said, “but Garner has become a recreation center.”
The Garner facility, said Lawlor, “has created a ‘build it and they will come’ situation. Garner is a modern mental hospital inside a modern prison, and it’s extraordinarily expensive. So here’s the dilemma: keep on stacking resources and expanding mental health services in prison, where the state gets no reimbursement from Medicaid, or develop other options in the community.”

Inside prison walls, inmates have a constitutional right to medical and mental-health care, but the federal government does not reimburse the states for those costs.

Barnes said he’s not aware of any concerns with the health center’s performance in the prisons, and, as a result, tinkering with UConn’s agreement with the correction department “will not be a priority of this budget cycle.”

But advocates say there are problems with the quality of medical and mental-health care.
David McGuire, a lawyer with the Connecticut Civil Liberties Union, said complaints from inmates about treatment delays and the quality of care are increasing.

“Seventy-five percent of the letters we receive from inmates concern inadequate health care,” McGuire said.
Nancy Alisberg, a lawyer with the state Office of Protection and Advocacy for Persons With Disabilities, also reported an uptick in complaints. She said her office has increased its monitoring of mental-health and medical care in prisons.

The protection and advocacy office and the American Civil Liberties Union sued the correction department in 2003 over substandard handling of mentally ill prisoners at the maximum security Northern Correctional Institution in Somers. The two sides reached a settlement in 2004 that, among some other reforms, increased access to the treatment programs at Garner for some mentally ill inmates who had been segregated at Northern. But the settlement expired in 2007.

James McGaughey, the executive director of the protection and advocacy office, said he feels the UConn-correction department agreement “is problematic,” but that providing mental-health and medical services at a consistently high quality in a prison environment is extremely difficult under any circumstance.

He recalled a visit to Garner: An inmate in his 20s stood in the front of his cell and screamed non-stop for the duration of McGaughey’s time there. He viewed a counseling session in which the counselor sat in the middle of a semi-circle of inmates who were seated in individual cages. The cages are used so correction officers don’t have to be in the room during the sessions.

“Not your typical therapy group,” McGaughey said.
UConn officials have said in public testimony that they are trying to control costs. They acknowledge in reports that overtime and the timely filling of vacancies in nursing services and other professional ranks have been an issue.

Dr. Robert Trestman, the correctional health care program’s director, told the appropriations committee in testimony in December that the number of inmates behind bars has declined in the last three years, but the percentage of those prisoners with mental illness has increased.