Questionable Business of Correctional Healthcare

(The following is an excerpt from the third article in the three-part series of the TransBorder Project: Medical Claims and Malpractice in a West Texas Immigrant Prison. Read the entire article.)

In Pecos, inmate complaints about healthcare at the Reeves County Detention Center in West Texas are commonly dismissed as whining and grandstanding. “They don’t have to work, they have all their utility bills paid, they get to play five hours a day, and plus they get medical attention,” said one county official. “If only the whole county should have it so good!” When asked about the liability that the county may face if the inmates take their cases to court, County Attorney Alma Alvarez said she was not worried, noting that GEO and PNA had recently secured accreditation for the prison from both the American Correctional Association and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). After visiting the prison herself, she said that she is confident the medical care is up to or above standards. But she acknowledged that she never spoke to any of the inmates about the quality of medical care, but only to the administration. Concerning the prisoner complaints made during the riots, Alvarez said, “They want to be media stars. They call the media from their cellphones and tell these stories because they want to be famous. It’s like they want to be on American Idol.” Noting that she was of immigrant origin herself, Alvarez said she had little sympathy for the protesting prisoners. “They are living well in there. Just imagine if they were in prison across the border in a Mexican prison,” she exclaimed. But it’s the comparison to conditions just outside the prison that really annoys the county attorney. “Inside the prison they are getting medical care far superior to what most people of this county get,” she observed. “And they even want dental care! Go and ask people here in Reeves County when they last had their teeth cleaned.” What also bothers Alvarez and many Reeves County residents is that the rioting inmates were destroying county property that they the taxpayers would need to pay for. “This is going to cost us,” said county treasurer Linda Clark. “It will take away from the small profit we make on the prison.” The multi-million contract with PNA doesn’t seem to bother the county. Before 2002 the county subcontracted with local care providers and foreign medical graduates (FMGs) to meet its obligations under its contract with the Bureau of Prisons. However, concerned about mounting costs and worried about the renewal of the BOP contract, the county hired PNA to assume responsibility for all medical, psychological, and dental care. That contract is now costing the county nearly $8 million a year in addition to the $800,000 it pays in medical liability insurance. That’s a large sum in a country where one in three lives in poverty, and the total county budget is only $79 million. Reeves County pays PNA $5.85 per day per inmate for its services. While few county residents are aware of what they are paying in correctional healthcare, there appears to be widespread resentment that immigrant prisoners are getting better care then they as U.S. citizens and county taxpayers receive. GEO Corp and PNA have refused to comment on inmate complaints about the poor quality of correctional healthcare at the immigrant prison, and some two-hundred prisoners and their families vow to take legal action against the public/private prison complex.

Read the entire article

Photo: Vernon "Trey" Farthing, founder and president of Physicians Network Association

Napolitano's Hard Echo of Liberal Immigration Strategy

(Following is an excerpt of news analysis from CIP America's Program. Read entire analysis.)

 Homeland Security Secretary Janet Napolitano shows few signs of reining in the immigrant crackdown launched by her predecessor Michael Chertoff. She recently called for "more boots on the ground" along the border and touted her determination to promote the "rule of law" in immigration enforcement.

 The "rule of law" framing of immigration policy copies the language of the Bush administration and the agenda of the immigration restrictionists. The apparent continuity between the enforcement agenda of Chertoff and Napolitano alarms advocates of comprehensive immigration reform (CIR).

 But Napolitano's tough talk on immigration enforcement reflects key components of the new messaging of the leading CIR advocates in Washington. As the immigration debate has shifted to the right, liberal groups like the National Immigration Forum, America's Voice, Center for American Progress, NDN, and National Council of La Raza have also been calling for an immigration reform that "secures the border" and "restores the rule of law."

 As a strategy to build center-right support for comprehensive immigration reform, including legalization, the Washington, DC-based liberal immigration lobby has advocated that the Democratic Party and all immigrant-rights advocates adopt a "rule of law" framework that includes more border security and employment verification while placing the onus on immigrants themselves to "get right with the law."

 The concept behind this strategic maneuvering is that Americans will support a legalization provision for illegal immigrants if the proposal is couched in tough "rule of law" language. In other words, by moving to the right immigration advocates would be better positioned to advance a liberal immigration reform. Thus far, however, this pro-immigration strategy of talking tough to advance CIR has fallen flat.

The Bush administration used the "rule of law" position on immigration to rationalize the immigrant crackdown. The Obama administration to date has shown few signs of backing away from the Bush administration's enforcement-first regimen. The "rule of law" logic of border control and immigration enforcement continues to dominate the immigration debate in America. In a Feb. 16 interview with NPR, Napolitano signaled her intention to embrace that agenda.

"First of all, the rule of law applies on the border, and we want to make sure that that happens, No. 1. That means manpower. That means technology—things like ground sensors. It means interior enforcement against those who intentionally are going into the illegal labor market and creating a demand for illegal laborers, so that's all going to continue. How we do that may change with me as a new secretary, but we want to make sure the rule of law is applied, and it's applied fairly and forcefully across the border."

Like Chertoff, who frequently explained the Bush administration's "enforcement-first" regime as an effort to "restore integrity" to immigration law and border control and thereby create a foundation for immigration reform, Napolitano sees enforcement and border control as laying the groundwork for immigration reform.

Medical Claims and Malpractice at West Texas Immigrant Prison

Part II PNA's Medical Gulag

Physicians Network Association (PNA), a Lubbock-based company that calls itself a leader in correctional healthcare,” has subcontracted with Reeves County since 2002.

As the owner of the prison, Reeves County has a contract with the Bureau of Prisons to hold fedeal immigrant prisoners. But rather than run the facility itself, the county subcontracts its responsibilities to GEO Group to operate and manage the prison and to PNA to provide medical and dental care. (See Medical Claims Part I)

In its presentation as part of the negotiations over its current contract with the county, PNA assured the county that “as a subcontractor, PNA has fourteen years’ experience assisting operators exceed expectations.”

PNA included GEO Group and Management and Training Corporation (MTC) among its references, and it told the county: “PNA has never had a contract canceled or been removed from a facility.”

It shouldn’t be surprising that long-running complaints about medical cars abuses sparked the inmate protests at the Reeves County Detention Center. Six years ago the Justice Department found widespread medical abuses at another county-owned, privately run adult detention center, where the same subcontractor, Physicians Network Association, was also the the medical services provider.

Concerned about civil rights violations at the detention center, the Justice Department sent a study team from its Civil Rights division to investigate the jail in May 2002 to determine if there were violations that could be prosecuted under the Civil Rights of Instiutionalized Persons Act (1997).

On March 6, 2003 the Justice Department sent a letter and a long report of its findings to Santa Fe County, which owned the jail and contracted with Management and Training Corporation (MTC), a private prison firm, to operate the jail.

Summarizing its findings, the Justice Department stated:

“We find that persons confined suffer harm or the risk of serious harm from deficiencies in the facility’s provision of medical and mental health care, suicide prevention, protection of inmates from harm, fire safety, and sanitation.”

In its report, the Justice Department team specified 52 actions that were needed “to rectify the identified deficiencies and to protect the constitutional rights of the facility’s inmates to bring the jail into compliance with civil rights standards. Thirty-eight of the 52 identified deficiencies related to medical services. The Justice Department report concluded:

“The Detention Center, through PNA, provides inadequate medical services in the following areas: intake, screening, and referral; acute care; emergent care; chronic and prenatal care; and medication administration and management. As a result, inmates at the Detention Center with serious medical needs are at risk for harm.”

(Read entire report on PNA’s Medical Gulag at: http://sites.google.com/site/transborderproject/medical-claims-and-malpractice-at-west-texas-immigrant-prison )

Political Economy of Immigration

(Here's an excerpt from a feature article in the current issue of Dollars & Sense, which is now available online here: http://dollarsandsense.org/archives/2009/0109barry.html ) What started off as a war against terrorism has devolved into a war against immigrants. The current “enforcement-only” approach to immigration policy has created a morass of new problems, including a host of human rights and financial issues associated with the annual detention and removal of immigrants. The immigrant crackdown has given rise to an unregulated complex of jails, detention centers, and prisons that create profit from the immigrant crackdown. At the outset of a new administration and new era, the political economy of immigration is decidedly anti-immigrant. Political and economic factors have combined to create a harsh environment for undocumented immigrants, present and future. Immigration reform may not be a top priority, but the Obama administration and new Congress would do well to begin to address the challenge of reshaping the political economy of immigration. First steps could include a more careful articulation of the intersection of immigration, rule of law, and national security. Napolitano should explain that the real threat to the rule of law is not having an immigration policy that provides a legal pathway to integration for the 11 million immigrants already within the United States. What’s more, she would do well to disarticulate the links established by the Bush administration between immigrants and terrorists. At the same time, closer links must be made between immigration policy and economic policy, guarding against labor exploitation while considering domestic economic need. Instead of a policy based on a calm assessment of the costs and benefits of immigrant labor to the U.S. economy, current immigration policy has been hijacked by the politics of fear, resentment, scapegoating, and nativism. The “enforcement only” immigration policy has fostered a national immigrant prison complex that feeds on ever-increasing numbers of arrested immigrants. As County Commissioner Ernie Chapa said, “Any time the numbers are high, it’s good for the county because it brings more income.”

Medical Claims and Malpractice in West Texas Immigrant Prison Part I

The failure of the Reeves County Detention Center in West Texas to provide adequate medical care spurred immigrant inmates to occupy the prison yard and set fire to prison buildings two times in the past few months.

But neither the government officials in charge of this county-owned prison in Pecos nor the private companies that run the prison and provide healthcare services have commented on prisoner complaints. Information about the state of medical care at the county-owned, privately operated prison have come almost exclusively from inmates themselves in calls to relatives and the media from smuggled cellphones. Reeves County, a desolate West Texas county of some 13,000 residents, built the 3,700-bed prison with revenue bonds, which it repays from per-diem payments from the Federal Bureau of Prisons in exchange for holding “criminal aliens” in this low-security prison. The county, however, has subcontracted out its imprisonment responsibilities to GEO Group, which manages the prison, and Physicians Network Association (PNA), which provides medical and dental care. PNA, which calls itself “a leader in correctional healthcare,” is part of the expanding prisoner outsourcing industry. Founded in 1990, Lubbock-based PNA contracts with private prison companies and with counties that own prisons in Arizona, New Mexico, and Texas. It has two-dozen medical services contracts, including ten with GEO Group (formerly Wackenhut Corrections), the private prison corporation that operates and manages the Reeves County prison At the Reeves County Detention Center, PNA provides correctional healthcare under a lucrative contract with the country government. The country receives between $45 and $55 per day per inmate it receives from the Federal Bureau of Prisons. All of the some 3500 inmates at the Pecos prison are noncitizens, illegal and legal immigrants that are serving time for federal charges, mostly drug possession and immigration violations. For each inmate, PNA receives a $5.85 per diem from the county, which took $7.7 million bite out of the county’s $79 million budget in 2008. In addition, the county covers itself with a $0.8 million annual medical malpractice insurance policy – which will protect it in the event that prisoner complaints about medical abuses are substantiated in court and by federal investigators. When PNA renegotiated its contract with Reeves County in 2006, the company said that it had the experience “to provide excellent, cost-effective, and constitutionally appropriate care.” It boasted, “We have a deep understanding of inmates’ healthcare needs.” Noting its history of medical care contracts with GEO, Corrections Corporation of America (CCA), Emerald Corrections, and Management and Training Corporation (MTC), PNA asserted that it “has never had a contract canceled or been removed from a facility” and was “proud of its record of no substantiated grievances in any facility.” PNA has provided medical services at the Reeves County Detention Center since 2002. At a commissioners’ court meeting in November 2002, prison officials explained why it was necessary to contract with an outsider provider rather than rely on the local doctors and hospital. Warden Rudy Franco told the meeting that of the many problems encountered in the prison “the hardest has been medical.” That’s because the inmates have a tendency to be more demanding. According to Franco, as reported in the Pecos Enterprise (11/25/02) a provider not accustomed to dealing with inmates would inadvertently provide the inmate with medication and other medical provisions that he doesn’t necessarily need. For the county commissioners, worried about healthcare expenses, the decline in surgeries, outside medical visits, and x-rays was impressive. As Franco explained, in the first four months of the PNA contract, compared with the previous seven months, the number of outside medical visits dropped from 59 to four, the number of surgeries decreased from 15 to two, and the total incidents of medical services declined from 3,148 to 222. “We had 101 x-rays and we now have had four since we went with PNA,” exclaimed Franco. Asked by commissioners about the comparative costs, Asst. Warden Tommy Duncan said “That’s a $400,000 savings” with PNA. Duncan said later that the county will also save money because PNA would be installing the communications technology that would allow inmates to consult with a doctor through “television” rather than incurring the expense of on-site visits. (Medical Claims and Malpractice, Part II PNA's Medical Gulag in next post)

Immigrant Inmates Caught in Outsourcing Complex

(Below is an excerpt of a new article on immigrant prisons. Entire article is at: http://sites.google.com/site/transborderproject/immigrant-inmates-caught-in-outsourcing-complex )

The launching of the “drug war” that resulted in mass imprisonment of drug users and low-level street distributors set the stage for this new era of prisoner outsourcing. Faced with rising number of convicted prisoners and the rise of illegal immigration, public prisons and detention centers became overcrowded. But there was little political will either at the federal or local level to use tax money to build new prisons. Conveniently, the rise of the political right in the late 1970s and especially during the Reagan administration brought with it a new widely shared ideological conviction that favored government downsizing and privatization. In 1983, faced with increasing numbers of detained immigrants, the Immigration & Naturalization Service with the blessing of President Reagan began outsourcing immigrants. While INS took the first step toward outsourcing federal detainees to private prisons, the U.S. Marshals Service and the Bureau of Prisons eventually followed. At first, most of this outsourcing went directly to private firms. Corrections Corporation of America (CCA) and Wackenhut got their start in the prison business as outsourcers of detained immigrants for the INS in 1983-85. Over the last couple of decades, county governments have joined the prisoner outsourcing bandwagon, commonly in collaboration with the private prison industry. CCA, GEO, and other private prison firms have seized on the opportunity of public financing to build and maintain the prisons they operate. Today, there are scores of counties that have followed the example of Reeves County, building new prisons with project revenue bonds to house outsourced prisoners from federal agencies and state governments. These generally poor and rural counties now constitute a central component of America’s prison outsourcing industry. What started out as a privatization of a core responsibility of government has over the past twenty-fives years has evolved into a prison complex in which private investors and corporations are dominant but in which local government has a new and expanding role. As seen in Reeves County, the prison business is a complex labyrinth that is run for profit by corporations such as GEO. Yet the booming private prison industry in Pecos and elsewhere is fundamentally dependent on government for a steady supply of prisoners, for ever-increasing per-diems, and even for the capital to build and maintain the prison complex. When the Bureau of Prisons signed the most recent contract with Reeves County to provide as many as 3,763 prison beds for “criminal alien residents,” it was GEO Group, not the county, which announced the new contract. In its January 2007 media release to business publications, GEO Group boasted that it believed “that the Reeves County Detention Complex (the "Complex") is the largest detention/correctional facility under private management in the world.”

It’s a part of a yet larger complex that is immensely profitable. At a time when most other industries are retracting, the private prison industry continues to boom. GEO Group experienced another record year in 2008, as its net income rose more than 14%.

Key to the prison complex’s lustrous bottom line are the outsourced immigrant inmates of Reeves County. Even as they rioted to demand decent health care, these outsourced immigrants were a major source of profits for the private/public prison complex.

Imprisoned Immigrants Riot, Prison Contract Missing

Immigrants got both the federal government and corporate America started in prisoner outsourcing business. That was in the early 1980s during the first Reagan administration when the Immigration & Naturalization Service started farming out immigrants for corporate detention. Today, the business of imprisoning immigrants is central to the booming private prison industry. But associated problems – inmate deaths, lack of transparency, rioting, patterns of abuses, and medical care deficiencies – are raising new questions about the advisability of making imprisonment profitable in America. Two companies with close ties to the Republican Party – Corrections Corporation of America (CCA) and Wackenhut (now GEO Group) – received the first INS contracts. Over the past quarter century those companies have developed into the world’s two largest private prison corporations. Immigrants remain central to the booming private prison industry, but the fate of these outsourced immigrants has become the center of a new public debate about private prisons. In particular, the mounting number of deaths of immigrants at prisons owned or operated by private prison firms has focused new attention on what critics call the private prison complex. In mid-December 2008 immigrants imprisoned at a prison in Pecos, Texas rioted after the body of a prisoner was removed from a solitary confinement cell. Rioting inmates took two guards hostage and burned part of the prison to raise attention to their charges that the prison wasn’t providing adequate medical care. The Reeves County Detention Center, which is owned by the county, is managed and operated by GEO Group. Most of the inmates are Mexican nationals who are serving time for minor criminal offenses, mostly drug possession and immigration violations. Many are legal immigrants who are designated “criminal aliens” and will be subject to deportation upon completing their sentences. On Jan. 31 inmates rioted again after another sick inmate was placed in solitary detention. Although the county and GEO released statements after two days claiming they had regained control of the prison, inmates confined to the prison yard set fire to another building the morning of Feb. 5. By the end of the day prison officials were once again asserting that they had the prison under control. While claiming that the issues leading to the riot were being addressed, the county provided no access by reporters or lawyers to the prisoners. County Judge Sam Contreras, the county’s top official, didn’t appear in his office at the county building the entire week of the riot. The Federal Bureau of Prisons (BOP) was mum (and still is). Ditto for the GEO Group’s management team at the prison, while GEO corporate headquarters has issued a couple of brief and vague statements. The only detailed information about conditions inside the prison and the issues that sparked the rioting has come from calls by inmates to relatives and the media from contraband cellphones. As smoke billowed from the 3,700 inmate prison that lay on the outskirts of this downtrodden West Texas town, the hunt began for information about the Pecos detention complex. Even though the prison is the county’s largest employer – by a wide margin – and its main source of revenue (and debt), there is little public information readily available. Asked to see a copy of the contract with the Bureau of Prisons that has made Pecos the prison capital of West Texas, a spokesman for the county judge’s office said that they were trying to locate it but they and wasn’t certain that it could be released in its entirety. Despite repeated requests by reporters covering the riot, the county kept stalling, although promising that the state’s public records act would, eventually, be respected. Meanwhile, County Clerk Dianne Florez, who has since being elected in 1994 served as the country official in charge of public records, said that neither the current judge nor the previous judge gave her office the Bureau of Prisons contract. “I am trying to do my job,” she said, “but I can’t make public records available to the public if I don’t have them.” “If you ever get hold of that contract, please let me make a copy of it,” Florez said.

Photo by Tom Barry