Ask Alexandra Morgan-Kurtz about the quality of medical care at the Allegheny County Jail and there’s an uncharacteristic pause.
“I’m trying to think of a polite way to say this,” says the staff attorney of the Pennsylvania Institutional Law Project. “Probably the worst health care in the state I’ve seen when it comes to prisons and jails.”
Problems related to health care at the county jail are hardly new. But after a March 23 City Paper story revealed that the state American Civil Liberties Union had launched an investigation into the jail’s distribution of HIV medication to inmates, fresh questions are being raised about why these problems have persisted and who is ultimately responsible for finding solutions.
“There’s not one person you can point to and say, ‘You made that decision; you have to fix it,'” Morgan-Kurtz says. “That’s a huge part of the problem. There is no one to hold the jail accountable.”
According to the ACLU, jail medical staff have not been providing HIV medication in a “timely and consistent way.” Regular HIV testing isn’t being conducted, the ACLU contends, nor is the jail keeping tabs on the levels of virus in the blood of infected inmates, providing sufficient “pre-release counseling,” or offering enough medication upon release.
But medication-delivery problems at the jail aren’t HIV-specific: “I don’t think HIV/AIDS patients are getting some kind of uniquely bad care,” says state ACLU Legal Director Vic Walczak. “It’s emblematic of what’s happening in the [jail] health-care-delivery system as a whole.”
Concerns about medication delivery were echoed by advocates and outside providers who consistently visit the jail.
Charles Christen, executive director of the Pittsburgh AIDS Task Force, an organization that has worked with inmates at the jail, says PATF has received complaints about a lack of HIV medication.
Testing and treatment are “really important, especially when you’re talking about a system where men are living together in an enclosed environment day after day,” Christen says. Missing doses of HIV meds can lead to future drug resistance and higher levels of virus in the blood, which makes spreading the disease more likely, a problem for inmates as well as for the general public when inmates are released.
Problems related to appropriate delivery of medications and staffing levels were also part of a scathing report released last December by Allegheny County Controller Chelsa Wagner, who told CP that the ACLU’s findings “certainly don’t surprise me.”
But figuring out who is ultimately responsible is not a straightforward task. Jail health care is directly administered by Corizon Health, a company hired in September 2013 as part of an effort to control rising costs and improve care. (Corizon receives about $11.5 million per year from the county.)
After refusing to grant an interview request, Corizon released a statement through a third-party public-relations firm that read, “We take seriously the concerns of patients, their families and the community related to clinical quality, especially when it comes to the treatment of HIV/AIDS … many of the allegations made in this article are untrue” — a reference to the ACLU’s claims. A spokesman would not elaborate on which claims they believe are untrue.
County spokeswoman Amie Downs wrote, “Providing jail medical care is challenging and there will always be issues that will need to be addressed. That being said, the administration is working alongside its numerous stakeholders to constantly address and improve the provision of medical care, and will continue to do so.”
Warden Orlando Harper declined comment via Downs, and the county would not answer specific questions about potentially inconsistent medication delivery. “In regards to your question on the HIV/AIDS policy, you will need to contact Corizon directly as that is a medical-care policy question,” Downs wrote.
But Marc Stern, a former assistant secretary for health care at the Washington State Department of Corrections, says municipalities can’t simply pass responsibility for poor health care to contractors.
“A lot of places privatize because they don’t understand health care and … understand it’s a high-risk, high-cost part of their jail,” says Stern, now a correctional health-care consultant and public-health professor at the University of Washington. “Many jail administrators misunderstand that you can’t contract away all your liability in providing constitutionally appropriate health care.”
The county controller approved a position on Dec. 9 for a “Healthcare Contract Monitor,” according to the controller’s office, but it is no longer posted and the position was not filled.
There can be good reasons to privatize, especially if a private company can offer more competitive salaries and attract talent, Stern says. But municipalities still have an obligation to make sure the terms of that contract are being met. And he says, “If you’re going to have that much expertise anyhow, I don’t think it’s a big leap to say, ‘Why not just operate it ourselves?'”
The larger issue, according to Stern, is not whether medical care is provided by a private company. (Stern formerly worked for a company that later became part of Corizon.) It’s overall funding. “I think we focus on: ‘The company’s trying to make a profit.’ You get the outcome that you paid for; [municipalities are] not willing to put the money into correctional health care that it needs,” he says.
But whatever the cause of the problems it alleges, the ACLU is continuing to investigate and could move in the direction of a lawsuit “if we don’t see any kind of improvement,” Walczak says.
“We’re not talking about not getting your aspirin; this is a whole lot more serious than that.”
This article appears in Apr 1-7, 2015.
