Danger zone

A proposal to privatize jail health services comes with a potentially steep cost to inmates and the public



Rita Connolly, a registered nurse who has worked with inmates in San Francisco jails since 1985, says she'll never forget the time she had to act fast to save a prisoner's life.

The man had just arrived from a different jail and was waiting to go through intake. He was slumped over and looking ill, too weak to voice a complaint. Several worried inmates beckoned Connolly over, and once she examined him, she realized he was in the midst of a heart attack. He was rushed to the emergency room. He lived — but sustained irreversible heart damage.

"He could have been someone who didn't live," Connolly told the Guardian, but he also could have had a better outcome. The inmate had alerted someone that he was having chest pains earlier in the day, she later learned, as he was boarding a bus from an Alameda County Jail. A medical services worker examined him just before the bus left, but allowed him to proceed. By the time he arrived in San Francisco, the warning signals had progressed to a full-blown heart attack.

The story highlights an extreme example of a trend Connolly said she observes regularly — inmates from counties that use privatized jail health services aren't receiving the same standard of care that San Francisco provides. Sometimes, there are obvious signs that the care is inadequate, placing inmates' health at risk.

Alameda's jail health services contractor, Tennessee-based Prison Health Services Inc. (PHS), has made headlines before for a track record marred by inmate deaths and lawsuits alleging negligence. PHS has expressed interest in contracting with San Francisco if the city opened the door to privatization, which Mayor Gavin Newsom has once again proposed in his latest budget.

That budget also calls for cuts to community-based health and human service programs that threaten to erode the safety net for those battling mental health issues, drug addiction, and chronic health problems, all proposals now being weighed by the Board of Supervisors Budget and Finance Committee.

But it is the debate over whether to make a $11 million cut to jail health services that raises the most thorny and telling questions about what sacrifices are considered acceptable — and what populations can be the most easily targeted — in the quest to balance a budget without the tax increases that Newsom opposes.



In San Francisco, the city's Department of Public Health contracts with the Sheriff's Department to address inmates' medical needs. Privatized jail health care would be cheaper, though by how much is a moving target. But nobody is arguing that the care would be better.

Newsom's budget proposes switching to a private firm as early as January 2011 to help solve a daunting budget deficit. The proposal originated with the Mayor's Office, and Sheriff Mike Hennessey — whose department would realize the potential savings — went along by including the item in his departmental budget.

In years past, the Board of Supervisors has repeatedly resisted the proposal and is likely to do so again — but rejecting it would mean finding up to $11 million in savings elsewhere.

"The fear is that when you bring privatization into the picture, there is a financial pressure to cut corners. And even though that may end up saving some money ... the price that comes with it is too high," Sup. David Campos said at a recent budget hearing. Referencing stories about inmates who died needlessly in jail under the care of for-profit firms, Campos said he isn't willing to risk a similar tragedy occurring in San Francisco.

The proposal has been floated repeatedly since as far back as the early 1990s, according to healthcare workers whose jobs have been jeopardized by privatization before. Newsom proposed the cut last year, and the year before.