A proposal to privatize jail health services comes with a potentially steep cost to inmates and the public
"In absence of the budget problem, [Hennessey] probably would not have proposed this, nor would we have proposed this," Newsom's budget director, Greg Wagner, told members of the Budget and Finance Committee at a May 26 hearing, adding that the mayor shares concerns about prisoner safety. Newsom's office did not return multiple calls requesting comment for this story.
The U.S. Supreme Court recently agreed to a hear an appeal by the state of California to the federal court ruling that substandard medical care in California prisons constitutes cruel and unusual punishment and necessitates the early release of about 40,000 prisoners. At the May 26 hearing, healthcare workers familiar with the interiors of county jails and state penitentiaries came forward with horror stories.
"Every week I receive at least one inmate who has an open gunshot wound. They have not seen medical care in the county jails," Dr. Elena Tootell, chief medical officer at San Quentin state prison, told committee members. "It's quite surprising to me that they send inmates with gunshot wounds to prison. They just walk off the bus. They often have paper towels stuck to their bodies, seeping the blood. And then we are obligated to take care of them. This does not happen from San Francisco County, I'm going to tell you that right now."
Tootell said she'd observed a significant difference between those counties using private firms and those using public health care. "They will have a fracture — they've never been splinted, they've never seen a doctor. They're on anticoagulation [medication], but haven't had their blood checked in weeks and have bruises all over their body."
Connolly echoed similar concerns. For example, she told the Guardian, she's found herself asking questions like, "You were on AIDS medication before you got arrested and now you're not?"
Susanne Paradis, a healthcare research contractor with SEIU Local 1021, rejects the premise that the same services could be provided at a lower price. Under a private model, she says, the priority is to keep costs low — and that means doing less.
A key issue, Paradis said, is that private firms tend to rely more heavily on licensed vocational nurses (LVNs) — lower-paid medical staffers who aren't trained to assess patient's medical needs and cannot administer the same care that registered nurses (RNs) can. Using PHS data, Paradis found that in Alameda, there is one RN for every 92 inmates, compared with one RN per 32 inmates in San Francisco.
"An RN has the ability to assess, observe, and determine if there's emergency care needed," Paradis explained. "An LVN does not have the ability to do that."
John Poh, a nurse practitioner stationed at a jail in San Francisco's Hall of Justice, explained the difference this way: "The more RNs you have working for you, the fewer deaths you have."
PHS, an obvious point of comparison with San Francisco since it serves Alameda, declined to answer questions about its services. Instead, media spokesperson Pat Nolan e-mailed a brief statement. "We are excited to hear that San Francisco is considering the contracting of correctional health care," he wrote. "Should the city choose to go through an RFP process, we would look forward to participating. We think it is the right thing to do for the city and its taxpayers."
LINES OF DEFENSE
While those incarcerated in San Francisco jails can be thought of by some as criminals, nuisances, or miscreants, those requiring medical attention are patients in the eyes of the jail healthcare workers.
Inmates routinely enter the system with diabetes, HIV/AIDS, hepatitis C, heart problems, liver disease, and substance abuse issues, Connolly said. On occasion, a woman will arrive in jail only to learn that she is pregnant. Mental health problems are common, and some battle psychiatric issues in combination with physical ailments.