By Tali Woodward

According to Mayor Gavin Newsom, it just makes financial sense to consider putting a private company in charge of health care at San Francisco's jails.

But anyone with expertise in correctional health will tell you that private companies hired to do this sort of work are notorious for providing shoddy care that threatens the well-being and even the lives of inmates.

Meanwhile, San Francisco's Jail Health Services – which is run by the city's health department – is a national model that's designed to be humane and, in the long run, to save money by offering preventative care to an intensely disadvantaged population: the 30,000 people who cycle through the city jails each year.

"It's really an opportunity to provide services to people who wouldn't otherwise have them," program director Dr. Joe Goldenson told the Bay Guardian, explaining that the doctors and nurses he manages are often the first to diagnose serious conditions like HIV and frequently treat communicable illnesses such as tuberculosis before inmates are released. "I know that they're concerned about the cost of our services, but we really believe that we're saving money."

Of all the outsourcing proposals contained in the city budget released by Newsom June 1, this one may spark the most controversy. It also epitomizes the sort of debate common to privatization battles. One side invariably focuses on potential monetary savings, while the other raises broader, more amorphous concerns involving accountability, long-term secondary costs, the overall good of society, and of course the dangers of introducing a profit motive. Those things are often hard to quantify or even to grasp.

But in this case much can be learned from the records of prison health contractors.

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Private firms including Correction Medical Services, Prison Health Services, Naphcare, and Wexford are now responsible for more than 40 percent of correctional health care nationwide.

These firms turn a profit by containing costs and have individually and collectively come under fire for skimping on medicine and staffing, neglecting sick inmates, and avoiding trips to the hospital even when someone's life may hang in the balance.

One of the companies that insiders believe would bid on the San Francisco contract is Tennessee-based Prison Health Services, which is contracted to deliver medical care to more than 300,000 inmates in 35 states. Some say that publicly traded PHS provides quality care, but it nonetheless faces more than 1,000 lawsuits for improper care. (In contrast, Jail Heath Services has had one small settlement during the past 13 to 14 years, according to Goldenson.)

It's not hard to turn up dozens of unnerving reports of PHS neglect like how, in 2002, a South Carolina prisoner with diabetes passed out and died, allegedly after no one called for help. Or how a Florida nurse sued the company that same year, claiming she was fired for refusing to record dosages of medicine that were never administered.

This March a thorough review of the Limestone Correctional Facility in Alabama, where PHS took over care in November 2003, was completed. "Patients continue to die because of the failure of the medical system," inspector Dr. Stephen Tabet concluded.

But for a better idea of what privatized care might be like in San Francisco, some experts suggest looking at Philadelphia.

PHS's record running the jails there came under close scrutiny after an inmate died of diabetic shock in 2000. The prisoner was allegedly vomiting for hours but was never given the insulin his body needed. When the city investigated, it unearthed more evidence that PHS was failing its patients, particularly those with HIV. Even the prison guards testified that the care was woefully inadequate. Philadelphia didn't renew the contract with PHS.

Escalating complaints about PHS in Palm Beach, Fla. – where 26 inmates have died over the past five years – have recently been detailed by the Palm Beach Post. In these and other media accounts, PHS has refused to discuss individual cases, and a company spokesperson could not be reached by press time.

One Palm Beach inmate was anemic, emaciated, sick with pneumonia, and going into cardiac arrest by the time he was taken to the hospital. A lab report showing that he was in serious need of a blood transfusion had gone unheeded for six days. Current and former PHS employees told the newspaper that "the company ignores inmates' needs, including cutting off psychiatric medicines cold turkey, withholding AIDS medications and not treating virulent infections."

Since then Palm Beach residents have criticized PHS for failing to provide proper care to inmates who are pregnant and needed medicine to the mentally ill. There are suspicions that the company's unwillingness to pay for medication has contributed to a staph infection outbreak. On June 3 a judge ordered one man released from the Palm Beach jail in light of evidence that PHS neglect had forced the amputation of his right leg.

Inviting PHS or another for-profit to take over in San Francisco doesn't sit well with Dr. Corey Weinstein, a primary care physician and California Prison Focus volunteer who has been visiting California prisons for 30 years. "To have the jail as part of the public health system and have a seamless relationship is very important for the city's overall health," he told us. "I can guarantee you there will be more lawsuits – and more successful lawsuits – with any contractor."

Director Goldenson said, "I haven't heard of any [private companies] that I would say provide an adequate level of care."

Jail Health Services aims to provide the type of care available in community clinics and nothing more. But the program focuses on the primary issues this at-risk population grapples with, such as HIV, addiction, and sexually transmitted infection.

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In a speech June 1 the mayor said he must put the program out to bid in order to trim costs but would welcome a bid from the Department of Public Health. DPH plans to submit one, but workers – who already coped with a $4 million reduction last year – say that less money simply means fewer services.

"It's unfortunate some folks in DPH feel they aren't able to compete," Newsom spokesperson Peter Ragone told us. "A lot of arguments will be made that are similar to arguments that have always been made when government tries to operate more efficiently. We are still going to explore reforms."

It may quickly become a numbers game, though Goldenrod and others insist the numbers being bandied about don't tell the whole story.

The San Francisco Chronicle reported June 1 that the current program costs $15,000 an inmate, but Goldenson clarified that the figure applies to a full year of care, whereas most inmates spend less time inside. The actual per-inmate cost is closer to $1,000, he said. San Francisco, he added, shouldn't be compared to Alameda and Los Angeles counties, where inmates typically spend their first, most expensive days in separate, city-run facilities.

Prisoners' rights advocates say any financial analysis should also consider the money likely to be spent on lawsuits if a for-profit is hired – and the costs offset by preventative care. In 2002 a long-term study conducted by the Department of Justice and the National Commission on Correctional Health Care found that treating several diseases that are common in jail could actually save the government money.

But eventually it circles back to the more complicated issue of societal values.

Inmates are vulnerable, said Dr. Milton Estes, who is the director of the HIV program for the jails, but ultimately they're also unable to go elsewhere for care. "It's up to society to do the decent thing for these people."

Rachel Brahinsky contributed to this story.

E-mail Tali Woodward.