The Rittenhouse Review

A Philadelphia Journal of Politics, Finance, Ethics, and Culture

Monday, February 28, 2005  

In the New York City Correctional System

Trust me when I tell you I take no joy in once again blogging about suicide, but in today’s New York Times there is a massive and alarming exposé, and that’s the only word for it, about jailhouse suicides, “In City’s Jails, Missed Signals Open Way to Season of Suicides,” by Paul von Zielbauer, an investigative piece a year in the making, that raises dozens of questions about attitudes toward the mentally ill and persons charged with crimes (often petty crimes), and, even more so, about the privatization of municipal services. (Hint: It’s not working.)

Von Zielbauer reports:

The death of Carina Montes was one in a spate of suicides in New York City jails in 2003 -- six in just six months, more than in any similar stretch since 1985. None of these people had been convicted of the charges that put them in jail. But in Ms. Montes’s death and four of the five others, government investigators reached a stinging judgment about one or both of the authorities responsible for their safety: Prison Health Services [Inc.], the nation’s largest for-profit provider of inmate medical care, and the city correction system. [Ed.: Prison Health is a subsidiary of America Service Group Inc. (Nasdaq: ASGR.)]

In their reports, investigators faulted a system in which patients’ charts were missing, alerts about despondent inmates were lost or unheeded, and neither medical personnel nor correction officers were properly trained in preventing suicide, the leading cause of deaths in American jails.

Prison Health has some explaining to do, as von Zielbauer reports:

The rash of suicides, and nine more during Prison Health’s tenure, is one measure of the company’s uneven and at times troubling record in meeting that challenge. But there are others.

Ten psychiatrists with foreign medical degrees were allowed to practice without state certification for more than a year after they were supposed to have been fired for failing to pass the necessary test. When it finally dismissed them on the city's orders in 2003, Prison Health was left with about one-third of its full-time psychiatrist positions empty, according to city health department figures.

The company has employed five doctors with criminal convictions, including one who had been jailed for selling human blood for phony tests to be billed to Medicaid. In all, at least 14 doctors who have worked for Prison Health have state or federal disciplinary records, among them a psychiatrist forbidden to practice in New Jersey after state officials blamed him for a patient’s fatal drug overdose.

The city’s Board of Correction, an oversight agency that sets minimum standards for jails, has complained that the company shuffles doctors from jail to jail -- regardless of where they are needed -- to avoid city fines and create the illusion that each building is properly staffed.

Many of the 30 current or former Prison Health employees interviewed for this article described an effort that, whatever its good intentions, frequently fails to adequately treat the mental illnesses that inmates take into jail and that follow them back out. [...]

Forever unable to find enough psychiatrists, the company plugs the gap by hiring part-timers, as well as psychiatrists from temporary agencies, some of whom may never have treated inmates. More than one-third of the mental health staff is part time.

Doctors rely on medical charts that have often been out of date or simply unavailable because of a shortage of clerks, according to the Board of Correction. Psychiatric evaluations and medications have been delayed for days or weeks, while inmates sometimes turn violent or suicidal, say the board and Prison Health employees.

The city itself, still working through the excesses of the administration of former mayor Rudolph Giuliani (R), also is not blameless:

Of course, the demands on Prison Health and the correction system are tremendous. The mentally ill have flooded New York's jails ever since the city cracked down a decade ago on lesser crimes like vagrancy. As many as one in four of the 14,000 prisoners in city jails on an average day have psychological ills, which need close supervision and expensive medicines. Often they fake symptoms or attempt suicide as a way of getting special treatment. In those ways, a mentally ill inmate jailed on a minor charge usually requires closer attention than a career criminal.

Here’s the beginning of the company’s attempt to do explain itself, as reported by the Times:

Prison Health Services, a Nashville-area corporation that bills itself as the gold standard of jail health care, says it has done a solid job at Rikers and a 10th jail, in Lower Manhattan, caring for more than 100,000 inmates a year as part of its largest contract among scores across the nation.

The company says it has worked hard to find qualified mental health specialists, held increases in medical expenses below the national average, and saved the city hundreds of thousands of dollars.

There is little dispute that New York City has long insisted on more generous jail care than most other places; the suicide rate, even under Prison Health, is about half the national average for jails.

Then again, the rate was lower before Prison Health arrived. And in the four years since, the rate of suicides at Rikers has been higher than in the Los Angeles jail system, the largest and one of the most violent in the nation.

Like I said, it isn’t working.

[Post-publication addendum (March 1): See also “Just As You Did It to the Least of These,” at the RiverStone Journal.]

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