A special expert is recommending to a federal judge that she override a state law that requires the Department of Corrections to farm out health care for inmates to private companies.
And former Chandler state legislator Bob Robson, who now lives in Ahwatukee, agrees.
In a 138-page report submitted last week, Dr. Marc Stern detailed what he said are systemic problems in the state meeting its legal obligation to provide health services to inmates.
He told U.S. District Court Judge Roslyn Silver, the results are directly from “severe underfunding’’ of health care, with a lack of proper staffing.
His report put current agency spending at about $195 million. Stern figures it would take an additional $73 million to bring spending up to what the state pays for similar services through its Medicaid program.
Those dollars, he said, should be used for the current private provider, Centurion, to increase staff and salaries.
Stern said there’s a more important structural change that needs to be made: It should be state employees responsible for and providing the care, not some outside contractor.
Stern’s report is the latest in a multi-year lawsuit against the state by the American Civil Liberties Union.
There was a settlement in 2014 with the state agreeing to meet certain standards for health care for inmates at prisons statewide. Since then, however, there have been charges that the agency has failed to comply.
Officials at the Department of Corrections did not take a position, noting the issues raised go to decisions made not by the agency but by the governor and lawmakers.
Robson suggested that the findings and the recommendation to scrap the private contract should come as no surprise.
“I wasn’t a fan of it,’’ said Robson who was in the Legislature in 2011 when his colleagues and then-Gov. Jan Brewer approved the mandate to contract out health services. And Robson said the ramifications of that decision go beyond the level of care being provided.
“The whole thing is they put it all on the director,’’ he said, referring to Charles Ryan who just retired, saying that Ryan was stuck implementing the decisions made by lawmakers.
“It lies square in the Legislature’s ballpark,’’ Robson said. “And it lies in the Legislature’s ballpark to fix it.’’
Stern said Arizona could save money by assuming health care of inmates.
“Switching back from privatization to self-operation would, in effect, immediately reduce that spending gap by shifting funds ADC is currently spending on the non-value-added parts of contract expenses,’’ Stern wrote.
That includes things like duplication of services and the profit margin for the vendor, a figure he estimated at $10 million a year.
Robson said one way for the state to save money would be greater use of telemedicine – a system where prison staff and lower-level medical workers can be available on-site for routine matters while essentially having doctors and specialists on call.
Stern said the current system of contracting out has made that impossible.
He said that Corizon, which had the inmate care contract before Centurion, tried to form relationships with individuals and organizations to provide more telemedicine services.
But he said the doctors and others declined because they didn’t want to invest the resources in setting up a system to multiple prison units when the prison health care company with whom they made the arrangements might, due to the nature of the contracting process “might ... not be around long enough to make the venture worthwhile.’’
Stern said if privatization continues, contracts need to provide true incentives to reduce vacancies.
Under the current system, he said, the vendor must reimburse the state when a position was vacant on a dollar-for-dollar basis.
“Reimbursement does little to motivate the vendor to keep positions filled because at the end of the transaction, the vendor is (financially) whole,’’ Stern wrote. But that still leaves the risks to patients from understaffing.
He said any penalties should be higher than the amount of money the contractor saves.