That lesson, of course, is even more meaningful when it comes to really difficult complicated problems like the one that came across my desk last week. This one arose from the death of an inmate in the Westchester County Jail in 2013. Rashod McNulty, originally from Mount Vernon, was 36 years old and a father of six. Mr. McNulty reported to the infirmary that he had serious chest pains and was given antacid and sent back to his cell. He collapsed on the way and was put in a wheelchair and wheeled back to his cell where he died less than two hours later of a massive heart attack. As you’d expect, the details of this case are playing out in the court system now, as his family has sued the County as well as the private healthcare contractor who is responsible for the healthcare in prison.
As I looked more into what happened I realized that this is not as rare as you might think. The medical provider in Westchester County, Correct Care Solutions, has been sued hundreds of times in Federal court alone and another half dozen times in State court around the country as well. Although I’m only a Councilman in the City of Mount Vernon, I still stand-up for issues affecting people beyond our four square miles. We must always remember that injustice and inequality must be addressed no matter where it may reside. The deeper you look into the private prison healthcare industry, the more clearly it seems that serious reform is in order. Don’t think that this is a small industry either. According to the Department of Justice’s annual spending report by states on prison healthcare exceeds $8 billion, with estimates suggesting that over half of that money is outsourced to private providers like Correct Care Solutions, Corizon Health, Wexford Health Sources and Correctional Medical Group Companies. As you might imagine, the number of cases filed against these entities stretches into the thousands.
But, let’s be clear, anyone can file a lawsuit for any reason, and just counting lawsuits is not sufficient to make a determination that private healthcare providers in jails and prisons is any worse than public healthcare – it’s really terrible too. The fact that healthcare has been privatized does not mean the quality of care is going to be worse. What we do know, however, is that privatizing prison healthcare is cheaper for states and counties, which is why they do it. We also know that these private providers have a profit motive and that often comes with substandard care in order to minimize cost. We have seen consistent claims in these lawsuits that substandard care costs lives. Rashod McNulty’s family can certainly attest to this.
I raise this issue now for a very specific reason: the Correct Care Solutions contract is up in June of this year and Westchester County has already indicated it will be issuing a contract bid process for the jail’s healthcare in the very near future. All of the companies mentioned above will likely put it bids to win that contract and, as part of the evaluation process, I suggest we take an opportunity to demand a few things of these proposed vendors, including:
Submission to Independent Oversight. Left to their own devices, private healthcare providers have no incentive to prioritize the care given to prisoners. That causes mistakes and leads to structural indifference and incompetence. The most effective private programs have rigorous oversight programs in place, whether from state or county regulators or independent observers (e.g., local hospitals). The private contractors must be held to the same standards of care as those practicing in the larger community, and they should be able to empirically demonstrate that in a transparent fashion.
Substantial Economic Consequences for Failure. One way to hold a private company accountable when it does not perform as expected is to severely penalize it where it hurts: in their pocketbook. Sadly, these contractors have negotiated contracts with public entities that make the fines for non-performance so insubstantial that they represent just an inconvenient “cost of doing business” rather then real deterrent to bad behavior. Any winning vendor should have to agree that performance and payment are based on the same level expected of practitioners outside of the prison system.
Evidence of Process Improvements. There isn’t going to be a single vendor who bids on this contract that hasn’t been sued multiple times over the years. That’s a sad reality. What the County can require, however, is evidence that lessons have been learned and applied in the vendor’s processes when it comes to providing care. All systems as complicated as healthcare can be improved and a quality company will be able to demonstrate such improvements have been incorporated into its system of “best practices.”
If we approach this issue clouded by emotion, we’re going to do a poor job of getting a decent deal in place. We need to set aside the moral judgments associated with how or why a person finds himself in need of prison medical care as well as the tendency to assume that incarcerated people are somehow less deserving of basic medical care. Let’s view this through clear eyes and a very simple proposition: the County is going to be paying a lot of tax money to a contractor to perform a vital service, and it has every right to expect the contractor to perform competently at all times. If performance falls short, there should be severe economic consequences.
There are six children out there without a father now. There is a huge hole in their lives that will never be filled, regardless of the outcome of any lawsuit. We owe it to them to make sure that their loss, while tragic and unnecessary can ultimately lead to something positive. Regardless of what he did to wind up in that jail, Rashod McNulty echoed the greatest fear all of us have when he pleaded to a nurse, “I don’t want to die.” At that moment he was just a vulnerable human being desperately asking for help. Help, which he did not get!
Let’s hope we’ve learned the lessons from his case and more importantly, let’s work to put in place a system that accomplishes its purposes. Let’s hold providers accountable and avoid the results that too frequently occur when no one is paying attention. This is after all, the real responsibility of government and the officials who inhabit it.
If you have any thoughts or comments, reach out to me at ADWCMV@gmail.com.