Gotham Gazette

The Place for New York Policy and politics



Rating Health Care Behind Bars


Six months ago, Prison Health Services -- the private, for profit company that manages health care in 10 of the city's 11 jails -- got a raise.

The Tennessee-based corporation, which has a virtual monopoly on health care in prisons nationwide, saw its payments increase by more than 10 percent -- a figure that has been adjusted for inflation -- since its previous agreement with the city in 2005.

That boost, which city officials attribute to cost of living increases, came despite the company's failure to meet at least 15 percent of its performance standards set by the city's Department of Health and Mental Hygiene between 2006 and 2008. On several occasions, the company did not meet a quarter of its performance indicators, which include completing intake histories and conducting physical exams, according to quarterly review reports from the department.

Because of this poor performance, the city has fined Prison Health Services for the past three years in a row.

While many advocates agree that care on Rikers Island has improved since it was run by a private hospital a decade ago, others say the city's jails still do not provide quality health care. Whether it's a lack of leadership or the challenges of dealing with a transient, often mentally ill, population, quality health care is as isolated from Rikers' inmates as the island itself.

The Quality Gap

Prison Health Services just kicked off its third, three-year contract with the city's Department of Health and Mental Hygiene. The price tag: $366 million.

As part of that contract, the health department issues quarterly performance review reports, evaluating whether the corporation has substantially met or failed to meet certain health care criteria. The reviews measure the quality of women's health, asthma care, confidentiality, testing for sexually transmitted diseases and more.

The measurements are gleaned from a review of 9,000 records per quarter, said Louise Cohen, deputy commissioner for health care access and improvement at the Department of Health and Mental Hygiene. These records assess Prison Health's performance through 40 indicators, some of which are analyzed by a random sample.

In its last two years of service to the city, the time leading up to the contract renewal, Prison Health Services has continuously failed to meet a handful of city standards -- some more than others. In six of the eight quarters from January 2006 through December 2007, Prison Health Services did not properly follow up on certain HIV treatment testing. Some inmates, Cohen said, received follow-up tests several days late.

For five consecutive quarters, until mid-2007, the corporation did not meet standards for taking inmates' histories when they arrive at Rikers, skipping over parts of the mandatory paperwork, said Cohen. On average, Prison Health complied with the department's intake standards about 61 percent of the time during that period.

Now that the department is rolling out an electronic intake system, Cohen said, that process should run more smoothly. The Bloomberg administration requires that every inmate receive an intake physical within 24 hours of arrival on the island . According to the Mayor's Management Report, more than 89,000 intake exams were given in fiscal year 2007 -- that out of approximately 100,000 annual admissions.

For three out of four quarters in 2007, Prison Health also did not meet standards for follow-up care for inmates in segregated housing. Cohen said this was due to security concerns in one facility that may have skewed the entire performance results.

Due to all of the unmet criteria in 2007, Prison Health was fined $244,000. In 2006, the corporation was fined $299,500 and $249,500 in 2005.

While some areas of care are problematic, the company has met criteria in others. For instance, women's care has received nearly a 100 percent compliance rate over the entire two-year period. This care includes cancer screenings, prenatal care and sonograms.

Prison Health has also consistently tested for sexually transmitted diseases during an inmate's admission to Rikers.

"We're more concerned than anyone in making sure that we have the right quality of care," said Cohen. "We are actually meeting the community standard in many cases and exceeding it in a number of others."

A spokesperson for Prison Health Services refused to comment for this story and referred any comment to the city's health department.

The Measures In Context

For all of 2007, according to city health records, Prison Health Services met the standards for documenting suicide watches approximately 95 percent of the time.

But, that doesn't mean there were no suicides on Rikers Island. There were three, according to the mayor's management report.

This is one indication of how performance standards can miss measuring actually quality of care. Prison Health may receive a mark of 100 percent in some areas where advocates continue to receive complaints about poor health care.

Dale Wilker, a staff attorney at the Prisoners' Rights Project at the Legal Aid Society, said by far the most serious complaint from prisoners who have serious ailments, from HIV to heart conditions or asthma, is failing to have continuous access to needed medication.

"The biggest complaints I have heard, not in terms of volume but in terms of seriousness, was medicine people are taking and are required to take are interrupted and not started for a period of time," said Wilker. "Since the city got away from using teaching hospitals and went to providers that are in some way to make money and to serve their stockholders, complaints have become much more frequent and much more serious."

According to city records, Prison Health Services has met criteria outlined by the health department for several standards that deal with medication or prescription delivery, including long-term medication for asthmatics, the availability of medication within 24 hours after it is prescribed and the timeliness of medication orders for mental health patients.

This is not the only area where anecdotal accounts of care contradict measurements by the city. The most frequent complaint of inmates, according to some advocates, is waiting times to get into one of the island's many clinics.

Inmates have told the Gotham Gazette they have waited for hours before receiving care, regardless of their condition. On the other hand, the mayor's management report contends for the past three years inmates have waited about a half hour to receive care.

A Quality Measurement

Some say the department's quality performance reviews, while worthwhile, are not an accurate reflection of the quality of care on Rikers nor do they measure what is most important in providing correctional health care.

It is difficult to determine whether the compliance record is a result of one box unchecked on an intake form, some say, or more serious failures by Prison Health Services.

"For our purposes, in terms of our role, they are not the best items to be using to assess (whether) the things that we care about are being met," said Hildy Simmons, the chair of the city's Board of Corrections, which oversees the city's correctional system.

Considering Prison Health Services' contract was just renewed, advocates contend the system must not be so atrocious that Rikers needs another provider -- as was true during the days of St. Barnabas in the early 1990s.

"That suggests to me that things weren't bad enough for the department of health to not want to contract with them at all, or maybe they couldn't find another provider," said Wilker, who would like to see the city contract with university-affiliated hospitals.

This is partially true. When the city requested contract bids for some of its independent borough facilities last year, no local, nonprofit hospital bid on it, said city health officials. Like any other city contract, Prison Health Services contract goes through a procurement procedure. This three-year contract was a renewal and was not put out to bid, said Cohen.

"We think PHS is performing adequately," said Cohen. "We would love to have a local, nonprofit partner. One just isn't stepping up to the plate."

The department does review all of its performance criteria on an annual basis to determine, which indicators to concentrate on. And, said Cohen, in any area the corporation fails, it is required to come up with a correction action plan, which the department continues to monitor.  

City Council Stated Meeting - February 15, 2006

Every two weeks the New York City Council meets for its Stated Meeting to introduce and pass legislation. As a regular feature, Searchlight covers these meetings and posts a summary of the bills passed.


"If you walk through Sheepshead Bay it looks nothing like it did four years ago. This neighborhood has been ravaged by developers. This measure comes four years after we asked for it and three-and-a-half years too late." - Councilmember Lew Fidler on a regulations meant to protect single-family homes.


The New York City Council under the new leadership of Speaker Christine Quinn is just beginning to put together its legislative agenda, so at the meeting of February 15 the council passed no new bills, but it did pass 18 land use measures, several aimed at slowing overdevelopment in the outer boroughs.

For Sheepshead Bay, Brooklyn the council passed a "downzoning" measure - which limits the height and density of new development - that will protect 309 single family homes from being torn down. Councilmember Lew Fidler, however, said it was "too little, too late."

"If you walk through Sheepshead Bay it looks nothing like it did four years ago," said Fidler who blamed the City Planning Department for its slow response. "This neighborhood has been ravaged by developers."

The council also approved downzonings in the Ferry Point and Woodlawn sections of the Bronx and in the Midwood section of Brooklyn.

Other measures were aimed at creating new housing. In Harlem, the council approved a measure that will create 50 new units of affordable housing. Councilmember Inez Dickens said that the new units would be overseen by the West Harlem Group, a local community organization, which purchases buildings and then sells them to existing tenants at low mortgage rates.

The meeting was also an opportunity for council members to introduce new legislation, or to reintroduce bills that did not get passed in the previous session. Each bill will be sent to the appropriate committee for consideration.

As usual, the council's legislation ranged from enormous city-wide initiatives (approving a new plan to dispose of the city's garbage) to more local concerns (creating a database to track problem spots for graffiti) to the somewhat bizarre (prohibiting the resale of underwear that has been returned to a store).

Some other bills that the council will consider in the coming months include:
- Suspending alternate side of the street parking on the birthdays of Lord Krishna and Lord Buddha.
- Raising the legal age to buy tobacco to 19 years.
- Requiring two-way radios and tracking devices in school buses.
- Requiring new financial data from non-profit agencies that receive city contracts worth $100,000 or more.
- Allowing hybrid taxicabs to use bus lanes.
- Regulating horse-drawn carriages and bicycle pedicabs.
- And preventing the eviction of elderly tenants.

The City Council also announced its schedule of hearings on the mayor's preliminary budget, which will run from March 6 to March 23. For a full calendar of hearings, visit the council's Web site.

The next Stated Meeting is scheduled for Wednesday, March 1, 2006.







City Council Stated Meeting - September 28, 2005

Every two weeks the New York City Council meets for its Stated Meeting to introduce and pass legislation. Gotham Gazette covers these meetings and posts a summary of the bills passed.

"[U]ndocumented immigrants have been mistreated and abused. This bill will be able to prevent that. It provides dignity for everyone, regardless of their status." - Councilmember Helen Sears on legislation to create job centers for immigrant construction workers.

"This is giving the official sanction… to illegal aliens. We are a body that makes the law. We should not be sanctioning breaking the law." - Councilmember Peter Vallone, Jr. in response.

Day laborers – immigrant construction workers who work for hourly wages wherever they can find a job - pose serious problems for the city and its residents.

The estimated 8,000 workers who struggle to find employment each day are often subjected to low pay, long hours, and hazardous working conditions.

Residents of the neighborhoods where day laborers congregate complain about men loitering on the corner, urinating in alleys, and harassing women.

In an effort to address concerns from both workers and neighborhood groups, non-profits in New York City have set up a handful of day laborer job centers. These facilities offer protections and better pay for workers and a specific location for construction crews to hire help.

The New York City Council wants to establish a commission to look into how more job centers could be developed across the city.

Councilmember Vincent Gentile from Bay Ridge, who helped draft the bill (Intro 592-A), said it was a "win-win."

"Laborers are protected," said Gentile. "And for the community, laborers are not congregating on street corners."

Councilmember Helen Sears from Jackson Heights, who also contributed to the bill, admitted that undocumented immigrants pose another difficult issue.

"While there are many day laborers who are undocumented, there are many who are not," said Sears. "And those undocumented immigrants have been mistreated and abused. This bill will be able to prevent that."

But Councilmember Peter Vallone, Jr. from Astoria objected to language in the legislation that would grant 12 of the 20 seats on the commission to immigrant day laborers or representatives of groups working with laborers.

"This is giving the official sanction... to illegal aliens," said Vallone, Jr. "We are a body that makes the law. We should not be sanctioning breaking the law."

Republican Councilmember James Oddo from Staten Island said he also had serious concerns about the bill, but because it is such a serious problem, he said he was "willing to take a leap of faith to see what they come up with" and vote for it.

The measure passed by a vote of 42 to 2. Peter Vallone and Dennis Gallagher voted "no."

The City Council voted unanimously to approve a new parking holiday to mark the Hindu celebration of Diwali.

Despite opposition from the Bloomberg administration, the council voted 44-0 in favor of Intro 420-A, which would suspend alternate side of the street parking rules for the Indian holiday, also called the "Festival of Lights."

Supporters argue that it is an important gesture to the Indian and South Asian community.

"This is a community which is large in civic affairs," said Councilmember Gale Brewer from the Upper West Side. "Diwali is a joyful and important festival."

The city's sanitation and transportation departments oppose the measure, arguing it sets aside one more day when the city cannot clean the streets. There are already 33 other such holidays, including Christmas, Yom Kippur, and the Muslim holidays of Eid Ul-Fitr and Eid Ul-Adha.

City Council Speaker Gifford Miller said that many of the parking holidays overlap or fall on the weekends, and he argued that the sanitation department has plenty of time to do its job.

"This mayor seems to want to find any conceivable opportunity to write tickets to anybody that drives a car in the city of New York," said Miller. "We try to give a little bit of relief and also to reflect the diversity of this city."


The Bloomberg administration said is reviewing the legislation; the council has more than enough votes to override the veto.

Diwali is a five-day celebration which occurs in the fall, usually in October or November. This year it runs from November 1 to 5. The parking holiday only applies to the third day of the celebration on the day that Lakshmi Puja is observed.

In 2002, the council passed legislation to suspend alternate side of the street parking rules on the Asian Lunar New Year, Purim and Ash Wednesday. Mayor Michael Bloomberg vetoed the legislation and the council overrode the veto.

The council also received two vetoes from Mayor Bloomberg.

The mayor rejected Intro 468-A known as the "Health Care Security Act," which would require grocery stores with more than 35 employees to contribute $2.50 toward health care for each hour an employee works, or $5,000 a year for a full-time employee. The council estimates that the legislation will apply to 300 grocery stores and ensure health care coverage for 27,000 workers. It also applies to large chain stores such as Wal-Mart that dedicate more than 10,000 square feet of their buildings to food.

The Bloomberg administration argues that it violates the federal Employee Retirement Income Security Act, which limits state and local government involvement in employee benefits.

The mayor also vetoed a bill (Intro 699-A) that bars permits for so-called "stoop-line" stands -- sidewalk stands for fruits, vegetables, candy, ice cream or soft drinks -- unless the city certifies that they will not block pedestrian traffic.

Such regulations already exist, but the legislation puts new requirements on the Department of Transportation to enforce them.

The City Council has 30 days to override the mayoral veto by a two-thirds majority.




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