Jail health care: Need vs. want

New Provider Answers Complaints From Inmates

One inmate no longer gets the pain medicine he had before. Another who is on long-term psychiatric medication receives smaller doses. Still another with serious health problems gets medication only after her mother brings in the prescription.

These are examples of complaints several local defense attorneys have heard in recent months from their clients, inmates at the Kenosha County Jail and Kenosha County Detention Center.

Inmates have complained about jail health care in the past, but the attorneys say complaints have escalated since a private health-care company took over care at the county's two jail facilities in September 2001.

``I've heard complaints before, but this is different,'' said Don Bielski. ``There's more of them, and they are real. People are getting denied medication.''

The county contracted with Health Care Professionals Ltd., which has since become Advanced Correctional Healthcare, because the company promised to provide good inmate care at the lowest possible price -- lower than the county spent contracting with local doctors.

While jail officials say the company is following through on its promises, some local attorneys fear the new system is sacrificing the welfare of the inmates to save tax dollars.

``I think (corrections medicine) is a buzzword for how do you want to save some money from seeing your inmates,'' attorney Fred Zievers said.

Shortly after the company took over, Bielski and Zievers heard a flurry of complaints. As a result, local judges requested a meeting with the company earlier this year.

Frank Volpintesta, corporation counsel, also looked into a complaint from an inmate last spring.

Volpintesta said he believes the situation has been resolved. Bielski, Zievers and others insist that problems still exist.

``We're still getting the stories,'' Bielski said. ``Medication is being withheld. Most of it is pain-related medication. The strongest thing they'll get is aspirin.''

Need vs. want

Dr. Norman Johnson, who handles the care of inmates at both the Kenosha County Jail and Kenosha County Detention Center, has worked in corrections medicine for about 20 years. He said inmate complaints are nothing new and believes the attorneys and other concerned people have an incomplete understanding of the situation.

``It comes down to they didn't get what they wanted,'' Johnson said of grievances. ``It's the duty of the jail to give them what they need.''

The question of need vs. want lies at the heart of the current debate, he said.

Many inmates come to jail overmedicated, Johnson said. In many cases, inmates come to jail with multiple prescriptions from multiple doctors, many with medications they don't really need.

``They believe they should have some kind of treatment when in fact it's not in their best interest,'' he said. ``When people are in jail they're very vulnerable.'85 It's our duty to do the very best for them and make sure they get everything they need but not necessarily everything they want.''

Before Health Professionals Ltd. took over, the jail was ``a candy store,`` Johnson said. All kinds of medications were distributed. In that type of environment, he said, inmates learn to manipulate the system.

Corrections medicine is based on what is called evidence-based medicine -- doctors act on what is scientifically provable, according to Johnson. It also relies on the socalled ``tried and true'' medications and methods of treatment instead of newer, less understood medications.

That means when someone has back pain the corrections doctor will tell the inmate to practice back exercises and take Tylenol as opposed to using narcotics right away. Also, Johnson said he tends to use older anti-depressant medications because they have proven effectiveness.

Many doctors make decisions based on what the patient wants, Johnson said.

``When you get to a subgroup with a large group of personality disorders, that's when you have to be careful about it,'' he said. ``That's why a person in the average field doesn't work in the jail. It takes a lot of experience.''

Johnson said his company abides by the standards set by the National Commission on Correctional Health Care and other corrections organizations.

Inmates and cost

It was the company's understanding of the inmate population as well its thriftiness that attracted the attention of Dave McRoberts, former captain of detentions for the Kenosha County Sheriff's Department.

``Simply stated, they understand the culture of working within a detention facility,'' McRoberts said last spring. ``They understand the needs from within. They understand the inmate culture and the propensity of an inmate to abuse the system.''

Health Professionals Ltd. operates in five states and 34 prisons and jails, including facilities in Walworth County, Rock County, Dodge County and Winnebago County.

This past summer Johnson split from Health Professionals Ltd. to form Advanced Correctional Healthcare. He runs seven facilities, including the two jails in Kenosha.

Administrators at the sheriff's department say they are pleased with the new system.

``I believe the county is getting a definite bang for their dollar,'' said Larry Apker, who replaced McRoberts as captain of detentions.

He said he gets occasional complaints from inmates, but doesn't consider that unusual given a population of more than 600 inmates.

``I think he understands what our needs are, what the inmates' needs are,'' Apker said of Johnson. ``I think he's reached that happy medium.'85 I get my casual complaint from the inmate that needs to be looked into, but that's the norm.''

Evidence-based medicine is also appealing from a financial aspect. ``They save Kenosha County money,'' McRoberts said.

According to Nancy Otis, who handles finances for the Kenosha County Jail, costs are down, but not substantially. The county sets a budget for three main categories of health care at the jail: medical/dental services, inmate medical services and pharmaceuticals.

Comparing figures for similar periods of 2002 and 2001, the jail has saved money in two major areas: pharmaceuticals and inmate medical services, which are the services that require inmates to leave the jail, such as X-rays.

Johnson said he has never seen a budget and the sheriff's department has never told him to keep costs down, but cost is one factor he considers when treating a patient. It is the fourth priority, he explains, after curing the disease, doing it with the least amount of side effects and with the least amount of discomfort.

``I suspect if you interviewed the nurses they would say it's a better system than what we had before,'' Johnson said. ``The truth is you had good doctors before. This has to do with experience and approach to the correctional patient.''

Nurses endorse system

Nurses at the jail say they like the new system. They are more involved with all aspects of patient care, and Johnson has given them a lot of support, they say. There are now protocols for nurses to handle emergencies that were not in place before, such as treating alcohol and heroin withdrawal. The number of outside visits has decreased because more emergencies are handled at the jail.

Nursing supervisor Mary Wade agreed that medicine was easier to obtain in the jail before the new company took over.

``There was such a drastic change,'' she said. ``People were used to coming in here getting anything they wanted.''

She and nurse Kathleen Duffin also roll their eyes when they hear about inmates not getting their medication.

``They know how to play the game once they get here,'' Duffin said.

The nurses say they are aware of the tricks that inmates play, such as ``pouching'' medicines. That means keeping a pill in the side of their mouth and either taking or selling it later.

Wade said the change in the system means the inmates can no longer resort to such tactics.

``They were not used to how things were going to change,'' she said.

Duffin said the change in inmates is apparent.

Since the new regime took over, ``you can actually see the difference in the inmates,'' she said, adding that inmates are more responsive and thus better participants in programs such as Living Free, a drug and alcohol treatment program.

Change for the worse?

But some local attorneys say the changes are not all for the better.

John Moyer, who works in the public defender's office, said he has received several complaints in recent months from inmates who say they were denied medication they needed. One client is suffering from sickle cell anemia and other problems, but Moyer said he didn't get the attention he needed and ended up in the hospital.

``To me that's bad. I think they need to talk to the doctor and find out what that client should be taking,'' Moyer said.

Attorney Nancy Barasch also said the jail dispenses medicine only if it is an absolute necessity and is reluctant to give antidepressant medication because of the cost.

Other lawyers said they get complaints, but they always have.

``It's a difficult situation,'' attorney Charles Malinsky said referring to the jail's task of handling the inmate population. ``I think the jail tries. They have a lot of people come and go. They're under pressure, too.''

Bielksy and Zievers are more skeptical of the current situation. Last spring they talked about filing a civil lawsuit, but so far they have not pursued legal action. They are still watching to make sure the health care company has their clients' best interests at heart -- even though those clients are inmates.

When a person is in pain, ``Putting (that person) in an orange jumpsuit doesn't mean it doesn't hurt any longer,'' Zievers said.