Starting next year, the New York City agency that runs its public hospitals, Health and Hospitals Corporation (HHC), will assume responsibility for health care at the Rikers Island jail complex, ending the island’s 15-year relationship with Corizon, the country’s largest private contractor of medical services to jails and prisons. HHC will take over a three-year $126.6 million contract.
The end of the Corizon deal, announced Wednesday, was accompanied by a scathing report from the city’s Department of Investigation, which cited poor oversight, disciplinary problems and neglect that may have led to the death of two inmates. It also reflected Mayor Bill de Blasio’s conviction that basic public services should not be entrusted to for-profit contractors.
But in moving to assert local control, New York was doing more than simply replacing a vendor that has come under fire. It was joining a trend to streamline care before, during, and after incarceration.
“A substantial portion of folks in Rikers get their care at HHC facilities” when they are not in jail, said Steven Rosenberg, president of Community Oriented Correctional Health Services (COCHS), an Oakland-based non-profit, and an advisor to the New York City Task Force on Behavior Health and Criminal Justice System. “Once you have a fully integrated system you’re able to create continuity of care so that what happens behind the wall follows up on what happens in the community and what happen in the community follows up on what happens behind the wall,” he said.
This was not the case under Corizon. Every suspect who entered the Rikers system was treated from scratch, beginning with the post-arraignment physical, even if the person had recently been diagnosed by a community-based doctor or treated in an emergency room. And upon release, the patient started over again.
“The better integrated prisoner medical care is with community medical care, the better it’s going to be,” said Dr. Robert Cohen, who sits on the New York City Board of Correction and was the medical director at Rikers during the 1980s. “HHC comes at it from a healthcare perspective, and not from a corrections perspective,” he added.
Continuity in care between jail and the community has become much more relevant since the passage of the Affordable Care Act last year. Prior to the act an estimated 90 percent of jail inmates were uninsured. Now many are eligible for insurance under Medicaid. Jails across the country are making efforts to enroll inmates.
“We have an essential responsibility to provide every individual in our City’s care with high-quality health services – and our inmates are no different,” said Mayor de Blasio in a written statement. “This transfer to HHC will give our administration direct control and oversight of our inmates’ health services – furthering our goal of improving the quality and continuity of healthcare for every inmate in City custody.”
Under HHC the city will be able to provide better coordination between hospital and jail-based services, the mayor’s statement said. The city also promised closer integration of physical and behavioral health services, as well as stricter accountability.
In a written response, Corizon said it was sorry to lose the contract, adding: “As the Mayor’s Office itself noted in December, the ‘provision of health services in the NYC jail setting has become significantly more difficult over the past year.’ Yet despite ongoing challenges, including an increase in the percentage of inmates suffering from mental illness and rising rates of violence against healthcare workers, we have made many improvements.”
Since 2012 Corizon has lost statewide contracts in Maine, Maryland, Minnesota and Pennsylvania and has come under pressure in Florida.
New York City joins a national trend of bringing jail health care closer to systems in place in the community. Earlier this week The Los Angeles Times reported that county supervisors there had voted to transfer health care from the sheriff’s office to the department of health in order to coordinate care in the county’s jails with services available before and after incarceration. Washington D.C. recently rejected a bid by Corizon to serve its county jail; city council members cited continuity of care in choosing to retain its current provider, non-profit Unity Health Care, the largest primary care provider in the area.
Providing health care behind bars is a daunting challenge. As many as 43% of inmates have at least one chronic condition according to a recent report from the Vera Institute of Justice in New York City, and in many cities jails have become virtual mental hospitals.
Debroah Golden, director of the DC Prisoners’ Rights Project, which lobbied to reject Corizon’s bid there , argued that the company — based in Brentwood, Tennessee and operating in 27 states — lacked local roots. “I think that Corizon has a terrible track record because they’re not oriented to the community,” she said. “You can’t provide good care unless it’s tethered to the community somehow.”
Unlike prisons, jails are, at least in theory, for short-term detention while awaiting trial or for serving sentences of less than a year. Only four percent of people in jail go on to prison, and the rest return home.
“If you look at how we’ve thought about corrections traditionally we send people off to islands — Alcatraz, Devil's Island, Australia, Rikers island — and we had this traditional philosophy that folks involved in the criminal justice system needed to be isolated from the communities,” said Rosenberg. But, he added, “What we learned over time that is a fallacious assumption.”