The Detroit Free Press
LANSING, Mich. — A plan by the Department of Corrections to reform its dysfunctional prison health care system with regional managed-care contracts — in effect, inmate HMOs — holds great promise. Still, to ensure progress, the state must provide the kind of independent oversight that ended when the Legislature closed its Corrections Ombudsman’s Office in 2003.
Such oversight could also come from a medical ombudsman appointed by the governor. In any case, it will become especially important, at least initially, as the state contracts for inmate care with health maintenance organizations that have little or no experience in prisons.
Under a plan detailed Tuesday by MDOC Director Patricia Caruso and consultant Robert B. Johnson, Michigan expects to become the first state to use HMOs for inmate care, which now costs taxpayers $300 million a year for a system with 50,500 people in 42 institutions.
The state will award six regional HMO contracts by January.
The reform plan also includes a new electronic medical records system, third-party evaluations, stronger performance standards, reorganized prison health care management, expanded care through video and electronic “telemedicine,” and a statewide contract for assisting newly released inmates who are chronically ill or medically fragile.
The new prison managed-care system will be like the one used, relatively successfully, by the state’s Medicaid program. Caruso said it would deliver better care for less money. That’s clearly possible. Medical care, when done correctly, costs less than the malpractice and incompetence that too often have plagued the system.
Because only licensed HMOs can bid, the new contract will probably exclude the current provider of primary medical services, Correctional Medical Services Inc. of Missouri. That’s encouraging, given the company’s dismal record in Michigan and in other states. As a private company, CMS has operated in near-secrecy while taking up to $90 million a year from Michigan taxpayers. The contract, assumed by CMS in 1998, has not been put out for bid since 1997.
A Free Press editorial page investigation last year showed systemic failures in the system, including misdiagnoses, delayed or denied treatment, poor record keeping, withheld medications and inadequate accommodations for the mentally ill and people with disabilities. In one case, Timothy Joe Souders, a 21-year-old mentally ill inmate sentenced to 1-4 years for shoplifting and resisting arrest, died of heat and thirst after spending most of his last four days strapped down, naked and soaked in his own urine.
An independent review of prison health care, ordered later by Gov. Jennifer Granholm, will wrap up in November. Johnson said the new managed-care system would include the study’s recommendations.
Caruso and the department deserve credit for acting now instead of waiting for the governor’s review. Johnson, a former CEO of Detroit Medical Center with expertise in urban health systems, was an excellent choice to lead the study, paid for by a $200,000 grant from JEHT Foundation of New York.
Now, there is reason for hope but also for caution. MDOC’s new managed-care contract lays the groundwork for a more accountable, cost-effective, efficient and humane system, but independent oversight is still essential. In changing a system that has rewarded incompetence, raised costs, invited lawsuits and federal intervention, and caused unnecessary suffering and death, Michigan must not fail again to oversee prison health care.