“Damning” Audit Sharply Criticizes Corizon in Allegheny County, Pennsylvania

by Gregory Dober

In December 2014, Allegheny County, Pennsylvania Controller Chelsa Wagner released an audit report on Corizon Health’s compliance with its contract to provide medical care at the county jail in Pittsburgh.

The audit cited 14 areas in which the company allegedly failed to perform contractually-required services, ranging from failure to maintain emergency equipment to long delays in providing prisoners with physical exams and medication. According to Marion Damick, a representative of the Pennsylvania Prison Society and past director of the Pittsburgh chapter of the ACLU, “None of the 14 allegations were a surprise to anyone who has been around the Allegheny County Jail this past year. The problem is how to correct the situation considering the contract.”

The jail holds approximately 2,700 prisoners on any given day. Allegheny Correctional Health Services (ACHS), a nonprofit organization affiliated with the county’s health department, previously provided medical services to prisoners before the county contracted with Corizon in September 2013. Like other jurisdictions that contract with private companies, Allegheny County was trying to find a better solution to manage and reduce costs at the jail.

Corizon’s contract with the county, for an initial two-year term that began on September 1, 2013, includes three one-year extensions. The contract requires Allegheny County to pay $11.5 million per year with increases for inflation. Based upon numerous complaints about Corizon’s performance at the jail since the contract began, Wagner was concerned the company was not honoring its obligations. She called the findings of the audit “damning.”

The report by the Controller’s Office described many of the same complaints that have been documented in other jurisdictions that have contracted with Corizon. Wagner requested punitive damages in the amount of $20,000 as a result of the Allegheny County jail losing its accreditation from the National Commission on Correctional Health Care (NCCHC). The contract stipulates that “Corizon and the County shall maintain NCCHC accreditation throughout the term of this Agreement.”

The accreditation had expired in January 2013 while the county was debating the merits of hiring a private medical care provider and preparing a request for proposals. The Controller’s Office could not find an extension granted by NCCHC to allow for the transition of medical services at the jail from ACHS to Corizon. In early 2014, NCCHC was asked to visit the facility in hopes of getting the accreditation process back on track and providing technical assistance to Corizon and jail staff. During their visit, NCCHC officials noted several areas that would need corrective action before they could renew accreditation. The county expected those deficiencies to be rectified and the accreditation process to start immediately; however, Corizon and the jail apparently failed to do so.

In Corizon’s response to the audit, the company argued that its contract began in September 2013 and the accreditation renewal schedule was “overly aggressive.” Yet after 17 months under Corizon’s management, the jail still was not accredited. As for the $20,000 in damages, the company countered there were no findings that it had “failed to meet essential or important standards with the resultant loss of accreditation.”

Subsequently, in January 2015 the Pittsburgh Post-Gazette reported on the deaths of two prisoners at the county jail, and noted that the facility’s mortality rate in 2014 – seven deaths that year – was roughly double the national average. NCCHC accreditation may not have lowered the mortality rate, but it’s difficult to understand how Corizon could argue that “important or essential standards” were being met while prisoners were dying at around twice the national average.

For example, prisoner Frank Smart, 39, died 48 hours after being booked into the jail following his weekend arrest for using a counterfeit bill to purchase football playoff tickets. His attorney, Lee Rothman, told the Post-Gazette that Smart “had a seizure disorder his entire life.... It’s my understanding that he was complaining of needing medication or else he’d have a seizure, and they said he would have to wait until Monday.” Smart’s death is reportedly being investigated.

The audit also found that Corizon has not maintained sufficient staffing levels at the jail – a complaint that has been an on-going and contentious issue. According to the audit, 78% of the shifts were staffed below contractual minimums; the report estimated that the jail was short an equivalent of six healthcare employees per 24-hour workday. Allegheny County’s contract with Corizon “is a fixed price contract,” the audit noted. “Given that Corizon has an incentive to lower its costs to increase the profit it realizes under the contract, the Allegheny County Jail should have been monitoring Corizon’s contractual performance to ensure that the Jail was receiving the services for which it was paying.”

In its reply, Corizon acknowledged some staffing issues but blamed the inherited staff it had received from ACHS as well as “unjustified criticism of Corizon Health in the media which hampered recruitment.”

PharmaCorr, a division of Corizon, is the pharmaceutical manager at the Allegheny County jail, and the audit noted numerous deficiencies in contractual compliance by PharmaCorr as well. PharmaCorr boasts on its website of cost effective and efficient inventory management for medications. However, the audit found serious problems; for example, 62% of the time the pharmacy reordered drugs, it said it had zero quantity of the drug on-hand before reordering. This resulted in medication shortages, emergency orders and priority shipments of necessary medicines.

Medications are provided twice a day for prisoners in the jail’s general population and more frequently for those in the infirmary or mental health units.A consistent issue with Corizon and PharmaCorr services has been the untimely provision of medication. The audit noted that of 298 prescription forms examined, 54% were filled late, with delays ranging from 1 to 58 days. For 22% of the prescriptions, the documentation was so poor that the Controller’s audit could not determine if they were timely or late. Despite Corizon blaming nursing staff for not following proper procedures for refilling prescriptions, the company could not provide evidence to that effect.

The audit further noted that 32% of prisoners whose medical intake examination forms indicated a need for healthcare had no documentation as to whether any follow-up care was in fact provided. The contract requires that “Physical exams are to be routinely completed within 14 days of admission to the Jail.” With respect to prisoners incarcerated 14 days or longer, the audit found that 23% of their medical files contained no indication that a physical exam had ever been performed. In addition, the report said that in 60% of the files examined, the physical exam was performed from 1 to 55 days late.

The Allegheny County contract also stipulates that “Corizon shall cause and require to be maintained complete and accurate medical records for each inmate housed in the Facility who has received healthcare services during the term of this Agreement.” Yet the audit found various deficiencies or inconstancies in medical charts. For example, the pharmacy had dispensed medications to 7 of 25 prisoners selected for the audit (28%) absent supporting orders or progress notes for the medications in the prisoners’ medical records. In another sample, the audit found that 20% of the medications were dispensed without adequate orders or follow-up as to the patient’s response to the drugs. Further, the report noted that these deficiencies and inaccuracies in recordkeeping also related to physical exams, sick call requests and other clinical services.

Another issue addressed in the audit was Corizon’s failure to implement an electronic medical records system. The contract stipulates that the company “shall provide the County with CorrecTek’s Electronic Medical Record Solution (“EMR”) inclusive of implementation and system maintenance.” The EMR system was to be implemented in September 2014 and functional within 90 days; however, the audit found that as of October 2014, no dates had been established for when the system would be implemented.

Placing prisoners in solitary confinement has been the subject of extensive debate in the criminal justice field. Many mentally ill prisoners languish in isolation for months and even years without proper healthcare, and the county’s contract with Corizon requires staff to assess and document each prisoner’s medical and behavioral health prior to placement in segregation. The audit found that 83% of the prisoners in segregation had not received such an assessment. In addition, there was no documentation that indicated medical or mental health care rounds in the segregation units had been performed.

The Controller’s audit criticized Corizon’s firing of Sister Barbara Finch in January 2014. Several weeks after the United Steel Workers (USW) filed a petition to unionize employees at the jail, Finch, a Catholic nun with over 40 years of nursing experience, was terminated following her criticism of safety and healthcare deficiencies at the facility. The USW filed an unfair labor practice complaint with the National Labor Relations Board on Finch’s behalf, arguing that she was unfairly fired for engaging in union activities. In February 2014, employees at the jail voted to approve the USW as their representative. In Corizon’s reply to the Controller’s audit, it maintained that the NLRB did not charge the company or the jail with unfair labor practices and that Finch had been rehired with the cooperation of the bargaining unit.

The audit did not exclude Allegheny County officials from criticism, and questioned the county’s ability to adequately oversee the Corizon contract. Despite the company’s extensive history of litigation and complaints related to healthcare, the responsibility for monitoring the contract was delegated by the county to an already busy deputy warden at the jail, in addition to his or her regular job duties. Upon the release of the Controller’s audit, Vic Walczak, legal director of the ACLU of Pennsylvania, told the PittsburghPost-Gazette that the county should hire an outside monitor to oversee the contract and make the findings publicly available.

The audit findings by the Allegheny County Controller’s Office mirror many of the complaints made in other jurisdictions that have contracted with Corizon, such as Idaho, Florida and Maine. [See: PLN, March 2014, p.1]. The company’s business model apparently involves cutting costs on fixed-fee contracts through reductions in qualified staffing and medical services, which, in turn, result in deficiencies in record-keeping, monitoring and dispensing medications, intake assessments, etc. When the company is blamed for its failures, it deflects the blame to the incompetence of its employees, third-party reviewers and auditors, and the media for “unjust criticism” of its operations.

What Corizon may do best is scapegoating others for its poor management and performance. Unfortunately, government officials are so concerned about the rising cost of prisoner healthcare that Corizon’s promises to cut costs often induce them to contract with the company in spite of documented problems in other jurisdictions.

On February 5, 2015, a group of local citizens formed the Allegheny County Jail Health Justice Project, to ensure that Corizon provides adequate medical treatment to prisoners. “Our basic goal is very straightforward and that is that all people that are in the custody of the Allegheny County Jail are to be provided timely and comprehensive health care,” stated Bret Grote, legal director for the Abolitionist Law Center.

Sources: Allegheny County Controller’s Office,Pittsburgh Post-Gazette, www.wesa.fm

Gregory Dober is a freelance writer in healthcare ethics and has been a contributing writer for PLN since 2007. He holds advanced degrees in bioethics and health care ethics from Loyola University of Chicago and Duquesne University in Pittsburgh.

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