The company hired to improve health care and cut costs at the Allegheny County Jail has struggled with one of its basic functions -- distributing medicine -- due to difficulties staffing the busy infirmary.
Tennessee-based for-profit firm Corizon Health Inc., hired to replace the nonprofit Allegheny Correctional Health Services, would not discuss the problems last week, nor its decision to slash physician staffing at the jail to roughly one-third of its prior level. Emails between county jail staff and Corizon, though, document a string of medication distribution problems that one jail watcher called "terrifying."
"I was just informed by the Captain on shift, the majority of the jail has not received medication AT ALL," wrote Deputy Warden Monica Long in an email to Corizon and jail staff on Nov. 17 at 1:03 p.m. "Staffing is at a crisis."
The Post-Gazette obtained the internal emails and other documents through a request to the county under the right-to-know law.
Asked about the emails on Thursday, following a meeting of the county Jail Oversight Board, Lee Harrington, Corizon vice president of operations, claimed no knowledge of any problems.
"We're constantly adjusting our services to make sure that we provide the services as contracted," he said. He declined to detail the adjustments.
Reading the emails, frequent jail visitor Marion Damick, the Pittsburgh representative of the Pennsylvania Prison Society, called the problems "abnormal. That never happened under Allegheny [Correctional], never.
"That's terrifying, actually. There is absolutely no reason that they would ever miss medication," she said, adding that such shortcomings can only increase costs in the long run.
She added that she is "not hearing bad news" about Corizon from inmates to date.
Corizon took over the jail infirmary Sept. 1, following a lengthy process meant to pick the successor to Allegheny Correctional.
Allegheny Correctional drew a steady stream of lawsuits stemming from inmate deaths and injuries, including some related to alleged failures to give inmates the right medicines. The nonprofit, which ran the infirmary since 2001, also allowed annual costs to creep up to around $12.5 million a year.
Corizon agreed to take on the 2,500-inmate jail for $11.5 million the first year, with annual increases of 4.25 percent.
Corizon said it would do a better job of staffing the infirmary. In a pre-takeover email dated Aug. 16 explaining why some Allegheny Correctional employees would soon lose their jobs, another Corizon vice president of operations, Mary Silva, wrote that "I ... really feel it is imperative to have adequate staffing on ALL shifts, not just day shift."
After Corizon's Sept. 1 takeover, though, staffing did not stabilize. That led to disruptions to the daily "medication passes" to the jail's 35 pods.
An Oct. 10 email from Ms. Long to Mr. Harrington and others asked for a "plan for successful implementation of medication passes" -- the term for the nursing staff's several-times-daily distribution to pods of medicines in packets stamped with the names of the receiving inmates.
On Oct. 21, Warden Orlando Harper wrote to Mr. Harrington and others: "We are continuing to experience issues pertaining to the following: 1. Staffing, 2. Medication distribution."
An email from Ms. Long complained that on Oct. 18 and 19, medication on Level 3 was passed out "after 11:00 p.m.," and on Oct. 20, "2 pods did not receive medication at all." She added that two pregnant inmates were "left in intake 24 hours" because Corizon nurses "did not know what to do" with them. An inmate on oxygen who "was supposed to be processed immediately" was left in the intake area for two shifts, she wrote.
On Nov. 16, a jail sergeant wrote that "Level 7 hasn't received Medication" by almost 2 p.m. "This is on going [sic] problem."
That day the person charged with solving the problem, longtime jail nursing director Kim Mike-Wilson, quit with no notice, according to the emails.
The next day, Ms. Long characterized the situation as "a crisis." In a response email, Corizon assistant health service administrator Michael Barfield blamed the day's crisis on Ms. Mike-Wilson's departure and a nurse's mid-shift departure due to illness.
The county declined to provide a list of Corizon staff inside the jail, indicating in a response to a right-to-know request that such information "is not directly related, or even relevant to" a contractor's performance of a governmental function.
A Nov. 20 meeting of jail and Corizon officials on medication passes and other issues failed to iron out the problems. Ms. Long wrote to Mr. Harrington two days later saying she "Just received another call that [pod] 5E has not received medications thus far."
Reached by phone Friday, Mr. Harper declined to detail his staff's interactions with Corizon. "Right now we're doing everything possible to make sure that our inmates receive the proper medical care," he said.
In an email response to questions Friday, county manager William D. McKain wrote that Corizon's leadership has been responsive to concerns.
He added that when transitioning from Allegheny Correctional to Corizon, "we expected that there will be a period of time in which there are problems and issues to be addressed.."
There are often disruptions when a jail changes its medical provider, said Mark Stern, former medical director at the Washington Department of Corrections, now an assistant affiliate professor at the University of Washington School of Public Health.
"It's not acceptable," said Dr. Stern, who worked briefly around 2000 for a company that merged into 35-year-old Corizon. "This is not [Corizon's] first rodeo. These problems are predictable and preventable."
Failing to deliver necessary medicines regularly would be "a serious violation of the constitutional right of inmates," he said. "There are some medications where a deviation of a few hours or even a day or so may not make a difference. There are other medications were the timing is much more critical.
"If we're treating tuberculosis and we don't treat it well in prison, then when they get out in the community, they're going to spread it."
Mr. Barfield told the Jail Oversight Board Thursday that Corizon had "ramped up the clinic visits." He said the key was hiring more nurse practitioners.
Jail medical director Michael Patterson highlighted for the board his focus on detecting and treating diabetes.
Dr. Patterson appears to be the lone remaining full-time physician in the jail under Corizon. The firm's contract calls for one additional part-time physician, and former jail medical employees who quit recently said that Eugene Youngue is filling that role.
Both Dr. Patterson and Dr. Youngue served the jail full time under Allegheny Correctional, along with physicians Lucille Aiken, Miguel Salomon and part-timer Morris Harper.
Dr. Aiken in September filed a state Human Relations Commission complaint against the county and Corizon, claiming that she was sent packing before the firm's takeover as retaliation for her efforts to ensure quality care for inmates, and because of her gender and status as an immigrant from Italy.
Allegheny Correctional also employed three psychiatrists and one psychologist. Corizon's contract requires that it provide one full-time psychiatrist and a part-time psychologist.
Mr. Harrington would not provide a raw number of physicians working in the jail following the board meeting Thursday, and on Friday failed to respond to an email and hung up when reached on his cell phone.
"We have a full complement of doctors," he said Thursday. "That's what we are contracted to provide."
Rich Lord: firstname.lastname@example.org, 412-263-1542 or on Twitter @richelord.