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Capitated compensation – a contract model in which private medical companies were paid based on prison population – may have been at the root of medical neglect that allegedly violated inmates’ 8th amendment rights at the Fluvanna Correctional Center for Women (FCCW), according to a lawsuit filed in U.S. District Court in Charlottesville.
The class action lawsuit by inmates at the Fluvanna Correctional Center for Women against the Virginia Department of Corrections has brought attention to inadequate medical care at FCCW, and to the controversial compensation method.
The Virginia Department of Corrections (VDOC) has chosen, since 2011, to use capitated compensation to pay the private contractors who provide medical services to its prisoners. Under this method, the contractor is paid a set amount per inmate housed in the facility. The less money the private contractor spends on the provision of medical services, the greater the profit seen by the contractor - an inherent inducement to the contractor to minimize services provided and medications given in order to decrease costs, and increase profits, according to the lawsuit.
“Corizon,” a Tennessee-based company that provides medical services to jails and prisons, earned $1.4 billion in 2014 from contracts in 27 states, but has recently suffered a ‘negative outlook’ rating from Moody’s Investors Service because of multiple lawsuits and lost contracts, according to an article by David Royse published in Modern Healthcare. Corizon won a five-year contract to provide health care services at the FCCW in 2013.
FCCW houses approximately 1,200 inmates, and has a medical building that includes an infirmary, and dental and mental health care offices. FCCW is considered the Virginia women’s prison best able to provide health services, and female inmates with serious and chronic health conditions are transferred to FCCW from other prisons across the Commonwealth.
Despite its reputation as the state’s best women’s prison for inmates with health concerns, some inmates at FCCW have died, and others suffered great pain and serious complications including amputations, kidney and liver failure, and blindness because of negligent health care, according to the lawsuit.
Documented incidents supporting the inmates’ claims of medical neglect include a known diabetic who entered the infirmary with symptoms of dangerously high blood glucose levels who laid untreated on a cot for several hours until she lost consciousness and died. Another inmate diagnosed with colorectal cancer was prescribed chemotherapy by a UVA oncologist in November 2013; chemotherapy was not begun until July of 2014 (this inmate died in March 2015.)
U.S. District Court Judge Norman K. Moon, whose final ruling on the settlement is expected in December 2015, wrote in a Memorandum Opinion released in November 2014 that, “Plaintiffs continue to experience the adverse effects of health problems they already had at the time this action was filed, as well as new health concerns in connection with which they remain subject to the seriously deficient medical care that is provided by FCCW on a systemic basis.”
“...with full awareness ... that the medical care at FCCW was already sub-standard on a systemic basis, the VDOC chose Corizon to serve as its contractor for the May 1, 2013, contract, based on a bid that was $17 million lower than the bid of Armor, the VDOC’s incumbent provider,” wrote Moon. “Bruce Teal, Armor’s Chief Executive Officer, testified that, based on its incumbent status, Armor was well aware of the costs of providing care at FCCW facilities, and that ‘under no circumstances’ could Armor have agreed to serve as the VDOC’s medical care provider under the new contract for the amount bid by Corizon.”
“Given these facts,” wrote Moon, “a reasonable fact-finder could conclude that a reduced level of medical care was the virtually inevitable result of the VDOC’s decision to select Corizon as its contractor,” wrote Moon. “I conclude that, based upon the evidence before me, a fact-finder could reasonably determine that the VDOC is deliberately indifferent to the serious medical needs of the Plaintiffs and the entire class of women residing at FCCW.”
The lawsuit was brought on behalf of the inmates by the Legal Aid Justice Center, Wiley Rein LLP of Washington, D.C., and the Washington Lawyers Committee for Civil Rights and Urban Affairs.
“Our goal,” said Legal Aid Justice Center Attorney Brenda Castaneda, “is to get that final order in there so that if they are not complying with the terms of the settlement we can go back to the judge who can find them in contempt. The doctor who is going to monitor the settlement is going to investigate and come up with suggestions for change.” Castaneda felt the ability to find the VDOC in contempt if conditions do not improve was integral to the success of the suit. “Until that happens I feel like real changes are not going to be made,” she said.
“The DOC has worked with us to reach a settlement,” said Castaneda. “They agreed that things should change and they worked with us to create a settlement that everyone could sign and agree to. I just hope they comply with the things that they have agreed to do.”
“After suffering years of pain and neglect due to inadequate medical care,” said Castaneda, “these women will finally receive justice through a major overhaul of the medical services provided at the Fluvanna prison.”
Assistant Attorney General Michael J. Parsons, who represented the VDOC for the Attorney General’s Office, could not be reached for comment on this case; VDOC Director of Communications Lisa V. Kinney said that the VDOC “doesn’t discuss pending litigation.”