Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date.
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San Francisco Examiner - May 19, 2003
Alison Soltau, Of The Examiner Staff
Doctors and nurses are alarmed at the prospect of losing their jobs and warn that the effort to shave $15 million off a $25 million budget is a Band-Aid measure that would severely affect the health of The City's prison inmates, who they claim receive some of the best care in the United States.
Increasingly across the country, counties and states are contracting out health-care services to private companies, with healthy and not-so-healthy results.
The issue was in limbo last week. On Friday, the DPH and the Mayor's Office were negotiating with members of the Service Employees International Union Local 790, with the possibility that The City would retain responsibility for providing the health-care services but would ask workers to give something back in return.
While critics of privatization say that companies chasing a buck have little incentive to provide quality health care, some 24 states across the country were providing completely privatized health-care systems to inmates in state prisons by 2000.
Others point out that in some states, the standard of care behind bars was so poor, governments were forced to contract it out, often under pain of lawsuits from civil liberties' groups.
One full-time physician, eight full-time nurses, and one part-time nurse and physician would lose their jobs in San Francisco should the privatization plan become reality, said John Poh, a nurse and union representative.
Poh cited scandals involving private contractors across the country, saying the system was fraught with problems.
These included contractors not providing sufficient malpractice-insurance coverage, resulting in sheriff's departments being left to pick up the bill, and apparent cases of neglect of inmates, leading to their death and subsequent court action, he said.
Health-care workers inside the San Francisco County Jail, who stand to lose their jobs, were critical of the standard of care provided by private contractors.
"The services we provide now -- if they're not the best, they're not equaled by many," Poh said. "We try to have a person leave (jail) in better health than when they came in."
One nurse, who asked not to be named, claimed that private contractors had a lower nurse-patient ratio than what the DPH provided and would provide "very limited" jail psychiatric services to the severely psychiatrically ill population housed in the county jail's "Pod C."
San Francisco is a leader in HIV and hepatitis-B and hepatitis-C testing and is thorough in immunization and care of chronic conditions such as hypertension, diabetes, and asthma, the nurse said.
"Because of San Francisco's high homeless rate and high HIV rate, it makes the population more sick than the average (jail population)," she said.
The jail conducts particularly thorough testing for sexually transmitted diseases on incoming inmates and conducts Pap smears -- services the nurse said could be lost if jail health care was bid out.
"If we treat them in jail, that dilutes the amount of disease going back into the community," she said. "So far, it's been an amazing help for the community at large."
"If I went to Sonoma, they wouldn't be providing these things. They would be putting Band-Aids on problems, hoping people would get out of jail before anything crops up," the nurse said.
But over in Sonoma County, where the Sheriff's Department has contracted out the jail system's health-care services for the past 15 years, things couldn't be better, according to Assistant Sheriff Mike Costa.
Sonoma County contracts with California Forensic Medical Group for everyday medical care, and patients needing surgery are transferred by CFMG to nearby privatized hospitals, Costa said.
Costa said Sonoma County required its contractor to adhere to the California Medical Association's standard for prison care -- that it matches the standard of outpatient care in the community.
Sonoma County retains control of prison psychiatric health care. Costa said that CFMG provided testing for sexually transmitted diseases and care for the chronically ill.
Like many California counties, Sonoma County probably initially decided to privatize its health-care services because it was faced with a dwindling county hospital system and needed to save money, Costa said.
"But we've been very happy with the arrangement," he said.
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