Aggressive management could improve inmate care

Gov. Jennifer Granholm, in her State of the State remarks, promised savings and efficiencies in state government -- including in the Corrections Department, which is one of the state's fastest-growing departments and consumes a fifth of the discretionary budget.

In comments to The Detroit News editorial board Thursday, she pointed to changes in the prison health care system as one source of savings through greater efficiencies. But the first problem to be solved is adequate delivery of health care in prison. A recent outside audit, ordered, to her credit, by the governor, said the state isn't getting its money's worth for the $300 million it spends on providing medical services to inmates.

The state contracts with a private health care provider for many services, and uses state staffers for others. As a result, the audit noted, lines of accountability for the delivery of services are unclear. And the private provider, which has held the contract for a decade, has not been required to live up to the terms of its contract.

The state Corrections Department has said it agrees with the audit and is modifying the terms of the contract. But as the governor observed Thursday on improving efficiency in all areas of state government, "it's a matter of good management."

The terms of the contract can be changed, but if there isn't sound contract management, the contract is irrelevant. The audit noted long waiting times for some inmates to get appropriate treatment, poor procedures for dealing with medical and psychiatric emergencies and a lack of appropriate medications on the list of pharmaceuticals available to prisoners.

The prison system's computerized medical record-keeping program, auditors added, is cumbersome and difficult to use, resulting in confusion and duplication of services. For various reasons, providers saw fewer patients per day than a well-run operation should, the audit contended.

One particular problem noted by the audit was that the private provider, CMS, was allowed to leave shifts at prisons unfilled by doctors or other medical practitioners. The terms of the contract, the audit noted, gave the department the power to impose financial penalties if the firm failed to live up to its terms, but the state during most of the last 10 years took little action. The audit stated it could not discern what the department's contract monitor, who has since retired, actually did. Auditors said they could not find a "single monitoring report."

While the audit noted recent improvement, it added in one scathing comment that "if the (Corrections Department) and CMS were operating in a truly arm's length relationship, there should be an immediate response from the (department) followed by rapid resolution of the problem, legal action, and/or termination of the contract. Instead, the contract has been continued for 10 years."

Changing the terms of the contract is a fine idea. The audit indicates there's plenty of room for savings through increased efficiency and productivity. And given the amount of spending on care for prisoners, the Corrections Department has every right to demand top-notch services.

But there has to be real follow-through and aggressive management, or money that should go to treatment for people whose health and even lives are literally in the hands of the state will again be wasted.