D.C. Inmates' Health Care Will Continue Outside of Jail

District Models Public Plan on Program in Massachusetts

The D.C. jail will become one of the first correctional facilities in the country to provide inmates with medical care that will follow them once they are no longer behind bars.

The program will offer men and women incarcerated in the city's main detention center continuity of primary and specialty care after they are released. The approach, modeled on a successful project in central Massachusetts, was announced yesterday by Mayor Anthony A. Williams (D) and other District officials.

"It's a very innovative, dynamic and comprehensive approach to the provision of inmate medical care," said the city's new corrections director, Devon Brown.

The jail has had a long history of deficient health care. From 1995 until 2000, medical and mental health services there were operating under an expensive, court-ordered receivership that ultimately improved treatment at an average cost of $11 million a year.

Under the new initiative, the nonprofit organization Unity Health Care will take over inside the jail and begin seeing the men and women there, many of whom have hepatitis C, tuberculosis or HIV. But Unity will not close inmates' files once they leave the facility. Instead, it will continue to manage their care and records through the nearly three dozen clinics, centers and other medical locations it operates across the District for the uninsured and underinsured.

"Once they're discharged from the prison, we'll still be responsible," Chief Executive Vincent A. Keane said yesterday. "The emphasis is for less expensive care and more appropriate care."

Unity will help evaluate inmates' substance abuse problems, but its work will not extend to comprehensive addiction treatment.

The program, which officials are hoping to begin Oct. 1, will receive technical help from a $7.5 million national project undertaken by the Robert Wood Johnson Foundation. That project expects to replicate the Hampden, Mass., model at as many as 16 correctional sites across the country over the next three years.

"We've recognized for a very long time that we do a very lousy job providing health care in correctional facilities," said Steven Rosenberg, project director at Community Oriented Correctional Health Services, a California-based organization that will assist each of the sites.

Given that more than nine in 10 people incarcerated at the D.C. jail are released into society, Brown likes the new program for recognizing "the intertwining concepts of public safety and public health."

Chronic and communicable diseases that do not receive continued treatment once an inmate is no longer in the jail can have a significant public impact. Were it not for the jail, "many of these people would not receive any medical care whatsoever," Brown said.

The executive director of the D.C. Prisoners' Legal Service Project supports Unity's plan for the same reasons.

"It's a, dare I say, enlightened move," Philip Fornaci said, though he worries that it will be difficult for the program to track all the inmates who come and go from the jail. The detention center's population often exceeds 2,100 inmates, and more than 19,000 people are incarcerated there in a year.

Since the mid-1990s, when a federal judge intervened and placed the jail's medical and mental health services in receivership, conditions and treatment have improved considerably. But there have been exceptions, such as the 2004 death of a quadriplegic man.

The District's latest initiative came about after the Department of Corrections approached Unity. Brown said he expects to see continued improvement once Unity takes charge, with care delivered more rapidly and more health education provided.