About 20 states, including Arizona, Illinois and Maryland, have shifted all or portions of their prison health-care operations to private providers in an attempt to cut costs, a trend that is raising concerns among unions and prisoners’ rights groups.

Officials in the states say the companies — which provide medical, dental, mental and pharmaceutical services — are less expensive than employing state workers, in part because using them saves on benefits and pension costs.

Human rights groups, however, say that private operators are not always providing care that is as good or better than what the state could do. Joel Thompson, co-chair of the Health Care Project at Prisoners’ Legal Services in Massachusetts, said using private services can have its own set of problems. “As with anything privatized or contracted out, you worry about whether the incentive to cut costs becomes too great,” he said.

Public employees see the move as yet another attack on unions, and they question the quality of care.

In Florida, labor unions filed suit in May, urging a judge to block the state’s proposal to contract out inmate medical services, which threatens the jobs of 900 state employees, said Jeanie Demshar, director of professional practice advocacy and labor relations for the Florida Nurses Association. The state planned to use two of the nation’s largest vendors, Corizon and Wexford Health Sources, but the court declined to rule on the case this month after determining that the suit was moot because the budget for the new fiscal year did not include the plan.

“The reason that privatization is a better model is that when you look at state departments of corrections and local facilities, their core mission is safety, security and rehabilitation of the inmates,” said Mark Hale, Wexford’s president and chief executive. “Health care is required by the Constitution but is not a core competency of those agencies.”

During the past two decades, states and private providers have been targets of lawsuits alleging negligent or inadequate care of prisoners.

“I’m not aware of any correctional system that thinks it’s where it needs to be,” said Jesse Jannetta, senior research associate at the Urban Institute’s Justice Policy Center. “I’ve noticed the same challenges and problems despite how things are structured or who is responsible for what aspect of care.”

Under the Eighth Amendment directive against cruel and unusual punishment, prisoners are guaranteed adequate health care.

But managing prisoners’ health care is difficult. Infectious disease, mental illness and addiction are common problems for inmates, according to the Center for Prisoner Health and Human Rights. Furthermore, a January report by Human Rights Watch detailed the growing number of aging inmates, who incur costs that are nine times as high as those for younger inmates.

Wexford and Corizon have faced criticism about the delivery of care. A March report prepared for a federal judge accused Corizon of poor medical care and neglect at one of Idaho’s prisons. The report alleged serious nursing mistakes and inadequate care for prisoners with terminal illnesses.

Corizon responded to the accusations in a news release, saying the report was “incomplete, misleading and erroneous,” and cited an audit by the National Commission on Correctional Health Care, which said Corizon met all required standards.

“Corizon has a dedicated staff that works hard every day to provide care to a patient population that is sometimes difficult to treat, and at the same time be mindful that they are stewards of the taxpayer’s money,” a spokesman said.

In response, the Idaho corrections department agreed in May to increase its staff and medical oversight. The court continues to review the system during the next two years.

Wexford’s longest-standing contract is with Illinois. John Maki, executive director of the John Howard Association of Illinois, a prison reform group, said inmates often tell him that they are receiving insufficient care.

“It’s hard to untangle what’s true and whether it’s the fault of the department of corrections or Wexford,” Maki said. When the state handles the prisons and health care is outsourced, there may be coordination issues, he said.

But Wexford is also working on providing computerized health records and increasing its use of telemedicine, moves that Maki says have been invaluable, particularly in rural areas.

To be sure, complaints about prison health care are also raised when the state provides it. In California, inmates’ health care has been under federal court supervision for the past six years after a judge found that the state failed to provide inmates with adequate medical treatment. The state’s corrections department tried in May to regain the authority to oversee the system but was refused by a federal judge. The judge said the department must first demonstrate that it is able to provide adequate medical treatment.

Don Specter, director of the Prison Law Office, the legal advocacy group that set the lawsuits against California in motion, said care has improved but is still inadequate.

— Kaiser Health News

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.