- Report: #624433
Complaint Review: Prison Health Service Inc. - Internet
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Author Not Confirmed
Why?
Prison Health Service Inc.
105 Westpark Drive, Suite 200 37027 Internet, United States of America
Phone:
800-729-0069
Web:
http://www.prisonhealth.com/index.htm
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Prison Health Service, Inc. American Service Group (parent company) Prison Health Care accomplished with diminished resources, medications, personal, and equipment Internet
Prison Health Services, Inc. (PHS), is the largest correctional health care company in the U.S. They have a well developed program to market, and dispense this kind of specialty care while maintaining a corporate profit motive. They employ 3800 employees nationwide according to their website. I had been an Advanced Registered Nurse Practitioner (primary care provider) at the local County Jail for 8 months with another Company, First Correctional Medicine (FCM). When they lost the contract on January 1st, 2006 I remained at this same jail and position but now with PHS who contracted to begin their service with the county Sheriff Department, who manage the jail.
This interlude gave me an opportunity to compare the corporate approach to the problems these two companies applied to this environment. Comparing these approaches showed me an attitude that skirted the edge of malpractice from the PHS approach in its effort to be profitable. When I first noticed this difference I "Googled" the inquiry "Prison Health Services" and Lawsuit in the search engine. I got 1250 hits. The main drift of these hits were news stories about lawsuits PHS was fending off due to their corporate approach to Prison health. These stories tell the main object of these lawsuits was that the staff involved said, "PHS made me do what I didn't want to do."
I found in the four and a half years I worked for them that they lied often about why they were doing things, and that the profit motive was usually the major reason for any corporate approach. The story was that we did many things until a lawsuit from elsewhere prompted us to change our approach. Although we never had any real lawsuits during my tenure we did get awfully close. Yet we had a constant inflow of information about lawsuits and contract losses from many of the corporate sites in different states and other locations in Florida.
I was aware of the policies of that FCM had, which were limited, but adequate. FCM had underbid for the contract against PHS in 2004 for $400,000 less each year. FCM did go bankrupt a few months after PHS came back in 2006. Yet I often wondered what this FCM would have done with the extra $800,000 PHS was going to get over the course of the next 2 years.
After the first month PHS called for a moratorium on FCM policies and instituted their own. I Was shocked at what they expected of the staff to work with and still accomplish the mission. Every time I questioned what they were asking us to do they said it is done at every other facility PHS was established in. I was also stunned with the differences in the formulary that lists all the drugs we would be able to order without further PHS approval.
FCM's formulary was about 18 pages long. Every drug listed was typed on a single line. There were very few axioms printed on any of the other lines. So there were about 400 drugs listed that could be stocked and administered without any further forms requesting corporate authority for use of that drug. The PHS Formulary was very well done and professional, but it had only 14 pages of medications.These were very well organized, and they frequently had notes which described when and how long these meds could be given. This probably contained maybe 200-225 medications, many of which could only be given for limited periods. This severely limited the care that could be administer and made that care completely ineffective at times.
This had an immediate effect, especially on the mental health medications. Mental Illness is a very significant aspect of the modern county jail population. Many of our jailed population in America are really mentally ill people with no other place to go. This is one reason we have the highest percentage of our total population is jailed. We had a mental health hospital about 60 miles north of Gainesville. It is one of four major mental health facilities in Florida. In 1972 the population for this hospital was around 8500 patients. After the federal regulations changed and said these people could not be kept against their will unless they were dangerous to society. So now that facility's population is closer to 2,500 patients. Where did those remaining 6,000 patients go? I can tell you that many of them went to the local county jails in Florida. So what is done for these people in jail. Well at PHS contracted facilities in Florida they are being serviced, but with a minimal selection of medications.
The nurse practitioner who was hired back in April of 2005 for FCM was called into a conference call. I was also attending and spoke of some of my own policy problems to the CEO who was a female physician based in Tucson, Arizona. When it was time for this new mental health nurse practitioner to discuss her situation the CEO said, "What are you trying to do to us. You spent $60,000 on mental health medications last month alone. We can't keep this up." The nurse practitioner went back to her situation and reduced her next month allotment down to $48,000. She was never approached with this problem again in the remaining months she was being monitored by FCM.
When she had to adjust the medication budget to PHS standards she was told that the mental health medications budget for this company was going to be $3,000 a month. With this in mind they began using medications I had not see used in mental health circles for the previous 15 or 20 years, the tricyclic antidepressants such as Pamalor. The revolution in these medications came in the early 90's with the introduction of Prozac and the other SSRI's. They have no greater effectiveness, but the client usually experiences less side effects. We had Prozac and several of the older SSRI's available but if you were on any of the newer ones you had to wait up to 2 weeks to begin on these older ones as a substitute. During that first February after PHS arrived in 2006 we began to see some of the more common side effects of the tricyclic antidepressants.
I had one man come to the clinic and complained of severe dizziness especially when he got up. We see a lot of dehydration in the jail because only water is available to the inmates to drink, and with the low humidity maintained in the jail inmates frequently do not drink enough fluids. When tested for orthostatic hypotension, this inmate had a pulse of 76 BPM laying down, and 136 BPM when he stood up. That is a 50 pulse difference, and 20 points is the limit for a diagnosis of orthostatic hypotension. The usual treatment is to replace the inmates fluids with a 2 liter IV infusion over 8 hours. This was ordered and done with no response. We were confused until a older nurse remembered that the tricyclic can cause orthostatic hypotension. We advised the mental health people of the inmates severe pulse changes with laying and standing, and the unresponsive nature of his problem to a fluid challenge.
It took this inmate 2 weeks after stopping the medication before his pulse checks returned to a normotensive state. However, another inmate was so dizzy when he got up at one point that he fell and broke his hip. This is when we saw them using the SSRI's more frequently, but not exclusively.
The other initial policy regarding mental health medications was the disposition of the atypical antipsychotic medications that have greatly improved the psychotic patient in the jail environment. The only one of these medications they were using during these first days of the contract was Geodon. This medication appeared on the website www.worstpills.org as a potential to have caused death in some patients. The cost difference of this med and Zyprexa is minimal, why were we using such a dangerous drug?
That February this all came to a head. A 38 year old male inmate with a long history of mental illness was taking Geodon. One weekend on call I was told his tongue swelled and I discontinued this medication. When the weekday schedule returned he was placed back on the Geodon by the mental health NP.
That Friday, I was approached just before leaving for the weekend. An inmate had told his security officers on the mental health unit that he was so constipated that he pushed a tooth brush into his rectum to try to get things moving. I rejected the probability as being low, admitted him to the male infirmary, and told the weekend staff to alert the on call provider if there was any problems.
The next day, at about 4 pm, this inmate was given his dinner in the infirmary cell. The security person on duty realized he had not seen the inmate for about 15 minutes after he received his meal. The officer got up and looked into the cell only to see the inmate on the floor. They called a code, but the inmate was gone and EMS and the ER did not revive him.
That Monday I realized this was the same inmate that had had the allergic reaction the weekend before, when I was on call, and that he was now back on the Geodon. When they made him take it again he told them, "You people are going to kill me."
When this inmate was autopsied he was found to have died of pulmonary edema. No further investigation was done. The inmate was 38 years old and had no history of heart problems, where did he develop pulmonary edema.
Geodon can cause heart arrhythmias VT (ventricular tachycardia) in patients with short QT intervals on their EKG. The EKG was ordered twice on this inmate by the mental health NP but it was never done. The VT can drive the heart to rates of 200 BPM or more which would reduce heart function dramatically. The end result could easily be pulmonary edema which could kill within minutes.
There are many other instances that I can relate but the volume of these is more at the level of a report and probably at the level of an investigation.
