Nonprofit partnership that replaced private contractor now seen as model for other facilities
By Naseem Sowti Miller
Staff writer
Published: Saturday, February 7, 2009 at 6:30 a.m.
OCALA — On a recent afternoon, Greg sat on a simple metal chair in a bare room at the Marion County Jail. The only colors were the red stripes of his jail outfit and the deep purple color that crawled up his legs.
He only wanted his first name used, so his family wouldn't be embarrassed by his incarceration.
When Greg was booked into the jail early in January, he was not just an inmate. He was a patient.
Greg said he's been suffering for five years from chronic cellulitis, an almost constant infection of the skin and the soft tissues underneath the skin, which in his case is caused by poor circulation.
He said that outside the jail, although uninsured, he sometimes had to take expensive antibiotics that he received for free from pharmaceutical companies. He regularly visited a wound care specialist.
But he wasn't sure what to expect after he was booked into the jail early in January.
"I'm in jail. It's a different kind of world. But I'm extremely thankful for the care I've gotten," he said. He said he had received antibiotics and daily wound care. "And they got me a small whirlpool bath," which helps with circulation in his legs.
Greg's experience stands in stark contrast with the interviews the Star-Banner conducted with inmates in 2007, before Sheriff Ed Dean ended the jail's contract with the national private medical provider, Prison Health Services, Inc.
Dean replaced PHS with a newly formed local nonprofit organization called Ocala Community Care.
"It's easy for people to say it won't work, because it's never been tried here," Dean said in an interview a few weeks before OCC took over the inmates' medical care in January 2008.
Now, a year later, he says, "I'm very excited and proud with quality and cost-effectiveness of OCC. I had great confidence in our medical care partners in the community and that we could do what we set out to do. I think the OCC model is now a bona fide model for others."
Complicated care
Correctional health care is costly and complicated. While health care is an inmate's legal right, most people in jails and prisons are poor, lack education, have high rates of mental illness and chronic illness and are frequently substance abusers or addicts.
Many are uninsured and have not seen a doctor or dentist for years.
Medical care in jails can be further complicated because inmates' lengths of stay are measured in days, instead of the years spent in prisons. The average length of stay in the Marion County Jail, with the average population of 1,800, is around 50 days.
"In correctional health care, you deal with everything," said Loretha Tolbert-Rich, who's the medical liaison for the Sheriff's Office and reports on OCC's quality of care.
Many jails resort to large private companies, like PHS, that not only promise to control costs, but also take control of all aspects of the inmates' medical care.
But critics of the privatized model say such companies cut corners when it comes to providing medical care to inmates to save money and keep their investors happy.
The private companies also rarely connect with health providers in the community for inmates' continuity of care once they're released.
So, when Dean decided to end his contract with PHS — he said that, due to county budget cuts, he was not able to renew that contract because he could only offer a 6 percent budget increase PHS had requested — he set out to create a new system, using local resources.
He brought several community leaders together to establish a nonprofit medical care system linked closely with major providers here. The OCC board is almost entirely made up of community leaders and health care providers.
OCC took over inmate medical care on Jan. 2, 2008, running on $5 million and faith in the community. OCC is running on nearly the same dollar amounts for its second year, a cost-saving measure, according to its leaders. And data shows that the quality of medical care for inmates has improved.
Community provided
The Marion County Jail is one of the few jails in Florida to implement a community-based inmate medical care.
Establishing such a system is complex and requires the participation of local institutions such as the hospitals and the county Health Department — factors that have turned off the interest of local governments in Florida and around the nation.
But that was not the case in Marion County. "This is an ‘us' scenario," said Phil Hoelscher, OCC's contract monitor and the president of Alliance Medical Management.
The Centers, the county's nonprofit mental health provider, sends in two psychiatrists and three mental health counselors, who sometimes have seen the patients before incarceration or will continue to see them after they're released.
A hospitalist from Munroe Regional Medical Center oversees the admission and care of inmates at the hospital, and is the jail's main point of contact for updates on inmates' conditions.
Three people at OCC are also authorized to electronically view the inmates' medical records while hospitalized.
And Tolbert-Rich, the medical liaison for the Sheriff's Office, listens to inmates complaints, and is the sheriff's "quality assurance person," as she put it.
With nearly three decades of experience in correctional health care, and with a nursing background, Tolbert-Rich has a deep understanding and knowledge of the system, which are some of the reasons Dean recruited her from the Department of Corrections.
Several studies have shown that community-based models can lead to cost savings, improved inmate and public health, reduced recidivism and improved public safety.
"When you build connectivity, [the inmates'] community-based provider is more likely to know them," said Steven Rosenberg, president of Community Oriented Correctional Health Services, a nonprofit organization that helps communities find ways to connect correctional health care with the health care in the community.
Dean consulted with the group while laying the groundwork for OCC and is now on the organization's advisory committee.
Rosenberg added that the community doctors see the inmates as a community member, not an offender.
"When you have a doctor who practices in the community, they practice at a different level and quality," he said.
A good example is Dr. Jaime Rubio, the medical director of OCC who was brought on board in April.
Since his arrival, he has developed protocols to ensure inmates receive their medications on time, are seen by a provider within hours or days, depending on their condition, and receive proper treatment.
"When I got here, there was not much of a system in place," he said. "So I spent more than 20 hours a week bringing everything up to date. There are no more past-due clinic visit dates."
He erased the "washout period" — where inmates who were thought to be substance abusers were taken completely off of their anti-psychotic medications. The treatments, he said, are now provided on a case by case basis.
Rubio, who has 10 years of experience in correctional health care, is also a physician at the Heart of Florida Health Center in Ocala, where everyone, regardless of insurance can receive treatment.
"I have a reputation to carry in my private practice," Rubio said, sitting in his small office in the jail. "And inmates should be seen as human beings, because you don't know if you'll end up in there one day."
Pleased with progress
Despite general public apathy toward those behind bars, the issue of inmate health is of concern to more than just the inmates themselves and their families.
More than 95 percent of inmates are eventually released back to their neighborhoods.
But many times, the biggest challenge in creating a community-based system for inmate medical care is changing people's frame of mind, Rosenberg of COCHS, said.
"Most of [the jail inmates] are pre-trial. These are community members who are temporarily displaced... or have minor misdemeanor charges," he said.
Officials at OCC, pleased with their progress, say that during the first year they focused on building the core of the program. Now they're building onto the core and completing the bridge into the community health care system.
They're adding a dialysis center on site, and are looking into applying for national accreditation for their medical system. And while the mental health court is being re-established, OCC officials hope their community based system will help reduce the rate of recidivism.
Dean's ultimate goal for OCC, from the very start, has been extending the program's services to other segments of the community, including employees of the Sheriff's Office.
"I think we've just scratched the surface of what we can do in America to make health care affordable and accessible in America," he said.
Contact Naseem Sowti Miller at 867-4140 or naseem.miller@starbanner.com.
By Naseem Sowti Miller
Staff writer
Published: Saturday, February 7, 2009 at 6:30 a.m.
OCALA — On a recent afternoon, Greg sat on a simple metal chair in a bare room at the Marion County Jail. The only colors were the red stripes of his jail outfit and the deep purple color that crawled up his legs.
He only wanted his first name used, so his family wouldn't be embarrassed by his incarceration.
When Greg was booked into the jail early in January, he was not just an inmate. He was a patient.
Greg said he's been suffering for five years from chronic cellulitis, an almost constant infection of the skin and the soft tissues underneath the skin, which in his case is caused by poor circulation.
He said that outside the jail, although uninsured, he sometimes had to take expensive antibiotics that he received for free from pharmaceutical companies. He regularly visited a wound care specialist.
But he wasn't sure what to expect after he was booked into the jail early in January.
"I'm in jail. It's a different kind of world. But I'm extremely thankful for the care I've gotten," he said. He said he had received antibiotics and daily wound care. "And they got me a small whirlpool bath," which helps with circulation in his legs.
Greg's experience stands in stark contrast with the interviews the Star-Banner conducted with inmates in 2007, before Sheriff Ed Dean ended the jail's contract with the national private medical provider, Prison Health Services, Inc.
Dean replaced PHS with a newly formed local nonprofit organization called Ocala Community Care.
"It's easy for people to say it won't work, because it's never been tried here," Dean said in an interview a few weeks before OCC took over the inmates' medical care in January 2008.
Now, a year later, he says, "I'm very excited and proud with quality and cost-effectiveness of OCC. I had great confidence in our medical care partners in the community and that we could do what we set out to do. I think the OCC model is now a bona fide model for others."
Complicated care
Correctional health care is costly and complicated. While health care is an inmate's legal right, most people in jails and prisons are poor, lack education, have high rates of mental illness and chronic illness and are frequently substance abusers or addicts.
Many are uninsured and have not seen a doctor or dentist for years.
Medical care in jails can be further complicated because inmates' lengths of stay are measured in days, instead of the years spent in prisons. The average length of stay in the Marion County Jail, with the average population of 1,800, is around 50 days.
"In correctional health care, you deal with everything," said Loretha Tolbert-Rich, who's the medical liaison for the Sheriff's Office and reports on OCC's quality of care.
Many jails resort to large private companies, like PHS, that not only promise to control costs, but also take control of all aspects of the inmates' medical care.
But critics of the privatized model say such companies cut corners when it comes to providing medical care to inmates to save money and keep their investors happy.
The private companies also rarely connect with health providers in the community for inmates' continuity of care once they're released.
So, when Dean decided to end his contract with PHS — he said that, due to county budget cuts, he was not able to renew that contract because he could only offer a 6 percent budget increase PHS had requested — he set out to create a new system, using local resources.
He brought several community leaders together to establish a nonprofit medical care system linked closely with major providers here. The OCC board is almost entirely made up of community leaders and health care providers.
OCC took over inmate medical care on Jan. 2, 2008, running on $5 million and faith in the community. OCC is running on nearly the same dollar amounts for its second year, a cost-saving measure, according to its leaders. And data shows that the quality of medical care for inmates has improved.
Community provided
The Marion County Jail is one of the few jails in Florida to implement a community-based inmate medical care.
Establishing such a system is complex and requires the participation of local institutions such as the hospitals and the county Health Department — factors that have turned off the interest of local governments in Florida and around the nation.
But that was not the case in Marion County. "This is an ‘us' scenario," said Phil Hoelscher, OCC's contract monitor and the president of Alliance Medical Management.
The Centers, the county's nonprofit mental health provider, sends in two psychiatrists and three mental health counselors, who sometimes have seen the patients before incarceration or will continue to see them after they're released.
A hospitalist from Munroe Regional Medical Center oversees the admission and care of inmates at the hospital, and is the jail's main point of contact for updates on inmates' conditions.
Three people at OCC are also authorized to electronically view the inmates' medical records while hospitalized.
And Tolbert-Rich, the medical liaison for the Sheriff's Office, listens to inmates complaints, and is the sheriff's "quality assurance person," as she put it.
With nearly three decades of experience in correctional health care, and with a nursing background, Tolbert-Rich has a deep understanding and knowledge of the system, which are some of the reasons Dean recruited her from the Department of Corrections.
Several studies have shown that community-based models can lead to cost savings, improved inmate and public health, reduced recidivism and improved public safety.
"When you build connectivity, [the inmates'] community-based provider is more likely to know them," said Steven Rosenberg, president of Community Oriented Correctional Health Services, a nonprofit organization that helps communities find ways to connect correctional health care with the health care in the community.
Dean consulted with the group while laying the groundwork for OCC and is now on the organization's advisory committee.
Rosenberg added that the community doctors see the inmates as a community member, not an offender.
"When you have a doctor who practices in the community, they practice at a different level and quality," he said.
A good example is Dr. Jaime Rubio, the medical director of OCC who was brought on board in April.
Since his arrival, he has developed protocols to ensure inmates receive their medications on time, are seen by a provider within hours or days, depending on their condition, and receive proper treatment.
"When I got here, there was not much of a system in place," he said. "So I spent more than 20 hours a week bringing everything up to date. There are no more past-due clinic visit dates."
He erased the "washout period" — where inmates who were thought to be substance abusers were taken completely off of their anti-psychotic medications. The treatments, he said, are now provided on a case by case basis.
Rubio, who has 10 years of experience in correctional health care, is also a physician at the Heart of Florida Health Center in Ocala, where everyone, regardless of insurance can receive treatment.
"I have a reputation to carry in my private practice," Rubio said, sitting in his small office in the jail. "And inmates should be seen as human beings, because you don't know if you'll end up in there one day."
Pleased with progress
Despite general public apathy toward those behind bars, the issue of inmate health is of concern to more than just the inmates themselves and their families.
More than 95 percent of inmates are eventually released back to their neighborhoods.
But many times, the biggest challenge in creating a community-based system for inmate medical care is changing people's frame of mind, Rosenberg of COCHS, said.
"Most of [the jail inmates] are pre-trial. These are community members who are temporarily displaced... or have minor misdemeanor charges," he said.
Officials at OCC, pleased with their progress, say that during the first year they focused on building the core of the program. Now they're building onto the core and completing the bridge into the community health care system.
They're adding a dialysis center on site, and are looking into applying for national accreditation for their medical system. And while the mental health court is being re-established, OCC officials hope their community based system will help reduce the rate of recidivism.
Dean's ultimate goal for OCC, from the very start, has been extending the program's services to other segments of the community, including employees of the Sheriff's Office.
"I think we've just scratched the surface of what we can do in America to make health care affordable and accessible in America," he said.
Contact Naseem Sowti Miller at 867-4140 or naseem.miller@starbanner.com.
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