The Arizona Department of Corrections is sending hundreds of inmates to Kino Hospital's emergency room every month, shifting much of the cost of their care to Pima County taxpayers - and making it more likely that Tucsonans will be treated alongside criminals.
The state is paying less than it used to for inmate care, leaving the county to pick up the slack. The change also requires the county to spend up to $500,000 on safety and security upgrades, said Honey Pivirotto, Pima County assistant administrator for health policy.
The situation began late last year after the two hospitals where most Arizona prisoners were treated - Carondelet St. Mary's in Tucson and Maricopa Medical Center in Phoenix - rejected the state's move to lower reimbursement rates and terminated their contracts with the DOC.
Last week the state signed a contract with Abrazo Health Care, which has five hospitals in Central and Northern Arizona. But it hasn't found a new hospital partner in Tucson and, as a result, inmates who need care beyond what can be provided by prison doctors are being taken to emergency rooms, mostly University Physicians Hospital at Kino, or UPH Kino.
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Previously, inmates were treated in secure detention areas at St. Mary's. Now UPH Kino is seeing 180 to 250 inmates a month, county documents say. Charles Flanagan, deputy director of the state corrections department, disputed those numbers, saying the DOC has sent 366 inmates statewide to emergency rooms since contracts were terminated.
The DOC has a long history of bringing inmates into the community, Flanagan said.
"The primary focus of our mission is to protect the public," he said. "I assure you that the number of problems are very few and far between. This is something that has happened for a very long period of time with a very successful record."
Lower reimbursement
Inmates' emergency treatment costs state taxpayers less, DOC officials say, because of the lower reimbursement rates.
That may be true, but it's costing county taxpayers more, County Administrator Chuck Huckelberry said.
The DOC now matches reimbursement rates for the Arizona Health Care Cost Containment System, the state's indigent health plan. That amounts to 75 to 80 percent of the cost of treating inmates, said Sarah Frost, business development and strategy manager for UPH Kino. The DOC used to pay 175 to 210 percent of AHCCCS rates.
The county and the hospital have to pick up the difference - and spend $300,000 to $500,000 on safety upgrades to equip the hospital for criminal patients, Pivirotto said.
"Clearly, the hospital did not seek this patient population," she said.
Though University Physicians has a lease to operate UPH Kino, the hospital is owned by Pima County. The hospital already sees a high volume of uninsured and underinsured patients, Huckelberry said, and the Department of Corrections is "forcing a disproportionate burden of insufficiently compensated care onto the hospital," causing it to lose money.
"They are pushing the cost on the public in another way," he said.
County taxpayers already subsidize the money-losing hospital, and DOC's move will aggravate the county and hospital's losses, he said. He added that the county is considering all options, including legal action.
Contracts ended
The loss of contracts affects thousands of inmates. St. Mary's officials reported 1,781 admissions from the corrections department in the previous fiscal year; Maricopa Medical Center reported 3,082.
After the state lost those two contracts, DOC sent out a request for proposals and received no response. So the department is engaged in what the DOC's Flanagan calls "emergency direct contracting." By partnering with independent providers for cardiovascular care, dialysis treatment, oncology and other medical specialties, the department hopes to fill the void.
So far, the department has entered into three contracts to replace services formerly provided by the hospitals. In addition to Abrazo, DaVita will provide dialysis treatment in Tucson and 21st Century Oncology will provide cancer treatment in Queen Creek. It also has ongoing contracts with four hospitals in relatively rural areas and sometimes sends inmates to non-contracted specialists - 856 since late November.
Negotiations with UPH Kino are ongoing.
"They are coming to our emergency room, and we are ensuring that there is a contractual arrangement," Frost said.
Flanagan said the state hopes to have new contracts in place soon, but negotiations take time because they are extremely complicated.
"There are so many moving parts it is really very hard to describe," he said.
When inmates are transported outside of state prisons, they must undergo security and classification screenings, including strip searches and positive identification, Flanagan said.
Inmates are shackled and transported in secure vehicles by armed security staff members, who are present for the entirety of the medical visit.
Private clinics that see inmates also take steps to ensure inmate security and patient safety. At DaVita, for example, the staff received special training, and inmates will be brought in through a separate entrance and treated in a secluded area of the building.
"We have talked to our patients and prepared them, and at this point there have been no concerns," said Kenneth Sutch, DaVita's regional operations director.
Some care affected
DOC officials say inmates are getting the care they need.
But they acknowledge that some inmates with chronic or specialized health conditions not considered urgent aren't receiving the same care they did in the past.
Donna Leone Hamm, executive director of Middle Ground Prison Reform Inc., says she has seen such an increase in inmate complaints that she suspects the level of their care has declined.
"Ultimately what will happen is a major disaster will occur with an inmate that is directly attributable to lack of care," she said. "That's something that has to happen first to make legislators change their positions."
With a reported average daily population of more than 30,000 inmates, and more than 2,500 inmates in need of specialized care, Hamm said a piecemeal system doesn't cut it.
"They cannot continue to use intermittent, haphazard medical providers," Hamm said. "They have to have a system, and it has to be solid and consistent."
Bethany Conway is a University of Arizona journalism student who is apprenticing at the Star. Contact her at 573-4198 or at starapprentice@azstarnet.com
