Concerns about medical care in Baton Rouge's jail reached a boiling point in August 2015 when a group of nurses laid their grievances before the parish Metro Council, describing dire staffing shortages and inadequate mental health services that advocates blamed for an outsized inmate death rate.

An independent consultant confirmed widespread problems and recommended doubling the parish's annual corrections healthcare budget to about $10 million.

But city officials chose a different route: privatizing medical services without a significant increase in cost. They contracted with CorrectHealth, one of several companies nationwide specializing in inmate health care — a burgeoning and profitable field that has grown in recent decades alongside the American prison population.

Nevertheless, questions remain about whether that contract has resulted in measurable improvements. CorrectHealth representatives will deliver a presentation at Wednesday's Metro Council meeting, touting a recently acquired national accreditation that indicates their care meets certain standardized benchmarks. 

The meeting provides a rare opportunity for public discussion on the issue, which has received little attention from elected officials since they negotiated the contract three years ago.

Prisoner rights advocates are skeptical about CorrectHealth's accomplishments at East Baton Rouge Parish Prison in part because people are still dying there — at a rate more than double the national average for jail deaths. That rate hasn't decreased since CorrectHealth took over, and the company's internal investigations into the circumstances surrounding the deaths are being withheld from public view.

"We are locking people in cages — these are people being held pretrial, who haven't been convicted of any crime — and allowing them to die there," said the Rev. Alexis Anderson, a local prisoner rights activist. "These are human lives being lost."

CorrectHealth and the East Baton Rouge Sheriff's Office have consistently emphasized the prevalence of preexisting conditions within the incarcerated population that often have gone untreated or even undiagnosed.

CorrectHealth President Dr. Carlo Musso said it's a population that few medical professionals want to serve, but "the impact on public health is literally transformational — what you can provide to individuals who rarely get health care on the outside."

'Episodic and inconsistent'

Baton Rouge leaders and advocates agree that inmate medical care was best when the parish's prisoners were transported to hospitals for almost all their health needs — services the state paid for under its public charity hospital system. But Gov. Bobby Jindal's administration started privatizing that system in 2013, leaving both parish jails and state prisons scrambling to find an alternative.

That's when East Baton Rouge Parish Emergency Medical Services started providing primary and preventative care inside Parish Prison, but officials soon acknowledged that care under EMS leadership was falling woefully short.

The consulting firm that conducted an assessment in 2016, Health Management Associates, observed "episodic and inconsistent" care and determined the parish should roughly double the staffing allotment for both medical and psychiatric providers — and increase the annual jail healthcare budget from about $5 million to $10 million, records show.

The firm presented various options, including maintaining EMS services with an overhaul of the current leadership, contracting with a local hospital, or bringing in a private vendor. Officials zeroed in on the last option and the Metro Council quickly approved a contract with CorrectHealth in late 2016 for $5.3 million a year.

Recent depositions in an ongoing inmate wrongful death suit show city officials had been in contact with CorrectHealth for months before the consultant's report was even complete. A former emergency room doctor based in Georgia, Musso grew up in Louisiana and attended LSU for both undergraduate and medical school. He founded CorrectHealth two decades ago and it has since become one of the largest such business in the southeast.

Musso himself has become a controversial figure within the medical community for his willingness to perform prison executions in Georgia. Critics argue that violates widely accepted ethical standards for doctors; Musso has said he hopes to ensure the executions are as humane as possible.

When Baton Rouge officials started publicly discussing a contract with CorrectHealth, the company was facing criticism in Savannah after officials there hired an independent monitor to assess medical services in their jail following a string of deaths. The monitor described a number of problems that could trigger "potential loss of life," according to reporting from Reuters published in September.

It's unclear whether Baton Rouge leaders were aware of those particular allegations, but when Musso promised to provide higher quality medical care for roughly the same price, they jumped on board.

Musso said in a recent interview that he's made good on his promise thanks to more efficient leadership decisions. He said significant savings on prescription drugs, for example, have allowed him to hire more staff, and his connections within the industry give him a larger pool of qualified candidates to choose from.

Baton Rouge officials said the best measure of improvement lies in the jail's new national accreditation from the National Commission on Correctional Health Care. They said it "speaks for itself" and shows clear improvements when compared with the 2016 consultant's report, which used similar metrics back then.

Darryl Gissel, chief of staff for Baton Rouge Mayor-President Sharon Weston Broome, said the accreditation program allows municipalities to monitor such private jail health care companies, which otherwise face limited oversight.

Death rate

Reports produced during the accreditation process include limited information about deaths inside the jail, focusing on procedures that CorrectHealth staff must follow when a prisoner dies.

Records show at least 16 inmate deaths have occurred since January 2017 when CorrectHealth took over the medical program. Two were suicides and two more were accidental drug overdoses while the rest resulted from natural causes, according to autopsy reports. The total inmate count was about 1,400 people when the accreditation assessment was completed last summer.

The jail's death rate was 381 per 100,000 inmates in 2018, the last full year for which data is available, according to researchers at the Promise of Justice Initiative, a New Orleans nonprofit that published a 2018 report on East Baton Rouge inmate deaths. That's more than double the national average, which was 137 deaths per 100,000 inmates between 2005 and 2014 — and more than three times Louisiana's statewide average during that time, according to the most recent comprehensive report available from the federal Bureau of Justice Statistics. Similar data isn't available for individual cities.

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CorrectHealth is required to conduct a mortality review each time an inmate dies, according to accreditation standards. Officials said the reviews are meant to examine the circumstances surrounding the death and assess whether additional preventative steps could be taken in the future.

But CorrectHealth has refused to release those investigations, arguing in court records that they fall under attorney-client privilege. Musso also told The Advocate he believes the reports are exempt from public records laws. CorrectHealth's legal division hasn't responded to a public records request.

Prisoner rights advocates have repeatedly raised the issue in recent months, citing both the death rate and the secretive review process, and calling on Baton Rouge leaders to take action.

"This is something that everyone should be concerned about," said Shanita Farris, a staff attorney for the Promise of Justice Initiative. "Literally anyone can end up in jail for various reasons, especially people with mental health conditions. These are some of the most vulnerable in our society, and the prison is failing in its duty to care for them."

CorrectHealth has responded to such accusations with an emphasis on the prevalence of serious preexisting conditions within a notoriously unhealthy population. During a recent tour of the jail, company representatives said a lot of inmates weren't receiving medical care before their arrests for conditions such as diabetes, high blood pressure and drug abuse.

Local officials also point to the widespread closure of inpatient psychiatric facilities and defunding of mental health services across Louisiana, which have led to more people with severe mental illness ending up in jail instead of treatment.

Mental health shortfalls

Filings in an ongoing wrongful death case illustrate some persistent problems. 

Jonathan Fano, 27, was booked into Parish Prison in late October 2016, about two months before CorrectHealth took over the jail's medical program. He had a long history of mental health issues and was arrested on misdemeanor counts when police found him wandering the streets of downtown Baton Rouge naked and delusional.

After three months in Parish Prison, Fano hanged himself and later died at a hospital. His family filed a lawsuit alleging "deliberate indifference" to his medical condition. A psychiatrist had assessed Fano in the weeks prior to his death and found he was likely faking his mental illness, determining he should be weaned off his medications, according to the complaint.

The case remains ongoing and attorneys for the plaintiffs, represented by the Claiborne Firm of Savannah, Georgia, argue that CorrectHealth has failed to achieve substantial improvements to inmate medical care, particularly for those with severe mental illness, either before or after Fano's death.

An expert hired by the plaintiffs concluded the "ongoing practices … are clearly increasing the likelihood of death for detainees."

Dr. Homer Venters, who spent several years overseeing the medical program in New York City's notorious Rikers Island jail and later became one of its biggest critics, toured East Baton Rouge Parish Prison in June and noted its practice of keeping suicidal inmates and others experiencing severe mental illness in solitary confinement at least 23 hours per day, calling those cells "the most dangerous units I have observed in an American jail or prison."

He pointed to "numerous suicide risks including the open bars, more than one of which had cloth ties affixed to bars at the time of our tour." 

Sheriff's Office officials have argued there's nowhere else to put inmates to keep them safe during a mental health crisis, another reason the parish needs a new, more modern detention facility. Officials declined to comment on pending litigation.

Parish voters have repeatedly rejected proposals to fund construction of a new jail but did approve funding for a mental health crisis center that's set to open in the coming months and fill an existing void in services. The Bridge Center, which is meant to provide psychiatric stabilization and detox, will serve as an alternative to overcrowded emergency rooms and the local jail — both of which have become dumping grounds for mental health patients. The center has garnered strong support from local law enforcement leaders and elected officials.

In the meantime, CorrectHealth's providers are struggling to meet what officials describe as an unprecedented need for services.

Dr. Robert Blanche, a Baton Rouge psychiatrist who spends eight hours a week evaluating and treating inmates, said it's a longstanding problem that has become even worse in recent years. Monthly reports from CorrectHealth also indicate significant fluctuations in the number of patient encounters for those with mental health needs, in some cases due to staffing vacancies.

"When I come in here, everybody wants to see me," Blanche said. "I just have to focus on the most acute patients."

Warden Dennis Grimes, who in 2015 called the jail "very deplorable as far as mental health is concerned," said he believes medical care has improved overall under CorrectHealth. He said he receives fewer complaints from inmates since the company took over.

CorrectHealth's contract, which has now increased to $5.7 million a year, was renewed through 2020 after being written into the annual budget passed last month.

Councilwoman Chauna Banks, who voted against contracting with CorrectHealth in 2016, said she hopes her colleagues will approach the presentation at Wednesday's council meeting as a chance to evaluate the company's performance and consider whether different options might better serve East Baton Rouge inmates.

Other council members didn't respond to recent requests for comment.

"Unfortunately because of the population at stake here and the negative context surrounding the jail, nobody really cares. That's the mentality. It's just a money grab," Banks said. "If we're going to change things for the better, it has to come from a place of really caring — really valuing the lives of these people."

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