COUNCIL OF THE CITY OF PHILADELPHIA PUBLIC HEARING BEFORE JOINT COUNCIL COMMITTEES ON PUBLIC SAFETY AND PUBLIC HEALTH AND HUMAN SERVICES - - - Room 696, City Hall Philadelphia, Pennsylvania Wednesday, 5/8/02 1:14 p.m. - - - RES. 010598 - Authorizing the City Council Committee on Public Health and Human Services and Public Safety to hold a joint committee hearing to continue monitoring and investigating the quality level of medical and mental-health care services that is provided or made accessible to prison inmates under the care of the Philadelphia prison system, and further authorizing the committee to issue subpoenas and such other process as may be appropriate to compel the attendance of witnesses and the production of documents in furtherance of the investigation to the full extent authorized by Section 2-401 of the Home Rule Charter. PRESENT: Councilman Angel Ortiz, Chair Councilman David Cohen Councilwoman Blondell Reynolds Brown Councilwoman Marion B. Tasco - - - VINCENT VARALLO ASSOCIATES, INC. Registered Professional Reporters Eleven Penn Center, Suite 600 Philadelphia, PA 19103 (215) 561-2220 INDEX WITNESS Thomas Costello, Prisons Commissioner.......... Margaret Minehart, Medical Director............ 21 Phila. Mental Health, Mental Retardation Svcs. 6 James Duckworth, Esquire, Solicitor's Office... 21 Timothy Gill, Deputy Managing Director......... 24 Dan Winterstein, Policy Analyst................ 42 Office of Mental Health Asia Russell, ACT-UP Philadelphia.............. 55 Patrick Scanlon................................ 58 Former Philadelphia Prison System Inmate James Pritchard................................ 65 Former Philadelphia Prison System Inmate Nina Gorman, Prisoner Health Advocacy Project 69 James Nelson................................... 71 Former Philadelphia Prison System Inmate Anthony Hightower.............................. 73 Former Philadelphia Prison System Inmate PHS REPRESENTATIVES Bruce Teal, Chief Operating Officer............ 87 Dr. Richard Helender........................... 87 Regional Medical Director, Personnel Dr. Cassandra Newkirk.......................... 87 Regional Behavioral Health Medical Director Robert Taylor.................................. 88 Regional Manager for Prison Health Services 3 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598
A quorum has been established, hearings now will continue. Would the clerk read the title of the resolution.
Authorizing the City Council Committee on Public Health and Human Services and Public Safety to hold a joint committee hearing to continue monitoring and investigating the quality level of medical and mental-health care services that is provided or made accessible to prison inmates under the care of the Philadelphia prison system, and further authorizing the committee to issue subpoenas and such other process as may be appropriate to compel the attendance of witnesses and the production of documents in furtherance of the investigation to the full extent authorized by Section 2-401 of the Home Rule Charter.
Thank you. This investigation, these hearings, this resolution was begun because of the death of one individual, and officials may not care about that individual's life maybe. He was in jail, so people take a perception of people who are arrested. He had not yet been tried, found guilty of anything. 4 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 And a newspaper report about his death while in prison -- not because he was killed but because he was neglected. Jose Santiago died needlessly. And I began to have hearings because I had questions. That raised questions about the level and quality of care that human beings in our prison systems got and were given. And ever since we started those hearings, everything I have gotten from them the administration at the prison is that the administration has been stonewalling. No 14 information was forthcoming; in fact, most of the information that we managed to get was through the newspapers. Bogus excuses were created, one after the other. Privilege for this and privilege for that. Privilege for consultant reports that we paid for, that the taxpayers paid for that were public records. That we have to have a Commonwealth decision saying those are public records. And, finally, in March, we begin getting the reports. And, finally, I don't know whether to be outraged, I don't know how many people should be 5 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 indicted, arrested, because a lot of criminal negligence has taken place. And I get this report not from you guys. If something is happening in the prison system, it is your duty to report it, it is your duty to go after the individuals that neglected to do their job. You're costing us money because every time there's neglect, there's a lawsuit, and hundreds of thousands of dollars are being paid out. Philadelphia Prison System Internal Affairs Division, to Walter P. Donley, the Warden, he should be fired. Captain Melvin Whitaker, Internal Affairs Division. March 14, 2001. Investigation Case No. , I guess, is 876-63591600. In the medical treatment room at the Curran Fromhold correctional facility. It's outrageous. , because one of the things that Mr. Whitaker ends up with in his report, he says: "Therefore, the allegation of staff misconduct is sustained. However, due to the complexity of this entire collection of evidence, the investigator has 6 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 's Office obviously has not communicated because they're doing an investigation. 's Office this morning, I got a call from Hillary Connor calling for Lynne Abraham. D. report as of this date, a report dated March 2001. We're in May 2002. It's a report that says allegations of misconduct are sustained. And we have asked for questions and answers on this. The District Attorney has not received this. " I'm sorry, you're not privileged; you're negligent. And then we finally get the report. The Brooming Group, a report by Dr. Robert Greifinger. In a letter dated March 20, 2002, he concludes in his last paragraph -- because I don't blame the contracting company; this is not a failure of the contracting company; they get paid. We should have 7 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 people that demand service for the money that the taxpayers are paying to the tune of 27, $28 million a year. It's the report that we could not get. And he -- in the cover letter, he says, "The progress on a number of key contractual items... " Contractual items, that means the City administration is the overseer and has to be monitoring this contract. "The progress is slow or stalled. As I mentioned in my previous report, PHS does not have sufficient administrative resources on site to accomplish their task. " And he says the company was very helpful in preparing the report. Well, why not, why not. We signed a contract in which if they don't meet the requirements that they're contracted for, there are really no penalties. We get -- the only thing we can say to them is, Can you please fix it.
And if you try, you know, next year, we'll renew your $27 million again. The same company has a contract with New 8 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 York. In New York, if the company doesn't perform or was performing given the way Dr. Greifinger reports in his report to the Administration, they would be -- there will be some penalties for it. I'm telling you, I am -- I don't know -- I am so angry at this point because of the stalling tactics. We've been at this for over a year. Commissioner Costello, please come to the mic. ) COMMISSIONER COSTELLO: I'm at the mic, Councilman.
Go ahead, talk to me. Why is this not in the D.A.'s Office? COMMISSIONER COSTELLO: I cannot discuss that case, Councilman.
I know you cannot discuss this case. Why -- I didn't ask you to discuss it; I asked you, why wasn't it reported? Why is the D.A. saying to me today that they don't have this in their office? This is a year ago. COMMISSIONER COSTELLO: And you're making the assumption that we did not contact the D.A.'s Office; is that true? 9 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598
I am not making the assumption. The D.A. said the D.A. has not received the report but will be investigating the matter now. COMMISSIONER COSTELLO: Maybe I can enlighten you on our procedures, Councilman.
Enlighten me on the procedures that take a year to go to the D.A.'s Office. COMMISSIONER COSTELLO: Our procedures are -- our procedures are --
And what happens to the staff that was neglectful? COMMISSIONER COSTELLO: Our procedures are that we contact the District Attorney's Office, and they contact us back. That is the procedures.
You contacted the D.A.'s Office. Your position is you contacted the D.A.'s Office. COMMISSIONER COSTELLO: We did the D.A.'s Office.
You wrote 'em a letter? COMMISSIONER COSTELLO: We contacted the D.A.'s Office. 10 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598
You wrote them a letter, you sent them the report? COMMISSIONER COSTELLO: We contacted the D.A.'s Office.
What is the nature of the contact? COMMISSIONER COSTELLO: It was a telephone call.
A telephone call office, you leave a message. Was the machine on or was it the secretary? COMMISSIONER COSTELLO: I have nothing more to comment on.
Who did you contact? I'm not asking you to comment on the case. Who did you contact at the D.A.'s Office? COMMISSIONER COSTELLO: The internal affairs contacted an individual at the D.A.'s Office.
You got to have a name. 11 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 COMMISSIONER COSTELLO: They were contacted.
You got to have a name. COMMISSIONER COSTELLO: They were contacted.
You go back and you bring me that individual from the I.A.D. Office here, and you tell me who you contacted in the D.A.'s Office, because they say they have not received it. Why was this not sent? Why, instead of a phone call, do you not pick up a pen or a computer and write a letter and say, Captain Melvin Whitaker has concluded, has concluded, that the allegation of staff misconduct are sustained? Do you disagree with Captain Whitaker? COMMISSIONER COSTELLO: (No immediate response.)
Yes or no? COMMISSIONER COSTELLO: (Addressing lawyer from City Solicitor's Office.) You want me to comment on this? It's active litigation, Councilman, I cannot comment on it. 12 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598
Do you disagree with Captain Whitaker? COMMISSIONER COSTELLO: Councilman, I cannot --
Why did you not send this to the D.A.? Why did you not write a letter? Why didn't you make a phone call when somebody dies? You make a phone call. COMMISSIONER COSTELLO: I said that was the --
You don't write a report and send it to the D.A. as (indiscernible) like this? COMMISSIONER COSTELLO: That's the first step, Councilman.
A year ago. You didn't call back, you didn't call back. You said, Hey, we contacted you. You didn't call Lynne Abraham, you don't have Lynne Abraham's phone number. You say, Lynn, my people have contacted your people, and we made a phone call and you have not returned my phone call. I have this report, I have this report that, in essence, establishes criminal negligence on 13 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 the part of your staff. A year, more than a year. March. It's May. A phone call? COMMISSIONER COSTELLO: That's the first step, Councilman.
But it's a year. COMMISSIONER COSTELLO: The phone call took place --
How long does it take to take the second step? When did you take the second step? COMMISSIONER COSTELLO: The second step is on the part of the District Attorney's Office.
Oh, she didn't answer your phone call, so you wait. You make one little phone call to somebody that you don't know who it is, and you don't get a return, and then you wait for over a year. This is ridiculous. It's incompetent. First step, first step. A person dies who was just merely arrested because of negligence of the staff, and you take the first step to the D.A.'s Office a year ago -- more than a year ago with a phone call? You don't put it down in writing 14 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 that you have a report from your staff? COMMISSIONER COSTELLO: That was the first step, Councilman.
You keep saying that. When are you taking the second? What is this, "Simon Says"? I find you totally incredulous, disingenuous. And if you expect us to just sit here and say that is it... Deaths are occurring in your system, sir. Somebody was killed just the other day. Deaths are occurring in your system; too many deaths are occurring in your system. I want the name of the person that was contacted in the D.A.'s Office, I want to know who made the phone call. I don't want you to give me details about something in litigation. I know this is going to cost us a lot of money. You're costing the taxpayers of this City, besides having a system that's in place that Dr. Greifinger finds lacking, and after months and reports after reports, still does not come up to the quality that we should be paying -- that we are paying for, you have people that are dying, that haven't been convicted. Too 15 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 many of them. You got a staff that just doesn't take care of business, and if they don't take care of business, there's no supervision. And you say you took the first step, you made a phone call a year ago. That's ridiculous. A person dies under your care, the family suffers. He vomits, he's forced to drink toilet water. He's neglected for over hours. 11 And you can only make a phone call to the D.A. 12 COMMISSIONER COSTELLO: We didn't just 13 make a phone call, Councilman. 14
Did you fire anybody, 15 by the way? 16 COMMISSIONER COSTELLO: There was a 17 complete investigation -- 18
There was, I know. 19 COMMISSIONER COSTELLO: -- into the 20 matter -- 21
There was a complete 22 investigation. 23 COMMISSIONER COSTELLO: -- including the 24 police, the Medical Examiner's Office. It wasn't just a phone call; there was a lot of work on this 16 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 particular case.
Was the investigation given over to the D.A.? Did you find that the nature of the investigation deserved to be sent over to the D.A.? Obviously, you didn't; you just made a phone call. Was anyone suspended at least? Was anyone reprimanded? Was a letter written into the record? (Commissioner Costello confers off the record with City Solicitor attorney.) COMMISSIONER COSTELLO: I've been advised not to answer anything.
Of course not, of course not, of course not, because let me tell you something, you're going to answer now or you're going to answer in court. And it's going to cost us money. We can't afford to keep paying this type of money, not when the kids are out there picketing about the public school system, when we don't have enough money for books and so on. I want the name. I want to know what 17 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 you did with this investigation, why the D.A. is not involved. Why do I receive a phone call this morning from the D.A.'s Office that says, We have not received that report? Why is this report not in her office? You have an excuse for that: You made a phone call and you didn't get an answer back. But you didn't sit and down write her a letter saying, "I am forwarding this report, and my captain, my investigation unit has recommended that it be reviewed by the District Attorney's Office." You didn't do that, did you? You made a phone call. COMMISSIONER COSTELLO: The Captain contacted the District Attorney.
You made a phone call; you didn't send the report over. You just made a phone call. COMMISSIONER COSTELLO: They were contacted.
They were contacted by phone, but you did not forward the report, did you? COMMISSIONER COSTELLO: They were 18 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 contacted.
You did not forward the report. That's not in litigation, by the way; you can answer that. You did not forward the report. That will not impact the litigation. You did not forward the report; you just -- in fact, you didn't make the phone call. Captain Whitaker was -- at least he recommended it to the warden; it's the warden that should have done it. It's not the captain's duty to do this; he's recommending that the warden pass this on. It's not the captain's job; it's the warden and your job to make sure that this report got to the D.A.
Good afternoon. As a procedural matter, what happens procedurally when an employee, or one of your staff members, has not followed standard operating procedure? What happens under normal circumstances? COMMISSIONER COSTELLO: Procedurally, 19 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 there's an investigation completed by the facilities. If there is a -- on certain matters, on certain reporting incidents, it's referred to the Internal Affairs Division by the warden. The warden refers it to I.A.D., I.A.D. conducts the investigation. And they -- after completing their investigation, they bring charges against the individual, clear them, or they may contact the District Attorney's Office for any further action.
And you say under certain circumstances, they are referred to the internal investigative unit. Define "certain circumstances"; give me three examples. COMMISSIONER COSTELLO: If there's a suicide a homicide, an escape, a major disturbance, excessive use of force. There are a number of incidents that are referred to the Internal Affairs Division for investigation. And the results of that investigation may vary, depending on the circumstances, depending on the amount of negligence or even criminal misconduct on the part of the staff.
Okay. And 20 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 given the magnitude and tragedy of this circumstance, you're not at liberty to tell us if that procedure, as you have outlined it, was followed/ COMMISSIONER COSTELLO: I cannot comment on the Santiago case, Councilwoman.
I'm not asking you to talk about that; I'm asking you only why wasn't it sent over to the D.A.? COMMISSIONER COSTELLO: I can't comment, Councilman.
Computers were not working? COMMISSIONER COSTELLO: (No verbal response.)
We have a meeting with the President at 1:30, an emergency meeting. Could I have the offices of PHS who are here identify themselves, okay? Come up here, okay, and use the microphone. (PHS reps come forward.) 21 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598
I'm Dr. Cassandra Newkirk, I'm the chief psychiatrist here at Philadelphia.
My name's Robert Taylor, and I'm the Regional Manager for Prison Health here in Philadelphia.
Thank you, Commissioner. You can get up now, and I'll call you back. Could you two identify yourselves please.
I'm Margaret Minehart, and I'm the Medical Director for the Philadelphia Office for Mental Health and Mental Retardation Services.
Yes, good 22 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 afternoon. I'm reading the report that was provided to us from Councilman Ortiz, and it's a summary of the report by Dr. Greifinger, and in it, he talks about the use by the health services of this medication, and that there's -- that they have staffing problems and that they're operating at a deficit. And some of it is attributed to the excessive -- I don't want to misuse the word... That an overwhelming majority of inmates in the mental health caseload were dependent on psychotropic medications, and the provider had been cited by both consultants with excessive use of this medication, which, if reduced by one-third, according to this doctor, could save Philadelphia health services up to $500,000 a year. Could these inmates qualify for services through the Mental Health Department since it's all City-related?
I think I can answer this. They qualify for services that we contracted for while they're in the prison, which is Prison Health Services, which provides the behavioral health. 23 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 But in terms of, for instance, the Office of Mental Health, or CBH (Community Behavioral Health), they don't have benefits when they're in the prison.
Benefits. They lose their Medicaid, Social Security -- they lose benefits when --
So they don't have any access to any of the services they would --
Exactly. So when they're in prison, we contracted with Prison Health Services to provide the care, and we're working with Prison Health Services, but that is the -- so the care they get is under the Prison Health Services.
So what is your relationship with Prison Health Services? Do you monitor the contact?
We have not been the formal monitor. There is a contract monitor, but the Office of Mental Health has not been the formal monitor of the contract. We're working much more closely in the 24 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 past year to develop, actually, standards to do more monitoring, but we --
It's really Tim Gill who is the contract monitor for the City.
Good afternoon. My name is Timothy Gill. I'm Deputy Managing Director and am currently assigned to major prison contracts.
So what is your background, your educational background or 25 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 experience?
I hold a master's degree in public administration from Temple University, and I've been with the City of Philadelphia for approximately years, and the major bulk of my 7 administrative work has been with contracts 8 initiation, citywide contracts, and service 9 contracts. 10
So if Dr. Patterson 11 and these doctors give you a report about this 12 contract, one that may spell out the over-excessive 13 use of a drug, are you capable of evaluating that 14 situation? What would you do about it? 15
The way that this particular 16 contract is monitored, I draw on the resources of 17 the professionals around the City that are at my 18 disposal to help with the evaluation and the interpretation of the findings that monitors or evaluators would give us. I do not have a medical background, which is not necessarily a requirement for overseeing the administration of the contract, and, therefore, resort to the advice and the consultation of other City officials that help me with that. 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 There is varying schools of thought and understanding of what the standards are for psychotropic medications and what are some of the therapies that are appropriate for inmates, or even in the community, for standards for treating behavioral-health issues, and that, in fact, we view the recommendations by the monitors as mainly that, recommendations. We have a relationship with those monitors, that we utilize them more than just giving us a score card for how well we're doing; they also actually consult with us. They consult with the staff of PHS, the corrections staff, and the other officials of the City of Philadelphia that work with us in the monitoring of this. In fact, just recently, we've had all-day sessions with the monitors that came and worked with us on identifying problems, working with us towards solutions, and not simply giving us recommendations for us to then implement; they kind of work with us based on their experience and other jails and prisons throughout the country on helping us resolve the issues.
I'm somewhat at a 27 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 disadvantage 'cause I haven't been able to read this full report that's dated March 28, 2002. So -- but what -- as I understand it, this is a three-year contract with one-year renewals?
I think PHS has been on board since before 2000, hasn't it?
They were on board in providing the medical care and -- (inaudible, off-mic.)
It was a separate contracting period, yes. They used to provide medical care, but then they -- they now provide behavioral health as well as mental health. 28 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598
Yeah, prison health, but not in different contracts, that's correct.
So was this contract given out on a request for propose?
I can give you a little bit of background on how the process works. It is a one-year contract, just as -- I can't speak for every service contract, but most service contracts in the City of Philadelphia are for one-year periods. However, in a large-scale contract, where there is a requirement to do a lot of capitalization, a lot of hiring of staff, that vendors cannot do an efficient job of preparing for the work, unless they have some level of understanding that it would be for a multi-year period. For them to ramp up for just 12 months and hire all of the staff needed -- doctors and nurses and equipment and supplies and medication and materials -- for just a 12-month period, it's not a lot of security for the worker bees that are a part 29 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 of that contract -- the nurses, the LPNs, and the regular staff that are a part of it. Therefore, if performance is at a level that the City of Philadelphia feels is worthy for a renewal period, there is a process by which a contractor -- and this goes for grass-cutting contracts or medical contracts or even maintenance contracts, whereby a provider would have the option of a renewal period. At the end of the renewal periods, then it must be rebid, it must go back to an RFP process, whereby all vendors that are qualified for this kind of work are invited back to participate in another go-around of bidding.
Dr. Greifinger begins 30 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 his report of March 20, 2002 saying: "PHA's management staff is functioning in a crisis mode. Recruitment of nurses remains a problem. There have been unanticipated illnesses and resignations of key supervisory staff. As a consequence, the regional vice president and medical director have been unable to mount coherent efforts to remedy deficiencies that have been reported before, that have been aberrant throughout term of the contract. "PHS has not provided resources corporate resources to support the onsite management team. The plans to improve the support system have not been substantially realized." What is being done? You're the monitor. You got this.
Because of this -- the status of these reports, I'm not able to comment on them at this time.
You're not able to comment on this report, as of that paragraph.
As the letter that was sent to you April 12th indicated --
-- the City administration's position is that these documents are confidential.
And it also requested that Dr. Greifinger and Dr. Patterson be present today, but you were also informed that because of a scheduling confident, they would not be able. Dr. Greifinger and Dr. Patterson can be here to present a briefing to this committee, and it would probably be much more beneficial that at that time, questions of this nature about the reports are addressed, and --
And why is that little paragraph that I just said so controversial? Let me tell you something: This is a government. This body appropriates money for reports that are supposed to be public documents, okay? I have -- the courts have said to you 32 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 constantly, you know, that this is not -- this is the legislative body. This is a report of a consultant that is paid with money that we appropriate. We appropriate 27, $28 million for this contract. We have to be sure that that $28 million is being used effectively. If not, then this body should be able to say, No, we don't want to appropriate $28 million to that company. I don't understand why the public cannot know whether a company that we hire is working effectively, efficiently or not. I understand that, obviously, because it has not been working effectively, efficiently, lawsuits have emerged, and it's costing us taxpayers money way and above and beyond what we're paying the company. I think we need to know why we should continue to pay $28 million to a company that is probably costing us money. And if you cannot make the case that this company should be renewed, then we should have -- and we should have legislation that a contract of this magnitude should come to City Council for review. And as of now, these contracts do not come to City Council for review. 33 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 Yes, Councilman Cohen?
I have one question addressed to the representative of the City Solicitor's Office.
You have case law that says that you can use the privilege against City Council? Is there any case which gives you the right? And I would request that you send to the Chairman of the committee your legal support. I do not believe that anything is privileged. I would have to respectfully disagree with the superintendent who says he cannot answer it with your advice to him, because I do not understand how this can be privileged against the Council. And if necessary, I would like to be recommending to the City Council that we contest that issue in court. I don't see how it is possible for us to conduct our business if the City administration at any time, under any circumstances, decides that something that City Council feels is necessary for the proper exercise of the appropriation powers the Chairman has just indicated is being denied to us.
Sir, if I may clarify. 34 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 The questions that were directed against Commissioner Costello are in the matter of Jose Santiago, which is in active litigation.
Excuse me. The questions that I asked Mr. Costello is why this report has not been delivered to a year after the report was given --
The estate of Jose Santiago has filed suit against the PHS and against the City of Philadelphia and --
Yes, but that cannot take away the power of City Council. Maybe you have privileges against the person or group filing the lawsuit, but I don't know how can interpret that as suddenly giving you the right to exclude City Council.
And the reports of Dr. Greifinger and Dr. Patterson have been turned over to this committee, which the chairman does have in his possession.
Yeah, but how can we exercise our oversight judgment about the efficiency of the staffing of the prison system when we can't even find out if the District Attorney was notified 35 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 in person or who was notified about something in the District Attorney's Office?
Respectfully, sir, those are two separate, independent issues.
Excuse me. As a member of the committee speaks, I would ask that you respect that right of the member of the committee to ask the question before you try to answer it. How can you possibly justify diminishing the power of this City Council and taking away its information-obtaining ability on the basis of some third party suing the City of Philadelphia? And if you have any legal support, I'm asking that you submit it to the chairman; otherwise, I am going to be moving quickly in City Council to authorize the institutional lawsuit to deny the City administration of its alleged power to deny City Council information, 'cause I know of no 23 basis in law that gives you that right. I've been listening quietly, expecting at some point that somebody would say, "In such-and-such a case, it was 36 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 so held." But you don't have any such right; you're treating us as if we're outsiders. We're the people that budgeted, as the chairman said, your salaries. We have to know whether it's appropriate to budget that money. Thank you, Mr. Chairman.
I don't see any purpose in continuing this until we get a resolution. I think the City administration is assuming it has a clear power to treat the City Council as if it were the public generally and to deny the City Council information that's absolutely necessary for us to have. Everybody knows the reason for the one-year contract and the three-year options; it's to get around the provision of the Home Rule Charter, which requires City Council approval of all contracts of four years or longer. That's the reason why you do the -- It's not the reason you gave, sir, to give the City opportunity to test out something and to see whether it works and then authorize 37 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 year-by-year options. The purpose is to avoid having to come before City Council for approval. That by itself begins to raise very serious questions in our mind. And then, on top of that, you try to use the privilege of saying this matter is privileged. Privileged against City Council? I don't understand that. So I think we'll be in court shortly on that issue. Thank you.
Mr. Gill, one last question, 'cause I'm not going to belabor this thing. I made a comparison between the New York and -- because PHS is hired by the New York prison system and ours. And in New York, they have a series of penalty clauses and amounts of monies that the company is required to pay if they don't meet certain levels of services. And as I go down ours and New York's, in women's health services, and we go down each one of the categories, New York has $5,000 of penalties for non-compliance on not meeting the specifications, and we have none. 38 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 And we have reports, obviously, that for one reason or another, PHS is not meeting its contracting obligations, and we have that from Dr. Greifinger. Why? Give me a -- you know, maybe you can explain that. Why do we not have penalties on a contract of this magnitude?
Councilman, I'm not familiar with the New York contract; I haven't read it or --
That being said, not knowing the specifics of the New York contract and how they're structured --
Why are there not penalties for nonperformance, for not meeting contractual obligations?
Indeed, the contract that is held by the City of Philadelphia has the provision for the imposition of liquidated damages for any reason that the City of Philadelphia deems appropriate. In fact, that is -- that could be even more of a burden on a contractor without the strict 39 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 schedule of penalties that may be common in other contracts. In fact, at the beginning of this contract, when it was --
We went through our contract and New York, and we don't find that.
Could you send that to me in writing, the specific clauses in the contract that specifically say that?
Okay. We have a meeting with the -- Councilwoman Tasco.
The two reports that are here, the one from Dr. Patterson that offers a number of recommendations for staffing and service delivery, will you look towards this recommendation as you review the contract, whether 40 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 or not to renew this contract coming up in July? Either one of you, do you just automatically renew the contract? On what basis do you renew the contract? 'Cause you don't have to renew it if they're not performing.
There have been some recommendations on an ongoing basis with our dialogue with the consultant that we asked for some examples or some guidance on what had been successful staffing ratios in other municipalities or jurisdictions where they had experiences, and that could be where some of those recommendations came from for either, you know, psychiatrists or medical personnel per patient. In an ongoing effort for us to improve the quality of our services, we do try to establish something as close as possible to either community standards of care or standards that are established by the National Commission on Correctional Health Care or the American Correctional Association whereby we're addressing the needs that are as current or as up to standard as possible. Our ability to either fully fund or fully implement what their staffing recommendations 41 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 are things that we're looking at closely right now. If there are other ways or some alternatives to either systems changes or therapy changes or ways in which the staff are deployed, instead of just looking at total numbers, we do look at that on an ongoing basis through the contract year. And we are considering some of their recommendations for either the renewal periods or future contracts. It's likely that many of the recommendations that the consultants give us, which we put a lot of stock in, will wind up in when we go in and totally revamp the scope of services for the RFP for the next go-around.
Let me go back to the initial request or the RFP for this contract. When you issued the specifications for this contract, how did you determine what level of service that you wanted? And are they meeting that level of service?
Actually, Tim wasn't there when the RFP went out, and I honestly --
He picked up the initial 42 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 contract, but he wasn't there when we first contracted with PHS. When the RFP went out, there were certain specifications, and a group was put together, I think, from a variety of resources, and Dan Winterstein is from the Office of Mental Health. But there were a variety of people brought together -- nursing, social work, psychiatry, administration, prison -- to look at what services had been in place and what would need to be in place or what we thought would need to be in place. And that's how the RFP was put together. And there were, I think, four vendors that bid on the RFP.
So those people that put the RFP together, did they determine that the specifications were adequate enough to provide quality delivery service to the prisons? Could somebody answer the question?
Why don't you come to the table and identify yourself. (Witness comes forward.)
My name's Dan Winterstein, I'm a policy analyst at the Office of 43 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 Mental Health.
So explain to me how you put the RFP together, explain to me why we are looking at recommendations from a consultant saying this company doesn't have enough staff people. Are they meeting the standards set forth in the original proposal?
As Dr. Minehart mentioned, there was a committee, a fairly large committee, composed of both local and national experts that met over several months to try to formulate what really at that time was a major upgrade of services, particularly in behavioral health. The prison population has been expanded at an exponential rate over the last five years, and I think there was a judgment three years ago, when the RFP was developed, that behavioral health services at that time really weren't adequate and that we needed to substantially upgrade them. So A committee met, again, over several months, to kind of define what the nature of that upgrade should be. And those specifications found their way into the RFP. 44 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598
I could expand on that. I mean, I think Dan's statement about the expansion of the prison population too, because it has grown, and I think it was based on what we thought would meet the needs of the population.
And so you look at the contract each year, and this company had the contract since when?
So you reviewed the contract last year, and what did you see and what was the evaluation of the performance?
So you just renewed the contract without an evaluation of the performance?
The Office of Mental Health didn't do it. Tim can speak to that.
The review and evaluation is on an ongoing and daily basis. I think that, basically, the assumption that a provider has met certain criteria for overall and comprehensive health care, that unless there are overwhelming and 45 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 compelling reasons for nonperformance, lack of performance, and non-responsiveness to areas that are identified as deficiencies, those are the justifications for not renewing. This particular provider has been, what I consider in my experience with other contracts, one of the hallmarks of a provider that is cooperative and one that does not play a game of cat-and-mouse with the City of Philadelphia; whereby we're trying to constantly catch them doing something wrong, we take a more proactive approach, an approach that brings both members of the senior staff and the medical staff of the contractor with senior staff and monitoring staff with the City of Philadelphia to work problems through, identify them early, and head them off before they become major problems. In a large situation and in a large institution where problems do occur, we are then in a position where we work together and we work proactively to resolve them. And having that cooperative relationship, we think, is one of the differences between having contracts with very specific and very rigid penalties built into the 46 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 structure of the contact. And that I've been involved in other contracts with that kind of setting, and it usually turns into a situation where contractors are either trying to cover their tracks or avoid detection or leaving the onus on the City of Philadelphia to track them down and catch them doing something wrong. In our scenario, whereby we work more proactively and more cooperatively before problems become big, we come to the table and we talk about them and try to resolve systems issues, administrative issues, staffing issues, or problems about interpretations of quality care or community standards of care together with the agencies of the City of Philadelphia, including the Office of Mental Health, the Health Department, or our other agencies in and outside of the City is where we feal as though we've got a good relationship, whereby problems are handled quickly, they're handled in a way that is not going to be in any way damaging to the comprehensive care of the inmates. And the biggest piece of all of this is the integration of one provider caring for both the 47 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 behavioral-health issues and the medical issues. Previous to this existing contract, that was not the case. There was barriers just institutionally between the mental-health staff caregivers and the medical health-care givers. Now those barriers are gone. There's integrated medical records for the patients, there's regular meetings between behavioral health and medical health staff. In addition to that, corrections included with those meetings. And it's more of a trinity of care whereby better communication and better cooperation amongst the players inside the jails, we believe, is resulting in better quality of health care on an overall basis for the patients at the jail.
So when the RFP was distributed, it was based on a certain level of number of inmates, right? And as the population expanded, expanded to the point where it was difficult for the provider to provide the level of staffing it needed to based on the dollar amount of the contract?
Looking at the 48 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 recommendations -- just like I said, I have not read it, and so I may be taking things out of context, but just looking at the recommendations for increasing the staffing levels, is that probably what happened?
I can state that one of the other contracts I oversee is the food provision contract as well, and that, like medical, not responding directly to what you're referring to, but they are both driven by population, yes. More patients to be seen certainly either stresses the services to be provided, increases the number and amount of staffing that would be required, medications, all down the line. So there is -- certainly, population is a factor.
In his report, Dr. Patterson makes a point in terms of poor -- that poor management eventually translates into additional litigation-related costs. And the City -- and he makes the point also that recently, the City has found itself in a lot of new litigation for poor discharge of planning of inmates from the 49 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 prisons. And this is part and parcel of why these hearings are being held, because there has been poor administration, and the contract really has not been met. And have you ever applied any penalties that you say there are? Have you ever done that?
To my knowledge, no, penalties have not been assessed. Liquidated damages in terms of money have not been assessed.
And this is not about a game of catching anyone or somebody, you know. I think -- I think Dr. Greifinger's report is very clear. I mean, he's been coming and his evaluations are quarterly, aren't they, right?
And so this latest one of March of 2002, he's made these 19 recommendations before; is that not true? 20
There is some follow-up on the issues that he does make in previous reports, yes.
And these have not been taken care of. I mean, he makes it very clear that PHA is functioning in a crisis mode without any 50 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 details, what staff is not there, and that the ratio of staff per patient is not adequate, does he not?
I'm saying that Dr. Greifinger has been establishing that PHA has been functioning in a crisis mode, that staffing is not available, that the ratio of staff to patient really is not adequate, and supervisory staff -- and this is not the first time he says this. Is that not so?
I believe if that's related in any way to the shortages in medical staffing available, I think on a nationwide basis, then that --
I'm talking about the contract. Look, you got a contract, you got to demand that individuals fill it up and fill out what they're supposed to do. Don't tell me what nationwide basis is going on. You contract out for some services, and they either provide it or they don't provide it. And you have to demand that they provide it. They have to go out and get that, how ever they have to 51 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 get it. Don't make excuses. I mean, you know, you've given me nationwide crises of nurses. I know there's a nationwide crisis in teachers, but we're not telling the Superintendent of School, Oh, we've got to forgive you, you can't hire enough teachers. No, you got to go out and find them.
I do believe that PHS has really been making efforts to fill all of their staff positions, without question. The question of --
You see, everybody understands, but nobody takes care of the problems. It's costing us money.
In litigation, in medication, in every other way. I mean, $28 million should resolve problems. If not, find somebody who does. That's all I'm saying.
I can't speak for -- 52 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598
These problems are ongoing. Now we have the DePaul report from 1996 to 2002 that detail a whole series of problems in staffing levels, in management, in supervision. They're ongoing. Why are they not taken care of? Recommendations are made, they're ongoing recommendations. I know being nice guys -- I'm not saying that they're not nice guys. And I think Dr. Greifinger explains that they really are cooperative. But medical services are not being provided. It is detailed here: They're not being provided. At one point, the City administration has to make some decisions and come in here and say to us, You know all those problems, they've been resolved. You haven't been able to do that. I've been doing this for a year, sitting across from you and not getting any answers. These problems have been ongoing for over a year, not now, not as of March. These problems have been ongoing since they got the contract. That's why there is litigation in court, that's why we're paying lawyers, that's why 53 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 we're paying other people. I don't want to pay lawyers. Don't give me this thing month after month. This has been going for over two years now. Actually more -- since '96. What are you going to do? tell me. When is this going to be resolved? Mr. Gill, tell me. I mean, we're going to make this a part of the public report, and we've going to issue a report, and I'm going to put some legislation together, okay? Tell me, when are we going to stop making excuses? Tell me.
For the record, we will continue to work with the medical provider for the Philadelphia prison system to improve the quality of care that they provide to give them access to --
When are they going to be meeting the contractual obligation -- (Unintelligible; parties talking over each other.)
Hold on a second. When are they going to be meeting the contractual obligations? When are you going to come here? Do you have a timeline? So I can put a timeline, so I can say, Yes, Mr. Gill said that on such-and-such 54 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 date, we are going to come here and they have met the timeline and they are meeting and fulfilling the contractual obligations that they contracted with the citizens of Philadelphia.
The timeline is that we'll work with them every day to make sure that the requirements of the contract are fulfilled, and that any deficiencies in the contract that are not being fulfilled, we'll take appropriate steps to either find solutions in a partnership with them or identify ways that they can be improved.
Thank you. Thank you very much. Asia Russell, Pat Scanlon, James Pritchard. (Addressing previous witnesses.) I don't think you should leave, by the way. Come to the table. (Witness comes forward.)
Asia Russell, Pat Scanlon. By the way, I expect from the City Solicitor's Office, I expect to see the papers that Mr. Cohen requested. I don't think you'll find any. 55 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 Yes, sir -- ma'am, identify yourself for the record.
My name's Asia Russell and I'm a member of ACT-UP Philadelphia. I'm going to speak briefly today about the consistent unaddressed problems community advocates in Philadelphia are aware of regarding health care in Philadelphia jails, the implications of these problems, and demands of the current care- provider at Prison Health Services as well as the City for their immediate reform. First I'll remind Council that we have testified on this matter in the past several times. To be frank, AIDS activists, mental-health activists, legal excerpts, X-inmates, and their loved ones are frustrated that matters critical to the public health of our city are not being resolved by the Office of the Managing Director, Estelle Richman, or by PHS, despite ample documentation of these problems and of their etiology. What are our concerns and what should be done to address them? First, contract overhaul. The contract between the City and PHS is troubled at best. Prison Health Services violates the 56 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 obligations set out in this contract with impunity. Obligations such as 100 percent screens among men and women for sexually-transmitted infections like gonorrhea and chlamydia on intake, next-day delivery of medications by subcontractees, or access to chronic-care clinic within days of submission of 8 an inmate request are not being up upheld by Prison 9 Health Services with disastrous public-health 10 results, and the City is not holding Prison Health 11 Services accountable. 12 Furthermore, the contract itself does 13 not set out clear and significant consequences for 14 PHS if and when it fails to comply with its obligations. The City's inaction amounts to rewarding negligent behavior on the part of Prison Health Services. 1. The contract must be immediately and substantially revised this year with amendments, including daily fines, for example, for PHS's failure to comply. 2. PHS's understaffing. Prison Health Services does not have enough staff employed to do its job. This is a persistent problem documented well by the City as well as by independent medical 57 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 experts. Instead, the few health-care and administrative staff on State Road are spread thin, are cutting corners, and people are suffering. Recruitment and retention of jail health-care providers is difficult, but PHS is contractually obligated, and is paid, to employ a certain number of clinicians. PHS is unwilling to adhere to this obligation, so it is the responsibility of the City to take action and to fine PHS for their violations. This problem will not and has not resolved on its own. 3. Ongoing oversight. There is no 14 independent public entity responsible for ongoing monitoring of the administration of health care in jails and in the compliance, or lack of compliance, of Prison Health Services with its contract that makes its findings available to the public in a timely and transparent fashion. Successful models for provision of jail mental and physical health care always include ongoing medical oversight with a component of public reporting and public evaluation. Philadelphia, therefore, must include this provision as well. 4. Coordinated discharge planning. 58 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 Inmates with chronic illnesses are discharged at a rapid clip from the Philadelphia prison system. PHS is paid, paid, to provide discharge planning for inmates to ensure some measure of continuity of care among inmates with serious medical. Medical discharge planning is spotty at best and chaotic at worst. When inmates with HIV, hepatitis or serious mental illness are discharged without medications, without comprehensive treatment plans, their health is jeopardized, taxpayers are ripped off, and the public health of the community suffers. 5. Administration of medications. Inmates consistently report interruptions in their medicines.
For inmates with illnesses like schizophrenia, missing mental-health medications carries unacceptable risk. Likewise for inmates with HIV disease, interruptions in therapy increase the development of HIV that's resistant to treatment and, thus, increases the chances among inmates of sickness and death. Incarceration is punishment enough. The denial of basic, essential physical and mental-health care is inhumane and it is dangerous. 59 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 Philadelphia jail health care is in a state of the crisis. I have listed only a few examples. There are many more that have been explicated before this Council in the past several months. We demand change immediately. If the City chooses to disregard the legitimate, essential health-care needs of its inmates, it does so at its own peril. People with chronic illnesses who complete jail time return home to our communities, and the medical neglect they sustain while incarcerated affect the public health of the entire community while making the City vulnerable to protracted, costly lawsuits, and City taxpayers foot the bill again and again. This unconscionable situation can, and must, be corrected. Thank you.
My name's Patrick Scanlon and I'm here today because I'm a former inmate of the Philadelphia prison system. I was an inmate from August 8th of 2000 until January 2nd of this year. 60 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 Upon arriving at the Philadelphia prison system -- I do have AIDS -- it took me seven days to get my medicine. And as Asia just stated, any interruption in my medication, you run into drug resistant [sic]. I wasn't tested for three months for my viral load to see if my medicine was working, if that interruption did cause any damage. In the months I was incarcerated, I was only tested 10 three times for my viral load, which should have 11 been tested every three months. 12 I wish I could give you dates and times 13 and names of everything. I was afraid to keep 14 records of these because I didn't know, I was 15 scared. I was afraid that the prison system might 16 keep me in my full sentence if they seen I was 17 trying to do anything. And I believe that's why a 18 lot of people don't come forward, 'cause they're scared, they're on parole, they're on probation. And chances are that many of us will go back to jail; it's a known fact that people that go through the prisons system will go back to the jail before the end of their life. One night, I fell down 15 steps. I woke up at the bottom of the steps. I was unconscious 61 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 for a couple of minutes. Sergeant Griffin was there; she works 3 to 11 at the House of Correction. She called for medical. A nurse came down for me with four inmates with a stretcher. I had no 6 feelings in my legs. My back -- my lower back hurt. I didn't know what was wrong with me. The four inmates proceeded to put me on the stretcher and carry me up the steps without strapping me in and taking me to medical, where I was given two pain pills, and the doctor was then called. Three hours later, I was taken to the Detention Center -- not on a stretcher, but shackled and handcuffed and forced to walk from one end of the House of Corrections to another, get in the van, and forced to walk from the van at the Detention Center all the way up to medical, where I was met by a lady in green scrubs that said, Well, he could walk up here, he's all right, take him back. Thank God my injuries weren't that bad, but at the time, I didn't know what was wrong. During my course at the stay of the House of Correction, they gave me a job as a center runner. While most inmates were running drugs and 62 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 cigarettes through the jail, I was watching everything that goes on. Every movement that goes through the House of Correction comes through the center. I seen on one day a man being brought in from the yard. He had broken his leg. Most of our legs swing forward and backwards; his legs was swinging sideways from the knee. He was taken to medical, and at this time, it was around 8:00 o'clock. I worked till 11:00 o'clock and I didn't see him leave the jail on a stretcher or go to a hospital, so he was still upstairs. The next day, I talked to an Officer Talbert, and he told me that he was taken to the Detention Center, given some morphine, and brought back. The next day, they took him to Temple University Hospital. For two weeks, the man was put on a regular block with crutches, and every day, at night, when he went for medication, 'cause you have to go to the second tier in the House of Correction, I had to walk with him up the steps to make sure that he got up there. Towards the end of my stay at the House 63 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 of Correction, I was on F-1. There was a man on my block continually having seizures every day, sometimes twice a day. I know from working at the jail that everything is documented in the jail. Anytime medical comes to a block, it's documented in the log book or put on the computer. For two weeks straight, this man went through seizures.
After a while, I asked a nurse -- his name was Bob. I said, Why is this man still having seizures? His answer was that he's faking it, that all's he wants is his 10-milligram intramuscular Valium. One day, I had to hold him down on the floor. I rolled him on the side, he was having a seizure. He wasn't faking it. I had bruises all up and down my legs and arms from holding him. Again, a stretcher was brought to take the person up to medical by four inmates. I was asked to help carry the stretcher. I told the guard I'm not doing that. " He said, "We don't get involved with that, it's not in our contract. " I told the guard I wasn't going to do 64 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 it. " and I know what that means: That means maybe going to the hole. So I helped carry the man up to the... After another week of seizures, he was taken to a hospital and, I guess, put on the right medicine 'cause he came back to the House of Corrections, was put on C-1, which is supposedly a mental-health block, and he seem all right. A month later, I was transferred to ASD. My custody level had dropped. While I was at ASD, medication times were 5 in the morning if you worked and 8:00 o'clock at night. If you were on a regiment for HIV, you need to take your medicine every 12 hours. When I was discharged, I was discharged with no medication, no after-plan. I was discharged to a drug program. When I got to the program, I had to go see my doctor the next day to get my own medication. And I'm not here for myself; I'm here so that the health-care system can be improved in the prison health system. I realize that we are inmates, we did wrong, and jail is our punishment, but I find it an outrage that in this country that 65 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 we scream about civil rights all over the world, and people's civil rights are being violated in our own city. Thank you.
My name is James Pritchard. In December of 2000, I was incarcerated for 60 days, but previously to that incarceration, I was in a car accident that year, and I was under therapy from a chiropractor three times a day -- three times a week. And when I got into the system, all they asked me for was life-threatening medications that I needed. I also told them I needed therapy for my back, and they said they don't have that there. And every day that I was locked up, the pain kept getting worse and worse. And the PA that was giving me medication said, All you're going to get is ibuprofen. That wasn't doing anything but putting holes in my stomach. I was starting to bleed after a while and I had to stop taking ibuprofen. 66 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 I seen a lot of abuse there of not having proper medication. There's a lot of days where seizure meds were not there, AIDS medication was not there. The gentlemen had to go back into their cell and wait till the next day to get their medication. I also had to wait a few days to get my blood pressure medicine 'cause they ran out. I mean, I feel sorry for the prisoners stuck in there now. I mean, I know they're under contract. I asked the PA, did she have any medical knowledge? and she said no. And that's scary. She don't have no medical assistant degree, she's not a registered nurse or an LN. It scares me to think they're just putting people in there to take care of us if we get in jail. I was only in jail for 60 days, and 50 days of it was a nightmare. I couldn't sleep at night, I was keeping the guards up all night, talking to them 'cause I couldn't sleep.
I was talking to the other inmates; they told me, you know, there's nothing you could do, just ride it out, 'cause I 67 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 didn't want to get in any more trouble. I did my time, I did something wrong, and I'm here to make things right, 'cause there's no chiropractic treatment in --