In the free world, the forces of market competition and consumer choice largely protect patients from grossly inadequate care and neglect by their healthcare providers. If you don’t like the coverage provided by your healthcare plan, you can buy a different one. If you think that your doctor is incompetent or indifferent to your medical needs, you can get a second opinion. While the American health care system is far from perfect, competitive pressures generally force the lowest-quality healthcare providers to either improve or go out of business.
Healthcare in U.S. jails and prisons is different. Inmates typically have no ability to choose their doctor and little to no say over what care they receive. Most have no immediate recourse if their assigned providers choose to downplay or ignore their serious medical needs. Today, healthcare inside a correctional facility frequently is not even provided by a state or local government: it is the responsibility of a private, for-profit corporation that specializes in the outsourced prison healthcare business. Corizon, Centurion, Wexford, and Wellpath are some of the largest players in this industry and have annual revenues in the hundreds of millions to billions of dollars.
The competition that exists between these companies comes in the form of pressure from their governmental clients to submit the lowest bid for the contract, rather than from their captive patients to provide quality care. State and local governments often pay these companies a fixed fee to shoulder the responsibility for all of the medical needs of their incarcerated population. Under these “fixed-fee” arrangements, the contractor loses money whenever it provides a medical service to an inmate. Every time a test is ordered, or a prisoner is sent off-site to a specialist, the cost of the test or off-site procedure reduces the contractor’s profit on the contract, dollar-for-dollar. Fixed-fee arrangements provide these companies with an irresistible financial incentive to deny healthcare to incarcerated people. Inmates with serious medical conditions, who have no one else to turn to for desperately needed care, are placed in a bind.
Under the Eighth Amendment to the United States Constitution, prisoners have certain legally enforceable rights to receive medical treatment. But federal law places substantial technical hurdles in the way of incarcerated people seeking to enforce their constitutional rights. The Prison Litigation Reform Act, a law passed by Congress in 1996, requires persons confined in jails and prisons to exhaust their remedies under any administrative grievance procedure applicable to the facility in which they are confined prior to bringing a claim in federal court. These administrative grievance procedures, in turn, often have extremely tight deadlines and confusing technical rules designed to impede prisoners’ access to the courts.
For example, the grievance procedure for the Michigan Department of Corrections (MDOC Policy Directive 03.02.130) requires prisoners to take action to informally resolve the issue within two business days of becoming aware of the denial of medical treatment, then file a Step I grievance within five business days after that, then file a Step II grievance appeal within ten business days of receiving the Step I response (or within ten business days of the date the Step I response was due, if the Department does not respond, including any extensions that the Department grants itself to respond), then file a Step III grievance appeal within ten business days of receiving the Step II response (or within ten business days of the date the Step I response was due, if the Department does not respond, including any extensions the Department grants itself to respond). Each grievance must be filed on a specific departmental form, which prisoners have to send out a request in order to receive. Grievances also need to name the specific people or companies responsible for the denial of care, starting with the Step I grievance, because the prisoner can lose his legal rights with respect to any person or entity not named at Step I. If a prisoner misses any of these deadlines, or does not comply with any of the other myriad rules of the MDOC grievance policy concerning the content of the grievance, the prisoner can forever lose his or her legal rights with respect to the incident in question.
Margolis & Cross represent individuals who have been denied access to minimally-adequate medical treatment while incarcerated. Filing a lawsuit may, unfortunately, be the only way for your incarcerated loved one to obtain the care that they need. If you or a loved one has been denied necessary medical care by a for-profit prison or jail healthcare contractor, call us today. Due to the tight deadlines and strict technical rules of correctional-facility grievance procedures, it is extremely important to get a lawyer involved in your case at the earliest possible time.
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