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St. Louis County jail medical team casts wary eye on move to privatize health unit

St. Louis County jail medical team casts wary eye on move to privatize health unit

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CLAYTON • In a medical career spanning 30 years, Dr. Mary Vatterott Hastings has cared for patients young and old in urban communities, in rural settings and on college campuses.

Still, it’s the population Hastings began treating in 2010 that has unexpectedly provided the greatest measure of professional fulfillment.

“I’ve never worked with more grateful people,” said Hastings, a St. Louis University School of Medicine physician assigned to the St. Louis County Justice Center. “They are at a time in their lives when they’ve hit rock bottom and are open and interested in making changes.”

Hastings is now concerned that the job she loves, along with those of nearly 70 medical jail nurses and other personnel employed by the St. Louis County Department of Public Health, may soon be modified or eliminated.

The concern was prompted by a request for proposals the county issued in July seeking bids from private companies with an interest in delivering medical and mental health services to 1,250 inmates housed at the Justice Center in downtown Clayton and an additional 35 juveniles detained in the nearby Family Court Juvenile Court Center.

County Executive Steve Stenger said Friday the objective of requesting proposals is to identify ways to cut the $7.5 million annual cost of the program.

“We are simply looking for a way to provide more efficient services to the jail,” Stenger said, emphasizing that “no decision has been made” on whether to turn jail health services over to a private vendor.

TALLYING COSTS

Stenger said the cost of treating 3,600 inmates a year averages about $2,000 a patient. The average is inflated by the medical needs of the 140 inmates requiring specialty care for cardiovascular disease, cancer and advanced diabetes.The county executive stressed that a decision on how to proceed – or whether to make any changes at all – will be made after the proposals are analyzed. The bidding process ends in mid-September.But he emphasized no layoffs will occur no matter what decision is made.

“There’s not even a risk of job loss,” Stenger said.

Longtime Justice Center Medical Director Dr. Fred Rottnek disputes the mere suggestion that private enterprise might improve on the performance of a medical team he says contributed to the justice center’s standing as the only jail in Missouri meeting the accreditation benchmarks of the American Correctional Association.

The posting of the request for proposals seeking a “for-profit, publicly traded, investor-owned corporation,” Rottnek said, is both “abrupt and ill-advised.”

Rottnek, in addition to his responsibilities at the jail, is an associate professor and director of Community Medicine with the St. Louis University School of Medicine.

The county pays the medical school $1.8 million annually.

The money covers the cost of Rottnek’s services, SLU physicians and mental health professionals assigned to the justice center, and work-study students.

The SLU employees are one component in a medical team that initiates a relationship with inmates the moment they arrive at the Justice Center.

Staff members say the intake physical and psychiatric evaluation can broaden into recommendations for preventive and follow-up care after an inmate departs for a state correctional institution or release.

The care received while incarcerated is the only time some inmates have had continuous, quality medical and mental health care in their adult lives, employees say.

“One of the best things we do is educate the patients and give them information so they can follow up in the community, even if they don’t have insurance,” said a justice center nurse.

(County health department employees interviewed for this story asked not to be identified to protect their jobs.)

Alan Felthouse, the director of forensic psychiatry at SLU, is a former justice center chief psychiatrist who still occasionally visits inmates in Clayton.

He notes the increasing presence of inmates suffering from mental disorders. The tremendous challenge created by incarceration of the mentally ill, Felthouse says, makes it “all the more important that we have a team of experienced, highly dedicated (mental health professionals) on hand to deal with very significant types of pathology sometimes complicated by being in a correctional setting.”

The employees say the majority of interaction is with men and women being held for nonpayment of child support, drugs or outstanding traffic warrants.

And in what can often be a confrontational environment, the nonadversarial medical unit is often thrust into the role of intermediary.

“We are the people who help them,” says one nurse. “We do what we can to make them feel good about themselves.”

NO WARNING

There was no indication, employees say, that county health department officials were displeased with their performance.“No one sent up any red flags that said we’re not taking good care of these people,” Hastings said.Then, on July 26, the employees learned about the request for proposals about to appear on the county website.

The official delivering the news, Assistant County Health Director Jade James, advised unit workers that privatization could result in layoffs or requests for some or all existing employees to reapply for their jobs.

Those in attendance say James concluded the meeting by proposing the employees “pray on” what lay ahead for them in the weeks and months to come.

Stenger called James’ remarks “fearmongering” and said “her conduct will be addressed as a personnel matter.”

The county stipulated that the successful bidder “shall give priority consideration to all employment applications submitted by current St. Louis County Corrections Medicine employees.”

Stenger promised employees would be reassigned to another health department division should an agreement with a private vendor result in a reduction in justice center medical unit positions.

Staff fears, however, were exacerbated on Thursday with an emailed invitation to discuss the “overwhelming emotions” people are experiencing because of the potential change.

The email pointed workers to county Employee Assistance Program counseling services and included links to advisories such as “Financially Preparing for a Layoff,” “Getting Started After A Job Loss” and “When Others Around You Have Lost Their Jobs.”

“Kind of funny to get these from personnel when our jobs are not in jeopardy,” a health unit nurse said.

Rottnek acknowledges the unit could reduce costs by replacing registered nurses who leave with licensed practical nurses or medical assistants.

He said there are also ways to streamline the current system of recording and reporting patient information.

The medical director said he’d have gladly shared his research on cost-cutting measures with county or health department officials.

But “they never asked,” Rottnek said. “The county apparently doesn’t want to engage in that type of discussion. They just want to turn over health care to the lowest bidder.”

Stenger disagrees with that contention.

“This is essentially a study to make this operation better,” he said. “I think we can do better than $7.5 million.”

The county, Stenger said, invites any for-profit or nonprofit capable of improving the existing model to submit a bid.

And that, he added pointedly, includes St. Louis University.

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Steve Giegerich is a reporter for the St. Louis Post-Dispatch.

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