Despite horror stories and deaths, will Illinois keep an expensive prison health care provider?

Health care behind bars in Illinois comes with heavy financial and human costs. Since 2011, Illinois has paid Wexford Health Sources, a private company, more than a billion dollars to provide medical care to people in the state’s prisons. During that time, a federal judge determined the care was so poor it violated the U.S. Constitution, and an independent monitor has released reports documenting deaths from substandard medical care.

Wexford’s shortcomings could be measured in numbers:

Fifty percent of the health care provider’s jobs in Illinois are unfilled. Three Wexford doctors lack proper credentials. Patients in need of dental fillings at one prison are on a 104-week waitlist. And in a review of 17 deaths, an outside monitor found that medical staff gave two prisoners medications that contributed to their deaths.

Or you could measure the failings in the horror stories:

James Cox lost sight in his left eye after another inmate hit him with a book. But medical staff refused to provide him care because of Wexford’s “one good eye policy,” which, at the time, allowed for care to be denied as long as a prisoner had, as the policy’s name implies, one functioning eye.

A man with mental illness told medical staff he had swallowed two plastic utensils and needed them removed. But instead of providing care, the plastic remained in his body, tearing him from the inside. He lost 24 pounds in a single month and then died.

In another case, Wexford staff discontinued maintenance chemotherapy for a survivor of brain cancer. After the cancer reappeared, staff took months to schedule a surgery. But it was too late. He died.

Wexford’s 10-year contract with Illinois expired in 2021, but the company continues to provide care in prisons. The state is seeking bids for a new contract, which gives Illinois a chance to make a change and rethink its prison health care — but advocates worry Wexford or another similar profit-driven company will win the deal and essentially continue the status quo.

“I think we have to come at providing health care inside our prisons differently than we do now,” said Jennifer Vollen-Katz, executive director of the John Howard Association, a prison watchdog group.

“We would like to see the state of Illinois take this seriously and understand that these are Illinois citizens that are suffering … and that is a violation of their constitutional rights.”

Missed opportunity for change?

This year, it seemed as though Illinois was on the cusp of switching up health care in prisons. Officials had designed a plan that would assign each prison to 1 of 5 geographic zones in Illinois. That would have allowed smaller government and nonprofit organizations (like state hospitals and universities) to provide the care behind bars.

Vollen-Katz said those kinds of providers would be better, because they aren’t driven by profits, like Wexford. “I think we need to be concerned any time there’s a profit motive involved in taking care of people who are incarcerated,” Vollen-Katz said. “The more money they do not spend addressing someone’s medical needs, the more money they put in their pockets as profit.”

She also said partnerships with universities or hospitals would allow more oversight and transparency and access to high-quality care. It’s an approach the state has experimented with on a small scale. In a pilot program, Southern Illinois University provided medical care in a few of the state’s facilities.

But Department of Corrections spokesperson Naomi Puzzello said the department decided to scratch the plan to divide the state into zones and go with a statewide approach “to ensure continuity of care is upheld no matter where or when an individual is placed.”

Harold Hirshman represents incarcerated people under the Lippert consent decree, a massive lawsuit the state settled in 2019 by promising to provide better care and submitting to federal oversight.

He said he thinks the plan to stick with a statewide contract makes it likely there will be more of the same.

“The chances that you’re going to get anybody but Wexford are probably pretty small. And why you would want Wexford again is, well, beyond me,” Hirshman said.

Chronic short-staffing and poor care

As part of the 2019 settlement, the court appointed a monitor to evaluate health care in the Department of Corrections, providing an independent view of a system that largely operates outside of public view.

Recent reports from that monitor say that one of the biggest problems is that Wexford has continually failed to hire the number of providers required by the agreement. The monitor found the medical staffing shortages in the state’s prisons is a “crisis” that “threatens the safety” of incarcerated people.

In fact, there are fewer medical staff members than when a judge originally ordered oversight as part of the settlement. Fifty-three percent of physician and medical director positions are vacant, and 48% of registered nurse jobs are open.

Hirshman, the attorney, said even under court monitoring, Wexford has never provided the number of staff it promised.

“The care hasn’t improved. It’s still lousy, there aren’t enough medical personnel, they don’t do the work, and it’s sad.”

The Illinois Department of Corrections and the governor’s office would not answer questions about alternatives to Wexford, say how many bids it had received or provide any information on when it is expected to make a final decision.

Shannon Heffernan is a criminal justice reporter for WBEZ. Follow her @shannon_h.