Inmates, wardens, and outside observers all agree on one thing when it comes to the condition of Florida’s jails and prisons: They’re in terrible shape. For example, most lack air conditioning. Providing health care services to inmates in jails and prisons is difficult but doing so in extreme heat and under conditions that invite the proliferation of pathogens is more difficult still. Florida’s history of issuing long prison sentences ensures many inmates will age in prison, needing more and more health care while they are locked up.
Most would agree that the health care conditions of Florida’s jails and prisons are primarily a problem created by governmental institutions, including state (prisons) and local (jails) governments.
But, in September, the Miami New Times chronicled the tragic deaths of several inmates who have died in facilities where the health care services were provided by Miami-based Armor Health Services, a private company. The story highlights Armor Health Services’ failures in those cases to argue against the very presence of private health care providers in corrections.
Unfortunately, the fact is that correctional health care is a challenge no matter who the provider. The poor conditions of correctional facilities make horror stories, such as those presented in the article, all too commonplace.
Florida’s systemic corrections problems require fundamental changes to the state’s correctional institutions across the board. When state or local agencies contract out health care services, they’re often attempting to make the best of a bad situation by finding a way to provide health care at lower costs than the government itself can provide. The contracts with private health care companies offer the opportunity to implement benchmarks and requirements to ensure base levels of quality of care and to protect inmates from the tragedies the New Times reported. Most corrections health care contracts, for example, include clauses that punish health care providers that fail to provide certain services or maintain agreed-upon, proper staffing levels to meet a prison’s needs.
Performance-based contracting is the best path forward, particularly with health care services in correctional facilities. By moving the focus from the number of services provided to specific health-based outcomes, agencies can better ensure inmates receive services they need for health care and otherwise.
Prisons in Australia and New Zealand, for example, currently operate performance-based contracts that financially reward the private prison operators for meeting goals. Whereas Florida’s prisons may not have air conditioning, these prison companies even lose money if the temperature gets too high in the prison’s living areas. And rather than incentivizing locking more people up, the private prisons are being financially incentivized to rehabilitate inmates and lower recidivism rates.
Undoubtedly, getting corrections health care on the right track is a massive challenge for Florida’s prison system. Rather than seeking to blame or ban private contracting for health care services in correctional facilities, however, the focus should be on eliminating intolerable conditions in jails and prisons. Private contracts should incentivize a new era of criminal justice reform. Well-designed private prison contracts can be used to reduce prison populations, provide quality health care to inmates, and produce education and training programs to help people re-enter society.