St. Louis County Jail Medical Team Casts Wary Eye on Move to Privatize Health Unit

By Steve Giegerich St. Louis Post-Dispatch | St Louis Post-Dispatch (MO), August 2, 2015 | Go to article overview

St. Louis County Jail Medical Team Casts Wary Eye on Move to Privatize Health Unit


Steve Giegerich St. Louis Post-Dispatch, St Louis Post-Dispatch (MO)


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. …

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