NYC Health & Hospitals officially took over the $237 million health program that serves inmates at Rikers Island and other city jails in January, ending the city's relationship with Corizon, a for-profit provider. While the health system begins the arduous work of addressing safety and staffing concerns, many of the same problems remain.
In the months leading up to the takeover, NYC Health & Hospitals reshuffled its leadership structure and completed credential reviews and background checks on the 1,200 workers who were employed under Corizon. About 85% of those employees were rehired, according to a spokesman for the health system.
“During this transition period, there were no lapses in coverage and no disruptions in patient care,” said Ram Raju, president of NYC Health & Hospitals during a City Council Health Committee hearing Monday.
Two healthcare workers who remain at Rikers said they haven't seen any improvements, either, and have yet to receive any additional training or orientation.
“Clinically, I haven't really noticed a difference,” said a mental-health treatment aide at Rikers, who declined to be named. He said he did have a 10-minute interview about his job duties before NYC Health & Hospitals took over.
If anything, the quality of care has suffered during the transition, said a therapist in the mental-health units at Rikers, who has worked there for three years.
“Our case loads are so high,” she said. “Every day we're expected to see way too many people, given the eight-hour time frame.”
NYC Health & Hospitals' division of Correctional Health Services did not comment on the issue of high case loads or whether any additional training or orientation was planned.
Administrators are working with the Department of Correction to address persisting safety and organizational issues that affect the quality of care delivered to the city's inmates, said Patsy Yang, H&H's senior vice president for Correctional Health Services, during a hearing before the City Council Health Committee Monday.
DOC has the final say on many issues, and Yang was asked if that was a challenge. "Yes, we are definitely in their facilities, in their jails," she replied. But she added that communication between DOC and H&H is improving through weekly planning meetings and daily on-site huddles to discuss the most challenging patients.
So far, the interagency strategizing has not prevented the recurrence of tragedies that made headlines under Corizon's tenure. Just last week, a Rikers inmate with a history of mental-health issues, Jairo Polanco Munoz, killed himself after his psychological assessment was postponed because of a lockdown, the Daily News reported.
Security measures like lockdowns and alarms are among the factors that have a major impact on the ability to provide inmates with requested medical visits and follow-up care, said DOC and H&H earlier this month during a joint presentation before the Board of Correction, which oversees DOC. Other contributing factors include programming conflicts and insufficient or uncoordinated staffing across facilities. In January, 4,397 of 6,606 scheduled medical follow-up visits, or about two-thirds, were delivered, according to the presentation.
The use of solitary confinement, in which an inmate is confined to a cell for 23 hours per day, remains a major obstacle to improving health at Rikers. Raju said that if inmates received better mental-health care, they would be less likely to present behavioral issues that trigger solitary confinement.
But Councilman Corey Johnson, chair of the Health Committee, pushed Raju to clarify his stance.
"Do you think it's cruel and unusual and inhumane punishment?" he asked.
"I probably think it is," Raju said.
H&H's Yang said she hopes to create more Clinical Alternative to Punitive Segregation units, which divert inmates with mental-health issues from solitary and offer therapy. People in CAPS units are less likely to try to harm themselves, but each one costs about $1.5 million more per year to run than other types of mental-health units, according to a report by New York City correctional staff that was published last year in the International Journal of Environmental Research and Public Health.
H&H is also trying to improve the continuity of care between the jails and the community. Starting in late December, MetroPlus staff members have been stationed at the Rikers Island visitors' center one Friday each month to educate people about insurance options. By February, it has signed up 38 people.
Raju said he aims to bring the quality of care inside city jails up to the standards in the larger health system.
“We want to make sure there's the same quality at Rikers Island as what we provide at Bellevue,” he said at Monday's hearing. “We're working on that.”
"What has changed at Rikers since its for-profit health care provider left? Not much, so far" originally appeared in Crain's New York Business.