DEPARTMENT OF CORRECTIONS
HEALTHCARE
Public Health
and Public Safety
in the
Commonwealth’s
Prisons

Executive Summary
IN SEPTEMBER 2011, the Commonwealth requested
bids to greatly expand the current private healthcare
services within the Department of Corrections (DOC).
The history of contracted prison healthcare both in
Pennsylvania and across the country is a history of
unrealized cost savings, lawsuits, and diminished care.
Expanding the scope of privatized healthcare will likely
result in more of the same for the DOC.
Corrections is a core responsibility of state government
that directly impacts the safety and health of
Pennsylvania communities. Putting more of our
Corrections system into the hands of for-profit, private
companies opens our state up to a whole host of
potential problems.
Proponents of privatization promise to fix budget
woes by saving the government money. But numerous
examples in a variety of sectors show that projected
savings don’t always materialize. Cost overruns
combined with hidden and indirect costs, such as
contract monitoring and administration, can make
privatization more expensive than in-house services
for governments.  
The Commonwealth currently subcontracts certain
medical, psychiatric, and pharmacy services in state
prisons. Nursing care is not subcontracted, though
private sector staffing agencies are used to fill nurse
shortages in DOC facilities. Many of the problems
DOC staff encounter working with these agency nurses
would exist with nurses employed by a contracted forprofit company.
In 2009, Jeffrey Beard, the former DOC Secretary
acknowledged the essential role DOC nurses have in
maintaining quality health services in the current multiple
contractor arrangement. According to Mr. Beard,
“Critical to the success of managing this new multiplevendor system is a strong central office staff and welltrained on-site correctional healthcare administrators
and nurses who are state employees.”

DEPARTMENT OF CORRECTIONS HEALTHCARE	

Before the Commonwealth embarks on a potentially
expensive and dangerous decision to expand
subcontracted prison healthcare, legislators and the
public have a right to know about the performance
of the current subcontracted services and how the
Commonwealth expects to operate with potentially
expanded subcontracting. Answers to the following
questions must be provided before taking any steps
to further subcontract:
n	 Will all subcontracted healthcare staff have the
same level of security training as current DOC
nurses?
n	 Will the Commonwealth guarantee the same level
of nurse staffing if it decides to subcontract?
n	 Where does the Commonwealth
expect to find savings while providing
the same level of service?
n	 How does the Commonwealth
expect to provide oversight
without Commonwealth
nurses?
n	 Over the past 5 years,
what has been the yearly
estimate of the cost of the
current healthcare contracting
agreement and final yearly
cost of the agreement,
including amendments to the
agreement?
n	 Over the past 5 years, what
are all the deficiencies in
PHS/Corizon-run clinics and
penalties assigned?
n	 Over the past 5 years, how

3

many times has the Commonwealth found PHS/
Corizon out of compliance in its PHS/Corizon-run
clinics?
n	 What are the estimated and actual savings with the
PHS/Corizon implementation of the Catalyst SM
electronic health record system?
n	 Are there any financial or performance audits
pertaining to the current contracting Agreement?

4	

When the above questions are answered it will be
clear that pursuing further outsourcing of healthcare
services in Pennsylvania’s prison is not good for the
Commonwealth or its citizens. Outsourcing could
diminish safety and security within state prisons,
expose the public to increased health risks, and there
is no guaranteed cost savings to the Commonwealth.
We urge the Pennsylvania legislature, the Department
of Corrections and Governor Corbett to abandon any
plans to put this core responsibility of government into
the hands of any for-profit contractor.

DEPARTMENT OF CORRECTIONS HEALTHCARE

Public Health and Public Safety in the
Commonwealth’s Prisons
CORRECTIONS IS A CORE GOVERNMENT SERVICE
necessary to protect Commonwealth citizens from
dangerous criminals, safeguard the employees who
work in prisons, and protect the health of communities
when prisoners return home after serving their
sentences.
In September 2011, the Commonwealth requested
bids to greatly expand the current private healthcare
services within the Department of Corrections (DOC).
The history of contracted prison healthcare both in
Pennsylvania and across the country is a history of
unrealized cost savings, lawsuits, and diminished care.
Expanding the scope of privatized healthcare will likely
result in more of the same for the DOC and undermine
DOC’s ability to guarantee the safety and security of
both employees and the public.
Before the Commonwealth decides to subcontract
more corrections healthcare, the state should look
deeper into the record of subcontracting in prisons and
make sure it can guarantee the health and safety of our
communities.

Prison Healthcare
Prior to federal courts intervening in numerous states,
prison healthcare was often poor and limited. Many
prison officials considered healthcare a privilege and
withheld it as punishment. Prisoners and prisonrights advocates filed numerous lawsuits related to
inadequate medical care and in 1976, the Supreme
Court ruled that “deliberate indifference” to a prisoner’s
serious health problem violates the Eighth Amendment
prohibition of cruel and unusual punishment. The court
established the right to “reasonably adequate medical
care.”1

healthcare. Medical care is the most litigated issue
involving prisons2 and has contributed to dangerous
prison incidents.
In 1989, prisoners at SCI Camp Hill rioted for four
days before being brought under control. In the
class action complaint that eventually led to the
“Austin Agreement,” plaintiffs cited the failure of the
Department of Corrections and its contractors to
provide adequate routine and emergency medical
care as one of the causes of the riot. The complaint
specifically cited high RN and LPN vacancies.3

Unhealthy Prisoners
It is important to provide prison healthcare because
prisoners suffer disproportionately from many
dangerous diseases and the vast majority will return
to their communities. Prisoners have very high rates of
HIV, Hepatitis C, Tuberculosis and have elevated risk of
chronic diseases such as diabetes and other conditions
because of smoking, heavy alcohol consumption,
and poor nutrition.4 Effective prison healthcare
includes both treatment where appropriate, and more
importantly, education to help inmates manage their
conditions and protect communities from infection.

Privatizing Prison Services
When the government decides to vest its power
over prisoners in a for-profit corporation, the state is
transferring a substantial amount of public authority to
a subcontractor, but the liabilities largely stay with the
state. It is one thing to transfer the authority to operate
concessions in the Capitol building, it’s quite another
to cede power over the care of prisoners who have a
constitutional right to adequate healthcare.

Why the Push to Subcontract?
The vagueness of what is reasonable is still debated
and has led to many legal proceedings around

DEPARTMENT OF CORRECTIONS HEALTHCARE	

Governor Corbett’s privatization taskforce is charged
with examining government services to see where

5

privatization could be a benefit to taxpayers.
Proponents of privatization promise to fix budget woes
by saving the government money. However, the record
of subcontracting in general and prison health services
specifically, is not one of regular savings. Numerous
examples in a variety of sectors show that projected
savings don’t always materialize. Cost overruns
combined with hidden and indirect costs, such as
contract monitoring and administration, can make
privatization more expensive than in-house services for
governments. In fact, the Government Finance Officers
Association estimates that hidden and indirect costs
can add up to 25% to the contract price.5 
The Government Accountability Office has found
that methods by which agencies and privatization
consultants conduct projections and report contract
costs can make cost savings appear greater than
they actually are.6 According to a 2007 survey by the
International City/County Management Association,
52% of governments that brought services back inhouse reported that the primary reason was insufficient
cost savings.7
In 2001, a U.S. Bureau of Justice Assistance-backed
study on prison privatization concluded that private
prisons offered only 1% cost savings on average,
primarily achieved through lower labor costs. There
also was “no evidence found that the existence of
private prisons will have a dramatic effect on how
non-private prisons operate.”8
A trail of evidence,9 scandals,10 canceled contracts,11
costly lawsuits,12 and public records13 makes clear
to legislators their imperative to assess the costs
and benefits in their particular circumstances.

Recent Examples of Privatization
Failing to Save Money
In Maine, a 2011 report by the Legislature’s Office
of Program Evaluation and Accountability (OPEGA)
concluded that the company (Corizon) that provides
medical services to Maine’s prison inmates failed to
adequately fulfill many of its contractual obligations.
The report stated that 50% of the contractor’s medical
records were in error and that records could not be
found for nearly 10% of the prisoners treated.14
6	

In 2011, Florida’s Jackson Health System announced
it is reversing course and will not outsource inmate
healthcare. Executives last year were so convinced that
outsourcing would save money that they placed the
estimated $8 million savings in the budget for this fiscal
year, which ends Sept. 30. When Jackson’s new chief
executive, Carlos Migoya, arrived in May, he reviewed
the program, which covers 6,000 Miami-Dade County
inmates. After the second set of final bids came in, he
decided the proposals were “notably higher” than what
his team thought it would cost Jackson to perform the
same service, he said. “There was a big difference,” he
said. Chief Financial Officer Mark Knight said the lower
of the two bids was $60.5 million. Executives now
believe Jackson can provide the same services for no
more than $58 million—and perhaps considerably less
next year with reduced labor costs.15
Recent studies by the Arizona Department of
Corrections found that, despite a state law mandating
private prisons must create “cost savings,” inmates in
private prisons can cost up to $1,600 more per year
while often housing only relatively healthy inmates.16
In 2000, the South Carolina General Assembly
conducted a review of the state’s use of subcontracted
healthcare in its prisons. The report documents the
experience with subcontracted healthcare in the SC
prison system was rife with problems that ranged
from very poor medical care to cost over-runs and
substantial funds spent on services that were never
provided.17

Subcontracting Prison Health
Jeopardizes Public Health
As mentioned above, prison populations suffer from
disproportionately high rates of infectious diseases,
mental illness, and substance abuse. These challenges
pose not just a threat to the prison population, but can
be devastating to communities that typically receive
former inmates once they are released. Nationwide,
thousands of offenders are released daily from prison.18
Incidentally, Governor Corbett has proposed increasing
the amount of prisoners released as part of his 20122013 budget proposal.
Any proposals to further subcontract Pennsylvania
prison health must bear this increasing release rate in
DEPARTMENT OF CORRECTIONS HEALTHCARE

mind. Prison healthcare companies promise to reduce
healthcare costs, but many articles and reports show
that companies cut costs by creating obstacles to care,
hiring too few staff, employing inexperienced staff, and
skimping on medication.19

days after he was jailed on a probation violation. The
ACLU says Lucas had chronic heart disease and was
wearing a pacemaker when taken into custody. The suit
contends the private healthcare subcontractor failed to
provide proper medications or care for Lucas.23

Recent Examples of Prison Healthcare
Subcontracting Putting Communities at
Risk

In 2010, Delaware replaced the company that provided
medical care in the state’s prisons after five years
of criticism and turmoil over the quality of inmate
healthcare. The change was a result of frustration with
the subcontractor and a 2005 investigation by The
News Journal. The newspaper’s series brought to light
problems with high inmate death rates, especially from
AIDS and suicide. It also pointed out neglect of sick
inmates who were in filthy infirmaries that sometimes
lacked beds. Following the series, a federal monitor
was appointed by the U.S. Justice Department to
oversee prison healthcare.24

Since 2005, a leading prison healthcare contractor
has lost contracts or failed to win renewals with prison
systems in four states, each with seven to 24 prisons:
Vermont (2005), Alabama (2007), Delaware (2010) and
Maryland (2010). Additionally, the company also lost
contracts at individual county jails in Galveston County,
Texas (2007), Pima County, Ariz. (2008), and Monroe
County, N.Y. (2010).
In almost every case, the contract losses followed
allegations by correctional or county officials that the
company failed to provide adequate health care. Pima
County officials withheld $1.3 million in payments over
staffing and healthcare problems.20
Over 12 months ending in June 2011, Idaho fined a
prison healthcare contractor more than $270,000 for a
wide range of medical and mental healthcare shortfalls,
including staffing shortages. Public documents
released to the Associated Press said the contractor
was supposed to fill vacancies within 60 days, but left
the South Boise Women’s Correctional Center without
an Ob/Gyn for more than two years and left another
maximum-security prison without a staff psychologist
for more than eight months.21
In 2006, an 18-year old woman with bipolar disorder
and clinical depression hanged herself while
incarcerated in solitary confinement in a Florida prison.
In 2011, her family settled a $500,000 lawsuit over
her death with the Florida Department of Corrections
as well as private companies contracted to provide
medical and mental health services.22

In 2010, Maryland state officials decided to extend the
current contract for six months while searching for a
new company to oversee medical care for Maryland
prisoners. A 2007 state audit found “several significant
areas of noncompliance,” and a state auditors’ review
of those findings released in April 2010 found that there
were still problems. At that time, the whole system,
serving some 23,000 inmates at a cost of about $150
million per year, had only one medical doctor. Even
inmate deaths could not be properly reviewed.25
In 2011, Monroe County,
NY and its former jail
healthcare provider have
agreed to pay $275,000
to the family of a man
who died of a heart
attack in the jail in 2007.
Attorneys for the family
of Orlando Samuels had
argued in a lawsuit that
medical officials at the jail

In 2009, the American Civil Liberties Union filed a
wrongful death lawsuit over the death of a jail inmate
in St. Louis, claiming he did not get proper care for
a heart condition. 32-year-old Courtland Lucas died
at the St. Louis City Justice Center in May 2009, five
DEPARTMENT OF CORRECTIONS HEALTHCARE	

7

ignored Samuels’ heart condition, causing his death
in May 2007. The county no longer contracts with the
healthcare contractor and last year sued the company,
seeking $2 million in contractual restitution for alleged
staffing shortages while CMS ran jail medical care.26
In 2007, The Michigan Department of Corrections
(MDOC) conducted a thorough review of its corrections
healthcare. MDOC used a private contractor for
physicians and physician assistants. Nurses, dentists,
and support staff are MDOC employees. The findings
include:
n	 Contracting out providers leads to organizational
problems.
n	 It is not always clear who is in charge and how
change can be made.
n	 Providers don’t feel a need to correct problems as
they are not employees of MDOC.27
In 2006, to save money on its contract with the New
Mexico state corrections department, a contractor
cut costs and provided poor healthcare to inmates.
In the wake of Wexford Health Sources’ cost-cutting,

8	

“chronically sick inmates were routinely refused off-site
specialty visits. Other inmates waited for days, even
weeks, to receive critical prescription drug renewals.
Still other inmates were forced to lie in their own feces
because basic supplies, like bed sheets, were in such
short order.” In addition, staffing was a problem in
prison medical units due to the contractor not filling
vacant positions as yet another means of cost-cutting.
In the end, people ranging from “Wexford’s top medical
officers in New Mexico to nurses and administrative
employees” resigned as a result of the effect of the
company’s
belt-tightening on their ability to help patients.28
According to an investigation of one prison healthcare
contractor, as a matter of formal policy, the contractor
discourages treatment for hepatitis—which is epidemic
in prisons—and the onerous protocol pathway is just a
way of making it harder for prisoners to demand it.29
In 2009, a Virginia jury awarded $1.5 million to be paid
by a prison health services contractor to settle a lawsuit
filed by the widow of a mentally ill man who died of
pneumonia and dehydration six days after he was jailed
on a misdemeanor charge.30

DEPARTMENT OF CORRECTIONS HEALTHCARE

WHY CONTRACTING OUT
NURSING SERVICES IS WRONG
FOR PENNSYLVANIA
Corrections is a core responsibility of state government
that directly impacts the safety and health of
Pennsylvania communities. Putting more of our
Corrections system into the hands of for-profit, private
companies opens our state up to a whole host of
potential problems.
The Commonwealth currently subcontracts certain
medical, psychiatric, and pharmacy services in state
prisons. Nursing care is not subcontracted, though
private sector staffing agencies are used to fill nurse
shortages in DOC facilities. Many of the problems DOC
staff encounter working with these agency nurses
would exist with nurses employed by a contracted forprofit company.
For example, DOC nurses and corrections officers
frequently express their unease at working alongside
agency nurses who are not committed to security.
Agency nurses do not have the same training and
experience in security protocols that DOC nurses have.
Inmates are acutely aware of that lack of training and
often look to take advantage of inexperienced staff.
Agency nurses do not view themselves as part of the
security team and place an extra strain on DOC staff
because they often insist on being accompanied by
corrections officers whenever they work with inmates.
Moreover, agency nurses do not have the same level
of commitment to educating inmates about managing
their conditions and diseases for their eventual return
to the community. Health education is an involved
process that takes time and requires establishing a
rapport with the patient. A more transient workforce
will be less effective at education than a stable,
dedicated workforce.

DOC Nurses are Critical for Oversight
In 2009, Jeffrey Beard, the former DOC Secretary
acknowledged the essential role DOC nurses have in
maintaining quality health services in the current multiple
contractor arrangement. According to Mr. Beard,
“Critical to the success of managing this new multiplevendor system is a strong central office staff and wellDEPARTMENT OF CORRECTIONS HEALTHCARE	

trained on-site correctional healthcare administrators
and nurses who are state employees.”32
Commonwealth nurses have two concerns when they
go to work every day—maintain safety and provide
needed care. They are the on-the-ground oversight of
the current medical vendors and take seriously their
role of guardians of the Commonwealth budget. In
conversations with DOC nurses and nurse supervisors,
many expressed concerns over waste and lack of
oversight of the currently contracted services.
There are structural barriers to effective governmental
monitoring of private prison contractors.32 When a
government agency contracts for services in other
areas such as constructing a public road, taxpayers
can easily see the results. Prisons, on the other hand,
are closed institutions where the public has almost no
ability to evaluate the quality of services purchased with
taxpayer money. In addition, when an agency such as
DOC has selected a contractor, the agency may be
reluctant to publicize failures on the part of the contractor
for fear that it may reflect poorly on the agency.

DOC’s Nurses are Trained, Experienced
and Effective
DOC nurses are more than just caregivers. They are
integral to the state corrections system and are front
line workers necessary for the security of staff, inmates,
and the community. DOC staff’s principal duties are
“Care, Custody, and Control” and DOC nurses are
charged with all three. Their workplace is typically in the
bowels of a prison and they are often called on to enter
prison cells in emergency situations.
Beyond the dramatically different work environment,
DOC nurses also don’t treat the same patients as a
typical nurse. They treat dangerous criminals, many
of whom are infected with serious infectious diseases
such as HIV, Hepatitis, and Tuberculosis.
In addition, DOC nurses are treating more and more
criminals with severe mental health issues as the
Commonwealth closes more State Hospitals and the
former residents end up in our prison system.33
If services are subcontracted, the vast bulk of current,
well trained staff could be lost, thanks to the lower pay,
9

poorer conditions, and fewer benefits. If a contractor
doesn’t work out, as is frequently the case, the staff
who left can’t just be re-hired as they will likely have
moved on to new jobs. A new staff would have to be
built from scratch.

questions must be provided before taking any steps to
further subcontract:
n	 Will all subcontracted healthcare staff have the
same level of security training as current DOC
nurses?

Protectors of Public Health
Most inmates that enter the state corrections system
eventually return to the community. DOC nurses help
cure inmates of infectious diseases before they are
released. If the disease is incurable, they ensure that
inmates know how to manage and prevent the spread
of their diseases before they return to their families
and communities. Without DOC nurses providing this
critical education to inmates, we would see increases
in HIV, Hepatitis and other serious diseases in our
communities.

Training
Prior to entering the corrections system, DOC nurses
undergo rigorous training at the DOC Training Academy
where they learn the full spectrum of security protocols
needed to work in a dangerous setting and to keep the
entire facility safe. In addition, DOC nurses participate
in yearly refresher courses on inmate security protocols
and self defense.

Relationship with Corrections Officers
Within a corrections facility, every inmate, including
patients, are considered potentially dangerous and
every employee is responsible for security. Nurses and
corrections officers work as a team when inmates are
in a healthcare setting. Typically, DOC nurses work
with inmate patients with a corrections officer nearby
but not guarding individual inmates. Nurses rely on
their training and experience to maintain security
while corrections officers trust that nurses can react to
potential situations and alert officers as needed.

DOC Healthcare Subcontracting—
More Questions Than Answers
Before the Commonwealth embarks on a potentially
expensive and dangerous decision to expand
subcontracted prison healthcare, legislators and the
public have a right to know about the performance
of the current subcontracted services and how the
Commonwealth expects to operate with potentially
expanded subcontracting. Answers to the following
10	

n	 Will the Commonwealth guarantee the same level
of nurse staffing if it decides to subcontract?
n	 Where does the Commonwealth expect to find
savings while providing the same level of service?
n	 How does the Commonwealth expect to provide
oversight without Commonwealth nurses?
n	 Over the past 5 years, what has been the yearly
estimate of the cost of the current healthcare
agreement and final yearly cost of the agreement,
including amendments to the agreement?
n	 Over the past 5 years, what are all the deficiencies
in PHS/Corizon-run clinics and the penalties
assigned?
n	 Over the past 5 years, how many times has
the Commonwealth found PHS/Corizon out of
compliance in its PHS/Corizon-run clinics?
n	 What are the estimated and actual savings with the
PHS/Corizon implementation of the Catalyst SM
electronic health record system?
n	 Are there any financial or performance audits
pertaining to the Agreement?
Ultimately, we believe that when the above questions
are answered, it will be clear that pursuing further
outsourcing of healthcare services in Pennsylvania’s
prison is not good for the Commonwealth or its
citizens. Further outsourcing could diminish safety
and security within state prisons, expose the public
to increased health risks, and there is no guaranteed
cost savings to the Commonwealth. We urge the
Pennsylvania legislature, the Department of Corrections
and Governor Corbett to abandon any plans to put this
core responsibility of government into the hands of any
for-profit contractor.
DEPARTMENT OF CORRECTIONS HEALTHCARE

ENDNOTES
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32	
33	

Bedard, Kelly and Frech, H.E. Prison Healthcare: Is Contracting Out healthy? September 2007.
Ibid.
Complaint in the District Court for the Eastern District of Pennsylvania. Civil Action No. 90-7497.
Private Prisons and Healthcare: The HMO from Hell. Private Corrections Working Group. 2011.
AFSCME, “Government for Sate: An Examination of the Contracting Out of State and Local Government Services,” Eighth edition.
United States Government Accountability Office, “Department of Labor, Better Cost Assessments and Department-wide Performance Tracking Are Needed to
Effectively Manage Competitive Sourcing Program.” November 2008. GAO-09-14.
International City/County Management Association. See: http://icma.org/en/results/surveying/survey_research/whats_new.
Austin, J. & Coventry, G. (2001, February). Emerging Issues on Privatized Prisons. [Monograph] Bureau of Justice Assistance, National Council on Crime and
Delinquency, NCJ 181249. Retrieved from http://www.ncjrs.gov/pdffiles1/bja/181249.pdf.
Hall, J., Walsh, K., & Walsh, M. (2010, April). Are Florida’s Private Prisons Keeping their Promise? Retrieved from Florida Center for Fiscal and Economic Policy
Web site: http://www.fcfep.org/attachments/20100409--Private%20Prisons.
Mastropolo, F. (2009, March 27) Judges accused of jailing kids for cash. ABC News 20/20. Retrieved from http://abcnews.go.com/2020/
story?id=7178686&page=4.
Van Natta, D. (1995, August 12). Despite setbacks, a boom in the private prison business. The New York Times. Retrieved from http://www.nytimes.
com/1995/08/12/nyregion/despite-setbacks-a-boom-in-private-prison-business.html.
ACLU Press Release. (2010, December 1). Recently released video of beating crystallizes need for immediate reform. Retrieved from http://www.aclu.org/
prisoners-rights/aclu-says-brutal-beating-idaho-correctional-center-another-example-rampant-violence.
Tennesseans for Improving Public Accountability. (2010, March 15). Metro’s Contract with Corrections Corporation of America to Operate the Metro-Davidson
County Detention Facility. Retrieved from http://www.tipatn.org/TIPA%20report%20on%20Metro%20CCA.pdf.
Prison Healthcare Contractor Under Scrutiny. MPBN News. January 6, 2012. http://www.mpbn.net/Home/tabid/36/ctl/ViewItem/mid/3478/ItemId/19684/
Default.aspx.
http://www.miamiherald.com/2011/07/28/2335730/jackson-health-system-reverses.html.
http://www.nytimes.com/2011/05/19/us/19prisons.html?_r=1&pagewanted=print.
Margauerite Rosenthal, Ph.D. Prescription for Disaster: Commercializing Prison Healthcare in South Carolina. April 2004.
The Council of State Governments. Corrections Healthcare Costs. 2004.
Margauerite Rosenthal, Ph.D. Prescription for Disaster: Commercializing Prison Healthcare in South Carolina. April 2004.
http://www.azcentral.com/news/articles/2012/02/10/20120210arizona-prisons-health-care-quandary.html.
Ibid.
http://www.npr.org/2011/06/08/137055836/the-root-inmate-health-care-another-kind-of-prison.
http://www.legalnews.com/detroit/732304.
http://www.doc.delaware.gov/news/10press0505.pdf.
http://citypaper.com/news/con-care-1.1085656.
http://www.mcordova.com/legalnews/?p=2590.
http://www.privateci.org/private_pics/MDOC_HCS_Report.pdf.
http://www.ire.org/resource-center/stories/23045/.
Hylton, W.S. (2003). “Correctional HMOs and the Coming Prison Plague.” Harpers Magazine. August 2003.
http://findarticles.com/p/news-articles/virginian-pilot-ledger-star-norfolk/mi_8014/is_20091215/15m-settlement-reached-inmates-2006/ai_n45104561/.
Beard, Jeffrey and Ellers, Richard. The Evolution of Contracted Healthcare Services in Pennsylvania. Corrections Today. October 2009.
Private Prisons and Healthcare: The HMO from Hell. Private Corrections Working Group. 2011.
L. Aron, R. Honberg, K. Duckworth et al. (2009) Grading the States 2009: A Report on America’s Health Care System for Adults with Serious Mental Illness,
Arlington, VA: National Alliance on Mental Illness. Pg. 133.

319 Market St., 3rd Floor
Harrisburg, PA 17101
www.clearforpa.org

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Harrisburg, PA 17102
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