JAIL'S HEALTH CENTER UNDER THE WEATHER

Lowdown On Lockups: County, Accrediting Agency At Odds On Reason For Suspension

Ailing inmates at Cook County Jail may soon find their troubles compounded.

Recent personnel changes and proposed county budget cuts at Cermak
Health Services, the medical center for the jail's 9,500 inmates,
have caused the National Commission on Correctional Health Care to
suspend the center's accreditation pending a full review in March.

Cook County officials say the accreditation was withdrawn at the
health service's request, as part of its plan to upgrade
record-keeping procedures at the South Side facility.

But critics argue that the NCCHC's action resulted from a decline in
the quality of care at the health center.

"We are now aware of some significant changes that are ongoing that
would affect the provision of health care services and compliance
with the NCCHC 2003 standards for health services in jails," said
Judith Stanley, the agency's director of accreditation.

The NCCHC placed Cermak on probationary status in June 2006 because
of "a significant number and type of compliance issues that required
corrective action."

The move for suspension is not ordinarily a part of the process and
indicates considerable cause for worry, Stanley said.

Charlie Fasano, the director of the jails and prisons program for the
John Howard Association, a nonprofit oversight agency that advocates
corrections reform, said his agency is considering the possibility of
legal action, citing a 1982 federal consent decree that governs the
treatment of mentally ill inmates at Cermak.

"This borders on criminally irresponsible," he said.

According to the county, about 10 percent of Cook County Jail inmates
have mental illnesses.

Although NCCHC accreditation is voluntary, it provides oversight for
correctional health centers that are not liable to strict regulation.
Because Cermak Health Services does not receive state or federal
regulation, its limited oversight comes only through the state
Department of Corrections, Fasano said.

"There's no easy way to find statistics on the quality of care," Fasano said.

"It has not been established conclusively that the quality has been
diminished, but there's considerable evidence that could be the case."

Steve Mayberry, Stroger's spokesman, said Cermak withdrew its
voluntary accreditation in cooperation with NCCHC.

"It made no sense to sit back and wait to be suspended," he said. "We
were in dire need of changes and withdrew voluntarily."

Ed Harrison, president of NCCHC, disagrees.

"They say they have made a decision to withdraw prior to getting a
notice from us," he said. "Unfortunately, we didn't get anything in
writing from them, so we felt obligated to put something in writing."

County officials intend to work toward reinstatement of accreditation
over the next 12 to 18 months, citing the need for time to implement
electronic record-keeping.

"Care is going to remain substantially the same or better," said
David Fagus, Cermak's chief operating officer. "Accreditation doesn't
guarantee that you're providing good service or not; our problem is
mainly documentation. On care, we have one of the best records there is."

According to Mayberry, county health chief Dr. Robert Simon is
"looking at what needs to be kept and what needs to be eradicated in
order to protect the taxpayers."

Both Mayberry and Fagus cited nonemergency dental care as an
extraneous service.

"Emergency dental care will still be available," Mayberry said.
"However, the standard that they were getting that was not mandated
by the law will not be continued."

The county's downplay is a bluff, according to Fasano.

"It's a lie. They had plenty of opportunities to choose to withdraw,"
he said. "They did not exercise those opportunities."

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Extras

Proposed Cuts

In Cook County Board President Todd Stroger's amended 2007 budget,
the Cook County Jail's medical center faces several cuts. Among the
proposals are cutting the medicine and surgery department by nearly
one-third, and halving the tuberculosis and STD
infection control team.

Also included are a 50 percent reduction of in-patient mental health
services and cutting the number of dental services employees from 15 to four.

"What we're dealing with are issues of public health. Correctional
health care, particularly jail health care, is part of the continuum
of public health," said Judith Stanley, director of accreditation for
the National Commission on Correctional Health Care. "If we can catch
tuberculosis on an inmate coming in, we're protecting not only the
jail population, but the community at large."

The NCCHC suspended accreditation for Cermak Health Services, the
medical center for the jail. In 2006, Cermak performed 100,056 intake
health screenings and had 129,474 clinic and emergency room visits.
Nearly half of Cook County inmates are released within a week of their arrival.