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EMSA should be fired

Sheriff Everett Rice should fire EMSA Correctional Care.

The company that provides medical care for Pinellas County's 2,000 jail inmates has violated the terms of its contract. It lied about controversial provisions of the contract. Worst of all, it puts financial concerns above the health and welfare of inmates.

Yet with all of this information in front of him, including the death in April of an inmate who did not receive prompt medical attention, Rice seems unconvinced. What will it take for him to realize that the county should reclaim health care services for its jail inmates? Does he need another death or some catastrophe?

Privatization in the case of jail medical care is not working. In fact, EMSA is the type of horror story that turns people away from managed health care. And it should.

Through a court order that Rice himself inexplicably fought, the Times uncovered more evidence of EMSA's priority on profits. They showed a written guarantee of $250 bonuses to EMSA's jail doctor for not sending inmates who are sick to hospital emergency rooms. Both Rice and Janice Hill, who oversees jail health care for the Sheriff's Office, said they did not know of this provision in their contract with EMSA. Rice said the company apparently tried to hide it from the county, which EMSA denied. Rice's contract with EMSA requires the company to provide copies of "all contracts" and written agreements EMSA struck for medical services at the jail, but the county had no record of the doctor's bonus agreement.

In an earlier story, Times writer David Barstow quoted nurses working at the jail as saying health care was being sacrificed to profits. They cited an EMSA directive forbidding nurses to call 911 for emergency help for an inmate unless they had approval from EMSA's jail doctor or the patient was in a life-threatening emergency.

Yet when inmate Melony Bird collapsed in her cell and an electrocardiogram indicated she may have had a heart attack, it was 13 hours before Dr. David R. Webb arrived to examine the patient. She died an hour after she was sent to a hospital. The company said her death was not caused by the delay because her heart was damaged by cocaine abuse.

A provision of EMSA's contract that Rice supported says the company must pay the first $25,000 in medical bills of patients it sends out for hospital treatment. Without that, Rice said, "they'd ship every little problem out to the hospital." Perhaps that is a smart financial leash for a company, but how can it be construed in the best interest of sick inmates?

Both Webb and EMSA denied to the Times in May that they let money dictate inmate care. In fact, they denied specifically that Webb received bonuses for keeping inmates out of the hospital.

With a financial incentive for the doctor to keep patients from hospitals plus substantial penalties when they are sent, this system of alleged care is anything but. Investigators detailed the mess in an 872-page report after Bird's death. Still, the sheriff cannot decide what to do.

Jail inmates are not lesser human beings. In fact most of them are only charged with violating the law, not yet convicted. Thus, they have a presumption of innocence. But they do not have a presumption of competent medical care in the Pinellas County Jail as long as Rice refuses to act and EMSA Correctional Care remains.