"Why do you give a shit about that piece of shit?" then-Santa Fe County Adult Detention Facility Warden Cody Graham allegedly asked a nurse in late 2002 about inmate Jimmy Villanueva.

Villanueva, 55, was serving a one-year sentence at the facility for violating his probation on an underlying drug-possession offense, when he began to have back pain. SFCADF staff diagnosed him with everything from insomnia to fractured ribs. After Villanueva's pain became so acute that he couldn't move off his bunk, the detention center had him transported to an outside radiologist, who observed an abnormality in his chest that the clinician thought could be a tumor. The radiologist referred Villanueva for further testing. When none was performed, a nurse asked Graham about the lack of follow-up. Graham responded by calling Villanueva a "piece of shit."

Months dragged on without the prescribed diagnostic testing. At one point, Villanueva told a cellmate that, if he didn't go to the hospital, he would die in jail. Finally, he was transported by ambulance to Christus St. Vincent Regional Medical Center, where an MRI found fast-spreading lung cancer. Villanueva began "urgent radiation treatment" the following day. Two weeks later, still an inpatient at the hospital, he was dead.

"Our expert said that timely intervention could have saved Jimmy's life," Mark Donatelli, the Santa Fe attorney who negotiated a hefty settlement

for Villanueva's family after his death, tells SFR. "As a result of those delays, the Villanueva family had to experience the tragedy of not only losing a loved one, but watching the incredible suffering he went through with lung cancer."

Donatelli and others draw a connection between Villanueva's case and the jail's management: At the time of his death, the detention facility was run by a private corporation. During eight years of private management, the Santa Fe County jail got into legal hot water not only for Villanueva's death, but also for several other cases of medical and behavioral health care negligence. Since the county assumed control of the facility in 2005, there have been no medical malpractice suits related to inmate care.

But declining revenues and rising costs have put the prison in a different kind of trouble. Some officials say the county can't handle the expense, and they've proposed a solution: to return the jail's medical care to private management. To Donatelli and other critics, that's a death knell for the very prisoners the system is intended to heal.

And as county officials weigh their options, one company—Colorado-based Correctional Healthcare Management—waits eagerly in the wings.

Santa Fe County Adult Detention Facility Director Annabelle Romero started her career in corrections as a compliance monitor at the Penitentiary of New Mexico, where she oversaw the implementation of changes designed to improve living standards at the facility.Credits: Wren Abbott
Santa Fe County Adult Detention Facility Director Annabelle Romero started her career in corrections as a compliance monitor at the Penitentiary of New Mexico, where she oversaw the implementation of changes designed to improve living standards at the facility.Credits: Wren Abbott

Santa Fe County Corrections Director Annabelle Romero shuffles around her office, which is adorned with photos of family and an aerial shot of the Santa Fe County Adult Detention Facility. Romero looks more the part of librarian than director of a multi-million dollar correctional facility: She is soft-spoken and wears her hair in a bun, and comes across as sincere when she describes her passion for corrections work. Romero started her career at the state penitentiary right after the 1980 riots left 33 inmates dead. She was brought in to monitor the penitentiary's compliance with the Duran consent decree—a set of care standards imposed on the jail after Dwight Duran, a former inmate, sued over poor standards of living.

For Romero, working at the penitentiary in the wake of one of the country's most notorious prison riots was instructive.

"I saw firsthand what happens when we take shortcuts," she says.

When Santa Fe County took over operation of its jail in 2005, Romero was brought in as corrections director. As a nationally recognized corrections expert, she has testified as an expert witness on standards of inmate care in civil cases nationwide.

Today, Romero is one of the main obstacles in the push to privatize inmate medical services at the Santa Fe County jail.

Though conditions at the jail have improved since Romero started there—and the county's yearly insurance premiums have decreased by about $1 million since its biggest liability adopted better standards of care—the specter of its history still looms.

Between 1998 and 2005, the facility was run by private contractor Management & Training Corp., which subcontracted with Physicians Network Association for inmate medical care.

During that time, 10 cases—including Villanueva's—cost the county and its contractors millions of dollars in settlement fees. In 2003, Santa Fe County and its private contractors paid out one of the largest civil settlements in US history to the Santa Fe family of Tyson Johnson, another man who died at the facility.

Indeed, medical negligence at SFCADF was so egregious that the facility earned the scrutiny of the US Department of Justice, which conducted multiple investigations into the jail's practices and ultimately issued an injunction to force the county to maintain basic standards of care.

Romero makes an intuitive point: that the only way to lower costs is to reduce the quality or volume of medical care.

"I actually don't believe that there's money to be saved without compromising [care]," Romero says. "I don't think I'm doing more than what I'm constitutionally required to do right now."

Inmate Tyson Johnson, 27, ended his life by attaching this piece of blanket to a sprinkler fixture at Santa Fe County Adult Detention Facility while it was being run by a private contractor.Credits: Photo Courtesy Mariel Nanasi
Inmate Tyson Johnson, 27, ended his life by attaching this piece of blanket to a sprinkler fixture at Santa Fe County Adult Detention Facility while it was being run by a private contractor.Credits: Photo Courtesy Mariel Nanasi

The jail, however, was built on a different premise.

People who have been involved in criminal justice issues in Santa Fe for years can't help but laugh when they recall the expectations originally held for SFCADF. Built directly across from the state penitentiary, about 15 miles south of Santa Fe off of windswept Highway 14, the facility was originally expected to make a profit.

In 1997, instead of settling for a facility designed to hold about 280 inmates, the average number at the existing jail, the county sprang for a 600-bed facility in order to capitalize on additional inmates.
"They were going to go make money on the backs of the misery of incarceration of Santa Fe citizens," Donatelli says. "We [were] like, 'You don't need this; it's going to be a disaster. The county shouldn't be trying to make money through putting people in cages.'"

Such protests went unheard.

"They were sold this bill of goods about how it was going to be a moneymaking enterprise," Donatelli says, "and it's been nothing but headaches ever since."

A headache is exactly how Santa Fe County Commissioner Kathy Holian characterizes the jail problem today, calling the idea of its being profitable "a big joke."

"I'd have to ask some of the commissioners who were on the commission at that time: 'What were you thinking?'" Holian says.

History has borne out Donatelli's argument. Even though its population is augmented by inmates from around the state, along with federal prisoners being held for the US Marshals Service, the jail currently operates at about three-quarters capacity. To add to what Donatelli calls the "albatross" that is the county's predicament with the facility, the bond used to build it is a high-interest, 30-year bond that can't be refinanced at a lower rate. More than half of the annual gross receipts tax the county raises specifically for the county corrections department goes to pay back $2.3 million of that debt per year.

Last year, the jail's medical services budget came to $2.9 million, and its total operations constitute the county's single biggest budget item. The need to reduce that cost is a point belabored by county staff at every opportunity—including at a May community health meeting intended to address issues of patient care and labor disputes at Christus St. Vincent Regional Medical Center.

At a Feb. 1 special session of the Board of County Commissioners, Santa Fe County Commissioner Robert Anaya lamented that the SFCADF "is killing us, to put it bluntly."

Part of the problem, Romero says, is competition from other jurisdictions that also moved to capitalize on growing inmate populations by turning incarceration into a money-making enterprise.

In 2008, the construction of the Northeast New Mexico Detention Facility in Clayton—a privately-operated prison overseen by the state Department of Corrections—started a domino effect that led to dramatic underuse of Santa Fe's jail.

First, the New Mexico Department of Corrections terminated a contract it had with the Santa Fe Facility to house approximately 140 inmates, shifting them to Clayton's 625-bed facility. Next, the state Children, Youth and Families Department, which had contracted with the Santa Fe facility to house juvenile offenders, moved many juveniles to an Albuquerque facility. In Santa Fe, revenues dipped accordingly: While the jail brought in more than $9 million by housing inmates for other jurisdictions in fiscal year 2006, last year it made just $3.7 million.

County officials have considered trying to reverse that trend by bringing more inmates into the jail. Romero says that, to increase revenue by $1 million, she needs to bring in about 40 inmates—but that shifts other pieces of the puzzle, too, because she would have to increase staff accordingly. Right now, SFCADF has a staggering 82 frozen positions. In order to keep expenses down, Romero is forbidden to fill them. But there's another problem: In Romero's view, there just aren't that many inmates to be had.

"I'm probably going to be able to bring in a few more from the US Marshals, and hopefully maybe from Bernalillo, but the idea that there's a lot of adult inmates that we could bring in, it's just not there," she says. "When Clayton was built, those numbers went away. I can't bring them back."

As corrections revenues—and opportunities for increasing them—continue to dwindle, other entities' fiscal problems are also affecting SFCADF. Christus St. Vincent Regional Medical Center stopped paying about $280,000 to SFCADF for indigent inmates' medical care this year after Santa Fe County decreased the hospital's funding.

State budget woes affect the jail, too. Each year, the state pays SFCADF to house probation and parole offenders who are picked up on violations. In 2009, the state paid SFCADF $298,430 for housing those offenders; last fiscal year, it paid just $148,654, which is less than what it costs the facility to house them.

New Mexico Corrections Department spokesman Shannon McReynolds tells SFR that the formula for determining reimbursement for probationer housing costs is set by the state Sentencing Commission; commission Chairman Tony Ortiz did not return a call for comment before press time.

It's also unclear whether SFCADF's rates for housing inmates are too steep for neighboring counties, which have fiscal challenges of their own. While SFCADF charges approximately $80 per inmate per day, San Juan County Adult Detention Center charges just $63. Various jurisdictions allegedly owe the county a combined total of about $2 million, which it has struggled to collect due to contract complications.

Escalating costs of prison health care aren't exclusive to Santa Fe County or to New Mexico. The federal Department of Justice notes in its report to Congress on the FY 2012 federal prison budget that inmate medical costs in its facilities increased from approximately $310 million in 2004 to almost $500 million in 2010.

But Santa Fe County—at least in some areas—incurs higher costs than other facilities.

For example, providing medical care currently costs SFCADF an average of $18.90 per inmate per day, but San Juan County Adult Detention Center spends between $10 and $13, according to its director, Tom Havel.

Staffing is the most expensive component of providing inmates' medical care, and SFCADF's staffing levels currently exceed standards set for the facility by the US Department of Justice in 2004. In Santa Fe, three part-time psychiatrists provide a total of more than 56 hours per week of coverage; the DOJ requires only 12 hours per week. San Juan doesn't have an on-site psychiatrist, but offers nine hours per week of coverage by a psychologist.

The county estimates that SFCADF could reduce expenses by about $500,000 annually by reducing medical staff to DOJ minimums, but that only accounts for one-quarter of the total it is hoping to slash from the jail's budget.

Repayment of the high-interest, 30-year bond the county used to build its Adult Detention Facility costs taxpayers $2.3 million annually.Credits: File Photo
Repayment of the high-interest, 30-year bond the county used to build its Adult Detention Facility costs taxpayers $2.3 million annually.Credits: File Photo

Correctional Healthcare Management, the Colorado-based company courting Santa Fe County for control of its inmate medical care, claims it can solve these problems by dramatically reducing costs.

CHM already has contracts with San Juan and Bernalillo counties, and Todd Murphy, CHM's director of business development for New Mexico, says a deal with Taos County is also close to fruition.

CHM's pitch to Santa Fe County is threefold, Murphy explains: Reduce the number of prisoners transported to other facilities for medical care, control pharmaceutical costs and eliminate "surprises" by charging the county a flat fee.

Murphy says that, because CHM's contract would assume all liability for prisoner claims, it could be more conservative than the county in choosing whether to transport patients. CHM reduced transports in Wichita County, Texas, by 46 percent after taking over that county's inmate medical care, Murphy notes. (Santa Fe County has not provided data on its transport numbers.)

Murphy says CHM also reduces pharmaceutical costs by buying in bulk, as it provides medical services and drugs for 80,000 inmates around the country. According to a recommendation letter from Wichita County Jail Administrator Donny Johns, CHM also brought Wichita County approximately $200,000 in savings on pharmaceutical costs. According to Santa Fe County Finance Director Teresa Martinez, that's roughly equivalent to the total amount the Santa Fe facility spends on pharmaceuticals in a year. (Havel, however, says San Juan opted out of the pharmaceutical component of its contract with CHM out of concern that it would restrict medication choice. San Juan County spends about $140,000 annually on medication.)

Murphy adds that, under a CHM contract, there would be "no surprises" for the county because it would pay a fee up front. Most contracts for jail medical services are designed that way, so that the company receives a lump sum from which it carves out a profit by reducing inmates' care as much as possible. That incentive to reduce care is at the center of the problems that tend to recur under private medical contracts. In Villanueva's case, the reluctance to transport him for the specialty care he needed ultimately cost him his life.

"It's a frequent problem with private providers of medical care because they have to pay dollar for dollar out of their pocket for the off-site exams," Donatelli says. "If you were on the street and someone said there was a questionable mass in your chest X-ray, you'd be in tomorrow getting an expert to take a look at it. That didn't happen in Jimmy's case."

CHM is dealing with those same problems. In a pending lawsuit filed against the company late last year, a former inmate at San Juan County Adult Detention Center claims that her transport was delayed for three days after her appendix burst. The woman, who was incarcerated on misdemeanor charges, alleges in the complaint that jail staff ignored her requests for help and provided only the antacid Maalox as a remedy.

It's the very idea that a private company can somehow save the county money on inmate medical costs while still earning a profit for its shareholders that alarms critics. The only way to reduce costs that dramatically, some say, is to lower the standard of care.

"How do you provide adequate medical care and reduce the cost?" Santa Fe lawyer Bob Rothstein asks. "It doesn't work that way…The more they try and cut their costs, they'll find that more inmates suffer."

Susan Cave, a psychiatrist who works with the 1st Judicial District Court and frequently visits both the Santa Fe County-run jail and the CHM-run Bernalillo facility, says the Santa Fe facility offers higher-quality health care. In Bernalillo, Cave says, a lack of communication about inmate health conditions persists among medical staff. Cave has had to resort to asking corrections officers to relay critical health information because doctors don't respond to calls and faxes. At SFCADF, she has direct communication with staff doctors.

"I actually saw people recover from their mental illness in [SFCADF], which is almost unheard of," she says.

Romero isn't averse to using a private contract for certain parts of her operation; for instance, a private company provides the facility's food service. But with medical care, she is afraid that, if she relinquishes control and allows the hand-picked group of medical personnel she put together over the years to dissolve, the quality of care will erode, returning the facility to the poor health standards of the past.

"Medical care is different," Romero says. "There's just so much risk associated with that, that's not where I prefer to save money."

American Civil Liberties Union National Prison Project Director David Fathi agrees with Romero that jail medical care is fundamentally different from nonmedical services because there is no element of consumer choice. Without competition, Fathi notes, there are limits to how effectively oversight agencies can ensure a decent standard of care.

"The general rules of market discipline—the idea that, if a business provides bad service, or certainly if it injures or kills people, it will go out of business—those rules don't really work with private prisons or private prison medical care," Fathi says. "One obvious reason is they have no consumer choice. If a prisoner doesn't like the medical care at this prison, thinks it's dangerous or inadequate, he can't go down the road to a different prison where it's better."

During one of CHM's numerous meetings with county staff, the company gave Romero a "survey" to fill out about the needs of SFCADF. She has yet to do anything with it, despite facing questioning at subsequent Board of County Commissioners meetings. But the pressure from county officials continues to build. At the BCC's Feb. 1 special session, Santa Fe County Manager Katherine Miller reported that the county managers in Bernalillo and San Juan "said they were pleased with their contracts and that it was saving them money."

Still, Romero says that when county finance department employees make cursory calls to other counties to find out their jail medical expenses, they end up with distorted views. She needs to visit each facility to see what services it's getting for its buck—and she plans to do that in the upcoming weeks as part of her report back to the county. Romero says she finds the idea of contracting out the medical services distasteful, but she is researching the option just so she has all the information to effectively fire back.

There's no hard deadline for Romero to report back to the county, but she told the BCC she would visit comparably sized facilities sometime over the next month. Meanwhile, the Santa Fe facility is operating on reduced staff who she says can't sustain any more cuts; Romero herself was forced to drive prisoners to another facility recently because of the staff shortage. But she would rather do that than risk turning the facility's medical care back into the private-contract hell she helped reclaim it from in the past.

“The thing with correctional facilities is, it could look like we save a dollar today, but it’ll cost you,” Romero says. “It’ll cost you eventually.”  SFR