[House Hearing, 106 Congress]
[From the U.S. Government Publishing Office]
BEYOND COMMUNITY STANDARDS AND A CONSTITUTIONAL LEVEL OF CARE? A REVIEW
OF SERVICES, COSTS, AND STAFFING LEVELS AT THE CORRECTIONS MEDICAL
RECEIVER FOR THE DISTRICT OF COLUMBIA JAIL
=======================================================================
HEARING
before the
SUBCOMMITTEE ON THE DISTRICT OF COLUMBIA
of the
COMMITTEE ON
GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTH CONGRESS
SECOND SESSION
__________
JUNE 30, 2000
__________
Serial No. 106-229
__________
Printed for the use of the Committee on Government Reform
Available via the World Wide Web: http://www.gpo.gov/congress/house
http://www.house.gov/reform
----------
U.S. GOVERNMENT PRINTING OFFICE
72-581 WASHINGTON : 2001
_______________________________________________________________________
For sale by the Superintendent of Documents, U.S. Government Printing
Office
Internet: bookstore.gpo.gov Phone: (202) 512-1800 Fax: (202) 512-2250
Mail: Stop SSOP, Washington, DC 20402-0001
COMMITTEE ON GOVERNMENT REFORM
DAN BURTON, Indiana, Chairman
BENJAMIN A. GILMAN, New York HENRY A. WAXMAN, California
CONSTANCE A. MORELLA, Maryland TOM LANTOS, California
CHRISTOPHER SHAYS, Connecticut ROBERT E. WISE, Jr., West Virginia
ILEANA ROS-LEHTINEN, Florida MAJOR R. OWENS, New York
JOHN M. McHUGH, New York EDOLPHUS TOWNS, New York
STEPHEN HORN, California PAUL E. KANJORSKI, Pennsylvania
JOHN L. MICA, Florida PATSY T. MINK, Hawaii
THOMAS M. DAVIS, Virginia CAROLYN B. MALONEY, New York
DAVID M. McINTOSH, Indiana ELEANOR HOLMES NORTON, Washington,
MARK E. SOUDER, Indiana DC
JOE SCARBOROUGH, Florida CHAKA FATTAH, Pennsylvania
STEVEN C. LaTOURETTE, Ohio ELIJAH E. CUMMINGS, Maryland
MARSHALL ``MARK'' SANFORD, South DENNIS J. KUCINICH, Ohio
Carolina ROD R. BLAGOJEVICH, Illinois
BOB BARR, Georgia DANNY K. DAVIS, Illinois
DAN MILLER, Florida JOHN F. TIERNEY, Massachusetts
ASA HUTCHINSON, Arkansas JIM TURNER, Texas
LEE TERRY, Nebraska THOMAS H. ALLEN, Maine
JUDY BIGGERT, Illinois HAROLD E. FORD, Jr., Tennessee
GREG WALDEN, Oregon JANICE D. SCHAKOWSKY, Illinois
DOUG OSE, California ------
PAUL RYAN, Wisconsin BERNARD SANDERS, Vermont
HELEN CHENOWETH-HAGE, Idaho (Independent)
DAVID VITTER, Louisiana
Kevin Binger, Staff Director
Daniel R. Moll, Deputy Staff Director
David A. Kass, Deputy Counsel and Parliamentarian
Robert A. Briggs, Clerk
Phil Schiliro, Minority Staff Director
------
Subcommittee on the District of Columbia
THOMAS M. DAVIS, Virginia, Chairman
CONSTANCE A. MORELLA, Maryland ELEANOR HOLMES NORTON, Washington,
STEPHEN HORN, California DC
JOE SCARBOROUGH, Florida CAROLYN B. MALONEY, New York
EDOLPHUS TOWNS, New York
Ex Officio
DAN BURTON, Indiana HENRY A. WAXMAN, California
Melissa Wojciak, Staff Director
Howie Denis, Professional Staff Member
Victoria Proctor, Professional Staff Member
Jenny Mayer, Clerk
Jon Bouker, Minority Counsel
C O N T E N T S
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Page
Hearing held on Juen 30, 2000.................................... 1
Statement of:
Ekstrand, Laurie, Director of Administration of Justice
Issues, General Government Division, U.S. General
Accounting Office; Ronald Shansky, M.D., corrections
medical receiver; Karen Schneider, special officer for the
U.S. District Court for the District of Columbia; Erik
Christian, deputy mayor for public health and justice; and
John Clark, District of Columbia Corrections trustee,
accompanied by Odie Washington, director, District of
Columbia Department of Corrections......................... 20
Letters, statements, etc., submitted for the record by:
Christian, Erik, deputy mayor for public health and justice,
prepared statement of...................................... 120
Clark, John, District of Columbia Corrections trustee,
prepared statement of...................................... 128
Davis, Hon. Thomas M., a Representative in Congress from the
State of Virginia, prepared statement of................... 4
Ekstrand, Laurie, Director of Administration of Justice
Issues, General Government Division, U.S. General
Accounting Office, prepared statement of................... 23
Morella, Hon. Constance A., a Representative in Congress from
the State of Maryland, prepared statement of............... 15
Norton, Hon. Eleanor Holmes, a Delegate in Congress from the
District of Columbia, prepared statement of................ 11
Schneider, Karen, special officer for the U.S. District Court
for the District of Columbia, prepared statement of........ 45
Shansky, Ronald, M.D., corrections medical receiver, prepared
statement of............................................... 35
BEYOND COMMUNITY STANDARDS AND A CONSTITUTIONAL LEVEL OF CARE? A REVIEW
OF SERVICES, COSTS, AND STAFFING LEVELS AT THE CORRECTIONS MEDICAL
RECEIVER FOR THE DISTRICT OF COLUMBIA JAIL
----------
FRIDAY, JUNE 30, 2000
House of Representatives,
Subcommittee on the District of Columbia,
Committee on Government Reform,
Washington, DC.
The subcommittee met, pursuant to notice, at 10:05 a.m., in
room 2154, Rayburn House Office Building, Hon. Thomas M. Davis
III (chairman of the subcommittee) presiding.
Present: Representatives Davis, Morella, Horn, and Norton.
Staff present: Melissa Wojciak, staff director; Howie Denis
and Victoria Procter, professional staff members; David Marin,
communications director/counsel; Jenny Mayer, clerk; Jon
Bouker, minority counsel; and Jean Gosa, minority assistant
clerk.
Mr. Davis. Good morning and welcome.
Today's hearing is the second in a series of oversight
hearings examining the status of the D.C. agencies overseen by
the court-appointed receivers. Currently, there are three
agencies that are still in receivership, the Commission on
Mental Health Services, the Corrections Medical Receiver for
the District of Columbia Jail, and the Child and Family
Services. Concerns about the delivery of services and
managerial and financial practices in these agencies persists.
The fourth agency in receivership is the District of Columbia
Housing Authority, which has successfully recovered from
mismanagement and is ready to be returned to the D.C.
government's administration.
Today the subcommittee is focused on the corrections
medical receiver in the D.C. jail. The receiver was appointed 5
years ago by the U.S. district court in order to address
Constitutional violations in the delivery of health care at the
jail. It is scheduled to end in September 2000.
The subcommittee wants to examine the status of D.C.'s
progress in meeting its court-ordered obligations so the jail
may be returned to the city's jurisdiction.
Rampant problems in the D.C. jail were enumerated in two
class action lawsuits filed in the city in the early 1970's, in
Campbell v. McGruder and Inmates of D.C. Jail v. Jackson were
filed on behalf of pretrial detainees and sentenced inmates.
The plaintiffs' charged that the conditions and treatment
of inmates in jail were unconstitutional. The two suits were
consolidated and senior U.S. Judge William B. Bryant presided
over them for nearly 30 years.
The time line highlights key court actions and events
concerning the D.C. jail. Through the years, Judge Bryant has
issued orders requiring the D.C. government to rectify problems
with the jail's medical services. Despite assurances from the
city that the necessary changes would be implemented, nothing
materialized. Instead, the D.C. jail left the medical services
program to languish at below-Constitutional levels.
In April 1993, finding the D.C. government in persistent
noncompliance with his orders, Judge Bryant appointed a special
officer to monitor and report on the city's progress on meeting
its court-ordered obligations. The city, however, continued to
ignore the orders and the deficiencies in the jail's medical
services delivery persisted.
The jail's suicide rate was out of control. In addition,
the jail lacked an effective program to prevent the spread of
infectious tuberculosis.
On January 5, 1995, the court ordered the implementation of
the initial remedial plan. It was designed by the special
officer after extensive consultation with the plaintiffs and
the defendants and the special officer's own medical and mental
health experts. The plan addressed the most immediate and
egregious problems with the delivery of medical services at the
jail. It also provided the framework for major long-term
changes to policies and procedures, staffing, and
organizational structure. The initial remedial plan was never
implemented. In fact, on June 5, 1995, 5 months to the day
after the District was ordered to implement the remedial plan,
inmate Richard C. Johnson died. Mr. Johnson was an aged patient
in the jail's infirmary who had been neglected for several days
by the medical staff. His death highlighted the city's failure
to address the severe deficiencies in the delivery of medical
services at the jail.
Citing the physical danger that the D.C. government's
continued blatant violation of the court's previous order was
tragically causing, Judge Bryant placed the jail's medical and
mental health services under court-supervised receivership. The
receiver was ordered to implement the initial remedial plan.
The D.C. jail medical services have improved significantly
under the receiver, Dr. Ronald Shansky. Dr. Shansky's tenure
has brought the jail remedial changes to increase the level of
medical and mental health services to a Constitutionally
acceptable level.
In addition, the D.C. jail's tuberculosis epidemic has been
controlled, HIV/AIDS cases are identified and treated, and
qualified medical staff have been hired to improve the delivery
of care.
The receiver has successfully implemented a suicide
prevention program to identify potentially suicidal inmates and
provide them with the necessary prevention treatment.
Despite these improvements in the delivery of health care,
it is disturbing that the receiver is leaving the D.C. jail
with exorbitant medical costs per inmate and high staffing
levels. In both cases, the figures far exceed the national
average.
The court order creating the receivership essentially gives
the receiver carte blanche to spend the District's money
freely, without regard to sound financial practices and
accountability to the D.C. government. Of course, it is
important to provide a Constitutional level of medical and
mental health services to D.C. jail inmates, but should the
D.C. jail receivership accomplish this by spending at least two
to three times the national average per inmate per day? Can a
city emerging from bankruptcy really sustain this kind of
expenditure?
In addition, the receiver issued a request for proposal for
a 1-year contract to manage the medical services at the jail
once the receivership ends in September 2000. The contract was
awarded to individuals who were employed by the receiver at the
time the proposal was submitted, raising the specter of
impropriety in the receiver's procurement process. The benefit
of the RFP is questionable, since it requests bids that would
maintain the same services at the jail and therefore the same
cost, thereby perpetuating the already high costs that were
expended under the receivership.
D.C. government can't afford these inflated costs and D.C.
taxpayers shouldn't be forced to foot the bill if there are
other cost-effective alternatives.
Today we will be looking at what reforms, if any, still
need to be enacted to comply with the judge's order.
Additionally, the hearing will focus on what resources are
needed to maintain the reforms which have already been
instituted and to enact any additional reforms required for
compliance with the court order so that the jail may return to
the city's jurisdiction.
We will hear from GAO. We will hear from Dr. Shansky; the
receiver, John Clark; the corrections trustee; Erik Christian,
the deputy mayor for public safety and justice. Karen
Schneider, the special officer appointed by the U.S. district
court, who refused to testify, requiring this subcommittee to
issue its first ever subpoena mandating her appearance.
I would now yield to Delegate Norton for any opening
statement she wishes to make, and then we will move right on to
the witnesses.
[The prepared statement of Hon. Thomas M. Davis follows:]
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Ms. Norton. Thank you, Mr. Chairman. I very much appreciate
your initiative in calling this hearing and the way in which
you have worked with me on this matter, in particular.
Over a period of many years, the District of Columbia lost
control over four agencies, but only after the courts had seen
their orders violated for years. Judicial patience had
justifiably run out. Medical services at the D.C. jail before
us today were replete with violations and with inhumane
conditions. Respect for even minimal levels of Constitutional
rights compelled the action Judge William B. Bryant, a
distinguished judge of the U.S. district court here, took to
relieve the District of control of the medical function at the
jail in 1995.
Chairman Tom Davis and I, and the subcommittee, began our
oversight of receiverships only in the wake of a precipitating
event in one of the receiverships for which none of the actors,
including the receiver, had any explanation or took
responsibility, the death of an infant, Brianna Blackmond,
committed to the care of the Child and Family Services Agency,
under a receivership of the U.S. district court.
Shortly after the infant died, Chairman Davis asked me to
join him in requesting GAO investigations of all the
outstanding receiverships in order to assure that
accountability problems had not developed in the absence of
regular public oversight to which city agencies in the District
are subjected today.
The Chair then commenced this series of hearings on the
three receiverships that are still active, all of which have
been subject to serious criticisms. Our own preliminary
investigation has not been reassuring. We could not find
evidence of significant use by our receivers of best practices
of the kind required of District and Federal agencies, such as
management and fiscal audits; procurement practices that foster
fair and open competition; cost controls that reflect generally
acceptable national or regional standards; or even Anti-
deficiency Act requirements universally applicable to
government agencies to prevent overspending of funds that are
not authorized and available.
With the chairman, I then introduced H.R. 3995, the
District of Columbia Receivership Accountability Act. The House
passed H.R. 3995 unanimously, and the bill will be marked up by
the Senate Governmental Affairs committee shortly.
Even before the GAO reports were in, it is clear that, at a
minimum, receivers, their court monitors, and special officers
who stand in the shoes of agency heads and their supervisors
must operate at least at the standards required of those who
have been ousted from control of the agencies involved. The
agencies were removed from District control to achieve
improvements and higher levels of accountability, beginning
with the receivers and their supervisors, who, by definition,
are setting the example for the District as to how the agencies
are to be run in the future.
All of the receivership agencies originally had severe
operational and service problems, but the concerns that remain
differ. The jail medical receivership now before us has shown
sufficient operational improvements to be scheduled to expire
in August 2000, at the end of 5 years, pursuant to the court
order establishing the receivership. However, the cost
associated with these improvements would be astonishing to
taxpayers and to any public official charged with
responsibility for taxpayer funds.
The GAO investigation Chairman Davis and I have requested
is ongoing and unfinished, but three outside experts who looked
at the results have raised serious questions concerning cost
and procurement practices.
First, and most recently, the D.C. Board of Contract
Appeals found that challengers to the receivers' RFP had not
met the heavy burden necessary to divest the contract under
D.C. law, even though the receivers' own employees, while still
employed by the receiver, had been awarded the contract to
provide future services.
What was significant was the unusually strong language of
the board, which wrote, ``While the receiver asserts that he
took steps that no offer was unfairly advantaged or
disadvantaged, and, in particular, the procurement was designed
to encourage outside companies, as well as employee-formed
groups to participate, such actions are not apparent.''
Second, the corrections trustee, a former assistant
director for community corrections of the U.S. Bureau of
Prisons, the largest in the country, has been charged by this
subcommittee with assisting the entire corrections system with
systemic management and financial reforms prior to the
expiration of his tenure.
In meetings with the receiver and the special officer, the
corrections trustee repeatedly objected to the costs of the
receivership and the RFP but was successful only in getting the
cost lowered from $16 million to $12.5 million, a cost nearly
three times the national average for medical services at jails
in this country.
Third, Faiver, Campau and Associates, reputable experts in
the area of corrections health care, were commissioned by the
corrections trustee to analyze the potential cost resulting
from the RFP and winning bid. These experts found that the RFP
issued by the receiver ``incorporates an administrative
structure akin to that often found in a fairly large State
corrections system rather than in a moderately sized jail.''
These experts concluded that ``Nowhere in the country are
we aware of a facility of comparable size that has such a top
echelon of staff who are not significantly involved in direct
patient care.''
Confronted with cost figures so substantially above those
found nationally and in similarly situated regional
jurisdictions, and with sharply critical evaluations by outside
experts, an explanation is necessary. This hearing is being
held to give the receiver and the special officer the
opportunity to respond and other witnesses the opportunity to
elaborate and be questioned. Thus far, the only response
regarding these costs we are aware of from the receivership are
a letter from the special officer sent after I wrote to her
about our concern, followed by a visit by the special officers
receiver, and District correctional officials to my office for
a meeting.
In her letter, the special officer justifiably and
appropriately warns of the difficulty of doing cost
comparisons, but even so concedes that, using the available
data, the costs of the contract issued by the receiver is
almost twice the national average cited in the applicable
surveys.
She then cites the high administrative service cost which
she asserts would not be found in the budgets of other
jurisdictions. She also cites modifications that would reduce
these costs to $12.92 per inmate per day, although that amount
is still nearly twice the national average.
I am in full agreement concerning all the problems
associated with analyzing the data involved; however, today
local governments and especially the District of Columbia,
fresh from insolvency, no longer authorize the expenditure of
taxpayer funds without even an attempt to justify costs in
comparison to others with similar responsibilities.
In the District, health care, in particular, requires our
best effort at such attempts because more than 60,000 D.C.
residents have no health insurance. Their health care continues
to impose an enormous price on them, personally, on the health
care indicators of residents, and on the D.C. government. A
D.C. resident should not have to go to jail to get adequate
health care and jail should not afford health care that far
exceeds what is available to the average resident with and
without insurance.
The District government, which stands to inherit the costs
of the jail medical receivership, has the task of meeting both
Constitutional standards for the health care of people charged
with crime and the health needs of ordinary citizens, most of
whom are from families who work every day but must look to the
District to design a way for them to meet basic health care
needs.
Ultimately, the District must take its responsibilities for
both these sets of its residents more seriously than the city
has in the past.
I look forward to hearing today's witnesses and to
approaching the issues before us as problems that can be solved
with sufficient satisfaction to all concerned.
Thank you, Mr. Chairman.
Mr. Davis. Thank you very much.
[The prepared statement of Hon. Eleanor Holmes Norton
follows:]
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Mr. Davis. Thank you very much.
We have been joined by the vice chairman of this committee,
Mrs. Morella, who will make a brief statement, as well.
Mrs. Morella. Thank you, Chairman Davis. I appreciate
Ranking Member Norton for calling this very important hearing
today to examine the status of the receivership of the District
of Columbia's jail's medical and mental health services. I am
hopeful that this examination will help to enlighten us about
how best to deliver this service out of receivership and return
it to the control of the D.C. government.
Since Dr. Ronald Shansky was appointed the corrections
medical receiver for the D.C. jail 5 years ago, much of the
crisis has been averted. I am encouraged that many of the
problems that were faced by the receiver have been successfully
addressed. When the receivership ends in September, the goal
will have been met for attaining for the inmates a
Constitutional level of health care. Recognition and treatment
of depressed and unstable inmates has turned around a dismal
situation in the rates of suicide in the jail, the tuberculosis
epidemic has been brought under control, and HIV and AIDS cases
are identified and treated.
Dr. Shansky has brought in qualified medical staff and the
level of care provided to the inmates has been greatly
improved. I am obviously very concerned, though, that the
solution to the dire issues that face the jail can be sustained
by the District. Are there alternative staffing solutions and
resources that can be applied to this situation to sustain the
improvements that have been made under the receiver's care?
This level of care has been accomplished with medical costs
and staffing levels that far exceed the national average. The
receiver has not been held to sound financial practices and has
not been accountable to the District government for its budget.
I am further concerned that the request for proposal, the
RFP, for a 1-year contract to manage the medical services at
the jail once the receiver ends in September 2000, has resulted
in a contract being awarded that maintains the staffing levels
and medical costs endured under the receivership. If there is a
more cost-effective solution, then that needs to be further
explored.
And so I hope this hearing today addresses these concerns
and that, from what we learn, a suitable long-term solution may
be received.
Though the manner of care has improved over the past 5
years in the D.C. jail, it is imperative that the jail be able
to sustain a Constitutional level of services to the inmate.
I thank you, Mr. Chairman, and yield back.
Mr. Davis. Thank you very much.
[The prepared statement of Hon. Constance A. Morella
follows:]
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Mr. Davis. I want to call now our panel of witnesses and
supporting witnesses to testify: Ms. Laurie Ekstrand, the
Director of Administration of Justice Issues of the U.S.
General Accounting Office; Ronald Shansky, M.D., the receiver;
Ms. Karen Schneider, the Special Officer for the U.S. District
Court for the District of Columbia; Erik Christian, the deputy
mayor for public safety and justice; and Mr. Odie Washington,
director, District of Columbia Department of Corrections as a
supporting witness; and, of course, John Clark, District of
Columbia Corrections trustee.
As you know, it is the policy of our committee that all
witnesses and supporting witnesses be sworn before they can
testify, so if you would rise and raise your right hands.
[Witnesses sworn.]
Mr. Davis. Thank you very much.
To afford sufficient time for questions, if you'd try to
limit yourself, we've read the testimony that has been
submitted. We were here until 3 a.m., so we didn't have
anything else to do. It doesn't always get read, but in this
case it did.
All written statements are going to be made part of the
permanent record, so if you would try to dwell on the
highlights that will give us time for questions and we can get
you out of here earlier, as well.
I'll begin starting with Ms. Ekstrand and then move to Dr.
Shansky, Ms. Schneider, Mr. Christian, and then Mr. Clark.
STATEMENTS OF LAURIE EKSTRAND, DIRECTOR OF ADMINISTRATION OF
JUSTICE ISSUES, GENERAL GOVERNMENT DIVISION, U.S. GENERAL
ACCOUNTING OFFICE; RONALD SHANSKY, M.D., CORRECTIONS MEDICAL
RECEIVER; KAREN SCHNEIDER, SPECIAL OFFICER FOR THE U.S.
DISTRICT COURT FOR THE DISTRICT OF COLUMBIA; ERIK CHRISTIAN,
DEPUTY MAYOR FOR PUBLIC HEALTH AND JUSTICE; AND JOHN CLARK,
DISTRICT OF COLUMBIA CORRECTIONS TRUSTEE, ACCOMPANIED BY ODIE
WASHINGTON, DIRECTOR, DISTRICT OF COLUMBIA DEPARTMENT OF
CORRECTIONS
Ms. Ekstrand. Thank you, Mr. Chairman.
I am very pleased to be here today to discuss several
issues concerning the District of Columbia receivership
contract for medical and mental health services at the D.C.
jail. Without further ado, let me get right to the four issues
that we were asked to review.
The first one is cost. Our comparison of budget data for
medical services at the D.C. jail and comparable facilities in
Baltimore City and Prince George's County indicated that D.C.
jail's per capita costs are higher. Indeed, the officials to
whom we spoke during our review agreed that D.C. jail provided
certain medical services and had staffing levels that exceed
those of other facilities. Of course, this drives cost.
In relationship to staffing, the inmate-to-staff ratios, as
reported by the Office of the Corrections Trustee, is 13-to-1
at the D.C. jail, 74-to-1 in Baltimore, and 48-to-1 in Prince
George's County.
The fact that the D.C. jail provides fully staffed pharmacy
and both mental and dental services onsite, whereas Baltimore
and Prince George's County do not, provides some context for
understanding some of the differences in the inmate-to-staff
ratios.
Most of the officials to whom we spoke cited the court-
ordered remedial plan as the primary reason why the D.C. jail
provides enhanced medical services and has higher staffing
levels than other jurisdictions. The trustee, however--and I'm
sure he will address this himself--feels that adequate medical
services could be provided with fewer staff and at lower cost.
The next issue you asked us to review concerned acceptable
levels of care for jail inmates. We found that there is no
single threshold that determines what an acceptable level of
medical services is at the jail. According to experts, this is
the case because the acceptable level is related to the medical
circumstances and situations that need to be addressed. It can
also be a function of specific constraints such as court orders
placed on a specific jail facility.
Accreditation standards have been developed by several
organizations, including the National Commission on
Correctional Health Care. These standards define minimum
recommended medical service requirements for jail to
voluntarily obtain accreditation. When a facility seeks
accreditation, experts review a broad range of factors related
to the health of inmates and facility-related issues to make a
decision concerning accreditation based on the application of
standards to the specific jail setting. The standards then
cannot be used as a simple check list to assess whether a
facility provides an acceptable level of medical care.
You also asked us to look at the effects of the contracting
process on medical service costs. As you know, the current
contract maintains the level of medical services and staffing
at the levels already in place at the D.C. jail, but the
current contract can be modified at any time. In addition, it
can be re-competed at its current or scaled-back levels of
service and staffing when the base year ends in March 2001.
The solicitation that resulted in the current contract
requested that offerors submit proposals that would maintain
existing levels of service and staffing. These were referred to
as comparison proposals.
According to officials we spoke to, the District sought to
maintain existing levels of service to ensure that the
receivership is successfully terminated in August 2000, and
control of the jail is returned to the District. The
solicitation also encouraged offerors to submit alternative
proposals for providing health services differently or more
economically than they were currently provided.
The Evaluation Committee rated all of the proposals and
determined that none of the alternate proposals provided
specific enough information to ensure that they would maintain
the same level of medical services as would the comparison
proposals; thus, the final recommendation of the committee was
to endorse a comparison proposal. The committee's
recommendation was sent to the receiver, who selected the
contractor.
Finally, let me turn to the issue of whether the failure of
the receiver's employees to resign from their positions prior
to being awarded the contract violates D.C. law or regulations.
Under District personnel regulations, a District employee
may make an offer on a contract, but generally cannot be
awarded the contract while still in D.C. employment status. The
firm that was awarded the contract to provide medical services
at the D.C. jail was constituted of employees working for the
receiver, not for the District government, thus they were not
subject to these provisions of District law.
We would note that the D.C. Contract Appeals Board ruled in
May 2000, on a protest by a losing offeror to this procurement.
The protestor asserted that the receiver showed bias in favor
of the awardee, which was a company formed by the incumbent
medical director. The issue of employees' failure to resign
prior to the award was not raised in this protest. The Board
denied the protest, finding that there was not proof of bias
sufficient to challenge the award; however, the Board noted
that certain of the receiver's actions gave an appearance not
conducive to confidence in the fairness of the procurement.
This concludes my oral statement, and I would be glad to
answer any questions you may have.
[The prepared statement of Ms. Ekstrand follows:]
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Mr. Davis. Dr. Shansky.
Dr. Shansky. I, too, would like to indicate I appreciate
the opportunity to appear before you, and I will try to be
brief. I have submitted my written statement to you, as you
indicated.
At the time the receivership was created, I was contacted,
and only after several phone calls reluctantly agreed to accept
the responsibility. One of the reasons I agreed was that the
District wanted me to assume that responsibility.
When I took over in September 1995, the jail was a very
chaotic place. In fact, it was in some ways very frightening,
not just to me but to the medical staff and to the officer
staff, especially, and to the inmates. Numerous officers came
to me indicating that they were concerned that if they got
injured or something happened there would be no response.
As a result of my concerns and my overwhelming sense of
responsibility, I chose to stay in the jail. I took a cell and
I stayed there in order to make sure that nobody died.
Over the course of the next couple years, slowly but surely
we were able to recruit a staff that was able to provide
services consistent with my mandate, which was the previous
court orders.
The entire process that I have been involved in has been a
collaborative one with the District. This has not been a
receivership that has in any way forced anything down the
throat of the District. Quite the opposite. The District wanted
me to assume this responsibility. I took it. I never felt this
was my program or the court's program, it's the District's
program. I am a temporary housekeeper trying to put things in
order.
The District indicated to me that it wanted to maintain
services after I departed through a procurement process with a
contractor. I agreed to do a procurement and drafted an RFP in
complete collaboration with corporation counsel's office, the
Department of Corrections, plaintiffs, special officers, and
with input from the trustee's office. In fact, this RFP was
about 6 months in the drafting, with comments included in it
from probably a total of 10 or 12 different individuals, most
of whom were lawyers.
The procurement selection process we were very careful
about. We wanted to make sure that the evaluation was a fair
and objective one. As a result, a committee was put together
completely independent of me. I had no say on who sat on that
committee. I had no say in who they selected to assist them in
their evaluation process. My only suggestion was that that
committee, when it was created, have a majority of District
Department of Corrections appointed people.
The committee met. The RFP--the proposals were evaluated,
and ultimately a not-for-profit group created by employees was
selected. I did my own evaluation and I concurred. This was the
lowest bidder. For many reasons we thought that this would
guarantee the best value for the dollars spent.
With regard to is the District getting its bang for its
buck, which is a very legitimate question, the process is set
up, first of all, so that, literally beginning now, the
District can begin negotiating with the vendor on a second
year, and if it chooses to reduce some services, eliminate some
services, change how it wants the services staffed, it is able
to do that.
With a not-for-profit vendor, the unexpended moneys will be
returned to the District, just as I returned them over the
previous 5 years. We have always come in under budget, and I
have every reason to believe that this contract will also come
in under budget.
With regard to the issue of employees being able to submit
a proposal, that somehow it is unfair, every procurement that I
am familiar with, once you are in the second round of
procurements, has an incumbent, and that incumbent is never
excluded from participating because they currently have the
contract. That's not the way contracting is done.
This group, because it was a first time for them, was at
certain disadvantages in terms of their skills at writing
proposals, etc. The particular group that was selected
partnered with an experienced for-profit company to handle
fiscal management. I believe that the District and I believe
the Department of Corrections believes that the District has
gotten the best value it could out of its procurement process,
and I look forward to the termination of my receivership,
hopefully within the next 60 days, so I can get on to other
things in my life, but also so that the District can then
assume direct responsibility and make whatever modifications,
changes it wishes to based on changes in disease, based on
changes in responsibilities.
For instance, the sentenced felons are supposed to be going
to the Bureau of Prisons. When that happens one of the two
mental health units will be able to close down and there will
be a substantial savings of at least a half a million to $1
million. All of that is in process. When all of the prison
inmates are ultimately sent to the Bureau of Prisons, there may
be additional changes just based on that reality. So I have no
doubt in my mind that over the next several years the budget
and per capita costs of this particular contract are going to
diminish significantly.
I thank you for your time.
Mr. Davis. Thank you very much.
[The prepared statement of Dr. Shansky follows:]
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Mr. Davis. Ms. Schneider.
Ms. Schneider. Mr. Chairman, Ranking Member Norton, and
other Members, my name is Karen Schneider. I hold the position
of the special officer, which is the special master, as that
term is used in Federal rule of civil procedure 53. Judge
William Bryant of the U.S. district court for the District of
Columbia appointed my predecessor, Grace Lopes, to the position
of special officer in 1993 for the purpose of assisting the
court in the consolidated action captioned Campbell v. McGruder
and Inmates of D.C. Jail v. Jackson.
In Campbell, Judge Bryant had issued orders governing
conditions and practices of confinement and care at the
District of Columbia Jail. I was substituted as special officer
in November 1997.
Judge Bryant's order appointing a special officer in
Campbell found that the District of Columbia had a long history
of noncompliance with court orders regarding medical and mental
health care at the D.C. jail, and that a special officer was
necessary in order to assist the court to assure future
compliance.
I ask that Judge Bryant's order appointing a special
officer be made part of the record. The responsibilities,
powers, and limitations of the special officer in Campbell are
detailed in this order. The special officer is a judicial
officer whose principal responsibilities are to monitor and
facilitate the District of Columbia's compliance with the
remedial orders of the court and to report and make
recommendations to the court regarding compliance.
The order authorizes the special officer to informally
confer with the parties on compliance issues and to attempt to
fashion compromises among the parties, much as a judge might
seek to mediate or settle disputes among parties.
The order authorizes the special officer to conduct
hearings and to submit proposed findings of fact and
recommendations to the court.
Following her appointment in April 1993, the special
officer, with the assistance of experts, evaluated the medical
and mental health services at the D.C. jail, and in September
1993, issued a report regarding the compliance of those
services with the court's earlier orders. In March 1994, the
court, relying on the special officer's report, found the
District in contempt. In January 1995, the court ordered the
District to implement a remedial plan.
On July 11, 1995, when the District continued in its state
of noncompliance, the court ordered the appointment of a
receiver to correct the deficiencies in the delivery of medical
and mental health services at the jail. I ask that that order
be made part of the record.
Mr. Davis. Without objection, that will be made a part of
the record.
Ms. Schneider. The court's order detailed the history of
the District's noncompliance and states that over the more than
20 years of this litigation the court has attempted all
measures, short of the appointment of a receiver, to obtain the
defendant's compliance with its orders. The court finds that no
other less-intrusive remedial measures will succeed in
compelling the defendants to satisfy their court-ordered
obligations.
The July 11, 1995, order provides that the receivership
shall expire 5 years from the date the receiver is appointed
unless the court finds good cause to extend the appointment.
The court also reserved the discretion to terminate the
receivership at an earlier date if the special officer
certified that the defendants are in compliance with all the
orders of the court concerning medical and mental health
services at the jail, and that management structures are in
place to assure that there is no foreseeable risk of
noncompliance.
In August 1995, Judge Bryant appointed Ronald Shansky, and
in September Judge Bryant entered a detailed order regarding
the procedures for the receivership's exercise of power. I also
ask that that order be included in the record. That order has
governed the receivership over the last 5 years, and unless the
receivership is extended by the court it will expire within 2
months of this hearing.
Since Dr. Shansky is a witness before this subcommittee, he
is available to detail the specific activities in exercising
the powers given by the court.
I understand that this subcommittee is interested in the
contract awarded by the receiver to the Center for Correctional
Health and Policy Studies for the provision of health care
services at the D.C. jail.
My March 15, 2000, report to Judge Bryant regarding the
receivership sets forth the process which led to the
development of a request for proposal for that contract and the
selection of the vendor for the award of that contract. I ask
that that report be made part of the record.
I understand that the members of the subcommittee wish to
ask me questions. I previously have informed the subcommittee
that there are constraints on the comments I can make which are
imposed by the Code of Judicial Conduct for U.S. Judges. That
code very clearly states that it is applicable to special
masters like me. Decisions of the U.S. court of Appeals for the
District of Columbia circuit, the U.S. Supreme Court, and other
courts also have determined that a special master is a judicial
officer and that there are limits on what judicial officers can
say about a pending case.
As I am sure this subcommittee knows, in most circumstances
a judge would violate the ethical cannons of the Code of
Conduct if she makes public comment about a case that is still
pending before her. One of the reasons for that rule is that a
judge's comments might suggest some pre-judgment or the
appearance of pre-judgment of an issue that may later come
before the judge for decision in the case.
Since the Campbell case is still pending and I may be
called upon to address issues in that case in the future, I may
not be at liberty to answer all of the questions that are
addressed to me. My counsel has submitted a letter to the
subcommittee staff in which he elaborates on the legal
authority imposing those restrictions on me. I ask that the
letter be made part of the record.
However, I will try, to the best of my ability, within
those legal constraints, to be responsive and answer the
subcommittee's questions.
Thank you.
Mr. Davis. Thank you very much.
[The prepared statement of Ms. Schneider follows:]
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Mr. Davis. Mr. Christian.
Mr. Christian. Thank you. Good morning. My name is Erik
Christian, the Mayor's deputy for public safety and justice.
Good morning, Chairman Davis, Delegate Norton, Congresswoman
Morella, and Congressman Horn. Thank you for the opportunity to
testify before you today on the status of the current reform
efforts undertaken by the D.C. Department of Corrections to
improve medical and mental health services at the D.C. jail.
In the first 15 months of the Williams administration, the
District government has made great strides in instituting
improvements to introduce accountability for each and every
agency and employee in order to transform the government into
one that is responsive to its citizens. This approach has
already shown promising results in the first year and will
continue to drive changes in years to come.
When Mayor Williams took office, the management challenges
the administrator inherited were daunting. Accountability for
the District work force was rare, if not nonexistent. A deeply
entrenched culture existed that was resistant to change, and,
as we all know, there was infrastructure decimated by deferred
maintenance and disinvestment and technology needs that were
grossly inadequate.
Now, the mental and medical health delivery system was no
different. It was in need of repair. In fact, medical and
mental health services, as well as other conditions at the D.C.
jail, have been under court supervision for over 25 years.
More recently, in 1993, a medical expert retained pursuant
to court order to conduct an investigation and report on
medical services at the D.C. jail concluded, ``The quality of
medical services is deplorable, the physical condition of the
medical area horrible, and the infirmary is a disgrace.''
At the same time, significant deficiencies were also found
by a mental health expert retained pursuant to the court's
order to investigate and report on mental health services.
These reports led to the development of a remedial plan the
defendants were ordered to implement in January 1995.
Unable to implement the remedial plan, U.S. District Judge
Bryant, on July 11th, entered an order appointing a receiver to
run medical and mental health services at the jail. In its
order appointing a receiver, the court found that the District
had violated the court's order and, among other violations,
they had failed to properly conduct sick call, failed to
operate a chronic disease clinic, failed to implement a quality
assurance program, failed to maintain a full-time health
services administrator at the jail, failed to properly conduct
intake, failed to properly provide meaningful access to
specialty services, failed to appropriately and professionally
respond to life-threatening emergencies, failed to properly
provide medical guides, and failed to keep their own kitchen
and medical clinic clean.
Moreover, the population the District is serving at the
jail has a high rate of HIV/AIDS, a high rate of tuberculosis
and other infectious and chronic illnesses such as
hypertension, heart disease, epilepsy, diabetes, and asthma,
and a significant percentage of inmates requiring treatment for
preexisting injuries such as prior gunshot wounds and chronic
disabilities. Moreover, the jail had experienced a rash of
suicides, and there is a high percentage of inmates who suffer
a series of mental health problems.
But what is the solution for these problems? The solution
is to instate the same solid management practices that this
administration is applying to other troubled areas.
Throughout his campaign for Mayor, Mayor Anthony Williams
repeated the mantra, ``One government, good government, and
self government.'' These six simple words comprised his vision
for the city. One government is a government where all
functions that have been placed by the courts under the control
of a receiver are returned to the control of this government
under the Mayor's leadership an with oversight of the
District's City Council. This administration is working to
create one government and commit it to terminating court-
imposed receiverships. Good government is an efficient and
effective government. Good government facilitates the goal of
one government and will ensure that the city can and does
provide human and proper treatment to its jail population; that
it complies with the law; and that a structure is instituted
that not only makes sure that we end this receivership but
assures that we do not in the future revert back into
receiverships in the dictates of the court order.
This government is committed to exploring all ways to
maximize efficiency and effectiveness. If this contract or any
government contract of service is not efficient or effective,
we will work to correct, modify, or replace it.
The District wants to work with the Congress, the GAO, and
the court to identify ways to continue to reduce costs while
maintaining the improved quality of health services required by
the law and recommended by correctional health experts to
address the unique medical and mental health needs of our
population.
Ending receivership is a clear priority of this
administration. As this administration continues to apply the
principles of good government, we must be successful in our
efforts to bring this receivership and all receiverships back
under the authority of a Mayor with oversight from the District
City Council.
The District is one city and our citizens deserve a unified
government. This city deserves the democracy and home rule that
receiverships prevent. We need to continue to perform at this
high level so that we, as the District government, can
demonstrate that we can provide all of our citizens, even those
that are incarcerated, the highest and finest level of
professional services at competitive rates.
Plain and simple, we need to return to one unified
municipal government in the District under the leadership of
officials that are accountable to our voters. By returning
District agencies that are currently under receivership back to
local control, democracy will be driving government here in the
Nation's capital.
Thank you, Mr. Davis and committee members.
Mr. Davis. Thank you very much.
[The prepared statement of Mr. Christian follows:]
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Mr. Davis. Mr. Clark.
Mr. Clark. Good morning. Thank you, Mr. Chairman, Ranking
Member Norton, members of the committee. It is a privilege to
appear before the committee today at this important hearing. Of
course, I have submitted a detailed statement and I will try to
just briefly summarize that here.
It is not any secret that for 2\1/2\ years I have been very
concerned on behalf of the District about the exorbitant costs
of the receiver's operation. I've made my views known to all
the appropriate parties and tried to work to resolve matters. I
have not been particularly successful.
So what are my concerns?
To summarize, when I assumed this new position I was
charged, Mr. Chairman, and directed by various authorities in
the District and the Congress, including this committee, to
take seriously my role of financial oversight in protecting the
funds provided for corrections operations both by the District
government and the Congress. I assure you I've taken that
charge very seriously. Therefore, I was stunned when I first
visited the jail and reviewed its budget in the fall of 1997
and compared it to my experience as a warden of a similar
facility, a Federal facility in Miami about three-quarters the
size, and also my experience as Assistant Director of the
Federal Bureau of Prisons for 6 years, where I had policy
oversight for all BOP urban jails.
In short, the receiver had about 150 FTEs, compared to
about 33 at my facility in Miami, and a $16 million budget
compared to the equivalent of about a $4 million budget at my
similar facility. Further, I was puzzled that when national
averages for correctional health care are consistently reported
at about $7.50 a day per inmate, it had cost in the District's
jail in excess of $20 a day.
As I show in my testimony, in my written testimony, on the
chart on page 6, if this contract runs its full length, the
price to the District of the receiver's tenure and the follow-
on contract that he has awarded will be over $120 million
versus the national average for that period of about $45
million.
So the question now arises as to whether it is useful or
fair to make comparisons of the receiver's costs and staffing
to other jails. Some have said that we cannot make such
comparisons. I assert that of course we can, although certainly
it is important to make proper allowances for unique variables.
Every manager, whether in private business or public
management, has to subject themselves to comparisons. We have
to be held accountable to explain differences and
discrepancies. That is particularly true in the face of such
differences as we face here, which are not, Mr. Chairman,
differences at the margins but are an order of magnitude
problem.
The District simply cannot afford such extravagance. I'm
not here to question that the receiver has remedied the former
crisis and has installed at the jail a Constitutional level of
care for the prisoners, but at what cost to the District?
Apart from the past 5 years, my other concerns, primary
concerns, at least, are that the District is now stuck with an
expensive contract in the amount of $68 million over the next 5
years unless some action is taken.
The RFP, further, is not performance based, requiring the
vendor to supply a certain level of service and care, giving
only lip service to cost containment in certain narrative
statements. But, where it counts, in the evaluation factors
delineated in the RFP, de minimis value was given to cost
containment.
I would refer the committee to table five on page 13 of my
testimony, which is reproduced from the RFP. As one could see,
the total weight of price is listed at 26 percent of the total
score. Itself, a low weight but not unprecedented.
However, on closer inspection it is clear that element A,
overall price, was only one of five elements scored in the
price category, worth approximately 5 to 10 percent of the
total score of the bid proposal, to be given little more weight
than such vague elements as rational budget, salary structure,
and fringe benefits or budget presentation. In other words, the
lowest price could easily be more than counterbalanced by a
much higher bid--just in this price category--which was simply
more rational or showed a better package of benefits or was
presented more attractively.
In my extensive experience overseeing Federal Government
contracts, price is price. Here the issue was totally blurred.
Where it counted, the real message was that price is not
that critical, and so the message went out. Everyone wanted to
please the receiver, and to do that a rich staffing level was
expected.
The message was heard by the bidders in the form of $12 to
$14 million bids for a 1,650 bed operation. The well, indeed,
had been poisoned against mainstream price and staffing bids.
In fact, to allow for a true comparison to contracts
awarded by other jurisdictions, about $2.5 million should be
added to the receiver's contract cost to account for outside
medical expenses covered by other contracts but here borne by
the DOC. Therefore, making a true comparative cost figure for
medical services at the jail, it's about $15.2 million. But
getting away from averages and rates to more recent comparable
examples of actual contracts for medical services, I think Mrs.
Morella would be interested to know that in Baltimore and in
the Baltimore Detention Center--and several surrounding
Maryland facilities, a contract was procured recently for all
the services, all-inclusive services for those facilities, for
6,500 inmates, for $19 million. That's $19 million for four
times the number of prisoners that here in the District we are
paying $15 million to provide services.
Again, this week in the clips I noticed in Delaware a
contract was awarded for more than 6,000 prisoners for $14.2
million. Again, the same money for four times the number of
prisoners.
A final example I'd give, in a recent report, another
report by GAO in April noted that the Federal Bureau of
Prisons, in its only private contract award in a facility--
actually, several facilities together in Texas--awarded a
contract for $10 million for 5,400 prisoners. That's several
million dollars less for three times the number of prisoners.
Compared with the jail, these are differences in the order
of magnitude of three or four times, not at the margins.
I am not asserting that these jurisdictions are identical
to the District's needs or that we should be among the cheapest
in the country, but we should be somewhere near the mainstream.
Finally, everyone has to be concerned, in my estimation,
that the receiver did not voluntarily recuse himself from being
the sole procurement official in what turned out to be a $68
million award, particularly when it became clear that his
professional associates and employees were forming a group to
bid.
Now, I've never objected that the employee group was
bidding, but I did strongly suggest that the entire procurement
be turned over to the D.C. Office of Contracts and Procurement.
This was declined by the receiver and the special officer--in
my estimation a violation of the most fundamental principles of
public contracting, the perception of a fair and level playing
field.
In summary, a wonderful opportunity has been missed for the
District over these past 5 years, as the receiver's legacy
leaves no appropriate or usable template for the future of
medical services at the jail. I'm afraid that the city must
start from scratch to rebuild this mishandled jail medical
services operation. Since we cannot change the past, in my
estimation the District must immediately, since the clock is
ticking, begin the development of a new procurement process to
replace the current contract at the first option date next
March.
Thank you, Mr. Chairman. I look forward to the committee's
questions.
Mr. Davis. Thank you.
[The prepared statement of Mr. Clark follows:]
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Mr. Davis. We'll have a number of them. I'm going to start,
I think, with Mr. Horn, who has another commitment. He has come
in. We'll start the questions with him.
Let me just make one comment. I think, Dr. Shansky, my
impression, just sitting here and listening to everything, is
you were brought into a very, very tough job and you turned the
place around in terms of meeting the criteria and everything
else. You are a doctor. I mean, you're not a manager. That's
not your job, and so on. And when it came to the bid, you
wanted to make sure you could get some people in place that
knew how to do the job and they were bidding. If they got it,
great. If they didn't, at least you knew you had somebody
competent. That's my take on it, and that's appropriate.
Now, I think you had some cost problems that go beyond what
you perceived or what your expertise is, and that's always the
difficulty when courts take over these is that courts are not
managers, they are not administrators, and as we get ready to
transition we've got some tough questions to ask.
That's my perspective on it, if it makes you feel better.
Ms. Norton. Would the gentleman yield on that point?
Mr. Davis. I'd be happy to.
Ms. Norton. I think the chairman makes an important point.
If we are showing concern--and this is before we get to our
colleagues who are going to ask questions, because I want to
simply make a point and not ask a question. In a real sense, we
in the Congress are confronted with the same problem when it
comes to HMO and managed care, and one of the reasons that
doctors have lost control of medical services is that if, in
fact, you turn over the bank to them, they will exercise the
best of their professional judgment, and what has happened as a
result is all of us who are not in jail are now in HMOs and
managed care precisely because we are trying to press costs
down, and we've taken these costs from medical judgment, alone,
and that turns out apparently not to have been the case here.
Mr. Davis. I'm going to yield to Mr. Horn for questions.
Mr. Horn. Thank you, Mr. Chairman. I hope I haven't
disrupted the committee too much, but I have two questions, and
I'd be particularly interested in all of your views on this.
To what extent in the D.C. jail do we have literacy
education? That's one.
To what extent do we have appropriate mental health
services in the jail and when they are out of jail in the
community? Can you just give me a thumbnail of what you experts
have looked at there--literacy and mental health.
Ms. Ekstrand. Sir, I'm afraid I can't answer the question
about literacy because it was outside the scope of what we were
asked to look at.
In terms of mental health, they do have onsite facilities
at the jail for mental health care.
Mr. Horn. Well, how good it is? I think Dr. Shansky is
probably the expert, isn't he, on this?
Ms. Ekstrand. I'm sure that he is more expert than I am.
Mr. Horn. Well, Dr. Shansky, I think you are the expert.
What is the answer to it?
Dr. Shansky. First of all, with regard to literacy, there
are literacy problems, but I am--and we have a health educator
who works with the inmates trying to teach them at different
levels of literacy skills how to take responsibility for their
own health.
I think the Director of Corrections would be better able to
comment on literacy, overall.
With regard to mental health, the D.C. jail is a unique
facility in the country. The D.C. system is a combined prison
and jail system. There are only five jurisdictions that I am
aware of that are combined prison and jails under one single
Department of Corrections.
The District, long before I came, decided to put its only
inpatient mental health services at the D.C. jail, so if you
were an inmate and became unstable you got transferred to the
inpatient unit at the D.C. jail, and when I came on board not
only were there a lot of legitimately mentally ill people, but
there are also individuals who would manipulate in seriously
destructive ways, maybe to come from Lorton, VA, into the
District.
We had to put together a program that identified mental
illness at intake, and we've done that successfully. I am
pleased to report we've had no successful suicides in over a
year-and-a-half, compared to, before I took over, an average of
a successful suicide every other month.
Mr. Horn. Can I ask how many unsuccessful suicides you had?
Dr. Shansky. Actually, the number of serious attempts has
been dramatically reduced. Those instances are pretty
occasional now.
The thing that you need to remember is----
Mr. Davis. Dr. Shansky, let me just stop you. Mr. Horn
health as got to leave, but what we'd like you to do is provide
this for the record, because I think he'd like to have this on
the record and I think it is an important piece of information.
Dr. Shansky. The thing that you need to be aware of is, as
you are aware, the mental health program for the District is
also under receivership. There are many people who are released
from jail who, were they to be maintained adequately in an
outpatient program in the community, would not, in all
likelihood, come into the jurisdiction of the criminal justice
system. In fact, my staff have participated with others in an
effort to create a mental health court that will divert some of
these individuals away from incarceration, provided that they
maintain their therapeutic program that has been prescribed by
the appropriate professionals.
There is no question, because we service the prison system,
also, that the number of mentally ill inmates, seriously
mentally ill inmates at the jail is dramatically higher than
anywhere else in the country.
We know that when the Federal Bureau of Prisons ultimately
takes responsibility for all of the sentenced felons the number
of seriously mentally ill inmates in the jail is going to
dramatically go down, because we have a substantial number of
inmates who are in the mental health units at the jail who are
sentenced felons.
In fact, we proposed early on that if the chronically
mentally ill who were stable and were sentenced felons were to
be transferred to the Bureau of Prisons--and at one point they
had agreed to take them 2 years ago--that would result in an
immediate reduction in cost of between a half a million and $1
million.
We know that by the end of 2001 all of the sentenced felons
will be the responsibility of the Federal Bureau of Prisons,
and clearly the contract situation we've created allows the
District to negotiate with its vendor literally at will to
reduce staffing levels in services provided based on the
population needs that it is responsible for at any given point
in time.
Mr. Davis. Thank you.
Does anyone else want to address that?
[No response.]
Mr. Davis. Let me ask Ms. Schneider a question. You
received a letter inviting you to testify. You refused. You
stated that to do so would be a violation to the Code of
Judicial Conduct.
After consultation with the U.S. House of Representatives
Office of the General Counsel, the subcommittee concluded that
you were not prohibited from testifying at this hearing.
We made it abundantly clear to you that we really had no
intention of influencing any judicial proceedings or discussing
any quasi-judicial functions you could exercise in your role as
special officer. We repeatedly offered to meet with you to
dispel any concerns you had about testifying. Finally, on
Monday your attorneys came to this subcommittee for what we
thought was to be a meeting in good faith. It turned out to be
anything but that. Present at the meeting were the House
general counsel, the majority and minority counsel for the
Committee on Government Reform, subcommittee counsel, and
majority and minority subcommittee staff. They agreed that your
presence at this hearing was imperative.
Your attorneys were uncooperative, and therefore this
subcommittee issued its first subpoena in the 6-years that I
have chaired this, mandating your appearance today. You know
how hard it is to get Mr. Waxman and Mr. Burton to agree on a
subpoena.
Ms. Schneider, you've gone to incredible lengths to avoid
this hearing, and yet it has come to my attention that during
the 2-weeks since you received the invitation letter you have
been consulting with the media. From the subcommittee's
conversations with you, we couldn't ascertain what your
relationship to the receiver is, but in this article in the
Post today you have been quoted as saying that Shansky has not
been a Lone Ranger.
How could you talk to the media and yet say you couldn't
talk to Congress?
Ms. Schneider. Mr. Chairman, I first must say that my
concerns about publicly commenting on this matter relate to my
belief that I am bound as a judicial officer to the Code of
Judicial Conduct. I did not talk to the press about that. That
is apparently taken from a letter that I wrote to Mr. Odie
Washington. I have made no comments to the press and have never
spoken to the press about this matter due to my concerns about
the Code of Judicial Conduct and my publicly speaking.
I do not want to be in a position to compromise this
litigation. This litigation is almost 30 years old. I may be
called upon by the judge or by the parties to make
recommendations to the judge. It will compromise my ability to
do that to comment publicly about the merits of this case.
Mr. Davis. So you are testifying here under oath that you
have not spoken to any Post reporters about this?
Ms. Schneider. I have not spoken to the Post reporter. I
did not state that comment to the Post reporter. I was
contacted by a Washington Post reporter and I informed him that
I could not discuss the matter with him.
Mr. Davis. So let me just understand this. The only comment
you made to the Post reporter was that you couldn't discuss
this matter with him?
Ms. Schneider. That's correct.
Mr. Davis. OK. Thank you.
Ms. Norton.
Ms. Norton. Dr. Shansky, you have repeatedly noted that one
of the problems with the--that you encountered in the D.C. jail
necessitating greater expenditures is that there are problems
relating to the medical condition of these inmates greater than
in other jurisdictions. What is your evidence that the District
jail inmates are sicker than inmates in New York, Baltimore,
L.A., and other large cities in the United States?
Dr. Shansky. Well, for instance, just to take one example,
HIV's seral prevalence. The District's seral prevalence rate is
about 10 percent, 9 to 10 percent at last survey. New York is
similar--actually, a little higher. Baltimore's I'm not
familiar with. L.A. County is substantially lower.
Ms. Norton. What is it in Chicago?
Dr. Shansky. Chicago, it is about 1 to 2 percent.
Ms. Norton. That's HIV/AIDS?
Dr. Shansky. That's correct. That's just one.
Ms. Norton. You know, we have a somewhat higher HIV/AIDS
rate than some other cities, but your testimony is that you
have evidence that the costs that were required in D.C. are so
much greater because the inmates are substantially sicker than
they are in other large American cities.
Dr. Shansky. What my statement is that the reasons for the
increase in cost are multifactorial. Epidemiology of disease
and prevalence of disease is just one factor. Another factor is
the decision by the District to house all of its acutely
mentally ill, even from the prison system, at the D.C. jail.
Had it chosen not to do that----
Ms. Norton. If you took the acutely mentally ill out, what
would be the cost of this contract?
Dr. Shansky. The mental health program, as described, that
would probably reduce the program by a couple million.
Ms. Norton. You have testified--well, let me ask you
concerning your testimony. The contract that has been let, is a
contract that could last as long as 5 years?
Dr. Shansky. Well, it is a 1-year contract with a
possibility of four option years, each of which is to be
negotiated between the Department of Corrections, the city
administration really, and the vendor. And, as I indicated, the
city is the appropriate jurisdiction, I think, to determine
what kinds of services, what types of services should be
needed.
As I indicated, we know that when the Bureau of Prisons
takes all the sentenced felons the whole mental health program
is going to be dramatically scaled down. Even if that is done
in the middle of the year, the Department can renegotiate with
a vendor and change in the middle of the year the staffing and
other expenditures that are in the contract.
So we set it up flexibly enough so that the Department and
the city administration will taper the services and
expenditures to its perceived needs.
Ms. Norton. Indeed, that is certainly the case. One of the
reasons why collaboration with Mr. Clark was important--and you
seem to have been willing to collaborate with the District,
which seems to have been willing to do anything you said--but
one of the reasons that collaboration with Mr. Clark was
necessary is precisely the kind of transition that you speak of
with respect to mental health.
For example, if you were to take the couple of million
dollars out, you'd still be left with the cost of these
services twice the national average, but if the point was to
collaborate because we are in transition, I can't understand
why an objective observer who comes from the Bureau of Prisons
would have been somebody you didn't even want to hear nor did
Ms. Schneider apparently want to hear, because it is hard to
detect any oversight by her of you.
Dr. Shansky. Let me----
Ms. Norton. So if there is no oversight by her, and Clark
comes in as somebody charged by us and a Presidential appointee
to look at management and financial reform, I cannot understand
why the District of Columbia and Ms. Schneider and you, Dr.
Shansky, wouldn't have used that opportunity, an opportunity
that comes precisely from the Congress, to try to collaborate
and perhaps go back to the court with a revised notion of what
might be necessary here.
Dr. Shansky. Let me correct the record. Neither the
District nor the special officer of the court have done
everything that I wanted. That is not the way the process has
worked. We have negotiated from day one how to implement, how
to design services, how to create the proper program that the
District wants. It has been a very fair and open and candid
series of discussions we've had over 5 years.
I did not get everything. Everything is not done exactly
the way I wanted. I realized from the beginning this is not my
program, it is the District's program, and I have worked very
closely----
Ms. Norton. Dr. Shansky, you gave us no indication until
you've just spoken of how those negotiations resulted in your
getting less than you wanted. Would you care to give some
examples?
Dr. Shansky. Initially we talked about providing certain
kinds of services in certain ways when we proposed the budget,
based on what the remedial plan required. There were different
interpretations. We participated with the corporation counsel's
office, and the budgets each year, in essence, were negotiated
around what needed to be required.
Each year the process took place. And, as you can see, each
year the budget was scaled back, and each year we returned
moneys to the District.
Ms. Norton. How did the budget go down from $16 million to
$12 million? Was that a voluntary act on your part? Did you cut
back on your part by yourself in your own judgment?
Dr. Shansky. It was a collaborative effort between myself,
the corporation counsel's office, the Department of
Corrections, special officer, and plaintiffs.
Ms. Norton. Mr. Clark, what role did you play in that
process?
Mr. Clark. Well, as I mentioned, when I first came in I was
quite stunned by this level, although I think, you know, to be
fair to Dr. Shansky, the $16 million level in 1997 included
$1.5 million or an extensive amount of a 1-year grant, I think,
money from the Marshals for some equipment and some other
factors there, so I think his true budget was somewhere in the
$14.5 million range that year.
But, on the other hand, there hadn't been that much of a
reduction, and I don't know why he made decisions. But I know
that when I came in and learned of this, I started to raise
serious concerns with both him and particularly with Ms.
Schneider and with the District, and I think that had some
significant influence on lowering that budget.
Ms. Norton. Dr. Shansky and Ms. Schneider have indicated
that the District can always contract for services for a lower
amount. This receivership for 5 years was supposed to be
returned to the District so that the District could take it off
the shelf and run it, and if that is not the case then I don't
understand what a receivership is about.
Dr. Shansky. Just to set the record straight, that is the
case.
Ms. Norton. All right, but----
Dr. Shansky. At the end of August----
Ms. Norton. But when this matter goes before the City
Council of the District of Columbia I can guarantee you that it
will be very hard to justify this level of cost, given the
other pressures on the D.C. government.
Both of you have indicated that the District is free to
reduce the cost. This, of course, will take some considerable
re-engineering to make sure that the new contract takes into
account the very quality concerns that resulted in the District
being ousted from jurisdiction, while at the same time meeting
the District's budget requirements.
This is precisely the expertise that the D.C. government
lacks, and I submit that Mr. Washington clearly lacks now when
he says, ``We're getting all we paid for,'' and clearly shows
no indication that he wants to reduce these costs at all. He
loves these costs. He loves this contract.
So I don't understand why, after 5 years, you are giving
the District back a contract that almost surely will have to be
re-engineered, unless the Mayor of the District of Columbia is
willing to pay considerably more for jail costs than he has
shown a willingness to pay above the national average for costs
for other residents. I do not understand how you have spent
your time, if it is to say, ``You can take what I've done,
throw it out, re-engineer it, and bring the cost down.'' Why do
we need you in the first place?
Dr. Shansky. I believe that----
Ms. Norton. That was your job, to----
Dr. Shansky. Let me just indicate----
Ms. Norton [continuing]. Give us back a cost-efficient----
Dr. Shansky. Let me just indicate I believe I was needed in
order to save lives, and I tried to do that, and I believe I
was successful.
With regard to the competence of the city administration, I
have every confidence that they have the expertise, the know-
how, and the commitment to tailor a program based on their
perception, the city's perception of what needs and what
services should be provided. I have every confidence in them,
and I will so report that to the judge.
Ms. Norton. Well, of course you have confidence. One of the
reasons I would have confidence in them is they're getting a
re-engineered program, a program that has been fixed. It is
hard for us to understand how you can fix a program that leaves
us this for out of the range of average services.
Mr. Chairman, I will pass and come back.
Mr. Davis. Thank you very much.
Mrs. Morella.
Mrs. Morella. Thank you.
I'd like to first of all direct a question to Ms.
Ekstrand--and this was picked up by Mr. Clark--the differences,
the disparity with regard to Baltimore, Prince George's County,
and the District of Columbia. Could you tell me, from the GAO
study, what are the differences in the kinds of medical
services and problems that you found in Baltimore and Prince
George's County compared to the District?
Ms. Ekstrand. We do know that there is 24-hour-a-day
pharmacy onsite at the D.C. jail and that is not the case in
Baltimore City, not the case in Prince George's County.
We did also focus on mental health services, and again
mental health services are enhanced in D.C. compared to Prince
George's County and Baltimore City.
We did not have the opportunity in the time we had to do
this review to go through item-by-item to make that comparison,
but those are two of the larger items.
Mrs. Morella. Are you kind of in that statement sort of
justifying the fact that the District of Columbia costs that
much more, the pharmacy and the mental health?
Ms. Ekstrand. Well, I'm just making the point that the
enhanced services and enhanced staff means that it costs more
money. We did not have the opportunity in the few weeks that we
looked at this program to determine whether there were other
aspects that affected costs, such as efficiency or salary
levels. Those were outside the scope of what we could look at
since the end of May. But at least we were able to identify
some factors, and those factors had to do with enhanced
services.
Mrs. Morella. Thank you.
Let me ask Mr. Clark to pick up on that. With all the
experience that you have had with the Federal system and in
Miami, do you see--I know the difference is, like, four times
the difference in terms of price, and we know it is basically
because it is staffing, but can you see an equation between the
kinds of services provided and the cost? Does that make up for
it?
And then I'm curious. Has anybody looked at, like,
recidivism rates? I mean, can you show something for this
difference?
Mr. Clark, would you like to comment? And then if anyone
else would like to comment?
Mr. Clark. Well, two or three points.
I think everybody would agree that one difference, one
legitimate difference, is the service provided to the sentenced
felons, which is a group which will go to the Federal Bureau of
Prisons within the next year or so. I think Dr. Shansky, while
he noted that the total mental health cost may be $2 million, I
think he testified a couple of times that when the felons go
that would reduce the cost by a half a million to possibly $1
million. I wouldn't argue with that. Other than that, I don't
see any--the services that the inmates are being provided in
Baltimore, whether it is pharmacy, mental health, or all the
other services, meet Constitutional standards. They meet
accreditation standards. They've all been accredited in those
facilities. So the total package of services I don't think is a
problem in those facilities in Baltimore or in many other
places around the country.
And I'd like to make what I think is an important
distinction. Higher staffing levels do not equate directly to
improved services. At a certain point you reach a point of
diminishing returns, and adding more staff members on the
evening shift or adding additional nurses, pharmacists, or
whatever, does not significantly improve the services. So once
you've met a basic level, adding additional staff has marginal
benefits, in my estimation.
Mrs. Morella. I have kind of confirmation of what you are
saying, and that is a quote from a company, Faiver, Campau and
Associates, ``Nowhere in the country are we aware of a facility
of comparable size that has such a top echelon of staff who are
not also significantly involved in direct patient care.''
That's quite a----
Dr. Shansky. Congresswoman Morella, could I respond to
that?
Mrs. Morella. Of course, Dr. Shansky.
Dr. Shansky. That particular consultation, which was
solicited by the trustee, was done purely by paper. There was
no interviewing. In fact, that particular consultation was
completely inaccurate.
All of the staff, virtually all of the staff that he refers
to as being 100 percent administrative are spending a
significant percentage, 50 percent or more of their time,
providing direct services. So it isn't the case that these
people are purely doing administrative functions. He never
found that out because he never interviewed anybody.
Mrs. Morella. Have you--recognizing all of that, do you
feel--and knowing that you have made some reductions, putting
this all together, do you feel you could reduce the number of
staff?
Dr. Shansky. It is my view----
Mrs. Morella. And enhance efficiency.
Dr. Shansky. It is my view--right now we are in the process
of completing the renovation, so efficiencies just physically
are difficult. That should be finished by the end of October.
And it is my view that, in fact, there can be some reductions,
and we've already talked about it with the vendor. The District
has talked about it. And I have every expectation that for the
next contract there will be significant reductions in
expenditures.
But I believe those are the District's decisions, and I
have attempted to take, to a great extent, besides taking
leadership from the court, also from the District because it is
ultimately their program.
Mrs. Morella. We have a Government Performance and Results
Act, you know, where we require our agencies and say, ``OK, now
what have you accomplished, not so much what your mission is
and what your modus operandi are.'' It seems to me that the
system could certainly use a Performance and Results Act
requirement.
Dr. Shansky. We have built exactly those performance
measures into this request for proposal. It is the first one
that I am aware of--and I was responsible for issuing request
for proposals for 12 years for the Illinois State prison
system, the first system ever to privatize. The reality is that
we have put in performance measures, not just ensuring that
certain processes are completed, like intake processing, but
that the degree of control of chronic illnesses is such that
morbidity and hospitalization are prevented. All of that is
built into this RFP. It is unquestionably performance based.
Mrs. Morella. OK. I know my time has elapsed, and I thank
you.
Mr. Davis. Let me try to put a perspective. I would much
rather be here talking now about overstaffing and high salaries
than I would a situation that we couldn't correct. I just put
that in perspective.
This looked like an impossible situation at the time you
took it over and you turned that around, so that is understood
and that is good.
But, for those of us that have to operate within the
confines of government, which is transparent, which has limited
salaries and everything else, you know, this violates all the
rules, and it violates all of the traditional rules of
government because we were not--you didn't have political
oversight. You had oversight from a judiciary branch. And
that's where you go back into the political spectrum and it
goes back to the city that is not ready to transition, and
that's why we are asking these questions.
Dr. Shansky. I believe it is ready for transition. The
contract is in the midst of its first year. The Department can,
beginning to work right now with the vendor, restructure or
shift or move or----
Mr. Davis. It's a lot more ready to transition now than it
was when you took it over. No question about it.
Dr. Shansky. There's no question.
Mr. Davis. So I'd put that in perspective.
Dr. Shansky. There is no question about that.
Mr. Davis. But I think you would concede and I think Mr.
Clark and the GAO and others who have testified make it very
clear that the payment for what were getting is very, very high
by any normal governmental standard.
Dr. Shansky. And the District has the opportunity to make
decisions about what it wants to pay for and what value it is
getting for the dollar.
Mr. Davis. Of course.
Dr. Shansky. And that's why I think this is a perfect
situation in terms of the closure of this receivership within
the next----
Mr. Davis. And that's why we are holding the hearing. We
need to understand that, and if the city had these costs in
every part of its government and couldn't afford it, it would
be a lot better run city, but that's a different issue.
I'm just trying to put it in perspective, and you don't
need to be overly defensive, but I just--and I can understand
why you are that way. The main mission was accomplished, and it
looked almost impossible when you took it over.
My wife is a doctor, too, so I understand. She's tighter on
finances than I am, but I just want to put that in perspective
for you.
Now, let me ask a few questions here for Ms. Schneider.
What are the major duties you perform on a regular basis as
the special officer?
Ms. Schneider. My duties as a special officer is to ensure
the compliance of the court's orders. That can be done through
mediation with the parties on various issues, through observing
and reporting to the court, and making recommendations.
Mr. Davis. When you look at your priorities, cost has not
been at the top in terms of trying to do it within the
restrained budget. You're really looking at turning this around
and----
Ms. Schneider. Well, my mandate is precisely to ensure that
the court orders that are in existence are followed, and that
is by the order that appoints me. It requires me to ensure that
those orders are followed.
Mr. Davis. OK. So the court orders, no staffing levels are
required? That's a judgment call that you would make?
Ms. Schneider. There were staffing levels required in the
initial remedial plan, and there has been a process in this
litigation where those staffing levels have been reduced each
year through negotiations with the party and a budget that was
submitted to Judge Bryant each year for consideration.
Mr. Davis. But did you ever make any comparisons to other
jurisdictions' costs and services while the plan was being
worked out among the parties, for example?
Ms. Schneider. Well, my mandate was to ensure that the
court order, as it existed, was followed.
Mr. Davis. All right. Now, I think I understand how we got
to where we are, and I don't know that anybody is culpable or
anything, I just want to try to understand that cost was really
the kind of last thing you'd look at as you try to work your
way through a very, very difficult situation when you took this
over, and I can appreciate that.
The corrections trustee reports that you appointed the
receiver as the sole appeal authority on the procurement over
his very own decision. Can you explain that decision?
Ms. Schneider. Excuse me, that was not my decision to
appoint the receiver as the sole----
Mr. Davis. Whose decision was that?
Dr. Shansky. When we drafted the RFP, we had discussion
with counsel on a variety of things. One of the issues that
came up was to what extent we could parallel, if you will, D.C.
procurement law.
Now, the reality is D.C. procurement law refers to and is
applicable to D.C. agencies. I was clearly not a D.C. agency
head, so, strictly speaking, D.C. procurement law wasn't
applicable to a procurement that I was going to do, and I
couldn't, in my procurement, somehow require the chief of
procurement to be responsible. I had to accept that
responsibility myself.
Mr. Davis. And your argument now is, as the city
transitions they can renegotiate.
Dr. Shansky. Yes. Exactly.
Mr. Davis. Then that makes my next question for Mr.
Christian and Mr. Washington. What mechanisms do you have in
place to renegotiate the contract and control costs at this
point?
Mr. Washington. Thank you, Mr. Davis.
First of all, I want to simply say that I, like many in the
District, love the services that are currently being provided,
but we all have a problem with cost, as has been the case for
the last 5 years, but I have been impressed by the fact that
the cost continues to go down every year and I am convinced
that costs will continue to go down.
The best way to do that is to return control of medical
services and mental health services back to the District, where
we will be able to negotiate specific services and further
reduce the cost. I am confident the that District of Columbia
will be able to do that.
Mr. Davis. If you don't do that, don't come running to
Congress. You'll have to go somewhere else to find the money.
I'll let you make that argument with the Mayor, but I think
that's--and that's really the bottom line at the end of the
day.
Mr. Washington. And clearly that is understood, Mr.
Chairman.
Mr. Davis. Do you have any mechanisms in place right now?
Can you give us any idea where you might be headed on that,
what cost controls you put in effect, what some of the services
are being provided that you might not be able to provide, or
anything?
Mr. Washington. Well, one of the things that we will be
doing is to hire our own medical expert to oversee the
contract. That will be our person to evaluate the services that
are being provided and to determine what services can be
reduced. That is a position that will be established.
Mr. Davis. I'll tell you what. Instead of putting you on
the spot today with that, maybe you can get back with the
committee and talk to us as you transition about what some of
your thoughts are with specificity. Would that be amenable?
Mr. Washington. Yes.
Mr. Davis. I think that would be helpful to us.
Mr. Christian, do you have anything to add on that?
Mr. Christian. Again, Mr. Chairman and Council members, we
are trying to maintain the quality of services that have
already been provided at the most efficient and effective
manner, so we would be looking at that contract during this
period and when it expires.
Mr. Davis. Why don't you try, let's say in the next--within
10 days could you get us back something in terms of your
thoughts on transitioning this back to something that is
affordable?
I would just say one thing: the city--I mean, not you,
personally--you weren't probably with the city then--but the
city had this thing really messed up. It has been fixed from a
services point of view, but now we have to contain costs, and
we are just eager to understand how you are going to do that,
how you are going to get there, because if these costs continue
it just doesn't mesh with the culture of this city or any other
city when you take a look at the other staffing ratios. So we
want to see how we make this transition.
If I have to put an emphasis anywhere, it is on making sure
the city isn't sued again and that we are fulfilling our
Constitutional obligations, so you have to do that. You can
pick and choose, and I think you have a better system here than
you have in Baltimore or you have in Prince George's or the
others, but you are paying a lot more for it, too, and what
that balance is, we're just eager to know what your thoughts
are on that. That's all I'm trying to get at.
Let me now yield to my ranking member, Ms. Norton, for a
few more questions.
Ms. Norton. Mr. Christian and Mr. Washington, you are aware
that, as this hearing is going on, the Appropriation Committee
is having a hearing in which it is looking precisely into
whether or not the District is not only improving its services
but is improving the management of those services. The
Appropriation Committee is very much in sympathy with what this
committee is doing and has made that known.
Are you prepared, when the appropriation comes before the
Appropriation Committee next year, to come forward with a
contract with these costs in it?
I ask that of you, Mr. Washington, because you said to the
Washington Post, ``I think we are getting what we are paying
for,'' therefore I don't see any inclination on your part even
to begin to reduce costs, and so must assume that when you go
before next year's appropriation you will not be recommending
to the Mayor that any changes be made. Therefore it would be
the Appropriation Committee or the Council that would have to
do the oversight here.
Mr. Washington. Well, actually, Congresswoman Norton, I
think it would be just the opposite. I think we will very much
be prepared to discuss cost reductions.
One of my primary concerns, as a relatively new director of
this department, is to ensure that the D.C. Department of
Corrections does not revert back to 30 years of neglect in our
department. We have a wonderful opportunity to get from under a
30-year court mandate and oversight of the D.C. Department of
Corrections and return control to----
Ms. Norton. When this program comes back, who will be the
officer who has control over it?
Mr. Washington. Well, the Director of the Department of
Corrections will be responsible for medical and mental health
services.
Ms. Norton. That's you, isn't it?
Mr. Washington. That's correct.
Ms. Norton. And you want control over this and you want it
back from the receiver?
Mr. Washington. Absolutely.
Ms. Norton. So you have been cooperating with the receiver
in order to make sure that you, in fact, get this program back.
Mr. Washington. Yes. I think the quickest way to reduce
cost is to return control to the Department of Corrections and
negotiate future contracts. I think we have a good level of
services. That's important to ensure that we do not have
continued court oversight, and further reduce costs.
Ms. Norton. Dr. Shansky and you have said the same thing.
That's a dangerous thing to say to this Congress. You know, the
chairman and I have kept this matter before this committee. In
doing so, we have made sure that we focus not on the courts.
Neither of us believe it is inappropriate for courts to take
over functions that are in the shape these functions are in,
but there are many who disagree with us. To the extent that
there is testimony before the Congress that courts don't have
any obligation to contain costs when trying to reform matters
in receiverships, you endanger the whole notion of court
receiverships and non-interference by the Congress of the
United States. I think you should be told that.
This matter could just as easily be in the Judiciary
Committee, and if it were there would be a very different kind
of hearing. Indeed, the Congress has already intervened into
receiverships. You do not help those of us who believe that the
courts, particularly with respect to jails and to prisons, have
done a service to the country in taking over such systems. You
do not do a service when you say that it is quite all right for
the receivers to rack up any costs they want to and then give
it back to the people who couldn't manage in the first place to
bring down the cost, and that is what I am hearing from you,
Mr. Washington, and that is what I'm hearing from the two
receivership officers.
Dr. Shansky. Let me correct what may be a misperception on
your part. My mandate was to put the program together and to
save lives, but it was also to be fiscally responsible. We have
been audited. We will be audited again at the end of the
receivership. The audits were court mandated and arranged by
the city. We negotiated and discussed each budget, literally at
times every position and every service. We have returned money
to the District each year that was unspent. I don't think that
is a record of someone who feels that a receiver has no
responsibility to look at cost factors. Quite the contrary. We
have been sensitive to the cost concerns, and I think the
District has also been sensitive, as has the special officer.
Ms. Norton. Dr. Shansky, it was precisely because there was
no audit of the kind that D.C. agencies are required to engage
in and only a two-page audit spreadsheet presented that this
House unanimously passed a bill requiring that full-scale
audits be done not after the receiver is through but on an
annual basis while there is a receiver so that the receiver is
not held to a standard less than the agency who has given up
the function would be held.
Dr. Shansky. Once again let me correct the record. The
audit that was to be performed was determined by the city it
was supposed to be done under the existing city contract by a
firm, Peat Marwick, which was doing all the city agencies. I
had no say in determining how that audit was done, who was
doing it, or what it consisted of.
Ms. Norton. Just a moment. Did not the court require an
audit?
Dr. Shansky. Yes. That's correct.
Ms. Norton. Ms. Schneider.
Ms. Schneider. That's correct.
Ms. Norton. Did you regard that as the kind of audit that
was satisfactory?
Ms. Schneider. There was a court order requirement for the
audit, and the audit was----
Ms. Norton. Do you know what an audit is, Ms. Schneider? Do
you know the kind of audit that District agencies, in fact,
routinely have to go through?
Ms. Schneider. This was an audit that was done. It was
organized by the city, by the agency that was doing the city
audits.
Ms. Norton. Mr. Washington, are you aware of the kind of
audit--who organized it? Who was the officer? Was it Mr.
Washington?
Dr. Shansky. I believe this preceded Mr. Washington.
Ms. Norton. Are you aware of the kind of audits that the
new auditor requires when he does an audit of D.C. agencies?
Dr. Shansky. I wasn't made aware----
Ms. Norton. Do you think that this is representative of the
kind of audit that agencies should go through?
Dr. Shansky. Let me indicate, after approximately 2 weeks
of providing all financial records, all invoices, all bank
statements, etc.--and, again, this was an audit arranged by the
city by the contractor with a contract to audit city agencies--
no one was more disappointed than we were to get, for the cost
of that audit, which I'm told was about $40,000, that two-or
three-page statement, believe me.
Ms. Norton. Again, I'm not sure what Ms. Schneider's job
is, but obviously the District wants to get out of the
receivership. The District apparently felt it had no stake in
the kind of audit these agencies have to go through.
I repeat, I am concerned if the District now has to figure
out how to reduce these costs, because the District is going to
have to, in fact, design an RFP that meets quality concerns and
also the cost concerns that the Council and the Mayor will
raise.
When I look at the number of physicians, no matter how we
get into this contract, questions are raised that any public
official--you, Mr. Christian; you, Mr. Washington; you, Ms.
Schneider; you, Mr. Shansky; and certainly the GAO--should have
wanted to question.
For example, 15 doctors serving something over 1,600
inmates here, five serving something over 3,000 inmates in
Baltimore----
Dr. Shansky. Those figures, by the way, are inaccurate. We
do not have 15 physicians, and I'm not sure----
Ms. Norton. How many do you now have?
Dr. Shansky. We have----
Ms. Norton. You obviously had it at one point. How many do
you have now?
Dr. Shansky. We have, I believe, nine.
Ms. Norton. Compared to five for more than twice as many in
Baltimore, three times as many as these now----
Dr. Shansky. Again, you are quoting figures from a report
in which the data was demonstrated to be inaccurate. Now, it is
very hard to have a discussion----
Ms. Norton. Give me the accurate data. I'm giving you the
data you told me. It was nine. Prince George's, same size as
D.C.----
Dr. Shansky. Again, inaccurate data.
Ms. Norton [continuing]. One M.D. for 78 compared with one
for 15 here. What are your figures now?
Dr. Shansky. When we talked with the officials at these
agencies, they told us, first of all, in the Baltimore contract
they said the numbers were part of an overall contract and it
was very difficult for them to attribute the costs related to
the jail part of that contract.
Ms. Norton. I'm just asking you about doctors now.
Dr. Shansky. I don't recall the specifics of the doctors,
but----
Ms. Norton. I'm just saying that Prince George's, which is
the same size as we are, the same kind of population, one
doctor for 78 inmates compared with one for 15 inmates here,
and we're supposed to say, ``That's fine. The quality has
improved, so don't ask any more questions.''
Mr. Davis. Let me recognize Mrs. Morella.
Mrs. Morella. Picking up on our discussion today, I notice
another difference probably among many of the correctional
institutions in health care is the on-and offsite staffing, and
I note in your testimony, Dr. Shansky, you mentioned that the
offsite consists of, like, a physician and a nurse at D.C.
hospital.
Dr. Shansky. Yes.
Mrs. Morella. I'm wondering whether this--and I'm going to
get to you in a minute, Mr. Clark, whether this occurs in other
hospitals, too. But it was interesting, as I was re-reading
your statement, where you indicated that they are there also to
make sure that they don't stay there too long, to control. And
I was thinking of the problems that patients have with HMOs,
you know, where you've got a gatekeeper that says, ``You can
only stay 3 days,'' or whatever it may be. That's the same kind
of thing you're doing.
Would you like to just comment on how effective you think
it is having a----
Dr. Shansky. That's a very legitimate concern. We added
this, because when I came on board--and all of the Lorton
facility, as well as the jail and the Correctional Treatment
Facility use D.C. General as its main resource. One of the
things that I found was corrections patients admitted to D.C.
General were distributed among a variety of house officers,
most of whom had their major focus on their non-incarcerated
patients, and so the concern wasn't that people were being sent
out too quickly, as might be the case with an HMO, but they
were literally forgotten or neglected and allowed to stay way,
way too long.
We talked to the District. The District felt that it would
be a cost-effective investment to make sure that we had one
doctor in control of all of the patients admitted to D.C.
General from Lorton, from CTF, as well as the jail.
There is no question we dramatically reduced the length of
stay because our doctor focuses on those patients and gets them
out in as timely a manner as possible.
Now, when the prisons close down the city may decide,
because there are fewer patients in the hospital, maybe it
doesn't want to support that service. But, given the number of
admissions from all of the Department of Corrections
facilities, it made sense to put a doctor in charge of that
care, and therefore reduce the length of stay.
This was particularly important because the D.C. General
Hospital became a public benefits corporation and began billing
the Department of Corrections. Up until that time, which was
roughly 1998, there was no transfer of funds, as far as I
understood. But when they began doing that we talked with the
Department, and the Department said, ``Yes, we don't want to be
paying for unnecessary services, for people who are just laying
around after they've received maximum hospital benefit.'' It
was on that basis that we instituted this program.
Mrs. Morella. Mr. Clark, would you like to comment on
whether this is being done any other place and what you think
about the efficiency? I mean, it is a pretty convincing case if
you are reducing the time and you are watching them.
And then I would like to also ask you about this pharmacy.
Have you found that there are other places where--I mean, is it
common to have a pharmacy connected with a jail of that size?
And then would it be better to--I mean, more cost effective to
have a contract with a vendor for that kind of service? I don't
know much about it.
Mr. Clark. Three issues, I guess, Mrs. Morella.
The first one: I generally agree with Dr. Shansky on the
advisability of having a physician or--well, principally a
physician--whose loyalty or whose concern is primarily directed
to the Department of Corrections providing some oversight to
those cases at D.C. General or any of the other outside
hospitals.
On the other hand, I have a significant problem, as I
mention in my written testimony, with the way the RFP, the
second RFP was restructured to remove the responsibility for
outside medical from the vendor so that the incentive, which
had been built in and which is common in these contracts
everywhere, as far as I can tell--and within the last few days
we've contacted eight or nine States who contract out all or
part of their services, and they all require the vendor who is
providing the jail or prison health care to also be responsible
for the outside medical care. If you don't do that, you reduce
the incentive or there is a reverse incentive in terms of
providing the treatment in-house. And there is almost an
incentive on marginal cases to move that case to the local
hospital when then it becomes an expense to the Department of
Corrections.
That was our experience in the Federal system under
contract facilities, and we went to total outside contracts,
first with a catastrophic limit of $5,000 or $10,000, and then
I know more recently they have removed that catastrophic limit.
So I have, as I have testified in my written statement, a
major concern that it was not in the economic interest of the
District to remove that responsibility from the vendor.
Your next question was about the pharmacy. It is not
uncommon to have in-house pharmacy operations. I think in these
contracts that is more of a market question. In other words,
you ask to have a certain level of pharmacy services provided,
and in some cases it is done more on an operation, in-house
operation, sometimes more on a regional kind of a basis.
Again, the problem that I have with the requirements in
this contract are not that it is in-house; it is that they
have, in my estimation, much exceeded the numbers of staff who
are commonly needed to run a pharmacy in a correctional
facility.
I forget your third question, ma'am.
Dr. Shansky. Could I respond on the--I think it needs
edification, the offsite service responsibility.
The usual arrangement that I have seen is where you build
in some sort of risk sharing, as alluded to by Mr. Clark, with
the vendor. We had every intention of doing that, and we
intended to negotiate with the selected vendor the conditions
of that risk sharing.
Some time in the fall of 1999 we were informed by
corporation counsel's office that, if we were to want this
contract to be assigned to the District, we could not engage in
those kinds of discussions with a vendor at the time of
selection, so that we were locked into whatever was in the RFP
if we're going to leave this in, No. 1.
No. 2, the vendors came up with per diem rates in their
proposals that were, in fact, not as good as the per diem rate
that the District had at that time, so we felt this was not in
the district's interest.
The other thing is that the vendor's proposals were very
divergent. One vendor was very low on the outpatient side, very
high on the inpatient side. Another vendor was very low on the
inpatient side, very high on the outpatient side. None of them
justified their numbers.
We felt the wisest thing to do, particularly since we had a
doctor in place and that doctor controls both admissions and
discharges, so the risks that Mr. Clark is alluding to are
taken care of by our having our person in control of those
patients, which isn't the case with most contracts with
correctional facilities, and on that basis we felt the wise
thing to do, the thing that was most prudent, was to take the
offsite services out in the first year and then, for the second
year, the Department of Corrections and the Mayor and the
director of Corrections could, if they chose to, negotiate the
kind of risk-sharing and offsite responsibilities that they
felt were in the District's best interest. That's why we made
those decisions.
Mr. Clark. I'd like to respond to that.
One of the issues here is on this performance-based
contracting and whether or not there was an incentive built
into the contracting for the bidders to be innovative and
creative. In this area, a couple of the bidders bid
significantly below the District's cost, one of them way below.
I would call that innovation or creativity. In this case, Dr.
Shansky chooses to say that the companies were confused and
somehow didn't understand. Well, these companies bid on these
contracts all over the country. They understand. They knew what
they were doing. And for some reason--again, I've got a chart,
I think, that compares the bids on page 16 of my testimony that
makes that point.
Dr. Shansky. Let me respond that the numbers were not
justified. There was no basis for the numbers.
Mr. Davis. Dr. Shansky, let Mr. Clark finish before you
interject, OK?
Dr. Shansky. OK.
Mr. Clark. Again, I think this is another example where
creativity and innovation were removed or not rewarded, and
whether or not the receiver in his role as the procurement
official, understood or felt that the background development of
how these numbers came to be may have been justified, the
company bid, in one case, was $1.3 million, which was about
half the District's estimated cost.
When you bid, if the bid is accepted, then you are going to
have to live with that, and to me that's innovation. It's not
confusion.
Dr. Shansky. Let me just indicate we selected the lowest
bidder, No. 1. Within the finance category, lowest bid was
considered the determining factor, and that was the largest
single factor of any of the factors considered.
With regard to the offsite services, had we been able to
negotiate with a vendor at the time of selection, we would have
stuck with it. When we were told by corporation counsel
contract lawyers that we could not do that, we felt it was
potentially dangerous for the District to enter into a contract
based on numbers that had no justification.
What we didn't want was a vendor not hospitalizing people
in order to meet the bottom line, which was inappropriate, that
they had proposed and the District suffer the consequences of
that sort of gatekeeping.
Mrs. Morella. Dr. Shansky, I just want to say that I think
that this hearing has brought together a lot of the issues that
have been smoldering, and I hope that what will happen is not
only we will continue to be updated as we move along and get
out of the receivership but that there will be some compromises
worked out so that, you know, I think some of the things we've
said and that we've listened to could be worked out, so I guess
in that sense of moving ahead for the correction system and the
accountability and all, this has been a great meeting.
I yield back the remainder of my nothing time.
Mr. Davis. Mrs. Morella, thank you.
Let me make a couple of comments, and then I'm going to--I
mean, I think we get the gist of what has happened. I think
everybody has had their say here and we understand.
What concerns me now looking ahead is, is the city ready
for prime time? Are they ready to take this over, because I've
seen very little oversight from the city during this time
except that they are eager to take back the control, and,
frankly, I'm not sure I am comfortable with that.
Mr. Clark, what is your judgment on that? Is the city--can
they innovate these--have they shown the oversight initiatives
and the like that show they have any understanding of how they
can reduce these costs and maintain a level of service that
will be acceptable Constitutionally?
Mr. Clark. Well, I know that Director Washington is working
to step into the--to have the Department step into the role of
oversight of the contract, but what I--and I guess this is
partly why I got into the uncomfortable position that----
Mr. Davis. Let me just interject, obviously they can spend
what they are spending and it will be fine, but that has other
ramifications city-wide at this point.
Mr. Clark. Absolutely. I mean, this is money that could be
spent for schools or police or pot holes.
Mr. Davis. Well, you have people that are working two jobs
trying to support kids that have no medical care, and the
people who are in jail are getting much, much better care, and
if that is the city's priority, but I don't think it is.
Mr. Clark. I think what I found when I came in almost 3
years ago was that the city felt impotent in the face of this
receivership. This is what--this was the sense that I got from
the Department of Corrections director and other officials
there, and, frankly, from the corporation counsel. That in the
face of this long suit and so on, which had many legitimate
aspects, obviously, they didn't feel that they could stand up
to the receiver on these issues, and that's, frankly, why I, in
my independent position, felt that I had to.
Mr. Davis. Frankly, I don't think they could have stood up
to him. I don't think they had the knowledge and I don't think
they had the background or they had the competence to do it,
and if you look at what had happened, you know, to this
previously when they had it and took a look at what was
happening around the rest of the city and the priorities, the
city had to develop it. I understand that. I mean, it cost a
lot of money to turn this around, probably more than if we had
been a little more cost conscious. We could have done this a
little cheaper. But we are here where we are today and we have
something we are not worried about in terms of meeting the
Constitutionality test and the like.
The difficulty now is, from a budgetary point of view,
making this transition, and I am, frankly, concerned about the
city's--I've asked them for some guidelines and they are going
to send union something within 10 days, and the proof of the
pudding is in the eating. I hope we see something of a
substantive nature.
But that's our concern. Let me just say that if you think
this hearing is tough, you want to go see Mr. Istook and the
appropriators. I guarantee you--Ms. Norton is not going to be
there. She's your friend. I think at the end of the day she
wants this thing to work out. You just won't get the money, and
then we could be right back to where we were. We want to get
this stuff solved here at the authorization level, and the way
you do that is you show us a plan, you show us it is not going
to be the same program you have today because you are not going
to have the money, but we just want to see it. I just don't get
the sense here that we are ready to do that as a city.
Mr. Clark. No. I think the focus--I mean, I think,
unfortunately, you are right. The focus within the Department
has been to be ready to take over the oversight of the
contract, but I don't know that there is--that anybody--again,
and this feeling of sort of impotence, that anyone has felt
that they were in a position to start trying to re-engineer
this receivership's operation.
Mr. Davis. Well, just for----
Ms. Norton. Mr. Chairman, could I just comment on just that
point?
Mr. Davis. Sure.
Ms. Norton. The lost opportunity here, it seems to me, why
the committee and the President and the Congress insinuated Mr.
Clark into the matter was that there was a management and
financial expert, so that you had, on the one hand, a doctor,
and the doctor's job is to deal with patients, you had a
receiver, a monitor. She also isn't in the management business,
and we understood that. And we were clear, and I have been
clear with Mr. Washington that the way to round this out was to
take this expert who had the second-highest position in the BOP
and make a synergy and it could all have worked.
What is most disturbing to me, Mr. Chairman, is that
somehow or the other an adversarial relationship developed
there and his suggestions were considered not to be relevant,
and therefore your question as to whether the District prepared
to do it is an important one because Mr. Clark's tenure is
running out and I'm not sure who then is to be the expert,
except that the city is going to have to hire some experts. Mr.
Washington has already said they're going to have to hire a
physician to help them monitor it, whereas I wanted something
off the shelf, because we sure paid a lot for what we are
getting back here.
Mr. Davis. And I don't want to dwell on what we paid. I
think we have been through that. We don't need to beat a dead
horse.
The bottom line is we took an agency here that was in awful
shape, terrible shape, and that at least has turned around.
Fundamentally, that's what the task was. That's what the court
wanted to do. I just don't think we need to go back on all the
money that was spent and those kind of issues. I don't think
that serves any purpose except transitioning now. The city has
to have a little bit more than just taking it over, and ``we
think we can do it.'' They've got to show some vision. They
need to show some accountability. That's what we're going to be
waiting to see, and we're going to watch it very closely.
Ms. Norton.
Ms. Norton. Well, I just want to be clear that what the
chairman said about the appropriation hearing--and I mentioned
it before--is a shot across the bow. There is no question that
if the Council gets these costs there will be many questions
raised, and the time to deal with them is now.
Mr. Shansky, what is your current position?
Dr. Shansky. With regard to the District?
Ms. Norton. No. Your full-time position?
Dr. Shansky. I consult on correctional health care around
the country, both----
Ms. Norton. What was your professional position before
that?
Dr. Shansky. I was the Medical Director of the Illinois
prison system.
Ms. Norton. I asked because I thought that was your
position. I certainly regard you as an expert, and I certainly
accept the notion that these services have been reformed and
meet Constitutional standards. I would hate to think that they
hadn't at this point.
Apparently, appropriate services or similar services are
being provided in the State of Illinois Correction Department,
at only 63 percent of the national average, $4.80, compared to
$7.68. I can't understand why some of that expertise, where in
Illinois you are below the national average, wasn't brought to
bear here in the District of Columbia so that we not only got
it fixed but got it fixed at costs comparable to what
apparently you have contributed to in Illinois.
Dr. Shansky. The Illinois numbers you are referring to are
our prison system. This is a jail. The services designed to be
provided at this jail are unique in terms of certain
responsibilities. We have brought the budget down and it is now
in a position where the Department and the city administration
will tailor it in any way it chooses. And the fact is that I
had 12 years of opportunity to work with the Illinois
Department of Corrections and create the system that I left
there.
Ms. Norton. And you had 5 years here. And if we took mental
health services out, for example, we are still left with twice
the national average.
The outside experts said, ``Nowhere in the country are we
aware of a facility of comparable size that has such a top
echelon of staff who are not also significantly involved in
direct patient care. With these salaries, with a medical
director of $192,857, the Mayor should resign and take this
job,'' on down. And these salaries are very high.
Dr. Shansky. Those are not salaries. That's salary plus
fringe.
Ms. Norton. We say salary plus fringe.
Dr. Shansky. You just said salaries.
Ms. Norton. Well, it says salary plus fringe.
Dr. Shansky. OK. thank you.
Ms. Norton. The point is that they are compared, however,
with facilities of comparable size.
I point this out only to say, and certainly to say to Mr.
Christian and Mr. Washington, if I'm pointing this out to the
receiver, you can bet your bottom--I don't know if you speak
for the Mayor. Do you, Mr. Washington, when you say you are
satisfied with this contract?
Mr. Washington. I'm satisfied with the services that have
been provided for the D.C. Department of Corrections to
remediate a 30-year court oversight.
Ms. Norton. Yes. I----
Mr. Washington. I'm confident that----
Ms. Norton. This is not about that, sir. We're not doing an
oversight hearing on the services, and we haven't questioned
the quality of the services. The City Council is not going to
be asking you about the services. They're going to be asking
you about the cost of the services. I'm asking if you are
speaking for the Mayor when you say you are satisfied with the
cost of the services, not the quality of the services. No
question has been raised about the quality of the services.
Mr. Washington. I've never said I was satisfied with the
cost of the service. I'm satisfied with the services. I believe
very strongly that the costs will continue to go down, and I
also feel very strongly that----
Ms. Norton. Are they automatically going to go down? What
are you going to do to bring the cost down?
Mr. Washington. We are going to evaluate all the services
that have been provided. We will have staffing positions, and I
will provide a plan to this committee to show exactly how the
Department of Corrections will be prepared to take over this
contract and further reduce costs.
Mr. Davis. Let me just say in the next 10 days you are
going to give us an outline. It doesn't need to be detailed,
but just kind of a path.
Ms. Norton. That would be very helpful.
Mr. Davis. I don't know how you want to do that.
Ms. Norton. That will be very helpful.
Mr. Davis. And rather than try to sit here and go off the
top of your head, we'd rather have you go back and do something
that is a little reflective and send it back.
Ms. Norton. My concern, Mr. Chairman, is that these costs
will go down. Costs never go down. You've got to make costs go
down.
Costs always go up, Mr. Washington. Making costs go down or
maintaining quality is an art, and it is going to take real
craftsmanship to do that, given the level of cost here.
Mr. Shansky, I note that your own requirement will be that
the contractor of these very same services you have designed
now go forward and get accreditation. Why did you not get
accreditation, since you've had them for 5 years?
Dr. Shansky. First of all, I sit on the board of the
National Commission on Correctional Health Care.
Ms. Norton. You can recuse yourself, just as you could have
with respect to the procurement.
Dr. Shansky. Would you like my answer?
Ms. Norton. Don't tell me it is because you sit on the
board. Is there a reason other than a reason that you could
have easily been released from why you didn't ask for
accreditation to be--so that you could have handed us back
fully accredited services.
Dr. Shansky. Would you like an answer?
Mr. Davis. Yes. Give us the reason why you didn't get it.
Dr. Shansky. The reason why we didn't go for accreditation
was very simple: the accreditation process, when we talked with
the District, was something that the District wanted to do and
to take responsibility for. An accreditation of a receiver
program has nothing to do with whether the program run by the
District is accredited, and we decided jointly with the
District to wait for that accreditation process until the
District had responsibility, and that's why it was written into
the contract as well as the RFP that by the end of the contract
year the vendor would achieve accreditation.
Am I confident that we could have achieved accreditation?
Unquestionably. I have also been a surveyor for the Joint
Commission on Accreditation of Health Care Organizations and
have surveyed 20 of the Federal Bureau of Prison facilities. I
know how to achieve accreditation. I don't think it proves much
when I achieve accreditation.
Ms. Norton. Well, one thing it might prove is that we
really do have a level of services that anybody can have
confidence in.
I think you should be given the opportunity to reply to the
way in which the Board of Contract Appeals regarded the
procurement. Apparently the D.C. Contract Appeal Board says,
``There appears to be little question that, in accordance with
generally accepted government procurement practice, the initial
late proposal of the bidder, the person who was successful, was
improperly handled. The proper procedure would have been to
hold the proposal unopened, apparently because it was late.''
They also say that you restricted access by other bidders
to your current employees, even though they had information
that should have been made available to all offerors. That's
from the Appeals Board. They say you gave no basis for your
statement that the proposal of your employees was dispatched in
time, and they go on to say the record is clear that the
proposal was not dispatched at a reasonable time.
``Regardless of the correctness of the decision, the
failure of the receiver to make a written finding supported by
a record as to his reasons for considering a late proposal
gives the appearance of impropriety.''
I think it is only fair that you be allowed to respond to
that.
Dr. Shansky. Thank you.
First of all, I put into the RFP a time deadline to ensure
that no vendor would be advantaged by having more time to work
on their proposal. When I was informed by my consultant that
one proposal was received late, I asked the circumstances. I
was told that the vendor had arranged to fly--deliver the
proposal to Atlanta, where the proposals were to be received.
The vendor's roughly noon flight was canceled, was delayed,
then the next one was canceled. They put the proposal on Delta
Dash. The electrical storms in Atlanta then knocked out the
computers, so Delta Dash couldn't find it for 6 hours. To me
that seemed like no situation in which any vendor was
advantaged. The proposal was finished well in advance for
delivery several hours in advance of the deadline.
I also felt that it was in the District's interest to have
three proposals considered rather than two.
I was advised later on that, according to CAB decisions,
any deadline can be extended, even in the event of a late
proposal, if it is for the purpose of expanding the scope of
competition and especially where the number of proposals is
small and where there is no unfair advantage.
I felt all of those things obtained.
The reality is we ended up, because we had to amend the
contract because the offsite service situation was a problem
and was not going to be in the District's interest, we ended up
amending the RFP anyway and sending out a new one. All vendors
had a completely fair and open process.
Look, the reality is one of the vendors, the vendor who
protested, in fact, had my CFO working with them, so they had a
person who knew more about my finances and salaries than any of
the vendors. That's No. 1. So, in terms of them being
disadvantaged, it's just not true.
Second of all, all of the salaries and budgets were
available. They're filed with the court. Anyone had access to
them.
The third thing is some of the other vendors proposed
leadership people that were similar to the or the same as the
group who had actually ultimately won the contract. We provided
more data with regard to services, types, utilization, costs,
etc., than in any RFP I've ever seen. This was as open and
competitive a process--and remember, the committee that did the
evaluation and made the recommendation was not created by me. I
had no say in who was appointed and I had no contact with that
committee during their deliberations. So the recommendation
came completely independent of anything that I had to do with
it.
Ms. Norton. At bottom finally let me say I think the fact
that the costs found in this contract are out of line with any
comparisons that we have been able to come up with or anyone
else has been able to come up with and no cost comparisons were
made by you, if, in fact, even with the difficulty of making
such comparisons, such attempts had been made, I believe that
we probably would not be sitting here today, because we have
fully accepted the notion that it is very, very difficult to
make those comparisons. What we cannot accept is that no
attempt should be made; that attempts have to be made by other
agencies of the District of Columbia, but not by the Department
of Corrections when it comes to the D.C. jail.
I was particularly interested to read in Mr. Clark's
testimony that he had offered to provide examples of RFPs from
the BOP--and here I am looking at page 11 of his testimony--
awarding a similar medical service contract for its four-prison
complex in Beaumont, TX, at a rate of under $6 a day, and the
offer was declined. You see, that is what we cannot understand.
I don't know why you, Mr. Shansky, or you, Ms. Schneider----
Dr. Shansky. I never received such an offer.
Ms. Norton. Well, it is in his testimony.
Dr. Shansky. Well, he can testify, but I never----
Ms. Norton. He said the offer was declined.
Dr. Shansky [continuing]. Received such an offer.
Ms. Norton. What do you have to say to that, Mr. Clark? At
bottom, this is my concern: that nobody looked to see what
anybody else was doing, not necessarily that you cost more.
Dr. Shansky. I have looked at prisons and jails in between
30 and 40 States, between 100 and 200 facilities. There is no
one with more experience looking at facilities and issuing RFPs
in the country than me.
Ms. Norton. And we haven't found a single one at the cost
you have left the District with.
Now, Mr. Clark, you say the offer was declined. What does
that mean?
Mr. Clark. This was an offer that I made in the course of
meetings during the 6-months that was referred to in the
preparation and detailing of the RFP, I think going back to
some time in 1998, in meetings with a number of the parties in
that process that was mentioned.
Ms. Norton. Clearly what we didn't have here was the kind
of collegial relationship you say you had with the District
government. We needed it with you to do that. I really am
tough, but I'm tough because it is better for me to be tough
than the folks you all are going to meet next year, and because
I think that this still can be done.
I want to say first, as one whose former life was as a
Constitutional lawyer, spent her early years doing nothing but
writing briefs to Courts of Appeals and to the Supreme Court on
cases not unlike the case before us, that I do not want to be
misunderstood as to the job you had before you or the lack of
respect I have for the District of Columbia for what it took to
finally get this thing under control, and that they,
themselves, did not get it under control and it took outside
experts to do so.
I believe that the District is ready to receive this
function back, but I don't believe it because of anything I've
heard from Mr. Washington or Mr. Christian here today. I
believe it because I know the way the Mayor is right-sizing the
rest of the government. I know that in some detail. I have seen
what he has required of his department heads. I know that, in
taking this back, he will put on the task experts that will, in
fact, right-size this while keeping the quality necessary. I
say that because there is precedent for his doing it.
At the same time, I must say that I regret that the city
will have to spend money on the cost control, and cost
efficiency aspects of the medical jail receivership. This
should have been part and parcel of what the medical receiver
gave us back. I hold not only Dr. Shansky responsible for that.
It is hard to hold him entirely responsible because he acted
the way that doctors always act. I hold Ms. Schneider
responsible for that, since she was to mediate. When she saw
that Mr. Clark, an outside expert who didn't have a dime in
this dollar except he was commissioned by us to make sure that
this was cost efficient, it was your job as the mediator, a
role you have defined for yourself, to bring Mr. Clark
sufficiently into this so that there would be cost controls, to
help Mr. Washington and Mr. Christian understand that this was
not a stick-up, that they had to do whatever Shansky said or
else they didn't get it back, and to do for Dr. Shansky what
managers are having to do for doctors all over the country. It
is very painful, but unless we do it this way what we will say
is that those who already have health care can eat up all the
health care dollars and those such as the residents of the
District that the Mayor is going to have to get health care for
simply get left out in the cold.
Yes, I think you are ready, but I think you are ready
largely because of the management structure of the D.C.
government, not because of anything I've heard here today.
Thank you, Mr. Chairman.
Mr. Davis. Thank you, Ms. Norton.
We have 10 days to hear from you, Mr. Washington and Mr.
Christian.
Anyone want to add anything? I don't want anybody to feel
they didn't get the last word, if they wanted to make a
comment.
[No response.]
Mr. Davis. I'm going to enter into the record a briefing, a
memo distributed to the subcommittee members.
We'll hold the record open for 2 weeks from this date, for
those who might want to forward any other submissions for
possible inclusion.
I want to again thank all the witnesses for taking the time
to come today and for your dedication to this.
These proceedings are closed.
[Whereupon, at 12:27 p.m., the subcommittee was adjourned.]
[Additional information submitted for the hearing record
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