In 1999, 38-year-old Thomas Pizzuto was beaten to death by two guards at the Nassau County jail because he would not stop begging for methadone.

The heroin addict was serving a 90-day sentence for driving while impaired, according to media reports at the time.

Pizzuto’s death came only days after he entered the facility, kick-starting an investigation and civil rights lawsuit by the U.S. Dept. of Justice that put the spotlight on the quality of inmate health care in the county.

Allegations by the justice department included deliberate indifference to inmate medical needs; medical care by unlicensed and untrained staff; failure to provide routine and acute medical care in a timely manner; and failure to adequately manage medication and medical records.

A resulting settlement agreement with the justice department required improvements to health care at the violation-plagued jail, despite costs that were double Westchester County’s per capita inmate health-care costs.

More than a decade later little has changed, according to an audit by Nassau County Comptroller George Maragos, and an ongoing investigation by the New York Civil Liberties Union that alleges improper health-care practices put inmates risk.

On May 14, Florida-based Armor Correctional Health Services of New York Inc. took over in-jail services from Nassau Health Care Corporation, which operates Nassau University Medical Center, a skilled nursing facility, and five medical clinics.

The two-year Armor contract will save the cash-strapped county $11.5 million by the end of 2012, according to Nassau County Executive Edward Mangano.

County officials say they are hopeful that health care at the jail will improve – and the county will save money – with the Armor contract that will cost $11.28 million for 2011-2012, plus other expenses.

Inmate Ailments Ignored?

Nassau Health has close ties to the county. Their board is appointed by elected officials, their debt is guaranteed by Nassau, and their employees are public.

The nascent public benefit corporation held its first board meeting in Sept. of 1999, three months before Pizzuto’s fatal beating, after the county terminated day-to-day management of Nassau University Medical Center hospital.

Since last fall, the ACLU has gotten complaints about medical care at the jail from approximately 60 inmates that all revolve around improper management of medication, and a lack of follow-up and specialty care, said Samantha Fredrickson, an attorney and director of the Nassau County Chapter of the New York Civil Liberties Union.

Like the glaucoma patient who requires regular medication to avoid a buildup of pressure in his eyes that can lead to blindness.

“He complained to us he would go weeks at a time without receiving them,” Fredrickson said. “He ended up having to be rushed to the emergency room twice in a two-month period because he wasn’t receiving his medication. This was substantiated by his medical records.”

Another inmate talked about wanting to commit suicide. After a brief interview with staff he was released back into general population, at which point he jumped off a second-floor balcony.

If inmates at the Nassau County jail have not been receiving proper medical care in a timely fashion, it is difficult to tell who is responsible.

Fredrickson said blame might belong with corrections and Nassau Health.

It is a question she said she wants to resolve.

The ACLU recently filed a lawsuit against Nassau County for failing to release records related to inmate medical care.

“From what we hear and from what we know, there is definitely a problem with high-level staff,” Fredrickson said. “The nurses in the jail write in their notes, ‘this person needs specialty care.’ Then why aren’t [inmates] going?”

A Cost Saving Contract

The Armor contract does not put Nassau Health out of the inmate health-care business entirely.

The hospital will continue to provide emergency services, inpatient, and specialized health care, with the aid of an underground tunnel that leads from the jail to the hospital.

Armor will provide dental, medical and psychiatric care inside the jail.

The Armor contract was recently approved by the Nassau Interim Finance Authority, the board that took control of Nassau’s finances after finding it had a $176 million deficit. NIFA must approve all county contracts over $50,000.

To avoid excessive inpatient services, cost control measures include criteria for hospital referrals; performance indicators and measurements with financial penalties for failure; and a cost sharing agreement whereby Armor will absorb 60 percent of the cost of off site services above a maximum of $750,000, said Brian Nevin, a spokesman for Mangano.

Financial Mismanagment?

Jerry Laricchiuta, president of CSEA Local 830, the union that represents jail-dedicated medical personnel, said inmate health care costs rose due to unnecessary emergency room visits.

“They didn’t staff the jail with enough doctors 24 hours a day,” Laricchiuta said.

He said too few doctors meant expensive trips to the emergency room for minor issues, with each inmate accompanied by two corrections officers who might require overtime pay.

Audits by the Nassau County comptroller in 2002 and 2011 both found problems with Nassau Health billing and reporting practices that drove up costs for the county, which approached $18 million each year for inmate health care. While the 2002 audit focused on inmate medical care, the 2011 audit evaluated general patient billing practices. In both instances, the county recommended changes.

Nassau Health was in the black for the first time in 2009 by a little more than $800,000, but it might have missed out on funds that equals nearly half its 2009 profit.

The 2011 audit found Nassau Health lost out on at least $3.5 million due to pre-billing errors and missing patient registration information. In response, Nassau Health cited a much lower figure of $391,000.

Worried About the Future

Lariccchiuta was concerned that turning over in-jail medical care will not improve health care there.

“Considering all the history there, and the suicides, and the DOJ citation, we shouldn’t be looking to scale back health care, but we are,” said Laricchiuta, referencing the four inmates in one year who committed suicide at the jail.

Fredrickson said she also worried that medical care could further deteriorate under Armor’s watch.

“Everything always comes back to money, right?”

The corporation had dozens of pending lawsuits filed against them in Virginia and Florida, according to federal court records, but Armor spokeswoman Yeleny Suarez said there is no cause for concern.

“Armor has never had a judgment entered against it and its malpractice premium continues to decrease while the inmate population it services continues to grow,” Suarez said. “In addition, Armor’s litigation rate is well below the national average.”

Armor hired 40 or 50 Nassau Health employees.

Shelley Lotenberg, a spokeswoman for Nassau Health, said it was too soon to tell what would happen to the rest of the approximately 60 other employees dedicated to the jail.

Nassau County Legislator Wayne Wink (D-Roslyn) said he was concerned by both cost and the quality of medical care by Armor, whose contract was approved in a vote of the Rules Committee rather than the full Legislature.

“It seems to me when you are talking tens of millions of dollars, it certainly sounds as though it is a contract that would warrant approval by the whole Legislature,” said Nassau County Legislator Wayne Wink (D-Roslyn), a member of the rules committee.

Wink said the process left uncertainty regarding the expense to the county of medical equipment purchases.

“Whether it’s purely out of concern for inmate health care or out of concern for the financial heath of the county, at the end of the day there has to be concern with respect to what health care is being offered to inmates,” Wink said.