U.S. GOVERNMENT PRINTING OFFICE

72–581 DTP WASHINGTON : 2001

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

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

(II)

COMMITTEE ON GOVERNMENT REFORM

DAN BURTON, Indiana, Chairman

BENJAMIN A. GILMAN, New York

CONSTANCE A. MORELLA, Maryland

CHRISTOPHER SHAYS, Connecticut

ILEANA ROS-LEHTINEN, Florida

JOHN M. MCHUGH, New York

STEPHEN HORN, California

JOHN L. MICA, Florida

THOMAS M. DAVIS, Virginia

DAVID M. MCINTOSH, Indiana

MARK E. SOUDER, Indiana

JOE SCARBOROUGH, Florida

STEVEN C. LATOURETTE, Ohio

MARSHALL ‘‘MARK’’ SANFORD, South

Carolina

BOB BARR, Georgia

DAN MILLER, Florida

ASA HUTCHINSON, Arkansas

LEE TERRY, Nebraska

JUDY BIGGERT, Illinois

GREG WALDEN, Oregon

DOUG OSE, California

PAUL RYAN, Wisconsin

HELEN CHENOWETH-HAGE, Idaho

DAVID VITTER, Louisiana

HENRY A. WAXMAN, California

TOM LANTOS, California

ROBERT E. WISE, JR., West Virginia

MAJOR R. OWENS, New York

EDOLPHUS TOWNS, New York

PAUL E. KANJORSKI, Pennsylvania

PATSY T. MINK, Hawaii

CAROLYN B. MALONEY, New York

ELEANOR HOLMES NORTON, Washington,

DC

CHAKA FATTAH, Pennsylvania

ELIJAH E. CUMMINGS, Maryland

DENNIS J. KUCINICH, Ohio

ROD R. BLAGOJEVICH, Illinois

DANNY K. DAVIS, Illinois

JOHN F. TIERNEY, Massachusetts

JIM TURNER, Texas

THOMAS H. ALLEN, Maine

HAROLD E. FORD, JR., Tennessee

JANICE D. SCHAKOWSKY, Illinois

———

BERNARD SANDERS, Vermont

(Independent)

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

STEPHEN HORN, California

JOE SCARBOROUGH, Florida

ELEANOR HOLMES NORTON, Washington,

DC

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

(III)

C O N T E N T S

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

(1)

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.

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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

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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 costeffective 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 Antideficiency 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

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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

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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

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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

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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.

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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

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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

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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 21⁄2 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.

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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.

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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?

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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

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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 quasijudicial 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

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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.

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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.

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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——

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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?

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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.

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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——

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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,

159

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

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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

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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.

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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.——

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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

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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.

165

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.

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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.

167

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 fiVerDate 11-MAY-2000 08:54 Jul 11, 2001 Jkt 000000 PO 00000 Frm 00171 Fmt 6633 Sfmt 6633 C:\DOCS\72581.TXT HGOVREF1 PsN: HGOVREF1
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nancial 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

169

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

170

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

171

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 recVerDate 11-MAY-2000 08:54 Jul 11, 2001 Jkt 000000 PO 00000 Frm 00175 Fmt 6633 Sfmt 6633 C:\DOCS\72581.TXT HGOVREF1 PsN: HGOVREF1
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ommendation 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

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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 follows:]

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