The Questionable Business of Correctional Healthcare

Medical Claims and Malpractice at a West Texas Immigrant Prison


(This is the third and final article in a series on medical care at the immigrant prison in Pecos. The first two are Medical Claims and PNA’s Medical Gulag.)


Tom Barry
February 20, 2009


The mounting number of deaths of imprisoned immigrants over the past few years has highlighted the government’s deeply flawed response to the immigration crisis. The medical gulag of immigrant detention has also underscored the increasing privatization of America’s prison system and the consequent problems.


Recent prisoner protests over deficient medical care at a West Texas detention center for “criminal alien residents” underscores the severity and persistence of the human rights problems associated with the massive incarceration of legal and illegal immigrants. Investigative reports by the New York Times and the Washington Post have documented the medical services scandal that wracks the immigrant detention system.


However, the complicated character of America’s new private/public prison complex – which brings together federal agencies with local governments and a welter of private contractors and subcontractors -- has led to a lack of clarity about who is primarily responsible for the humane care of imprisoned immigrants.


Reflecting the federal government’s new immigration enforcement policy, immigrants (both legal and illegal) are being imprisoned for violations of immigration laws. The new policies criminalizing illegal immigration and visa overstays have flooded the judiciary and penal systems. The combination of the immigrant crackdown and the jailing of drug-law violators has been a boon to the private prison industry, which holds most federal prisoners in privately operated or privately owned detention centers.


An array of prison industry contractors are prospering as the result of federal and local government contracts to hold and care for prisoners and detainees that are technically under government custody. This is the case at the Reeves County Detention Center, a county-owned prison complex that lies on the outskirts of the downtrodden town of Pecos in West Texas.


Immigrants imprisoned there repeatedly protested the quality of medical care in December through early February. The death of an ill inmate in solitary confinement sparked the first protest on Dec. 12.


Although it is Reeves County that owns the prison and the Federal Bureau of Prisons that is the legal custodian, the immigrant inmates are in the day-to-day care of two private contractors. GEO Group runs and manages the detention center, while Physicians Network Association is contracted to provide medical services.


PNA was founded in 1991 by Vernon “Trey” Farthing to provide medical services to the Lubbock County jail. Paralleling the growth of the private prison industry, PNA has become a business of 450 employees with two dozen medical services contracts in Arizona, New Mexico, and Texas. Dr. Farthing, a Lubbock physician, boasts that PNA is a “leader in correctional healthcare.”


Farthing and his associates oversee PNA’s small correctional healthcare empire from the firm’s headquarters in Lubbock. It also has offices in Raymondville, Texas where it provides medical services to the large immigrant detention center in Willacy County that is run by MTC.


Farthing’s connections to MTC extend back to its three-year stint as the main healthcare provider at the Santa Fe County Detention Center, which MTC operated. Farthing made occasional jailhouse visits to Santa Fe, traveling from Lubbock in the company’s jet.


When seeking the renewal of the Reeves County contract, PNA submitted a statement to the county commission declaring that it was “proud of its record of no substantiated grievances in any facility” and that it “never had a contract canceled or been removed from a facility.”


However, if the county commissioners had bothered to seek a second opinion they would have discovered a record of neglect and gross contract violations while working with MTC in Santa Fe. Both MTC and PNA dropped their contracts at the Santa Fe detention center in the wake of a Justice Department civil rights investigation that found that the pre-trial detainees “suffer harm or the risk of serious harm from deficiencies in the facility’s provision of medical and mental health care, suicide prevention, protection of inmates from harm, fire safety, and sanitation.” Rather than seeking to improve its medical care services at the jail, PNA pulled out of the contract with MTC and the county.


In an investigative report on the death of one inmate, “Dying In Jail,” the Santa Fe Reporter (April 2, 2003) recounted the medical neglect and faulty diagnosis leading to the death of Jimmy Villanueva. The article quotes the county’s jail monitor, Greg Parrish, as saying that the majority of grievances from both inmates and their families focused on lack of access to both care and needed prescriptions.


Villanueva who died in a local hospital from a metastasizing chest cancer that PNA hadn’t diagnosed arrived in the jail after the Justice Department investigators had left but according to the newspaper, “Villanueva’s case exemplifies what the DOJ and others have characterized as a health system that puts inmates at serious risk.”

This was not the first time that a county that contracted PNA for medical services at its jail found it subject to civil rights investigation and attendant lawsuits. In 1998 the Lubbock County jail overhauled its practices after two suicides and a civil rights suit filed by a former detainee. Jail officials told Lubbock’s Avalanche-Journal that they decided to revamp inmate screening and medical treatment procedures to better identify potentially suicidal or mentally ill prisoners.


Private Prison Firms and Providers


Correctional healthcare firms like PNA work closely with such private prison companies as Corrections Corporation of America (CCA), GEO Group, Management and Training Corporation (MTC), and Emerald Corrections. PNA contracts mainly with MTC and GEO Group, with which it has ten contracts (six of which are in Texas).


The close ties between the private prison companies and the correctional medical services firms are evident in one of the prison industry’s main promotional organizations, namely the Association of Private Correctional & Treatment Organizations.


PNA Vice President Jean Brock is the new president of APCTO, which says it “represents the interests of organizations that provide an increasingly broad array of correctional and treatment services.” Over the past three years, APCTO’s leadership has included the executives of the major private prison firms -- CCA, GEO Group, Emerald, MTC, and Cornell Companies) as well the executives of such correctional healthcare firms as PNA, Correct RX Pharmacy Services, and Addus Healthcare.


Better Care Inside than Outside the Prison


In Pecos, inmate complaints about healthcare are commonly dismissed as whining and grandstanding. “They don’t have to work, they have all their utility bills paid, they get to play five hours a day, and plus they get medical attention,” said one county official. “If only the whole county should have it so good!”


When asked about the liability that the county may face if the inmates take their cases to court, County Attorney Alma Alvarez said she was not worried, noting that GEO and PNA had recently secured accreditation for the prison from both the American Correctional Association and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).


After visiting the prison herself, she said that she is confident the medical care is up to or above standards. But she acknowledged that she never spoke to any of the inmates about the quality of medical care, but only to the administration.


Concerning the prisoner complaints made during the riots, Alvarez said, “They want to be media stars. They call the media from their cellphones and tell these stories because they want to be famous. It’s like they want to be on American Idol.”


Noting that she was of immigrant origin herself, Alvarez said she had little sympathy for the protesting prisoners. “They are living well in there. Just imagine if they were in prison across the border in a Mexican prison,” she exclaimed.


But it’s the comparison to conditions just outside the prison that really annoys the county attorney. “Inside the prison they are getting medical care far superior to what most people of this county get,” she observed. “And they even want dental care! Go and ask people here in Reeves County when they last had their teeth cleaned.”


What also bothers Alvarez and many Reeves County residents is that the rioting inmates were destroying county property that they the taxpayers would need to pay for. “This is going to cost us,” said county treasurer Linda Clark. “It will take away from the small profit we make on the prison.”


The multi-million contract with PNA doesn’t seem to bother the county. Before 2002 the county subcontracted with local care providers and foreign medical graduates (FMGs) to meet its obligations under its contract with the Bureau of Prisons. However, concerned about mounting costs and worried about the renewal of the BOP contract, the county hired PNA to assume responsibility for all medical, psychological, and dental care.


That contract is now costing the county nearly $8 million a year in addition to the $800,000 it pays in medical liability insurance. That’s a large sum in a country where one in three lives in poverty, and the total county budget is only $79 million.


Reeves County pays PNA $5.85 per day per inmate for its services. While few county residents are aware of what they are paying in correctional healthcare, there appears to be widespread resentment that immigrant prisoners are getting better care then they as U.S. citizens and county taxpayers receive.


GEO Corp and PNA have refused to comment on inmate complaints about the poor quality of correctional healthcare at the immigrant prison, and some two-hundred prisoners and their families vow to take legal action against the public/private prison complex.


Tom Barry directs the TransBorder Project of the Americas Program ( at the Center for International Policy in Washington, DC. He blogs at