Committee chairman Roger Katz, a Republican senator from Augusta, said he couldn't see a reason, given Corizon's performance, why it should be allowed to bid on the contract. In an interview Ponte said he didn't know how he could exclude Corizon from bidding. But, he added, "We have their history."

Ponte also has assigned employees to monitor inmate care. Only "medically necessary" care will be allowed. This is a major way he expects to bring down costs.


Change brings resistance

On its face, "medically necessary" is hard to argue with. But its implementation is proving to be controversial.

Knee-replacement or shoulder-repair surgery, for example, will only be allowed if the prisoner can't function with the injury, even if he's in pain. And the same minimalist philosophy will be used with prescription drugs, including painkillers.

Ponte is particularly eager to reduce narcotic painkillers, though substitutes will be offered, if needed. He told the committee of one inmate who had been on Oxycontin for five years. Reducing narcotics could reduce longstanding drug abuse and trafficking problems in the prisons.

Inmates and prisoner advocates are worried, however, that cost-cutting will trump legitimate medical needs, especially in the alleviation of pain. Kim Robbins, a nurse whom Ponte has appointed health services coordinator, told the committee that reducing opiates has provoked "pushback."

It's not just the reduction of opiates that's a problem. An inmate at the women's prison in Windham wrote Judy Garvey of the Maine Prisoner Advocacy Coalition about her fear of having her psychiatric medication changed: "This is the first time in my entire life I have actually felt completely mentally stable. Now I am being taken off of something that has helped me rehabilitate and learn."

By all accounts, prisoners' legitimate medical needs are enormous. Many convicted criminals, who are overwhelmingly poor, enter prison with long-neglected medical conditions. Then within the prison, inmates claim, bad care exacerbates their difficulties.

In a letter to OPEGA, Maine State Prison inmate Richard McEachern suggested why prison care was so costly: "Could it possibly be because of poor-quality medical care which does not treat medical conditions until they become so acute that it costs three or four times what it would have cost had the medical malady been treated in a timely fashion?"

Although at the committee meeting Ponte criticized much that had gone on in the past, in interviews he defended current care.

"I probably get two or three letters a day on medical stuff," he said. "Historically, I'm told, the inmate who complained a lot eventually would get whatever they were complaining about, and that may not be the best medical care. The medical department throughout the agency now is making better decisions about what's medically necessary."

Lack of staff has been a recurrent complaint about prison medical services, especially in the state prison's Mental Health Unit. Ashcroft told the committee that medical "staffing has been an issue." But Ponte said staffing is adequate, though he is hiring an additional mental-health employee.


Balancing reforms and cost

Cost inevitably looms large in Ponte's mind. While undertaking reforms, he is under the gun of a tight-fisted Republican governor, Paul LePage, and a Republican Legislature. His position requires delicate balancing.

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