<DOC> [106th Congress House Hearings] [From the U.S. Government Printing Office via GPO Access] [DOCID: f:72581.wais] BEYOND COMMUNITY STANDARDS AND A CONSTITUTIONAL LEVEL OF CARE? A REVIEW OF SERVICES, COSTS, AND STAFFING LEVELS AT THE CORRECTIONS MEDICAL RECEIVER FOR THE DISTRICT OF COLUMBIA JAIL ======================================================================= HEARING before the SUBCOMMITTEE ON THE DISTRICT OF COLUMBIA of the COMMITTEE ON GOVERNMENT REFORM HOUSE OF REPRESENTATIVES ONE HUNDRED SIXTH CONGRESS SECOND SESSION __________ JUNE 30, 2000 __________ Serial No. 106-229 __________ Printed for the use of the Committee on Government Reform Available via the World Wide Web: http://www.gpo.gov/congress/house http://www.house.gov/reform ---------- U.S. GOVERNMENT PRINTING OFFICE 72-581 WASHINGTON : 2001 _______________________________________________________________________ For sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: (202) 512-1800 Fax: (202) 512-2250 Mail: Stop SSOP, Washington, DC 20402-0001 COMMITTEE ON GOVERNMENT REFORM DAN BURTON, Indiana, Chairman BENJAMIN A. GILMAN, New York HENRY A. WAXMAN, California CONSTANCE A. MORELLA, Maryland TOM LANTOS, California CHRISTOPHER SHAYS, Connecticut ROBERT E. WISE, Jr., West Virginia ILEANA ROS-LEHTINEN, Florida MAJOR R. OWENS, New York JOHN M. McHUGH, New York EDOLPHUS TOWNS, New York STEPHEN HORN, California PAUL E. KANJORSKI, Pennsylvania JOHN L. MICA, Florida PATSY T. MINK, Hawaii THOMAS M. DAVIS, Virginia CAROLYN B. MALONEY, New York DAVID M. McINTOSH, Indiana ELEANOR HOLMES NORTON, Washington, MARK E. SOUDER, Indiana DC JOE SCARBOROUGH, Florida CHAKA FATTAH, Pennsylvania STEVEN C. LaTOURETTE, Ohio ELIJAH E. CUMMINGS, Maryland MARSHALL ``MARK'' SANFORD, South DENNIS J. KUCINICH, Ohio Carolina ROD R. BLAGOJEVICH, Illinois BOB BARR, Georgia DANNY K. DAVIS, Illinois DAN MILLER, Florida JOHN F. TIERNEY, Massachusetts ASA HUTCHINSON, Arkansas JIM TURNER, Texas LEE TERRY, Nebraska THOMAS H. ALLEN, Maine JUDY BIGGERT, Illinois HAROLD E. FORD, Jr., Tennessee GREG WALDEN, Oregon JANICE D. SCHAKOWSKY, Illinois DOUG OSE, California ------ PAUL RYAN, Wisconsin BERNARD SANDERS, Vermont HELEN CHENOWETH-HAGE, Idaho (Independent) DAVID VITTER, Louisiana Kevin Binger, Staff Director Daniel R. Moll, Deputy Staff Director David A. Kass, Deputy Counsel and Parliamentarian Robert A. Briggs, Clerk Phil Schiliro, Minority Staff Director ------ Subcommittee on the District of Columbia THOMAS M. DAVIS, Virginia, Chairman CONSTANCE A. MORELLA, Maryland ELEANOR HOLMES NORTON, Washington, STEPHEN HORN, California DC JOE SCARBOROUGH, Florida CAROLYN B. MALONEY, New York EDOLPHUS TOWNS, New York Ex Officio DAN BURTON, Indiana HENRY A. WAXMAN, California Melissa Wojciak, Staff Director Howie Denis, Professional Staff Member Victoria Proctor, Professional Staff Member Jenny Mayer, Clerk Jon Bouker, Minority Counsel C O N T E N T S ---------- Page Hearing held on Juen 30, 2000.................................... 1 Statement of: Ekstrand, Laurie, Director of Administration of Justice Issues, General Government Division, U.S. General Accounting Office; Ronald Shansky, M.D., corrections medical receiver; Karen Schneider, special officer for the U.S. District Court for the District of Columbia; Erik Christian, deputy mayor for public health and justice; and John Clark, District of Columbia Corrections trustee, accompanied by Odie Washington, director, District of Columbia Department of Corrections......................... 20 Letters, statements, etc., submitted for the record by: Christian, Erik, deputy mayor for public health and justice, prepared statement of...................................... 120 Clark, John, District of Columbia Corrections trustee, prepared statement of...................................... 128 Davis, Hon. Thomas M., a Representative in Congress from the State of Virginia, prepared statement of................... 4 Ekstrand, Laurie, Director of Administration of Justice Issues, General Government Division, U.S. General Accounting Office, prepared statement of................... 23 Morella, Hon. Constance A., a Representative in Congress from the State of Maryland, prepared statement of............... 15 Norton, Hon. Eleanor Holmes, a Delegate in Congress from the District of Columbia, prepared statement of................ 11 Schneider, Karen, special officer for the U.S. District Court for the District of Columbia, prepared statement of........ 45 Shansky, Ronald, M.D., corrections medical receiver, prepared statement of............................................... 35 BEYOND COMMUNITY STANDARDS AND A CONSTITUTIONAL LEVEL OF CARE? A REVIEW OF SERVICES, COSTS, AND STAFFING LEVELS AT THE CORRECTIONS MEDICAL RECEIVER FOR THE DISTRICT OF COLUMBIA JAIL ---------- FRIDAY, JUNE 30, 2000 House of Representatives, Subcommittee on the District of Columbia, Committee on Government Reform, Washington, DC. The subcommittee met, pursuant to notice, at 10:05 a.m., in room 2154, Rayburn House Office Building, Hon. Thomas M. Davis III (chairman of the subcommittee) presiding. Present: Representatives Davis, Morella, Horn, and Norton. Staff present: Melissa Wojciak, staff director; Howie Denis and Victoria Procter, professional staff members; David Marin, communications director/counsel; Jenny Mayer, clerk; Jon Bouker, minority counsel; and Jean Gosa, minority assistant clerk. Mr. Davis. Good morning and welcome. Today's hearing is the second in a series of oversight hearings examining the status of the D.C. agencies overseen by the court-appointed receivers. Currently, there are three agencies that are still in receivership, the Commission on Mental Health Services, the Corrections Medical Receiver for the District of Columbia Jail, and the Child and Family Services. Concerns about the delivery of services and managerial and financial practices in these agencies persists. The fourth agency in receivership is the District of Columbia Housing Authority, which has successfully recovered from mismanagement and is ready to be returned to the D.C. government's administration. Today the subcommittee is focused on the corrections medical receiver in the D.C. jail. The receiver was appointed 5 years ago by the U.S. district court in order to address Constitutional violations in the delivery of health care at the jail. It is scheduled to end in September 2000. The subcommittee wants to examine the status of D.C.'s progress in meeting its court-ordered obligations so the jail may be returned to the city's jurisdiction. Rampant problems in the D.C. jail were enumerated in two class action lawsuits filed in the city in the early 1970's, in Campbell v. McGruder and Inmates of D.C. Jail v. Jackson were filed on behalf of pretrial detainees and sentenced inmates. The plaintiffs' charged that the conditions and treatment of inmates in jail were unconstitutional. The two suits were consolidated and senior U.S. Judge William B. Bryant presided over them for nearly 30 years. The time line highlights key court actions and events concerning the D.C. jail. Through the years, Judge Bryant has issued orders requiring the D.C. government to rectify problems with the jail's medical services. Despite assurances from the city that the necessary changes would be implemented, nothing materialized. Instead, the D.C. jail left the medical services program to languish at below-Constitutional levels. In April 1993, finding the D.C. government in persistent noncompliance with his orders, Judge Bryant appointed a special officer to monitor and report on the city's progress on meeting its court-ordered obligations. The city, however, continued to ignore the orders and the deficiencies in the jail's medical services delivery persisted. The jail's suicide rate was out of control. In addition, the jail lacked an effective program to prevent the spread of infectious tuberculosis. On January 5, 1995, the court ordered the implementation of the initial remedial plan. It was designed by the special officer after extensive consultation with the plaintiffs and the defendants and the special officer's own medical and mental health experts. The plan addressed the most immediate and egregious problems with the delivery of medical services at the jail. It also provided the framework for major long-term changes to policies and procedures, staffing, and organizational structure. The initial remedial plan was never implemented. In fact, on June 5, 1995, 5 months to the day after the District was ordered to implement the remedial plan, inmate Richard C. Johnson died. Mr. Johnson was an aged patient in the jail's infirmary who had been neglected for several days by the medical staff. His death highlighted the city's failure to address the severe deficiencies in the delivery of medical services at the jail. Citing the physical danger that the D.C. government's continued blatant violation of the court's previous order was tragically causing, Judge Bryant placed the jail's medical and mental health services under court-supervised receivership. The receiver was ordered to implement the initial remedial plan. The D.C. jail medical services have improved significantly under the receiver, Dr. Ronald Shansky. Dr. Shansky's tenure has brought the jail remedial changes to increase the level of medical and mental health services to a Constitutionally acceptable level. In addition, the D.C. jail's tuberculosis epidemic has been controlled, HIV/AIDS cases are identified and treated, and qualified medical staff have been hired to improve the delivery of care. The receiver has successfully implemented a suicide prevention program to identify potentially suicidal inmates and provide them with the necessary prevention treatment. Despite these improvements in the delivery of health care, it is disturbing that the receiver is leaving the D.C. jail with exorbitant medical costs per inmate and high staffing levels. In both cases, the figures far exceed the national average. The court order creating the receivership essentially gives the receiver carte blanche to spend the District's money freely, without regard to sound financial practices and accountability to the D.C. government. Of course, it is important to provide a Constitutional level of medical and mental health services to D.C. jail inmates, but should the D.C. jail receivership accomplish this by spending at least two to three times the national average per inmate per day? Can a city emerging from bankruptcy really sustain this kind of expenditure? In addition, the receiver issued a request for proposal for a 1-year contract to manage the medical services at the jail once the receivership ends in September 2000. The contract was awarded to individuals who were employed by the receiver at the time the proposal was submitted, raising the specter of impropriety in the receiver's procurement process. The benefit of the RFP is questionable, since it requests bids that would maintain the same services at the jail and therefore the same cost, thereby perpetuating the already high costs that were expended under the receivership. D.C. government can't afford these inflated costs and D.C. taxpayers shouldn't be forced to foot the bill if there are other cost-effective alternatives. Today we will be looking at what reforms, if any, still need to be enacted to comply with the judge's order. Additionally, the hearing will focus on what resources are needed to maintain the reforms which have already been instituted and to enact any additional reforms required for compliance with the court order so that the jail may return to the city's jurisdiction. We will hear from GAO. We will hear from Dr. Shansky; the receiver, John Clark; the corrections trustee; Erik Christian, the deputy mayor for public safety and justice. Karen Schneider, the special officer appointed by the U.S. district court, who refused to testify, requiring this subcommittee to issue its first ever subpoena mandating her appearance. I would now yield to Delegate Norton for any opening statement she wishes to make, and then we will move right on to the witnesses. [The prepared statement of Hon. Thomas M. Davis follows:] [GRAPHIC] [TIFF OMITTED] T2581.001 [GRAPHIC] [TIFF OMITTED] T2581.002 [GRAPHIC] [TIFF OMITTED] T2581.003 [GRAPHIC] [TIFF OMITTED] T2581.004 Ms. Norton. Thank you, Mr. Chairman. I very much appreciate your initiative in calling this hearing and the way in which you have worked with me on this matter, in particular. Over a period of many years, the District of Columbia lost control over four agencies, but only after the courts had seen their orders violated for years. Judicial patience had justifiably run out. Medical services at the D.C. jail before us today were replete with violations and with inhumane conditions. Respect for even minimal levels of Constitutional rights compelled the action Judge William B. Bryant, a distinguished judge of the U.S. district court here, took to relieve the District of control of the medical function at the jail in 1995. Chairman Tom Davis and I, and the subcommittee, began our oversight of receiverships only in the wake of a precipitating event in one of the receiverships for which none of the actors, including the receiver, had any explanation or took responsibility, the death of an infant, Brianna Blackmond, committed to the care of the Child and Family Services Agency, under a receivership of the U.S. district court. Shortly after the infant died, Chairman Davis asked me to join him in requesting GAO investigations of all the outstanding receiverships in order to assure that accountability problems had not developed in the absence of regular public oversight to which city agencies in the District are subjected today. The Chair then commenced this series of hearings on the three receiverships that are still active, all of which have been subject to serious criticisms. Our own preliminary investigation has not been reassuring. We could not find evidence of significant use by our receivers of best practices of the kind required of District and Federal agencies, such as management and fiscal audits; procurement practices that foster fair and open competition; cost controls that reflect generally acceptable national or regional standards; or even Anti- deficiency Act requirements universally applicable to government agencies to prevent overspending of funds that are not authorized and available. With the chairman, I then introduced H.R. 3995, the District of Columbia Receivership Accountability Act. The House passed H.R. 3995 unanimously, and the bill will be marked up by the Senate Governmental Affairs committee shortly. Even before the GAO reports were in, it is clear that, at a minimum, receivers, their court monitors, and special officers who stand in the shoes of agency heads and their supervisors must operate at least at the standards required of those who have been ousted from control of the agencies involved. The agencies were removed from District control to achieve improvements and higher levels of accountability, beginning with the receivers and their supervisors, who, by definition, are setting the example for the District as to how the agencies are to be run in the future. All of the receivership agencies originally had severe operational and service problems, but the concerns that remain differ. The jail medical receivership now before us has shown sufficient operational improvements to be scheduled to expire in August 2000, at the end of 5 years, pursuant to the court order establishing the receivership. However, the cost associated with these improvements would be astonishing to taxpayers and to any public official charged with responsibility for taxpayer funds. The GAO investigation Chairman Davis and I have requested is ongoing and unfinished, but three outside experts who looked at the results have raised serious questions concerning cost and procurement practices. First, and most recently, the D.C. Board of Contract Appeals found that challengers to the receivers' RFP had not met the heavy burden necessary to divest the contract under D.C. law, even though the receivers' own employees, while still employed by the receiver, had been awarded the contract to provide future services. What was significant was the unusually strong language of the board, which wrote, ``While the receiver asserts that he took steps that no offer was unfairly advantaged or disadvantaged, and, in particular, the procurement was designed to encourage outside companies, as well as employee-formed groups to participate, such actions are not apparent.'' Second, the corrections trustee, a former assistant director for community corrections of the U.S. Bureau of Prisons, the largest in the country, has been charged by this subcommittee with assisting the entire corrections system with systemic management and financial reforms prior to the expiration of his tenure. In meetings with the receiver and the special officer, the corrections trustee repeatedly objected to the costs of the receivership and the RFP but was successful only in getting the cost lowered from $16 million to $12.5 million, a cost nearly three times the national average for medical services at jails in this country. Third, Faiver, Campau and Associates, reputable experts in the area of corrections health care, were commissioned by the corrections trustee to analyze the potential cost resulting from the RFP and winning bid. These experts found that the RFP issued by the receiver ``incorporates an administrative structure akin to that often found in a fairly large State corrections system rather than in a moderately sized jail.'' These experts concluded that ``Nowhere in the country are we aware of a facility of comparable size that has such a top echelon of staff who are not significantly involved in direct patient care.'' Confronted with cost figures so substantially above those found nationally and in similarly situated regional jurisdictions, and with sharply critical evaluations by outside experts, an explanation is necessary. This hearing is being held to give the receiver and the special officer the opportunity to respond and other witnesses the opportunity to elaborate and be questioned. Thus far, the only response regarding these costs we are aware of from the receivership are a letter from the special officer sent after I wrote to her about our concern, followed by a visit by the special officers receiver, and District correctional officials to my office for a meeting. In her letter, the special officer justifiably and appropriately warns of the difficulty of doing cost comparisons, but even so concedes that, using the available data, the costs of the contract issued by the receiver is almost twice the national average cited in the applicable surveys. She then cites the high administrative service cost which she asserts would not be found in the budgets of other jurisdictions. She also cites modifications that would reduce these costs to $12.92 per inmate per day, although that amount is still nearly twice the national average. I am in full agreement concerning all the problems associated with analyzing the data involved; however, today local governments and especially the District of Columbia, fresh from insolvency, no longer authorize the expenditure of taxpayer funds without even an attempt to justify costs in comparison to others with similar responsibilities. In the District, health care, in particular, requires our best effort at such attempts because more than 60,000 D.C. residents have no health insurance. Their health care continues to impose an enormous price on them, personally, on the health care indicators of residents, and on the D.C. government. A D.C. resident should not have to go to jail to get adequate health care and jail should not afford health care that far exceeds what is available to the average resident with and without insurance. The District government, which stands to inherit the costs of the jail medical receivership, has the task of meeting both Constitutional standards for the health care of people charged with crime and the health needs of ordinary citizens, most of whom are from families who work every day but must look to the District to design a way for them to meet basic health care needs. Ultimately, the District must take its responsibilities for both these sets of its residents more seriously than the city has in the past. I look forward to hearing today's witnesses and to approaching the issues before us as problems that can be solved with sufficient satisfaction to all concerned. Thank you, Mr. Chairman. Mr. Davis. Thank you very much. [The prepared statement of Hon. Eleanor Holmes Norton follows:] [GRAPHIC] [TIFF OMITTED] T2581.005 [GRAPHIC] [TIFF OMITTED] T2581.006 [GRAPHIC] [TIFF OMITTED] T2581.007 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:] [GRAPHIC] [TIFF OMITTED] T2581.008 [GRAPHIC] [TIFF OMITTED] T2581.009 [GRAPHIC] [TIFF OMITTED] T2581.010 [GRAPHIC] [TIFF OMITTED] T2581.011 [GRAPHIC] [TIFF OMITTED] T2581.012 Mr. Davis. I want to call now our panel of witnesses and supporting witnesses to testify: Ms. Laurie Ekstrand, the Director of Administration of Justice Issues of the U.S. General Accounting Office; Ronald Shansky, M.D., the receiver; Ms. Karen Schneider, the Special Officer for the U.S. District Court for the District of Columbia; Erik Christian, the deputy mayor for public safety and justice; and Mr. Odie Washington, director, District of Columbia Department of Corrections as a supporting witness; and, of course, John Clark, District of Columbia Corrections trustee. As you know, it is the policy of our committee that all witnesses and supporting witnesses be sworn before they can testify, so if you would rise and raise your right hands. [Witnesses sworn.] Mr. Davis. Thank you very much. To afford sufficient time for questions, if you'd try to limit yourself, we've read the testimony that has been submitted. We were here until 3 a.m., so we didn't have anything else to do. It doesn't always get read, but in this case it did. All written statements are going to be made part of the permanent record, so if you would try to dwell on the highlights that will give us time for questions and we can get you out of here earlier, as well. I'll begin starting with Ms. Ekstrand and then move to Dr. Shansky, Ms. Schneider, Mr. Christian, and then Mr. Clark. STATEMENTS OF LAURIE EKSTRAND, DIRECTOR OF ADMINISTRATION OF JUSTICE ISSUES, GENERAL GOVERNMENT DIVISION, U.S. GENERAL ACCOUNTING OFFICE; RONALD SHANSKY, M.D., CORRECTIONS MEDICAL RECEIVER; KAREN SCHNEIDER, SPECIAL OFFICER FOR THE U.S. DISTRICT COURT FOR THE DISTRICT OF COLUMBIA; ERIK CHRISTIAN, DEPUTY MAYOR FOR PUBLIC HEALTH AND JUSTICE; AND JOHN CLARK, DISTRICT OF COLUMBIA CORRECTIONS TRUSTEE, ACCOMPANIED BY ODIE WASHINGTON, DIRECTOR, DISTRICT OF COLUMBIA DEPARTMENT OF CORRECTIONS Ms. Ekstrand. Thank you, Mr. Chairman. I am very pleased to be here today to discuss several issues concerning the District of Columbia receivership contract for medical and mental health services at the D.C. jail. Without further ado, let me get right to the four issues that we were asked to review. The first one is cost. Our comparison of budget data for medical services at the D.C. jail and comparable facilities in Baltimore City and Prince George's County indicated that D.C. jail's per capita costs are higher. Indeed, the officials to whom we spoke during our review agreed that D.C. jail provided certain medical services and had staffing levels that exceed those of other facilities. Of course, this drives cost. In relationship to staffing, the inmate-to-staff ratios, as reported by the Office of the Corrections Trustee, is 13-to-1 at the D.C. jail, 74-to-1 in Baltimore, and 48-to-1 in Prince George's County. The fact that the D.C. jail provides fully staffed pharmacy and both mental and dental services onsite, whereas Baltimore and Prince George's County do not, provides some context for understanding some of the differences in the inmate-to-staff ratios. Most of the officials to whom we spoke cited the court- ordered remedial plan as the primary reason why the D.C. jail provides enhanced medical services and has higher staffing levels than other jurisdictions. The trustee, however--and I'm sure he will address this himself--feels that adequate medical services could be provided with fewer staff and at lower cost. The next issue you asked us to review concerned acceptable levels of care for jail inmates. We found that there is no single threshold that determines what an acceptable level of medical services is at the jail. According to experts, this is the case because the acceptable level is related to the medical circumstances and situations that need to be addressed. It can also be a function of specific constraints such as court orders placed on a specific jail facility. Accreditation standards have been developed by several organizations, including the National Commission on Correctional Health Care. These standards define minimum recommended medical service requirements for jail to voluntarily obtain accreditation. When a facility seeks accreditation, experts review a broad range of factors related to the health of inmates and facility-related issues to make a decision concerning accreditation based on the application of standards to the specific jail setting. The standards then cannot be used as a simple check list to assess whether a facility provides an acceptable level of medical care. You also asked us to look at the effects of the contracting process on medical service costs. As you know, the current contract maintains the level of medical services and staffing at the levels already in place at the D.C. jail, but the current contract can be modified at any time. In addition, it can be re-competed at its current or scaled-back levels of service and staffing when the base year ends in March 2001. The solicitation that resulted in the current contract requested that offerors submit proposals that would maintain existing levels of service and staffing. These were referred to as comparison proposals. According to officials we spoke to, the District sought to maintain existing levels of service to ensure that the receivership is successfully terminated in August 2000, and control of the jail is returned to the District. The solicitation also encouraged offerors to submit alternative proposals for providing health services differently or more economically than they were currently provided. The Evaluation Committee rated all of the proposals and determined that none of the alternate proposals provided specific enough information to ensure that they would maintain the same level of medical services as would the comparison proposals; thus, the final recommendation of the committee was to endorse a comparison proposal. The committee's recommendation was sent to the receiver, who selected the contractor. Finally, let me turn to the issue of whether the failure of the receiver's employees to resign from their positions prior to being awarded the contract violates D.C. law or regulations. Under District personnel regulations, a District employee may make an offer on a contract, but generally cannot be awarded the contract while still in D.C. employment status. The firm that was awarded the contract to provide medical services at the D.C. jail was constituted of employees working for the receiver, not for the District government, thus they were not subject to these provisions of District law. We would note that the D.C. Contract Appeals Board ruled in May 2000, on a protest by a losing offeror to this procurement. The protestor asserted that the receiver showed bias in favor of the awardee, which was a company formed by the incumbent medical director. The issue of employees' failure to resign prior to the award was not raised in this protest. The Board denied the protest, finding that there was not proof of bias sufficient to challenge the award; however, the Board noted that certain of the receiver's actions gave an appearance not conducive to confidence in the fairness of the procurement. This concludes my oral statement, and I would be glad to answer any questions you may have. [The prepared statement of Ms. Ekstrand follows:] [GRAPHIC] [TIFF OMITTED] T2581.013 [GRAPHIC] [TIFF OMITTED] T2581.014 [GRAPHIC] [TIFF OMITTED] T2581.015 [GRAPHIC] [TIFF OMITTED] T2581.016 [GRAPHIC] [TIFF OMITTED] T2581.017 [GRAPHIC] [TIFF OMITTED] T2581.018 [GRAPHIC] [TIFF OMITTED] T2581.019 [GRAPHIC] [TIFF OMITTED] T2581.020 [GRAPHIC] [TIFF OMITTED] T2581.021 [GRAPHIC] [TIFF OMITTED] T2581.022 Mr. Davis. Dr. Shansky. Dr. Shansky. I, too, would like to indicate I appreciate the opportunity to appear before you, and I will try to be brief. I have submitted my written statement to you, as you indicated. At the time the receivership was created, I was contacted, and only after several phone calls reluctantly agreed to accept the responsibility. One of the reasons I agreed was that the District wanted me to assume that responsibility. When I took over in September 1995, the jail was a very chaotic place. In fact, it was in some ways very frightening, not just to me but to the medical staff and to the officer staff, especially, and to the inmates. Numerous officers came to me indicating that they were concerned that if they got injured or something happened there would be no response. As a result of my concerns and my overwhelming sense of responsibility, I chose to stay in the jail. I took a cell and I stayed there in order to make sure that nobody died. Over the course of the next couple years, slowly but surely we were able to recruit a staff that was able to provide services consistent with my mandate, which was the previous court orders. The entire process that I have been involved in has been a collaborative one with the District. This has not been a receivership that has in any way forced anything down the throat of the District. Quite the opposite. The District wanted me to assume this responsibility. I took it. I never felt this was my program or the court's program, it's the District's program. I am a temporary housekeeper trying to put things in order. The District indicated to me that it wanted to maintain services after I departed through a procurement process with a contractor. I agreed to do a procurement and drafted an RFP in complete collaboration with corporation counsel's office, the Department of Corrections, plaintiffs, special officers, and with input from the trustee's office. In fact, this RFP was about 6 months in the drafting, with comments included in it from probably a total of 10 or 12 different individuals, most of whom were lawyers. The procurement selection process we were very careful about. We wanted to make sure that the evaluation was a fair and objective one. As a result, a committee was put together completely independent of me. I had no say on who sat on that committee. I had no say in who they selected to assist them in their evaluation process. My only suggestion was that that committee, when it was created, have a majority of District Department of Corrections appointed people. The committee met. The RFP--the proposals were evaluated, and ultimately a not-for-profit group created by employees was selected. I did my own evaluation and I concurred. This was the lowest bidder. For many reasons we thought that this would guarantee the best value for the dollars spent. With regard to is the District getting its bang for its buck, which is a very legitimate question, the process is set up, first of all, so that, literally beginning now, the District can begin negotiating with the vendor on a second year, and if it chooses to reduce some services, eliminate some services, change how it wants the services staffed, it is able to do that. With a not-for-profit vendor, the unexpended moneys will be returned to the District, just as I returned them over the previous 5 years. We have always come in under budget, and I have every reason to believe that this contract will also come in under budget. With regard to the issue of employees being able to submit a proposal, that somehow it is unfair, every procurement that I am familiar with, once you are in the second round of procurements, has an incumbent, and that incumbent is never excluded from participating because they currently have the contract. That's not the way contracting is done. This group, because it was a first time for them, was at certain disadvantages in terms of their skills at writing proposals, etc. The particular group that was selected partnered with an experienced for-profit company to handle fiscal management. I believe that the District and I believe the Department of Corrections believes that the District has gotten the best value it could out of its procurement process, and I look forward to the termination of my receivership, hopefully within the next 60 days, so I can get on to other things in my life, but also so that the District can then assume direct responsibility and make whatever modifications, changes it wishes to based on changes in disease, based on changes in responsibilities. For instance, the sentenced felons are supposed to be going to the Bureau of Prisons. When that happens one of the two mental health units will be able to close down and there will be a substantial savings of at least a half a million to $1 million. All of that is in process. When all of the prison inmates are ultimately sent to the Bureau of Prisons, there may be additional changes just based on that reality. So I have no doubt in my mind that over the next several years the budget and per capita costs of this particular contract are going to diminish significantly. I thank you for your time. Mr. Davis. Thank you very much. [The prepared statement of Dr. Shansky follows:] [GRAPHIC] [TIFF OMITTED] T2581.023 [GRAPHIC] [TIFF OMITTED] T2581.024 [GRAPHIC] [TIFF OMITTED] T2581.025 [GRAPHIC] [TIFF OMITTED] T2581.026 [GRAPHIC] [TIFF OMITTED] T2581.027 [GRAPHIC] [TIFF OMITTED] T2581.028 [GRAPHIC] [TIFF OMITTED] T2581.029 [GRAPHIC] [TIFF OMITTED] T2581.030 Mr. Davis. Ms. Schneider. Ms. Schneider. Mr. Chairman, Ranking Member Norton, and other Members, my name is Karen Schneider. I hold the position of the special officer, which is the special master, as that term is used in Federal rule of civil procedure 53. Judge William Bryant of the U.S. district court for the District of Columbia appointed my predecessor, Grace Lopes, to the position of special officer in 1993 for the purpose of assisting the court in the consolidated action captioned Campbell v. McGruder and Inmates of D.C. Jail v. Jackson. In Campbell, Judge Bryant had issued orders governing conditions and practices of confinement and care at the District of Columbia Jail. I was substituted as special officer in November 1997. Judge Bryant's order appointing a special officer in Campbell found that the District of Columbia had a long history of noncompliance with court orders regarding medical and mental health care at the D.C. jail, and that a special officer was necessary in order to assist the court to assure future compliance. I ask that Judge Bryant's order appointing a special officer be made part of the record. The responsibilities, powers, and limitations of the special officer in Campbell are detailed in this order. The special officer is a judicial officer whose principal responsibilities are to monitor and facilitate the District of Columbia's compliance with the remedial orders of the court and to report and make recommendations to the court regarding compliance. The order authorizes the special officer to informally confer with the parties on compliance issues and to attempt to fashion compromises among the parties, much as a judge might seek to mediate or settle disputes among parties. The order authorizes the special officer to conduct hearings and to submit proposed findings of fact and recommendations to the court. Following her appointment in April 1993, the special officer, with the assistance of experts, evaluated the medical and mental health services at the D.C. jail, and in September 1993, issued a report regarding the compliance of those services with the court's earlier orders. In March 1994, the court, relying on the special officer's report, found the District in contempt. In January 1995, the court ordered the District to implement a remedial plan. On July 11, 1995, when the District continued in its state of noncompliance, the court ordered the appointment of a receiver to correct the deficiencies in the delivery of medical and mental health services at the jail. I ask that that order be made part of the record. Mr. Davis. Without objection, that will be made a part of the record. Ms. Schneider. The court's order detailed the history of the District's noncompliance and states that over the more than 20 years of this litigation the court has attempted all measures, short of the appointment of a receiver, to obtain the defendant's compliance with its orders. The court finds that no other less-intrusive remedial measures will succeed in compelling the defendants to satisfy their court-ordered obligations. The July 11, 1995, order provides that the receivership shall expire 5 years from the date the receiver is appointed unless the court finds good cause to extend the appointment. The court also reserved the discretion to terminate the receivership at an earlier date if the special officer certified that the defendants are in compliance with all the orders of the court concerning medical and mental health services at the jail, and that management structures are in place to assure that there is no foreseeable risk of noncompliance. In August 1995, Judge Bryant appointed Ronald Shansky, and in September Judge Bryant entered a detailed order regarding the procedures for the receivership's exercise of power. I also ask that that order be included in the record. That order has governed the receivership over the last 5 years, and unless the receivership is extended by the court it will expire within 2 months of this hearing. Since Dr. Shansky is a witness before this subcommittee, he is available to detail the specific activities in exercising the powers given by the court. I understand that this subcommittee is interested in the contract awarded by the receiver to the Center for Correctional Health and Policy Studies for the provision of health care services at the D.C. jail. My March 15, 2000, report to Judge Bryant regarding the receivership sets forth the process which led to the development of a request for proposal for that contract and the selection of the vendor for the award of that contract. I ask that that report be made part of the record. I understand that the members of the subcommittee wish to ask me questions. I previously have informed the subcommittee that there are constraints on the comments I can make which are imposed by the Code of Judicial Conduct for U.S. Judges. That code very clearly states that it is applicable to special masters like me. Decisions of the U.S. court of Appeals for the District of Columbia circuit, the U.S. Supreme Court, and other courts also have determined that a special master is a judicial officer and that there are limits on what judicial officers can say about a pending case. As I am sure this subcommittee knows, in most circumstances a judge would violate the ethical cannons of the Code of Conduct if she makes public comment about a case that is still pending before her. One of the reasons for that rule is that a judge's comments might suggest some pre-judgment or the appearance of pre-judgment of an issue that may later come before the judge for decision in the case. Since the Campbell case is still pending and I may be called upon to address issues in that case in the future, I may not be at liberty to answer all of the questions that are addressed to me. My counsel has submitted a letter to the subcommittee staff in which he elaborates on the legal authority imposing those restrictions on me. I ask that the letter be made part of the record. However, I will try, to the best of my ability, within those legal constraints, to be responsive and answer the subcommittee's questions. Thank you. Mr. Davis. Thank you very much. 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Mr. Christian. Mr. Christian. Thank you. Good morning. My name is Erik Christian, the Mayor's deputy for public safety and justice. Good morning, Chairman Davis, Delegate Norton, Congresswoman Morella, and Congressman Horn. Thank you for the opportunity to testify before you today on the status of the current reform efforts undertaken by the D.C. Department of Corrections to improve medical and mental health services at the D.C. jail. In the first 15 months of the Williams administration, the District government has made great strides in instituting improvements to introduce accountability for each and every agency and employee in order to transform the government into one that is responsive to its citizens. This approach has already shown promising results in the first year and will continue to drive changes in years to come. When Mayor Williams took office, the management challenges the administrator inherited were daunting. Accountability for the District work force was rare, if not nonexistent. A deeply entrenched culture existed that was resistant to change, and, as we all know, there was infrastructure decimated by deferred maintenance and disinvestment and technology needs that were grossly inadequate. Now, the mental and medical health delivery system was no different. It was in need of repair. In fact, medical and mental health services, as well as other conditions at the D.C. jail, have been under court supervision for over 25 years. More recently, in 1993, a medical expert retained pursuant to court order to conduct an investigation and report on medical services at the D.C. jail concluded, ``The quality of medical services is deplorable, the physical condition of the medical area horrible, and the infirmary is a disgrace.'' At the same time, significant deficiencies were also found by a mental health expert retained pursuant to the court's order to investigate and report on mental health services. These reports led to the development of a remedial plan the defendants were ordered to implement in January 1995. Unable to implement the remedial plan, U.S. District Judge Bryant, on July 11th, entered an order appointing a receiver to run medical and mental health services at the jail. In its order appointing a receiver, the court found that the District had violated the court's order and, among other violations, they had failed to properly conduct sick call, failed to operate a chronic disease clinic, failed to implement a quality assurance program, failed to maintain a full-time health services administrator at the jail, failed to properly conduct intake, failed to properly provide meaningful access to specialty services, failed to appropriately and professionally respond to life-threatening emergencies, failed to properly provide medical guides, and failed to keep their own kitchen and medical clinic clean. Moreover, the population the District is serving at the jail has a high rate of HIV/AIDS, a high rate of tuberculosis and other infectious and chronic illnesses such as hypertension, heart disease, epilepsy, diabetes, and asthma, and a significant percentage of inmates requiring treatment for preexisting injuries such as prior gunshot wounds and chronic disabilities. Moreover, the jail had experienced a rash of suicides, and there is a high percentage of inmates who suffer a series of mental health problems. But what is the solution for these problems? The solution is to instate the same solid management practices that this administration is applying to other troubled areas. Throughout his campaign for Mayor, Mayor Anthony Williams repeated the mantra, ``One government, good government, and self government.'' These six simple words comprised his vision for the city. One government is a government where all functions that have been placed by the courts under the control of a receiver are returned to the control of this government under the Mayor's leadership an with oversight of the District's City Council. This administration is working to create one government and commit it to terminating court- imposed receiverships. Good government is an efficient and effective government. Good government facilitates the goal of one government and will ensure that the city can and does provide human and proper treatment to its jail population; that it complies with the law; and that a structure is instituted that not only makes sure that we end this receivership but assures that we do not in the future revert back into receiverships in the dictates of the court order. This government is committed to exploring all ways to maximize efficiency and effectiveness. If this contract or any government contract of service is not efficient or effective, we will work to correct, modify, or replace it. The District wants to work with the Congress, the GAO, and the court to identify ways to continue to reduce costs while maintaining the improved quality of health services required by the law and recommended by correctional health experts to address the unique medical and mental health needs of our population. Ending receivership is a clear priority of this administration. As this administration continues to apply the principles of good government, we must be successful in our efforts to bring this receivership and all receiverships back under the authority of a Mayor with oversight from the District City Council. The District is one city and our citizens deserve a unified government. This city deserves the democracy and home rule that receiverships prevent. We need to continue to perform at this high level so that we, as the District government, can demonstrate that we can provide all of our citizens, even those that are incarcerated, the highest and finest level of professional services at competitive rates. Plain and simple, we need to return to one unified municipal government in the District under the leadership of officials that are accountable to our voters. By returning District agencies that are currently under receivership back to local control, democracy will be driving government here in the Nation's capital. Thank you, Mr. Davis and committee members. Mr. Davis. Thank you very much. [The prepared statement of Mr. Christian follows:] [GRAPHIC] [TIFF OMITTED] T2581.104 [GRAPHIC] [TIFF OMITTED] T2581.105 [GRAPHIC] [TIFF OMITTED] T2581.106 [GRAPHIC] [TIFF OMITTED] T2581.107 [GRAPHIC] [TIFF OMITTED] T2581.108 Mr. Davis. Mr. Clark. Mr. Clark. Good morning. Thank you, Mr. Chairman, Ranking Member Norton, members of the committee. It is a privilege to appear before the committee today at this important hearing. Of course, I have submitted a detailed statement and I will try to just briefly summarize that here. It is not any secret that for 2\1/2\ years I have been very concerned on behalf of the District about the exorbitant costs of the receiver's operation. I've made my views known to all the appropriate parties and tried to work to resolve matters. I have not been particularly successful. So what are my concerns? To summarize, when I assumed this new position I was charged, Mr. Chairman, and directed by various authorities in the District and the Congress, including this committee, to take seriously my role of financial oversight in protecting the funds provided for corrections operations both by the District government and the Congress. I assure you I've taken that charge very seriously. Therefore, I was stunned when I first visited the jail and reviewed its budget in the fall of 1997 and compared it to my experience as a warden of a similar facility, a Federal facility in Miami about three-quarters the size, and also my experience as Assistant Director of the Federal Bureau of Prisons for 6 years, where I had policy oversight for all BOP urban jails. In short, the receiver had about 150 FTEs, compared to about 33 at my facility in Miami, and a $16 million budget compared to the equivalent of about a $4 million budget at my similar facility. Further, I was puzzled that when national averages for correctional health care are consistently reported at about $7.50 a day per inmate, it had cost in the District's jail in excess of $20 a day. As I show in my testimony, in my written testimony, on the chart on page 6, if this contract runs its full length, the price to the District of the receiver's tenure and the follow- on contract that he has awarded will be over $120 million versus the national average for that period of about $45 million. So the question now arises as to whether it is useful or fair to make comparisons of the receiver's costs and staffing to other jails. Some have said that we cannot make such comparisons. I assert that of course we can, although certainly it is important to make proper allowances for unique variables. Every manager, whether in private business or public management, has to subject themselves to comparisons. We have to be held accountable to explain differences and discrepancies. That is particularly true in the face of such differences as we face here, which are not, Mr. Chairman, differences at the margins but are an order of magnitude problem. The District simply cannot afford such extravagance. I'm not here to question that the receiver has remedied the former crisis and has installed at the jail a Constitutional level of care for the prisoners, but at what cost to the District? Apart from the past 5 years, my other concerns, primary concerns, at least, are that the District is now stuck with an expensive contract in the amount of $68 million over the next 5 years unless some action is taken. The RFP, further, is not performance based, requiring the vendor to supply a certain level of service and care, giving only lip service to cost containment in certain narrative statements. But, where it counts, in the evaluation factors delineated in the RFP, de minimis value was given to cost containment. I would refer the committee to table five on page 13 of my testimony, which is reproduced from the RFP. As one could see, the total weight of price is listed at 26 percent of the total score. Itself, a low weight but not unprecedented. However, on closer inspection it is clear that element A, overall price, was only one of five elements scored in the price category, worth approximately 5 to 10 percent of the total score of the bid proposal, to be given little more weight than such vague elements as rational budget, salary structure, and fringe benefits or budget presentation. In other words, the lowest price could easily be more than counterbalanced by a much higher bid--just in this price category--which was simply more rational or showed a better package of benefits or was presented more attractively. In my extensive experience overseeing Federal Government contracts, price is price. Here the issue was totally blurred. Where it counted, the real message was that price is not that critical, and so the message went out. Everyone wanted to please the receiver, and to do that a rich staffing level was expected. The message was heard by the bidders in the form of $12 to $14 million bids for a 1,650 bed operation. The well, indeed, had been poisoned against mainstream price and staffing bids. In fact, to allow for a true comparison to contracts awarded by other jurisdictions, about $2.5 million should be added to the receiver's contract cost to account for outside medical expenses covered by other contracts but here borne by the DOC. Therefore, making a true comparative cost figure for medical services at the jail, it's about $15.2 million. But getting away from averages and rates to more recent comparable examples of actual contracts for medical services, I think Mrs. Morella would be interested to know that in Baltimore and in the Baltimore Detention Center--and several surrounding Maryland facilities, a contract was procured recently for all the services, all-inclusive services for those facilities, for 6,500 inmates, for $19 million. That's $19 million for four times the number of prisoners that here in the District we are paying $15 million to provide services. Again, this week in the clips I noticed in Delaware a contract was awarded for more than 6,000 prisoners for $14.2 million. Again, the same money for four times the number of prisoners. A final example I'd give, in a recent report, another report by GAO in April noted that the Federal Bureau of Prisons, in its only private contract award in a facility-- actually, several facilities together in Texas--awarded a contract for $10 million for 5,400 prisoners. That's several million dollars less for three times the number of prisoners. Compared with the jail, these are differences in the order of magnitude of three or four times, not at the margins. I am not asserting that these jurisdictions are identical to the District's needs or that we should be among the cheapest in the country, but we should be somewhere near the mainstream. Finally, everyone has to be concerned, in my estimation, that the receiver did not voluntarily recuse himself from being the sole procurement official in what turned out to be a $68 million award, particularly when it became clear that his professional associates and employees were forming a group to bid. Now, I've never objected that the employee group was bidding, but I did strongly suggest that the entire procurement be turned over to the D.C. Office of Contracts and Procurement. This was declined by the receiver and the special officer--in my estimation a violation of the most fundamental principles of public contracting, the perception of a fair and level playing field. In summary, a wonderful opportunity has been missed for the District over these past 5 years, as the receiver's legacy leaves no appropriate or usable template for the future of medical services at the jail. I'm afraid that the city must start from scratch to rebuild this mishandled jail medical services operation. Since we cannot change the past, in my estimation the District must immediately, since the clock is ticking, begin the development of a new procurement process to replace the current contract at the first option date next March. Thank you, Mr. Chairman. I look forward to the committee's questions. Mr. Davis. Thank you. [The prepared statement of Mr. Clark follows:] [GRAPHIC] [TIFF OMITTED] T2581.109 [GRAPHIC] [TIFF OMITTED] T2581.110 [GRAPHIC] [TIFF OMITTED] T2581.111 [GRAPHIC] [TIFF OMITTED] T2581.112 [GRAPHIC] [TIFF OMITTED] T2581.113 [GRAPHIC] [TIFF OMITTED] T2581.114 [GRAPHIC] [TIFF OMITTED] T2581.115 [GRAPHIC] [TIFF OMITTED] T2581.116 [GRAPHIC] [TIFF OMITTED] T2581.117 [GRAPHIC] [TIFF OMITTED] T2581.118 [GRAPHIC] [TIFF OMITTED] T2581.119 [GRAPHIC] [TIFF OMITTED] T2581.120 [GRAPHIC] [TIFF OMITTED] T2581.121 [GRAPHIC] [TIFF OMITTED] T2581.122 [GRAPHIC] [TIFF OMITTED] T2581.123 [GRAPHIC] [TIFF OMITTED] T2581.124 [GRAPHIC] [TIFF OMITTED] T2581.125 [GRAPHIC] [TIFF OMITTED] T2581.126 [GRAPHIC] [TIFF OMITTED] T2581.127 [GRAPHIC] [TIFF OMITTED] T2581.128 [GRAPHIC] [TIFF OMITTED] T2581.129 Mr. Davis. We'll have a number of them. I'm going to start, I think, with Mr. Horn, who has another commitment. He has come in. We'll start the questions with him. Let me just make one comment. I think, Dr. Shansky, my impression, just sitting here and listening to everything, is you were brought into a very, very tough job and you turned the place around in terms of meeting the criteria and everything else. You are a doctor. I mean, you're not a manager. That's not your job, and so on. And when it came to the bid, you wanted to make sure you could get some people in place that knew how to do the job and they were bidding. If they got it, great. If they didn't, at least you knew you had somebody competent. That's my take on it, and that's appropriate. Now, I think you had some cost problems that go beyond what you perceived or what your expertise is, and that's always the difficulty when courts take over these is that courts are not managers, they are not administrators, and as we get ready to transition we've got some tough questions to ask. That's my perspective on it, if it makes you feel better. Ms. Norton. Would the gentleman yield on that point? Mr. Davis. I'd be happy to. Ms. Norton. I think the chairman makes an important point. If we are showing concern--and this is before we get to our colleagues who are going to ask questions, because I want to simply make a point and not ask a question. In a real sense, we in the Congress are confronted with the same problem when it comes to HMO and managed care, and one of the reasons that doctors have lost control of medical services is that if, in fact, you turn over the bank to them, they will exercise the best of their professional judgment, and what has happened as a result is all of us who are not in jail are now in HMOs and managed care precisely because we are trying to press costs down, and we've taken these costs from medical judgment, alone, and that turns out apparently not to have been the case here. Mr. Davis. I'm going to yield to Mr. Horn for questions. Mr. Horn. Thank you, Mr. Chairman. I hope I haven't disrupted the committee too much, but I have two questions, and I'd be particularly interested in all of your views on this. To what extent in the D.C. jail do we have literacy education? That's one. To what extent do we have appropriate mental health services in the jail and when they are out of jail in the community? Can you just give me a thumbnail of what you experts have looked at there--literacy and mental health. Ms. Ekstrand. Sir, I'm afraid I can't answer the question about literacy because it was outside the scope of what we were asked to look at. In terms of mental health, they do have onsite facilities at the jail for mental health care. Mr. Horn. Well, how good it is? I think Dr. Shansky is probably the expert, isn't he, on this? Ms. Ekstrand. I'm sure that he is more expert than I am. Mr. Horn. Well, Dr. Shansky, I think you are the expert. What is the answer to it? Dr. Shansky. First of all, with regard to literacy, there are literacy problems, but I am--and we have a health educator who works with the inmates trying to teach them at different levels of literacy skills how to take responsibility for their own health. I think the Director of Corrections would be better able to comment on literacy, overall. With regard to mental health, the D.C. jail is a unique facility in the country. The D.C. system is a combined prison and jail system. There are only five jurisdictions that I am aware of that are combined prison and jails under one single Department of Corrections. The District, long before I came, decided to put its only inpatient mental health services at the D.C. jail, so if you were an inmate and became unstable you got transferred to the inpatient unit at the D.C. jail, and when I came on board not only were there a lot of legitimately mentally ill people, but there are also individuals who would manipulate in seriously destructive ways, maybe to come from Lorton, VA, into the District. We had to put together a program that identified mental illness at intake, and we've done that successfully. I am pleased to report we've had no successful suicides in over a year-and-a-half, compared to, before I took over, an average of a successful suicide every other month. Mr. Horn. Can I ask how many unsuccessful suicides you had? Dr. Shansky. Actually, the number of serious attempts has been dramatically reduced. Those instances are pretty occasional now. The thing that you need to remember is---- Mr. Davis. Dr. Shansky, let me just stop you. Mr. Horn health as got to leave, but what we'd like you to do is provide this for the record, because I think he'd like to have this on the record and I think it is an important piece of information. Dr. Shansky. The thing that you need to be aware of is, as you are aware, the mental health program for the District is also under receivership. There are many people who are released from jail who, were they to be maintained adequately in an outpatient program in the community, would not, in all likelihood, come into the jurisdiction of the criminal justice system. In fact, my staff have participated with others in an effort to create a mental health court that will divert some of these individuals away from incarceration, provided that they maintain their therapeutic program that has been prescribed by the appropriate professionals. There is no question, because we service the prison system, also, that the number of mentally ill inmates, seriously mentally ill inmates at the jail is dramatically higher than anywhere else in the country. We know that when the Federal Bureau of Prisons ultimately takes responsibility for all of the sentenced felons the number of seriously mentally ill inmates in the jail is going to dramatically go down, because we have a substantial number of inmates who are in the mental health units at the jail who are sentenced felons. In fact, we proposed early on that if the chronically mentally ill who were stable and were sentenced felons were to be transferred to the Bureau of Prisons--and at one point they had agreed to take them 2 years ago--that would result in an immediate reduction in cost of between a half a million and $1 million. We know that by the end of 2001 all of the sentenced felons will be the responsibility of the Federal Bureau of Prisons, and clearly the contract situation we've created allows the District to negotiate with its vendor literally at will to reduce staffing levels in services provided based on the population needs that it is responsible for at any given point in time. Mr. Davis. Thank you. Does anyone else want to address that? [No response.] Mr. Davis. Let me ask Ms. Schneider a question. You received a letter inviting you to testify. You refused. You stated that to do so would be a violation to the Code of Judicial Conduct. After consultation with the U.S. House of Representatives Office of the General Counsel, the subcommittee concluded that you were not prohibited from testifying at this hearing. We made it abundantly clear to you that we really had no intention of influencing any judicial proceedings or discussing any quasi-judicial functions you could exercise in your role as special officer. We repeatedly offered to meet with you to dispel any concerns you had about testifying. Finally, on Monday your attorneys came to this subcommittee for what we thought was to be a meeting in good faith. It turned out to be anything but that. Present at the meeting were the House general counsel, the majority and minority counsel for the Committee on Government Reform, subcommittee counsel, and majority and minority subcommittee staff. They agreed that your presence at this hearing was imperative. Your attorneys were uncooperative, and therefore this subcommittee issued its first subpoena in the 6-years that I have chaired this, mandating your appearance today. You know how hard it is to get Mr. Waxman and Mr. Burton to agree on a subpoena. Ms. Schneider, you've gone to incredible lengths to avoid this hearing, and yet it has come to my attention that during the 2-weeks since you received the invitation letter you have been consulting with the media. From the subcommittee's conversations with you, we couldn't ascertain what your relationship to the receiver is, but in this article in the Post today you have been quoted as saying that Shansky has not been a Lone Ranger. How could you talk to the media and yet say you couldn't talk to Congress? Ms. Schneider. Mr. Chairman, I first must say that my concerns about publicly commenting on this matter relate to my belief that I am bound as a judicial officer to the Code of Judicial Conduct. I did not talk to the press about that. That is apparently taken from a letter that I wrote to Mr. Odie Washington. I have made no comments to the press and have never spoken to the press about this matter due to my concerns about the Code of Judicial Conduct and my publicly speaking. I do not want to be in a position to compromise this litigation. This litigation is almost 30 years old. I may be called upon by the judge or by the parties to make recommendations to the judge. It will compromise my ability to do that to comment publicly about the merits of this case. Mr. Davis. So you are testifying here under oath that you have not spoken to any Post reporters about this? Ms. Schneider. I have not spoken to the Post reporter. I did not state that comment to the Post reporter. I was contacted by a Washington Post reporter and I informed him that I could not discuss the matter with him. Mr. Davis. So let me just understand this. The only comment you made to the Post reporter was that you couldn't discuss this matter with him? Ms. Schneider. That's correct. Mr. Davis. OK. Thank you. Ms. Norton. Ms. Norton. Dr. Shansky, you have repeatedly noted that one of the problems with the--that you encountered in the D.C. jail necessitating greater expenditures is that there are problems relating to the medical condition of these inmates greater than in other jurisdictions. What is your evidence that the District jail inmates are sicker than inmates in New York, Baltimore, L.A., and other large cities in the United States? Dr. Shansky. Well, for instance, just to take one example, HIV's seral prevalence. The District's seral prevalence rate is about 10 percent, 9 to 10 percent at last survey. New York is similar--actually, a little higher. Baltimore's I'm not familiar with. L.A. County is substantially lower. Ms. Norton. What is it in Chicago? Dr. Shansky. Chicago, it is about 1 to 2 percent. Ms. Norton. That's HIV/AIDS? Dr. Shansky. That's correct. That's just one. Ms. Norton. You know, we have a somewhat higher HIV/AIDS rate than some other cities, but your testimony is that you have evidence that the costs that were required in D.C. are so much greater because the inmates are substantially sicker than they are in other large American cities. Dr. Shansky. What my statement is that the reasons for the increase in cost are multifactorial. Epidemiology of disease and prevalence of disease is just one factor. Another factor is the decision by the District to house all of its acutely mentally ill, even from the prison system, at the D.C. jail. Had it chosen not to do that---- Ms. Norton. If you took the acutely mentally ill out, what would be the cost of this contract? Dr. Shansky. The mental health program, as described, that would probably reduce the program by a couple million. Ms. Norton. You have testified--well, let me ask you concerning your testimony. The contract that has been let, is a contract that could last as long as 5 years? Dr. Shansky. Well, it is a 1-year contract with a possibility of four option years, each of which is to be negotiated between the Department of Corrections, the city administration really, and the vendor. And, as I indicated, the city is the appropriate jurisdiction, I think, to determine what kinds of services, what types of services should be needed. As I indicated, we know that when the Bureau of Prisons takes all the sentenced felons the whole mental health program is going to be dramatically scaled down. Even if that is done in the middle of the year, the Department can renegotiate with a vendor and change in the middle of the year the staffing and other expenditures that are in the contract. So we set it up flexibly enough so that the Department and the city administration will taper the services and expenditures to its perceived needs. Ms. Norton. Indeed, that is certainly the case. One of the reasons why collaboration with Mr. Clark was important--and you seem to have been willing to collaborate with the District, which seems to have been willing to do anything you said--but one of the reasons that collaboration with Mr. Clark was necessary is precisely the kind of transition that you speak of with respect to mental health. For example, if you were to take the couple of million dollars out, you'd still be left with the cost of these services twice the national average, but if the point was to collaborate because we are in transition, I can't understand why an objective observer who comes from the Bureau of Prisons would have been somebody you didn't even want to hear nor did Ms. Schneider apparently want to hear, because it is hard to detect any oversight by her of you. Dr. Shansky. Let me---- Ms. Norton. So if there is no oversight by her, and Clark comes in as somebody charged by us and a Presidential appointee to look at management and financial reform, I cannot understand why the District of Columbia and Ms. Schneider and you, Dr. Shansky, wouldn't have used that opportunity, an opportunity that comes precisely from the Congress, to try to collaborate and perhaps go back to the court with a revised notion of what might be necessary here. Dr. Shansky. Let me correct the record. Neither the District nor the special officer of the court have done everything that I wanted. That is not the way the process has worked. We have negotiated from day one how to implement, how to design services, how to create the proper program that the District wants. It has been a very fair and open and candid series of discussions we've had over 5 years. I did not get everything. Everything is not done exactly the way I wanted. I realized from the beginning this is not my program, it is the District's program, and I have worked very closely---- Ms. Norton. Dr. Shansky, you gave us no indication until you've just spoken of how those negotiations resulted in your getting less than you wanted. Would you care to give some examples? Dr. Shansky. Initially we talked about providing certain kinds of services in certain ways when we proposed the budget, based on what the remedial plan required. There were different interpretations. We participated with the corporation counsel's office, and the budgets each year, in essence, were negotiated around what needed to be required. Each year the process took place. And, as you can see, each year the budget was scaled back, and each year we returned moneys to the District. Ms. Norton. How did the budget go down from $16 million to $12 million? Was that a voluntary act on your part? Did you cut back on your part by yourself in your own judgment? Dr. Shansky. It was a collaborative effort between myself, the corporation counsel's office, the Department of Corrections, special officer, and plaintiffs. Ms. Norton. Mr. Clark, what role did you play in that process? Mr. Clark. Well, as I mentioned, when I first came in I was quite stunned by this level, although I think, you know, to be fair to Dr. Shansky, the $16 million level in 1997 included $1.5 million or an extensive amount of a 1-year grant, I think, money from the Marshals for some equipment and some other factors there, so I think his true budget was somewhere in the $14.5 million range that year. But, on the other hand, there hadn't been that much of a reduction, and I don't know why he made decisions. But I know that when I came in and learned of this, I started to raise serious concerns with both him and particularly with Ms. Schneider and with the District, and I think that had some significant influence on lowering that budget. Ms. Norton. Dr. Shansky and Ms. Schneider have indicated that the District can always contract for services for a lower amount. This receivership for 5 years was supposed to be returned to the District so that the District could take it off the shelf and run it, and if that is not the case then I don't understand what a receivership is about. Dr. Shansky. Just to set the record straight, that is the case. Ms. Norton. All right, but---- Dr. Shansky. At the end of August---- Ms. Norton. But when this matter goes before the City Council of the District of Columbia I can guarantee you that it will be very hard to justify this level of cost, given the other pressures on the D.C. government. Both of you have indicated that the District is free to reduce the cost. This, of course, will take some considerable re-engineering to make sure that the new contract takes into account the very quality concerns that resulted in the District being ousted from jurisdiction, while at the same time meeting the District's budget requirements. This is precisely the expertise that the D.C. government lacks, and I submit that Mr. Washington clearly lacks now when he says, ``We're getting all we paid for,'' and clearly shows no indication that he wants to reduce these costs at all. He loves these costs. He loves this contract. So I don't understand why, after 5 years, you are giving the District back a contract that almost surely will have to be re-engineered, unless the Mayor of the District of Columbia is willing to pay considerably more for jail costs than he has shown a willingness to pay above the national average for costs for other residents. I do not understand how you have spent your time, if it is to say, ``You can take what I've done, throw it out, re-engineer it, and bring the cost down.'' Why do we need you in the first place? Dr. Shansky. I believe that---- Ms. Norton. That was your job, to---- Dr. Shansky. Let me just indicate---- Ms. Norton [continuing]. Give us back a cost-efficient---- Dr. Shansky. Let me just indicate I believe I was needed in order to save lives, and I tried to do that, and I believe I was successful. With regard to the competence of the city administration, I have every confidence that they have the expertise, the know- how, and the commitment to tailor a program based on their perception, the city's perception of what needs and what services should be provided. I have every confidence in them, and I will so report that to the judge. Ms. Norton. Well, of course you have confidence. One of the reasons I would have confidence in them is they're getting a re-engineered program, a program that has been fixed. It is hard for us to understand how you can fix a program that leaves us this for out of the range of average services. Mr. Chairman, I will pass and come back. Mr. Davis. Thank you very much. Mrs. Morella. Mrs. Morella. Thank you. I'd like to first of all direct a question to Ms. Ekstrand--and this was picked up by Mr. Clark--the differences, the disparity with regard to Baltimore, Prince George's County, and the District of Columbia. Could you tell me, from the GAO study, what are the differences in the kinds of medical services and problems that you found in Baltimore and Prince George's County compared to the District? Ms. Ekstrand. We do know that there is 24-hour-a-day pharmacy onsite at the D.C. jail and that is not the case in Baltimore City, not the case in Prince George's County. We did also focus on mental health services, and again mental health services are enhanced in D.C. compared to Prince George's County and Baltimore City. We did not have the opportunity in the time we had to do this review to go through item-by-item to make that comparison, but those are two of the larger items. Mrs. Morella. Are you kind of in that statement sort of justifying the fact that the District of Columbia costs that much more, the pharmacy and the mental health? Ms. Ekstrand. Well, I'm just making the point that the enhanced services and enhanced staff means that it costs more money. We did not have the opportunity in the few weeks that we looked at this program to determine whether there were other aspects that affected costs, such as efficiency or salary levels. Those were outside the scope of what we could look at since the end of May. But at least we were able to identify some factors, and those factors had to do with enhanced services. Mrs. Morella. Thank you. Let me ask Mr. Clark to pick up on that. With all the experience that you have had with the Federal system and in Miami, do you see--I know the difference is, like, four times the difference in terms of price, and we know it is basically because it is staffing, but can you see an equation between the kinds of services provided and the cost? Does that make up for it? And then I'm curious. Has anybody looked at, like, recidivism rates? I mean, can you show something for this difference? Mr. Clark, would you like to comment? And then if anyone else would like to comment? Mr. Clark. Well, two or three points. I think everybody would agree that one difference, one legitimate difference, is the service provided to the sentenced felons, which is a group which will go to the Federal Bureau of Prisons within the next year or so. I think Dr. Shansky, while he noted that the total mental health cost may be $2 million, I think he testified a couple of times that when the felons go that would reduce the cost by a half a million to possibly $1 million. I wouldn't argue with that. Other than that, I don't see any--the services that the inmates are being provided in Baltimore, whether it is pharmacy, mental health, or all the other services, meet Constitutional standards. They meet accreditation standards. They've all been accredited in those facilities. So the total package of services I don't think is a problem in those facilities in Baltimore or in many other places around the country. And I'd like to make what I think is an important distinction. Higher staffing levels do not equate directly to improved services. At a certain point you reach a point of diminishing returns, and adding more staff members on the evening shift or adding additional nurses, pharmacists, or whatever, does not significantly improve the services. So once you've met a basic level, adding additional staff has marginal benefits, in my estimation. Mrs. Morella. I have kind of confirmation of what you are saying, and that is a quote from a company, Faiver, Campau and Associates, ``Nowhere in the country are we aware of a facility of comparable size that has such a top echelon of staff who are not also significantly involved in direct patient care.'' That's quite a---- Dr. Shansky. Congresswoman Morella, could I respond to that? Mrs. Morella. Of course, Dr. Shansky. Dr. Shansky. That particular consultation, which was solicited by the trustee, was done purely by paper. There was no interviewing. In fact, that particular consultation was completely inaccurate. All of the staff, virtually all of the staff that he refers to as being 100 percent administrative are spending a significant percentage, 50 percent or more of their time, providing direct services. So it isn't the case that these people are purely doing administrative functions. He never found that out because he never interviewed anybody. Mrs. Morella. Have you--recognizing all of that, do you feel--and knowing that you have made some reductions, putting this all together, do you feel you could reduce the number of staff? Dr. Shansky. It is my view---- Mrs. Morella. And enhance efficiency. Dr. Shansky. It is my view--right now we are in the process of completing the renovation, so efficiencies just physically are difficult. That should be finished by the end of October. And it is my view that, in fact, there can be some reductions, and we've already talked about it with the vendor. The District has talked about it. And I have every expectation that for the next contract there will be significant reductions in expenditures. But I believe those are the District's decisions, and I have attempted to take, to a great extent, besides taking leadership from the court, also from the District because it is ultimately their program. Mrs. Morella. We have a Government Performance and Results Act, you know, where we require our agencies and say, ``OK, now what have you accomplished, not so much what your mission is and what your modus operandi are.'' It seems to me that the system could certainly use a Performance and Results Act requirement. Dr. Shansky. We have built exactly those performance measures into this request for proposal. It is the first one that I am aware of--and I was responsible for issuing request for proposals for 12 years for the Illinois State prison system, the first system ever to privatize. The reality is that we have put in performance measures, not just ensuring that certain processes are completed, like intake processing, but that the degree of control of chronic illnesses is such that morbidity and hospitalization are prevented. All of that is built into this RFP. It is unquestionably performance based. Mrs. Morella. OK. I know my time has elapsed, and I thank you. Mr. Davis. Let me try to put a perspective. I would much rather be here talking now about overstaffing and high salaries than I would a situation that we couldn't correct. I just put that in perspective. This looked like an impossible situation at the time you took it over and you turned that around, so that is understood and that is good. But, for those of us that have to operate within the confines of government, which is transparent, which has limited salaries and everything else, you know, this violates all the rules, and it violates all of the traditional rules of government because we were not--you didn't have political oversight. You had oversight from a judiciary branch. And that's where you go back into the political spectrum and it goes back to the city that is not ready to transition, and that's why we are asking these questions. Dr. Shansky. I believe it is ready for transition. The contract is in the midst of its first year. The Department can, beginning to work right now with the vendor, restructure or shift or move or---- Mr. Davis. It's a lot more ready to transition now than it was when you took it over. No question about it. Dr. Shansky. There's no question. Mr. Davis. So I'd put that in perspective. Dr. Shansky. There is no question about that. Mr. Davis. But I think you would concede and I think Mr. Clark and the GAO and others who have testified make it very clear that the payment for what were getting is very, very high by any normal governmental standard. Dr. Shansky. And the District has the opportunity to make decisions about what it wants to pay for and what value it is getting for the dollar. Mr. Davis. Of course. Dr. Shansky. And that's why I think this is a perfect situation in terms of the closure of this receivership within the next---- Mr. Davis. And that's why we are holding the hearing. We need to understand that, and if the city had these costs in every part of its government and couldn't afford it, it would be a lot better run city, but that's a different issue. I'm just trying to put it in perspective, and you don't need to be overly defensive, but I just--and I can understand why you are that way. The main mission was accomplished, and it looked almost impossible when you took it over. My wife is a doctor, too, so I understand. She's tighter on finances than I am, but I just want to put that in perspective for you. Now, let me ask a few questions here for Ms. Schneider. What are the major duties you perform on a regular basis as the special officer? Ms. Schneider. My duties as a special officer is to ensure the compliance of the court's orders. That can be done through mediation with the parties on various issues, through observing and reporting to the court, and making recommendations. Mr. Davis. When you look at your priorities, cost has not been at the top in terms of trying to do it within the restrained budget. You're really looking at turning this around and---- Ms. Schneider. Well, my mandate is precisely to ensure that the court orders that are in existence are followed, and that is by the order that appoints me. It requires me to ensure that those orders are followed. Mr. Davis. OK. So the court orders, no staffing levels are required? That's a judgment call that you would make? Ms. Schneider. There were staffing levels required in the initial remedial plan, and there has been a process in this litigation where those staffing levels have been reduced each year through negotiations with the party and a budget that was submitted to Judge Bryant each year for consideration. Mr. Davis. But did you ever make any comparisons to other jurisdictions' costs and services while the plan was being worked out among the parties, for example? Ms. Schneider. Well, my mandate was to ensure that the court order, as it existed, was followed. Mr. Davis. All right. Now, I think I understand how we got to where we are, and I don't know that anybody is culpable or anything, I just want to try to understand that cost was really the kind of last thing you'd look at as you try to work your way through a very, very difficult situation when you took this over, and I can appreciate that. The corrections trustee reports that you appointed the receiver as the sole appeal authority on the procurement over his very own decision. Can you explain that decision? Ms. Schneider. Excuse me, that was not my decision to appoint the receiver as the sole---- Mr. Davis. Whose decision was that? Dr. Shansky. When we drafted the RFP, we had discussion with counsel on a variety of things. One of the issues that came up was to what extent we could parallel, if you will, D.C. procurement law. Now, the reality is D.C. procurement law refers to and is applicable to D.C. agencies. I was clearly not a D.C. agency head, so, strictly speaking, D.C. procurement law wasn't applicable to a procurement that I was going to do, and I couldn't, in my procurement, somehow require the chief of procurement to be responsible. I had to accept that responsibility myself. Mr. Davis. And your argument now is, as the city transitions they can renegotiate. Dr. Shansky. Yes. Exactly. Mr. Davis. Then that makes my next question for Mr. Christian and Mr. Washington. What mechanisms do you have in place to renegotiate the contract and control costs at this point? Mr. Washington. Thank you, Mr. Davis. First of all, I want to simply say that I, like many in the District, love the services that are currently being provided, but we all have a problem with cost, as has been the case for the last 5 years, but I have been impressed by the fact that the cost continues to go down every year and I am convinced that costs will continue to go down. The best way to do that is to return control of medical services and mental health services back to the District, where we will be able to negotiate specific services and further reduce the cost. I am confident the that District of Columbia will be able to do that. Mr. Davis. If you don't do that, don't come running to Congress. You'll have to go somewhere else to find the money. I'll let you make that argument with the Mayor, but I think that's--and that's really the bottom line at the end of the day. Mr. Washington. And clearly that is understood, Mr. Chairman. Mr. Davis. Do you have any mechanisms in place right now? Can you give us any idea where you might be headed on that, what cost controls you put in effect, what some of the services are being provided that you might not be able to provide, or anything? Mr. Washington. Well, one of the things that we will be doing is to hire our own medical expert to oversee the contract. That will be our person to evaluate the services that are being provided and to determine what services can be reduced. That is a position that will be established. Mr. Davis. I'll tell you what. Instead of putting you on the spot today with that, maybe you can get back with the committee and talk to us as you transition about what some of your thoughts are with specificity. Would that be amenable? Mr. Washington. Yes. Mr. Davis. I think that would be helpful to us. Mr. Christian, do you have anything to add on that? Mr. Christian. Again, Mr. Chairman and Council members, we are trying to maintain the quality of services that have already been provided at the most efficient and effective manner, so we would be looking at that contract during this period and when it expires. Mr. Davis. Why don't you try, let's say in the next--within 10 days could you get us back something in terms of your thoughts on transitioning this back to something that is affordable? I would just say one thing: the city--I mean, not you, personally--you weren't probably with the city then--but the city had this thing really messed up. It has been fixed from a services point of view, but now we have to contain costs, and we are just eager to understand how you are going to do that, how you are going to get there, because if these costs continue it just doesn't mesh with the culture of this city or any other city when you take a look at the other staffing ratios. So we want to see how we make this transition. If I have to put an emphasis anywhere, it is on making sure the city isn't sued again and that we are fulfilling our Constitutional obligations, so you have to do that. You can pick and choose, and I think you have a better system here than you have in Baltimore or you have in Prince George's or the others, but you are paying a lot more for it, too, and what that balance is, we're just eager to know what your thoughts are on that. That's all I'm trying to get at. Let me now yield to my ranking member, Ms. Norton, for a few more questions. Ms. Norton. Mr. Christian and Mr. Washington, you are aware that, as this hearing is going on, the Appropriation Committee is having a hearing in which it is looking precisely into whether or not the District is not only improving its services but is improving the management of those services. The Appropriation Committee is very much in sympathy with what this committee is doing and has made that known. Are you prepared, when the appropriation comes before the Appropriation Committee next year, to come forward with a contract with these costs in it? I ask that of you, Mr. Washington, because you said to the Washington Post, ``I think we are getting what we are paying for,'' therefore I don't see any inclination on your part even to begin to reduce costs, and so must assume that when you go before next year's appropriation you will not be recommending to the Mayor that any changes be made. Therefore it would be the Appropriation Committee or the Council that would have to do the oversight here. Mr. Washington. Well, actually, Congresswoman Norton, I think it would be just the opposite. I think we will very much be prepared to discuss cost reductions. One of my primary concerns, as a relatively new director of this department, is to ensure that the D.C. Department of Corrections does not revert back to 30 years of neglect in our department. We have a wonderful opportunity to get from under a 30-year court mandate and oversight of the D.C. Department of Corrections and return control to---- Ms. Norton. When this program comes back, who will be the officer who has control over it? Mr. Washington. Well, the Director of the Department of Corrections will be responsible for medical and mental health services. Ms. Norton. That's you, isn't it? Mr. Washington. That's correct. Ms. Norton. And you want control over this and you want it back from the receiver? Mr. Washington. Absolutely. Ms. Norton. So you have been cooperating with the receiver in order to make sure that you, in fact, get this program back. Mr. Washington. Yes. I think the quickest way to reduce cost is to return control to the Department of Corrections and negotiate future contracts. I think we have a good level of services. That's important to ensure that we do not have continued court oversight, and further reduce costs. Ms. Norton. Dr. Shansky and you have said the same thing. That's a dangerous thing to say to this Congress. You know, the chairman and I have kept this matter before this committee. In doing so, we have made sure that we focus not on the courts. Neither of us believe it is inappropriate for courts to take over functions that are in the shape these functions are in, but there are many who disagree with us. To the extent that there is testimony before the Congress that courts don't have any obligation to contain costs when trying to reform matters in receiverships, you endanger the whole notion of court receiverships and non-interference by the Congress of the United States. I think you should be told that. This matter could just as easily be in the Judiciary Committee, and if it were there would be a very different kind of hearing. Indeed, the Congress has already intervened into receiverships. You do not help those of us who believe that the courts, particularly with respect to jails and to prisons, have done a service to the country in taking over such systems. You do not do a service when you say that it is quite all right for the receivers to rack up any costs they want to and then give it back to the people who couldn't manage in the first place to bring down the cost, and that is what I am hearing from you, Mr. Washington, and that is what I'm hearing from the two receivership officers. Dr. Shansky. Let me correct what may be a misperception on your part. My mandate was to put the program together and to save lives, but it was also to be fiscally responsible. We have been audited. We will be audited again at the end of the receivership. The audits were court mandated and arranged by the city. We negotiated and discussed each budget, literally at times every position and every service. We have returned money to the District each year that was unspent. I don't think that is a record of someone who feels that a receiver has no responsibility to look at cost factors. Quite the contrary. We have been sensitive to the cost concerns, and I think the District has also been sensitive, as has the special officer. Ms. Norton. Dr. Shansky, it was precisely because there was no audit of the kind that D.C. agencies are required to engage in and only a two-page audit spreadsheet presented that this House unanimously passed a bill requiring that full-scale audits be done not after the receiver is through but on an annual basis while there is a receiver so that the receiver is not held to a standard less than the agency who has given up the function would be held. Dr. Shansky. Once again let me correct the record. The audit that was to be performed was determined by the city it was supposed to be done under the existing city contract by a firm, Peat Marwick, which was doing all the city agencies. I had no say in determining how that audit was done, who was doing it, or what it consisted of. Ms. Norton. Just a moment. Did not the court require an audit? Dr. Shansky. Yes. That's correct. Ms. Norton. Ms. Schneider. Ms. Schneider. That's correct. Ms. Norton. Did you regard that as the kind of audit that was satisfactory? Ms. Schneider. There was a court order requirement for the audit, and the audit was---- Ms. Norton. Do you know what an audit is, Ms. Schneider? Do you know the kind of audit that District agencies, in fact, routinely have to go through? Ms. Schneider. This was an audit that was done. It was organized by the city, by the agency that was doing the city audits. Ms. Norton. Mr. Washington, are you aware of the kind of audit--who organized it? Who was the officer? Was it Mr. Washington? Dr. Shansky. I believe this preceded Mr. Washington. Ms. Norton. Are you aware of the kind of audits that the new auditor requires when he does an audit of D.C. agencies? Dr. Shansky. I wasn't made aware---- Ms. Norton. Do you think that this is representative of the kind of audit that agencies should go through? Dr. Shansky. Let me indicate, after approximately 2 weeks of providing all financial records, all invoices, all bank statements, etc.--and, again, this was an audit arranged by the city by the contractor with a contract to audit city agencies-- no one was more disappointed than we were to get, for the cost of that audit, which I'm told was about $40,000, that two-or three-page statement, believe me. Ms. Norton. Again, I'm not sure what Ms. Schneider's job is, but obviously the District wants to get out of the receivership. The District apparently felt it had no stake in the kind of audit these agencies have to go through. I repeat, I am concerned if the District now has to figure out how to reduce these costs, because the District is going to have to, in fact, design an RFP that meets quality concerns and also the cost concerns that the Council and the Mayor will raise. When I look at the number of physicians, no matter how we get into this contract, questions are raised that any public official--you, Mr. Christian; you, Mr. Washington; you, Ms. Schneider; you, Mr. Shansky; and certainly the GAO--should have wanted to question. For example, 15 doctors serving something over 1,600 inmates here, five serving something over 3,000 inmates in Baltimore---- Dr. Shansky. Those figures, by the way, are inaccurate. We do not have 15 physicians, and I'm not sure---- Ms. Norton. How many do you now have? Dr. Shansky. We have---- Ms. Norton. You obviously had it at one point. How many do you have now? Dr. Shansky. We have, I believe, nine. Ms. Norton. Compared to five for more than twice as many in Baltimore, three times as many as these now---- Dr. Shansky. Again, you are quoting figures from a report in which the data was demonstrated to be inaccurate. Now, it is very hard to have a discussion---- Ms. Norton. Give me the accurate data. I'm giving you the data you told me. It was nine. Prince George's, same size as D.C.---- Dr. Shansky. Again, inaccurate data. Ms. Norton [continuing]. One M.D. for 78 compared with one for 15 here. What are your figures now? Dr. Shansky. When we talked with the officials at these agencies, they told us, first of all, in the Baltimore contract they said the numbers were part of an overall contract and it was very difficult for them to attribute the costs related to the jail part of that contract. Ms. Norton. I'm just asking you about doctors now. Dr. Shansky. I don't recall the specifics of the doctors, but---- Ms. Norton. I'm just saying that Prince George's, which is the same size as we are, the same kind of population, one doctor for 78 inmates compared with one for 15 inmates here, and we're supposed to say, ``That's fine. The quality has improved, so don't ask any more questions.'' Mr. Davis. Let me recognize Mrs. Morella. Mrs. Morella. Picking up on our discussion today, I notice another difference probably among many of the correctional institutions in health care is the on-and offsite staffing, and I note in your testimony, Dr. Shansky, you mentioned that the offsite consists of, like, a physician and a nurse at D.C. hospital. Dr. Shansky. Yes. Mrs. Morella. I'm wondering whether this--and I'm going to get to you in a minute, Mr. Clark, whether this occurs in other hospitals, too. But it was interesting, as I was re-reading your statement, where you indicated that they are there also to make sure that they don't stay there too long, to control. And I was thinking of the problems that patients have with HMOs, you know, where you've got a gatekeeper that says, ``You can only stay 3 days,'' or whatever it may be. That's the same kind of thing you're doing. Would you like to just comment on how effective you think it is having a---- Dr. Shansky. That's a very legitimate concern. We added this, because when I came on board--and all of the Lorton facility, as well as the jail and the Correctional Treatment Facility use D.C. General as its main resource. One of the things that I found was corrections patients admitted to D.C. General were distributed among a variety of house officers, most of whom had their major focus on their non-incarcerated patients, and so the concern wasn't that people were being sent out too quickly, as might be the case with an HMO, but they were literally forgotten or neglected and allowed to stay way, way too long. We talked to the District. The District felt that it would be a cost-effective investment to make sure that we had one doctor in control of all of the patients admitted to D.C. General from Lorton, from CTF, as well as the jail. There is no question we dramatically reduced the length of stay because our doctor focuses on those patients and gets them out in as timely a manner as possible. Now, when the prisons close down the city may decide, because there are fewer patients in the hospital, maybe it doesn't want to support that service. But, given the number of admissions from all of the Department of Corrections facilities, it made sense to put a doctor in charge of that care, and therefore reduce the length of stay. This was particularly important because the D.C. General Hospital became a public benefits corporation and began billing the Department of Corrections. Up until that time, which was roughly 1998, there was no transfer of funds, as far as I understood. But when they began doing that we talked with the Department, and the Department said, ``Yes, we don't want to be paying for unnecessary services, for people who are just laying around after they've received maximum hospital benefit.'' It was on that basis that we instituted this program. Mrs. Morella. Mr. Clark, would you like to comment on whether this is being done any other place and what you think about the efficiency? I mean, it is a pretty convincing case if you are reducing the time and you are watching them. And then I would like to also ask you about this pharmacy. Have you found that there are other places where--I mean, is it common to have a pharmacy connected with a jail of that size? And then would it be better to--I mean, more cost effective to have a contract with a vendor for that kind of service? I don't know much about it. Mr. Clark. Three issues, I guess, Mrs. Morella. The first one: I generally agree with Dr. Shansky on the advisability of having a physician or--well, principally a physician--whose loyalty or whose concern is primarily directed to the Department of Corrections providing some oversight to those cases at D.C. General or any of the other outside hospitals. On the other hand, I have a significant problem, as I mention in my written testimony, with the way the RFP, the second RFP was restructured to remove the responsibility for outside medical from the vendor so that the incentive, which had been built in and which is common in these contracts everywhere, as far as I can tell--and within the last few days we've contacted eight or nine States who contract out all or part of their services, and they all require the vendor who is providing the jail or prison health care to also be responsible for the outside medical care. If you don't do that, you reduce the incentive or there is a reverse incentive in terms of providing the treatment in-house. And there is almost an incentive on marginal cases to move that case to the local hospital when then it becomes an expense to the Department of Corrections. That was our experience in the Federal system under contract facilities, and we went to total outside contracts, first with a catastrophic limit of $5,000 or $10,000, and then I know more recently they have removed that catastrophic limit. So I have, as I have testified in my written statement, a major concern that it was not in the economic interest of the District to remove that responsibility from the vendor. Your next question was about the pharmacy. It is not uncommon to have in-house pharmacy operations. I think in these contracts that is more of a market question. In other words, you ask to have a certain level of pharmacy services provided, and in some cases it is done more on an operation, in-house operation, sometimes more on a regional kind of a basis. Again, the problem that I have with the requirements in this contract are not that it is in-house; it is that they have, in my estimation, much exceeded the numbers of staff who are commonly needed to run a pharmacy in a correctional facility. I forget your third question, ma'am. Dr. Shansky. Could I respond on the--I think it needs edification, the offsite service responsibility. The usual arrangement that I have seen is where you build in some sort of risk sharing, as alluded to by Mr. Clark, with the vendor. We had every intention of doing that, and we intended to negotiate with the selected vendor the conditions of that risk sharing. Some time in the fall of 1999 we were informed by corporation counsel's office that, if we were to want this contract to be assigned to the District, we could not engage in those kinds of discussions with a vendor at the time of selection, so that we were locked into whatever was in the RFP if we're going to leave this in, No. 1. No. 2, the vendors came up with per diem rates in their proposals that were, in fact, not as good as the per diem rate that the District had at that time, so we felt this was not in the district's interest. The other thing is that the vendor's proposals were very divergent. One vendor was very low on the outpatient side, very high on the inpatient side. Another vendor was very low on the inpatient side, very high on the outpatient side. None of them justified their numbers. We felt the wisest thing to do, particularly since we had a doctor in place and that doctor controls both admissions and discharges, so the risks that Mr. Clark is alluding to are taken care of by our having our person in control of those patients, which isn't the case with most contracts with correctional facilities, and on that basis we felt the wise thing to do, the thing that was most prudent, was to take the offsite services out in the first year and then, for the second year, the Department of Corrections and the Mayor and the director of Corrections could, if they chose to, negotiate the kind of risk-sharing and offsite responsibilities that they felt were in the District's best interest. That's why we made those decisions. Mr. Clark. I'd like to respond to that. One of the issues here is on this performance-based contracting and whether or not there was an incentive built into the contracting for the bidders to be innovative and creative. In this area, a couple of the bidders bid significantly below the District's cost, one of them way below. I would call that innovation or creativity. In this case, Dr. Shansky chooses to say that the companies were confused and somehow didn't understand. Well, these companies bid on these contracts all over the country. They understand. They knew what they were doing. And for some reason--again, I've got a chart, I think, that compares the bids on page 16 of my testimony that makes that point. Dr. Shansky. Let me respond that the numbers were not justified. There was no basis for the numbers. Mr. Davis. Dr. Shansky, let Mr. Clark finish before you interject, OK? Dr. Shansky. OK. Mr. Clark. Again, I think this is another example where creativity and innovation were removed or not rewarded, and whether or not the receiver in his role as the procurement official, understood or felt that the background development of how these numbers came to be may have been justified, the company bid, in one case, was $1.3 million, which was about half the District's estimated cost. When you bid, if the bid is accepted, then you are going to have to live with that, and to me that's innovation. It's not confusion. Dr. Shansky. Let me just indicate we selected the lowest bidder, No. 1. Within the finance category, lowest bid was considered the determining factor, and that was the largest single factor of any of the factors considered. With regard to the offsite services, had we been able to negotiate with a vendor at the time of selection, we would have stuck with it. When we were told by corporation counsel contract lawyers that we could not do that, we felt it was potentially dangerous for the District to enter into a contract based on numbers that had no justification. What we didn't want was a vendor not hospitalizing people in order to meet the bottom line, which was inappropriate, that they had proposed and the District suffer the consequences of that sort of gatekeeping. Mrs. Morella. Dr. Shansky, I just want to say that I think that this hearing has brought together a lot of the issues that have been smoldering, and I hope that what will happen is not only we will continue to be updated as we move along and get out of the receivership but that there will be some compromises worked out so that, you know, I think some of the things we've said and that we've listened to could be worked out, so I guess in that sense of moving ahead for the correction system and the accountability and all, this has been a great meeting. I yield back the remainder of my nothing time. Mr. Davis. Mrs. Morella, thank you. Let me make a couple of comments, and then I'm going to--I mean, I think we get the gist of what has happened. I think everybody has had their say here and we understand. What concerns me now looking ahead is, is the city ready for prime time? Are they ready to take this over, because I've seen very little oversight from the city during this time except that they are eager to take back the control, and, frankly, I'm not sure I am comfortable with that. Mr. Clark, what is your judgment on that? Is the city--can they innovate these--have they shown the oversight initiatives and the like that show they have any understanding of how they can reduce these costs and maintain a level of service that will be acceptable Constitutionally? Mr. Clark. Well, I know that Director Washington is working to step into the--to have the Department step into the role of oversight of the contract, but what I--and I guess this is partly why I got into the uncomfortable position that---- Mr. Davis. Let me just interject, obviously they can spend what they are spending and it will be fine, but that has other ramifications city-wide at this point. Mr. Clark. Absolutely. I mean, this is money that could be spent for schools or police or pot holes. Mr. Davis. Well, you have people that are working two jobs trying to support kids that have no medical care, and the people who are in jail are getting much, much better care, and if that is the city's priority, but I don't think it is. Mr. Clark. I think what I found when I came in almost 3 years ago was that the city felt impotent in the face of this receivership. This is what--this was the sense that I got from the Department of Corrections director and other officials there, and, frankly, from the corporation counsel. That in the face of this long suit and so on, which had many legitimate aspects, obviously, they didn't feel that they could stand up to the receiver on these issues, and that's, frankly, why I, in my independent position, felt that I had to. Mr. Davis. Frankly, I don't think they could have stood up to him. I don't think they had the knowledge and I don't think they had the background or they had the competence to do it, and if you look at what had happened, you know, to this previously when they had it and took a look at what was happening around the rest of the city and the priorities, the city had to develop it. I understand that. I mean, it cost a lot of money to turn this around, probably more than if we had been a little more cost conscious. We could have done this a little cheaper. But we are here where we are today and we have something we are not worried about in terms of meeting the Constitutionality test and the like. The difficulty now is, from a budgetary point of view, making this transition, and I am, frankly, concerned about the city's--I've asked them for some guidelines and they are going to send union something within 10 days, and the proof of the pudding is in the eating. I hope we see something of a substantive nature. But that's our concern. Let me just say that if you think this hearing is tough, you want to go see Mr. Istook and the appropriators. I guarantee you--Ms. Norton is not going to be there. She's your friend. I think at the end of the day she wants this thing to work out. You just won't get the money, and then we could be right back to where we were. We want to get this stuff solved here at the authorization level, and the way you do that is you show us a plan, you show us it is not going to be the same program you have today because you are not going to have the money, but we just want to see it. I just don't get the sense here that we are ready to do that as a city. Mr. Clark. No. I think the focus--I mean, I think, unfortunately, you are right. The focus within the Department has been to be ready to take over the oversight of the contract, but I don't know that there is--that anybody--again, and this feeling of sort of impotence, that anyone has felt that they were in a position to start trying to re-engineer this receivership's operation. Mr. Davis. Well, just for---- Ms. Norton. Mr. Chairman, could I just comment on just that point? Mr. Davis. Sure. Ms. Norton. The lost opportunity here, it seems to me, why the committee and the President and the Congress insinuated Mr. Clark into the matter was that there was a management and financial expert, so that you had, on the one hand, a doctor, and the doctor's job is to deal with patients, you had a receiver, a monitor. She also isn't in the management business, and we understood that. And we were clear, and I have been clear with Mr. Washington that the way to round this out was to take this expert who had the second-highest position in the BOP and make a synergy and it could all have worked. What is most disturbing to me, Mr. Chairman, is that somehow or the other an adversarial relationship developed there and his suggestions were considered not to be relevant, and therefore your question as to whether the District prepared to do it is an important one because Mr. Clark's tenure is running out and I'm not sure who then is to be the expert, except that the city is going to have to hire some experts. Mr. Washington has already said they're going to have to hire a physician to help them monitor it, whereas I wanted something off the shelf, because we sure paid a lot for what we are getting back here. Mr. Davis. And I don't want to dwell on what we paid. I think we have been through that. We don't need to beat a dead horse. The bottom line is we took an agency here that was in awful shape, terrible shape, and that at least has turned around. Fundamentally, that's what the task was. That's what the court wanted to do. I just don't think we need to go back on all the money that was spent and those kind of issues. I don't think that serves any purpose except transitioning now. The city has to have a little bit more than just taking it over, and ``we think we can do it.'' They've got to show some vision. They need to show some accountability. That's what we're going to be waiting to see, and we're going to watch it very closely. Ms. Norton. Ms. Norton. Well, I just want to be clear that what the chairman said about the appropriation hearing--and I mentioned it before--is a shot across the bow. There is no question that if the Council gets these costs there will be many questions raised, and the time to deal with them is now. Mr. Shansky, what is your current position? Dr. Shansky. With regard to the District? Ms. Norton. No. Your full-time position? Dr. Shansky. I consult on correctional health care around the country, both---- Ms. Norton. What was your professional position before that? Dr. Shansky. I was the Medical Director of the Illinois prison system. Ms. Norton. I asked because I thought that was your position. I certainly regard you as an expert, and I certainly accept the notion that these services have been reformed and meet Constitutional standards. I would hate to think that they hadn't at this point. Apparently, appropriate services or similar services are being provided in the State of Illinois Correction Department, at only 63 percent of the national average, $4.80, compared to $7.68. I can't understand why some of that expertise, where in Illinois you are below the national average, wasn't brought to bear here in the District of Columbia so that we not only got it fixed but got it fixed at costs comparable to what apparently you have contributed to in Illinois. Dr. Shansky. The Illinois numbers you are referring to are our prison system. This is a jail. The services designed to be provided at this jail are unique in terms of certain responsibilities. We have brought the budget down and it is now in a position where the Department and the city administration will tailor it in any way it chooses. And the fact is that I had 12 years of opportunity to work with the Illinois Department of Corrections and create the system that I left there. Ms. Norton. And you had 5 years here. And if we took mental health services out, for example, we are still left with twice the national average. The outside experts said, ``Nowhere in the country are we aware of a facility of comparable size that has such a top echelon of staff who are not also significantly involved in direct patient care. With these salaries, with a medical director of $192,857, the Mayor should resign and take this job,'' on down. And these salaries are very high. Dr. Shansky. Those are not salaries. That's salary plus fringe. Ms. Norton. We say salary plus fringe. Dr. Shansky. You just said salaries. Ms. Norton. Well, it says salary plus fringe. Dr. Shansky. OK. thank you. Ms. Norton. The point is that they are compared, however, with facilities of comparable size. I point this out only to say, and certainly to say to Mr. Christian and Mr. Washington, if I'm pointing this out to the receiver, you can bet your bottom--I don't know if you speak for the Mayor. Do you, Mr. Washington, when you say you are satisfied with this contract? Mr. Washington. I'm satisfied with the services that have been provided for the D.C. Department of Corrections to remediate a 30-year court oversight. Ms. Norton. Yes. I---- Mr. Washington. I'm confident that---- Ms. Norton. This is not about that, sir. We're not doing an oversight hearing on the services, and we haven't questioned the quality of the services. The City Council is not going to be asking you about the services. They're going to be asking you about the cost of the services. I'm asking if you are speaking for the Mayor when you say you are satisfied with the cost of the services, not the quality of the services. No question has been raised about the quality of the services. Mr. Washington. I've never said I was satisfied with the cost of the service. I'm satisfied with the services. I believe very strongly that the costs will continue to go down, and I also feel very strongly that---- Ms. Norton. Are they automatically going to go down? What are you going to do to bring the cost down? Mr. Washington. We are going to evaluate all the services that have been provided. We will have staffing positions, and I will provide a plan to this committee to show exactly how the Department of Corrections will be prepared to take over this contract and further reduce costs. Mr. Davis. Let me just say in the next 10 days you are going to give us an outline. It doesn't need to be detailed, but just kind of a path. Ms. Norton. That would be very helpful. Mr. Davis. I don't know how you want to do that. Ms. Norton. That will be very helpful. Mr. Davis. And rather than try to sit here and go off the top of your head, we'd rather have you go back and do something that is a little reflective and send it back. Ms. Norton. My concern, Mr. Chairman, is that these costs will go down. Costs never go down. You've got to make costs go down. Costs always go up, Mr. Washington. Making costs go down or maintaining quality is an art, and it is going to take real craftsmanship to do that, given the level of cost here. Mr. Shansky, I note that your own requirement will be that the contractor of these very same services you have designed now go forward and get accreditation. Why did you not get accreditation, since you've had them for 5 years? Dr. Shansky. First of all, I sit on the board of the National Commission on Correctional Health Care. Ms. Norton. You can recuse yourself, just as you could have with respect to the procurement. Dr. Shansky. Would you like my answer? Ms. Norton. Don't tell me it is because you sit on the board. Is there a reason other than a reason that you could have easily been released from why you didn't ask for accreditation to be--so that you could have handed us back fully accredited services. Dr. Shansky. Would you like an answer? Mr. Davis. Yes. Give us the reason why you didn't get it. Dr. Shansky. The reason why we didn't go for accreditation was very simple: the accreditation process, when we talked with the District, was something that the District wanted to do and to take responsibility for. An accreditation of a receiver program has nothing to do with whether the program run by the District is accredited, and we decided jointly with the District to wait for that accreditation process until the District had responsibility, and that's why it was written into the contract as well as the RFP that by the end of the contract year the vendor would achieve accreditation. Am I confident that we could have achieved accreditation? Unquestionably. I have also been a surveyor for the Joint Commission on Accreditation of Health Care Organizations and have surveyed 20 of the Federal Bureau of Prison facilities. I know how to achieve accreditation. I don't think it proves much when I achieve accreditation. Ms. Norton. Well, one thing it might prove is that we really do have a level of services that anybody can have confidence in. I think you should be given the opportunity to reply to the way in which the Board of Contract Appeals regarded the procurement. Apparently the D.C. Contract Appeal Board says, ``There appears to be little question that, in accordance with generally accepted government procurement practice, the initial late proposal of the bidder, the person who was successful, was improperly handled. The proper procedure would have been to hold the proposal unopened, apparently because it was late.'' They also say that you restricted access by other bidders to your current employees, even though they had information that should have been made available to all offerors. That's from the Appeals Board. They say you gave no basis for your statement that the proposal of your employees was dispatched in time, and they go on to say the record is clear that the proposal was not dispatched at a reasonable time. ``Regardless of the correctness of the decision, the failure of the receiver to make a written finding supported by a record as to his reasons for considering a late proposal gives the appearance of impropriety.'' I think it is only fair that you be allowed to respond to that. Dr. Shansky. Thank you. First of all, I put into the RFP a time deadline to ensure that no vendor would be advantaged by having more time to work on their proposal. When I was informed by my consultant that one proposal was received late, I asked the circumstances. I was told that the vendor had arranged to fly--deliver the proposal to Atlanta, where the proposals were to be received. The vendor's roughly noon flight was canceled, was delayed, then the next one was canceled. They put the proposal on Delta Dash. The electrical storms in Atlanta then knocked out the computers, so Delta Dash couldn't find it for 6 hours. To me that seemed like no situation in which any vendor was advantaged. The proposal was finished well in advance for delivery several hours in advance of the deadline. I also felt that it was in the District's interest to have three proposals considered rather than two. I was advised later on that, according to CAB decisions, any deadline can be extended, even in the event of a late proposal, if it is for the purpose of expanding the scope of competition and especially where the number of proposals is small and where there is no unfair advantage. I felt all of those things obtained. The reality is we ended up, because we had to amend the contract because the offsite service situation was a problem and was not going to be in the District's interest, we ended up amending the RFP anyway and sending out a new one. All vendors had a completely fair and open process. Look, the reality is one of the vendors, the vendor who protested, in fact, had my CFO working with them, so they had a person who knew more about my finances and salaries than any of the vendors. That's No. 1. So, in terms of them being disadvantaged, it's just not true. Second of all, all of the salaries and budgets were available. They're filed with the court. Anyone had access to them. The third thing is some of the other vendors proposed leadership people that were similar to the or the same as the group who had actually ultimately won the contract. We provided more data with regard to services, types, utilization, costs, etc., than in any RFP I've ever seen. This was as open and competitive a process--and remember, the committee that did the evaluation and made the recommendation was not created by me. I had no say in who was appointed and I had no contact with that committee during their deliberations. So the recommendation came completely independent of anything that I had to do with it. Ms. Norton. At bottom finally let me say I think the fact that the costs found in this contract are out of line with any comparisons that we have been able to come up with or anyone else has been able to come up with and no cost comparisons were made by you, if, in fact, even with the difficulty of making such comparisons, such attempts had been made, I believe that we probably would not be sitting here today, because we have fully accepted the notion that it is very, very difficult to make those comparisons. What we cannot accept is that no attempt should be made; that attempts have to be made by other agencies of the District of Columbia, but not by the Department of Corrections when it comes to the D.C. jail. I was particularly interested to read in Mr. Clark's testimony that he had offered to provide examples of RFPs from the BOP--and here I am looking at page 11 of his testimony-- awarding a similar medical service contract for its four-prison complex in Beaumont, TX, at a rate of under $6 a day, and the offer was declined. You see, that is what we cannot understand. I don't know why you, Mr. Shansky, or you, Ms. Schneider---- Dr. Shansky. I never received such an offer. Ms. Norton. Well, it is in his testimony. Dr. Shansky. Well, he can testify, but I never---- Ms. Norton. He said the offer was declined. Dr. Shansky [continuing]. Received such an offer. Ms. Norton. What do you have to say to that, Mr. Clark? At bottom, this is my concern: that nobody looked to see what anybody else was doing, not necessarily that you cost more. Dr. Shansky. I have looked at prisons and jails in between 30 and 40 States, between 100 and 200 facilities. There is no one with more experience looking at facilities and issuing RFPs in the country than me. Ms. Norton. And we haven't found a single one at the cost you have left the District with. Now, Mr. Clark, you say the offer was declined. What does that mean? Mr. Clark. This was an offer that I made in the course of meetings during the 6-months that was referred to in the preparation and detailing of the RFP, I think going back to some time in 1998, in meetings with a number of the parties in that process that was mentioned. Ms. Norton. Clearly what we didn't have here was the kind of collegial relationship you say you had with the District government. We needed it with you to do that. I really am tough, but I'm tough because it is better for me to be tough than the folks you all are going to meet next year, and because I think that this still can be done. I want to say first, as one whose former life was as a Constitutional lawyer, spent her early years doing nothing but writing briefs to Courts of Appeals and to the Supreme Court on cases not unlike the case before us, that I do not want to be misunderstood as to the job you had before you or the lack of respect I have for the District of Columbia for what it took to finally get this thing under control, and that they, themselves, did not get it under control and it took outside experts to do so. I believe that the District is ready to receive this function back, but I don't believe it because of anything I've heard from Mr. Washington or Mr. Christian here today. I believe it because I know the way the Mayor is right-sizing the rest of the government. I know that in some detail. I have seen what he has required of his department heads. I know that, in taking this back, he will put on the task experts that will, in fact, right-size this while keeping the quality necessary. I say that because there is precedent for his doing it. At the same time, I must say that I regret that the city will have to spend money on the cost control, and cost efficiency aspects of the medical jail receivership. This should have been part and parcel of what the medical receiver gave us back. I hold not only Dr. Shansky responsible for that. It is hard to hold him entirely responsible because he acted the way that doctors always act. I hold Ms. Schneider responsible for that, since she was to mediate. When she saw that Mr. Clark, an outside expert who didn't have a dime in this dollar except he was commissioned by us to make sure that this was cost efficient, it was your job as the mediator, a role you have defined for yourself, to bring Mr. Clark sufficiently into this so that there would be cost controls, to help Mr. Washington and Mr. Christian understand that this was not a stick-up, that they had to do whatever Shansky said or else they didn't get it back, and to do for Dr. Shansky what managers are having to do for doctors all over the country. It is very painful, but unless we do it this way what we will say is that those who already have health care can eat up all the health care dollars and those such as the residents of the District that the Mayor is going to have to get health care for simply get left out in the cold. Yes, I think you are ready, but I think you are ready largely because of the management structure of the D.C. government, not because of anything I've heard here today. Thank you, Mr. Chairman. Mr. Davis. Thank you, Ms. Norton. We have 10 days to hear from you, Mr. Washington and Mr. Christian. Anyone want to add anything? I don't want anybody to feel they didn't get the last word, if they wanted to make a comment. [No response.] Mr. Davis. I'm going to enter into the record a briefing, a memo distributed to the subcommittee members. We'll hold the record open for 2 weeks from this date, for those who might want to forward any other submissions for possible inclusion. I want to again thank all the witnesses for taking the time to come today and for your dedication to this. These proceedings are closed. [Whereupon, at 12:27 p.m., the subcommittee was adjourned.] [Additional information submitted for the hearing record follows:] [GRAPHIC] [TIFF OMITTED] T2581.130 [GRAPHIC] [TIFF OMITTED] T2581.131 [GRAPHIC] [TIFF OMITTED] T2581.132 [GRAPHIC] [TIFF OMITTED] T2581.133 [GRAPHIC] [TIFF OMITTED] T2581.134 [GRAPHIC] [TIFF OMITTED] T2581.135 [GRAPHIC] [TIFF OMITTED] T2581.136