Arranging medical appointments is a trivial task, except when the patients are inmates who must travel under guard and without prior notice so they can't plot an escape. In 2006, Jerry Heftler ditched his old business model -- providing cardiac imaging services -- in favor of managing prisoners' outside care. Integrated Medical Solutions, based in Mansfield, Texas, contracts with hospitals and doctors around 13 client prisons, makes inmates' appointments, arranges for outside rehab and nursing services, and manages case files and insurance paperwork.
They were our second customer, and we'd had them only a couple of days: a federal prison in Texas with approximately 1,600 inmates. I'd made a preliminary call to the contracting officer -- our first point of contact -- and planned to conduct extensive conversations with the director of health services and other officials there the following week. Beyond that, we didn't even know who was who.
It was late on a Friday afternoon. My staff of three and I were phoning physicians' offices near the prison, setting up a network of providers willing to serve inmates. (That's not always easy. Some physicians resist exposing their regular patients to guys in handcuffs and jumpsuits. Even those who sign on with us often require that inmates be delivered through a back door and hustled straight to the examining room.) I was talking about the prison with one physician when he asked if I'd seen the TV. "There's a riot going on there," he told me.
The physician described the scene unfolding on his television and, sure enough, it was our new client's facility. He said there were medevac helicopters hovering overhead, so we knew there were injuries. I presumed chaos. Staff would be trying to account for every employee to make sure there were no hostages. Making sure there were no bodies. Working like crazy to secure the institution.
I immediately phoned the prison and worked my way through to the health-services director. I introduced myself and asked what we could do. Technically, our contract didn't kick in for another week, but she asked if we could start now. She and her small staff were triaging inmates (thankfully, no staff had been hurt, but one inmate died), then dispatching the worst cases on gurneys to the back gate, where they were being loaded onto helicopters and into ambulances. Many had head traumas and multiple stab wounds, but still they traveled in handcuffs. Whichever guards or other staff members were on hand jumped in alongside them. The emergency vehicles were transporting the injured to six hospitals in five cities as far as 75 miles away. In the chaos of those early hours, no one was sure who had gone where.
When you're new in a business, you want to impress customers with your experience. Probably few vendors could have reassured this client with, "Hey, don't worry. This isn't my first prison riot." But I'd spent 22 years at the Department of Justice, where among other things I practiced and taught hostage-negotiation skills. A cool head comes with the territory. I told the director of health services that we would track down the inmates, make sure the hospitals had authorization for surgeries and respirators, and arrange additional transportation and treatment at specialist facilities where needed. We would also alert the prison to everyone's whereabouts in an organized way so they could efficiently dispatch guards to take over for whoever had left with the injured. Even in their hospital beds, the prisoners would need guarding 24/7.
We spent the next eight hours and all of Saturday on the phone, first trying to convince hospital officials of who we were (they were deluged with inquiries from journalists and ambulance chasers, so they were understandably wary) and then struggling to put names to the 26 inmates who had been evacuated. Most had arrived at the hospitals unconscious, and the staff members with them often did not know who they were. And, of course, inmates don't carry wallets. In many cases, hospital staff had identified patients by their prison tattoos: "Inmate: knife through cross"; "Inmate: Mexican Mafia." To simplify things, I decided we would enter those same descriptors into our own system until we had better information. We used the tattoos to coordinate and track treatment with the hospitals, authorize procedures, and help health officials at the prison keep a handle on things while the corrections side contained the riot and brought life back to normal. For months afterward, we wrestled with the insurance snafus that predictably resulted from care administered amid such bedlam.
I had promised the director of health services I'd stay in constant touch. Once she finished triage, she was out and about in the facility. She gave me her cell number, which was useless since you can't bring cell phones into prisons. So I'd call the control center; they'd send her the message via radio, and she would rush to a phone. We had a lot to talk about. Most of the inmates required surgery -- some had more than 30 stab wounds.
We also found ourselves inundated with queries from the press. Once hospital personnel understood we were coordinating inmates' health care, they started giving our contact information to journalists. Family members started calling as well. I gave my employees a quick course in federal law-enforcement requirements for protecting information.
Today, we have 13 prisons under contract, but our relationship with that second customer is unusually close. We've been through the fire together and have a shared sense of perspective. When small problems crop up, no one breaks a sweat. They have confidence in us. We have confidence in us, too. When it was all over, we looked at each other and said, "If we made it though this, we can make it through anything."