THE COMPANY that once supplied health care in a third of South Carolina’s prisons is back asking for a second chance to deliver the service.

Correctional Medical Services worked for the state from 1986 until 2000. The company walked away from its contract in 2000.

A 2000 Legislative Audit Council report suggests that while it might not have been disastrous, the arrangement between CMS and the state had some significant problems. Its re-emergence on the state’s doorstep should prompt an in-depth review of its past performance. The state shouldn’t rush to hire CMS or either of the other two companies — Wexford and Prison Health Care — interested in caring for inmates until it thoroughly reviews the last foray into privatizing prison health care.

One of the criticisms in the LAC report was that the state had not done its homework. “We found that the department did not analyze the potential costs or benefits of contracting before entering into agreements with CMS,” the report said. Attempts by the LAC to get information about privatization from corrections officials in Alabama, Florida, Georgia, Mississippi, North Carolina, Tennessee and Virginia yielded an unsettling revelation. “None of these states had conducted a formal analysis before contracting for medical services.”

CMS began working in three prisons in 1986. By 1997, it had a contract to deliver medical, psychiatric and dental services and program support in nine prisons. In 1998, it entered a 10th prison under a separate contract, which was later amended to include care for chronically mentally ill patients. In 2000, CMS walked away from the contract after a dispute over how much it was being paid and how much service the company was to provide.

The state took over in all the prisons. Today, the state’s per-inmate costs are among the lowest in the country. Director Jon Ozmint believes they can get lower. So he’s looking at privatizing in hopes of a better price and better staffing.

Anton Gunn, executive director of South Carolina Fair Share, said the state should steer clear of privatization. He’s also surprised to see CMS’s name pop up. “It wasn’t the best marriage at all,” Mr. Gunn said. “Four years later, the same company is coming back in submitting a bid.”

Fair Share and another community-based nonprofit from Charlotte, Grass Roots Leadership, had two studies done that point out problems with privatizing prison health care. The reports were produced by Marguerite G. Rosenthal, a professor of Social Work at Salem State College in Massachusetts.

“The bottom line of what we found is the state is much better off in leaving the system public,” Mr. Gunn said.

Mr. Ozmint said he has seen the reports, but nothing in them makes him rule out privatization.

Looking back at CMS’s performance might not be enough to rule out privatization, either. But it certainly ought to make the state take a deep breath before committing to a private firm. The March 2000 report raises a number of questions about CMS’s performance and the state’s handling of the contracts. Here are some of the report’s findings:

Corrections did not conduct audits to ensure the state was getting adequate service from the private provider. The LAC reviewed audits from July 1997 to May 1999. There were no behavioral medicine audits. At least seven should have been done during that time. Audits outlining the administration of medicines were not found for seven of eight institutions where they were required. No audits were found for five of nine medical service areas at the Lee Correctional Institution.

An audit of medication administration at one site found that the service did not meet the minimal compliance rating established by department policy. “We found that inmates at this facility are still not receiving their medications in a timely manner.” A comparison of a CMS-run prison with a similar state-run one yielded this result: “We found that 92% of the prescriptions were provided within the required period at the SCDC-provided site, while 54% of the prescriptions were provided in a timely manner at the contracted site. Further, at the contracted site, three medications appeared not to be administered at all.”

While the contracts allowed Corrections to deduct funds from payments to the contractor for deviations in contract requirements, the review showed officials never determined whether funds were due. In one instance, the department allowed the contractor to determine the amount of deduction for HIV/AIDS treatment. “Department officials do not know if this amount is fair and reasonable,” the report said.

CMS didn’t adequately plan for the discharge of inmates treated for chronic mental illness so they could successfully return to the community. “For two months, the contractor did not assign staff to handle discharge planning. During this period, at least ten inmates were released.”

Counseling staff for inmates at CMS and the Corrections Department sites did not meet minimum qualifications.

If state officials privatize prison health care, a service I believe the state is obligated to keep in its hands and not those of a private company, they must not relinquish responsibility. We can’t privatize this service and turn our backs, which is what happened before. The state must be willing to commit to a comprehensive monitoring program that ensures we will get what we think we’re paying for.

Still, that might not be enough.

Reach Mr. Bolton at (803) 771-8631 or wbolton@thestate.com.