INTRODUCTION:

Billy Roberts, a prisoner in an Alabama state prison, had a history of severe psychiatric disorders. He was often put on suicide watch, and received large doses of psychotropic drugs. A managed health care company, Correctional Medical Services (CMS), was responsible for the health care at the prison. After Roberts had a suicidal episode, CMS's statewide mental health care director reportedly put Roberts in an isolation cell rather than a psychiatric care unit. The mental health care director also ordered that Roberts' medication be discontinued pursuant to an alleged policy of CMS to get as many prisoners off psycho- tropic drugs as possible in order to keep costs down. Six days later, Billy Roberts hanged himself. This is not an isolated case. In an effort to cut costs or to provide constitutionally adequate health care to inmates, an in- creasing number of prisons have been using managed care systems to provide health care. Although the use of managed care has saved states money, the quality of health care arguably has decreased. Inadequate care has been a recurring problem in prisons run by private managed health care firms. Consequently, prisoners and staff continue to complain, and prisoners are filing suits asserting that their constitutional rights have been violated.