with recruiting qualified staff can be attributed to both the physical isolation of women's prisons (often placed in areas that are considered undesirable to live in, where there are few available medical professionals), and to the relative lack of medical resources and low salaries that prisons offer to medical staff. Dr. Valda Chijide, a former HIV doctor in an Alabama prison, for instance, resigned from her position due to inadequate support. In this case, the HIV unit was rat-infested, with broken windows covered in plastic. Privatization of prison health care There is also a trend towards privatizing health care by hiring outside, for-profit health care companies to provide medical care to inmates. According to a 1996 survey by the National Institute of Corrections (NIC), forty-four state Departments of Corrections contract out at least some of their medical care to private vendors - in 1996 this amounted to $706 million. This can result in a lack of accountability, as proper monitoring makes a contract more expensive. Oversight is often lacking. In Alabama, the same official who previously held a high level position at Prison Health Services, one of the nation's largest private vendors, now works in a position within the Alabama Department of Corrections which requires her to oversee Prison Health's compliance to the contract. Prison Health Services, which has cared for 237,000 inmates, has had to pay millions of dollars in fines and settlements due to inadequate care. In another example, according to a former supervisory nurse of a jail operated by Correctional Medical Services (CMS), a large private contractor, the jail would often release pregnant women when they went into labor, and then arrest them again after they gave birth, in order to avoid having to pay for the inmates' medical expenses. Lack of accountability also results due to varying state and federal laws on private contractors' liability for medical abuse and neglect. Private contractors can be challenged under the same federal civil rights law that applies to state and local governments, but these corporations cannot be sued for unconstitutional medical practices. See also Incarceration in the United States Incarceration of women in the United States Reproductive health References Imprisonment and detention of women in the United States Healthcare in the United States Sexual health