BALTIMORE (AP) - Prison Health Services Inc., which provides medical care to Maryland's 24,000 inmates, has disciplined three nurses and a physician assistant at the Baltimore women's detention center in connection with the treatment of the 34-year-old woman whose death last month is being investigated by the state.

Deborah Epifanio died Sept. 14, four days after being taken by ambulance from the jail to University of Maryland Medical Center, where doctors diagnosed an advanced case of cryptococcal meningitis. Hospital records indicate she had been experiencing fainting spells for several days by the time jail caregivers sent her to the emergency room. Records also mention a head injury Epifanio apparently incurred in a jailhouse fight, although state correctional officials say no incident report was ever filed.

Members of Epifanio's family, who say they saw correctional employees covering her bruises with makeup when they arrived at the hospital to view her body, wonder whether quicker or better care at the jail might have saved her life.

In a new disclosure, a July 13 letter from Epifanio stated that she also had been hospitalized for fainting spells for several days while in the custody of the Maryland Correctional Institution for Women in Jessup.

State officials won't comment on any aspect of the case, pointing to a pending internal investigation by the Department of Public Safety and Correctional Services.

Prison Health Services, a subsidiary of American Service Group Inc., based in Brentwood, Tenn., released a statement Tuesday saying that the four employees - a registered nurse, two licensed practical nurses and a physician assistant -had been "reprimanded and assigned to new duties" as of Oct. 6, "upon completion of interviews and investigations. ... The analysis revealed that these employees did not perform a function customarily done during the intake process."

The actions come as Prison Health Services faces harsh criticism for purported lapses in its institutional medical care. Palm Beach County, Fla., officials recently implicated the company's shortcomings in nine inmate deaths during the past two years. A report last June by the New York Commission on Correction blamed the company's cost-cutting measures for an inmate's death after his prescribed medication was withheld.

In Baltimore, a 2002 report by the U.S. Department of Justice found that at least six deaths at the city's detention center were due to chronic health neglect. Attorneys for the American Civil Liberties Union and the Public Justice Center alleged in a filing last March that medical care at the detention center is so poor that it is unconstitutional.

Prison Health Services has provided medical care for Maryland's inmates since 2000, under a contract due to expire June 30. By then the state will have paid the company about $261 million for its services, although a company press release last July said that the contract had become a money loser - with $1.1 million in losses coming in last May alone - because of rising hospitalization costs, a growing inmate population and a greater number of mental health patients and patients infected with the AIDS virus.

Epifanio fell into the latter category. Her family described her as mildly mentally retarded, and she was often in and out of jail on drug and prostitution charges. She had been seeking counseling from the YANA project to break the cycle when she was imprisoned at Jessup last May on another prostitution charge.

Information from: The Sun, www.baltsun.com