This excellent article was sent to me by my friend, Steve Hampton, Esq., who has had to file numerous lawsuits on behalf of inmates abused by the prison health care system here in Delaware.
You can reach Steve at:
Grady and Hampton LLC
6 North Bradford Street
Dover, DE 19904
Thank God that word is starting to spread about this nation wide crisis.
Excerpts from the Article:
As a child growing up in Pueblo, Colorado, Jeremy Laintz travelled widely with his father, an aeronautics engineer at Lockheed Martin, who sometimes took his four kids along on business trips. Family vacations included tours of aerospace facilities and, on one occasion, a trip to watch a space-shuttle launch at Cape Canaveral. Laintz’s mother managed a bakery, and Laintz, the youngest child in the family, recalled enjoying a warm home life. He played soccer and football, and spent summers hunting and fishing on a ranch that his family owned in North Dakota. As a teen-ager, though, he slipped into trouble—he was arrested first for driving under the influence, and then, in his late teens, for felony car theft. He spent a year in prison, where he learned to weld, and a few more years in halfway houses. Then, in 2003, he moved to Alaska, where he joined a Christian fellowship and took seasonal jobs welding, repairing roofs, and working in a fish-processing plant. He often made good money, and his life seemed back on track.
Six years later, though, when he was thirty, he returned to Colorado and, while working in a warehouse, tore a tendon in his wrist. A doctor prescribed opioids for the pain, and Laintz immediately started abusing them. Then a friend persuaded him to try heroin, and soon he was addicted. He was arrested on a charge of possession and, while out on bond, in early October of 2016, failed to show up for a court-ordered drug test. He was arrested again and booked into the Pueblo County jail.
As part of the standard booking procedure, medical personnel at the jail evaluated him. Pueblo County had a contract with Correctional Health Partners, a doctor-owned, for-profit company based in Denver, to provide health services; there was a medical facility on site, supplied with basic equipment. Laintz told company nurses on duty that he used heroin and suffered from hepatitis C, an affliction common among intravenous drug users. Correctional Health staff prescribed loperamide (for diarrhea) and meclizine (for nausea and vomiting) to ease his withdrawal while he awaited sentencing, a lawyer representing Laintz said.
A week later, though, according to filings in a recent lawsuit, Laintz submitted a written request for medical help, noting that he was experiencing a level of pain “so bad I don’t know what is going on,” and that he could “hardly breathe” and “hardly move.” A Correctional Health E.M.T. gave him over-the-counter medication for “possible chest pain or anxiety/panic attack.” On October 15th, a Saturday, when his mother visited, Laintz complained to her, too, of severe pain. The following Thursday, he was sentenced to ninety days in jail. When his mother returned, a week later, he told her that he was still in “rough shape,” so she called the Correctional Health unit. His father also went to speak to the county sheriff, who oversaw the jail.
A physician’s assistant examined Laintz again, and found that he had low blood pressure and an elevated pulse. According to court documents, she told him to try “relaxation and breath control.” After he told deputies that he was too weak to walk to the dining hall, they allowed other inmates to bring him food in his cell. On November 1st, an administrator at Correctional Health left a voice-mail message for Laintz’s mother reporting that, according to the medical staff, “everything is pretty much normal.” He suggested that Laintz had been deliberately hyperventilating to produce his symptoms, in an attempt to be sent to the hospital. “There is no medical reason for him to go,” the administrator said, and asked her to tell her son “to quit hyperventilating and to coöperate with us.”
That evening, however, a sheriff’s deputy noticed that Laintz looked pale and was having difficulty breathing. The deputy declared an emergency, but, rather than send him to a hospital, a Correctional Health physician’s assistant ordered treatment with intravenous fluids in the jail’s medical facility. When Laintz insisted on being taken to the hospital, a sergeant at the jail overruled the assistant and sent Laintz in a police car to the St. Mary-Corwin Medical Center. There, according to his lawyer, doctors diagnosed dehydration, sepsis, pneumonia, and acute renal and respiratory failure. They put him in a medically induced coma and intubated him, then had him airlifted to a hospital near Denver, where he spent a month undergoing multiple procedures, including the partial removal of a lung. He also lost part of six toes to gangrene.
Laintz is suing the county and Correctional Health Partners for “deliberately indifferent policies.” The county declined to comment on pending litigation. In a court filing on February 12th, Correctional Health disputed Laintz’s account, saying that “at no time” did its personnel fail to “address and treat his medical needs.” Madison Barr, a spokeswoman for the company, had previously told me that she also could not comment on the lawsuit, but she pointed out that increasing numbers of people are entering jails with medical problems related to chronic conditions, such as addiction, and that, at the time of their booking, “these conditions don’t necessarily show symptoms.”
There are more than three thousand jails in the United States, usually run by sheriffs and county offices, which house some seven hundred thousand people. They are typically waiting to make bail—or, if they can’t, to go to trial or enter a plea—or are serving short sentences. Barr is right about the crisis of chronic health conditions among them. According to a study released in 2017 by the Bureau of Justice Statistics, nearly half the people held in jails suffer from some kind of mental illness, and more than a quarter have a severe condition, such as bipolar disorder. The same year, the bureau reported that about two-thirds of sentenced jail inmates suffer from drug addiction or dependency; that number was based on data from 2007-09, so it does not take into account the recent catastrophic rise of opioid addiction. That epidemic and other public-health emergencies, in jails across the country, are being aggravated by failings in the criminal-justice system.
Jails have a much higher turnover rate than prisons, where inmates generally serve long sentences. Prison wardens face their own problems, serving populations that suffer from chronic diseases and conditions related to aging, in addition to high rates of addiction and mental illness. Yet the crisis is particularly acute in jails, because large numbers of people booked into custody are in a state of distress or, like Laintz, will suffer withdrawal, which can require close monitoring and specialized treatment that jail wardens are not equipped to provide. Many jails are in rural or poor counties, where administrators complain that they have neither the resources nor the expertise to hire, train, and supervise doctors and nurses in the particular demands that their facilities require. Increasingly, they have turned to for-profit companies operating in the field known as “correctional health care,” which pledge to deliver quality care while containing costs.
The growth of for-profit firms providing medical services to the incarcerated is part of a trend that started in the nineteen-eighties, during the Reagan Administration, toward privatization in the general management of correctional facilities. The trend accelerated after the passage of tough sentencing laws in the nineties—notably the Violent Crime Control and Law Enforcement Act of 1994—which caused the number of people held in jails and prisons to jump from about three hundred thousand, in 1980, to more than two million today. More than a third of that population is African-American. According to a 2018 study from the Pew Charitable Trusts, more than half the states hire private companies to provide at least some of their prison health care. There are no comprehensive statistics about the prevalence of private health-care companies in jails. But, according to the National Commission on Correctional Health Care, which accredits programs in correctional facilities around the country, about seventy per cent of the jails that it inspects outsource their medical services, and for-profit companies have a sizable share of those contracts.
People held in correctional facilities are entitled to a judicially mandated standard of care, but no large-scale studies have been conducted to compare the quality of treatment provided by private companies with that provided by government-run services. The evidence available from lawsuits filed against the companies is troubling, however. With the help of Gabrialle Landsverk and Alejandra Ibarra Chaoul, postgraduate researchers at Columbia University’s Graduate School of Journalism, I reviewed complaints, depositions, and affidavits in lawsuits filed against jail operators and correctional-health-care companies.
We focussed on two of the largest nationwide providers, Corizon Health, which is based in Brentwood, Tennessee, and Wellpath, which is headquartered in Nashville. The two companies have been sued about fifteen hundred times during the past five years—according to the federal and state court records that we collected—over matters including alleged neglect, malpractice, and, in dozens of cases, wrongful injury or death. (Corizon was the defendant in more than a thousand of the cases.) Most of the suits were filed pro se, or without the help of a lawyer; petitioners had legal counsel in only about a quarter of them. More than a hundred ended in settlements, but, owing to confidentiality agreements, it is often not clear whether the company or the local government made a payment, or, if so, for how much.
Corizon reports that it is responsible for the care of about a hundred and eighty thousand people on a day-to-day basis. Wellpath, which until last November was known as Correct Care Solutions (the company changed its name after merging with a competitor), says that it is responsible for about two hundred and fifty thousand people on any given day. Executives from both companies told me that the lawsuits shouldn’t be seen as indicative of over-all problems with how they treat patients. Many cases involve flimsy or inconclusive evidence and don’t result in findings of liability. Donna Strugar-Fritsch, a prison-health-care consultant based in San Francisco, who advises state and local governments on providing medical services to prisoners, said that, for the companies, managing suits alleging poor treatment is “just a cost of doing business in this industry.”
In some states, though, public-interest lawyers have brought class-action suits alleging inadequate health care against the entire system. In Arizona, civil-rights groups filed a class-action suit in 2012. A year later, after the state passed legislation privatizing prison health care, it signed a contract with Corizon to provide medical services in its prisons. In 2015, a federal district court, seeking to resolve the suit, approved a settlement in which the state pledged to overhaul care. But, last June, Judge David Duncan found that “widespread and systemic failures remain,” and held the state in contempt, issuing it fines of more than a million dollars. Martha Harbin, who has served as Corizon’s director of external relations, said in an e-mail that the company does “not agree with the judge’s description” of its performance in Arizona. Last month, the state, which has also disputed the judge’s finding, announced that, as of July, it is awarding the contract to another company.
In December, in a case in which a federal judge is supervising a settlement designed to improve medical services at Baltimore’s city jail, the State of Maryland, which oversees the facility, said in court documents that Wexford Health Sources, the company it hired to provide the services, had failed to respond to directions to improve its performance. It had allegedly provided “unreliable” reports, and operated while “critically short of care providers and clerical staff,” leaving “key clinical and leadership positions vacant for lengthy periods.” Wexford lost the contract, though it is not a party to the litigation, and a spokesperson for the company said that it and the state “had a difference in opinion” about how to best provide health care to inmates.
Taken as a whole, evidence from cases across the country suggests that four decades of policy failures in both health-care and criminal-justice reform have left a largely neglected population vulnerable and, at times, at risk, and that for-profit companies, which were promoted as a solution, have instead become an integral part of a troubled system.
The standard of care that incarcerated people have a right to receive was established in the landmark case of Estelle v. Gamble, in 1976. J. W. Gamble was an inmate in the Huntsville Unit of the Texas prison system. On November 9, 1973, a six-hundred-pound bale of cotton fell on him while he was on work assignment in a textile mill. He complained repeatedly of severe back pain, and prison doctors gave him pain relievers, but they did not take any X-rays. After refusing to work, he was moved to solitary confinement. He filed a pro-se lawsuit, in the form of a twenty-four-page handwritten complaint, objecting to the quality of medical care he had received.
A federal judge dismissed the suit, but Gamble appealed to the Fifth Circuit Court of Appeals, which appointed Daniel K. Hedges, a corporate litigator in Houston, to represent him. Hedges never met his client, but he argued that Gamble’s treatment was unconstitutional, because of the Eighth Amendment’s prohibition of cruel and unusual punishment. The case made its way to the Supreme Court, where Hedges again argued it. Justice Thurgood Marshall, writing for an eight-to-one majority, found that “deliberate indifference to serious medical needs of prisoners” was indeed inconsistent with Eighth Amendment guarantees, and ordered that Gamble’s care be reëvaluated.
Gamble himself did not benefit from the ruling: after his case was returned to the Fifth Circuit, the appellate court found that his care had not been sufficiently poor to justify compensation. (A few years later, he was killed by a fellow-prisoner.) Still, practitioners of prison medicine today like to point out that, thanks to Gamble’s suit and Marshall’s opinion, the incarcerated are the only people in America with a constitutional right to health care.
The Estelle decision was handed down just as the American Medical Association was leading a drive to reform health care for the incarcerated. It conducted a survey of conditions in hundreds of jails, in which operators reported dilapidated and ill-equipped facilities. Many lacked emergency medical equipment. Some didn’t even have first-aid kits. The standard of care set by Estelle was modest, calling only for an absence of “deliberate indifference.” But, building on the decision, the A.M.A. sought to establish uniform standards, which, in turn, led to the creation, in 1983, of the National Commission on Correctional Health Care. Estelle also spawned a wave of civil-rights litigation seeking to enforce the Eighth Amendment protection; this gradually led to improvements in the judiciary’s definition of a required standard. Today, prisoners are typically entitled to what a judge for the First Circuit Court of Appeals defined, in 1987, as “adequate” care at a level “reasonably commensurate with modern medical science.” (The irony remains that inmates’ rights to health care have expanded, while citizens on the outside still have no universal right to care.)
Litigation, though, is not always the best way to improve public policy. David Cloud, who works on prison-health-care issues for the Vera Institute, a nonprofit research group that focusses on criminal justice, told me, “I definitely don’t want to discount the importance of litigation, because it’s so critical.” Still, he added, correctional health care is more than an arena that requires legal accountability when failures occur. Its troubles affect many people beyond those who are incarcerated. Jails may hire private companies in the interest of saving taxpayer dollars. But, if people suffering from addiction or chronic illness are released back into communities without having received adequate treatment, “they’re still going to draw on taxpayers—just somewhere else.”
Companies that contract to provide health care to the incarcerated are tapping into an enormous business opportunity—annual spending now exceeds ten billion dollars—and they are obligated to their owners to seek profit. David Fathi, the director of the National Prison Project, at the American Civil Liberties Union, told me that companies therefore have compelling incentives to cut costs and staff, which can result in “denying care in what is literally a captive market.” He added, “I don’t mean to suggest that government-run prison health care is perfect. It’s often appallingly deficient. But, at least when a government is providing the service, there is some measure of oversight. There is some measure of democratic control.” Apart from the court-enforced standards that have evolved since Estelle, “you don’t have that with the private companies.”
The companies negotiate multiyear contracts with each jail and prison that they serve. Medical staff, prescription drugs, and outside services such as hospital stays constitute the major costs. Often, the companies receive a per-diem, per-individual rate, so profits depend on holding costs below that amount. Sometimes contracts include provisions that increase a company’s potential profit if it holds down transfers to hospitals or to other outside providers. Medicare and private health-insurance companies follow similar incentives to contain costs, prioritize preventive care, and avoid unnecessary tests and procedures. But a distinct feature of correctional health care is that, if incarcerated people believe that their health—or their life—is in jeopardy, they can’t just drive themselves to an emergency room. As Fathi put it, “Market forces don’t operate in the prison context for the reason that prisoners have absolutely no consumer choice.”
The potential effects that contract incentives might have on health care have featured in a number of lawsuits in recent years. One case involved a forty-four-year-old man named Kenneth McGill, who was booked into the jail in Jefferson County, Colorado, after violating probation for a D.U.I. conviction. He had been there two months when, in September of 2012, he began to experience facial drooping and dizziness—symptoms, he thought, of a stroke. He and other inmates reported his symptoms to the deputies on duty and to a nurse with Correctional Healthcare Companies, which had a contract to provide medical services at the jail. (The company has no connection to Correctional Health Partners; in 2014, it was acquired by Correct Care Solutions, the company that became Wellpath.) According to court documents, company staff waited more than twelve hours before sending McGill to a hospital. Doctors there determined that he had had a stroke—he says that he still suffers from vertigo and from a loss of mobility in his right arm—and he sued the company.
Anna Holland Edwards, one of McGill’s attorneys, told me that, at the trial, she and her colleagues pointed to a provision in Correctional Healthcare’s contract which stipulated that the company had to pay the first fifty thousand dollars in costs when an inmate went to the hospital. “There’s nothing wrong with being a for-profit company,” she said in her closing argument. “But the intersection of profit and health care has its problems.” She continued, “The company gets to decide whether the care is provided and know that they’re the ones that have to pay for it when it is.” (A spokesperson for the county later disputed that its contract with Correctional Healthcare discouraged hospitalization.) The jury awarded McGill eleven million dollars, including more than seven million in punitive damages against Correctional Healthcare. The parties then settled for an undisclosed amount.