Community resource for those monitoring abuses of prisoners across the criminal justice system, and for those subject to or surviving state violence, neglect and abuse.
This first press release is just in from the ACLU of Arizona. I think the DOC is getting off easy without having a public trial, but it saves money and time to do this instead. They were definitely going to lose...
The second press release is from the head of the AZ DOC, Charles Ryan, the guy who was named in the suit. Sounds like he won the lawsuit or something. These are vastly different accounts of the settlement. My bet is that the AZ DOC put the most spin on their version, but it concerns me that they say the following: " “This
is positive news,” said ADC Director Charles Ryan. “On the eve of
trial, the plaintiffs in this case have essentially agreed that the
department’s current policies and practices, along with recent
enhancements to programming opportunities, adequately addresses the
plaintiffs’ concerns relating to constitutional healthcare and
conditions of confinement for maximum custody and mentally ill inmates. " AND: " ADC
will monitor its own compliance, thus avoiding costly court oversight,
and the Plaintiffs’ attorneys, through record review and on-site tours
will confirm compliance, as well."
Say what??? No way!!! I'm going to have to read the settlement docs myself and get back to you all with another analysis..
----------
Arizona Agrees to Major Improvements in Prison Health Care, Crucial Limits on Solitary Confinement in Landmark Settlement
PHOENIX – The American Civil Liberties Union, the ACLU of Arizona, the Prison Law Office, and co-counsel today filed a settlement agreement
in their class-action suit on behalf of more than 33,000 prisoners in
Arizona’s state prisons. Under the settlement, the Arizona Department of
Corrections must fix a broken health care system plagued by long-term
and systemic problems that caused numerous deaths and preventable
injuries. The settlement will also allow prisoners in solitary
confinement who have serious mental illnesses to have more mental health
treatment and time outside their cells, and will make other critical
reforms in prison conditions.
“The Arizona Department of Corrections worked with us on a settlement
that shows a commitment to protecting prisoners’ physical and mental
health,” said David Fathi, the Director of the ACLU’s National Prison
Project. “We hope other states will now find ways to provide adequate
medical, mental health, and dental care to their prisoners.”
“The Arizona Department of Corrections has agreed to changes that will
save lives,” said Don Specter, Director of the Prison Law Office. “This
settlement will bring more humane treatment for prisoners with serious
health care needs, and the potential for their conditions to improve
rather than worsen.”
The settlement in Parsons v. Ryan requires the Arizona
Department of Corrections (ADC) to meet more than 100 health care
performance measures, covering issues such as monitoring of prisoners
with diabetes, hypertension, and other chronic conditions; care for
pregnant prisoners; and dental care.
The settlement also requires ADC to overhaul the rules for prisoners
with serious mental illnesses in solitary confinement. Instead of
spending all but six hours a week in their cells, such prisoners will
now have a minimum of 19 hours a week outside the cell, and this time
must include mental health treatment and other programming. ADC must
also restrict guards’ use of pepper spray on these prisoners, using it
only as a last resort when necessary to prevent serious injury or
escape.
The settlement provides for ongoing monitoring and oversight by the
prisoners’ lawyers to make sure the state is complying with its terms.
The groups filed the federal lawsuit in 2012, challenging years of
inattention to the health needs of state prisoners and improper and
excessive use of solitary confinement, resulting in serious harm and
unnecessary deaths. Judge Neil V. Wake of the U.S. District Court in
Phoenix certified the case as a class action in March 2013, and the U.S.
Court of Appeals for the Ninth Circuit affirmed that ruling in June
2014. Last month, the groups filed reports by nationally recognized
experts in corrections and in medical, mental health, and dental care,
showing system-wide problems with the prisons’ health care and excessive
use of solitary confinement.
In addition to the ACLU and the Prison Law Office, other attorneys on
the case are Perkins Coie, Jones Day, and the Arizona Center for
Disability Law, which is also a plaintiff in the case.
PHOENIX (Tuesday, October 14, 2014) – The Arizona Department of Corrections (ADC) has reached a settlement agreement in collaboration with the ACLU, Prison Law Office and ACDL prior to the pending trial.
The parties have agreed to approximately 100 performance measures applicable to medical, mental health, dental and conditions of confinement.
“This is positive news,” said ADC Director Charles Ryan. “On the eve of trial, the plaintiffs in this case have essentially agreed that the department’s current policies and practices, along with recent enhancements to programming opportunities, adequately addresses the plaintiffs’ concerns relating to constitutional healthcare and conditions of confinement for maximum custody and mentally ill inmates.
“In regards to those issues, the settlement notwithstanding, it’s unfortunate that the plaintiffs continue to use rhetoric such as ‘solitary confinement’ to describe housing for some inmates. No such confinement exists in our institutions. The Department of Corrections has always followed nationally-accredited standards for housing single-cell inmates that include requirements for natural daylight and contact with others, and out-of-cell time.
“Additionally, it should be noted that Arizona’s inmate mortality rates, including incidents of suicide, are within the national average for corrections departments. In 2012, the most recent year for which statistics are available, Arizona reported 215 deaths per 100,000 inmates, compared to the national average of 254 per 100,000. Additionally, Arizona averaged 17 inmate suicides per 100,000, which is in line with the national average of 16 per 100,000.
“By avoiding a costly trial, the Department saves significant resources that can be further directed towards continuing to provide constitutional healthcare and structured programming to support successful community reintegration. This is especially relevant in light of the fact that despite the state of California spending nearly $18,000 per inmate for health care costs due to two decades of litigation by the same plaintiffs in the Parsons case, California is still under court supervision and the inmate mortality rate there exceeds that of Arizona.
By contrast, Arizona spends nearly $3,800 per inmate in health care costs.
ADC will monitor its own compliance, thus avoiding costly court oversight, and the Plaintiffs’ attorneys, through record review and on-site tours will confirm compliance, as well. ADC, through its contracted vendor, must meet specific compliance thresholds at its facilities. Within two years, monitoring of performance measures automatically terminates when those performance measures meet agreed-upon thresholds. ADC can petition the court to terminate the entire settlement agreement after four years.
What follows is an interview with a Corizon whistleblower/former employee, Teresa Short, and the results of extensive research by KPNX investigative journalist, Wendy Halloran. Wendy has even posted critical evidence for us from her research below. Teresa worked in the infirmary at ASPC-Tucson/Rincon, and was deeply troubled by much of what she saw while there. If you or a loved one of yours has been mistreated at ASPC-Tucson/Rincon in the past year, please get in touch with me. And to anyone out there who is or will be litigating Corizon: you need to send this article to your attorney. These people are preying on the sick and dying. AZ DOC prisoners and their families owe both Teresa and Wendy a debt of gratitude for their willingness to risk retaliation by the powerful to bring the truth to light. Even our state's legislators are afraid to call DOC and Corizon out for what they've been up to. This experiment has not only been a colossal waste of taxpayer dollars that could be used to prevent crime and incarceration, but will be sucking resources out of the state budget long after Corizon has run away with its profits. At great cost to Arizonans - with the blessing of our Republican legislature and governor - Wexford and Corizon have perpetrated additional harm on the very people the DOC is supposed to be "rehabilitating", costing the lives and livelihoods of far too many individuals who do not deserve to be thrown away.
Rather than whitewashing things like this poor man bleeding out due to negligent care, DOC Director Ryan should be pounding down the Governor's door saying "THIS ISN'T WORKING!!!!", and begging the legislature to reverse their order to privatize state correctional health care. He owes them the truth - he owes that to all of us.
To all the rest of you at the DOC and Corizon who are trying to do the right thing by the patients you serve: thank you for all your acts of kindness and professionalism, but your silence still makes you complicit with the real bad guys. Please talk to SOMEONE about what you have seen and been ordered to do as well, if it goes against yours or your profession's ethics. Otherwise, they will most surely get away with this fraud, waste and abuse. You might want to start with contacting Wendy Halloran at KPNX. If anyone can put the info you may have to good use, it's her. Wendy Halloran, KPNX/12News 200 East Van Buren Phoenix, AZ 85004 602-444-1212
Arizona
taxpayers are footing a $10.2 million per month bill for healthcare a
12 News investigation has found leaves some patients untreated.
Arizona taxpayers pay $125 million a year to Corizon,
a company contracted to provide healthcare to Arizona's inmate
population. A 12 News investigation revealed there are questions about
whether the company is driving up its profits at the expense of
taxpayers.
What's more, billing records show the Department of
Corrections is spending millions more to defend itself from a 2012
class-action lawsuit filed by the American Civil Liberties Union of Arizona and the Prison Law Office out of Berkeley, Calif.
That filing accuses the department of not providing adequate medical care, mental health care and dental care to prisoners.
The state hired Struck, Wieneke & Love PLC,
a private law firm in Chandler, to handle its defense. Legal billing
records show taxpayers have already paid the firm $2,988,910.68 as of
April, 2014.
In an interview, Dan Pochoda, the legal director for
the ACLU of Arizona, says the defense of the lawsuit was given to a
private firm too quickly. He questions why the Attorney General's Office
is not defending the case.
"The Attorney General's Office, they
have a section that does the defense for this specific agency, in this
case the prison systems, as they do for other agencies and presumptively
it should start off obviously with the AG," he said. "You know it's
going to be a significant expense once we go outside. These are
profit-making firms just like the health-care provider is a
profit-making provider. Their bottom line is making more money."
That's
nearly $3 million in public money to a private firm defending the
Department of Corrections against allegations its private healthcare
provider is doing an inadequate job.
Questions about inmate care
We
reviewed records from March through October 2013 and found at least
16,000 medical delays, ranging from not treating an HIV-positive
prisoner to inmates not getting antipsychotic medication.
Why should taxpayers care? Every day Corizon is on the job, we pay on average $339,000, whether it does its job or not.
Teresa
Short worked as a patient care technician for Corizon at the state
prison in Tucson. She resigned in March and has since had trouble
dealing with the death of an inmate she cared for.
That inmate was James Copeland. Copeland was serving time for failing to register as a sex offender.
Copeland
was diagnosed with dementia and kidney disease. He was a dialysis
patient housed in the medical unit where Short worked at the prison.
Copeland had a vascular catheter inserted in his chest, which is a port
for dialysis.
That device prompted Short to warn her colleagues on
several occasions after she caught Copeland disturbing its cap. Short
was nervous and believed due to his dementia he needed constant
supervision or he might compromise the catheter. She was very skeptical
about Corizon's decision to house Copeland there rather than in a
hospital.
A
Corizon nurse's progress notes on Copeland on November 19, 2013 reveal
signs of dementia. The nurse wrote that Copeland became agitated and
stated "he wants to go that way, pointing to the other end of the unit,"
and pulling on the lines attached to medical equipment such as his
vascular catheter and blood-pressure monitor.
On November 23, the nurse writes of Copeland's state, "confused and needs frequent directions and orientation."
Short says
Copeland would pull on oxygen lines during dialysis treatment, would
pull on his vascular catheter lines and would stand up all the time when
he was supposed to be sitting down receiving treatment.
Reports
show Short checked on Copeland at 4 a.m. on November 28, 2013. That was
Thanksgiving Day. He was hungry and asked for food.
The security
check log shows a corrections officer accounted for all inmates being
alive and well in that wing of the prison at 4:46 a.m.. Copeland
displayed no unusual behavior.
At 5:25 a.m., Short went to Copeland's cell to give him some food and discovered him lying on his bed in a pool of blood.
"When I walked into the room, I was stepping on blood clots that were the size of livers, I mean they were huge," said Short.
Copeland had done what Short predicted, ripping off the cap which covers the catheter opening.
Short says she could see blood on the walls and even Copeland's shoe print in blood near the door.
"I felt like I failed him," she said.
The Department of Corrections Inmate Death Notification
says medical responders performed life-saving techniques on Copeland.
Pictures taken by DOC's investigation team show patches from a heart
defibrillator on the inmate's chest.
The report shows an AED
(automated external defibrillator) was utilized, but did not recommend
shock. Medical staff determined not to perform CPR due to the fact that
Copeland had bled out and there was not a sufficient amount of blood
left to try to resuscitate.
According to
the DOC's criminal investigative report, Nurse Brenda Hinton and Nurse
Robin Sheppard pronounced Copeland deceased at 5:45 a.m. Nurse Hinton
was directed by the on-call doctor, a Dr. Barciaga, to call 911.
The
report states there was a disagreement among Hinton, Sheppard, and
Barciaga. The Tucson Fire Department, which has a station across the
highway from the prison, did not arrive on scene until 6:58 a.m. and
pronounced Copeland deceased.
The report does not detail what the
disagreement was about, but makes it sound like the two nurses were
arguing about whether to call 911 or disobey the instructions of the
on-call doctor.
On December 30, 2013 the Pima County medical
examiner listed the cause of death as exsanguination - fatal blood loss -
due to an uncapped vascular dialysis catheter. The manner of death was
ruled accidental.
In a statement to 12 News, DOC Director Charles
Ryan says, "All inmate deaths are investigated criminally and
administratively. This process involves a review conducted by Corizon, a
review by ADC, as well as an independent report by the county medical
examiner. This investigative process determined conclusively that the
death of inmate Copeland was accidental; a fact independently
corroborated by the Pima County medical examiner.
"At the time of
the incident, the unit was appropriately staffed and inmate Copeland's
welfare was documented on a regular basis. He was discovered
unresponsive by a certified medical technician who immediately alerted
an ADC correctional officer and the on-duty RN and LPN. Each of these
investigations determined that the death of inmate Copeland was
accidental and none raised any concerns about the medical protocols for
inmate Copeland either prior to or following his death."
According
to DOC monitor reports, prepared monthly by staff in the Department of
Corrections' Department Health Services Contract Monitoring Bureau, a
problem with infirmary staffing was identified on October 30. Just weeks
later, Copeland died at a time when staffing levels at the infirmary
were still inadequate, according to Short.
Related documents
• DOC monitor report - Tucson, see page 71 for staffing comments (PDF, 9.91 MB)
• DOC monitor reports - All prisons, April-October, 2013 (Zip, 319 MB)
"We're the ones who have to carry the burden
when something is preventable and we cannot prevent it because we don't
have enough people to supervise the ones that need supervision the
most," she said.
Teresa Short says she was compelled to blow the whistle. If not for Copeland, for the people footing the bill.
"The
taxpayers need to really see what's happening to people," she said. "I
think most people would be disgusted. They care about the bottom line,
they care about the dollar."
Copeland's death just the tip of the iceberg
According
to the Department of Correction's own monitors, Corizon failed to
deliver timely medical care at least 16,000 times during an eight-month
period in 2013.
In fact, some of the documentation shows the provider was not providing any healthcare. These cases include:
At the prison in Tucson, an HIV-positive inmate received no treatment.
Chemotherapy for two other inmates was delayed.
An inmate had to have a craniotomy after falling 33 times because he wasn't supervised in the infirmary.
At the Eyman facility, Corizon failed to reorder chronic-care medication for dozens of prisoners.
No timely treatment for an inmate with prostate cancer.
In Yuma, mentally ill prisoners had not been seen by doctors since December, 2012.
Psychotropic medications were not renewed.
At Perryville, the women's prison, long delays to see the doctor once prisoners were referred by nurses.
"They're
examples of what you see month after month after month," said Corene
Kendrick, an attorney for the Prison Law Office in Berkeley, Calif.
"If
I were a taxpayer, someone who feels very tough on crime, I would be
outraged by this because it's taxpayer money that's going into the
pockets of a corporation," she said.
Kendrick
is one of the attorneys behind the class-action lawsuit filed by the
ACLU and the Prison Law Office against the Arizona Department of
Corrections. The suit alleges inadequate medical, mental health, and
dental care.
Kendrick contends no effort is being made by the
Arizona Department of Corrections to hold Corizon accountable for the
violations when the evidence, she says, is overwhelming in the reports
being made by DOC's own monitors.
Which brings us to four inmates
who've been granted medical parole in the last six months by the Arizona
Board of Executive Clemency.
Name
Medical parole date
Dean Vocke
10/31/13
Glen Huggins
12/11/13
Nishma Kanabar
2/28/14
Margaret Van Wormer
4/18/14
Huggins and Kanabar have already died.
Dean
Vocke was given six months to a year to live. Before he was medically
paroled, Vocke had ten months left on his sentence for vehicle theft
when he complained about back pain in October, 2012.
Vocke gave 12
News permission to review his medical records for our reporting; we are
not publishing them due to the amount of personally identifying
information they contain.
His first appointment was cancelled
because no provider was available. X-rays taken at the end of February
showed bone abnormalities consistent with cancer. The nurse requested an
MRI.
"They wouldn't do an MRI, they kept denying an MRI, denying an MRI," Vocke said. "They didn't want to spend the money."
At
the end of May, 2013, medical staff ordered CT scans, but Corizon
denied it. Finally, at end of July, 2013 a CT scan was performed.
It confirmed Vocke had cancer which now had spread to his hips and his spine.
"And finally [the cancer] ate my pelvis and my hip away," said Vocke.
In September a second CT scan showed the cancer spread to his abdomen and one of his kidneys.
Medical records show there was an eight-month delay in treating Vocke, because of Corizon's actions.
"It
was kidney cancer that could have been 95 percent survivable and now
they're saying I can't survive it whatsoever," Vocke told us.
Vocke's physician sent a request to the Arizona Board of Executive Clemency for early release due to imminent death.
From that request, the clinical summary and prognosis read:
"Inmate
Vocke has been diagnosed with renal cell carcinoma with metastasis to
the bone. He underwent a right nephrectomy and will start chemotherapy
in a few weeks. This is a very aggressive form of cancer and his
oncologist and onsite Medical Director for ASPC-Tucson have both
recommended clemency. Since inmate Vocke is wheelchair bound and in the
advanced stage of the disease, he is not considered a threat to society.
"Because
of the aggressive and advanced nature of his cancer, he is not expected
to survive this illness. The oncologist has indicated that for this
type of cancer, about 50% of patients may survive up to six (6) months
while about 35% may live up to one year."
The physician indicated Vocke has a life expectancy of six months or less.
On
October 31, 2013 the Board of Executive Clemency commuted Vocke's
sentence. He was granted medical parole, so he can die surrounded by
family. His wife Laurie says it's torn them apart.
We tried to seek comment from Corizon on the many issues outlined in our reporting.
Susan
Morgenstern, a spokeswoman for Corizon asked us to supply her with the
documentation we obtained under Arizona's Public Records Law. We
requested the quarterly and monthly monitoring memos and reports
referred to above, known as MGAR (short for Monitoring-Green-Amber-Red)
reports.
In response to our questions, Corizon provided these answers via email:
Mr.
Copeland. You asked about the investigation into the tragic death of
Mr. Copeland. As I believe you know, it has been investigated and
officially determined to be an accident. It's been thoroughly reviewed
by several agencies; and the care provided and protocols followed were
all appropriate.
As you know, HIPPA [sic] prevent health care
providers such as Corizon from providing any medical details about
specific individuals to you or anyone else. But I can assure you that we
are always willing to review individual care plans to be sure
appropriate care is provided.
As for your very general
allegations, we would be happy to check into them and provide
information if you could give us enough detail to do so. You referenced
delays in care and prescriptions; can you give us the specific instances
you are talking about (date/time/location/documentation)?
You've
also talked about four unnamed inmates who were medically paroled and
alleged they did not receive proper care. If you will give us the names
of these individuals, we will review their medical records to ensure
they received proper care.
Finally, you've alleged there are
staffing shortages, but that is simply not accurate. When the transition
to Corizon occurred in March 2013, we immediately assessed the staffing
and began an aggressive recruiting and training program. Today all
current staff levels exceed the contract requirements.
We
believe that Corizon is providing quality care to the patients we treat
every day, and we stand behind our medical professionals who work inside
the correctional facilities.
Corizon responded with a second statement after we provided more specific information.
Teresa Short: A former Corizon employee alleges lack of care, staffing shortages, and that she was "set up to fail."
Corizon
is first and foremost a health care provider, whose top priority is the
health and safety of patients. To that end, we practice evidence-based
medicine as prescribed by licensed medical professionals and focus on
providing quality health care.
The vast majority of our current
staff levels exceed the contract requirements. For example, since the
time of the MGARs provided you, the staffing for mental health care at
the Yuma facility has increased substantially.
We not only
empower our employees to succeed in fulfilling our mission, we also
require them to meet the highest standards of conduct and
professionalism.
MGAR Reports: Various allegations
As
you know, MGAR reports are monitoring tools meant to raise issues that
are then addressed and resolved. By design, they capture issues
requiring attention at a specific moment in time, some of which are
immediately resolved. The MGARs provided you are now 8-9 months old.
In
addition, Corizon is prohibited by HIPAA from discussing individual
patient cases, just as any other health care provider or hospital is
restricted.
But it's important to note that Corizon care follows
the guidelines of the NCCHC and the ACA, which are the correctional
industry standard.
Complaints from patients who were medically paroled
Again, HIPAA prevents Corizon from discussing details of individual patient care.
As
a health care provider focused on quality, we stand behind our
dedicated medical professionals and the treatment plans they provide to
patients.
The process for inmate compassionate discharge is
initiated by the inmate or the family and is considered by the Board of
Executive Clemency, not Corizon nor the ADC.
Expired Licenses
Our staff has all necessary and appropriate licenses, so this allegation is simply not true.
Most Arizonans probably think "good riddance" whenever a death row prisoner commits suicide. I've seen such remarks on comments following articles posting about young drug offenders hanging themselves in jail or prison, too, however, suggesting a particular public callousness towards all prisoners of the state, as well as their survivors. What I've seen in the wake of these suicides, though, has been the grief of the survivors, who dont deserve the community's abuse or ridicule when searching news articles for answers, and I know that in cases where a killer dies, it brings up all sorts of feelings for the survivors of victims as well. Condolences to all of you whose grief is triggered by this news. That said, this is to announce that another condemned prisoner has beaten the state to the punch and taken his own life: that's three from death row in less than nine months. Gregory Dickens, 48, was preceeded by Dale Hausner in June and Milo Stanley in May of 2013.
The deaths of these condemned men is part of a streak of suicides and suspicious, premature deaths that have happened since Corizon took over the contract to provide medical and psychiatric services for AZ DOC prisoners in March 2013. To make a sweet profit at less than the state would have provided such services for, they're cutting corners wherever they can - apparently mostly for prisoners they think the public doesn't care about anyway, like these guys held in AZ DOC's supermax prison complex, ASPC-Eyman, which includes death row. Say what you will about the evils some of them may have perpetrated, but we are condoning torture through gross medical neglect. Like medical care, psychiatric "treatment" under corizon has been streamlined to maximize efficiency and company profit. This May 2013 letter from advocate Donna Hamm to DOC Director Charles Ryan illustrates the kind of "care" prisoners at the Supermax are getting from Corizon. Keep in mind that many of these men were imprisoned in the first place or sent off to Supermax because of poorly treated psychiatric conditions - and that most male suicides are occurring in these maximum custody and solitary confinement cells.
Ms. Hamm was soon put on notice about other troubling practices and policies put in place by Corizon for evaluating and treating serious mental illness, as indicated in this October email to the DOC director. Mr. Ryan's responses to her letter are embedded in the email in bold letters.
Note that
Mr. Ryan asserts all these men received "private consulations with the
provider". That's not what the men say, though, as evidenced by this
email from a mother a month ago:
"He did try to get mental health when during his time in the
minimum unit but he was never called in. When he was in medium security
unit he was finally called in for evaluation, he was woken up at 2am,
handcuffed, and taken to Central unit. At that time, as no-one was
telling him what was going on, and he thought, he was gong to get moved
there and he could get executed. The visit was a "telemedical" visit and
he had to speak with someone over the TV. Obviously, he did not like
the fact he had to speak in front of other inmates about his issues. The
frequency of his anxiety attacks increased significantly immediately
after and he declined further care...."
Given
that at least ten prisoners now (perhaps more, as many young recent
deaths have been noted by DOC as due to "unknown causes") have killed
themselves in less than a year with Corizon HealthScare, it seems as if
its' time for the DOC to seriously re-evaluate that contract.
AZ
legislators who ordered DOC to privatize the health care for prisoners
should be less worried about assuring corporate profits to Corizon and
more concerned with public health consequqneces of mass incarceration
and poor prison health care. Keep in mind that 95% of these prisoners
will someday return to the community - over 40% of whom are infected
with Hepatitis C now, due to rampant heroin addiction in the prisons and
an obscene lack of substance abuse treatment services (only 4% of state
prisoners are able to access help for their addictions in a given
year).Prisoner health IS public health.
From: Middle Ground Prison Reform
Sent: Friday, October 11, 2013 10:30 AM
To: RYAN, CHARLES; Kim Ives, Litigation Manager; NORTHUP, DAWN; GROSS, ARTHUR; PRATT, RICHARD
Subject: Unprofessional Treatment of Mentally Ill Prisoners
Mr. Ryan:
On
or about October 3, 2013, about 20 men at the Meadows Unit (medium
custody) were placed into shackles, chains and cuffs and transported to
the Browning Unit (maximum custody) where they
were placed in a holding cell, awaiting a video-conference with a
psychologist. Apparently, this is the imminently "professional" manner
in which Corizon, with the cooperation of DOC security staff,
is conducting psychological evaluations for dispensing
mental health medications. During the entire time the men were inside
the locked holding cell awaiting their turn for the videoconference, the
shackles, chains and cuffs were not removed. This exercise took
approximately five (5) hours. I do not have information
about whether the men were fed during the five (5) hours, but I suspect
they were not. If they were, how does one eat or drink when one's
hands are attached to a belly chain?
It
should not be surprising to you that these men were extremely upset
with this procedure. The failure to remove the shackles, chains and
cuffs for medium custody inmates who were locked
in a cell in a maximum custody cellblock is no doubt based upon pure
institutional convenience -- another way of putting it would be to say
that the guards were too lazy to go through the "effort" to remove
security devices that would later be reapplied.
The security implements were not removed from the prisoners until they
returned to the Meadows Unit.
Several
of the affected inmates have stated to me that they do not wish to
continue on their psych meds if they are forced to go through
this psychologically stressful and tortuous exercise
in the future in order to be given an impersonal "interview" of very
brief duration with someone who is dispensing medications via
videoconferencing.
In
addition to the reprehensible decision to leave these men in shackles,
cuffs and chains, it is particularly important to take note of the fact
that these men were transported for the purpose
of having their psychotropic medications evaluated, approved or
modified/renewed. Because of the externally-caused psychological
stress, it seems quite problematic for any psychiatric professional to
be able to make an accurate determination of the patient's
affect, response to current course of psychotropic treatment, and
potential need for modification of medication or dosage when the patient
is presenting under such externally negative conditions.
It
is noteworthy that if these men were so stressed by the procedure that
was devised and utilized by the ADOC that they subsequently elect to
withdraw from psychiatric treatment rather than
be subjected to such an unprofessional and distressing course of
action, then the entire "scheme" of psychiatric treatment for these men
must be called into serious question. The Department of Corrections
cannot utilize a method that, in fact, directly interferes
with the very diagnostic procedure that they are claiming to provide. This
is akin to giving 20 inmates a ride on a super high roller-coaster
and then lining them up to test to see if they need blood pressure
medication.
Please answer the follow questions:
1.Why
are medium custody inmates transported to a maximum custody facility in
the first place? This would appear to be a violation of your own
Classification Policy which prohibits
mixing custody levels.
Browning
Unit is the designated facility for tele-med in the Eyman Complex.
Custody levels are not mixed during the process. However, it would be
allowed by policy to occur since it is lower
custody to higher.
2.
You only have two maximum custody facilities, but you have a host of
lesser custody units at Florence. Why not have videoconferencing
facilities at each classification level so that
custody levels do not have to be mixed? IF YOU AND CORIZON ARE SAVING
SO MUCH MONEY BY VIDEOCONFERENCING RATHER THAN BY PROVIDING PERSONAL
CONTACT WITH A PSYCHOLOGIST, PSYCHIATRIST OR DOCTOR, THEN WHY ISN'T SOME
OF THAT SAVINGS APPLIED TO INSTALLATION OF
VIDEO CONFERENCING IN EACH UNIT? Or at least at each administrative
building in each unit?
The
practice of tele-med has been in place in ADC for a number of years,
long before privatization of health services. It is the practice to
place
the equipment in the highest custody unit at the complex as policy does
not allow to transport to a lower custody unit. It does not preclude
transport to a higher custody unit. Your suggestion will be given due
consideration.
3.Prior
to chaining and transporting these men for five (5) hours and holding
them in a locked cell for so long, were their medications (for other
conditions) checked? Were diabetics or
men with other conditions negatively affected by such conditions
imposed for five (5) hours? The
total time of transport reported was 3 hours, not 5. Upon learning that
the inmates were left in restraints during this time, the Deputy Warden
issued a directive, prospectively, that the
restraints will be removed once the inmate is secured in the holding
area. All the inmates received their medications prior to the transport
and those that had KOP’s were allowed to take theirs as well. The
inmates were fed prior to the transport and did not
miss any meals.
4.
If it is an inconvenience to apply and remove shackles, cuffs and
chains for individual inmates, then why not eliminate all need for
shackles, cuffs and chains by installing one more
videoconferencing site in the unit -- or at least at a commensurate
custody level unit -- where inmates will be cared for via
video-conferencing?
Responded to this issue above in #2.
5.
Were each of the 20 men given a private consultation with the doctor,
or were they given group consultations while chained, without privacy?
All inmates that participated in this tele-med visit were provided with a private consultation with the provider.
Please
respond in a timely manner. I would like to insure that this procedure
is not taking place at any unit in any prison for Arizona's prisoners.
This has been addressed appropriately throughout ADC.
For
some reason I didn't post this piece in April when it first came out in
the Arizona Republic, so am doing so now, as July 1 was Wexford's first
day on the job in Arizona's state prisons. Be sure to let them know,
folks, that we'll be watching them...
The private contractor taking over health care in Arizona's prisons
promises significant improvements in care while saving money, in effect
saying it will do more with less. But critics charge that Wexford Health
Sources' record elsewhere suggests that sometimes it fails to live up
to its promises and may do less with less.
Arizona's Department of Corrections, fighting a federal lawsuit that
accuses it of providing grossly inadequate health care, issued a
contract to Wexford this week as part of the state Legislature's
attempts to save money by privatizing prison health care.
See the Wexford contract
Wexford, which is due to take control of operations by June 1, said in its contract with the state that it will:
Hire the equivalent of at least 781 full-time health-care workers, a
number that is a 30 percent increase from Corrections' current
health-care-staffing level.
Offer the 600 current correctional health-care employees first crack at
the jobs and won't cut the salaries of any of those workers it hires.
Have nursing staff on hand at every state prison 24 hours a day, seven days a week, which is not currently the case.
Provide every correctional officer in the system 40 hours of training on dealing with mentally ill inmates.
Have its medical staff monitor inmates in isolation daily and have
mental-health staff see those inmates at least weekly, representing a
significant increase in frequency.
The company promises to do all this for $116.3 million a year, which
is more than the $111.3 million the Department of Corrections spent on
health care last fiscal year. In that year, 20 to 25 percent of
health-care positions were unfilled, with the department slow to replace
employees who left before the pending privatization.
But Wexford's budget would be less than the roughly $120 million the
department projected spending this fiscal year. Wexford plans to keep
$5.4 million as profit and spend $2.7 million on out-of-state
administrative expenses. It is headquartered in Pittsburgh.
Some prison-system observers are raising questions about whether the
company can provide the savings the state hopes for while providing
significant improvements in service.
"There are reasons for great skepticism" that Wexford can deliver
what it promises, said Caroline Isaacs, director of the Tucson office of
the American Friends Service Committee, a prison-watchdog group. "One
is that Wexford has a clear pattern of not living up to its commitments
in other contracts," and another, she said, is that the Department of
Corrections has a history of failing to hold other contractors, such as
private-prison operators, accountable when they haven't lived up to the
terms of their contracts.
Lowering expenses
Wexford spokeswoman Wendelyn Pekich said the company is still
identifying, in cooperation with Corrections, where it can cut costs and
improve efficiencies while providing what she termed "an
industry-standard quality of care." As possible areas for improvement,
she cited more efficient staffing patterns, improved training and record
keeping, and use of telemedicine -- diagnosing patients remotely via
video.
Rep. John Kavanagh, House Appropriations Committee chairman, who led
the push in the Legislature for privatizing correctional health care,
said he expects the company will cut costs and save the state money by,
for example, bringing into the prisons some services for which inmates
are now transported.
The switch to privatization comes at a time when the state is
fighting a lawsuit over allegations of inadequate prisoner care and
defending itself against accusations by Amnesty International of
inhumane treatment of prisoners.
A federal lawsuit, filed against the Department of Corrections last
month by the American Civil Liberties Union and the Prison Law Office of
San Quentin, Calif., alleges that inmates have died, been disfigured or
permanently harmed by poor medical care in state-run prisons and that
mentally ill inmates held in isolation often go months without seeing a
psychologist or getting counseling.
If privatization improves care, that's a bonus for Kavanagh,
R-Fountain Hills. "The caliber of service wasn't an issue" in the state
prison system at the time lawmakers voted to privatize prison health
care, he said. Lawmakers weren't aware of the allegations -- which he
stressed are not yet proved -- in the ACLU lawsuit.
The impetus for privatization, Kavanagh said, "was always to save money in tough economic times."
In the contract, Wexford offered some specific examples of ways it
may save money: for example, hiring an oral surgeon who will travel a
circuit of the prisons to extract teeth and perform other procedures for
which inmates currently must be taken to outside providers, escorted
and transported by correctional officers.
Wexford noted in the contract that it and the state also will save
money beginning in 2014, when the majority of inmates will become
Medicaid-eligible and reimbursement rates for Medicaid will increase by
half because of changes related to the Patient Protection and Affordable
Care Act.
However, the contract and bid documents provided to Corrections by
Wexford raise questions about how fully the company disclosed
performance issues elsewhere. Wexford lists 20 contracts it said ended
either because the company lost a rebid or didn't rebid, among other
reasons.
Some problems
In one example, Wexford said it opted not to renew a contract with
Clark County, Wash., that expired at the beginning of 2010. Wexford
noted that an independent audit "cited several instances of poor
operations, which were already in effect when Wexford Health took over
the contract" in 2007.
Although there were pre-existing problems, that audit, by the
Institute for Law and Policy Planning, was more critical than Wexford
admitted. It concluded that "Wexford has systematically failed to
comply" with its contract and had failed to provide adequate staffing,
properly licensed staff, and adequate and timely medical service.
The auditors, who said they examined Wexford's record elsewhere,
wrote that "past experience in other counties reveals that jail
administrators typically put up with Wexford's cost cutting and
substandard level of care until the problems become too egregious to be
borne."
Wexford disputed the allegations.
In Mississippi, Wexford said that a 2007 audit by a state legislative
committee made "recommendations related to documentation and record
keeping."
Wexford didn't disclose that the audit was harshly critical of both
the company and state corrections officials for failing to provide
timely, adequate medical care. Nor did it disclose that the audit said
Mississippi's Department of Corrections failed to collect $931,310 in
fines its chief medical officer recommended against Wexford after the
company charged the state for more staff members than it actually
provided.
Mississippi's Department of Corrections didn't respond to requests
for comment. In its bid documents, Wexford said that it addressed the
audit's concerns and that Mississippi renewed its contract. Wexford said
that, in Mississippi, it collaborated with the American Civil Liberties
Union to get a consent decree lifted last year that had been imposed by
a federal court, requiring that state to improve its correctional
medical care.
ACLU officials in Mississippi did not respond to requests
for comment.
Wexford's bid noted a $12,500 fine by New Mexico's Department of
Corrections in 2006 "for infirmary rounds/physicals not conducted within
contracted time frames," an issue it said it corrected. Wexford didn't
mention that a 2007 audit by a state legislative finance committee
reported extensive medical-staff shortages and long delays in reporting
inmate deaths, among other problems.
Wexford disclosed that it was fined $106,000 by Ohio's Correction
Department in 2009 for contract violations for what it described as
"non-critical incidents," such as failing to fill a vacancy or comply
with procedures for disposing of used "sharps." In its bid document,
Wexford said it addressed the problems and has been in compliance with
its Ohio contract ever since.
Wexford listed other fines, including $50,000 by Chesapeake, Va., in
2006 for staffing shortages; three fines totaling $273,000 by Florida's
Department of Corrections in 2005 for what it described as
"service-delivery issues that were resolved" before the contract's end;
and a $68,000 fine by the Broward Sheriff's Office in Florida in 2003
for delays in providing medical services.
The company also noted in its bid document that, over the five years
ending Sept. 1, 2011, it received 794 formal or informal legal claims,
including many that it termed "frivolous 'alleged deliberate
indifference' " suits. The company said it settled 18 claims
confidentially for a total of $252,425 and won six claims in court.
Arizona's contract
Arizona's contract with Wexford took effect Tuesday and goes into
full operation June 1. It gives the Department of Corrections authority
to impose fines or suspend or terminate the contract for violations of
its terms. The fine amounts vary according to the severity and extent of
the violation, from $10,000 for an act of deliberate indifference that
risks an inmate's health or safety to those of $25,000 a day or more.
Corrections also will have on-site monitors at every prison and will
conduct quarterly audits, according to the contract.
One state health-care employee, who asked not to be identified, said
that whatever happens with Wexford, "the only way to go is up."
According to allegations in the ACLU/Prison Law Office suit, Corrections
systematically and unconstitutionally fails to provide adequate care to
inmates and has done so for years. The department has not filed a legal
response to the allegations.
.JPG)
