Reports on inmate deaths weren’t regularly turned over to the state by private companies handling prison health care, as required, and medical exams showing whether inmates were injured by guards were missing in 2013 and 2014, documents obtained by The Palm Beach Post show.
Florida Department of Corrections contract monitors examining a sampling of inmate files at 19 prisons wrote that death information in 33 instances, including autopsies, either was not provided for state review, only partly provided or provided late.
As media scrutiny of inmate deaths from guard brutality and medical neglect intensified last year, former DOC Secretary Michael Crews said last week that he had been pressured by the governor’s office to keep details of inmate deaths out of writing, effectively hiding the scope of the crisis.
Through his press office, Gov. Rick Scott declined to comment on Crews’ allegations, made to The Miami Herald.
Reviews by state contract monitors and an oversight panel outline a litany of potentially lethal failings by the two companies handling almost all inmate health care: Corizon Inc. and Wexford Health Sources.
Last week, Senate Criminal Justice Committee Chairman Greg Evers, R-Baker, told the Department of Corrections to rebid a combined $1.3 billion in contracts held by those two companies.
“I want accountability, I want reasonable health care for inmates, and I don’t want injuries or sickness or illness to go unnoticed and ultimately cause their deaths,” Evers said.
“If you are not going to rebid, at least renegotiate to get decent health care, and if you can’t do that and get decent health care, then do away with them and we will do something else.”
The Post reported in September that roughly 100 days after medical privatization was fully phased in, the monthly inmate death count shot to a 10-year high. The trend continued through 2014, when all deaths, including deaths from illness and suicide, also rose to the highest levels since 2004.
Cancer patients treated with Tylenol
It’s not surprising that Corizon, which treats the vast majority of Florida inmates — at least 75,000 of 100,000 state prisoners — would rack up the most criticism.
But those criticisms were significant. Expired and mislabeled medicines were a frequent finding. Proof that doctors or nurses saw inmates was sometimes faked or nonexistent. Psychiatric drugs were handed out like candy.
In half a dozen cases, suspected cancers were slow to be diagnosed or treated.
In late January, 45-year-old Tammie White died after cancer spread through her lungs, bones, brain and major organs. She became at least the third prisoner in 10 months whose end-stage cancer symptoms were dismissed, misdiagnosed and treated with ibuprofen and Tylenol.
At Hernando Correctional Institution near Tampa, Donna Pickelsimer died last June. Even as lumps bulged from Pickelsimer’s upper arm and back, The Post reported last fall, medical staffers prescribed Tylenol and hot compresses to treat her undiagnosed lung cancer.
Anthony Carvajal was told by medical staff that a lump on his spine was a pulled muscle and prescribed ibuprofen. Carvajal had end-stage bone cancer.
Last September, 48 hours before The Post published stories detailing those and other inmate stories, DOC issued a press release acknowledging Corizon was not meeting standards for care, and warned the company that its billion-dollar contract was at risk.
“We are always troubled by any questions or concerns on the care we provide,” said a Corizon spokesman, who pointed out several steps the company has taken, including initiating its own internal audits and hiring 40 more staffers. And repeat reviews at some prisons have resulted in fewer criticisms, he said. “We know there is still work to be done.”
Crews’ successor, Julie Jones, met with both Wexford and Corizon officials within weeks of joining DOC, agency spokesman McKinley Lewis said.
“It’s no secret that she is not pleased with where we are right now,” Lewis said. “She has laid out expectations. We are not going to stand idly by and do nothing.”
Inmate deaths but no paperwork
When a prisoner dies, medical and death information, such as an autopsy, is forwarded to a DOC mortality review panel by the private health company, where details of medical treatment leading up to the death can be evaluated.
At Lowell Correctional prison and annex near Gainesville, where wardens expressed concern about medical care and seven women died last year — three of them in the same two week period — no information on inmate autopsies was provided by Corizon to the state in four instances. And four times, the state’s mortality review committee didn’t get required paperwork on details of inmate deaths there.
It wasn’t just four cases, and it wasn’t just Lowell. Monitors cited 14 lapses at Lake and Union prisons, where Corizon also handled medical care. At Everglades, where Wexford handled care, required information on deaths didn’t get to the state three times.
Further, at some prisons, nurses and medical staff weren’t checking inmates after guards used force to subdue them. It’s a mandatory practice: Even by-the-book procedures can injure inmates.
But at five prisons where Corizon handled medical care, records proving inmates weren’t seriously harmed by guards were either incomplete, outdated or nonexistent.
Medical staff failed to make rounds
Lake Correctional Institution near Orlando, which chalked up some of the worst marks by contract monitors, also had one of the highest increases in deaths.
Monitors found medical staffers failed to make rounds for months, expired drugs were being stocked and inmates with abnormal lab results weren’t always being seen. One inmate with heart trouble was slated for neurology care. Charts for inmates with chronic illnesses were missing basic medical information.
Last year, six Lake inmates died — more than had died in the previous five years combined.
At the Taylor Correctional Institution and annex southeast of Tallahassee, getting medical care that could not be provided by the health companies’ on-site doctors could take months. In one case cited by the Correctional Medical Authority, a governor-appointed oversight panel, both the prison doctor and an outside specialist wanted an inmate with lung cancer to immediately receive tests and treatment. Three months later, the inmate was still waiting.
In another case at Taylor, the prison doctor made an urgent request for an inmate with abnormal EKGs to see a cardiologist. It took four months to get him there. An inmate with a history of abnormal bleeding waited for specialized help, CMA found. So did inmates with glaucoma, seizures, kidney disease and in two cases, badly broken bones.
Loose control of psych drugs
Psychiatric care frequently fell short, despite contracts with Corizon and Wexford devoting pages of detailed requirements for treating mentally ill inmates.
That’s because inmates have more serious mental illnesses than the general population, posing a danger of injury to themselves, other inmates and corrections staff alike.
Further, untreated mental illness can lead to inmates committing new crimes after their release.
However, in multiple files examined by monitors, doctors didn’t evaluate inmates before they prescribed powerful psychiatric drugs. Lab tests required before the drugs could safely be taken were missing, too. At one prison, there was no explanation for dosages or changes in drugs.
Inmates are supposed to give written consent before they take the drugs, which have serious side effects, yet over and over again, there was no record they knew about or agreed to the risks.
But time to speak with inmates was at a premium, noted CMA: Two psychiatrists at Union were responsible for 1,900 inmates, including 600 with moderate to severe mental illness.
Governor cites high standards
One of the most consistent findings involved drugs. Different prisons had different problems, but almost all had one or more lapses: Mislabeled and unlabeled medicines were found, and directions on medicines couldn’t always be read. Open vials of drugs weren’t promptly discarded.
At one prison, vaccines and insulin were left in a drawer. Some drugs had to be thrown away.
Many times, there was no record nurses gave inmates their medicines. Sometimes inmates refuse to take pills, but there was also no notation of refusal in patient records.
At Tomoka Correctional Institution near Daytona Beach, where 11 inmates died last year — the highest yearly death count at that prison in a decade — surveyors found confusion about drugs. One inmate was given two heart medications he should not have been prescribed, given his medical condition, wrote the CMA.
One Tomoka inmate was kept on a drug that a specialist had said should be discontinued. Another inmate mistakenly was cleared of tuberculosis although the treatment was not completed. One inmate was given the wrong IV. Another was given a drug he was allergic to. And the pharmacy staff said that the automated drug ordering system was down for six months.
Last month, DOC issued $22,500 in contract violation penalties against Corizon and $2,500 against Wexford.
Unlike DOC chiefs Crews and Jones, Scott, who championed privatizing prison medical care, has not directly addressed the critiques and mortality figures.
But in a prepared statement, Scott spokesman John Tupps said that, “The governor has very high standards for agency leaders and holds them responsible for making improvements and addressing any chronic failures within their systems.”
Meanwhile, Scott’s new budget calls for an additional $7.9 million to offset rising inmate medical costs. The money is earmarked primarily for Corizon and Wexford.
What Michael Crews said
Last year, then-Department of Corrections Secretary Michael Crews balked at the rising number of deaths from illness and seemed in lockstep with Gov. Rick Scott in handling incidents of guard abuse. But in an interview with The Miami Herald last week, Crews said as reports of inmate abuse and medical neglect mounted in 2014’s tight election year, Scott’s office peppered him with frantic phone calls, instructing him to make sure reports of inmate deaths from any cause, including old age, weren’t put in writing. Crews should take the information by phone, he said he was told. As a result, Crews told The Herald, he got phone calls night and day, both at his office and at his home. “We couldn’t ever sleep a whole night through,’’ Crews’ wife, Terri, told the paper.
What The Post reported
Savings with cold-blooded ramifications. Just months after all medical care in state prisons was privatized to save money, the count of inmate deaths spiked to a 10-year high in January 2014 and continued at a record pace. Doctors were alarmed, seeing far fewer inmates at hospitals. A cancer patient treated with Tylenol and ibuprofen died.
Guide to coverage: To view prison health monitor reports, see past coverage of prison health issues and watch a slide show documenting past health care problems at the Palm Beach County jail, go to MyPalmBeachPost.com