Oct. 25–Long before Florida hired Corizon Inc. to handle prison health care, the Tennessee-based company racked up impressive revenues, securing a string of government contracts and dominating the inmate care industry.
But as Florida inked its $1.09 billion deal with the company in 2012, Corizon also quietly was signing off on lawsuit settlements linked to dangerously deficient care. It faced withering criticism in an Idaho class-action suit and was faulted in a federal report on an immigrant detainee’s death. Maine auditors criticized Corizon care.
None of that made its way into Corizon’s 2,300 page bid for the Florida contract, despite a requirement to disclose investigations and legal settlements.
In fact, none of the criticisms and incidents should have come as a surprise to state officials. High-profile deaths and lawsuits linked to Corizon and the two companies that merged in 2011 to create it — Prison Health Services and Correctional Medical Services — span more than a decade. Many were in Florida.
Booked into the Volusia County Jail on a misdemeanor charge, Tracy Veira died in 2009 from forced, and untreated, opiate withdrawal; she had been left alone in a cell for the last four days of her life. The same year, Collier County Jail inmate Joan Graeber lost her baby after staffers delayed treatment for a blood condition lethal to the fetus.
Between 2002-2004, when Corizon handled medical care at the Palm Beach County Jail, two inmates died when medicines were withheld, including one HIV-positive prisoner treated with Tums. Judges released two others so they could get medical care. The health department threatened legal action if a potentially deadly infection racing through the jail wasn’t brought under control.
Two cancer-stricken Florida state prison inmates were treated with Tylenol and ibuprofen by Corizon staffers this year as their undiagnosed disease spread, The Palm Beach Post reported last month. One inmate died in June. A second is dying.
This, too, was not a first for Corizon: In 2010, Manatee County inmate Jovon Frazier’s arm pain was treated with Tylenol and muscle exercises for four months before an MRI indicated he had bone cancer, a suit brought by his mother charges. His arm was amputated. However, cancer already had spread to his lungs. Frazier, serving less than a year for theft and drug charges, died.
State: Corizon fully disclosed
Corizon believes details of those and other cases did not have to be divulged, and that it stayed well within the terms of what the state wanted to know. “Corizon Health is confident that its bid was responsive,” company spokeswoman Courtney Eller said.
Florida corrections officials agree. Even if information on lawsuit settlements, the Maine audit and federal investigation had been provided, the company’s bid response met the definition of full disclosure, Florida Department of Corrections spokeswoman Jessica Cary said.
Late last month, after The Post identified a spike in inmate mortality rates, Corrections Secretary Michael Crews formally warned Corizon its contract could be pared back or payments withheld unless medical treatment improved.
The warning was based on “serious concerns” about inmate health care, Cary said, and Crews has directed the company to take “immediate, specific measures.”
While not specifically addressing the written warning, Corizon’s Eller said that “we have implemented a number of improvements over the past year. We look forward to continuing that progress in the future.”
But attorney Randall Berg, who sued both DOC and Corizon on behalf of an amputee inmate who could not get a prosthetic leg, remains skeptical of both the company and DOC.
“When one has to sue DOC and Corizon to get inmates’ hernia surgeries, prosthetic legs, artificial knees; finally the secretary does something,” said Berg, executive director of Florida’s Justice Institute, an inmate advocacy group.
“Corizon has been a disaster and in breach of contract since assuming the contract.”
Other states’ criticisms
Citing the need to slash costs, the Legislature voted to hand off state prisoners’ medical, psychiatric and dental care to private companies in 2011. By late 2013, privatization was complete.
Today, Corizon and Wexford Health Sources share responsibility for roughly 100,000 Florida inmates under five-year contracts worth more than a combined $1.3 billion. Corizon snared $1.09 billion of that.
It’s not surprising that Corizon and the two companies that merged in 2011 to form it — Prison Health Services and Correctional Medical Services — would come under fire. Prison care is difficult and prisoners are litigious. Inmates can, and do, fake illness. They don’t necessarily need to fake, though: Prisoners frequently suffer complex and chronic diseases, as well as mental illness and serious dental problems. It’s why even a 50-year-old Florida inmate is considered elderly.
Even so, bidders for the Florida contracts were required to disclose settled lawsuits and federal reports involving inmate care within the previous five years. Corizon provided a list of financial penalties assessed by governments for unspecified contract lapses and a paragraph confirming “certain oversight or regulatory agencies have on occasion reviewed issues at facilities contracted to Corizon.”
However, nowhere in Corizon’s bid documents are details of five five court settlements, a critical federal report on the death of an immigrant detainee, a Maine report detailing shortcomings in that state and in 2010, renewed federal oversight of an Idaho prison where Corizon provided medical care. All occurred within the five-year time frame.
–Between 2007 and 2009, Corizon spent more than $6.6 million to settle suits brought by three pregnant women who lost their unborn babies and a fourth whose baby sustained permanent brain damage.
–In 2011, U.S. immigration officials commissioned a formal inquiry into the fatal heart attack of an immigrant detainee who was held in two jails, including a jail in Albany, N.Y. jail. The woman died in Albany, where Corizon provided treatment. The federal report found that the woman’s previously prescribed heart medicines were given in the wrong dosages and at the wrong time.
–In 2010, a doctor hired by Corizon quit after six months at an Idaho prison. Unqualified staffers handled medical care and pharmacy operations ran afoul of state law, he said, a practice he reported to state medical boards. A federal judge subsequently appointed a monitor to report on medical care at the prison. The monitor’s assessment was so scathing state lawyers sought to keep it sealed.
–A 2011 Maine audit found that Corizon was slow to respond to inmates reporting illness, failed to conduct regular physicals and could not always prove medicine was administered at the right time or in the right amount. State prison officials challenged the review’s findings, in part because of the small sample size.
ER trip: Money for ‘foolishness’
In two other back-to-back legal settlements not found in Corizon’s bid documents, the company’s nurses faulted company practices.
In 2007, 25-year-old Brett Fields was serving time in the Lee County Jail on two misdemeanor charges when he came to the infirmary with a red, pull-filled lump on his arm. Corizon’s medical staff prescribed antibiotics.
It didn’t help. Fields’ arm remained swollen. Back pain followed, then uncontrollable twitching in his legs. Four weeks into his confinement, Fields couldn’t walk or uinate. He had no knee reflex. He was given Tylenol.
Crawling to a toilet, Fields’ lower intestines fell out of his bowels. A nurse appeared, accused him of faking, had him placed on a sheet and dragged to a medical observation cell.
The same nurse later testified that Corizon supervisors “yelled a lot” about nurses sending inmates to hospitals. Staff was told to make sure doctors decided whether inmates needed an ambulance, she said, “because it cost … so much money every time we take somebody to the ER.”
If a doctor makes the call, she said, “that way, there’s not any unnecessary money spent for foolishness.”
Reluctance to use emergency transport was repeated in Minnesota in 2010, a court case alleges, where inmate Xavius Scullark-Johnson’s anti-seizure drug had been cut in half, triggering multiple convulsions. A nurse turned away an ambulance, the suit said.. Scullark-Johnson was left brain dead.
In Fields’ case, the delayed call for emergency treatment came as an untreated, antibiotic-resistant infection spread to his spine. There, it created an abscess, damaging his spinal nerves. When finally sent to a hospital, he was rushed into surgery, but as doctors, a jury and an appeals court later agreed, help came too late to avert permanent damage. He remains partly paralyzed.
A jury awarded Fields $1.2 million in damages.
Protocols not followed
In the fall of 2013, as Corizon’s billion-dollar state contract was being implemented, the company was settling another lawsuit brought by the family of a county jail inmate, one which also involved disturbing statemrnts by acompany nurse.
Tracy Veira told medical staff she was taking prescribed opiates when she was booked into the Volusia County jail on drug charges. Corizon staffers halted the medication without explanation.
Opiate withdrawal can be managed. Untreated, it can be deadly. Almost immediately, Veira no longer could eat or keep down liquids. In the space of a week, she dropped 20 pounds, according to court documents.
Confined to an isolation cell, Veira spent much of four days alone, throwing up volumes of noxious green fluid.
She died of dehydration. The cell was so fouled that even an hour after her death, workers had trouble remaining in it.
One of three nurses on duty the night before Veira died, Inga Jones, described seeing Veira lying across clinic chairs, pale, slurring her words and twitching while the supervisory nurse read a book.
Jones believed Veira needed to get to a hospital. So did another nurse. Neither was in charge, though.
Jones also believed Veira had not been seen by a doctor and was not checked after she was locked into her cell.
But that was the norm, Jones said in court papers. “Drug and alcohol withdrawal protocols were routinely not followed,” wrote Jones. “Many times I recalled returning to duty and finding a patient in full-blown detox.”
Cruel and unusual
Inmates are not legally entitled to excellent care. They are, however, legally entitled by the U.S. Constitution’s ban on cruel and unusual punishment to adequate care.
“A prisoner who receives a sentence of 2-10 years, deserves to do 2-10 years,” wrote a Michigan federal judge in 2006. “What he does not deserve is a de facto and unauthorized death penalty at the hands of a callous and dysfunctional health care system.”
The judge was overseeing a Michigan class-action suit alleging substandard medical and psychiatric care. That care was being handled by Correctional Medical Services, or CMS, the Corizon predecessor.
Among the cases cited: A psychotic 21-year-old strapped to a concrete slab for four days when the heat index hovered at 100. He died of heat and thirst.
A doctor saw him once, according to court documents, but did not take his vital signs. On the fourth day, a nurse detected a “faint” pulse — but prison video shows he then left the cell. The inmate died an hour later.
After hearing details of the death, the judge ordered multiple changes, writing that, “The days of deadwood in the Department of Corrections are over, as are the days of CMS intentionally delaying referrals and care for craven profit motives.”
Killer forces change
Florida has had its own taste of federal judges controlling prison care. In 1972, convicted Florida murderer Michael Costello’s handwritten lawsuit alleging poor medical care by the state — not private companies — triggered a landmark class-action suit lasting two decades.
Because a federal judge in the Costello case was persuaded that overcrowding was linked to poor health care, state prisoners had to be released and expensive new prisons built. The state’s bond rating was threatened by the ongoing litigation.
The court relinquished control only after Florida created the Correctional Medical Authority, a state-financed, independent panel that surveyed prison health care.
In 2011, the same year state lawmakers voted to put health care in the hands of for-profit companies, they eliminated money for CMA, effectively abolishing it.
Some money was restored in 2012. CMA began inspecting prisons again in 2013.
Several got good marks. For instance, treatment at Hernando Correctional prison was equivalent to community standards, the team wrote, and medical staff deserved to be commended. Inmates, they wrote, “were generally satisfied with health care.”
Two months after the CMA review, Hernando inmate Donna Pickelsimer was taken to a state prison hospital to live out her last days. For months, medical records show, Pickelsimer’s painful, spreading lung cancer was treated with Tylenol and warm compresses by Corizon staff, even as bulges appeared on her chest, back and arm.
When Pickelsimer complained of pain, she was placed in an isolation cell.
CMA’s report did not reference any inmate with lung cancer. However, sandwiched between praise for the medical staff were observations that cancer treatment for two women wasn’t carried out. Months after a cancer specialist prescribed a round of testing, one inmate was still waiting on the screenings.
The other woman’s prescribed follow-up treatment related to ovarian cancer had been denied by Corizon. There was no record that the prison doctors offered any alternate plan of treatment.
‘It makes anybody cry’
Despite the criticisms and high-profile cases, privatizing to manage burgeoning inmate medical care costs remains popular. In the past 12 months, Corizon has inked contracts valued at more than $1 billion with jails or prisons in California, Kansas, Georgia and Minnesota.
In Indiana, prison officials last year signed Corizon to a three-year contract, despite the highly publicized death of Rachel Wood the previous year.
Inmates said Wood, 26, was bleeding from her eyes and nose when prison medical staff directed an ambulance to take her, not to a hospital, but to a long term care facility.
Dead on arrival, Wood had more than 3,600 nanograms of the antidepressant Citalopram in her system, said her father, Claude Wood. The recommended dosage is no more than 120 nanograms. A medical examiner ruled her death was a result of “therapeutic misadventure” — medical error.
“Why did state officials blow this off?” asked Wood of Indiana’s decision to hire Corizon. “It makes anybody cry, what they’ve done.”