Corizon HealthScare: Meet me in St. Louis...

The article below was posted from the AP to the St. Louis Post-Dispatch today. This was the comment I left for their readers: 

Corizon has been nothing but disastrous to Arizona state prisoners, ignoring too many to death and leaving their families devastated. We've had a whistleblower speak out and a class action lawsuit here (Parsons v Ryan), exposing how evil they are - as well as numerous protests by prisoners' loved ones and interviews with survivors, but it has been to no avail. 

Some think that's due to Good Old Boy Terry Stewart's influence in AZ (he's the former AZ DOC director - Chuck Ryan's mentor - now in bed with the folks at Corizon Healthscare), but I can't explain why other states still have contracts with them. Voters should really scrutinize things closely if their jails or prison systems are going with these folks and renewing contracts year after year, there's probably something dirty going on that keeps them sucking your tax dollars up for their profits at the expense of some of your most vulnerable citizens. Stop the privatization all together, if you can. It doesn't deliver what it promises, and you'll end up paying more after too many die in the end.

Posted as Peggy Plews

God only knows why the new governor, Doug Ducey, has retained Chuck Ryan after the embarassment his administration was to Brewer - must have something on that guy, too. It's like the whole Republican party here just dug their heads in the sand when it comes to the AZ DOC, though, not just the chiefs. Their mascot should be an ostrich, not an elephant. Elephants are, after all, thoughtful, compassionate, and wise...

By the way, if you're fighting these bastards on behalf of a loved one at the AZ DOC, follow the links to these older pieces, but be sure to be current on the relevant AZDOC policies (Department Orders) and send them the right copies - the docs and links in these old posts have probably expired.

 Corizon's Cruel and Unusual Greed: Follow the Money with Prison Legal News

Corizon and the AZ DOC: Prisoners & Families, Know Your Rights.

 

Corizon's deliberate indifference: fighting back.

 

artwork is mine....

------------from the St Louis POST-DISPATCH--------

Country's biggest for-profit prisoner health care provider under increased scrutiny

St Louis Post-Dispatch

Janaury 20, 2014 

By ADAM GELLER Associated Press

Months after he landed in Florida’s Manatee County Jail, Jovon Frazier’s pleas for treatment of intense pain in his left shoulder were met mostly with Tylenol.

“I need to see a doctor!” he wrote on his eighth request form. “I done put a lot of sick calls in & ya’ll keep sending me back and ain’t tell me nothing.”

Four months later, after Frazier’s 13th request resulted in hospitalization and doctors diagnosed bone cancer, his arm was amputated, according to a lawsuit by his family.

But the cancer spread. Frazier died in 2011 at age 21, months after his release.

As an inmate, his medical care had been managed not by the county sheriff’s office that runs the jail, but by a private company under contract.

That company, Corizon Health Inc., is under growing pressure after the loss of five state prison contracts, downgrades by analysts and increasing scrutiny of its care of inmates held by some of its largest customers, including New York City.

Corizon, responsible for 345,000 inmates in 27 states, including Missouri, is the country’s biggest for-profit correctional health provider, but it’s just one of many firms vying for billions of public dollars spent on prisoner care.

Corizon was established in 2011 when privately held Valitás Health Services Inc., the Creve Coeur-based parent of Correctional Medical Services Inc., acquired America Service Group Inc., a Tennessee-based provider of prison health services.

With corporate headquarters in Brentwood, Tenn., Corizon touts Creve Coeur as home to its operational headquarters.

For-profit prison care raises questions about ceding public responsibilities to private companies. It turns, though, on a thornier issue: How do you ensure care of people who society mostly would prefer not to think about?

Inmates “are still human beings. I think some people forget that, I really do. They’re somebody’s child,” said Shirley Jenkins, Frazier’s grandmother.

PRIVATIZED CARE

States spend $8 billion a year, a fifth of their corrections budgets, on prison health care, according to the Pew Charitable Trusts and the MacArthur Foundation. Local jails spend millions more.

Some critics fault the idea of privatizing the job.

“The problem is a structure that creates incentives to cut corners and deny care to powerless people that have no other options,” said David Fathi, director of the American Civil Liberties Union’s National Prison Project.

Others say deficiencies with prison care go beyond whether it is privatized.

“I don’t have a great love for private health care ... but I don’t think that they’re the source of the problem,” said Dr. Marc Stern, former health services director for Washington state’s prisons. Stern, who once worked for a Corizon predecessor in New York state, issued a 2012 report criticizing the company’s care of Idaho prison inmates while serving as a court-appointed expert.

“I think the problem is how much money and effort we are willing to put into correctional health care,” Stern said.

Some critics, though, say Corizon is notably problematic.

“We get letters from prisoners about medical care not being provided, and the list is endless. And it’s increased tremendously since Corizon took over,” said Randall Berg, executive director of the Florida Justice Institute, who represents inmates petitioning for care.

Corizon says it strives to provide quality care.

“We are always troubled by any questions on the care provided to our patients and view this as an opportunity to reconfirm our commitment to operational ethics and professionalism,” company spokeswoman Susan Morgenstern said in a written statement. The company declined to answer questions.

The criticism surrounding Corizon isn’t new. Correctional Medical Services, or CMS, which later became Corizon, was the main subject of a 1998 Post-Dispatch investigation of for-profit prison health care providers. Looking at CMS and other firms, the investigation found more than 20 cases nationwide in which inmates died as a result of alleged negligence, indifference, understaffing, inadequate training or cost-cutting.

In 2012, Corizon was sued for alleged medical missteps in the death of Courtland Lucas, an inmate in the St. Louis jail. He died May 25, 2009, from complications of a heart problem, congenital aortic valve stenosis, while under the care of CMS. The lawsuit was settled in the fall of 2014, but the terms were not disclosed.

Corizon’s struggles are widespread.

Its care of the 11,000 inmates at New York City’s Rikers Island is under “comprehensive review” by officials, who say they are concerned about problems including at least 16 deaths since 2009.

Arizona hired Corizon last year to replace Wexford Health Sources Inc. after its care came under fire. But an advocacy group warned that “if anything, things have gotten worse” in state prisons. Arizona and the ACLU recently reached a settlement calling for more monitoring of inmate care.

Meanwhile Corizon has lost long-standing prison contracts in Minnesota, Maine, Maryland, Tennessee and Pennsylvania since 2012. Auditors in three states documented problems, including slowness to address poor recordkeeping and inmates’ urgent requests for off-site care.

Corizon, which generated $1.4 billion in revenue in 2013 and is owned by a Chicago private equity firm, has battled stiffening competition. In recent months, Moody’s and Standard & Poor’s have downgraded Corizon’s holding company, citing financial underperformance, contract losses and competition that has squeezed profits.

The connection between Corizon’s contract losses and questions about the quality of care it provides is not clear.

But the challenges are evident in Florida, where a year after the state privatized prison care and awarded Corizon a $1.2 billion contract, news reports point to rising inmate deaths. If the company does not address substandard care, the state’s corrections commissioner wrote to Corizon’s CEO in September, Florida may begin withholding payment.

In Minnesota, an audit last year found that inadequate communication between prison staff and Corizon doctors during overnight hours “may have been a contributing factor to inmate deaths.”

But in announcing Minnesota’s change of contractors, the corrections commissioner said Corizon had provided “excellent” service. In a written response to questions, the state corrections department said its decision was not related to the audit. It would not comment on inmate deaths.

Corizon’s work in local jails also has come under scrutiny.

In October, Volusia County, Fla., officials questioned Corizon executives about lawsuits and its financial stability before voting unanimously to switch contractors. The hearing was held in the shadow of a lawsuit filed locally by the family of Tracy Veira, an inmate who choked to death in 2009 in a cell where she was supposed to be under watch while detoxing from painkillers.

A nurse working for one of the companies that merged to form Corizon saw an ailing Veira in the jail’s clinic the afternoon before she died. She told a supervisor the inmate looked as if she needed hospitalization, but Veira was instead sent back to her cell, according to an affidavit filed in the case.

When the commissioners questioned Corizon’s executives, there was no mention of Veira. But Commissioner Deb Denys said she was mindful of the case, scheduled for a July trial.

“I think everybody was,” Denys said. “Sometimes you don’t state the obvious.”

Jennifer Mann of the Post-Dispatch contributed to this report.

How greedy states and profiteers bleed prisoners and families dry.

The following article is the good work of my friend Vikki Law, who edits the zine Tenacious, which is by and for women in prison. She wrote the book on women's resistance in prison - literally. Vikki's pretty prolific, and covers a lot of issues re: prisoners, crime and punishment - find links to her other articles here.

Info about the AZ DOC revised (OCT 15, 2014) money policy is here:

https://corrections.az.gov/electronic-payments

here's the director's instruction, modifying the existing policy:
 
https://corrections.az.gov/sites/default/files/policies/DI/di_322.pdf

----from TRUTH-OUT.ORG (inserted art is mine)------

Public Prisons, Private Profits

Saturday, 01 November 2014 09:39 By Victoria Law, Truthout | Report

When her daughter was first incarcerated in Arizona's Perryville State Prison, "Rae" sent her money orders bought at the local cash-checking place or from Walmart. But those took too long to clear, leaving her daughter without needed supplies, so she began driving to the post office to buy money orders. Throughout her daughter's four years in prison, Rae has sent her money twice a month - $100 on the first of the month and whatever she can afford (usually $50 or less) on the 15th of the month.

"When she first got there, she was issued two pairs of underwear, which had been worn by someone else," Rae told Truthout. So Rae sent her daughter money to buy her own underwear, bras and socks as well as tennis shoes and a TV set. "It was $300 for the TV," she recalled.

Her daughter earns 35 cents an hour cleaning inside the prison. Although the prison supplies some necessities, like one roll of toilet paper each week and a limited number of tampons or pads, Rae's daughter relies on the money from home to get her through each week. These money orders enable her to buy the additional toilet paper and feminine hygiene supplies she needs each month. It also enables her to buy Tylenol and cold medicine as well as pay the $4 co-pay on each medical visit. "Occasionally she can splurge and buy herself a candy bar, but that's rare," Rae said.

Services that had previously been provided by the jail or prison, such as medical care, transportation, phone and communication services, food, and even money exchanges, are increasingly handled by private companies.

On October 15, 2014, however, Arizona changed the way family members like Rae can send money. Now, instead of paying $1.25 for a money order at the post office, Rae must use one of three companies - JPay, Global TelLink or Keefe - to send her daughter money. To send $50 through Keefe, Rae also needs to pay a $4.75 internet transaction fee. Families without internet access can deposit money by phone - for a fee of $5.75 - or in a storefront transaction for $5.95. (Global TelLink and JPay have different fee structures.)

Despite the added cost, Rae is determined to send her daughter the same amount of money. "I'm going to have to eat the fees and make up the money somewhere else," she said. "I'll have to give something up. So will my husband." The couple has already had to sell their camper to cover the cost of visiting their daughter once a month. They've cut down on going out and other activities that cost money. On occasion, they've also had to choose between sending money to their daughter in prison or helping their son, who is not. "I feel bad that I can't help him because all our money is going to his sister," Rae said.

Only 8 percent of the nation's prison population is held in private prisons. But, as Rae's experience and recent news stories have demonstrated, private companies have found other ways to profit from bodies in government-run prisons. Services that had previously been provided by the jail or prison, such as medical care, transportation, phone and communication services, food, and even money exchanges, are increasingly handled by private companies.

Sending in Money Costs Money
As Rae's story shows, prison systems have contracted with private companies to handle money sent by family members to their loved ones inside. In the federal prison system, the contract was awarded to Bank of America. In 32 state systems, the contract belongs to private company JPay.

In February 2014, New Jersey prisons began utilizing JPay to handle these monetary transactions. "Before, it would only cost a stamp and the cost of the money order," said "Pam," currently incarcerated at the Edna Mahan Correctional Facility for Women. "Now, it cost our families or friends $4.95 in addition to whatever amount they send us." Loved ones also have the option of mailing a money order to JPay, but the money takes seven to 10 days to be credited to a woman's account. Pam's mother balked at paying an additional $7 and mailed a money order. The money was not credited to Pam for 14 days.

At Edna Mahan, commissary - or the prison store - is only available every other week. For women like "Pam" whose family chooses to save money and mail money orders, the delay means missing the chance to buy necessities, such as shampoo and feminine hygiene supplies.

"If a person owes restitution, the prison takes 55 percent of whatever money he receives," a mother told Truthout. Thus, to put $56 in his prison account so that he can buy food, she had to send $125.

"Gwen" has also experienced delays of up to four weeks when her family mails a money order to JPay. She told Truthout that, while women can order from commissary every two weeks, certain items, such as photos, clothing and beauty supplies, are only available once a month. In addition, many women rely on food items at commissary to supplement the prison's meals, which she described as "truly inedible."

Daily wages at Edna Mahan range from $5 at the top-paying commissary job to $2.40 for working in the kitchen or cleaning housing units. If a woman is sick or unable to work, as in Gwen's case, she must either learn to go without supplies or rely on money from family. "It isn't a lot of money, but $28 can mean a whole commissary for me," Gwen explained.

California is another state that has instituted JPay to handle money sent to prisoners. But the fees make sending money an exorbitant expense for many family members. "Samantha," for instance, must send her son twice the amount of money that he needs. "If a person owes restitution, the prison takes 55 percent of whatever money he receives," she told Truthout. Thus, to put $56 in his prison account so that he can buy food, she had to send $125. And that's not including JPay's service fees, which vary depending on the amount of money sent. "There's no readily available list of charges," she told Truthout. "I literally had to call and hunt down how much would be charged."

"If you put money in a couple of times a month, you pay that fee a couple of times a month. Families with the least amount of money get hit the hardest."

JPay provides money transfers to more than 1.7 million people or nearly 70 percent of the US prison population. It charges state prison systems nothing for handling payments and, for every payment processed, it sends between 50 cents and $2.50 back to the prison. According to an exposé in Time, JPay sent approximately $4,000 each month to the Illinois Department of Corrections in 2013.

"Jill"'s daughter has less than two years on her sentence at Arizona's Perryville prison. When Arizona announced the switch to electronic money transfers, Jill decided to skip the fees and send a money order for the total amount her daughter would need during her last year behind bars. But, she told Truthout, many of the family members she has met cannot afford that option. "Many families have to budget in order to send money," she said. "If you put money in a couple of times a month, you pay that fee a couple of times a month. Families with the least amount of money get hit the hardest."

The Kick-Out Fee - and the Fees That Go With It

A person leaving the Arizona prison system for the first time is given $100 upon her release. The money, saved from the wages earned at prison jobs, is called the "kick-out fee."

Until 2013, people released from Arizona's prisons were given the kick-out fee in the form of a check. However, banks often refused to cash the check with a prison ID, usually the only form of identification many women have after years in prison. Thus, accessing their only $100 first required a trip to the Department of Motor Vehicles for identification or finding a friend willing to deposit the check for them.

Now, they are issued a debit card through Bank of America. "If women are coming out after a long time, they don't know how to use debit cards," Jill explained. "They're scared to death about using them." In addition, Bank of America charges a $1.50 monthly maintenance fee and, like many other banks, charges a $1.50 withdrawal fee if a person uses a non-Bank of America ATM and a 25 cent point-of-sale fee for every transaction.

No staff member explains the various fee structures, which means that people are unaware that they deplete their funds each time they use the card. If a person chooses to withdraw the entire amount from her debit card, she is charged a $5 fee.

In addition, if she loses the card, no replacement is issued. Her money is simply gone. For a woman in a halfway house, shelter or other temporary living situation, this means sleeping with the card tucked into her bra or panties.

Arizona is not alone in utilizing this new method. The Center for Public Integrity recently reported on Bank of America's contract with the Federal Bureau of Prisons to issue debit cards to people upon release. Under that contract, they've issued cards to nearly 50,000 people. The Center's report has spurred a government audit into the contract.

Privatizing Health Care - But at What Cost?

"We live by violence, but we die by neglect."

Handling prisoner accounts is not the only service that has been privatized. Across the country, jails and prisons have been contracting with private, for-profit companies to provide medical services to people inside.

Cecily McMillan experienced this firsthand during her 58 days on Rikers Island, New York City's island jail complex. When she arrived, she was denied her prescribed medications for mild anxiety and ADHD. Instead, jail medical staff gave her BuSpar, the same medication, McMillan says, that every woman was prescribed regardless of her actual needs. After three weeks of fighting for her proper medication, a fight that included help from sympathetic city council members, McMillan had her medications reinstated. But that was not the only medical horror she encountered.

She recalled making an appointment to see a gynecologist. Warned that the jail's male gynecologist was "kind of handsy," she requested to see the jail's female gynecologist only to be told that she wasn't available for six weeks. When she saw the doctor, he informed her that she needed to undergo a gynecological scrape even though McMillan had had a check-up before entering Rikers. "He scraped me until I was bleeding," she recalled. When he finished, McMillan realized that his fly had been open the whole time.

During her 58 days on the island, McMillan also saw how medical care could be deadly: Judith had been prescribed low-dose methadone pills for back pain, McMillan recalled. But when Judith arrived at Rikers, the doctors insisted that she take methadone in high-dose liquid form. Taking higher dosages of methadone induced intense vomiting in Judith, who had hepatitis C. McMillan recalls seeing her friend vomit blood and what she described as "chunks of her liver." The women in the housing unit demanded that the officers call the doctor. When medical staff failed to respond, they physically carried Judith to the clinic. Days later, Judith was dead.

Judith's death is only one of a string of recent deaths on Rikers Island. In 2013, 19-year-old Andy Henriquez died from a tear in his aorta after his pleas for medical attention were ignored. That same year, 46-year-old Carlos Mercado and 39-year-old Bradley Ballard died after their medications were withheld. The families of all three men are suing Corizon, the private medical provider that has held the contract for medical services at Rikers since 2003. However, according to DNAinfo, Corizon's contract with New York City stipulates that the city will represent the firm in lawsuits arising from its care. It also ensures that the city will cover costs arising from medical malpractice or civil rights violations.

New York is not alone in turning to privatized health care for people behind bars. In 2011, Florida governor Rick Scott contracted with Corizon to provide medical care in its state prison system for $1.2 billion. Corizon took complete control in 2013. According to an investigation by The Palm Beach Post, three months later the number of deaths "shot to a 10-year high," with 30 deaths in four of the past seven months.

Corizon currently holds contracts in 27 states with approximately 345,000 people under their care. (In October 2013, Therese Brumfeld, vice president of Corizon's provider operations and purchasing, stated that Corizon had contracts in 29 states with over 400,000 people.) From 2008 to 2013, Corizon has been sued 660 times for malpractice.

In Alabama, the Southern Poverty Law Center filed a federal suit against the state's prison system for ignoring the medical and mental health needs of its prisoners. (Corizon provides medical care only. MHM, another private company, holds the contract for mental health care.) Unlike its contract with New York City, Corizon's 34-month, $224 million contract with Alabama requires it to pay for any legal work in the event of a lawsuit, even if it is not named in the suit.

Arizona recently settled class-action suit Parsons v. Ryan. The suit, filed by the American Civil Liberties Union (ACLU) in 2012, charged that the state ignored the basic needs, including medical needs, of people in its prison system for years. Corizon took over the state prison's health care system in March 2013 after the state terminated its contract with private health care provider Wexford following multiple deaths and accusations of medical neglect.

However, medical care did not improve under Corizon and the ACLU continued its suit. On October 14, 2014, Arizona settled the suit, agreeing to meet more than 100 health care performance measures, including monitoring people with chronic conditions, such as diabetes and hypertension as well as improving pregnancy and dental care.

Before the court decides whether to approve the settlement, however, each of the 33,000 people in Arizona state prisons must receive notice of the settlement and an opportunity to submit comments to the court. David Fathi, director of the ACLU National Prison Project and co-lead counsel on Parsons, estimated that the process would probably take two months. The settlement does not become effective until the court grants its approval.

In the meantime, health care needs continue to go unaddressed. The day after the settlement was announced, Jill spoke with her daughter who told her that her yard had no health needs request forms, which every person must fill out to start the process of receiving medical attention.

"We live by violence, but we die by neglect," a woman told McMillan when she entered Rikers.

After hearing stories from her daughter, Jill doesn't dispute this. She recalls her daughter telling her about a woman on her yard whose complaints about bleeding and pain were ignored. She was finally taken to the hospital where she was diagnosed with ovarian cancer. She died in her 30s.

"My daughter went in a very healthy 25-year-old," Jill said. "She was not given a life sentence or death. She should be given enough medical care so that when she comes out, she can resume living a normal life."

ALABAMA's DOC chief : Corrupt profiteer CORIZON isn't "bad" - they're just misunderstood.

This guy must be buddies with Arizona DOC's director Chuck Ryan: neither of them give a damn about the horrendous neglect of their seriously ill and disabled prisoners by Corizon. Guess this guy is getting sued, too.

Fortunately, Alabama prisoners and their supporters are organized. Here's a good model for folks in AZ to look at. If you love a prisoner, don't wait for me to organize something like this - chat with others at visitation, join prison talk, organize, and put up a blog too. I'm not going to be around here forever, after all...

THE FREE ALABAMA MOVEMENT

(flyer from ALABAMAPRISONWATCH.ORG)

(also on FACEBOOK)

---------from AL.COM----------

Alabama prison boss gives vote of confidence to embattled inmate health care firm

By Brendan Kirby | bkirby@al.com

on August 20, 2014 at 6:51 PM, 

updated August 20, 2014 at 6:56 PM

 

 

 

Alabama Corrections Commissioner Kim Thomas supports Corizon Health Inc.

  

ORANGE BEACH, Alabama – Alabama Corrections Commissioner Kim Thomas on Wednesday gave a vote of confidence to Corizon Health Inc., which has been accused in lawsuits across the country of providing inadequate health care to prisoners.

One of those lawsuits is pending in federal court in Montgomery, where the Southern Poverty Law Center accuses the company of failing to provide adequate health care to prisoners with disabilities.

The company's performance has been an issue in suits filed in Arizona and New York.

Thomas, who appeared at the annual convention of the Alabama Association of County Commissions on Wednesday, said in an interview that lawsuits are common in corrections. He said Corizon's competitors also have been sued.

"This is a litigious business, whether it's on the inmate side or the health care side," he said.

Thomas noted that in the Arizona case, Corizon took over the prison health contract for another company, Wexford, shortly before the lawsuit was filed in March 2013.

"The idea that Corizon is the bad guy in Arizona is just disregarding the facts," he said.

Corizon was the sole bidder to provide health care to Alabama's inmates after other companies dropped out of the competition. It signed a 34-month, $224 million contract with Alabama prison system in 2012.

Thomas said the company has done a good job under difficult circumstances. He said prisoners are a difficult population to treat, for a variety of reasons.

"It's the same standard of care in the prison as in the community," he said. "Inmates are the only subset of our society that have a constitutional right to health care."

Wendy Halloran rocks! Once-touted PHX arson squad under heavy fire.

When I started Arizona Prison Watch 5 years ago, one of my main reasons for doing so was my lack of confidence in the mainstream media's interest in publishing the truth about Power and their police in this state. I've always been highly critical of TV news, for good reason, I think. They mostly serve the interests of the power I fight, particularly police power, by being the primary medium by which the state exploits racism and xenophobia and oppression through outright propaganda. 


Furthermore, the state leaks information about arrests and misrepresents "facts" they cant prove in court all the time to tip the scales of justice against the accused, and the media so often plays along. Once you're condemned there, a plea deal favorable to the prosecution is much easier to obtain - as are a conviction and severe sentence if the defendant dares go to trial. Never mind that "innocent until proven guilty" standard you learned in civics class - you're pretty much done in America's injustice system if the news gets a hold of you before the jury ever hears a word.


No, as far as I was concerned, despite an occasional exception, neither the liberal "alternative" press or conservative local  media could be trusted to get to the bottom of what this state was doing to those of us it accused or held in custody any more than Joe Arpaio could be counted on to care who died on his watch. The only stories that would ever play here would be those who served the corporate media's own interests - or the state's. 


After the death of AZ state prisoner Marcia Powell in 2009 I began blogging and trying to figure out  how to get at the truth and put it out there myself, cursing the cowardice of journalists and news outlets in this state (except for the guy who followed her case more closely, Stephen Lemons at the PHX New Times, that is...). My favorite target of criticism for pandering to police and political power was the Arizona Republic - albeit a favorite target of the right, as well, for not being loyal enough to conservative mores. As far as I was concerned, they did the dirty work of the state whenever bidden to do so by publishing their press releases as if they were "truth", which was all I needed to know.  The only people I could really trust were fellow bloggers, it seemed. 


Since then, this blog has resulted in literally hundreds of letters and phone calls from prisoners and their families with information about abuses in the state prison system, as well as local jails and police departments. Unfortunately, no matter what I learned in my work with prisoners (and their survivors, in cases where they died in custody), I didn't have enough audience to ever impact a state policy or liberate someone wrongfully imprisoned, so I nevertheless often appealed to mainstream journalists to help those I couldn't. They seldom ever did. I really resented Arizona's media for awhile for whitewashing the DOC with silence on the state's real crimes, in fact. Big media, especially, was wholly knowingly complicit, as far as I was concerned. 

Then I noticed investigative journalist Wendy Halloran covering what was happening in the prisons, the courts and the larger world of crime and punishment that I'm now tuned into. She exposed the gross neglect of Tony Lester as he lay bleeding to death, unassisted in any way by the first responders of the AZ Department of Corrections. Her investigations into the DOC's,  Wexford's, and Corizon's shoddy treatment of the sick and mentally ill has helped bring the problems of prisoner's health care to the forefront, such that there is now a class action suit alleging system-wide negligence and abuse. And she's gone after corruption, racism and shady cops in the Mesa,  Phoenix, and Goodyear police departments fearlessly in the past few years. She sticks up for the underdog behind the scenes, too - she's not just out for her own glory, she's out for justice.

Because of their willingness to believe the unbelievable about the conduct of state agents, Wendy Halloran and the folks at 12news/KPNX have now helped bring about a criminal investigation into the conduct of the "crack" Phoenix arson squad, demanding justice for those wrongfully targeted by them. She and her station went out on a limb doing so, too. I even worry for Wendy's safety due to the heat she's brought down on powerful people in this state, so when you see her out and about in the Valley of the Sun, dear People, please watch this woman's back. After all, she's been watching ours...


Here's the latest in Wendy Halloran's coverage of the Phoenix Fire Department's Arson Squad, followed by links to the rest of her work on that case. Thank you, KPNX/ AZCentral and Gannett News, for supporting this kind of  journalism, and Wendy Halloran for your courage and commitment to pursuing the truth. 

-----from CH12/AZCENTRAL.COM----

3 Phoenix arson investigators put on paid leave

DPS recommending criminal charges against two for acts of dishonesty during investigation. 

Wendy Halloran, 12 News  
11:05 p.m. MST July 25, 2014

"Three members of the Phoenix Fire Department's once highly touted arson squad were put on leave Friday in the face of the release of a state criminal investigation, according to a departmental news release released to the media.


Capts. Sam Richardson and Fred Andes and unit director Jack Ballentine were placed on paid administrative leave a day after the Arizona Department of Public Safety reported it had concluded a criminal investigation into the members' alleged misconduct and improper investigative techniques.


A final, redacted review has not yet been released to fire officials.


The DPS review came at the request of the department after a series of 12 News reports into the squad.


1.       Raked Over the Coals

http://archive.azcentral.com/video/2152644923001


2.       Phoenix City Councilman calls for inquiry into arson unit

http://archive.azcentral.com/video/2194033984001



3.       Mayor responds to investigation

http://archive.azcentral.com/video/2224313250001


4.       FBI Launches probe/The Captain, His Crew and Carl Caples

http://archive.azcentral.com/video/2351415559001


5.       Phoenix Fire Department Captain insists his investigation was solid

http://archive.azcentral.com/video/2351186725001


6.       Phoenix Fire Department releases findings from arson review

http://archive.azcentral.com/video/2762486885001


7.       Which Lab is Better? The chocolate lab or the crime lab?

http://archive.azcentral.com/video/2992112970001


8.       One-on-one with Phoenix Fire Chief Bob Khan –Phoenix Fire Department inflates arson clearance rates

http://archive.azcentral.com/video/3115428973001


9.       Officials want outside inquiry into Phoenix Fire Department


http://www.azcentral.com/community/phoenix/articles/20140213officials-want-outside-inquiry-into-phoenix-fire-department-arson-unit.html


10.  Judge Orders depositions of fire investigators in death penalty case


http://www.azcentral.com/story/news/local/phoenix/2014/06/03/12news-judge-orders-depositions-for-investigators/9935329/

Execution by Deliberate Indifference: Killing Robert W. Murray.

UPDATED JULY 1 2014: There's nothing new about this, sadly - the AZ DOC has been executing prisoners all along by way of failing to treat their critical  medical and psychiatric conditions. Three death row prisoners in just over  a year have also committed suicide...

You must be a subscriber to see Gary Grado's newest article at the Capitol Times  about the above notice of Robert Murray's death -  if you can afford it,  check it out. Below is the original piece on Murray's cancer last fall, also by Grado, along with my post at the time. Not sure anything more needs to be said, except condolences to anyone who might have cared about this prisoner, as well as to the loved ones of his victims, for whom this will be an emotional time as well. 

----------------

SOS from Arizona's living dead: 
Deliberate indifference to life on death row
(originally posted to arizonaprisonwatch.org on September 26, 2013 7am)

 one of many letters received at AZ Prison Watch re: 

prisoner frustration over difficulty accessing medical care.

A big thanks goes out to Gary Grado at the AZ Capitol Times for interviewing this prisoner, and to the publication for making this particular article accessible to non-subscribers. Prisoners don't make sympathetic news subjects - especially not those on death row. A lot of folks would just as soon let Murray die of throat cancer untreated, in favor of putting those health care resources into the community (as if the state would actually re-direct "savings" there, instead of into the private pockets of profiteers). 

All I can say is that withholding medical care from Murray because the state plans to kill him anyway is akin to choosing to execute him by applying acid to his throat in small doses over the course of  9 months or so, letting it eat slowly away at his ability to  swallow, speak, and breathe, knowing this will not only kill him, but will make him suffer horribly as he dies. This has nothing to do with one's feeling about the death penalty - it's a question of whether or not you are for the constitution and against torture. If you believe in the rule of law, and that we should not torture our prisoners, then you have to support the provision of a basic standard of medical and mental health care to them.

The other thing is that prisoner health IS public health, and if we don't treat them inside, they come out with high rates of chronic illness, infectious disease, psychiatric disability, and so on. The imprisoned population is especially high-risk, medically, and many live marginally once back in the community, where they are more likely to lack access to health care than most non-felons. In prison they're frequently exposed to things like Hepatitis C (at least 40% of prisoners are believed to be infected), but as a captive patient population, they would be more likely than not to follow up on treatments and regimens that lower their mortality and long term health risks considerably, if their dietary plans and health care provider will offer them.

But that's not what appears to be happening. Deliberate indifference to human suffering is the absolute worst cancer there is in a society, and it's metasticized from the head of the AZ DOC to the agency's extremities. I hear stories like Murray's all the time, sadly - and it's not just the guys on death row. Remember Benny Joe Roseland? I've written to him a few times, but haven't heard back from him since writing that post. DOC says he's still alive, but that's all I can get from them.

Furthermore, as Dan Pochoda points out below, how we treat our prisoners says a lot about our society. The conditions in Arizona's prisons - from the medical neglect to the prevalence of heroin, the dominance of criminal gangs, and the rampant racialized violence - are among the worst in the country. There was a brief spell of progressive vision a the AZ DOC while Dora Schriro was director, under then-governor Janet Napolitano, but she was often mocked as being a "thug-hugger" for favoring rehabilitative programs over punishments, and her efforts were frequently undermined by the Good Old Boys network of DOC administrators and officers.

According to prisoners and former employees, things at the AZ DOC got dramatically worse as soon as Jan Brewer became governor, bringing Charles Ryan out of retirement to be her chief disciplinarian at the AZ DOC. The culture of contempt for prisoners and human rights that permeates that institution has actually been decades in the making, much of it under the direction of the younger Chuck Ryan, so all the bad stuff began to flourish again once he took over the reins there. 

I don't understand that man at all, I have to say. He's spent his career climbing that ladder, but now there, he appears to have utterly ceded control of his prisons to the gangs and profiteers - either that, or he's knowingly and intelligently aiding and abetting them. In either case,  his directorship  should be an embarassment to the Governor's office - for some reason Jan still stands by her man, though. 

Check out the other work the Capitol Times has been doing on the prison system here. If you're a subscriber, this is a pretty good piece that just came out about the class action lawsuit over health care, also by Gary Grado:

Exhibit in class-action lawsuit details failings of prison health system

-------from the AZ Capitol Times (9/16/13)--------

Prison ordeal

Death row inmate struggles with cancer

By Gary Grado

Published: September 16, 2013 at 8:41 am

A lab discovered death-row inmate Robert Murray had cancer the same day a Scottsdale surgeon removed his tonsils, but his disease went unknown to him and untreated for seven more months.

As Murray, 48, and his lawyers try to figure out what went wrong with his medical treatment, one thing is certain. The breakdown coincided with the turmoil surrounding the Department of Corrections’ transition to a private health care provider for Arizona prisoners, and his situation didn’t improve after the first company parted ways with DOC and a new company came under contract.

Murray endured long, painful delays between doctor’s appointments, a misdiagnosis, and a time in which blood from a burst abscess on his tonsil gushed from his mouth. He came to learn he had cancer when the surgeon he hadn’t seen in months asked him if he was finished with radiation to treat the illness, a treatment he never had.

Despite the delays, the cancer didn’t spread. Murray said an oncologist told him that although the situation could have become grave, he should have a full recovery with proper treatment.

“It was prayer, luck it just didn’t explode like it could have,” Murray said in a 21-minute interview from death row in Arizona State Prison Complex-Florence, where he’s been locked up since October 1992.

Such allegations aren’t unusual. A class-action lawsuit alleging DOC has provided inadequate health care for years offers other medical horror stories. And a suit recently filed by the survivors of an inmate who died in October 2012 alleges employees of Wexford Health Sources Inc. of Pittsburgh refused to treat him while he convulsed on the floor. Wexford is a company that provides prisoner health care in Arizona and elsewhere.

“We get weekly at least one letter that is equivalent, literally, to this fellow on death row,” said Dan Pochoda, the legal director for ACLU-Arizona.

Pochoda is one of more than 20 lawyers involved in the class action suit. He said the medical hardships of prisoners don’t resonate with the public, but they should because the state has a heavy obligation to provide adequate health care once it takes control of someone’s life.

“To paraphrase Dostoevsky, the test of a society is how they treat persons in prison,” Pochoda said.

Pleas for help

Murray and his brother, Roger Murray, are on death row for convictions in the May 14, 1991, robbery and murders of Dean Morrison, 65, and Jacqueline Appelhans, 60, at their store in Grasshopper Junction in Mohave County.

Morrison and Appelhans were found face down in their bathrobes, shot several times each in the head with shotguns and handguns. Appelhans was clutching Morrison’s arm.

Murray wrote a book titled “Life on Death Row” in which he denied committing the murders.

He has contended with an assortment of health problems during his 21 years in prison, and it was during an examination in February 2012 that he first complained of a lump in his throat.

Murray’s tonsils were becoming swollen and sore by April 2012, which was one of the final months that DOC provided medical care. Murray saw a DOC doctor in May and was diagnosed with an infected tonsil and given antibiotics.

Just days before his appointment, DOC and Wexford Health Solutions announced the company had been awarded a five-year contract to provide onsite medical, dental, pharmacy and mental health care, as well as the administration of third-party services.

Murray claims in a nine-page affidavit that the antibiotics had no effect and his many requests over the next month to see a doctor went unfulfilled as the swelling worsened and swallowing became difficult.

“His neck and face were visibly deformed,” said Murray’s attorney, Jennifer Garcia, a deputy federal public defender.

Wexford took over on July 1, 2012, and the company informed Murray he was on a waiting list to see a doctor, even as he continued to submit medical requests pleading for help.

“At least once during this period I overheard RX delivery nurses state that ‘Wexford has no available doctors for (the infirmary),’” Murray wrote.

In a Cure Notification, a letter to Wexford to outline how it wasn’t complying with the contract, DOC said the company’s staffing shortage created “inappropriate scheduling gaps in on-site medical coverage.”

In his requests to see a doctor, Murray writes about shooting pains in his ear, choking and coughing and difficulty breathing. He saw a nurse practitioner on July 20, 2012, who became alarmed by his condition and prescribed “magic mouthwash,” a formula of various medicines used to treat ulcers in the mouth.
Four days later the abscess burst.

“A warm fluid gushed into my mouth, I thought I may be vomiting and hurried to my sink,” he wrote.

He was rushed to the hospital, but he didn’t see a surgeon until September and wasn’t on the operating table until Nov. 19, 2012.

DOC, meanwhile, was already unhappy with Wexford’s performance, stating in the Cure Notification that the company was inadequately staffed, administered medication incorrectly, inconsistently and incompletely, and lacked a sense of urgency in addressing crisis situations.

DOC referred to several incidents in which it said Wexford did not comply with the terms of the contract, including not giving medication to a mentally ill inmate who hanged himself and a nurse who contaminated diabetes insulin with syringe tainted with Hepatitis C and continued to inject inmates with it.

Wexford responded with a letter of its own explaining that “the majority of the problems Wexford now faces are long-standing issues, embedded into (DOC) health care policy and philosophy, and which existed well before Wexford Health Sources assumed responsibility of the program.”

Wexford also alleged that DOC kept key information hidden during the procurement process.

An aggressive form of cancer

Dr. Joel Cohen of the Allergy Ear Nose and Throat Center in Scottsdale removed Murray’s tonsils on Nov. 19 and sent them to a nearby lab. The lab confirmed he had cancer and phoned the results to Cohen the next day, according to the pathology report.

Dr. Sun Yi, a University of Arizona professor who specializes in cancers of the head and neck, said that after diagnosis, blood work and scans would be done to determine the severity, or stage, of the cancer, a process that generally takes a few months.

From there, the patient would be referred to various oncologists.

“With malignancy, the more time you wait the more time the tumor has to continue to populate and grow,” said Yi, who is not involved in the case. “The worst case scenario is the cat’s out of the bag situation where it metastasizes and becomes phase four and for most cancers incurable at that point.”

Yi said cancer in the throat is extremely aggressive.

There are no records of any of the steps Yi described in Murray’s medical file.

Murray said Cohen wanted to see him 14 to 21 days after the surgery, but “ADOC-Wexford failed to take action.”

Cohen said he reported the cancer by telephone to a doctor at DOC on Nov. 20, 2012, and recommended treatment.

The doctor said he regularly treats prisoners and he understands there are all sorts of prison protocol that must be followed for each visit. He typically wants to see a patient for post-operative visit in 10 to 14 days.

“The prisoners can’t always come back when they’re told to come back,” Cohen said.

He said it is not his responsibility to prescribe the cancer treatment.

A spokesman for DOC and spokeswoman for Wexford declined to comment for this story. The agency and company agreed Jan. 30 to end the contract and DOC signed a new one with St. Louis-based Corizon Health Inc., which took over services on March 4.

Murray’s throat was still irritated and swollen in the meantime, and he got an appointment with Cohen on May 14.

“He’s talking to Corizon all the time about this problem and no one seems to be addressing them for months either,” Garcia said. “It doesn’t seem to me things have been measurably better under Corizon.”

Murray said Cohen asked him about his radiation treatment, which he never had, but the doctor still didn’t tell him about the cancer.

Records indicate Murray was prescribed radiation and a CT scan that day, but there is nothing in the record explaining why. When Murray returned to the doctor’s office on June 7 he saw Lee, Cohen’s associate.

“He said, ‘You have cancer, you didn’t know,’” Murray said. “It was kind of an astounding moment, surreal.

I kind of expected something was not right.”

Ray Norris, a medical malpractice attorney with the firm Gallagher and Kennedy, said medical negligence is determined by whether a doctor fell below the standard of care.

Norris, who is not involved in Murray’s case, said standard of care is measured by what an ordinary, prudent, and reasonable health care provider would do under the same circumstance.

“If there was a breach of the standard of care, the question then becomes causation, or in other words, what difference did it make,” Norris said.

Murray’s theory is he thinks Cohen expected him to return for a follow up visit within a few weeks and was going to inform him then about the cancer, but when Wexford failed to schedule the appointment Cohen never followed up. “I think it was probably just an accident, but an accident can be easily overlooked,” Murray said.

Murray is still undergoing treatment, and while it isn’t going at the pace he would prefer, he said he’s been assured it is normal pace for treating such a cancer. He said he is still considering his options on filing a lawsuit and looking for a civil lawyer.

Health Decline

May 2012: Inmate Robert Murray diagnosed with possible infected tonsils and given antibiotics. Wexford Health Solutions is awarded $349 million contract to provide health services to Arizona prisoners.

June 2012: Swelling in neck worsens.

July 1, 2012: Wexford takes over medical services.

July 24, 2012: Abscess in neck bursts and Murray rushed to hospital.

Aug. 17, 2012:  In an incident not related to Murray, Wexford nurses are accused of improperly administer medication by making inmates lick powdered medication from hands.

Aug. 23, 2012: Mentally ill inmate who didn’t receive psychiatric medication for weeks found hanged in cell.

Aug. 27, 2012: Wexford nurse allegedly contaminates diabetes insulin with syringe tainted with Hepatitis C.

Sept. 21, 2012: Arizona Department of Corrections informs Wexford of assorted contract breaches.

Nov. 19, 2012: Murray, whose face is deformed from swelling, undergoes tonsillectomy and lab results show he has cancer.

January 2013: Murray’s requests for follow up with surgeon unfulfilled, problems and pain with neck persist. Wexford and DOC agree to cancel contract. Corizon becomes new contractor.

June 7, 2013: Murray informed he has cancer that went untreated for seven months.

Corizon's Cruel and Unusual Greed: follow the money with Prison Legal News.

 Excellent but troubling article below from Prison Legal News: print and send it to prisoners!  Prisoner subscriptions to Prison Legal News are only $30 a year for the print edition (for prisoners), and one of the best investments you can make.

www.prisonlegalnews.org

P.O. Box 1151

Lake Worth, FL 33460

info@prisonlegalnews.org   

For those fighting Corizon over  a loved one's health care, 

check out  these posts 

Corizon and the AZ DOC: Prisoners & Families, Know Your Rights.

Corizon's deliberate indifference: fighting back.

"DEATH SENTENCE": KPNX's Halloran and whistleblower expose depth of negligence at Corizon/AZ DOC.

and feel free to contact me if you think I can help:

----from PRISON LEGAL NEWS----

Corizon Needs a Checkup: Problems with Privatized Correctional Healthcare

published in Prison Legal News March, 2014, page 1

Loaded on March 15, 2014

by Greg Dober

Corizon, the nation’s largest for-profit medical services provider for prisons, jails and other detention facilities, was formed in June 2011 through the merger of Prison Health Services (PHS) and Correctional Medical Services (CMS).


In April 2013, the debt-rating agency Moody’s downgraded Corizon’s nearly $360 million worth of debt to a rating of B2 – an indication the company’s debt is highly speculative and a high credit risk. According to Moody’s, the rating downgrade was due to an “expectation of earnings volatility following recent contract losses, margin declines from competitive pricing pressure on new and renewed contracts, and Moody’s belief that Valitás [Corizon’s parent corporation] will be unable to restore metrics to levels commensurate with the prior B1 rating over the near to intermediate term.”


Valitás Health Services is majority owned by Beecken Petty O’Keefe & Company, a Chicago-based private equity management firm. Beecken’s other holdings are primarily in the healthcare industry.


On September 23, 2013, Moody’s again downgraded Corizon’s debt rating and changed the company’s rating outlook from “stable” to “negative.” The following month Corizon announced that it had replaced CEO Rich Hallworth with Woodrow A. Myers, Jr., the former chief medical officer at WellPoint Health. Hallworth, who had been appointed Corizon’s CEO in 2011, previously served as the president and CEO of PHS. At the same time that Hallworth was replaced, Corizon president Stuart Campbell also stepped down.


Prison Medical Care for Profit

According to Corizon’s website, the company provides healthcare services at over 530 correctional facilities serving approximately 378,000 prisoners in 28 states. In addition, Corizon employs around 14,000 staff members and contractors. The company’s corporate headquarters is located in Brentwood, Tennessee and its operational headquarters is in St. Louis, Missouri.

The 2011 merger that created Corizon involved Valitás Health Services, the parent company of CMS, and America Service Group, the parent company of PHS. The Nashville Business Journal reported the deal was valued at $250 million.

“Corizon’s vision is firmly centered around service – to our clients, our patients and our employees,” Campbell said at the time. “To that we add the insight of unparalleled experience assisting our client partners, and caring professionals serving the unique healthcare needs of [incarcerated] patients.”

Corizon has around $1.5 billion in annual revenue and contracts to provide medical services for the prison systems in 13 states. The company also contracts with numerous cities and counties to provide healthcare to prisoners held in local jails; some of Corizon’s larger municipal clients include Atlanta, Philadelphia and New York City (including the Rikers Island jail). Additionally, the company has its own in-house pharmacy division, PharmaCorr, Inc.

The prison healthcare market has flourished as state Departments of Corrections and local governments seek ways to save money and reduce exposure to litigation. [See: PLN, May 2012, p.22]. Only a few major companies dominate the industry. Corizon’s competitors include Wexford Health Sources, Armor Correctional Health Services, NaphCare, Correct Care Solutions and Centurion Managed Care – the latter being a joint venture of MHM Services and Centene Corporation. Around 20 states outsource all or some of the medical services in their prison systems.

As Corizon is privately held, there is little transparency with respect to its internal operations and financial information, including costs of litigation when prisoners (or their surviving family members) sue the company, often alleging inadequate medical care.

For example, when Corizon was questioned by the news media in Florida during a contract renewal, the company initially tried to prevent the release of its litigation history, claiming it was a “trade secret.”

In 2012, Corizon agreed to settle a lawsuit filed against PHS – one of its predecessor companies – by Prison Legal News, seeking records related to the resolution of legal claims against the firm in Vermont. Based on the records produced pursuant to that settlement, PHS paid out almost $1.8 million in just six cases involving Vermont prisoners from 2007 to 2011. [See: PLN, Dec. 2012, p.16].

Companies like Corizon provide healthcare in prisons and jails under the HMO model, with an emphasis on cutting costs – except that prisoners have no other options to obtain medical treatment except through the contractor.

Arizona DOC

A former Corizon nurse had her license suspended and is currently under investigation by the Arizona State Board of Nursing for incompetence. In January 2014, nurse Patricia Talboy was accused of contaminating vials of insulin at three units at the ASPC-Lewis prison, potentially exposing two dozen prisoners to HIV or hepatitis.

Talboy reportedly used a needle to stick prisoners’ fingers to check their blood sugar levels. She then used the same needle to draw insulin from vials of the medication utilized for multiple prisoners, possibly contaminating the insulin in the vials. After placing the vials back into inventory, other staff members may have unknowingly used them to dispense insulin.

“Every indication is that the incident is the result of the failure by one individual nurse to follow specific, standard and well-established nursing protocols when dispensing injected insulin to 24 inmates,” Arizona Department of Corrections (ADC) director Charles L. Ryan said in a January 9, 2014 statement.

Talboy’s failure to follow procedures was discovered after a prisoner told a different nurse about the issue. Corizon reportedly delayed three days before publicly reporting the incident; in a press release, the company admitted that one of its nurses had been involved in “improper procedures for injections.” Talboy received her nursing license in August 2012 and became an RN in June 2013; as a rookie nurse, Corizon likely paid her less than more experienced nurses.

Following the insulin-related incident, the company was ordered to develop a comprehensive plan that includes “supplemental training and competency testing procedures for blood glucose testing and administration of insulin,” as well as “nurse-peer reporting education to ensure professional accountability” and “patient awareness education on injection protocols.”

Granted, Corizon isn’t alone with respect to such incidents. In August 2012, a nurse employed by the ADC’s previous medical services contractor, Wexford Health Sources, contaminated the insulin supply at ASPC-Lewis through improper injection protocols, potentially exposing 112 prisoners to hepatitis C. [See: PLN, July 2013, p.1].

Corizon has a three-year, approximately $370 million contract to provide medical care in Arizona state prisons, which began in March 2013. The contract award generated controversy because former ADC director Terry Stewart was hired by Corizon as a consultant; current director Charles Ryan had previously worked under Stewart, raising a potential conflict of interest. Ryan denied any improprieties.

According to a report by the American Friends Service Committee released in October 2013, titled “Death Yards: Continuing Problems with Arizona’s Correctional Health Care,” medical services in Arizona prisons did not improve after Corizon replaced Wexford as the ADC’s healthcare contractor. “Correspondence from prisoners; analysis of medical records, autopsy reports, and investigations; and interviews with anonymous prison staff and outside experts indicate that, if anything, things have gotten worse,” the report stated.


Florida DOC

In 2013, the Florida Department of Corrections (FDOC) awarded Corizon a five-year, $1.2 billion contract to provide medical services to state prisoners in north and central Florida. Wexford Health Sources was contracted to provide similar services in the southern region of the state for $240 million. [See: PLN, June 2013, p.24]. The wholesale privatization of healthcare in Florida’s prison system followed a 2011 legislative decision to disband the state’s Correctional Medical Authority, which had oversight over prison medical care. [See: PLN, May 2012, p.30].

The contracts were part of the Republican administration’s initiative to expand privatization of government services, including prison management and healthcare, in spite of previous setbacks. In 2006, PHS withdrew two months into an almost $800 million contract to provide medical care to Florida prisoners; at that time, the company said the contract was not cost-effective and claimed it would lose money.

The 2013 contract awards to Corizon and Wexford followed a two-year legal fight. In 2011, AFSCME Florida and the Federation of Physicians and Dentists/Alliance of Healthcare and Professional Employees filed suit challenging the prison healthcare contracts, in an effort to protect the jobs of nearly 2,600 state workers.

On June 21, 2013 the First District Court of Appeals approved the privatization of medical care in FDOC facilities, overturning a ruling by the Leon County Circuit Court. The appellate court noted in its decision that “The LBC [Legislative Budget Committee] simply moved funds from different line items within the Department’s Health Services’ program, providing additional funds for contracts that the Department otherwise had the authority to enter.” See: Crews v. Florida Public Employers Council 79, 113 So.3d 1063 (Fla. Dist. Ct. App. 1st Dist. 2013).


Under the terms of the FDOC’s contract with Corizon, the company must provide medical care to Florida state prisoners for 7% less than it cost the FDOC in 2010. When entering into the contract, state officials apparently had few concerns about the numerous lawsuits previously filed against Corizon, and no hard feelings toward the company’s predecessor, PHS, when it terminated its 2006 contract to provide medical services to Florida prisoners because it wasn’t profitable.


“Most people feel, as long as they achieve their 7 percent savings who cares how they treat inmates?” noted Michael Hallett, a professor of criminology at the University of North Florida.


Florida Counties


In a September 6, 2012 unpublished ruling, the Eleventh Circuit Court of Appeals affirmed a $1.2 million Florida jury verdict that found Corizon – when it was operating as PHS – had a policy or custom of refusing to send prisoners to hospitals. The Court of Appeals held it was reasonable for jurors to conclude that PHS had delayed medical treatment in order to save money. See: Fields v. Corizon Health, 490 Fed.Appx. 174 (11th Cir. 2012).


The jury verdict resulted from a suit filed against Corizon by former prisoner Brett A. Fields, Jr. In July 2007, Fields was being held in the Lee County, Florida jail on two misdemeanor convictions. After notifying PHS staff for several weeks that an infection was not improving, even with antibiotics that had been prescribed, Fields was diagnosed with MRSA. PHS did not send him to a hospital despite escalating symptoms, including uncontrolled twitching, partial paralysis and his intestines protruding from his rectum. A subsequent MRI scan revealed that Fields had a severe spinal compression; he was left partly paralyzed due to inadequate medical care.


The Eleventh Circuit wrote that PHS “enforced its restrictive policy against sending prisoners to the hospital,” and noted that a PHS nurse who treated Fields at the jail “testified that, at monthly nurses’ meetings, medical supervisors ‘yelled a lot about nurses sending inmates to hospitals.’” Further, PHS “instructed nurses to be sure that the inmate had an emergency because it cost money to send inmates to the hospital.”


At trial, the jury found that PHS had a custom or policy of deliberate indifference that violated Fields’ constitutional right to be free from cruel and unusual punishment. The jurors concluded that Fields had a serious medical need, PHS was deliberately indifferent to that serious medical need, and the company’s actions proximately caused Fields’ injuries. The jury awarded him $700,000 in compensatory damages and $500,000 in punitive damages. [See: PLN, March 2013, p.54; Aug. 2011, p.24].


More recently, the estate of a 21-year-old prisoner who died at a jail in Manatee County, Florida filed a lawsuit in October 2013 against the Manatee County Sheriff’s Office and Corizon, the jail’s healthcare provider. The complaint accuses the defendants of deliberate indifference to the serious medical needs of Jovon Frazier and violating his rights under the Eighth Amendment.


In February 2009, Frazier was incarcerated at the Manatee County Jail; at the time of his medical intake screening, staff employed by Corizon, then operating as PHS, noted that his health was unremarkable. Frazier submitted a medical request form in July 2009, complaining of severe pain in his left shoulder and arm, and a PHS nurse gave him Tylenol.


Throughout August and September 2009, Frazier submitted five more medical requests seeking treatment for his arm and shoulder. “It really hurts! HELP!” he wrote in one of the requests. PHS employees saw him and recorded his vital signs. Despite the repeated complaints, Frazier was never referred to a doctor or physician assistant; on September 9, 2009 his treatment was documented as routine but he was placed on the “MD’s list.”


An X-ray was taken on September 17, 2009 to rule out a shoulder fracture. The X-ray was negative for a fracture, and Frazier was not referred to a doctor. He submitted two more medical requests that month and five requests in October 2009 seeking treatment for his increasingly painful condition. The complaint alleges that in total, Frazier submitted 13 medical request forms related to pain over a period of three months; he was seen by a nurse each time but not examined by a physician.


On October 29, 2009, Frazier received an X-ray to determine if he had a tendon injury. An MRI was recommended and he was transported to a hospital where an MRI scan revealed a large soft tissue mass on his shoulder. A doctor at the hospital, concerned that the mass was cancerous, recommended additional tests.


After being diagnosed with osteosarcoma, a form of bone cancer, Frazier was returned to the jail and subsequently treated at the Moffitt Cancer Center, where he received chemotherapy, medication and surgery. Despite this aggressive treatment the cancer progressed and Frazier’s left arm was amputated. The cancer continued to spread, however, and he was diagnosed with lung cancer in June 2011. He died within three months of that diagnosis, on September 18, 2011.


In a letter to the attorney representing Frazier’s estate, Florida oncologist Howard R. Abel wrote that the lack of treatment provided by Corizon at the Manatee County Jail constituted “gross negligence and a reckless disregard to Mr. Frazier’s right to timely and professionally appropriate medical care.”


The lawsuit filed by Frazier’s estate claims that Corizon was aware of his serious medical condition but failed to provide adequate treatment. In addition, the complaint contends the company has a widespread custom, policy and practice of discouraging medical staff from referring prisoners to outside medical practitioners and from providing expensive medical tests and procedures. Finally, the lawsuit states that “Corizon implemented these widespread customs, policies and practices for financial reasons and in deliberate indifference to [the] serious medical needs of Frazier and other inmates incarcerated at Manatee County Jail.”


On January 10, 2014, U.S. District Court Judge James Moody denied Corizon’s motion to dismiss the case. The company had argued that the allegations in the lawsuit failed to assert sufficient facts to establish deliberate indifference, amounted only to medical negligence and were insufficient to establish gross negligence, and failed “to adequately allege a policy or custom that violated Frazier’s rights.” Judge Moody disagreed, finding the claims set forth in the complaint were “sufficient to establish a constitutional violation.”


The Manatee County Sheriff’s Office had better luck with its motion to dismiss. The Sheriff argued the complaint did not establish facts indicating that the jail had a similar practice – like Corizon – of providing deliberately indifferent medical care to prisoners. The court agreed and dismissed the claims against the Sheriff’s Office; the claims against Corizon remain pending. See: Jenkins v. Manatee County Sheriff, U.S.D.C. (M.D. Fla.), Case No. 8:13-cv-02796-JSM-TGW.


Idaho DOC


In February 2013, the Idaho Department of Corrections (IDOC) announced it had reached a one-year extended agreement with Corizon to provide medical care in the state’s prison system. However, the Idaho Business Review reported that the extension also resulted in a rate increase. Then-Corizon president Stuart Campbell informed the IDOC Board of Correction that the company wouldn’t sign an extension for less money, stating the current contract had become too costly. During the preceding three years of the contract the IDOC had incurred approximately 20% in cumulative rate increases.


Both sides agreed that the contract would run through December 2013 and the IDOC would pay an additional $250,000. It seems odd that Idaho was willing to continue contracting with the company, though, as the relationship between the IDOC and Corizon has been a rocky one.


The quality of medical care at the Idaho State Correctional Institution (ISCI) in Boise has been an ongoing issue for nearly three decades. The prison was the focus of a class-action lawsuit filed on behalf of prisoners alleging a variety of problems, including inadequate healthcare. The lawsuit was known as the Balla litigation after plaintiff Walter Balla.


In July 2011, after new complaints were filed regarding medical care at ISCI, U.S District Court Judge B. Lynn Winmill appointed a special master, Dr. Marc F. Stern, to assess the situation at the facility. The court wanted Stern to confirm whether ISCI was in compliance with the temporary agreements established in the Balla case, and to investigate and report on “the constitutionality of healthcare” at the facility.


Dr. Stern, a former health services director for the Washington Department of Corrections who also had previously worked for CMS, one of Corizon’s predecessor companies, issued a scathing report in February 2012. With the aid of psychiatrist Dr. Amanda Ruiz, Stern and his team reviewed ISCI over a six-day period and met with dozens of prisoners, administrators and Corizon employees.


Stern stated in the report’s executive summary: “I found serious problems with the delivery of medical and mental health care. Many of these problems have either resulted or risk resulting in serious harm to prisoners at ISCI. In multiple ways, these conditions violate the rights of prisoners at ISCI to be protected from cruel and unusual punishment. Since many of these problems are frequent, pervasive, long-standing, and authorities are or should have been aware of them, it is my opinion that authorities are deliberately indifferent to the serious health care needs of their charges.”


The report found that prisoners who were terminally ill or in long-term care were sometimes left in soiled linens, given inadequate pain medication and went for long periods without food or water. The findings regarding sick call noted instances in which prisoners’ requests either resulted in no care, delayed care or treatment that was deemed dangerous. Emergency care situations had insufficient oversight, delays or no response; inadequately trained medical staff operated independently during emergencies without oversight from an RN or physician. The report also found problems with the pharmacy and medication distribution at ISCI.

In one case, a prisoner with a “history of heart disease was inexplicably dropped from the rolls of the heart disease Chronic Care Clinic.” As a result, medical staff stopped conducting regular check-ups and assessments related to the prisoner’s heart condition. A few years later the prisoner went in for a routine visit, complaining of occasional chest pain. No evaluation or treatment was ordered and the prisoner died four days later due to a heart attack. In another case, Corizon staff failed to notify a prisoner for seven months that an X-ray indicated he might have cancer.

Dr. Stern’s report not only reviewed processes but also staff competency and adequacy. The report cited allegations that a dialysis nurse at ISCI overtly did not like prisoners, and routinely “failed to provide food and water to patients during dialysis, prematurely aborted dialysis sessions or simply did not provide them [dialysis] at all and failed to provide ordered medications resulting in patients becoming anemic.” Stern concluded that prison officials were aware of this issue and the danger it presented to prisoners, but “unduly delayed taking action.”


The mental health care provided by Corizon at ISCI was found to be deficient by Dr. Ruiz, who conducted the psychiatric portion of the court-ordered review. The report noted that the facility had 1) inadequate “screening of and evaluating prisoners to identify those in need of mental health care,” 2) “significant deficiencies in the treatment program at ISCI” which was “violative of patients’ constitutional right to health care,” 3) an “insufficient number of psychiatric practitioners at ISCI,” 4) incomplete or inaccurate treatment records, 5) problems with psychotropic medications, which were prescribed with no face-to-face visits or follow-up visits with prisoners and 6) inadequate suicide prevention training.


The report concluded: “The state of guiding documents, the inmate grievance system, death reviews and a mental health CQI [continuous quality improvement] system at ISCI is poor. While not in and of themselves unconstitutional, it is important for the court to be aware of this and its possible contribution to other unconstitutional events.”


In March 2012, shortly after Dr. Stern’s report was released over the objection of state officials, Corizon disagreed with its findings. The company retained the National Commission on Correctional Health Care (NCCHC) to review the report. Corizon described the review as an “independent assessment,” even though it was paying NCCHC accreditation fees.


The NCCHC review consisted of a three-person team assessing the facility over a two-day period in April 2012. Unlike Stern’s assessment of medical and mental health care, the NCCHC team did not interview prisoners or include a psychiatrist. Regardless, the agency concluded that “The basic structure of health services delivery at ISCI meets NCCHC’s standards.”


Corizon stated in a press release that Dr. Stern’s report was “incomplete, misleading and erroneous,” and then-CEO Rich Hallworth appeared in a video defending the company. The NCCHC had previously accredited Corizon’s healthcare services at ISCI, thus in essence the NCCHC’s review was self-validating the organization’s prior accreditation findings. Also, according to NCCHC’s website, two Corizon officials sit on the agency’s health professionals certification board of trustees.


Corizon’s criticism of Dr. Stern’s report is just one example where the company has objected to an independent, third-party assessment of its medical services. The Balla case settled in May 2012 after 30 years of litigation. [See: PLN, Feb. 2013, p.40].


Indiana DOC


Following a competitive bidding process, Corizon was selected to continue providing medical care to Indiana state prisoners under a three-year contract effective January 1, 2014. The contract has a cap of $293 million, based on a per diem fee of $9.41 per prisoner.


Three weeks later, a lawsuit filed in federal court named Corizon and the Indiana Department of Correction as defendants in connection with the wrongful death of prisoner Rachel Wood. Wood, 26, a first-time drug offender, died in April 2012; the suit, filed on behalf of her family, claims she was transferred from prison to prison and denied care for her serious medical conditions, which included lupus and a blood clotting disorder.

“Notwithstanding the duty of the prison medical staff to provide adequate medical care to Rachel and to treat her very serious life threatening conditions, prison medical staff willfully and callously disregarded her condition, and allowed Rachel to deteriorate and die,” the complaint stated.

“That is just the attitude of these guys, is saving money rather than providing health care,” said Michael K. Sutherlin, the attorney representing Wood’s family.

Prison officials reportedly moved Wood among several different prisons and hospitals, and at one point lost track of her and claimed she had escaped even though she was still incarcerated.

“She died a horrible death and she died alone,” stated her father, Claude Wood. The lawsuit remains pending. See: Williams v. Indiana DOC, Marion County Superior Court (IN), Case No. 49D05-1401-CT-001478.


Maine DOC


In an October 2013 Bangor Daily News article, Steve Lewicki, coordinator of the Maine Prisoner Advocacy Coalition, discussed the state of healthcare in Maine’s prison system. “Complaints by prisoners are less,” he said, noting that while medical services provided to prisoners are better than in the past, there are still concerns. This relative improvement coincided with the end of the state’s contract with Corizon. The contract, valued at approximately $19.5 million, was awarded to another company in 2012.

A year earlier, the Maine legislature’s Office of Program Evaluation and Government Accountability (OPEGA) completed a review of medical services in state prisons. The agency contracted with an independent consultant, MGT of America, to conduct most of the fieldwork, and the review included services provided under Corizon’s predecessor company, CMS.

The OPEGA report, issued in November 2011, cited various deficiencies in medical care at Maine prisons – including medications not always being properly administered and recorded by CMS staff. Although the company was notified of the problem, no corrective action was taken. CMS employees did not follow policies related to medical intake and medical records; OPEGA reported that 38% of prisoners’ medical files had inadequate or inaccurate documentation regarding annual physical assessments, and that files were not complete or consistently maintained. The report found 11% of sick calls reviewed were either not resolved timely or had no documented resolution. OPEGA also criticized CMS for inadequate staff training.

At a January 2012 legislative committee hearing, state Senator Roger Katz asked Corizon regional vice president Larry Amberger, “My question to you is in light of this history, why should the state seriously be considering any proposal your company might make to get this contract back again?”

In response, Amberger criticized the methodology used by MGT during the assessment and said he believed Corizon provided quality medical care. Questioning and challenging the findings of an independent reviewer is the same tactic the company used in Idaho. Regardless, Corizon’s contract to provide medical care to Maine state prisoners is now a part of history.


Louisville, Kentucky


While some jurisdictions, like Maine, have chosen not to renew their contracts with Corizon due to performance-related problems, in 2013 the Metro Department of Corrections in Louisville, Kentucky (LMC) offered the company a chance to rebid for its $5.5 million contract to provide medical care at the LMC jail. This time, however, it was Corizon that said “no thanks.”

The rebid offer was made even though seven healthcare-related prisoner deaths occurred in a seven-month period in 2012 during Corizon’s prior contract, which expired in February 2013. Nevertheless, LMC and Corizon agreed to extend the contract through July 30, 2013 on a month-to-month basis pending a formal rebid.

After the expiration of the month-to-month contract extension, Corizon notified LMC that it was no longer interested in providing services to the corrections department and would not seek to rebid the contract. LMC director Mark Bolton told the Courier Journal he was “surprised” by the company’s decision. What seems more surprising is that LMC wanted to continue contracting with Corizon to provide medical services in spite of the number of prisoner deaths.

In April 2012, Savannah Sparks, 27, a heroin addict and mother of three, was arrested and held on shoplifting charges at the LMC jail. While withdrawing from heroin she vomited, sweat profusely, could not sit up, could not eat or drink, and defecated and urinated on herself. Six days later she was dead. According to the medical examiner, her death was due to “complications of chronic substance abuse with withdrawal.”

A subsequent wrongful death suit alleged that Corizon and LMC employees were negligent in failing to provide treatment for Sparks’ opiate addiction and withdrawal. Corizon settled the suit under confidential terms. See: May v. Corizon, Jefferson County Circuit Court (KY), Case No. 13-CI-001848.

Four months after Sparks’ death, on August 8, 2012, another LMC prisoner, Samantha George, died. A lawsuit filed in Jefferson County Circuit Court claimed that George was moved from the Bullitt County Jail to the LMC facility on a charge of buying a stolen computer. According to the complaint, she told a Corizon nurse that she was a severe diabetic, needed insulin, and was feverish and in pain from a MRSA infection.

The nurse notified an on-call Corizon physician, who was not located at the facility and thus could not examine George in person, to decide if she should be taken to an emergency room. The doctor recommended monitoring George and indicated he would see her the next day. George’s condition rapidly deteriorated while she was monitored by staff at the jail; she was found unresponsive a few hours after being admitted to the facility and pronounced dead a short time later.

An autopsy concluded that George died due to complications from a severe form of diabetes compounded by heart disease. According to the lawsuit, the Corizon doctor never saw George; among other defendants, the suit named Corizon and LMC director Mark Bolton as defendants. The case was removed to federal court, then remanded to the county circuit court in October 2013. See: George v. Corizon, U.S.D.C. (W.D. Ky.), Case No. 3:13-cv-00822-JHM-JDM.

A few weeks after George’s death, Kenneth Cross was booked into the LMC jail on a warrant for drug possession. According to a subsequent lawsuit, upon Cross’ arrival at the jail a nurse documented that he had slurred speech and fell asleep numerous times during the medical interview. Several hours later he was found unconscious, then died shortly thereafter due to a drug overdose. The lawsuit filed by Cross’ estate alleged that employees at the LMC jail were deficient in recognizing and treating prisoners’ substance abuse problems and that the facility was inadequately staffed for such medical care.

After the deaths of Sparks, George, Cross and four other prisoners in 2012, LMC director Bolton said he believed Corizon took too long to evaluate and treat prisoners at the jail. According to the Courier-Journal, Bolton sent an email to his staff in December 2012 regarding the prisoners’ deaths, stating, “Mistakes were made by Corizon personnel and their corporation has acknowledged such missteps.” He further indicated that Corizon employees – not LMC staff members – were responsible for the care of the prisoners who died. Six Corizon employees at the LMC jail resigned in December 2012 during an internal investigation; they were not identified.

Bolton’s criticism was too little, too late to prevent the deaths of the seven LMC prisoners, though the jail has since made improvements to its medical services, including a full-time detox nurse and new protocols for prisoners experiencing withdrawal. One could speculate that LMC’s critique of Corizon might be a litigation tactic, to deflect responsibility. The fact remains that seven deaths occurred under Corizon’s watch and, notwithstanding those deaths, LMC was willing to renew its contract with the company.

In January 2014, the Louisville Metro Police’s Public Integrity Unit concluded investigations into three of the deaths at the jail, and criticized both Corizon and LMC. The Commonwealth Attorney’s Office found that Sparks’ and George’s deaths were preventable; however, no criminal charges were filed. Dr. William Smock, a forensic examiner who served as a consultant during the investigations, stated with respect to George’s death: “There is compelling evidence of a significant deviation from the standard of care and medical negligence on the part of the medical providers.”

“I’m glad to see that the government’s investigation matches exactly what our investigation showed, which is that her death and others like hers is easily preventable,” said Chad McCoy, the attorney representing George’s estate.


Minnesota DOC

After providing medical care to Minnesota state prisoners for 15 years, Corizon was not selected when the contract was rebid in 2013 – despite having submitted the lowest bid. Instead, competitor Centurion Managed Care was to begin providing healthcare services in Minnesota’s prison system effective January 1, 2014 under a two-year, $67.5 million contract.

Corrections Commissioner Tom Roy said the contract with Centurion was expected to “deliver significant savings to taxpayers while improving the quality of care for offenders.”

According to the Star-Tribune, nine prisoners died and another 21 suffered serious or critical injuries in Minnesota correctional facilities due to delay or denial of medical care under the state’s previous contract, which had been held by Corizon or its predecessor, CMS, since 1998.

That contract was for a fixed annual flat fee of $28 million. A flat fee contract provides an incentive for the contractor to tightly control costs, as a reduction in expenses results in an increase in profit. The Star-Tribune found that many of the staffing arrangements negotiated in the contract played a role in the deaths and injuries. For example, the contract allowed Corizon physicians to leave at 4:00pm daily and did not require them to work weekends. During off-hours there was only one doctor on call to serve the state’s entire prison system, and many of the off-hour consultations were done telephonically without the benefit of the prisoner’s medical chart. Under the contract, Corizon was not required to staff most facilities overnight.

The Minnesota Department of Corrections was held liable for nearly $1.8 million in wrongful death and medical negligence cases during the period when the state contracted with Corizon or CMS.

In October 2012, a jury in Washington County awarded Minnesota prisoner Stanley Riley more than $1 million after finding a Corizon contract physician, Stephen J. Craane, was negligent in providing medical treatment. The Star-Tribune reported that Riley suffered from what turned out to be cancer and had written a series of pleading notes to prison officials. One read, “I assure you that I am not a malingerer. I only want to be healthy again.”

In May 2013, the state paid $400,000 to settle a lawsuit over the death of a 27-year-old prisoner at MCF-Rush City. Xavius Scullark-Johnson, a schizophrenic, suffered at least seven seizures in his cell on June 28, 2010. Nurses and guards didn’t provide him with medical care for nearly eight hours. According to documents obtained by the Star-Tribune, Scullark-Johnson was found “soaked in urine on the floor of his cell” and was “coiled in a fetal position and in an altered state of consciousness that suggested he had suffered a seizure.” An ambulance was called several hours later but a nurse at the prison turned it away, apparently due to protocols to cut costs. Corizon settled the lawsuit for an undisclosed sum in June 2013. See: Scullark v. Garin, U.S.D.C. (D. Minn.), Case No. 0:12-cv-01505-RHK-FLN.


Philadelphia, Pennsylvania


In Philadelphia, Mayor Michael A. Nutter has been accused of being too loyal to his campaign contributors, including Corizon. The company donated $1,000 to Nutter’s 2012 campaign committee several months before the city renewed Corizon’s contract to provide medical care to 9,000 prisoners in Philadelphia’s prison system. Further, PHS donated $5,000 to Nutter’s mayoral campaign in 2008.

The contract renewal would have been routine except for the fact that Corizon’s performance in Philadelphia has been far from stellar. In July 2012 the company agreed to pay the city $1.85 million following an investigation that found Corizon was using a minority-owned subcontractor that did no work, which was a sham to meet the city’s requirements for contracting with minority-owned businesses.

The renewed year-to-year Corizon contract, worth $42 million, began in March 2013. Nutter’s administration was accused of using the year-to-year arrangement to avoid having the contract scrutinized by the city council; the city’s Home Rule Charter requires all contracts of more than one year to be reviewed by the council. Further infuriating opponents of the contract, Corizon was not the lowest bidder. Correctional Medical Care (CMC), a competitor, submitted a bid that would have cost the city $3.5 million less per year than Corizon. Philadelphia Prison Commissioner Louis Giorla defended the city’s decision to award the contract to Corizon at a council hearing; however, he declined to answer questions as to why the administration considered Corizon’s level of care to be superior to that provided by CMC.

Three union contracts with Corizon covering 270 of the company’s workers in Philadelphia’s prison system expired on November 26, 2013. Corizon demanded benefit cuts, including changes in employee healthcare programs, to offset wage increases promised under the company’s contract with the city. A strike was averted in December 2013 when the mayor’s office intervened and both sides reached a settlement. The Philadelphia Daily News reported that the new union contracts provide wage increases but also include a less-generous health insurance plan for Corizon employees.

Since 1995, Corizon and its predecessor, PHS, have received $196 million in city contracts. The company’s contract was terminated for several months in 2002 as a result of complaints that a diabetic prisoner had died after failing to receive insulin. The city renewed the contract anyway, citing affordability and pledging increased oversight. The city’s law department estimates that Philadelphia has paid over $1 million to settle lawsuits involving claims of deficient prison healthcare; the largest settlement to date is $300,000, paid to a prisoner who did not receive eye surgery and is now partially blind.

Based upon the number of lawsuits filed against Corizon alleging inadequate medical care, its use of a sham subcontractor and the company’s treatment of its own employees, it appears that maintaining the status quo – not best practices – may be the controlling factor in Philadelphia’s continued relationship with Corizon.


Allegheny County, Pennsylvania

On September 30, 2013, a prisoner jumped from the top tier of a pod at the Allegheny County Jail. Following an investigation, authorities refused to make public their findings and declined to disclose the prisoner’s injuries, citing medical privacy laws. The prisoner, Milan Karan, 38, was not transported to the hospital until the following day.

A spokesperson for Corizon, which provides medical care at the 2,500-bed jail, defended the nearly 24-hour delay by noting the prisoner “was under observation” before being sent to a hospital.

In December 2013, the Pittsburgh Post-Gazette reported that Corizon was having difficulty staffing the Allegheny County Jail. When the newspaper requested a comment from Corizon vice president Lee Harrington, Harrington claimed he had no knowledge of staffing problems – despite having previously received emails from the facility’s warden about that exact issue.

The staffing problems resulted in prisoners not receiving their medication in a timely manner. In emails obtained by the Post-Gazette, Warden Orlando Harper wrote to Harrington in October 2013, noting, “We are continuing to experience issues pertaining to the following: 1. Staffing, 2. Medication distribution.” Also, on November 17, 2013, Deputy Warden Monica Long sent an email to Corizon and jail staff. “I was just informed by the Captain on shift, the majority of the jail has not received medication AT ALL,” she stated, adding, “Staffing is at a crisis.”

That crisis had been ongoing since Corizon assumed the medical services contract at the facility on September 1, 2013. Before the $62.55 million, five-year contract was awarded, Corizon vice president Mary Silva wrote in an email that it was imperative the jail have “adequate staffing on ALL shifts.” That promise was made despite Corizon laying off many of the former employees of Allegheny Correctional Health Services, the jail’s previous healthcare provider.

Allegheny Correctional had provided four full-time and one part-time physician during its contract tenure. Corizon reduced the number of doctors to one full-time and one part-time physician. Allegheny Correctional also employed three psychiatrists and one psychologist. Corizon’s contract requires that it provide one full-time psychiatrist and a part-time psychologist.

In January 2014, the United Steelworkers union (USW) filed a petition with the National Labor Relations Board to unionize Corizon employees at the Allegheny County Jail, including nurse practitioners, RNs, physician assistants and psychiatric nurses. USW representative Randa Ruge indicated that the Corizon workers had approached the union for representation due to intolerable working conditions.

“Our folks [Corizon employees] are in danger of losing their licenses to practice by some of the things that the company has them doing,” she said. Ruge told the Post-Gazette that the jail had run out of insulin for more than a week and Corizon supervisors had “countermanded doctors’ orders.”

Several weeks after the USW filed the labor petition, a Catholic nun who worked as an RN at the jail was fired by Corizon, allegedly for union organizing activities. Sister Barbara Finch was dismissed after she openly expressed concerns about staffing, patient care and safety at the facility. The USW filed an unfair labor complaint against Corizon regarding Finch’s dismissal, claiming she was terminated in retaliation for her union activities.

“This is a clear case of intimidation and union-busting at its worst,” said USW President Leo W. Gerard. “Sister Barbara has been an outspoken advocate of change for these courageous workers and their patients, and this kind of illegal and unjust action, unfortunately, is par for the course with Corizon.”

On February 14, 2014, Corizon employees at the Allegheny County Jail voted overwhelmingly to unionize. “The next step is getting to the bargaining table and getting Corizon to bargain in good faith and get some changes made in the health system at the jail,” said Ruge.

The previous week, Allegheny County Controller Chelsa Wagner stated she had “grave and serious concerns” about medical care at the facility, including issues related to staffing and treatment for prisoners with certain mental health conditions. “I regard the current situation as intolerable and outrageous, and I fully expect necessary changes to be urgently implemented,” she wrote in a letter to Corizon.


Polk County, Iowa

On August 29, 2013, Ieasha Lenise Meyers, incarcerated at the jail in Polk County, Iowa on a probation violation, gave birth on a mattress on the floor of her cell. Her cellmates assisted with the delivery. Earlier, when Meyers, 25, had complained of contractions, a Corizon nurse called an offsite medical supervisor and was told to monitor the contractions and check for water breaking.

Despite Meyers having been twice sent to a hospital earlier the same day, and pleading that she was about to give birth, the nurse did rounds in other parts of the jail. Guards reportedly did not check on Meyers as required, even though the birth could be seen on a nearby security monitor. Only after the baby was born was medical care provided. Sheriff Bill McCarthy defended the actions of jail staff.

Corizon Employee Misconduct

Like most private contractors that provide prison-related services, Corizon tends to cut costs in terms of staffing and operational expenses. As noted above, this includes paying lower wages, providing fewer or inferior benefits and hiring less qualified workers who can be paid less. Sometimes, however, these practices result in employees more like to engage in misconduct.

At the Pendleton Correctional Facility in Indiana, a Corizon nurse was arrested and charged with sexual misconduct, a Class C felony. The Herald Bulletin reported that in April 2013, when Colette Ficklin was working as a contract nurse for Corizon, she convinced a prisoner to fake chest pains so they could be alone in an exam room. A guard told internal affairs officers that she witnessed Ficklin and the prisoner engaging in sex acts in the prison’s infirmary. [See: PLN, Sept. 2013, p.17].

In March 2013 at the Indiana State Prison in Michigan City, a Corizon practical nurse was charged with drug trafficking and possession with intent to distribute. Phyllis Ungerank, 41, was arrested and booked into the LaPort County Jail after attempting to smuggle marijuana into the facility. [See: PLN, July 2012, p.50].

A Corizon nurse at the Volusia County Branch Jail in Daytona Beach, Florida was fired after officials learned she was having sex with and giving money to a prisoner. Valerie Konieczny was terminated on December 18, 2012 when the jail was contacted by the brother of prisoner Randy Joe Schimp, who had written in a letter that a nurse was having sex with him and depositing money into his jail account. Investigators determined that Konieczny was the nurse who had sex with Schimp at both the Volusia County facility and another branch jail in 2011.


In New Mexico, Corizon physician Mark Walden was accused of fondling prisoners’ genitals and performing prostrate exams that were “excessive and inappropriate in terms of length and method.” At times, Walden reportedly did not wear gloves during the prostate exams. He was accused of sexually abusing 25 or more male prisoners while employed as a doctor at two privately-operated facilities, the Guadalupe County Correctional Facility in Santa Rosa and Northeast New Mexico Detention Facility in Clayton.


Lawsuits were filed against Walden, Corizon and private prison operator GEO Group, and Walden’s medical license was suspended in December 2013. The suits claim that Corizon allowed Dr. Walden to work at the Clayton prison “despite knowing of the risk of sexual abuse and having the ability to know that [he] was repeatedly sexually abusing patients” at the Santa Rosa facility. [See: PLN, Sept. 2013, p.47].


The Privatization Model


Economics professors Kelly Bedard and H.E Frech III at the University of California at Santa Barbara examined the privatization of correctional medical services in their research study, “Prison Health Care: Is Contracting Out Healthy?,” published in Health Economics in November 2009.


They concluded: “We find no evidence to support the positive rhetoric regarding the impact of prison health care contracting out on inmate health, at least as measured by mortality. Our findings of higher inmate mortality rates under contracting out are more consistent with recent editorials raising concerns about this method of delivering health care to inmates.”


Today, five years after the Bedard-Frech report was published, it has the benefit of hindsight. Since the report was written, its findings and conclusions have been reaffirmed in prisons and jails across the nation that have contracted with private companies to provide medical care to prisoners. Cost reductions in the provision of correctional healthcare tend to result in greater inefficiencies that lead to poorer outcomes. Consequently, for-profit medical contractors may actually be increasing morbidity and mortality in prison and jail populations.


Many governmental entities are willing to outsource correctional healthcare to private companies; reasons for doing so include cutting costs, risk management and removing healthcare duties from corrections departments. If Corizon’s record with respect to providing medical care to prisoners seems dismal, the company can always defend its actions by stating it does what it has been hired to do: Cut costs for its customers. And those costs have been rising due to an increasingly aging, and thus medically-needy, prison population. [See: PLN, Nov. 2012, p.22; Dec. 2010, p.1].


With respect to risk management, litigation is not a compelling issue within the prison healthcare industry and Corizon views lawsuits as simply a cost of doing business. “We get sued a lot, but 95% or 97% of cases were self-represented cases,” ex-CEO Rich Hallworth was quoted in an August 2013 article. He added that most lawsuits settle for an average of less than $50. Of course it is difficult for prisoners to obtain representation to pursue litigation – unless it’s a wrongful death case, and then usually their family or estate is doing the suing.


Nor are the public agencies that contract with private medical providers greatly concerned about their litigation records. In fact, when Florida contracted with Corizon and Wexford Health Sources to provide medical care for the state’s entire prison system, the Florida Department of Corrections didn’t ask the companies about their litigation histories – such as lawsuits raising claims of deliberate indifference, negligence and medical malpractice.


“What really troubles me about this is the fact that the department didn’t ask these very basic, elemental questions any system would ask,” observed ACLU National Prison Project staff attorney Eric Balaban. “These two vendors were taking over Florida’s massive health care system and you’d think they would have asked hard questions to determine if these companies can provide these services within constitutional requirements.”


Even worse, the downgrading of Corizon’s debt rating by Moody’s in 2013 creates a potential problem for the company’s service delivery model. The majority of Corizon’s revenue is derived from contracts with state and local agencies that are trying to reduce their budgetary expenses. Given those fiscal pressures and competition from Wexford, Armor, Centurion and other prison healthcare companies, Corizon cannot easily increase its revenue through contractual price increases. But the company’s expenses are largely within its control.


Unfortunately for prisoners, in order to reduce costs Corizon will likely have to curtail the quality or quantity of healthcare services it provides. As noted above, this can be done by reducing employee wages or benefits; the company can also cut costs through understaffing and by limiting prescription medications or providing fewer referrals to hospitals and specialists. A growing trend is to use off-site medical staff who consult with prisoners through telemedicine. [See: PLN, Dec. 2013, p.34].


The correctional healthcare industry, comprised of only a few large companies, is highly competitive. When one company loses a contract, another is more than willing to step in and submit a bid. What really matters for most government agencies and policymakers is the bottom line cost.


According to Dr. Marc Stern, the court-appointed special master in Idaho, “whoever delivers prison healthcare is doing it on less than adequate funding because that’s how much municipalities, state legislatures and county commissions are allocating.” He noted that privatization can be good in some cases and bad in others, depending on the level of oversight by the contracting public agency.

When Corizon compromises medical care to save money, such as curtailing the use of ambulances for emergency transports, reducing the number of on-site doctors or sending fewer prisoners to outside hospitals for needed treatment, government officials typically fail to take corrective action and deny responsibility for the resultant deaths and injuries. Indeed, as with the Idaho Department of Corrections and LMC in Kentucky, they sometimes want to reward the company with renewed contracts.

Why? Because continuity maintains cost control, which is the driving force behind privatization of prison and jail medical services.


Conclusion

The intent of this article was to review Corizon’s performance and practices based on publicly-available information, including news reports and court records. Although the company was formed in June 2011, its two predecessor firms, PHS and CMS, littered the news and judicial dockets over the years with lawsuits and articles involving cases of inadequate healthcare. Thus, the sins of Corizon’s parents, CMS and PHS, are forever linked with the progeny of their merger.

Such past misdeeds could be explained away had Corizon adopted a new, post-merger culture that was removed from prior practices under PHS and CMS. However, many of Corizon’s mid-level and top executives – including ex-CEO Rich Hallworth, former president Stuart Campbell, chairman Richard H. Miles and a number of vice presidents – were previously executives with PHS or CMS. It was during their tenure at those companies that numerous cases involving deficient medical care occurred.

The corporate culture of Corizon, as well as its business model, appears to be largely the same as those of its predecessors. Therefore, the only thing that may have changed as a result of the merger that created Corizon is the company’s name.

Gregory Dober is a freelance writer in healthcare and ethics. He has been a contributing writer for PLN since 2007 and co-authored Against Their Will: The Secret History of Medical Experimentation on Children in Cold War America, published by Palgrave in 2013. [See: PLN, Nov. 2013, p.36].

Sources: Bloomberg News, Forbes, www.businessweek.com, Philadelphia Inquirer, Philadelphia Daily News, The American Independent, Pittsburgh Tribune-Review, St. Louis Business Journal, www.browardbulldog.org, Miami Herald, WHAS-TV, The Tennessean, Courier-Journal, Idaho Business Review, Associated Press, The Arizona Republic, Maine Public Broadcasting Network, Bangor Daily News, WANE-TV, Raton Range, Des Moines Register, Star-Tribune, The Nation, The Florida Current, www.usw.org, KPHO-TV, WANE-TV, Tucson Citizen, WCAV-TV, www.wdrb.com, www.modernhealthcare.com, www.cochs.org, www.wndu.com, www.afsc.org, www.americanownews.com