by John E. Dannenberg

Prison Health Services (PHS), a subsidiary of America Service Group, Inc. (ASG), continues to face lawsuits and lose contracts for its deplorable record of prisoner health care gaffes in a dozen states. The old maxim Physician, heal thyself might be good advice for ASG, whose stock has tanked by over 55% from March 2005 to October 2006, based largely on negative publicity from PHS. Even more disturbing is that PHS is the nation's largest for-profit provider of prisoner health care, with 110 contracts in 37 states, meaning that its low-budget solution to prisoners' health needs has become bad medicine for an increasing number of our nation's prisoners. This report is an update to PLN's six earlier reports since 2002 on PHS's sordid performance (see, e.g., PLN, May 2005, p.34 and Aug. 2005, p.1).

Alabama

Alabama's Department of Corrections (ADOC) has been the target of major federal-court ordered health care reform at the Tutwiler, Limestone and Donaldson prisons, and continues to be troubled turf for PHS. On March 6, 2005, 53-year-old insulin-dependent diabetic Teresa Morris died of what PHS called natural causes at the Tutwiler Prison for Women. Visibly unnatural, however, was Morris' condition at the time of her death: her legs were so badly swollen that her shackles dug into them. Morris' family filed suit, claiming that PHS inexplicably took Morris off her insulin shots, a predictably fatal move. I can't say whether or not she was given insulin, said PHS Vice-President Ben Purser, adding, it was an expected death. Although Morris's death certificate listed diabetes, cirrhosis and Hepatitis-C as causes of death, she was not being treated by PHS for the latter two diseases. Morris was reportedly seen by PHS staff every three months, but not by a doctor. She was last visited by her mother just after Morris died. Her mother kissed Morris' swollen, shackled, still-warm body in the hospital, and held her hand.

PHS replaced prior medical care contractor Naphcare in November 2003, whose health care services had been a disaster. ADOC officials characterize PHS's services as better, but court monitor Dr. Joseph Bick reported that ADOC was far from compliant and suffered from severe shortages of doctors and nurses. PHS's own Montgomery-based medical director was pressed into service at Limestone, where he was reportedly their sole HIV doctor.

There have been six deaths at Tutwiler since PHS took over. Renowned prison health care expert and court monitor Dr. Michael Puisis audited Tutwiler and found mistakes in 19 of 22 prisoner charts he reviewed. Dr. Puisis recommended to the court that based on the chart reviews, PHS employee Dr. Samuel Englehardt, a retired obstetrician and the primary care physician at Tutwiler should not be providing general internal medicine care to the patients. Dr. Puisis's comments came on the heels of his investigation into three prisoner deaths, at least two of which were laid to no effective physician monitoring of patients. The state and PHS tried to keep Dr. Puisis' reports confidential, but the prisoners' class attorney, the Southern Center for Human Rights, fought for disclosure and accountability.

In May 2005, ADOC put its foot down. It annulled $1.2 million in payments on PHS's $143 million, three-year contract because the company had not provided enough doctors and nurses from May 2004 to February 2005. Whether PHS still made a profit from short staffing its facilities is not known. ADOC is also conducting an audit of PHS's staffing records to determine how much money ADOC should be reimbursed for billed vacant medical positions. But PHS is only losing money; prisoners are losing their right to adequate health care and their lives.

Accusations flew alleging interference with prisoners' access to attorneys during a federal suit against PHS's non-performance at ADOC's Hamilton Aged and Infirm Correctional Facility. There, 33-year-old prisoner Terry Miller, a habitual drunk driver who was severely injured in a car wreck, suffered from a hole in his stomach (a fistula, caused by bile eating through skin grafts) that exposed his intestines. For over a year at Hamilton, his only medical treatment was gauze to sop up the caustic drainage that was consuming his surrounding skin. Later treatment, ADOC spokesman Brian Corbett said, cost the state $500,000. Miller was reportedly seen by PHS 28 times and a chronic care clinic six times. But in his four years in ADOC, Miller never received the admittedly risky and complex surgery needed to correct the fistula. He wheeled himself out of the prison gates on June 2, 2005 with, by then, three fistulas, a ten-day supply of gauze pads and $10 from the state. Miller is a plaintiff in a class action lawsuit filed by the Southern Center for Human Rights alleging inadequate care at the Hamilton prison. The suit, which did not name PHS as a defendant, resulted in a partial consent agreement in March 2006. See: Aris v. Campbell, USDC ND AL, Case No. 1:05-cv-00396-PWG.

A fresh brouhaha arose in February 2006 when Nurse Brandon Kinard resigned from PHS to become a state employee (ADOC regional clinic manager) charged with monitoring PHS's performance under its contract with the state.

Attorney Rhonda Brownstein of the Southern Poverty Law Center opined that this smacked of a conflict of interest. Kinard had worked for PHS at the Hamilton facility as director of nursing and in administration, making patient health care decisions. After several weeks of employment with the state Kinard stated he would resign and go back to work for PHS, but then rescinded his resignation. Under Alabama law, state employees cannot immediately accept employment at companies they audited or regulated.

Kinard's supervisor, Associate Commissioner Ruth Naglich, was also formerly employed with PHS; she was vice president of sales and marketing for the company. I don't know if it violates any state laws. But effective monitoring of a private company by the state Department of Corrections needs to be done by people who are independent of the medical company and independent of the DOC& stated Southern Center for Human Rights attorney Joshua Lipman. And given PHS's record, such independent monitoring is necessary. In addition to withholding $1.2 million in payments to PHS due to contract violations in 2005, Alabama also withheld $580,000 as a performance penalty.

Florida

PHS, which contracts with a large number of Florida counties, has experienced an above-average amount of bad publicity and adverse incidents in the Sunshine State.

On March 4, 2004, Kimberly Ann Grey, after complaining to PHS medical staff and jail workers that she was in pain, gave birth to a son over a toilet at the Hillsborough County Jail. Although the mother and her newborn were belatedly taken by ambulance to a hospital after nurses initially refused to call 911, the infant died enroute. Suit was filed in December 2004 against PHS and jail personnel, alleging grossly inadequate medical care.

The umbilical cord had been wrapped around the baby's neck and PHS nurses were untrained with resuscitation and newborn care; they also initially refused to believe that Grey was in labor and dismissed her complaints of pain as mood swings. PHS fired one nurse practitioner and reprimanded two nurses over the incident. Grey's family's lawyer asked the federal court for nationwide discovery of PHS's records, but the court denied the motion as overbroad, notwithstanding a similar event reported in PHS's past. However, the court said it would entertain such a motion later if warranted. The case is ongoing. See: Lister v. Prison Health Services, Inc., USDC MD FL, Case No. 8:04-cv-02663-RAL-TGW.

Two former Hillsborough County Jail prisoners have also accused PHS of shoddy medical care. Sean Norbury was 19 years old and had a fractured hand when he was incarcerated in Oct. 2003. According to a lawsuit filed in Circuit Court on Oct. 26, 2005, he requested treatment but instead was ridiculed by PHS nurses. Despite swelling, bruising and complaints of pain, Norbury received no medical care and never saw a doctor; an X-ray was ordered but never taken. In a separate lawsuit filed one day earlier, Aretha Jackson claimed that PHS failed to provide treatment resulting in her going blind. Jackson, who was HIV-positive and suffered from deteriorating vision, was held at the jail from August 16, 2004 until June 1, 2005. She accused PHS employees of ignoring a doctor's follow-up order and alleged they were untrained, unfamiliar or indifferent to her medical needs and did not have proper treatment procedures or policies for HIV-positive prisoners. See: Jackson v. Prison Health Services, Inc., USDC MD FL, Case No. 8:05-cv-02157-SDM-TBM.

PHS is also being sued by the widow of 47-year-old Patrick Bilello, who suffered his third and fatal heart attack at the Palm Beach County jail on October 24, 2003. Dr. Edgar Escobar, PHS's jail doctor at the time, admitted that he had overlooked critical lab results showing low blood oxygen that required Bilello's immediate hospitalization four days earlier. Instead, he ordered that Bilello, who was also HIV-positive, receive Tums for indigestion and gave him an extra blanket. Escobar's malpractice history included two deaths and five lawsuits; he was later fired by PHS. A Circuit Court judge ruled in September 2005 that Bilello's widow, Roseanne Scarola-Bilello, could seek punitive damages against the doctor and PHS.

Since the death, and after numerous other complaints, the sheriff, also a defendant in the lawsuit, dumped PHS as the jail's medical provider.

Attorney Gary Susser, who represents Roseanne Scarola-Bilello, said, A jury ... will want to send a message to the corporate parent of PHS that profits should not rule over the sanctity of human life. After being terminated by PHS, Dr. Escobar was employed as a practicing physician at Johnson Medical Center in Hollywood. It was not until October 6, 2006 that he was finally disciplined by the Florida Board of Medicine in connection with Bilello's death, and only then after a personal plea from Bilello's widow. Escobar was fined $10,000 (the maximum allowable under state law), ordered to complete 200 hours of community service, and required to pay $5,000 for the cost of the investigation. His medical license was suspended until he passes a competency exam. Board member Dr. Elisabeth Tucker termed Escobar's actions in the Bilello case terribly egregious.

Mrs. Bilello's lawsuit against PHS and Dr. Escobar settled on August 15, 2006 under confidential terms. However, according to closed medical malpractice claim records maintained by the Florida Office of Insurance Regulation, the suit settled for $475,000 against Escobar. The settlement with PHS was undisclosed. See: Roseanne Scarola-Bilello v. Prison Health Services Palm Beach Co. Circuit Court, Case No. 50-2004-CA-009140.

One year previously, Dr. Escobar had settled an unrelated malpractice suit involving another prisoner at the Palm Beach County jail when he was employed with EMSA Correctional Care, Inc., a sister subsidiary of America Service Group. Stafford Wilder, who was serving a one-year jail sentence, complained of blurred vision in April 2002. Dr. Escobar and other medical staff took no action; eight months later Wilder had lost 90% of his vision due to untreated glaucoma. The malpractice suit against Escobar and EMSA reportedly settled in October 2005 for over $500,000, with $287,500 being paid by Escobar's malpractice insurer. See: Wilder v. EMSA Correctional Care Palm Beach Co. Circuit Court, Case No. 50-2003-CA-011473xxmmaa.

On February 22, 2005, Milton Oakes committed suicide at the Marion County Jail, one month after PHS staffers stopped giving him antidepressant medication. He was ignored when he began banging his head on the wall of his jail cell. Sheriff Ed Dean admitted that PHS did not provide the medical care he expected at the facility

Orestes Rendon began his 90-day jail sentence at the Sarasota County Jail in good health but finished it on November 14, 2005 in intensive care, unable to eat, speak or walk. Rendon had been on a work crew and a falling branch containing a hornet's nest resulted in his receiving more than a dozen stings. He filed forms for immediate health care as he went into shock, but it took six days for PHS to get him to a doctor, who put Rendon in the hospital. PHS nurses had only given him Tylenol, even though he complained of losing his eyesight.

Also in 2005, PHS contracted to provide health care at the Volusia County Jail; the company promised to save the county $2.2 million over a four-year period. However, in the first year of the contract the county was asked to pay an additional $1 million to cover PHS's medical services. More disturbing, according to County Chairman Frank Bruno, were allegations regarding the company's health care. My main concern is doctors taking away prescriptions, especially for non-convicted people going through court cases, said Bruno. While medical expenses at the jail have increased, the cost for psychotropic drugs declined sharply after PHS took over, dropping over 70% from the expenses charged by the previous health care provider.

According to The News-Journal, a local newspaper, defense attorneys have noted that their clients are being deprived of medication, which hampers their ability to assist in their criminal cases; the county's Public Defender and Chief Circuit Judge were concerned enough to call for a meeting with PHS officials to discuss the issue. Dr. David Hager, PHS's director of mental health services for Volusia County, has stated his approach to mental health treatment is often to discontinue all medication so he can observe the prisoner's symptoms, stating that less is more in terms of psychotropic drugs. PHS spokesperson Martha Harbin, however, said the company would never withhold care to hold down costs.

On June 5, 2003, former Sarasota Jail prisoner Gerrese Daniels was paralyzed after being thrown head-first into a concrete wall by a guard.

Two PHS nurses accused him of faking it, and he was dragged to a bus and transported to the Central Florida Reception Center without receiving any medical care. When he arrived and his injuries were discovered, he was airlifted to a hospital. Daniels subsequently sued PHS for two severed vertebrae and near-complete paralysis. The guard, Matthew O'Kon, was acquitted on a charge of intentionally slamming Daniels into the wall and then stepping on his neck. The case is pending. See: Daniels v. America Service Group, Inc., USDC MD FL, Case No. 8:05-cv-01392-JSM-TBM.

Manatee County prisoner Tony Myrick, 41, died in 2004 in the jail's infirmary after having four epileptic seizures over two days. PHS nurses allegedly did not provide adequate treatment. The company fired two nurses and its medical director as a result.

Two other PHS nurses were fired following a bizarre incident at the Charlotte County Jail in March 2006. Prisoner William Parbus, a diabetic serving a 15-day sentence, required an insulin shot. PHS nurse Karen Helmick, upon learning the infirmary was out of insulin, said she just did not feel like driving and getting it. Instead she broke open a sharps container used to dispose of medical and biohazard waste, and retrieved a vial of expired insulin. Sheryl Staples, another PHS nurse, then injected Parbus with the outdated drug. Unfortunately, it happened, admitted PHS health service administrator Linda Antuono.

In an unusual claim against the company, on August 21, 2006, Kevin Coleman filed suit against PHS claiming that grossly inadequate medical care at the Palm Beach County Jail caused him to admit to a crime he didn't commit. In July and August 2004, PHS staff reportedly misdiagnosed Coleman's abdominal pain, telling him it was gas when it was in fact diverticulitis, an inflammation of small pouches in the colon. Coleman lost 30 lbs. and eventually required emergency surgery. Convicted of first-degree murder in 1992, Coleman was being held at the jail pending a new trial after it was learned a detective had suppressed evidence in his case. He reluctantly pled no contest to a lesser charge in September 2004 in exchange for his freedom so he could obtain competent medical treatment. According to Coleman's lawsuit, he took a plea agreement whereby he admitted to a crime he did not commit in order to be immediately released from [PHS's inadequate] care.

On September 15, 2006, the estate of Herman B. Tucker, 24, who committed suicide at the Marion County Jail, filed suit against the sheriff, jail officials and PHS employees. Tucker, who was on suicide watch at the time he killed himself in September 2002, was allegedly drugged by PHS medical staff in order to subdue him; he was injected seven times with cocktails that included Ativan, Haldol and Benadryl. He received no mental health treatment. Tuckers estate is seeking compensatory damages for his funeral and burial expenses, and for the pain and suffering of his parents. See: McGough v. Marion County, USDC MD FL, Case No. 5:06-cv-00364-WTH-GRJ.

Despite PHS's dubious track record at county facilities, in January 2006 the Florida Department of Corrections (FDOC) hired PHS under a ten-year contract to care for 14,000 prisoners in 13 southeast Florida prisons. PHS's almost $800 million bid for the contract was $80 million less than that of its nearest rival, Wexford Health Sources, FDOC's prior health care contractor since 2001. Although FDOC had wanted to select the winner on factors other than cost, the state legislature ordered the department to reopen the contract and hire the lowest bidder. Governor Jeb Bush touted the deal, but state Senator Frederica Wilson said, It all seems very suspect, adding, I fear we can only expect greater disappointment. Competitor Wexford Health Sources was really surprised [PHS] ... bid as low as they did, calling the FDOC contract one of the most risky contracts that any prison health company could enter into because of the disproportionately high rate of Hepatitis-C, HIV, diabetes and hypertension in the FDOC prison population.

Such concerns proved correct when less then nine months into the contract, on August 21, 2006, PHS announced it was abruptly calling it quits, stating it had underestimated the cost of treating prisoners who required off-site hospitalization. This is what I was warning about, remarked state Senator Dave Aronberg, who had expressed misgivings about the PHS contract before it was finalized. Sen. Aronberg and Sen. Walter Campbell demanded to know why the company had not been fined or assessed liquidated damages for the contract cancellation. PHS acknowledged that it may be subject to fines, but said that was the cost of doing business; the company also complained that state officials had provided incorrect information during the bidding process. An audit of PHS's performance during the short-lived contract is on-going, and the company may submit another (presumably more realistic) bid when the FDOC's health care contract is re-bid in October 2006. Unless it wins the re-bid contract, PHS will stop providing services at FDOC facilities as of November 20, 2006.

Prior to canceling its contract with the state, PHS officials had approached FDOC Secretary James McDonough and tried to renegotiate for better terms, including moving some medically-needy prisoners to other facilities not serviced by the company. This is apparently standard operating procedure for PHS, which has renegotiated contracts after claiming it was losing money in Philadelphia and Maine in June 2002, in Kansas in October 2003 (unsuccessfully), in Wyoming in 2005, and in Vermont in mid-2006. McDonough declined to cut PHS any slack, however, saying, The answer was a polite no, there was nothing I would be doing for them.

Georgia

The October 17, 2005 death of 43-year-old Harriett Washington in the Gwinnett County Jail continues to dog PHS. Washington, who suffered from leukemia, died on the floor as her two cellmates watched. The cellmates, parole violators Kim Holmes and Carla Dotson, can't get the images of Harriet's death out of their minds, saying, She screamed in pain and was convulsing before dying. Their repeated pleas to PHS medical staff to get help for Washington were allegedly ignored for two days. When a nurse came in on the last day, she refused to look at the list of symptoms Holmes and Dotson had kept. At 2:10 a.m. the next morning Washington began vomiting continuously, but despite the cellmates' repeated screams for help, none came for 34 minutes. By then it was too late, Washington had exhaled a loud breath and her eyes were open and fixated.

On November 8, 2005, Holmes and Dotson wrote a detailed exposé to the medical unit supervisor and the Sheriff's Department internal affairs unit. We fulfilled all of our legal responsibilities to ensure she received the proper medical care, replied Department spokesperson Stacey Kelley. PHS declined to comment. Sheriff Conway's report was released in January 2006, clearing his deputies of any culpability. The report concluded that although Washington would have died even if she had been taken to an outside hospital, the appropriateness of her treatment would not have been in question. Nurses alleged that they responded within three minutes of Washington's screams for help (there are no doctors present on weekends at the Gwinnett jail). The emergency oxygen cart they brought was missing its tubing. One of the nurses, Brian Woodward, had also been accused of taking narcotics from the jail's medical unit. He resigned after admitting he messed up by failing to document Washington's treatment. It was learned that the PHS nurses had violated protocol by not keeping notes of care that was provided. They did, however, hastily jot some down after Washington died on their watch.

Sheriff Conway, beset by Washington's death, was considering firing the company. Two other lawsuits naming PHS were filed in Gwinnett County in 2005, including a federal suit involving the September 2003 death of prisoner Ray Charles Austin, who was forcibly injected with an anti-psychotic drug by PHS medical staff despite a doctor's order in Austin's file directing that he not be given injections. Austin became combative, was Tasered and then strapped in a restraint chair, where he received no medical treatment and later died. The lawsuit is pending. See: Lewis v. Prison Health Services, Inc., USDC ND GA, Case No. 1:05-cv-02434-TWT.

Regardless, on October 5, 2006, Gwinnett County renewed its contract with PHS to the tune of $6.1 million. According to Sheriff's Dept. Major Jim Hogan, a member of the committee that considered bids for the health care contract, the lawsuits against PHS were taken into consideration but it seemed that most of the companies we considered had similar situations somewhere around the country in some site that they provided service. Which simply seems to indicate that PHS is just as bad as many of its competitors. Seven companies bid on the contract; PHS was not the lowest bidder, but according to Hogan was selected, ironically, because of its experience, references and financial stability. The Gwinnett County chapter of the NAACP objected to the contract renewal due to three deaths at the jail under the company's watch.

Maryland

In May 2005, PHS learned that it had lost its bid to continue providing medical services at most Maryland prisons and Baltimore's jails, a total population of 20,000 prisoners. The winning bidder for the estimated $100 million annual contract was St. Louis-based Correctional Medical Services (CMS), whose track record is reminiscent of PHS's. PHS had signed a $270 million five-year contract with Maryland in 2000. But because the contract was based on a flat-fee model, it became a loss-leader for PHS over time, resulting in $13 million in red ink on $55 million in billings in the last year alone. Sally Dworak-Fisher, an attorney for Baltimore's prisoner-advocate Public Justice Center, criticized Maryland for pitting a contractor's loss against prisoners' health needs.

The Baltimore grand jury routinely reviewed jail health care performance and determined that there had been a poor job at medical care in the past five years (i.e., under PHS's reign) because of a flawed and under-funded contract. The result, the grand jury found, was that pressure on PHS's management to economize on operations made it more and more difficult for offenders to receive prescription medications, hospital procedures or laboratory tests. PHS President Trey Hartman called this charge blatantly false.

Under the new contracts, Maryland expects its annual prisoner health care costs to rise from $68 million to $110 million. The Public Justice Center and the ACLU have a long-standing lawsuit to improve medical services in Baltimore jails, and are skeptical that the new CMS contract will remedy their complaints.

New York

In May 2005, New York's state Department of Education, which regulates the practice of medicine, began an investigation into the terms of the five-month-old $300 million prisoner health care contract the state had signed with PHS. New York law requires that for-profit medical care companies be owned and controlled by doctors in order to prevent business considerations from influencing medical decisions. PHS insisted that doctors are in charge of medical decisions through its doctor-run subsidiary, PHS Medical Services P.C., which directs health care at the Rikers Island jail. However, that corporation is run by Dr. Trevor Parks, who is a regional medical director for PHS. Education Department investigators called this arrangement a sham.

Illegal contract concerns notwithstanding, a scant one month later the New York Department of Health and Mental Hygiene reported that in the first quarter of 2005, PHS failed 12 of 39 performance standards for treating prisoners at Rikers Island and Lower Manhattan jails. As a result, New York City withheld $55,000 in payments, its largest penalty against PHS for poor performance since 2001. Health Department official Paul Vallone criticized the department's decision to let PHS develop its own plan to remedy deficiencies. It's like a judge allowing a criminal to determine his sentence, he stated.

In 2003, York County prisoner Michael Herman, 19, who had a history of mental illness, was court-ordered not to be placed in general population because of his vulnerability. In January 2004, Herman was assaulted and put in a solitary-confinement cell pending a hearing. He was not watched for an extended period of time, during which he tried twice to commit suicide, once unsuccessfully with his shoelaces and once successfully with his bed sheets. Herman's family filed a wrongful death suit against prison officials and PHS for not providing Herman with appropriate medical care and treatment for his mental illness.

In December 2005, the very process by which New York health officials evaluate PHS's performance came under attack as slapdash, subjective and lenient. The state comptroller audited the Health Department's reviews of PHS's performance. One complaint was that PHS was allowed to preview audit-selected files to fix them just before the auditors gave them the once-over. When a mentally ill prisoner died in the prison ward at NYU Downtown Hospital, a PHS doctor and mental health workers went through the prisoners' medical files, doctoring the records where they had failed to doctor the patient. In another incident, a PHS doctor used correction fluid (which is unlawful) to change the date he had reviewed a prisoner's abnormal lab test result, to make it appear the review was done within the requisite 24 hours. At Rikers Island the rule that intake prisoners are to be given a physical examination within four hours of admission is repeatedly violated but dismissively overlooked by auditors, thus nullifying the important public health purpose of timely initial exams. One auditor said the only way she could keep a physician's assistant from altering selected prisoner medical charts was to get to work first, at 5:30 a.m. Since the tightening up of such previews, PHS has received 22 failing grades, for which the company was penalized $107,000, a drop in the proverbial bucket.

In an ominous sign of the audit tension, Dr. Bruce David, assistant commissioner with the Department of Health and Mental Hygiene, who monitored PHS as part of his $165,514 per year job, quit and took a position as mental health director for Nassau County. Dr. David's too-lenient grading of PHS was one criticism of the comptroller's audit of the Department's review process.

In January 2006, New York City health officials withheld $71,000 in payments to PHS for failure to meet standards in 10 of 39 audit areas in the final quarter of 2005. Six of the areas, including untimely administration of medication to mental health and HIV+ prisoners, had been failed for three consecutive quarters. Also in January 2006, the Deputy Commissioner for New York City's jail health care program quit after only seven months on the job. Dr. Arthur Gualtieri left for undisclosed personal reasons, but it was alleged that his resignation was due to his perception that prisoner health services (under PHS) suffered from a lack of leadership.

Tennessee

PHS isn't getting any breaks in its home state of Tennessee. The company is being sued by Memphis lawyer Archie Sanders III for the January 19, 2005 death of Davidson County Metro Jail prisoner Ricky Douglas, who was diabetic. Douglas died in his cell, on his stomach, with his tongue sticking out between his teeth, after PHS personnel allegedly made critical errors in his treatment (e.g., failing to respond to his requests for medication). Because of slipshod medical records, PHS nurses allegedly failed Ricky Douglas and did not provide him with anything close to medical care, according to the lawsuit. Sheriff Daron Hall said he had reviewed PHS's report and said, No, it's not a concern. Yet he did order PHS to give their nurses additional training, which company officials said they were too busy to do.

Apparently it was also not a concern eight days before Douglas' death, when Metro Jail prisoner Paul Burton, 40, died after lapsing into a diabetic coma. PHS allegedly had failed to give him enough diabetic medicine, according to Nashville attorney David Raybin. In January 2005, PHS official Phil Burser told the Tennessean, The personnel at the Davidson County Jail provided timely, effective and appropriate care.

Yet when prisoner Glen Lee checked into Nashville's Metro Jail in November 2005, he walked in unassisted. Three months later, after PHS allegedly denied him needed treatment, he was in a diabetic coma in the hospital for three weeks. Lee claimed that PHS not only didn't give him his insulin, they gave him an inappropriate diet. When his blood sugar hit 520 he went into shock. The American Diabetes Association is in touch with attorneys representing Burton and Douglas, families, in furthering the association's mission to ensure that diabetics receive proper care. Attorney Raybin may take Lee's case as well. One can only ask Sheriff Hall if three diabetic treatment failures in three months, two fatal, out of a jail population of 690, are not a concern.

PHS was also named in a federal suit involving the August 14, 2005 death of James Patrick McCullar at the Metro Jail. McCullar, who committed suicide using his boot laces, was allegedly not adequately screened by a PHS nurse at intake; the nurse requested a mental health referral that McCullar never received. The suit is pending. See: McCullar v. Prison Health Services, Inc., USDC MD TN, Case No. 3:06-cv-00786.

PHS's five-year contract with Metro went up for rebidding on June 30, 2005. Apparently medical care was now a concern to someone, because the Metro Jail dumped PHS and hired Correct Care Solutions of Nashville to replace the problem-plagued company.

South Carolina

PHS drove prisoner Antonio Richburg to suicide in May 2005 at the Richland County Jail. After going seven days without his medication, he wrote to his wife, I need you to call down here and get on them for me. He hanged himself the next day.

Richburg's attorney said he had been mentally ill, and that physician and court orders were not being followed. PHS spokesperson Stephany Snowden stated that PHS staff are not professionally trained in the area of mental health. PHS has been named in six lawsuits in Richland County since 2003, three of which involved questionable prisoner deaths.

A rare coroner's inquest was convened, and Richland County Coroner Gary Watts looked into having criminal charges brought against PHS as a result of Richburg's death. A coroner's jury found that Richburg died due to a lack of standard care by providers. Testimony revealed there were no jail records of diagnosed paranoid-schizophrenic Richburg receiving anti-psychotic or anti-depressant medications in the seven days prior to his suicide, even though a probate court had ordered jail staff to follow a treatment plan developed by Just Care, Inc., a private company that provided mental health care to prisoners. Attorney Richard Harpootlian, who handled two earlier jail suicide cases that settled for over $600,000, reportedly had arranged a partial settlement of $500,000 for Richburg's widow, Tiffany. No criminal charges were filed in Richburg's death.

In September 2005, based upon the coroner's jury ruling, the Richland County Council unanimously terminated PHS due to the three prisoner deaths. Council Member Val Hutchinson called PHS's performance unacceptable and inhumane. In March 2006, Richland County was negotiating a $2.7 million annual contract with Correct Care Solutions, Inc. to replace PHS's $1.9 million contract. PHS was given six months to pull out and its last day was March 17, 2006. Correct Care will provide 28 full-time medical staff, almost double the 15 staff members under PHS, to service the jail's 1,000 prisoners. In addition, the county will maintain its own nurse and an administrator at the jail. During PHS's tenure starting July 2001, the county paid $7.5 million for medical and mental health care services.

Wyoming

The Wyoming Department of Corrections (WDOC) apparently wasn't convinced by Mike Rigby's report panning PHS in the May 2005 issue of PLN. Citing PLN's article for PHS having received some bad press, WDOC spokesperson Anne Cybulski-Sandlian said, so have all of the private medical providers. In addition to hiring PHS for a $10.5 million annual contract in May 2005 (effective July 1, 2005), WDOC employs Consultants in Correctional Care to visit WDOC every quarter and audit prison facilities based on health care and contractual standards. PHS replaced Correctional Medical Services, Inc., which in turn had replaced Wexford. Linda Burt of the Wyoming ACLU reported that the number of health care complaints remained unchanged under all three providers, and noted that both Wexford and PHS had been sued.

In October 2005, auditors reported that WDOC prisoners were continuing to receive constitutionally adequate health care, notwithstanding complaints of delayed treatment due to the transition to PHS and the integration of its record-keeping system with that of its predecessor. The report found, however, that 36% of incoming prisoners were not screened within the required 24-hour period. Also, in a sampling of seven hypertensive patients, a majority did not have adequate control of their high blood pressure. Subsequent quarterly audits in Feb. and July 2006 found that PHS's services had improved significantly. The company entered into a renegotiated $14.2 million contract with WDOC in July 2006, a 35% increase over the initial contract amount. PHS claimed that it had lost $600,000 in a single quarter under the first contract.

Parenthetically, two former PHS nurses alleged they were fired or forced to quit because they complained about inadequate staffing and training by the company. Karran Bedwell and Debra Long said standards of care declined after PHS took over. According to Long, an LPN, prisoners who signed up for sick call were seen within 48 hours only 20% of the time and medications were not dispensed in a timely manner. Bedwell raised concerns about training for new medical staff, stating, One of the poorest things about [PHS] is when they hire someone they don't even orient them but put them right on the floor, adding, That is really scary for someone who's never been in a prison before.

Lawsuits, Settlements and Jury Awards

PHS has been named in 788 federal lawsuits over the past five years, in addition to an unknown number of complaints filed in state courts. The company, however, considers such litigation a cost of doing business.

Inmates are one of the most litigious groups in society, and the vast majority of the suits that are filed against PHS are dismissed as baseless, said PHS spokesperson Martha Harbin. In cases where claims of gross medical neglect, malpractice and deliberate indifference filed by injured prisoners or their survivors are not baseless, the company often settles under confidential terms. In addition to the lawsuits mentioned above, other recent cases involving PHS and other ASG subsidiaries include the following:

In December 2005, PHS settled a federal lawsuit in Ohio in which the company was accused of negligence. Booker Mitchell, 72, was pepper-sprayed and suffered a head injury during his arrest. Despite complaining about a severe headache, fatigue and vision problems, PHS nurses at the Mahoning County Jail told him to rinse his eyes with water and did not contact a doctor. Mitchell, who had a history of high blood pressure, got progressively worse, was diagnosed with a cerebral hemorrhage after his family took him to a hospital, lapsed into a coma and died six months later. The case against the Youngstown police department, the sheriff's office and PHS settled for $450,000. See: Pennington v. City of Youngstown, USDC ND OH, Case No. 4:02-cv-01343-PCE.

In New Jersey, Michael DiFelice, formerly incarcerated at the Gloucester County Jail, filed a Superior Court lawsuit in August 2006 against the county and PHS, the jail's medical provider. DiFelice claims he contracted a drug-resistant staph infection (MRSA) while held at the jail, and upon release infected his domestic partner. Similar lawsuits have been filed by over a dozen other former prisoners and jail guards.

On July 15, 2005 a federal jury in Albany, New York awarded $782,988 to former prisoner Byron Lake, which included $632,988 in punitive damages against EMSA Correctional Care, a subsidiary of ASG. The jury found that an EMSA employee had failed to properly treat Lake's undiagnosed heart attack when he was held at the Schenectady County Jail. Following the verdict the district court vacated the punitive damages and awarded $138,336 in attorney fees and $5,438.55 in costs to Lake. The case has been appealed to the Second Circuit. See: Lake v. Schoharie County, USDC ND NY, Case No. 9:01-cv-01284-DEW-DEP.

Patricia Ann Farrell, serving a five-month sentence at the Collier County Jail in Florida, filed a lawsuit on September 5, 2006 asking a federal judge to force the sheriff's office to let her leave the facility so she could undergo hip-replacement surgery for osteoarthritis, a painful degenerative disease. PHS, which provides medical care at the jail, gave her Tylenol instead of her prescription pain medication, and a PHS nurse reportedly told Farrell that her hip condition was not life threatening. See: Farrell v. Hunter, USDC MD FL, Case No. 2:06-cv-00454-UA-SPC.

In August 2005, PHS agreed to pay $350,000 to settle a lawsuit filed by the family of Ruth Hubbs, a 39-year-old prisoner who died at the Leon County Jail in Florida on May 16, 2003. An autopsy indicated she had an excessive amount of Doxepin (an antidepressant) in her system, but was unable to determine if PHS staff had given her an overdose. According to the suit, PHS had a policy of rarely using a different medication that was safer but more expensive. Guards at the jail reported that PHS medical workers seemed to be unconcerned about Hubbs' condition prior to her death. Under the terms of the settlement PHS did not admit liability. Following another death at the jail in June 2003, PHS replaced some staff members at the facility and made other changes, including implementing a medical-grievance committee and a medical hotline for family members and friends of prisoners. See: Travison v. Prison Health Services, Inc., USDC ND FL, Case No. 4:04-cv-00409-RH-WCS.

Most recently, in October 2006, the family of Robert Nichols, who died at the Chittenden Regional Correctional Facility in South Burlington, Vermont on February 5, 2005, filed suit in Rutland Superior Court, naming the state and PHS as defendants. The lawsuit claims that Nichols, who notified the jail staff he was suffering from heroin withdrawal, did not receive needed treatment. He was not seen by a PHS nurse for almost 16 hours. PHS had entered into a contract to provide medical care in Vermont's prisons shortly before Nichols died; in June 2005, a statewide advocacy group reported that Nichols' death could have been prevented had he received adequate medical care.

Internal Investigation, Stock Slide, Shareholder Suits

In March 2005, within one month of a damning three-part investigative series on PHS published in the New York Times, (which was reprinted with permission in the August, 2005 issue of PLN) parent company ASG's stock began a long, fairly steady decline with sudden, precipitous drops along the way [the Times also did a follow-up article on PHS's care at the Rikers Island Jail on June 10, 2005]. The series documented horrific cases of prisoner suicides, shoddy care to children in custody and prisoners dying after being denied treatment. Michael Catalano, ASGs CEO, called the story unfair, asserting that it gave no context, no perspective and completely failed to tell the real story of what it is like to provide health care in a correctional setting. Catalano also said the story had no effect on ASG's business. But with the loss of six contracts in 2005, earnings forecasts were lowered and the company's stock dropped accordingly.

In mid-March 2006, ASG shareholders headed for the exits again, taking the stock down 33% after the company announced lower-than-expected revenues.

Concurrently, ASG disclosed that following an internal investigation into accounting irregularities at its prison pharmacy subsidiary, Secure Pharmacy Plus, the company would have to restate $2.1 million in earnings from 2001-2004 and the first six months of 2005, and would refund $3.6 million in overcharges to clients who weren't properly credited with discounts and rebates for returned pharmaceuticals. As a result of the Secure Pharmacy Plus investigation, Grant Bryson, head of Secure Pharmacy Plus, and PHS president Trey Hartman were fired on December 7 and 9, 2005, respectively.

ASG's stock has fallen from a high of almost $30 a share in February 2005 to under $12 in August 2006; it has since rebounded to $13.62 a share as of October 12, 2006. Stock price does not necessarily correlate with a company's financial or operational health, private prison juggernaut CCA, for example, once traded as a penny stock after a series of management blunders. However, ASG's revenue continues to suffer as well; in August 2006 it was reported that the company's second quarter earnings plunged by 81% compared to the same period the previous year. ASG's net income fell to $4.37 million for 2005, less than half of its profit in 2004.

Investors have taken notice of the company's less-than-stellar performance. At least four shareholder suits were filed against ASG between April and May, 2006. The lawsuits allege that company officials violated federal securities laws by making false or misleading statements that inflated the value of ASG's stock. Specifically, ASG was accused of failing to disclose that it was not charging its customers pursuant to the company's contracts, failing to properly credit customers with discounts and rebates, and inappropriately using reserve capital, claims primarily related to the company's internal investigation of subsidiary Secure Pharmacy Plus.
Nasdaq, the stock exchange where ASG is traded, has also taken notice.
After two of the company's directors quit in May 2006 following unsuccessful efforts to oust ASG chairman Michael Catalano, the Nasdaq National Market threatened to delist the company due to non-compliance with rules requiring a majority of independent directors. One of the ASG directors who left, Michael Gallagher, stated, I no longer have confidence or faith in the leadership of the company. New directors were retained in June.

In the for-profit correctional health care industry, ASG (largely through PHS) holds 21% of the market while competitor CMS has 22%. As a result, competition has become intense and the lowest bid often wins the contract. For example, CMS underbid PHS by 10% in Maryland, by 14% in Idaho and by 21% in Indiana. Such contract losses for PHS have a direct impact on its profitability and stock performance.

While there are obviously huge difficulties in the execution of for-profit prison health care services, this writer believes that the underlying problem lies with the low bidder wins concept. As medical contractors, sheriffs and state DOCs are learning through lawsuits and court orders, pitting prisoners' health care against corporate profit margins is inherently incompatible with the Eighth Amendment. Indeed, the health and wellbeing of prisoners are reduced to mere chattel in a bidding process that is based solely or primarily on the financial bottom line. ASG's shareholders may be bleeding due to a decline in the company's stock price, but prisoners are suffering far heavier losses, including their lives in some cases, and such losses are not tax deductible. However, it is not as if government provided medical care in prisons or jails is much better.

However, when a prisoner dies of medical neglect due to government action, shareholders are not personally enriching themselves at the cost of human misery.

Sources: Birmingham News, Tuscaloosa News, Mobile Register, Decatur Daily, Montgomery Advertiser, Tampa Tribune, Palm Beach Tribune, Palm Beach Post, WSEH Channel 2, Miami Herald Tribune, St. Petersburg Times, Orlando Sentinel, www.gainesville.com, Atlanta-Journal Constitution, Baltimore Sun, Baltimore Daily Record, New York Times, Daily Record, Tennessean, WVLT-TV, The State, www.myrtlebeachonline.com, Casper Star-Tribune, Business Week, www.bizjournals.com, www.gwinnettdailypost.com, Naples News.