by David M. Reutter

Anthony Pierce was serving a 14 month sentence for parole violation of a burglary charge at Delaware's Sussex Correctional Institution when he discovered a marble-sized lump growing on the back of his head. A prison doctor employed by the Delaware Department of Corrections' (DDOC) medical contractor, Correctional Medical Services (CMS), said the lump was most likely a cyst or an ingrown hair.

Seven months later, the lump had become ten inches in diameter, or like a second head. The growth caused Pierce to be known by cellmates as the "brother with two heads." In August 2001, CMS' medical director, Dr. Keith Ivens, stabbed the bulging tumor five times with an 18-gauge needle, withdrawing a bloody fluid, which he emptied into a trash can rather than send to a lab for analysis.

"Despite the size and rapid growth of Pierce's lump," CMS medical staff ordered no tests or treatment. They just allowed it to grow unhampered. An autopsy report after the 21-year-old Pierce's death determined his lump was cancerous and he died from a brain tumor due to osteoscarcoma of the skull.

"That boy was growing another head," said Michell Thomas, a former CMS substance abuse counselor. It was the most grotesque thing I have ever seen in my life...All of us who worked there will forever carry his death on our conscience.

Pierce's death is one of the more egregious cases of medical neglect by a private medical contractor that is more focused on profit then caring for its patients, but it is far from an isolated incident. "They're the scum of the earth," said Thomas of CMS, her former employer. In October, 2005, CMS settled the wrongful death lawsuit brought by Pierce's estate a moth before it was scheduled to go to trial. The terms of the settlement were kept secret.

Privatized Medical Care

DDOC has a 25-year history of contracting with private medical service providers to deliver health care service to its prisoner population. In the 1970s, states began contracting out their medical services, hoping to improve medical care for their prisons, often under court order to do so. Most contracted with local hospitals and clinics.

By 2000, 34 states contracted for some medical services and 24 states' corrections systems were run completely by private contractors. By then, private medical correctional services in the United States had developed into a $7.2 billion a year enterprise.

CMS, founded in 1979, is the largest provider of privatized prison medical services in the United States. [Editor's Note: With constantly changing contracts and different definitions of what constitutes largest, the company with the most market share is constantly changing. At any given time either CMS or its rival Prison Health Services (PHS) will be the largest" private prison and jail medical care provider in the country.] With its 6,000 employees and 450 independent contractors, it provides health care at 360 facilities with more than 285,000 prisoners in state, municipal, and federal jails and prisons. It operates in 27 states.
CMS is on its third round of caring for DDOC prisoners. It held the DDOC health care contract from 1985-96, and again from 2000-02, when First Correctional Medical (FMC) outbid CMS by about $200,000. Delaware operates a unified jail and prison system that houses both pretrial detainees and sentenced prisoners.

In July 2004, DDOC "raised questions about deficiencies" in FMC's performance. After an audit by the National Commission on Correctional Health Care (NCCHC) revealed deep-rooted problems that couldn't be quickly corrected, it was agreed in March 2005 by FMC and DDOC to terminate FMC's contract effective on July 30.

CMS was then awarded the contract without going through DDOC's usual bid process. "I did that with full disclosure," said DDOC's Commissioner Stanley W. Taylor. "There was no sleight of hand. It was a vendor leaving on relatively short notice and having to ensure we would get quality health care and finding a vendor to come in and assume the current contract. The new contract with CMS is worth $25.9 million. Sen. Charles L. Copeland criticized that contract and the process leading to it. Instead of getting competitive bids from different medical providers, the administration gave a long-term, no-bid contract to a single provider, and what's worse, paid $9 million more than to the previous provider," says Copeland.

After a four-day series by the News Journal, a public outcry ensued to protest the medical care given DDOC prisoners. Taylor emphasized DDOC has been accredited since 1986 by the NCCHC. However, he neglected to say the accreditation is meaningless and measures only whether a prison system is physically capable of providing adequate medical care, not whether they actually do.

A Baby's Death

That accreditation was of no consequence to Bridgett Fogell, who was serving time for traffic violations including driving under the influence when she started experiencing trouble with her pregnancy weeks before giving birth.

Shortly after arriving at the Delores J. Baylor Women's Correctional Institution, Fogell began experiencing symptoms that suggested problems with a pregnancy: severe cramping and vaginal discharge. She was given extra food and some tests were performed, but CMS doctors told her everything was fine.

Twenty-two weeks into her pregnancy, Fogell's water broke on March 19, 2001, at 11 p.m. Other prisoners changed Fogell into dry sweatpants. Two CMS nurses arrived. One scolded Fogell by suggesting her water had not broken, but that she had urinated in her pants.

Fogell was taken to the infirmary. There she was left in a filthy room with no sheets, blanket, or pillow. Nurses checked in on her at 2:25 a.m. No one else bothered to check in on her condition again until 8:30 a.m. "I just couldn't figure out why I wasn't going [to the hospital]," said Fogell.
At 8:40 a.m., an ambulance was called. Upon admittance to St. Francis Hospital, Fogell was told she would be transferred to Christina Hospital, and they would try to prolong delivery to allow time for the transfer. Neither ever happened.

Instead, Fogell languished until 4:30 p.m., when a CMS doctor arrived. He wrote in her medical records that "there had been no prenatal complications until now." Around 6:00 p.m., "The nurse came in and told me they were inducing the baby," Fogell said.

24 hours and 27 minutes after her water broke, Fogell gave birth to Anna Lee. When the infant was handed to Fogell, dressed in a light blue gown, Anna Lee's eyes were fused, she wasn't breathing, and heart monitors showed her heart rate was slowing. Fogell cried for help, but no nurse or doctor responded.

"There was no attempt to save her," Fogell claimed. "Nobody was doing anything. I kept crying and singing to her, 'You are my sunshine.' I just didn't know what else to do." Anna Lee died at 3:10 a.m.

Two hours earlier, the CMS doctor had reached into Fogell's womb and supposedly removed the placenta. Days later, Fogell contracted an infection caused by a part of the placenta still being in her womb, which resulted in hospitalization to have it removed.

Fogell knows she was receiving inadequate prenatal care before her water broke. "What could I do?" asked Fogell. "You're helpless. It's not like you can get in your car and leave looking for competent medical care."

Lack of Oversight

Because prisoners have no health care options other than that provided by prison authorities, their only way to have the adequacy of that care examined is to file grievances. That option, however, is of no consequence in DDOC.

Delaware prisoners file about 500 grievances a month complaining about the quality of their health care. For a system that holds only 6,600 prisoners, it seems that many complaints would sound an alarm to prison administrators that something is amiss. DDOC, however, is so confident in its contracted health care provider that it allows CMS to oversee itself. Thus, no alarm can be sounded.

"All prisoner health care grievances go directly to CMS so they can be handled on the local level," says Taylor. If the grievance is denied, prisoners can appeal to guards, who lack medical training and in turn ask CMS for advice. A final decision is made by two senior DDOC officials, who also turn to CMS when medical issues are raised as they too lack medical training.

DDOC defends CMS' contract authority to oversee its delivery of health care. "Every vendor, medical vendor that we have chosen has met that criteria," says Richard Siefert, DDOC's deputy bureau chief of prisons. "Part of that is not only do they have to have the certification, in order to get the certification, they have to have by history proven that they provide the services within medical industry acceptable best practices. So, from my perspective, the selection of the vendor is the guarantee that these people are capable of delivering those things that they say they can."

Attorney Stephan Hampton questions Siefert's rationale. "What he's saying is 'They're a good vendor, because if they weren't a good vendor, the state wouldn't of hired them,'" said Hampton. "It's absolutely crazy. Even when a prisoner dies, an internal peer review is led by the contract vendor. The entire process is confidential, and the review stays with the vendor. Even autopsy reports, when done, are sent straight to CMS. A physicians group, The Medical Society of Delaware Prison Health Committee, may be asked to investigate a prisoner's death. But, their investigation can't order corrective actions. We are an advisory board," said Mark Meister, the society's executive director. "If appropriate, a letter will be sent to the person inquiring as to the disposition of our review."

Buried under Dirt

While DDOC touts the acceptable best practices its medical contractor provides, News Journal reporters found the kitchen at the Delaware Correctional Center appeared cleaner than the infirmary.

The medical examiner who examined prisoner Bernard Coston's body would agree CMS infirmary's aren't very sanitary. Coston, diagnosed with AIDS, went to prison in March 2002. His death 18 months later caused his release. In the four months prior to his death, according to prison officials, Coston remained in and received care in the prison infirmary.

While his death certificate simply states Coston died of AIDS, the autopsy report points a gruesome picture of neglect: The scalp is dirty; Examination of the skin on the back reveals a layer of dirt; Dirt is noted under the fingernails; Fecal matter is smeared on the buttocks.
"It's obvious he got poor, poor, poor medical care," said Lynda R. Kopiske, a forensic nurse and a branch director of Interim Healthcare in Newark. "If I did not know this individual was in the infirmary, I would wonder if he had been buried under dirt at some point in time."

The medical industry "acceptable best practices" CMS gives its DDOC patients has resulted in an AIDS death rate inside prisons that is 10 times that of the general population outside prison. Many of those deaths come from treatable infections, including wasting syndrome, pneumocystis carnii pneumonia, and cryptococcal meningitis a brain infection caused by a fungus found mainly in dirt and bird droppings.

In the last five years, 3 of the 22 AIDS deaths in DDOC resulted from pneumocystis carri pneumonia. "Its very rare to see patients with [pneumocystis carii pneumonia] nowadays," says Dr. Robert L. Cohen, a prison medical expert and former director of the New York City jail system. "You have to have AIDS experts seeing all patients with HIV infections." CMS only employs an infection-control nurse.

The lack of an AIDS expert in DDOC prisons cost Louis W. Chance, Jr., his life. Chance, 37, was serving a six-month DUI sentence when he developed a headache at the Webb Center, a work-release facility.

At his first medical visit, an FMC nurse, Beverly Anderson, was informed Chance had had a headache for three days. She gave him Excedrin and sent him back to his cell. The next day he was prescribed Motrin after he reported no relief.

Three days later, a guard reported Chance was confused and "possibly overdosed." He was transported to Gander Hill Prison, where he was reported to be disoriented, uncooperative, and hostile. Guards subdued him, put him in a straitjacket, and placed him in an isolation cell. Despite not being examined by a doctor, Chance was prescribed Antivan, Benadryl, and Haldol, which treat panic attacks, allergies, and psychosis, respectively. Together, they can calm a person.

After three more days, FMC's Dr. Niranjana Shah prescribed Tylenol and a daily cup of coffee because, according to Chance's medical records, caffeine helps combat headaches. Chance was then sent back to the Webb Center. Five days later, and seven days short of release, Chance died.
Had FMC doctors followed protocol for treating HIV-positive patients such as Chance, his life could of been saved. Chance had contracted cyptococcal meningitis, a disease HIV patients are highly susceptible to. It was the cause of his headaches and the disease created so much pressure in Chance's head that it affected his hearing, making him disoriented and uncooperative. "It appears to be a concerted effort to avoid treating someone who was HIV-positive," charged Ken Richmond, a Philadelphia attorney representing the Chance family in suing FMC. "This is gross negligence."

Despite cases such as those illustrated above, DDOC's bureau chief never considered that the medical vendor might delay or deny medical care to save money. Moreover, his confidence in the vendor is so high that he never asked DDOC employees to investigate prisoner claims of inadequate care; he just referred questions and grievances back to the vendor.

Early Release for Seriously Ill

Those in the know, however, are cognizant of the fact that DDOC will act to release seriously ill patients, which then places the cost burden onto the released prisoner and his/her family or the state Medicaid budget rather than upon DDOC and its medical vendor.

William "Brian" Hindt, 42, experienced a release shortly after a very serious and costly injury occurred while in DDOC's custody. Hindt was walking down a stairwell on March 28, 2005, in a courthouse to appear on charges of possession of marijuana, possession of drug paraphernalia, maintaining a dwelling where drugs are used, and conspiracy.

Wearing handcuffs and shackles, Hindt was ordered by guards to walk down the stairwell alone. Meanwhile, "The guards wanted to grab a cigarette," Hindt claims. With no one to hold his arm in case he slipped, Hindt did just that, tumbling from midway down the stairs to the concrete floor.
"I tried to save myself three times, reaching out, but I was handcuffed and shackled," said Hindt. "When I landed on that concrete floor, I hit my head, messed up my shoulder, and there was blood oozing out of my left leg. I busted the bones clean in half."

The blood was oozing from a compound fracture of Hindt's lower left leg. "I was screaming and yelling for a long time before anybody even came to help," he said. The next day, surgeons inserted nine pins and a metal plate in Hindt's leg.

After the leg was set, Hindt was returned to the infirmary at the Sussex Correctional Institution. He faced months of costly and intensive care and rehabilitation. "One day a doc comes in and cuts off my cast because I was gonna be released," Hindt says. The charges against Hindt were suddenly dropped "in the interest of justice" 31 days after his arrest.

If the court's order releasing Hindt had been truthful, it would have said "in the interest of fiscal savings." Once he was discharged from the system, "he was on his own," said Dover attorney Steve Hampton. "Maybe he'll be eligible for Medicaid." One thing is for certain, neither DDOC or its medical vendor will have to bear the costs unless or until Hindt successfully sues them for his injury and medical costs.

For the first time in his 20 years as a public defender, Ed Hillis experienced something for the first time after it was learned his client, Bill Cathall, Jr., needed open-heart surgery: An attorney general asked him to help get Cathall released. "It was bizarre," said Hillis.

Hillis could not believe that DDOC wanted a prisoner charged with arson to walk free without posting bail. "I was concerned that once DDOC was no longer technically responsible for him, he'd end up having to get his own care," said Hillis. The 44-year-old Cathall wasn't mentally capable of seeking care for his endocarditis, an infection of the heart valve. Cathall had spent most of his life in mental hospitals because he had the mind of an 8-year-old, was mentally disabled, and was schizophrenic.

Hillis decided against filing a motion that would result in Cathall's release. "If a judge granted the request, the prison could have discharged Cathall, called a taxi, and sent him on his way," says Hillis. Instead, he told DDOC to provide Cathall medical care immediately.

DDOC officials, however, took no action to rush Cathall to a surgeon. Rather, they wasted four days to orchestrate his release. Those officials deny they were scrambling to release Cathall to avoid costly surgery. While they allegedly sorted through the "complex issue of jurisdiction" to send Cathall to John Hopkins Hospital in Baltimore, Cathall's condition continued to deteriorate. By time DDOC got Cathall to John Hopkins, it was too late. Cathall died shortly after arrival at that hospital. Once again, DDOC and its medical vendor avoided a costly procedure for one of their wards.

Charging Prisoners

In the last year, numerous current and former DDOC prisoners have received bills for medical treatment they received while in DDOC's custody. Those bills came from private vendors that performed contract worked for FCM. Apparently, because FCM has been delinquent paying its bills, the vendors began billing prisoners.

FCM owes St. Francis Hospital close to $1 million. A Kent General Hospital spokesperson confirmed FCM owes them money too, but not as much as St. Francis. The result is that CMS is now having difficulty contracting with these same community medical providers.

Although he is still in prison, Ed Brittingham received a bill for about $2,100 for the massive doses of antibiotics prescribed in the hospital to treat a flesh eating bacteria. Don Bates, serving life for murder, received a bill for $76 from a radiology firm for two chest x-rays he received in 2003.

"Lots of inmates have received these bills," Bates wrote in a letter to the News Journal. A fitting question was raised by Brittinghams common-law wife. "What happened to all the millions of dollars the state paid FCM to take care of Ed and the other inmates?" asked Lee McMillion. "Where did all that money go?"

Infecting the Community

As PLN has reported for years, a virulent bacteria called methicillin-resistant staphylococcus auseus (MRSA) is prevalent in the prisons of the United States. Delaware is no exception.

MRSA bacteria enter the body through a cut or scrape. The infection is usually treated with a massive infusion of antibiotics. Amputations and skin grafts are common, and most survivors end up scarred when treatment is delayed. Physical contact is enough to pass on the bacteria. It can also be spread by touching surfaces or laundry that has been contaminated with tainted body fluids.

MRSA causes welts, boils, and oozing wounds that are often confused with spider bites. Treating MRSA is expensive. New York City, for example, spends $7 million annually to treat 3,000 people infected with MRSA.
Mark Stewart, 45, was exposed to and contracted MRSA after watching a cellmate burst his own untreated boils. Stewart spent six months in the Sussex Work-Release Center after violating his probation for possession of drugs and drug paraphernalia. For two of those months, he shared a cell with a prisoner prescribed Benadryl to treat a large boil on his leg.

"It got so bad he eventually cut it open to drain it himself," Stewart said. I know because I watched him do it." Soon after, Stewart developed a bump in the back of his head that continued to grow.

Because he felt he would not receive adequate treatment in prison and he had less than a month until release, Stewart waited until released to see a doctor. Within 24 hours of seeing a doctor, surgery was performed to remove an area from the scalp the size of a half dollar.

"I was in the hospital for four days while they treated me with IV antibiotics to stop the infection from spreading to the rest of my body," Stewart said. "On September 16, [2005], I was again operated on to perform a skin graft in order to cover [several more] inches of removed tissue." Stewart required 17 staples to hold that graft in place.

His problems are far from over, for he still carries an antibiotic resistant strain of MRSA. He fears infecting his fiancée and friends. "I'm sentenced to a lifetime of MRSA," says Stewart.

After having a wisdom tooth removed at Gander Hill Prison, prisoner Michael Surtees contracted MRSA in October 2004. Despite complaining to prison medical personnel that he was experiencing pain, neck swelling, and shortness of breath, Surtees was not treated for five days. When he finally was treated, he required several surgeries on his neck and throat. He was placed on a ventilator and remained unconscious for nearly a month. Surtees is lucky to be alive. It's an experience he will recall every time he speaks, for his now soft-voice has earned him the prison nickname of whispers.

While MRSA infections are a community threat to be feared, absolute terror reigns from the flesh-eating bacteria breeding in DDOC prisons. Necrotizing fasciitis is the medical term for flesh-eating bacteria. That disease can infect the skin through lesions caused by MRSA infection.

While on a weekend furlough, Gander Hill prisoner Ed Brittingham began experiencing intense pain in his shoulder. At sick call, an FCM nurse suspected a broken bone. She gave him a sling, took some blood, and ordered tests.

"When the x-rays showed I didn't have any broken bones, they wrote me up for faking," Brittingham said. "I knew it wasn't a broken bone. I told them this. They gave me Motrin, but the pain was pretty awful, so I took a double dose. They wrote me up for that, too."

When severe abdominal pain followed with blood in his urine, FCM's doctors assumed Brittingham was passing a kidney stone. He was given Motrin and a strainer. "I was drinking five gallons of water a day, but never passed any stone," he said. "I kept trying to get to medical, filling out sick call slips."

Prison officials prohibited Brittingham from seeking outside medical care. "They told me if I went to the hospital on a home furlough, they'd consider it an escape, and I'd get sent back to prison for the remainder of my sentence," he recalls. His wife was similarly warned.

"They told me if he had a heart attack and fell on the floor, I wasn't supposed to call 911," said his wife. "I was supposed to bring him back to the prison."

As time passed, Brittingham's pain became so unbearable that he went back to prison early from a home furlough. Rather than go to medical, he went to a guard. Brittingham then stripped naked and showed that guard the massive red lesions on his legs, foot, and shoulder. Prison doctors thought they were blood clots, causing Brittingham to be sent to St. Francis Hospital.

Once there, doctors lanced his shoulder and used a vacuum to remove dead tissue. After 11 days, Brittingham woke up and looked at his left shoulder. "When I saw it, it threw me into shock," he said. "They had to sedate me." The toll on his body caused him to go from size 38 pants to 27.

The frequent trips into the community exposed Brittingham's wife, friends, and the general public to the deadly disease eating away at his shoulder. One cough or sneeze could have spread the infection.

DDOC's Taylor contends that only three cases of the flesh-eating bacteria have been confirmed within his prisons. Yet, eight prisoners or family members told the News Journal that they have been treated over the past three years for necrotizing wounds.

"It's a nationwide problem in prison care," says Dr. Robert Cohen, a prison health expert who serves as a court-appointed monitor in four states. It spreads rapidly in a corrections environment. It doesn't have to if appropriate infection control techniques are followed.

A Mountain of Lawsuits

Since 1986, over 300 cases have been filed in Delaware federal courts against the DDOC's medical vendors. Most of those cases were filed pro se. Many were dismissed on summary judgment for lack of evidence to support the claims, failing to file paperwork, or the courts could not locate the prisoner. It is virtually impossible to win a medical case in court without expert testimony to show both causation and appropriate standards of care. Medical experts costs thousands of dollars to retain and are typically beyond the reach of most pro se prisoners.

Some cases, however, result in favorable judgments on behalf of prisoners for instance, CMS agreed in October 2005 to pay an undisclosed amount to the family of Anthony Pierce for the gross negligence that resulted in his death.

CMS is no stranger to lawsuits alleging it was deliberately indifferent to prisoners' serious medical needs. In fact, such suits seem to be part of the business model. In the Eastern District of Arkansas, CMS has been named as a party in about 200 lawsuits.

The last Arkansas suit against CMS comes after its physician, Dr. Olabode Olumofin, prescribed ineffective antibiotics to treat a bacteria that caused prisoner William Jobes' lungs to fill with infected pus. The suit alleges the lab reports were "blatantly and willfully disregarded" by Olumofin, who "wholly failed to take any action in response to save Bill Jobes' life." Moreover, it is contended that the failure to send Jobes to a hospital sooner than four days after he entered the prison infirmary cost him his life.

Of course, sending prisoners out for care at a community hospital greatly reduces CMS' profit. "I have been in many settings where I have seen medical vendors rewarded for not providing care," says Dr. Cohen. When care is tied to the profit of these companies, there will be serious problems on care in specific sensitive areas: specialty consultation and hospitalization. Delaying or denying services will make a lot of money for the company. When the state negotiates these contracts, that's likely to happen.

CMS, like legal experts nationwide, know that prisoners have an extremely difficult time procuring counsel. Absent competent counsel, most prisoners fail in the legal arena. "It is certainly very hard for prisoners alone," says Gouri Bhat of the ACLU's National Prison Project. Knowing that, why should CMS worry about the odd successful suit while making millions denying or delaying care?

Typically private medical companies are paid a flat per diem rate for each prisoner in a system. That rate supposes a basic level of care for all prisoners and the companies profits. When the company skimps on medical staffing, doesn't provide expensive care, etc., it maximizes its profits as every penny not spent on medical care for prisoners equals profit for the company.

Moreover, the private prison companies pursue a litigation policy of demanding secret settlements, even when they lose cases at trial, to prevent an accurate accounting of how many times they have been found liable or paid damages for inadequate medical care to prisoners. Something the government cannot do.

Nation's Highest Death Rate

Along with its horrid health care comes a distinction for the second time in four years: DDOC had the nation's highest rate of AIDS related deaths.

According to Dr. Janet Kramer, an expert in prison health care, DDOC's 6,600 prisoner population should equate to no more than three to four deaths a year. With 90 prisoners dying since 2000 until September 2005, that equates to about 18 DDOC prisoner deaths a year.

DDOC's suicide rate is twice the national average. DDOC, however, contends its suicide rate falls in the middle of the statistical range by any reasonable standard." That contention is based on DDOC's unique population, which holds convicted prisoners and those just arrested because Delaware has no local jail system. The national rate for jails is 14 suicides per 100,000 prisoners and 41 per 100,000 for convicted prisoners.

When you examine the attempted suicide of Gander Hill prisoner Robert Swan, one is left to wonder if DDOC takes appropriate steps to prevent suicide in prisoners known to be at risk to kill themselves. Swan called his mother, Tillie Carello, and told her he was going to kill himself. Carello called the prison to report the threat. Despite that warning, Swan was not placed on suicide watch and he hung himself with a bed sheet two days later. While he was found and resuscitated, he now exists in a progressive vegetative state.

To avoid reporting deaths to public or federal regulators, DDOC acts to discharge its most seriously ill prisoners. Anthony Pierce, for instance, received a medical discharge before he died from his untreated brain tumor. While it is uncertain how many DDOC prisoners have died after receiving a medical discharge, it certainly has to be enough to raise DDOC's prisoner death rate.

Circling the Wagons

After the News Journal published its four-day expose on the deplorable medical care provided by DDOC's medical vendors, Gov. Ruth Ann Minner and DDOC Commissioner Taylor began circling the wagons to assert its vendors were doing the job.

"Commissioner Taylor has worked very hard in recent years to improve the health care provided to inmates in Delaware prisons," said Minner. Like any program, there are areas we would like to improve, and the Commissioner has repeatedly said that. But to say the system is in crisis is not only wrong, but irresponsible.

Taylor does admit that deficiencies exist, but he defends the delivery of health care to DDOC prisoners because of DDOC accreditation by NCCHC since 1986. Yet, Taylor refuses to release the latest NCCHC audit, which found such serious problems it resulted in FMC's contract being terminated, on the basis it's not a public document. DDOC spokeswoman Elizabeth Welch, in response to a Delaware State News request for that audit, cited a statute that "specifically prohibits the disclosure of documents such as the audit. Therefore, the DOC is denying your request." The News contends the statute is inapplicable and has asked the attorney general for clarification.

When pressed on why DDOC's death rate is so high, Taylor said, The inmate population tends to be a population that comes to us with a difficult medical history: substance abuse, tattoos, risky sex, a lot of drug behavior. They don't take care of themselves.

While Taylor may have a point, the bottom line is what really counts for its medical vendor. "Patients come to correctional facilities without a history of regularly receiving care," says CMS spokesman Ken Fields. The diagnoses might not always be immediate and might take several tests and medical evaluations. "Patients often have multiple and complex conditions that in some cases are very rare." In other words, prisoner health care can be very cost intensive.

Dr. Vemulpalli, a former FMC employee who is now in private practice, experienced firsthand the bottom-line syndrome. While working at the Delaware Correctional Center, FCM's company owner, Dr. Tammy Kastre, ordered him to treat AIDS or hepatitis C but not both, even though many patients have both because it was too expensive to treat both.

"Most patients who come to the hospital from the Department of Corrections are generally too far advanced," says Dr. Vemulpalli. "I've seen several cases from prison all patients who have died that didn't get referred to the hospital at the appropriate time. They're not providing adequate care."

Despite Minner and Taylor's best efforts to put a happy face on DDOC's medical care, the images of Pierce's head and Brittingham's shoulder seared the public conscious.

Public Outcry

Protesters took to the streets of Wilmington and Dover on October 2, 2005. Over 50 protesters gathered on the steps of Legislative Hall before marching to the governor's mansion, where they outlined 10 recommendations to improve the prison health care system. One of those was to pay the vendors its cost plus a percentage. "The Delaware system is sick," says protest organizer Rev. Christopher Bullock. "The system is in critical condition."

A coalition of 30 churches, social service organizations, and the ACLU of Delaware asked the governor to dispatch medical teams to every adult prison to assess medical care. "This is as much a human rights issue as a civil rights issue," said Drewry Fennell, Executive Director ACLU of Delaware. "There are people who are in pain, who have medical issues that need to be addressed. They don't have the luxury of time."

The Delaware Legislature finally jumped into the fray on November 7, 2005, holding an informational" hearing to educate lawmakers about prison medical care for possible action at the next legislative session.

At the hearing, 50 members of the public did some scolding, testifying the state treats its prisoners worse than animals. "It's your facility clean it up," Matilda Carello yelled at Taylor, who was sitting at her side; Carello's son is a prisoner with Grave's Disease. "CMS you're a liar. Stan Taylor, you are a liar."

"I believe a person needs to be punished when they break the law of the land, but the punishment does not include neglect, humiliation, and death," testified Denise Rodriguez, a former CMS employee who worked at Gander Hill Prison. "Stan Taylor, I always told my clients that to make changes in your life, you have to hold yourself accountable. Someone needs to be held accountable."

Dover residents Lynn and Robert Sadusky mentor a Delaware prisoner. They testified that prisoner has relayed a list of complaints concerning medical care in the DDOC, including having to wait for two weeks now to be seen by a doctor to determine if he's suffering from lung cancer.

After about 50 people testified, speaker of the House, Terry Spence, R-Stratford said, "We've lost confidence in the department. We've lost confidence in CMS." Spence wants an independent oversight panel.

DDOC hired a health services administrator on November 28, 2005, to oversee the DOC's "day-to-day medical operation," said Ed Jynoski, DDOC's bureau chief of the Bureau of Management Services.

In that position was placed James Welch, a longtime HIV/AIDS educator from the Department of Public Health. What good Welch's appointment will do remains to be seen.

Welch said he's never experienced criticism's of CMS Medical Director, Dr. Keith Ivens, the same doctor who stabbed Chance's bulging tumor with an 18 gauge needle. "All I can say is he performed appropriately. I am not a physician. I can't give a professional opinion of his level of care," said Welch, a registered nurse. "His orders were appropriate." The public wants more done.

"The lack of response by our governor is the strongest indication of the need for outside oversight of prison conditions," says Maryanne McGonegal, secretary of Common Cause of Delaware. Common Cause has asked U.S. Attorney General Alberto Gonzales to open a federal investigation.

The News Journal's exposure and public outcry finally pushed the Civil Rights Division of the U.S. Department of Justice (DOJ) to "open a formal inquiry" into medical care and other systematic issues inside DDOC. The DOJ was alerted to problems within DDOC in mid-2004 by a defense attorney, who advised a prisoner had been assaulted by guards and then deprived adequate medical care. "Only now, has the DOJ decided to start a formal inquiry." Historically these DOJ inquiries result in the occasional report and not much else.

Despite all the publicized ill-treatment and pending investigations, Minner continues to defend the system's care provided to its prisoners. "If she thinks it's that good, maybe she should use the prison health system - not with a name, but as a number," suggests Sen. Karen E. Patterson, D-Stanton.
With its new $25.9 million contract, CMS seems likely to continue providing care to DDOC prisoners for the foreseeable future. After 25 years of relying on private medical vendors to care for its prisoners, one can only wonder if DDOC could ever rid itself of private contractors. The real questions, however is: Can privatized medical care of prisoners ever work?

One expert thinks not. "Any of these companies, with a risk-based contract-less services, more money-are extremely likely to go wrong," says Dr. Cohen. "I'm not aware of anywhere they've gone right."

Sources: The News Journal; Delaware State News; Newszop.com; Baltimore Sun; nwanws.com; Associated Press; Discover Magazine.