Trifecta for Michigan DOC: Three Reports Find Deficient Prison Medical Care

by David M. Reutter

From the advent of federal oversight of medical services for Michigan prisoners, the focus has been on three Michigan Dept. of Corrections (MDOC) facilities that house the state’s sickest prisoners in close proximity to Duane Waters Hospital in the Jackson area. Health care at those prisons – the Southern Michigan Correctional Facility, the Charles Egeler Reception & Guidance Center and the Parnall Correctional Facility – is provided by a private contractor, Correctional Medical Services (CMS).

Despite federal court monitoring of MDOC health care, which has been ongoing since the mid-1980s, little progress has been made to improve the quality of the care provided. To the contrary things seem to have worsened, which has resulted in egregious examples of medical neglect. Last year PLN reported several preventable deaths and injuries among Michigan prisoners caused by substandard medical care, as well as a court order holding the MDOC in contempt. [See: PLN, May 2007, pp.1, 7].

In an effort to hasten the end of federal court oversight, which is part of a long-standing class-action lawsuit known as the Hadix litigation, the MDOC proposed closing the Southern Michigan Correctional Facility. The shell game of transferring sick prisoners to facilities across the state was rejected by the court because it would not resolve the medical care problem.

When he denied the state’s prison closure proposal, U.S. District Court Judge Richard A. Enslen said he was concerned it would result in “more movement of prisoners [without] significant improvement in medical health care.” In other words, the question was what medical treatment would be like at facilities that were not under federal monitoring, if the health care at prisons subject to court oversight was so atrocious that it resulted in needless deaths.

A joint report by the Michigan Criminal Justice Program of the American Friends Service Committee (AFSC) and Prison Legal Services of Michigan, released on Feb. 6, 2008, answered that question and many more. The report, titled Tolerating Failure, painted a scary picture for those unfortunate enough to be on the receiving end of medical care at the MDOC prisons under federal oversight. Based upon prisoner interviews, court opinions, medical files and personal experience, the AFSC report revealed that even the most minor medical issue could turn deadly for Michigan prisoners.

The report is separated into three parts: History and Overview, Case Studies, and Mental Health. Part one begins by addressing why prison health care matters and which international standards apply to prisoners.

The AFSC report details the inhumanity of allowing prisoners to languish in their cells without medical treatment or a doctor’s visit. Legislators are reminded that prisoners are their constituents (albeit, constituents who can neither vote nor give them money) and merit protection from undue hardship and harm. Furthermore, by labeling prisoners as bad and free-world citizens as good, people in prison who are already on “the outskirts of society” are further ostracized, the report states.

The MDOC’s history of inept health care is grounded in its attitude toward providing treatment for prisoners, which consists of “we are doing this because we have to, not because you need it, or because we want to help you heal.” Yet prisoners are the only persons in the United States who are constitutionally entitled to such care, since “unlike the general public, prisoners are completely dependent on prison officials for their medical and mental health care.”

Despite the Supreme Court’s ruling in Estelle v. Gamble, 429 U.S. 97 (1976), the MDOC has persisted in providing inadequate medical treatment. Instead of ensuring that constitutional requirements are met, Michigan officials have obstinately failed to address ongoing, systemic problems. When the Prison Litigation Reform Act went into effect, the MDOC used provisions of the PLRA to terminate compliance plans under federal court consent decrees; Michigan also removed prisoners from the protections of state civil rights laws. Between 2001 and 2004, approximately 197 MDOC prisoners filed lawsuits related to inadequate medical services.

Under the guise of saving money, the MDOC began contracting its health care responsibilities out to CMS, a for-profit company, despite clear evidence that CMS had failed to meet its contractual obligations to provide adequate care in other states.

Over an eleven-year period ending on March 31, 2008, Michigan has paid CMS around $670 million to supply health care at the state’s 47 prisons. That cost does not include the additional expense for MDOC to operate an ineffective bureaucracy that fails to adequately monitor and enforce its contract with CMS. Additionally, the multi-million dollar payout to CMS does not reflect “the hidden cost to taxpayers of having to provide increasingly costly care to paroled prisoners whose illness could have been treated earlier and cheaper when discovered during incarceration,” the AFSC report found. This refers to the prison industry standard in which chronic or terminally ill prisoners are paroled so as to prevent the pricey cost of their care from draining prison budgets if they live long enough to access it.

Michigan also made it more difficult to review prisoners’ medical files, creating a “cloak of secrecy.” Prior to 2004, prisoner advocates could receive copies of such files by filing a Freedom of Information Act request and paying $.25 cents per page. After the Michigan legislature enacted the Medical Records Access Act, those advocates had to pay a $20 fee in addition to the per page copy cost, which was cost-prohibitive when reviewing large numbers of prison medical files.

Part two of the AFSC report examines specific case studies of various types of health care deprivations by CMS. This section deals with medication issues, denials of requests for specialty services, delayed access to medical service providers, arbitrary treatment changes when prisoners are transferred to different facilities, denial of special medical accommodations, denied Hepatitis C treatment, inattentive diabetes management and inadequate nutritional services, plus an ineffective grievance process.

The report’s second part is a compendium of prisoners’ stories of deliberate indifference to their chronic and serious medical needs. Some of these cases have been chronicled in the pages of PLN while others have not. All involve unnecessary and needless suffering due to inadequate care, resulting in prolonged pain, injuries or death. Space limitations prevent a fair recitation of the horrors that MDOC prisoners face when they become sick and are forced to seek medical treatment.

Finally, part three of the report addresses mental health care. Many mentally ill prisoners end up in the MDOC’s long-term segregation units; this is not unique to Michigan, and has become the norm for how most corrections systems deal with mental health issues. [e.g., see PLN, Sept. 2008, p.1].

Mentally ill prisoners are placed in segregation until they can conform to prison rules, which they are unable to do without mental health treatment, which is largely inadequate or unavailable. This Catch-22 policy resulted in the death of MDOC prisoner Timothy Souders, who died of dehydration while in four-point restraints in a segregation cell. [See: PLN, May 2007, p.4]. Absent improvements, the MDOC’s lack of sufficient mental health treatment will likely cost more mentally ill prisoners their lives or drive them into a deeper psychosis.

The AFSC report concludes by making sixteen factual findings and recommendations for improvement. Overall, the report found that MDOC’s “health care delivery system is broken, and creates barriers for those needing health care and mental health care, instead of just providing timely and adequate health care and mental health care.”

Some might question whether the AFSC is an unbiased source for information about prison-related issues; after all, the AFSC, founded by Quakers, is a faith-based agency that advocates for criminal justice reform. For example, CMS stated “It is important to note that no one from the organizations issuing this report even attempted to get the facts about inmate healthcare from Correctional Medical Services.”

Consider, however, that the conclusions of the AFSC’s Tolerating Failure report have been corroborated by the federal court overseeing MDOC’s medical care and by other investigatory agencies – including the National Commission on Correctional Health Care and Michigan’s own Auditor General.

According to a comprehensive report by the Office of the Auditor General dated March 2008, the MDOC’s “efforts to comply with selected policies and procedures related to the delivery of medical services were not effective.”

Specifically, the Auditor’s report found that the MDOC’s Bureau of Health Care Services (BHCS) “did not conduct all required chronic condition medical evaluations, routine annual health care screenings, and clinic visits resulting from prisoner requests for health care services. Also, BHCS did not ensure that it provided these evaluations, screenings, and clinic visits within time frames established in its policies and procedures. As a result, BHCS may have jeopardized its ability to identify, manage, and treat potentially serious medical conditions before they became more severe and costly to treat or before they became a threat to the prison population and staff.”

The Auditor General’s report further found an 18 percent vacancy rate for nurses in prison clinics, and stated the MDOC’s efforts to monitor its contract with CMS were only “moderately effective.” The audit did find that dental services at MDOC facilities were adequate.

Medical care for Michigan prisoners was also the subject of a National Commission on Correctional Health Care (NCCHC) report released in January 2008. That report, which was ordered by Governor Jennifer Granholm, concluded the state should reconsider its contract with CMS, finding that CMS medical staff were inefficient. Although the state had employed a full-time contract monitor, the NCCHC report said “it is not clear what he actually did.” The report also cited long waiting lists for prisoners in need of medical treatment, and an electronic medical records system that was slow and cumbersome. The NCCHC made 56 recommendations for improving medical and mental health care for Michigan prisoners; many of the recommendations were similar to those proposed by the AFSC.

The AFSC report, Tolerating Failure: The State of Health Care and Mental Health Care Delivery in the Michigan Department of Corrections, and the Michigan Auditor General’s report are available on PLN’s website. As a concluding note, the MDOC closed the Southern Michigan Correctional Facility and transferred prisoners with medical needs to other state prisons in November 2007, after the Hadix case was transferred to a different federal judge.

Sources: AFSC report, Office of the Auditor General report, Capital News Services, Grand Rapids Press, Associated Press