by David Reutter

With the advent of privatized prisoner health care in Florida, a spike in deaths has hit levels not seen in 10 years. Yet, privatization remains popular with Gov. Rick Scott, the former CEO of a healthcare conglomerate that bilked the government out of millions.

When campaigning to become governor, Scott promised to cut prison costs by privatizing the prison system. Despite opposition from guard unions, Scott won the election. He, however, lost a quest to privatize the entire prison system because such a move required legislative action. [See: PLN, Feb. 2012, p.1].

The court ruling ending prison privatization left open the option of privatizing the prison health care system. Scott too that option, and in 2012 the Florida Department of Corrections (FDOC) signed contracts with two companies totaling about $1.3 billion. Both companies are familiar to PLN readers for their history of putting profit before any semblance of real care [See: PLN, June 2013, p.24].

Corizon Health won a $1.2 billion, five year contract to care for prisoners in about 44 prisons. Wexford Health Services received a $240 million contract over the same period for overseeing care at nine south Florida prisons. FDOC and Corizon convened on September 11, 2013, for an Expectations Meeting to “identify specific expectations that [F]DOC had for Corizon during the transition and throughout the life of the contract,” said a letter from then-FDOC Secretary Mike Crews dated September 26, 2014. Crews met with Dr. Woodrow A. Myers, Jr., Corizon’s CEO in person on December 18, 2013 to “express concerns that appeared to be developing during the first two months of our partnership.”

Crews and Meyers “specifically discussed patient care issues, utilizations management, and communication.” As of the September 2014 letter, those issues, as well as a lack of “complete and full staffing,” continued “to be cause for concern.” Crews said in the letter that prisons failing to meet 80% of auditing standards would have payments withheld.

Concern is an understatement for what has transpired since privatization of prisoner health care was fully adopted. By January 2014—or roughly 100 days after the prisons profiteers took over prisoner care—the monthly prisoner death count shot to a 10-year high of 36 individuals, reported the Palm Beach Post.

The Post also found that in the first 7 months of 2014, there were 206 prisoner deaths, another 10-year high and an increase of 18.4% over 2012. By the end of 2014, 346 Florida prisoners died, which is an 11% increase over the record 313 in 2012.

“I would submit to you, if you look at the raw numbers, it tells you, ‘oh my gosh, we have a problem,’” said FDOC Secretary Julie Jones. “If you drill in the actual stats it won’t portray it’s a crisis.”

Jones said the “vast majority” of the 346 deaths in 2014 were from natural causes. That begs the question of what is natural as opposed to neglect, especially when one considers Corizon told Maine officials it could cut prison health care costs by 30 percent because “We have developed a new working definition of ‘medically necessary care.’”

The death of Hernando Correctional Institution prisoner Donna Pickelsimer, 52, was classified as natural death. She was serving a 15 year sentence for manslaughter.

“It started with a cough about a year ago,” wrote prisoner Lisa Key, a friend of Pickelsimer. “All medical would do was listen to her lung and tell her they were clear.”

In February 2014, a nurse noted that Pickelsimer reported a chronic cough that lasted three to four months. Less than a month later, the cough was so bad that other prisoners complained. She had lost weight and had pain in her back. She was given cough syrup.

Pickelsimer’s pain intensified. “She couldn’t mover her arm at all without screaming,” Key said. “She kept calling medical emergencies, but the nurses kept saying she was lying and it was all in her head.” Lumps began emerging on her skin. She was prescribed warm compresses, ibuprofen, and bed rest several times in April. When Pickelsimer complained her arm hurt so badly that she wanted to cut it off and die, she was placed in isolation on May 2. A doctor recommended she massage the lumps and keep her arm elevated.

Finally, on May 5, an ultrasound technician found a mass in her arm and recommended an MRI. It took a week before that test was approved. By then, Pickelsimer had pain her back and hip. The May 23 MRI found a suspicious mark and recommended more testing. She was transferred to the Reception and Medical Center in Lake Butler on a stretcher on May 28.

“I walked in, and it was horrible. I couldn’t believe it,” said her sister, Beverly Clancy. “Her left arm was full of lumps. They were all over her side.”

Eight days later, a chest scan was performed. She remained being treated with Tylenol. Morphine was not authorized for a week, The Post reported. Pickelsimer died on June 7 of lung cancer.

The next day, her chest scan was received.

“Animals are treated better,” her sister said.

When prisoner Anthony Carvajal, 44, slipped and fell after his leg buckled while working in a prison kitchen, the large lump on his spine was diagnosed as a pulled muscle. He was given ibuprofen.

A nurse got a reflex after tapping his knee and instructed him to return “because there’s nothing wrong with you.” As months passed, Carvajal lost weight and experienced crippling pain. He continued to be treated with over the counter medications until six months later he was diagnosed with multiple myeloma, a bone cancer that was destroying his spine. Early treatment could have given Carvajal another 10 years; he was given weeks when released from prison on compassionate release. He reached a confidential settlement with Corizon and was beating the odds 10 months after release.

Care all-around decreased for Florida prisoners. The number of prisoners sent to outside hospitals has dropped by 47% since 2012. Columbia Correctional Institution prisoner George Horn, 53, has been denied the final surgery to replace his hip joint since Wexford took over his care.

Horn required three surgeries to replace his hip, and he was awaiting the final one when Wexford required a second opinion. His doctor refused to operate. Moreover, Horn had been given liquid morphine for two years to deal with the pain, but it was abruptly discontinued by the new prison doctor. “She said she would not be a drug dealer,” said Horn.

With a transfer to a prison with Corizon care, a new consultation with a different surgeon was approved. Meanwhile, Horn lingers in constant pain. “It’s a terrible thing to say, but I wish God would take me,” he said.

The death of Lowell Correctional Institution (LCI) prisoner Michelle Tierney, 49, on October 9, 2014 is another “natural cause” classified death. Her son was very upset at the death and treatment if Tierney, who was scheduled to be released on January 2015.

“I’m more angry than anything,” said Ryan Tierney. “Apparently, she had cysts everywhere on her body, pneumonia, and septic shock. I don’t know how many competent medical professionals would have let that go.” A released friend of Tierney’s said a letter she received about a week before Tierney’s death stated she was in so much leg pain that she would cry and could not walk. She wrote that nurses at the infirmary would send her back, saying it was arthritis.

“You have to be on your deathbed before you can be sent to the emergency room because Corizon Health doesn’t want to pay for it,” said a nurse at LCI, who requested anonymity for fear of losing her job. “The prison is mostly staffed by LPN’s making life-and-death decisions.”

Corizon denies that claim. “Accusations that we make clinical decisions based on financial factors are simply not true,” said Susan Morganstern, a Corizon Health spokeswoman. “Clinical decisions are made based on each patient’s unique history, physical, and/or psychological assessment findings.”

As part of the bid process, bidders for the FDOC prison health care contract were required to disclose investigations and legal settlements over the last five years. In that period, Corizon was sued 660 times for malpractice, The Post reported. Of those, 91 resulted in confidential settlements. Between 2008 and 2012, Wexford faced 1,092 malpractice, “suits, notices of intent to sue, and letters from aggrieved inmates,” said a report from the Broward Bulldog. Those matters were not disclosed in the bid documents. 

Corizon, which was incorporated in 2011 following a merger between PHS Correctional Healthcare and Correctional Medical Services, is majority owned by Valitas Health Services, a private equity firm. “The claim a private corporation can do the same job as state employees more cheaply and create profits for its shareholders sounds too good on its face and the evidence suggests it’s false,” said David Fathi, Director of the ACLU’s National Prison Project.

PLN has been publishing evidence to prove that privatized prison health care proved by these companies is definitely more about profit than it is about providing proper care, which results in deaths, disfigurement, and unnecessary pain to prisoners subjected to profiteering that masquerades as taxpayer saving. While savings may occur up front, the states with privatized medical care are often sued right along with the companies, eating up savings with legal defense fees. [See: PLN, May 2012, p.22].

The companies have also been criticized for failing to provide documentation, such as autopsy reports after a prisoner dies. Seven prisoners died at LCI in 2004. In four of these cases Corizon failed to submit death documentation to FDOC. Another 14 death causes at Lake Correctional Institution and Union Correctional Institution were not submitted by Corizon to FDOC that year. Three times Wexford failed to submit mandatory death documentation to FDOC. Corizon and Wexford have also been faulted for failing to properly treat and care for FDOC’s mentally ill prisoners, which is 15 to 20 percent of its 100,000 person population, in October 2014m FDOC announced the creation of a Mental Health Ombudsman to act as a liaison to assure proper care is provided.

Meanwhile, FDOC continued to press its contractor to perform. An FDOC review showed that Apalachee East and West, Baker, Columbia, Hernando, Liberty, Polk, and Sumter Correctional Institutions had contract violations and lackluster performance.

Corrective action plan audits showed a failure of Corizon employees to properly maintain records, provide regular mental health counseling, or meet recently enacted federal standards. In January, FDOC fined Corizon $22,500 and Wexford was fined $2,500. Jones announced in February that she will rebid the contracts in 2016, which is expected to drive up the contracts/ costs for increased services.

“We are anticipating a cost increase, but we’re also adding electronic health records liquidated damages, and enhancements to the contract that will help us in the delivery of health care services,” said EDOC spokesman Mckinley Lewis.

While the fines and changes sound feasible on paper, the reality of medical care service remains to be seen Corizon’s new definition of medically necessary care has resulted in prisoners dying or being treated with over-the-counter medications when experts recommend costly medications or treatment. The Post found that fewer consults or treatment by outside specialists and Tylenol and ibuprofen being prescribed for overwhelming pain, and medication being abruptly changed or withdrawn are a common theme in lawsuits against Corizon and Wexford.

In Florida alone, these companies as well as the predecessors to Corizon, had 350 lawsuits filed against them between 2004 and 2014.

“I thought medical care provided by the [FDOC] was bad,” said attorney Randall Berg, director of the Florida Justice Institute, “but it was certainly better than what I’ve seen of late.”

The general public, sadly, takes little notice of the situation. “I admit I was one of those saying, ‘Hey, they’re in prison, they can’t expect a lot, ‘ “ said Sandra Bustin, whose nephew was given Aleve for bone cancer, “but even basic care was missing.”

The ACLU’s David Fathi knows the reason for such inhumane care. “Prisoners are uniquely powerless, politically unpopular, and literally captive market, so with private prison or private health care providers the usual rules of market discipline, the idea that bad businesses that injure or kill people will eventually go out of business, doesn’t apply,” he said. “If [prisoners] are injured their ability to recover compensation has been dramatically restricted by federal legislation…when you combine the profit motive with limited oversight and uniquely powerless population, you get bad and sometimes lethal results.”

Sources: Palm Beach Post, Miami Herald, huffingtonpost.com, wetv.tv, Associated Press