Timothy Strayer in his hospital bed in Dearborn County ICU after spending just one month behind bars at the county jail.

by Brian Sonenstein, Shadowproof

Timothy Strayer was approaching 70 years of age and suffering from multiple chronic illnesses in the summer of 2011 when he was arrested for marijuana possession with the intent to sell. One year later, his family launched a federal civil rights lawsuit that is still in progress to this day, alleging the sheriff, guards and the private healthcare company contracted to provide medical care at the jail, Advanced Correctional Healthcare (ACH), failed to provide for his obvious and critical medical needs, allowing his health to deteriorate to the point that he would need to be hospitalized for nearly 200 days.

Shadowproof conducted a three month investigation of ACH and the Strayer family’s story. Through multiple interviews, analysis of several active federal civil rights lawsuits, hundreds of pages of medical board records, corporate documents and county meeting minutes, we uncovered shockingly similar allegations of abuse and misconduct involving ACH and the doctors who were responsible for Strayer’s care, as well as a valuable glimpse into the mindset of a little-known but highly-profitable industry thriving in jails and prisons across the nation.

Strayer had Chronic Obstructive Pulmonary Disease, heart disease, one kidney, chronic psoriasis and acid reflux prior to his incarceration. Nonetheless, under the supervision of his personal physicians and with access to his prescription medications, Strayer was living relatively comfortably.

According to the lawsuit Strayer v. Dearborn County, that all changed in July 2011, when Strayer was first held at the Kenton County Detention Center in Covington, Kentucky. He alleges he was not given his heart medication for 10 days – right up until his last day at that jail. (Kenton County’s health care is provided by another private prisoner health care firm, Southern Health Partners).

Strayer was then transferred to Dearborn County Detention Center in Lawrenceburg, Indiana. The jail was severely overcrowded at that time, and Strayer was allegedly placed in the “drunk tank” for lack of cell space. He shared the communal cell and its only toilet with multiple prisoners for a few days until he was moved to a two-bunk cell that already had two prisoners living in it. He was made to sleep on a mat on the floor.

Already in a weakened state from his mistreatment in Kentucky, Strayer began to file medical requests. His psoriasis was getting worse and his skin began to flake off. Even though his wife, Kelley Kingston-Strayer, and his brother, Mike Strayer, had both given the jails a complete list of his prescriptions and contact information for his doctors, he was without stable access to his medication throughout his time behind bars.

Kelley was living in Kentucky at the time. She said her husband would call Mike and her frequently – sometimes more than once a day. He would often complain about the medical care at the jail and his inability to get access to his medications when he did. As time passed, Kelley noticed his voice sounded weak when they spoke on the phone.

At first, Kelley said her reaction was to tell her husband to advocate for himself. She told him to get the guards’ attention and let them know he was sick and needed to see a doctor. “Never in my wildest dreams did it occur to me that law enforcement would not take care of a sick inmate,” Kelley recalled to me in an interview this past spring. “It never ever crossed my mind.”

But less than one month after he set foot in Dearborn County Detention Center, Tim Strayer would be rushed to the hospital for emergency surgery to repair a perforated duodenal ulcer, which, as a CT scan of his abdomen and pelvis would later show, had caused “voluminous amounts” of free air and fluid to flood his abdominal cavity. Some doctors believe the perforation had occurred as many as four days before he was brought to the emergency room for treatment.

Despite the fact that Strayer’s health and medical care were supposed to be under the care and supervision of Dearborn County and Advanced Correctional Healthcare, the family would ultimately find themselves facing down a massive medical bill and a long road to recovery.

Inside Advanced Correctional Healthcare

Advanced Correctional Healthcare was founded in 2002 by Dr. Norman Johnson. Based in Peoria, Illinois, ACH is a rising star within a multi-billion dollar-per-year, taxpayer-funded industry, contracting with local jails to provide prisoner medical services. In 2012, ACH made $37.6 million.

Today, ACH is one of the largest prison medical providers in the state of Indiana, and its reach extends across the midwestern United States. The company oversees health care at over 200 jails across 17 states and advertises an expertise in providing treatment in the “correctional environment.”

Central to ACH’s business model is the belief that what might be considered proper healthcare on the ‘outside’ should in some instances be deemed inappropriate on the ‘inside.’ Documents produced by the company for the Itasca County Sheriff’s office in Grand Rapids, Michigan, for example, made clear “it is not the responsibility of the jail to supply care for general comfort illnesses such as mild acne, dandruff or dry skin.”

“As a result,” ACH writes, “the key to any utilization program comes down to the decision to treat or not to treat a given complaint.”

Someone was “crushing his chest”

On July 22, 2011, Timothy Strayer was mentioned in a preliminary report at the Dearborn County Detention Center. The officer writing the report noted Strayer said he felt like someone was “crushing his chest,” and thought he might have acid reflux.

After asking Strayer some questions about his symptoms, Officer Zachary Perkins spoke with the unlicensed medical assistant at the jail, Kelly Hogg. He was given Zantac and instructed to notify staff if he did not feel better by the morning.

Although she was technically only an administrative assistant and had no license or formal medical training, Kelly Hogg could be considered the de-facto primary caregiver at the Dearborn County Detention Center. Without a full-time doctor or licensed medical professional on site, prisoners brought their medical needs to Hogg. If Hogg could not manage the issue on her own, she would call ACH site physician Doctor Nadir Al-Shami.

One night, according to the lawsuit, a guard thought Strayer looked ill and decided to take him to the clinic. Assistant Kelly Hogg allegedly did not know what to do when she saw him. Strayer told her he could not breathe and requested an oxygen tank, but the jail was not equipped with one. He became delirious and was vomiting bile, unable to keep anything down but small sips of 7-Up.

Days passed, and Strayer’s health continued to worsen. The family says other prisoners became concerned and asked staff to help him. He begged to be brought to the hospital but was refused. He stopped calling home.

On August 1, Strayer filed a grievance with the jail, writing, “Medical treatment not anywhere near adequate. Doctor visit last two Mondays, no improvement, nor will there be.”

“My problems are so severe that a hospital stay is necessary,” Strayer wrote in an urgent and messy script. “Extreme psoriasis that no cream or ointment or [illegible] will help! In fact, [illegible]. Ear infection, blockage, skin rash, nothing has been done. Loss of hearing – problems! Hernia needs removal.”

“Have [social security] and will pay.”

ACH exempts “rare” diseases from prison treatment

Representatives from Advanced Correctional Healthcare claimed they would save taxpayers about $120,000 annually during their pitch to the Dearborn County Commission on February 15, 2005. ACH was the only offer on the table that day, on personal recommendation from a nearby sheriff – a friend of the commission who claimed the company saved his county $60,000.

ACH Director of Marketing and Sales Diane Anderson explained how the contracts typically work. The company would cover the first $10,000 of medical costs, and anything after would be the responsibility of the county.

Anderson said ACH would prefer to keep Dearborn County Detention Center’s assistant Kelly Hogg on staff because they felt she was doing a “good job.” She told the commission ACH would send its own physician to the jail once a week, with other doctors waiting on call 24/7 should there be emergencies or doctors who were unable to make their shifts. She claimed all of their staff were “correctional trained.”

ACH’s proposal covered all in-house medical services with some notable exceptions: “anything that deals with HIV/AIDS, hepatitis, rabies, [multiple sclerosis], cancer or court order[ed treatment].” All on-site pharmaceuticals and over-the-counter drugs would be included except for those dealing with these specific conditions. If they had to treat someone suffering from one of these exceptions, they would bill the sheriff at their “discounted network cost.”

In corporate documents, ACH states these illnesses and diseases are excluded because of their rarity among the prison population. However, the Centers for Disease Control (CDC) found “inmates in jails and prisons across the United States (US) are disproportionately affected by multiple health problems, including HIV, other sexually transmitted infections (STIs), tuberculosis (TB), and viral hepatitis.”

A different study by the Bureau of Justice Statistics also found prisoners suffer from chronic health issues disproportionately, specifically that “14% of jail inmates reported ever having tuberculosis, hepatitis, or other STDs excluding HIV or AIDS, compared to 5% of the general population.”

Additionally, the contract would not cover “elective care,” which the company defined as medical treatment that, “if not provided would not, in the opinion of ACH’s Medical Director (a licensed physician employed by ACH), cause the inmate’s health to deteriorate or cause harm to the inmate’s well being.”

The meeting adjourned while members considered their only prisoner health care proposal. By March 1, 2005, the contract had been approved.

When hernia surgery becomes ‘elective’

ACH Dr. Nadir Al-Shami did not report to the Dearborn County Detention Center for his rounds on August 2, 2011 – one day after Tim Strayer filed a medical request asking to be taken to the hospital. Dr. Ronald Davis was on back up duty that day and went in Dr. Al-Shami’s place.

Dr. Davis said in his deposition that Strayer was able to walk and talk but had obvious trouble moving. It was clear to him Strayer was very ill and was suffering from numerous, severe medical problems. The doctor recalled Strayer was an elderly man, and they spent 30 minutes together – the most time Dr. Davis spent with any prisoner that day.

Dr. Davis also said in his deposition he learned Strayer had not been able to eat for over a week because he believed he had a hernia causing him immense pain. He observed Strayer’s many health issues. He found Strayer’s ear was extremely swollen and it was causing him a lot of pain and some hearing loss. Dr. Davis saw Strayer had a severe rash covering his body that was extremely itchy. He noted Strayer’s groin was very raw and looked like it might have a fungal infection.

In his deposition, Dr. Davis also mentioned he thought Strayer had a fairly large hernia in his groin. Davis also said he noticed Strayer had an umbilical (or ventral) hernia in his mid-abdomen, but didn’t write it down in his exam notes “because [Strayer] wasn’t complaining about it.”

In ten years, Dr. Davis said in his deposition, he saw fifty to one hundred prisoners with hernias and only sent one or two for surgery, so he did not think Strayer’s apparent hernia was an emergency. Dr. Davis determined both hernias would need to be repaired by surgery, but would only send him if they had become strangulated. Otherwise, the surgery would be considered “elective” and would be outside the scope of care ACH considers appropriate for the “correctional environment.”

Assistant Hogg gave Strayer some medications and Dr. Davis ordered blood work. Strayer’s wife Kelley contends that blood work was never completed.

‘Control your pharmaceuticals’

On October 25, 2004, ACH’s Diane Anderson was before the Daviess County Commission in Kentucky, telling commissioners the best way to keep prisoner medical costs down was to “control your pharmaceuticals.” She said the jail had “a lot of inappropriate high dollar pharmaceuticals in their facility according to national standards.”

She told the commission this was not meant as an insult to their doctor, and in fact, their doctor was probably an excellent community physician. “But the correctional environment is different,” Anderson said, then added: “When you get inside the correctional environment, you don’t need sleeping pills, you don’t want narcotics, and you don’t want a lot of psychotropic drugs unless they are medically indicated.”

“[Anderson] stated they see not just in Daviess County, but they are in four states right now and historically, when they go in, there are a lot of inappropriate medications as the doctor is taking care of the wants. He is still treating inside the environment like he would the outside world, and there is nothing wrong with his treatment but within the correctional facility, you cannot have inappropriate medications.”

One commissioner pushed back and reminded Anderson some prisoners stay up all night and can’t sleep. “The jail has some guys who need to be calmed down in some way,” the commissioner stated. “If you start taking those medications away, you might cure one problem but create two more.”

Anderson disagreed. She claimed in their experience, ACH had been able to get by with “inmate health education information” they provided to sheriffs which instructs prisoners on how to care for issues like insomnia on their own.

‘You’re fucking killing me’

Timothy Strayer’s wife Kelley and his brother Mike were growing concerned. They hadn’t heard from him for the last few days, which was unusual. Kelley knew he had been sick, but she was too far away to visit. She decided to ask Mike to visit because he lived in Cincinnati and could get to Dearborn County Detention Center more easily.

When they spoke, Mike mentioned he noticed his brother’s voice was barely above a whisper during their most recent phone conversations. He promised he would visit the jail and check up on him.

At around 6:10 AM on August 3, 2011, Strayer called for the doctor complaining of shortness of breath. Officer Perkins contacted Kelly Hogg, who instructed the officer to give Strayer an inhaler.

A jail log entry filed by Officer Perkins stated “[Strayer] refused his inhaler, looked at me and said, ‘I don’t need my inhaler. I need fucking oxygen.’ After I informed him that we do not have oxygen to give him, he proceeded to tell me, ‘You’re fucking killing me.’“

Assistant Hogg then told Officer Perkins to call Dr. Nadir Al-Shami, who instructed them to watch Strayer and call emergency services for oxygen if his condition worsened.

Four hours later, at around 10:00 AM, Strayer’s brother Mike entered the jail. In a letter he wrote to his lawyers after the visit, Mike said, “Within 5 minutes it was obvious that [Tim’s] life was in danger.”

“His physical condition was appalling,” Mike wrote. “He was very frail, emaciated and pale and he was in obvious pain. His entire arms were a deep purple color with scales covering the entire area. His breathing was labored and could not speak above a whisper. He told me he was dying.”

“His strength was such that he could not continue the visit,” Mike recalled. “It lasted less than 5 minutes.”

Mike went to the jail reception desk to look for help and told prison staff there of his brother’s condition. He urged them to send him to the hospital immediately, leaving two voicemails for Assistant Hogg who was unavailable at the time. He drove to the office of the prosecutor in his brother’s case, but was denied a meeting.

Mike went home and emailed and faxed everyone he could. “I do not believe that without your immediate attention he will survive,” he wrote to the Sheriff. “Certainly, one of you has the authority to see that he receives the care that he urgently needs without further delay or hesitation. This is a dire situation and needs the full attention of someone with the authority to see that he receives medical care without the need of a formal request or judicial order.”

Kelley said she could tell something was wrong when Mike called her back. He told her she needed to get on a plane to Indiana immediately: Tim was not well. He said he wasn’t sure what was happening, but it was bad. Kelley caught the next flight with the help of close friends.

As Mike sounded the alarm about Strayer’s health, Assistant Hogg had Strayer transported to Dearborn County Hospital.

Timothy Strayer goes into shock

An expert medical report compiled by Dr. Lynne E. Eiler stated that on August 3, Strayer had described his pain to medical staff at Dearborn County Hospital as a ten on a scale of one to ten. He hadn’t eaten since July 29 and had been vomiting regularly. He said his symptoms began about four to five days before coming to the ER – about one day after his last meal.

The report states Strayer was in shock. Dr. Eiler estimated his perforated ulcer may have gone as long as twelve to forty eight hours without medical attention, and possibly longer. He believed this was consistent with the timeline and Strayer’s claims of pain. He determined Strayer was “critically ill” and “beyond presentation of new onset of perforation.”

Dr. Eiler believed the two prison guards who had observed Strayer in his deteriorating state, as well as Dr. Davis, who saw Tim on August 2, demonstrated “deliberate indifference” by not immediately sending him to the hospital. “The system failed Tim,” he wrote.

When Kelley arrived at Dearborn County Hospital, her husband was already in the intensive care unit on a ventilator with a guard at his bedside. He had been ordered to surgery within 45 minutes of his arrival at the hospital, and what Dr. Davis had assumed was a hernia was in fact stomach fluid pooled in his groin from his perforated ulcer.

After ten days at Dearborn County Hospital, Strayer’s condition was still not improving. On August 11, doctors determined he would need additional surgery. Kelley said that afternoon, Sergeant Amy Vance entered the room with a trash bag and said he was being “ROR’ed,” or released on his own recognizance. The trash bag contained Strayer’s belongings.

Kelley said she told Sergeant Vance she didn’t understand what being “ROR’ed” meant. She claims Vance threw the bag at her feet and said, “it means this isn’t over.” Now that Strayer was released on his own recognizance, his family had effectively assumed responsibility from ACH and the county for the full cost of his medical care.

Strayer was soon rushed to the University of Cincinnati Hospital in Ohio for additional surgery. Immediately after his intake examination, Kelley said a surgical ICU nurse pulled her out of the room and angrily confronted her about her husband’s condition, unaware he had just come from a jail.

“The nurse said, ‘have you seen your husband’s bottom?’,” Kelley said. “I said ‘no’ and she said, ‘he has a stage four decubitus ulcer. He has a bedsore. Where did he come from? Did he come from a nursing home?’ They thought he was an abuse victim.”

“The nurse rolled Tim onto his side,” Kelley told me. “On his tailbone, there was a hole the size of baseball. The flesh was black and rotted and the infection had eaten through the muscle, tissue and tendons, and all the way down to the bone”

“That was it for me,” Kelley told me. “After that, I started calling civil rights lawyers.”

‘Deliberate indifference’ and devastating medical bills

Timothy Strayer spent at total of 196 days in five separate medical facilities across three states after less than one month as a patient of Advanced Correctional Healthcare at the Dearborn County Detention Center.

Eleven days were spent in Surgical ICU, thirty three days in Critical Care and twenty three days on a Step Down Floor. He moved between hospitals for months before finally being sent to a nursing home to rehabilitate. He was then sent back to Indiana to resume his twelve month prison sentence.

Strayer’s total medical bill came to $685,135.94 – nearly three times the amount Dearborn County paid Advanced Correctional Healthcare for the first year of their contract. Now that Strayer is on dialysis, that number is expected to grow.

In their lawsuit, the Strayer family contends the defendants’ “deliberate indifference to Tim’s medical needs” constituted a violation of his Fourth and Fourteenth Amendment rights. They argue “Tim has incurred very substantial medical bills and lost wages, loss of enjoyment of life, and continues to suffer risk of death as the result of the complications received as the result of the defendant’s’ negligence and deliberate indifference.”

Dr. Al-Shami was dismissed from the lawsuit because he did not actually see Tim the week he was taken to the emergency room. Dr. Davis was dismissed too, because Strayer was so delirious the day they met he cannot fully remember his exam; he has no memory of what he told Dr. Davis on August 2, and so the judge determined the case could not proceed against him.

Advanced Correctional Healthcare was named as a defendant in the initial complaint, but is no longer part of the suit – which is still ongoing against Dearborn County Sheriff and several officers at the jail.

Part 2: Advanced Correctional Healthcare Doctor Faces Multiple Federal Lawsuits

An ongoing federal civil rights lawsuit alleges in less than one month at Indiana’s Dearborn County Detention Center, jail staff neglected the obvious and critical medical needs of a 69-year-old prisoner, allowing his conditions to deteriorate so severely he would later spend nearly 200 days recovering in hospitals and nursing homes.

Advanced Correctional Healthcare and one of their doctors, Dr. Nadir Al-Shami, were responsible for the medical care of prisoner Timothy Strayer. They are no longer named in the ongoing lawsuit he filed two years ago, but the company’s policies and the conduct of their staff lay at the heart of this story. As a result, the Strayers now potentially face hundreds of thousands of dollars in medical bills.

But Strayer is not the only prisoner to have suffered under the Advanced Correctional Healthcare regime. A three-month Shadowproof investigation uncovered multiple allegations of misconduct at various jails served by the company and, specifically, Dr. Al-Shami.

Dr. Al-Shami has been sued in multiple states because ACH physicians are what is known as ”circuit riders.” They serve as the site physicians for more than one jail at a time, managing the healthcare of hundreds of prisoners. These doctors are also on-call to fill in for one another in the event they can’t make their shifts.

Although ACH contracts stipulate their site physicians are supposed to visit their jails once a week, the majority of their day-to-day care is provided over the telephone because the doctors usually live far from the facilities to which they are assigned. Under this arrangement, prisoner complaints are often first evaluated by the jail’s staff. If a nurse or medical assistant can’t manage the complaint on their own, they call the site physician.

Analysis of statements by ACH officials indicate the company believes the key to efficiency in so-called “correctional health care” is discerning when and when not to treat a prisoner’s medical issue. This includes decisions to discontinue or alter prescription medications ACH deems, in their own words, “inappropriate” for use on the inside.

ACH’s contracts are especially attractive because they provide medical services at a substantially reduced cost compared to what local governments would pay to provide care on their own. Because ACH’s clients are most often cash-strapped local sheriff’s offices looking to control their booming spending on prisoner health care, it’s imperative companies like ACH deliver their services at a discount.

But there is a high cost associated with the seductive savings of privatized prisoner healthcare. Some evidence of this has been reported by local news outlets over the years, but for the most part they have gone largely unnoticed. For instance, in 2014, the company was accused of “[withholding] the most basic medical care in order to save money, banking on the insurance of the medical contractor to cover any resulting lawsuits.” This included the case of a 19-year-old prisoner who died of gangrene, naked on the floor of his cell, while in jail for stealing Star Wars DVDs and attempting to pass a fake $100 bill.

Earlier this year, I covered the story of another prisoner named Brandon Clint Hacker, whose mother sued Advanced Correctional Healthcare and Doctor Nadir Al-Shami after her son died from heroin withdrawal at the Madison County Detention Center in Kentucky.

Dr. Al-Shami’s actions as told through multiple federal complaints further illustrates how the cost-saving policies of private prison healthcare companies can have devastating effects.

Kenneth Collins

In November 2013, Kenneth Collins initiated a federal civil rights lawsuit against the city of Seymour, Indiana, several local police and jail officers, Dr. Nadir Al-Shami and Advanced Correctional Healthcare over “inadequate medical care” following his arrest and incarceration the year before.

According to the complaint, Collins had been arrested on August 12, 2012, for driving under the influence with a Blood Alcohol Concentration (BAC) of 0.28. Collins anticipated he would undergo alcohol withdrawal and requested to be taken to the hospital. Despite Jackson County Jail’s policy of not booking prisoners with a BAC over 0.25, Collins claims Officer Cornwell held him in the station and falsely stated he had taken the prisoner to the emergency room, where doctors had cleared him to go to jail.

Withdrawing from alcohol, Collins experienced severe delirium tremens, which is usually considered a medical emergency and has a high mortality rate. But two days after his arrest, on August 14, Collins was still in his cell, not in a hospital. A guard reported “Collins was talking to someone but was housed by himself.” When the two spoke, the officer noted Collins “knew where he was but was indifferent about who I was and his surroundings.”

Collins met with licensed practical nurse (LPN) Amber Easterday on August 15. She noted her patient appeared to be “paranoid and delusional” and described an encounter in which Collins told her, “I can’t get away from the door, because they’ll bust it down. I know they are there.” She had also reported Collins had told other jail staff he was on an elevator but had “called the wrong number.”

Dr. Al-Shami was unavailable when Easterday called that day, so she spoke with the next ACH doctor on-call, referred to only as “Dr. Butler,” who advised her to administer a one-time dose of Haldol and take Collins to the hospital if his condition did not improve in two hours. Dr. Al-Shami called back and Easterday said his condition was not improving. She was unable to take his vital signs. He was taken to the hospital for “acute dillusions [sic] (alcohol withdrawal).” The hospital allegedly did not want Collins discharged, but the jail insisted he be returned.

A jail log entry filed at 5:35 AM on August 16, 2012, stated, “Collins has been getting worse all night long.” Collins’ was not sleeping and had been found standing on top of his bunk.

A log dated August 17 stated an officer had been unable to take Collins’ vital signs for ten days “due to his physical state.” He was placed on a daily regimen of Librium, a sedative. Another log from that day prescribed treatments for a wound he had sustained on his shin and noted the Wound Care unit was “unable to see inmate Collins until his mental status and detoxing improves.”

On August 19, an officer reported Collins, “believed he was in the room of a house and [couldn’t] fix it.” Another officer witnessed Collins prodding at his leg wound using a broken piece of his eye glasses. The glasses were taken from him and his leg was cleaned and bandaged.

Just over one week after Collins had been incarcerated, logs from August 20 claimed Collins was “still talking like he is somewhere else” and told staff he believed “two kids [were] going around stealing stuff.”

By August 22, jail records indicate Collins was being taken to the shower in a wheelchair. Observation logs from that day indicate that, between 6:00 AM and 7:15 AM, he was “laying on floor naked.” He was given dextrose tablets because he had not been eating his food.

The next day, at around 10:00 AM, Nurse Easterday filed a report stating Collins was “unable to converse or maintain eye contact.” She wrote: “[Collins] is not able to stand or sit up without assistance. Appears to have urinated on himself. Skin is damp and yellow tinged. Was able to get him to take his medication with assistance, as well as eat 3 bites of a peanut butter sandwich. [...] I called Dr. Alshami [sic] concerning his altered mental status and overall condition. Dr. Alshami [sic] advised to take him to the ER for labwork, fluids and further evaluation for possible liver failure. Inmate was taken to ER via ambulance, and officer T. Baxter followed. Nothing further at this time.”

By now, Collins was suffering from broken ribs and seizures, as well as hypothermia, hypertension, acute respiratory failure, dehydration and acute kidney injury. He was released on his own recognizance that day after being taken to the hospital; liability for his medical care was transferred to him from the county.

According to the lawsuit, Collins was “sedated, put on a ventilator, and given treatment to raise his body temperature. He was kept in the ICU until September 4, did not regain consciousness until September 8, and was discharged from the hospital on September 12th.”

The lawsuit maintains Dr. Al-Shami allowed Collins’ condition to deteriorate so much so that he suffered “unnecessary injuries that he would not have otherwise experienced.” It alleges the inadequate medical care Dr. Al-Shami provided to Collins “was objectively unreasonable and constituted deliberate indifference to his serious medical conditions.”

In an affidavit, Dr. Al-Shami contended there was nothing inadequate about his care, and that he was never contacted about Collins during the five day period from August 18-22, in which Collins’ condition dramatically deteriorated.

Dan Brewington

Dan Brewington is an Ohio blogger, who was jailed in 2011 for intimidating a judge after he spent two years criticizing the handling of his divorce and custody proceedings on his website. After a controversial trial, he was sentenced to two and a half years in jail and subsequently became a patient of Dr. Nadir Al-Shami.

Brewington was at Dearborn County Jail at the same time as Timothy Strayer. He remembers telling another prisoner Strayer looked like he was dying. “You knew it wasn’t right,” he told me in an interview this past spring. “You could just get that vibe in the jail, that people were concerned about him. There’s no way [jail and medical staff] could say they didn’t know.”

Brewington was personally familiar with the quality of healthcare being provided by Advanced Correctional Healthcare’s Dr. Al-Shami. In a blog post from September 2011, Brewington claimed his prescription regimen was changed substantially upon his arrival in jail. He said Dr. Al-Shami altered his prescription for Ritalin without consulting with his prescribing physicians, writing, “[Dr. Al-Shami] had to consult with a prescription reference book to determine what average Ritalin dosages [sic] actually were before he altered the dose of my prescribing physician, who specializes in treating adults diagnosed with ADHD.”

Brewington also said Dr. Al-Shami changed the scheduling of his doses, prescribing one of his twice-daily doses of Ritalin at night despite the fact that insomnia is a common side effect of the drug. He said he suffered from withdrawal after his medication was abruptly reduced upon his incarceration.

Danny Ray Burden

Danny Ray Burden was the brother of Mark Burden, Detective Sergeant for the Kentucky State Police. He was sentenced to jail on March 27, 2013. When he arrived at the Grant County Detention Center, he told the intake nurse he was “medically diagnosed as an insulin dependent diabetic and also suffered from Chronic Obstructive Pulminary Disease (COPD) and anxiety/panic attacks.” Burden received treatment for all three of those conditions prior to his incarceration.

According to the Virginia Mason Medical Center, normal blood sugar levels range between 70-140mg/dL. Before he was booked at the jail, the lawsuit states Nurse Kiefner took Burden’s blood sugar level. It was 336mg/dL. A glucose level as high as Burden’s should have provoked an immediate emergency medical intervention.

Kiefner called Dr. Al-Shami, who upon learning of his blood glucose level directed Kiefner to administer an insulin injection. However, she failed to administer the injection.

At 12:41 PM, Burden was seated for booking and given food. The deputy began asking him questions, but Burden was “increasingly lethargic to the point of nodding off and becoming incoherent and inconsistent with his answers.” About an hour and fifteen minutes later, Burden was struggling to stay alert and requested insulin, but that request was not met.

Burden began “coughing profusely.” The deputy stopped the booking process and asked him if he needed emergency medical attention. Burden said he did and also told the deputy he suffered from panic attacks and claustrophobia. The nurse advised ACH staff of the request for medical attention, but staff “failed and refused” to comply.

The nurse came to the booking area to take his vital signs, all of which should have indicated he was experiencing a medical emergency. Instead of sending him to the hospital, she allowed the booking process to continue.

Fifteen minutes later, his booking was suspended because Burden “was unable to stay awake and coherent in order to complete the process.” The complaint alleges Chief Warrant Officer McCarthy decided Burden should, at that point, be put in a detox cell.

McCarthy directed another officer to assign prisoner trustees to watch over Burden. Around 3:00pm, the trustees found him unconscious on the floor. They tried to wake him but could not. The deputy arrived on the scene and made an unsuccessful attempt to wake Burden. Another deputy came and attempted to wake Burden by “knocking on his cell door, calling [his] name and, once inside the cell, banging on the sink with his keys.” Those attempts failed as well.

The officers requested medical assistance and a nurse came on the scene with smelling salts, which did not revive him. Another nurse came but could not wake Burden. It was not until about twenty minutes after trustees initially found Burden that emergency medical services were contacted. When EMS arrived, they tried to resuscitate Burden but could not. He was admitted to the hospital for “altered mental status and cardiac arrest.”

Burden’s mother contacted the jail and was told her son had been taken to the hospital. Officials allegedly told her she had to come to the jail before the hospital “to sign a release bond,” despite the fact that this is not actually required by law. They did not inform her that her son was dying.

Burden’s mother did as she was told and went to the jail first. The lawsuit states “by taking the time to divert her travels to the [jail] to sign the ‘bond,’ she never saw her son conscious or alive again.” He was pronounced dead on April 4.

Part 3: Jailhouse Doctor’s Record Raises Questions About Private Prison Healthcare

The conduct of jail doctors working on behalf of medical contractor Advanced Correctional Healthcare is at the center of an ongoing federal civil rights lawsuit facing Dearborn County. Despite the fact that ACH touts its staff as being “correctional trained,” an examination of the records of their Doctors Nadir Al-Shami and Ronald Davis raise questions about the standards of care provided by the company, even though the company and the doctors are no longer named in the suit.

In 1994, California convicted Doctor Ronald Davis of the unauthorized practice of medicine after an undercover detective caught his unlicensed office assistant “examining, diagnosing, prescribing a method of treatment, and treating patients” at his private practice. His assistant was also found to have been illegally writing prescriptions for controlled substances.

Dr. Davis’ assistant was Martha Bice, also known as “Toni.” In some cases, patients reported they never actually saw Dr. Davis over the course of their treatment. They only met with Toni.

The Medical Board of California highlighted three cases in which Toni was found to have unlawfully provided care to patients: in July 1993, Toni examined and prescribed antibiotics to a girl named “Heather G.,” whose mother brought her to Dr. Davis’ office complaining of an ear infection. Toni saw and treated Heather on multiple occasions without Dr. Davis.

In October of that year, a woman named “Carla Y.” went to Dr. Davis’ office seeking treatment for an eye infection. Toni examined her and prescribed antibiotics, but when Carla arrived at the pharmacy to pick them up, she was so concerned about the severity of her infection she changed her mind and went straight to the emergency room.

Then, in the early fall of 1993, an undercover investigator for the California Medical Board named C.H. Conley visited Dr. Davis’ office after receiving an anonymous tip that his assistant had been seeing his patients. Adopting the name “Chuck Ray Coy,” Conley arrived at the office and told Toni he was suffering from back pain.

Toni told Conley the doctor wasn’t in, but she could examine him instead, and took him to a back room. After conducting an exam, Toni prescribed him codeine #4 (a controlled substance) and contacted the pharmacy to have it filled. She asked Conley if he needed anything else, and when he said no, she “pressed him by stating, ‘What about a vitamin shot or something.’”

Conley told Toni he really did not want a shot, but she gave one to him anyway; he was given a cortisone injection in the buttocks. Toni told him she didn’t want to inject him in his back because if she did it in the wrong place, it could paralyze him.

Conley returned to the doctor’s office a few days later and Toni again offered to examine him, as Dr. Davis was not in the office. This time, Conley said he would rather wait until the “other doctor” arrived. When he did, Conley told Dr. Davis that Toni “really fixed him up.” Davis agreed.

In subsequent interviews conducted by Conley, Dr. Davis admitted he knew Toni was seeing his patients and writing prescriptions for controlled substances. He also admitted he knew it was wrong. He apologized and offered to repay any money and make any restitution the board saw fit.

Timothy Strayer & the ‘circuit rider’

Timothy Strayer was sixty nine years old and suffered from serious chronic illnesses when he became a prisoner at the Dearborn County Detention Center in 2011. After less than a month in the facility as a patient of ACH, Strayer would find his urgent medical complaints unmet and suffer a perforated ulcer before he was finally taken to the emergency room on August 3, 2011. He would spend nearly 200 days in hospitals and nursing homes recovering from multiple surgeries before going back to jail to serve his twelve month sentence.

Doctor Ronald Davis examined Strayer the day before when he filled in for Dearborn County Detention Center’s site physician Doctor Nadir Al-Shami. Both men were employees of Advanced Correctional Healthcare: a private company under contract with the jail to provide medical care to prisoners.

In his deposition for Strayer’s lawsuit, Dr. Davis admitted he was not specially trained to care for prisoners, but practiced general family medicine. He felt that meant he could tend to a “broad variety of medical problems.” Dr. Davis also said he was “seeing the same kind of problems” among prisoners as he saw in general practice, although he conceded there may be “you know, some minor differences.”

Dr. Davis worked as a “circuit rider,” meaning he managed the care of hundreds of prisoners at multiple jails. At the time of his deposition, he claimed to be the site physician for four jails, but said he had been previously assigned to as many as seven or eight at a time. Dr. Davis’ jails were located anywhere from thirty minutes to three hours away from his house. In some cases, they were even further away.

He would get calls from his jails about five to ten times a day. They were mostly questions about health issues and medications, sometimes for new prisoners. Davis said if he couldn’t address a problem over the phone and felt it was urgent, he would have the prisoner sent to the hospital – a decision in which the jail’s nurses (or in the case of Dearborn County Jail, the unlicensed assistant, Kelly Hogg) would often participate. He also said sometimes he would move up his visit by a day or two if there were “serious medical problems.”

Sending the sick ‘somewhere else’

In seminars and contract presentations to local sheriff’s offices and county councils, ACH officials emphasize that their personnel are “correctional trained” and that its practices have brought significant savings to most, if not all, of their clients.

In 2005, ACH CEO Doctor Norman Johnson went before Kentucky’s Daviess County Commission to pitch a new contract. He said “one of the first things” ACH does is “train the staff, not just the nurses but the correctional officers [on] how to not take any medical responsibility, because right now they are taking responsibility as they have to make a judgement call as to whether somebody goes to the doctor, et cetera.”

“You know from experience that something is so bad that somebody has got to go to the emergency room, and if they do, then it is covered under the contract,” Johnson added. He then went on to say the company avoids major costs by “identifying sick cases ahead of time” and having prisoners with the worst medical emergencies released on their own recognizance or “sent somewhere else” so ACH and the county don’t have to be concerned about the cost.

Dr. Johnson explained the contract’s liability cap was rarely reached. He made it clear that exceeding the cap would not benefit any of them, saying they “cannot let [expenses] go over [liability limit], because if it does, [ACH is] not making money and [the county is] spending money and the only way we can keep this thing going is to keep [the county] very happy which [ACH has] been very good at.”

When pressed on how ACH is able to provide healthcare services at a lower cost than the county, Johnson responded, “The way it saves money is [ACH does] absolutely everything that is necessary for the care of the inmates. [ACH doesn’t] do absolutely everything the inmates want and when you start operating that way, the costs come way, way down.”

“[ACH is] very cognizant of inmate lawsuits and the eighth amendment rights of inmates,” Johnson also stated. “So [we] are very specific about how [we] do this.”

Dr. Davis’ license to practice medicine

On September 7, 1994, the Medical Board of California voted to suspend Dr. Davis’ medical license and he was placed on probation. Dr. Davis’ was apparently without legal counsel at the time he pled to his charges, and did not fully understand what his plea of nolo contendere meant. He was given a number of terms he was ordered to fulfill before his status could be restored, including additional exams and medical ethics training.

Ever since then, Davis has struggled to comply with California’s order and amend his status, and has said he’ll never go back to the golden state to practice medicine ever again. The Medical Licensing Board of Indiana learned of his suspension in California in 1996, and voted to suspend Dr. Davis’ license indefinitely after he failed to appear for a hearing on January 23, 1997. (Dr. Davis argues the notices were not sent to the proper address and failed to reach him overseas, where he was working on a medical mission in Indonesia).

Dr. Davis attempted to fight the ruling. In December 1998, Davis asked Medical Licensing Board of Indiana to rescind their decision, but they declined. The board denied his petition to modify his probation one week later. On September 10, 2001, the Virginia Department of Health Professions suspended Dr. Davis’ license to practice in that state after receiving word of his status in California.

Advanced Correctional Healthcare hired Dr. Davis in 2002, and the company wrote numerous glowing letters of recommendation to the board on his behalf over the next several years. In his own letters to the board, Davis detailed numerous financial and emotional hardships that created obstacles to his compliance with California’s orders: his wife had been in a serious car accident and the family now faced massive medical bills. He was paying to put his daughter through college, and she also had costly health care needs. He was the full-time caretaker of his elderly and dementia-stricken father as well.

Dr. Davis continued fighting his status and the Board kept ruling against him. In 2010, Dr. Davis was as close as he’s ever been to having his status amended. The Board moved to withdraw his probation in September of that year, but questions among Board members concerning unresolved issues with his case led them to ultimately table the decision at the last minute, at least until he completed all of his exams.

Davis’ last appearance before the Medical Licensing Board of Indiana was for a probationary appearance on June 25, 2015. Minutes are not taken for these meetings, but his medical license is still on probation.

‘Gaming the system’

Two years after former prisoner Timothy Strayer filed a federal civil rights lawsuit over his medical care at the hands of Advanced Correctional Healthcare, Indiana laws had changed and jails were required to have licensed medical professionals conduct prisoner exams. At the Dearborn County Detention Center in Lawrenceburg, the triaging of prisoner medical needs was conducted by an unlicensed medical assistant named Kelly Hogg.

On August 28, 2014, ACH CEO Dr. Norman Johnson went before the Dearborn County Council to propose a $400,000 increase to their contract. Dr. Johnson told the council he had never seen a jail as large as the one in Dearborn County go so long without a nurse. He was pursuing the increase to hire a licensed nurse, as well as increase doctor hours and purchase more supplies and medications.

The jail had a part-time registered nurse by 2014, but Hogg was still arguably the de facto primary caregiver. Prisoners made their medical complaints to Hogg, and while she was technically an employee of Dearborn County, she spent more hours than the doctor (who only came to the jail for a few hours once a week) or the part-time nurse seeing prisoners and providing care.

Although ACH had recommended keeping Hogg at her job nine years earlier when the company proposed a contract for Dearborn County, the Strayer lawsuit and amendments to Indiana’s Administrative Code created some urgency to bring a licensed professional on site. Without mentioning the Strayer’s lawsuit by name, Johnson seemed to raise it several times during the August 2014 meeting, as he blamed an “untrained person” for getting “in the middle of medical care.” (“Strayer v. Dearborn County” is the only active federal lawsuit facing the jail, and was the only suit at the time of the meeting).

Johnson urged the council to hire more staff to guard against attempts by prisoners to “game the system” and “get a trip to the hospital.”

Advanced Correctional Healthcare, Dr. Davis, the Dearborn county sheriff and his lawyer, and members of the county council did not respond to requests for comment by publication. Dr. Al-shami could not be reached.

Many thanks to KKS for her ‘Sherlockian Investigative skills’ in helping produce this story. This article was originally published by Shadowproof (www.shadowproof.com) as a three-part series in August 2015; it is reprinted with permission with minor edits.