by David Reutter

Private medical contractors have become popular among corrections officials eager to reduce the cost of providing health care to prisoners. As PLN continues to chronicle this phenomenon, we continue to find substantial evidence that for-profit companies fail to provide adequate medical care – including in county jails in Kentucky.

Nearly two-thirds of Kentucky’s jails have contracts with private medical providers Southern Health Partners (SHP) or Advanced Correctional Healthcare (ACH). SHP contracts with 30 jails in Kentucky and more than 170 facilities in 12 other states; ACH contracts with over 20 Kentucky jails plus more than 235 facilities in 16 other states.

For the most part, private medical providers are not subject to independent oversight.

“There is no inspection/investigation of the quality of medical care,” said Louisville attorney Greg Belzley, who has filed numerous lawsuits alleging that deficient health care has caused or contributed to deaths or near-deaths among prisoners in Kentucky jails.

“Doing the time is supposed to mean living in a jail with your liberty taken away, eating jail food, with unsavory characters. It doesn’t mean dying because your basic medical needs are ignored,” Belzley stated.

Yet that is exactly what happened to Kenneth Marcum, 50, while in a “detox cell” at the Campbell County Jail, which contracts with SHP. Despite jail policies that required regular cell checks every 20 minutes, Marcum was ignored for hours. He was found dead on the morning of April 27, 2008, when staff finally checked on him. His death was caused by a perforated ulcer.

“I don’t think anybody should have to suffer the way he suffered, because of lack of care,” said his mother, Sandra Richard.

A lawsuit filed over Marcum’s death was reportedly settled by SHP for around $113,000 in March 2011. See: Richard v. Southern Health Partners, U.S.D.C. (E.D. Ky.), Case No. 2:09-cv-00020-DLB-JGW. While that suit was pending, attorney Robert Blau asked the Kentucky Department of Corrections (KDOC), which has oversight over the state’s jails, to look into his death.

“No one should go to jail and die,” Blau wrote. “I believe that an investigation should be conducted of Mr. Marcum’s death. I believe that Southern Health Partners violated many standards in the care and treatment of Kenneth Marcum.”

The KDOC never responded to Blau.

“A months-long examination by WFPC’s Kentucky Center for Investigative Reporting found that the [K]DOC rarely probes deeply when a jail inmate dies,” the Center, a project of National Public Radio affiliate WFPL News, reported in 2015. “And it apparently has not sanctioned a single jail in connection with the more than 140 inmate deaths that have occurred during the past five and a half years.”

While incarcerated at the Montgomery County Jail, Ronald Gaunce suffered pain from severe drug withdrawal and awaited medical assistance from SHP staff before he died on March 25, 2013 due to a seizure. Six days earlier, Gaunce, 37, had been arrested for selling drugs prescribed to treat a back injury. He told a deputy he was “in bad shape.”

Hours before his death, Gaunce was found covered in his own feces and had to be wheeled to a shower, where he suffered the seizure and stopped breathing. At the time of his death, SHP’s contract doctor had never seen or examined him.

“This should never have happened,” stated his mother, Diana Rice. She said she once believed that people in jail “have a right to a certain degree of basic medical care, and that if something is wrong with you, you get that medical care. And that didn’t happen with Ronnie.”

In May 2016, U.S. District Court Judge Karen Caldwell declined to dismiss claims in a federal lawsuit brought by Gaunce’s family against SHP and Montgomery County jail staff. Caldwell stated that, upon initial review, it appeared the claims of medical neglect had sufficient merit for the case to proceed to trial.

According to a February 10, 2017 news report by the Associated Press, the county defendants settled the case for $400,000 and the sheriff’s office agreed to “regularly train” employees with respect to identifying drug and alcohol withdrawal symptoms. SHP entered into a separate settlement under confidential terms. See: Rice v. Montgomery County, U.S.D.C. (E.D. Ky.), Case No. 5:14-cv-00181-KKC-REW.

Tyler Butler, 25, also died at a Kentucky jail that contracted with SHP for medical care. When he entered the Hopkins County Jail on April 8, 2010 charged with misdemeanor assault, Butler told several guards and SHP employees that he had a staph infection.

He vomited twice while changing into a jail uniform; his skin was gray, he was sweating profusely and had trouble standing up, according to a November 2015 ruling by the Sixth Circuit Court of Appeals in a lawsuit filed after his death. Yet SHP staff did nothing to help Butler, based on “a custom and practice of requiring seriously ill inmates to request medical care before any services would be provided, even if the circumstances called for emergency medical treatment.” See: Shadrick v. Southern Health Partners, Inc., 805 F.3d 724 (6th Cir. 2015) [PLN, Nov. 2016, p.34].

A nurse found Butler without a pulse and cold to the touch on his fourth day in jail, on April 11, 2010. The wrongful death suit brought by his family settled with the county defendants and two SHP nurses in 2014 for $345,489, then continued against SHP before settling in April 2017 under undisclosed terms.

A lawsuit was filed against the Madison County Detention Center in February 2015 following the death of 35-year-old prisoner Brandon Clint Hacker. Medical care at the jail was provided by ACH. According to the suit, Hacker was arrested for failure to appear at child support hearings; after being jailed, he complained of stomach problems and other symptoms. He received no treatment over the weekend because medical staff were only present during week days. Contacted by phone, and without personally seeing or assessing Hacker, ACH doctor Nadir H. Al-Shami directed jail employees to give him certain medications.

Hacker died a few days later, on May 5, 2014, after going through heroin withdrawal and developing ulcers. The lawsuit, filed by his mother, remains pending. See: Winkler v. Madison County, U.S.D.C. (E.D. Ky.), Case No. 5:15-cv-00045-KKC.

In Grant County, the U.S. Department of Justice (DOJ) spent years investigating prisoner health care at the county’s jail. In a February 2013 letter of findings, the DOJ found a doctor was present at the facility only two or three hours a week. Such “medical deficiencies pose an unreasonable risk of harm to inmates,” federal investigators wrote. Just a month later a prisoner died at the jail, allegedly due to inadequate health care.

In July 2016 the DOJ released another scathing assessment of medical treatment at the Grant County Jail. As stated by the DOJ, prisoners remained at “risk of serious harm” due to the county’s ongoing failure to meet even “minimal constitutional standards” of medical and mental health care.

The DOJ assessment concluded that the presence of physicians or nurses at the facility for only eight hours each month fell below one-fifth of the medical staffing levels recommended by the National Commission on Correctional Health Care. The DOJ also found the jail’s mental health practices were “highly problematic,” with doctors failing to monitor patients for prescription-related side effects. Further, record keeping was dangerously deficient and portions of prisoner medical records were often missing.

One major failure with respect to the privatized health care provided by SHP and ACH is the delegation of their responsibilities to sub-contractors. Both companies contract with doctors to serve as chief medical officers at the jails where they supply health care.

Dr. Ronald Waldridge was the medical director at 21 jails in Kentucky that contract with SHP, housing a combined 3,500 prisoners. Pursuant to his contract he was supposed to spend up to three hours a week at the Montgomery County Jail, but visited the facility just once every two or three months. He also had a private practice where he saw up to 24 patients a day.

SHP was OK with that arrangement. “I guess as long as they can perform their duties, we’re fine with the number that they have,” said SHP President Jennifer Hairsine about the hours Waldridge was at the jail and the number of doctors in the company’s employ. “He and I had a conversation and.... I have allowed him to send a physician provider in his absence.”

In the place of doctors, nurses usually fill the void. But critics contend the lack of supervision by a doctor or advanced practice registered nurse is problematic; also, LPNs rather than registered nurses are often responsible for providing medical care to prisoners. In fact, the KDOC reportedly requested a change in state regulations to allow LPNs to serve as a jail’s “medical authority.” That change was approved in November 2011.

“You get what you pay for,” stated former Fayette County jailer Ray Sabbatine. “It’s pretty simple, it’s a financial issue. LPNs are 20 to 30 percent cheaper than an RN or any higher-degreed medical provider.”

One wonders how companies like SHP and ACH can retain their contracts and stay in business if they provide substandard care and prisoners die or suffer injuries as a result. Very simply, they are politically connected and help reduce jail medical costs.

For example, SHP is a “premier sponsor” of the Kentucky Association of Counties; it pays $50,000 annually for that designation, and in return the Association has endorsed SHP’s medical services at county jails. Additionally, Waldridge and other SHP contract doctors make campaign donations to local and state political candidates.

Even should the KDOC increase its oversight of health care in county jails, it’s doubtful that would result in substantive improvements.

“Here’s the problem with state inspections: The state elevates form over substance,” said attorney Greg Belzley. “In terms of anything that’s not immediately visible, the state looks to see if there’s a policy in place, if there is, it stops there.”

Combine that lack of oversight with political connections, the desire of jail officials to cut costs and private medical providers’ need to derive profit, and you have a deadly mix.

“This is not just a Kentucky problem. This is a national problem,” said Michele Deitch, a nationally-known authority on criminal justice policy issues who teaches at the University of Texas. “There needs to be a body that investigates as well as one that does routine monitoring. What kind of independent oversight and monitoring is going on?” she asked.

None, apparently.

In July 2016, the same month that the DOJ released its findings related to ongoing substandard medical care at the Grant County Jail, the county’s Fiscal Court passed a resolution to close the facility. But the closure was not to be; in October 2016 the county scrapped the resolution and opted to continue operating the jail. County officials claimed it would cost less to keep the jail open than to close it, as it would be more expensive to house prisoners at other facilities – where they presumably would receive better medical care. 

Sources: WFPC Kentucky Center for Investigative Reporting, www.southernhealthpartners.com, www.advancedch.com, www.wfpl.org, Associated Press, www.prisonprotest.com, www.fox19.com