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June 19, 2006
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Lloyd Byron Martell with his former girlfriend, Angela Douglas, and their children, Loyal, 5, and Lloyd Byron Martell Jr., 7. Martell, 41, of Detroit, is serving a one- to four-year sentence for fleeing a police officer. Medical records show his colon cancer was initially untreated. He now has about one year to live. |
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"It cannot be said enough that the Eighth Amendment prohibits cruel and unusual punishment. We are not a barbaric country. We will not set aside idly while prisoners, on a regular basis, contract cancer, kidney disease and other serious illnesses and are left untreated for lengthy periods of time." Read U.S. District Judge Richard Enslen's Oct. 9 court order, and much more at freep.com, including: |
This is the first in an occasional series of columns on problems with the health care system for state prison inmates.
Michigan doesn't have the death penalty, but the state of health care in its prison system makes you wonder.
Prisoners who get lousy health care don't get much sympathy from politicians or the public, especially when so many people on the outside are uninsured and struggling to get decent care. Still, most people would agree that negligent medical care leading to serious health problems, virtual torture and, yes, even death should not be part of a prison sentence.
It has happened, though, over and over, to hundreds and perhaps thousands of inmates.
More than 95% of the 50,000 people in state prisons will eventually get out and go back to their hometowns and families. It would be better for everyone, from relatives to taxpayers, if they returned in reasonably good health and not, for example, with untreated infectious diseases such as hepatitis C.
Yet the quality of prison health care seems to have gotten worse since 2000, when the state contracted with Correctional Medical Services Inc. for primary care physicians and other services. It should be getting better. The Michigan Department of Corrections has been under a federal consent decree since 1985 to improve medical care and other conditions at prisons in Jackson.
"The medical neglect seems worse, not better," Patricia Streeter of Ann Arbor, an attorney for the prisoners in the Hadix case, told me. "CMS has not adequately supervised its doctors or made timely specialist referrals, and MDOC appears unwilling or unable to see that it does."
Medical records, court documents and rulings, and interviews with inmates and advocates show a pattern of misdiagnosis, delayed or denied treatment, withheld pain medication and inadequate accommodations for people with disabilities.
"If you read the Hadix findings, any individual case might be egregious, but it's the systematic failure that's gut-wrenching -- that really turns your stomach," said Paul Reingold, director of the University of Michigan Clinical Law Program, which handles prisoner rights cases.
Last year, a diabetic inmate died after suffering at least 15 episodes of hypoglycemia, some so severe he fell unconscious. "Crisis after crisis occurred, and yet his caregivers did not implement a coordinated care plan," Dr. Jerry Walden, the prisoners' medical expert, wrote in a sworn statement in federal court. Despite the health problems, nurses transferred the inmate back to the general prison population in early 2005. "Sadly, CMS, MDOC and nursing can each point a finger and nothing will change," Walden stated. "There is a system problem and one that ... leadership needs to address."
In examining 16 recent prison deaths, Walden found patients with life-threatening diseases who were kept in their cells. Others suffered unnecessary episodes of severe hypoglycemia. One prisoner was taken off his inhaler despite chronic heart disease and failure, and another suffered an almost two-year delay in the diagnosis and treatment of bladder cancer.
Corrections administrators say most inmates are healthier and getting better medical care than they did when they were free. But even the poorest person outside prison has options that prisoners don't.
Plenty to worry about
Meet Lloyd Martell, MDOC prisoner No. 335246. He will die soon of colon cancer that could have been contained had prison doctors treated it 18 months ago.
Martell, 41, a Detroit auto mechanic, caught a small-time case in 2004 -- fleeing from Redford police after they tried to pull him over for a broken rear window. Martell has a history of petty crimes and took off because he had a suspended driver's license. After police arrested him, Martell got one to four years. It turned into a veritable death sentence.
In December 2004, Martell had what he believed was a hemorrhoid lanced in prison. Medical records show it was actually a cancerous polyp. Martell said Dr. Jerome Wisneski, who works for Correctional Medical Services, told him he would be fine.
"He said it was a clean cut," Martell, in a wheelchair with a colostomy bag on his stomach, told me two weeks ago inside the Charles Egeler Center in Jackson. "He said it was all contained in the tumor and I didn't have anything to worry about."
By October of last year, Martell was bleeding from the rectum and unable to walk. He was sent to Foote Hospital in Jackson, which contracts with CMS for specialty services. Doctors told him he had terminal cancer.
An oncology report from Foote in November is damning: "Lloyd Martell is a 40-year-old inmate whose history dates back to December of 2004 when he underwent resection of a polyp that, in fact, did have evidence of adenocarcinoma, but no further intervention was made."
A request for a medical parole, supported by physicians, in December stated that Martell had roughly 20 months to live. Even if broke, Martell could have walked into the emergency room of Detroit Receiving Hospital, or practically any hospital, and gotten better care for his cancer. In prison, he didn't have that choice, and now he's going to die.
Treatment denied or delayed
CMS spokesman Ken Fields said he couldn't comment specifically on individual cases, but said CMS "provides medical care that's evidence-backed and medically necessary, and those services are provided at the community standard of care." The company, founded in 1979 and based in St. Louis, Mo., has prison and jail health care contracts in 26 states, with 80 employees in Michigan. Corrections says CMS has performed adequately and saved the state nearly $10 million a year, partly by negotiating cost-effective specialty care contracts with outside physicians.
But sworn statements by experts filed in federal court in 2002, after reviewing thousands of documents, showed that dozens of prisoners with urgent and emergency symptoms were not seen for days. Nor did nurses respond properly to written medical requests, sometimes called kites.
In some cases, treatment denied or delayed meant unnecessary suffering. A patient with a suspected broken shoulder had an appointment scheduled six days after his written request. One patient vomiting blood was not seen for five days. An inmate requesting a four-point cane because he kept falling and injuring himself did not get an appointment.
In other cases, poor medical care probably led to death.
In 2002, a 76-year-old inmate with a history of heart disease, emphysema, diabetes and hypertension died while walking to his prison job during a heat wave. Despite evidence of a worsening heart condition and getting repeated requests for help, prison medical staff failed to treat the inmate and required him to walk outside to his prison job on a blistering August day. He died hours later.
These problems and many others were identified at the three prisons monitored under the Hadix consent decree: Southern Michigan Correctional Facility, Parnall Correctional Facility and the Charles Egeler Reception and Guidance Center -- all in Jackson. What's happening with health care at the rest of Michigan's 47 state prisons is less clear.
Earlier this month, Dr. Robert Cohen, the associate monitor on medical issues for Hadix, informed U.S. District Judge Richard Enslen of Kalamazoo that many prisoners with chronic medical problems, including seizure disorders, HIV infection, hypertension and diabetes, had not received their medications for about five days.
You won't hear much about any of these cases. Screwups and poor quality care are shielded by the secrecy of prison life in general, the confidentiality of medical records, and the rights to withhold information that private companies enjoy, even when they get millions of dollars of taxpayer money.
Malpractice suits, which could discourage poor medical practices, have little effect on prisons. Unsympathetic juries, hurdles to getting inmates' medical records, and compensation caps under the Prison Litigation Reform Act discourage attorneys from taking any but the most serious and clear-cut cases.
Accountable care
No doubt, delivering prison health care is tough. The state contracted with CMS for primary care mostly because it could not retain physician employees. Still, CMS gets $65 million a year from Michigan taxpayers to do a job. It should be accountable.
Legislators, Gov. Jennifer Granholm and her Republican opponent, Dick DeVos, must take a hard look at prison health care and find ways to fix it. Medical services for inmates have been bad for decades, under Democratic and Republican administrations. CMS won its contract under former Gov. John Engler, but his administration, like Granholm's, failed to provide proper oversight.
Change will come too late for some, including Martell, who has maybe a year to live.
Martell hopes to get a medical parole in August -- without question, he should. He's suing the state for malpractice and plans to set some money aside for his children.
Toward the end of our two-hour interview, he flipped his shirt up and down, showing me the colostomy bag on his stomach and the port in his chest, an opening the size of a quarter where the chemo is pumped.
"All this is unnecessary," he told me. "I know my life's over. I just don't want to die in here."
He shouldn't have had to die anywhere. Martell's one- to four-year bit turned into a death sentence. All of us need to make sure it doesn't happen again.
JEFF GERRITT is a Free Press editorial writer. Contact him at gerritt@freepress.com or 313-222-6585.
Copyright © 2006 Detroit Free Press Inc.
