State's sickest inmates: Sentenced to die?
In his cell at a Jackson prison, Joseph Griffin was dying, unable to convince his doctors he needed the care that could save his life.
Tests to diagnose his illness were repeatedly delayed by doctors working for Correctional Medical Services (CMS), the firm contracted to provide care for the state's more than 50,000 inmates. After five months of suffering with a swollen right arm and legs so bloated he no longer could walk, Griffin, serving time for shoplifting, died May 9, 2005.
He wasn't the only Michigan inmate who died last year due to inadequate medical care.
In January, Larry Ervans, a 61-year-old window washer doing time for selling drugs, bled to death in his cell two days after complaining to the medical staff about abdominal pain. The prison doctors didn't order a simple test that could have detected a bleeding ulcer.
In February, Hakim Muhammad, 45, convicted on a drug charge, died of non-Hodgkins lymphoma, untreated for months as a doctor repeatedly ignored requests to examine him. When he complained of severe pain in his hip and legs, the doctor canceled his medication and took away his wheelchair.
In June, Steven Boals, 52, convicted of armed robbery and auto theft, died of lung cancer two months after complaining of fatigue, weight loss and a lump on his chest. During the last two months of his life, he suffered in pain as a prison doctor repeatedly failed to examine him or order treatment.
Later that month, John McRae, a 70-year-old convicted murderer, died in his cell after the prison's medical staff failed to follow an outside doctor's instructions on caring for his many health problems, including heart failure, diabetes and internal bleeding.
In each case, the death certificates list the cause as "natural," but their deaths could have been avoided, or their suffering at least alleviated, if they had received proper medical care, according to an independent doctor who reviewed the cases.
Dr. Robert Cohen, appointed by U.S. District Judge Richard Enslen to monitor health care in the Jackson prisons, cited numerous examples of inmates suffering and dying due to understaffing, misdiagnosis and delays in treatment.
The inmates, including drug dealers, sex offenders and murderers, may not be the most pitiable group, but if their suffering isn't reason enough for concern, consider that:
Cruel and unusual?
Cohen, a nationally recognized expert on prison medical care, declined to be interviewed for this story, but in his report to Enslen last September, he cited numerous "significant problems with the care being provided to the sickest prisoners," particularly at the Duane L. Waters Hospital inside the Jackson prison complex.
"It was routine in Duane Waters Hospital for nurses to request physicians to examine patients and for physicians not to come," Cohen wrote. "I have never before heard of physicians failing to respond to nursing requests to evaluate a patient, but according to the medical records I reviewed, and according to the nursing staff at DWH, this is routine."
After reading Cohen's report, Enslen found the health care in the Jackson facilities amounted to cruel and unusual punishment under the Eighth Amendment, and he ordered the state to come up with a plan to improve it. State Corrections Department officials said they are implementing a plan, although they disagreed with Cohen's conclusion that health care in the prisons is substandard.
"We do not necessarily agree with everything Dr. Cohen said in his characterizations of these cases," said Richard Russell, head of the department's bureau of health-care services. "What you have to understand is, in any health-care system, there are cases that don't go the way you want them to go."
One doctor repeatedly faulted by Cohen for providing inferior care was forced to resign, although Russell called the doctor "a qualified physician. I'm saying I don't believe he needed to be let go."
He contended Cohen focused on the worst cases and "made generalizations that are not typical of our system."
But in August, Gov. Jennifer Granholm ordered an independent review of the entire prison health-care system following the death of 21-year-old mentally ill inmate. Timothy Joe Souders, doing one to four years for assault, resisting arrest and destroying police property, had spent most of his last four days in an isolation cell, his arms and legs shackled to a steel bed.
Although Souders suffered numerous physical and mental illnesses and the Corrections Department had issued a heat advisory, no doctor visited him during those four days.
His death "was a terrible unnecessary tragedy," Cohen wrote in an Aug. 14 letter to Enslen. " ... There are a number of additional continuing serious deficiencies in the medical program which require immediate action, some of which may have contributed to the abject failure to provide Mr. S. with medical care. ... This is an emergency that's gone on for too long and is having an extremely adverse effect on patient care."
Care is questioned
While Cohen's reports covered only the medical facilities inside the sprawling Jackson prison complex, some inmates' rights advocates contend the quality of care there is typical of the state's entire penal system.
"It's a nightmare," said David Santacroce, a University of Michigan law professor whose students have filed lawsuits for the inmates. "There's an incentive for them (CMS) to keep costs down. The less they spend on medical care, the higher their profit. It's a mess, and it shows no signs of getting better here or anywhere else CMS is present."
Patricia Streeter, an attorney in a class action lawsuit against the Department of Corrections, called health care in the prisons "appalling." That lawsuit led Enslen to appoint Cohen to monitor health care in the Jackson prisons two years ago. Prison health care never was all that great, Streeter said, but in the nine years since CMS took over, it has deteriorated.
"There are a lot of cases of misdiagnosis," she said. "They don't catch conditions quickly. Screening tests are ordered with no follow-up."
Carla Ringleka's family believes her death Aug. 28 could have been prevented if doctors at the Robert Scott Correctional Facility had diagnosed her breast cancer and started treatment earlier. Ringleka, of Stanton, convicted of second-degree murder in the death of her husband, first complained of a lump in her right breast in February 2001, but a prison health-care worker dismissed it as "fatty tissue." Seven months later, a mammogram showed the lump was cancer, which by then had spread to her lungs, liver and bones. She died awaiting a decision on her request for a medical commutation.
Robert Walsh, chief psychologist in the Jackson prisons at the time CMS took over, accused the company of "horrendous neglect."
"There's a complete failure of the bureaucracy in the central office (of the Corrections Department) to monitor this contract," he said.
Walsh, who retired in 1999, is helping Prison Legal Services, a nonprofit organization based in Jackson, prepare a report on the quality of prison health care.
Holding down costs?
St. Louis-based CMS provides health care for some 250,000 inmates in 26 states and 300 facilities. In its home state of Missouri, inmates accused the company of intentionally delaying or denying care for life-threatening illnesses. CMS paid $525,000 to avoid prosecution for manslaughter in the death of a North Carolina inmate.
Health care in Michigan's prisons was provided by state employees until 1997, when former Gov. John Engler's administration signed a 10-year contract with United Correctional Managed Care, a for-profit company in Anaheim, Calif. The following year, CMS bought some of United's assets and took over the contract.
The idea was to stem the rapidly rising cost of health care for the state's growing prison population. Despite the privatization, the cost of prison health care continued to rise, from $115 million in 1997 to a projected $190 million in the fiscal year beginning Oct. 1. The average annual cost of health care for each inmate rose from $2,573 in 1997 to $3,690 in 2005.
Yet the Corrections Department boasts that since 1997, the state has saved $86 million on prisoner health care. The state pays CMS the actual cost of health care plus an administrative fee. The contract includes financial incentives for CMS to hold down costs, but Corrections Department officials insist the provision does not prompt CMS to deny care.
Dr. Jerry Walden, an Ann Arbor physician and former medical director for a federal prison in Indiana, disagrees, claiming CMS has a financial incentive to delay and deny treatment for sick inmates.
"I'd like to see them get rid of for-profit health care," said Walden, hired as an expert witness for the plaintiffs.
Company defends record
A CMS spokesman denied the company delays or denies treatment to maximize its profits. "To the contrary," CMS spokesman Ken Fields said, "CMS health-care professionals are trained and encouraged to use their experience and judgment to decide what treatment is appropriate for a patient."
He declined to discuss Cohen's report, but said, "What I can say is we've worked closely with the Department of Corrections to enhance the level of care that is provided to inmates in Michigan. We believe we have made significant strides in doing so."
But on June 2, Cohen sent a letter to Enslen, saying many prisoners' prescriptions had gone unfilled for several days.
"This is an extremely dangerous situation, posing a critical risk to the health of many prisoners at the (Jackson) facilities, and it must be remedied as quickly as possible," Cohen wrote.
Corrections officials said prescriptions are being filled on time, since Pharmacorp, a CMS subsidiary, took over all pharmacy operations in the state's prisons July 1.
Every year, the department files the same annual report with the Legislature: "Correctional Medical Services, Inc. (CMS) continues to provide quality services to prisoners. ... "
That assessment is in stark contrast to Cohen's report.
"Extraordinary delays in the care of very sick patients with cancer, renal failure, AIDS have occurred over the past year," he said. "This system is designed to delay necessary specialty consultations and is hazardous to the health of patients."
Tylenol for kidney failure
Without naming the patients, Cohen detailed case after case of men who suffered and some who died for lack of proper care. The Press was able to identify some inmates by looking up death certificates.
They include Joseph Griffin, who had been in and out of prison for writing bad checks and shoplifting. He couldn't read or write, but was street smart, his sister, Yvonne Griffin, said.
In 2004, he suffered a stroke, which made it difficult for him to talk and prompted one CMS doctor to note he "speaks gibberish." Although Griffin was able to complain about the painful swelling of his arm and legs, he received no treatment other than Tylenol.
In April last year, a sheriff's deputy left a note at the Highland Park home of Griffin's sister, saying he was hospitalized in critical condition. Even then, after a blood test showed his kidneys were failing, CMS delayed calling in a kidney specialist, Cohen wrote. Griffin died May 9, 2005, at age 51.
If the doctors had to examine him, "they would have seen a very sick man, in need of urgent care," Cohen wrote.
Yvonne Griffin said she asked the Corrections Department to release her brother's body so he could be buried next to their mother but was refused. He was buried on a hill behind the prison, Cherry Hill Cemetery, where 828 inmates whose families were too poor or too indifferent to pay for a funeral have been buried since the 1930s.
'A very tragic case'
Next to Griffin is the grave of Steven Boals, whose lung cancer care "was unnecessarily and repeatedly delayed," Cohen wrote.
Hakim Muhammad, who died of non-Hodgkins lymphoma, is buried nearby, although his small, cement headstone incorrectly identifies him as "M. Hakim." He was discharged from Jackson's Foote Hospital and admitted to the prison hospital after a case manager, noting his stay had cost $170,000, expressed doubt CMS would pay for further inpatient care.
"A very tragic case," Cohen wrote. "Had he been treated aggressively with appropriate chemotherapy five or six or seven months earlier, before he developed acute renal failure, his response would probably have been much better."
Until recent years, a prison chaplain would say a few words at a graveside service, but no more, a prison employee said. Two or three times a month, "the funeral director brings 'em, and we put the body in the hole in a vault and cover it up," the employee said.
Ten empty vaults were stacked nearby.
Send e-mail to the author: pshellenbarger@grpress.com