PCI, 1114 Brandt Drive, Tallahassee FL 32308


Polk County Jail

Des Moines
Correctional Medical Services
Jun 5, 2016
Daughter: Murder suspect's trial — and health — on hold at Polk County Jail
Theresa Maher knows that when this story hits the internet, trolls will have a field day with their opinion of her mother and her condition.
She doesn’t care. They don’t know Pamela Jean Bullington or what she has lived through. Maher has got a question she feels needs to be answered: If her mother were any other woman, would she have to endure the extreme discomfort she’s going through at the Polk County Jail? Bullington's situation raises larger questions about whether the jail and its for-profit medical contractor are making decisions to cut costs at the expense of inmates' suffering. The 57-year-old made headlines a year and a half ago after she allegedly shot her longtime boyfriend, Jack Duane Dennis, in the head with a pistol and then called police. She reportedly told a dispatcher she would be sitting on the back porch, waiting for officers at a house the two shared near the Iowa State Fairgrounds on Des Moines’ east side. Bullington has pleaded not guilty to first-degree murder. She told police she was the victim of domestic violence at the hands of the 69-year-old Dennis. The record will show Dennis was no saint: He had a long history of arrests for consumption and intoxication, drunken driving, trespassing, disorderly conduct, assault, attempted murder and felony terrorism — and just before he died in 2014, domestic abuse causing injury. He pleaded to the lesser charge of assault on that last one and got two days in jail. Bullington's trial has since been delayed so she can recover from a hysterectomy that has not been performed. A recommendation was made, and preoperative appointments were scheduled. But in April, a medical expert sought by Corizon Health, the private, for-profit Tennessee company that oversees the Polk County Jail’s medical care, examined Bullington and decided surgery wasn’t necessary. Maher says her mother’s medical problems have only worsened since then. Bullington ultimately learned that her weakened vaginal wall had prolapsed, sending her bladder, uterus and rectum into the vaginal cavity. Her bladder now protrudes from her vagina, signaling an advanced stage III prolapse. Laugh if you want, but prolapses are pretty common. The result for Bullington is that if she coughs, she wets her pants. If she needs to urinate, she has to reach down and tap or massage her own protruding bladder so she can go. Suffice to say, bowel movements are difficult. The problem has been so uncomfortable, and the taunts around the Polk County Jail so bad, Bullington had to move to a single jail cell, away from other inmates, her daughter says. Maher contacted the Reader’s Watchdog, and her mother signed a medical release, so others were free to talk about why she is not being allowed to have the surgery she has said she needs. Most of the cost of any inpatient surgery would likely be borne by Medicaid, whether Bullington was in jail or not. But the county is ultimately responsible for what costs aren’t covered. Maher believes Corizon is not approving the surgery in order to save money. “Would anybody else in the world have to live like this?” she asked. “Would they be as likely to turn surgery down if she were not in jail?” Maher asked that I attend a court hearing Tuesday in Polk County District Court to help find answers. At the hearing, Judge Jeffrey Farrell was asked whether Bullington could have a second opinion from an expert not chosen by Corizon. Bullington’s attorney, Matt Sheeley, argued that his client may not be physically able to stand trial in September. He argued that it would be almost impossible for her to focus on the trial, which could last up to two weeks and decide whether she spends the rest of her life behind bars. Sheeley said he has been unable to find to any case law that applies to the issue. “If she had a broken leg, the court would suspend the proceeding until she received the necessary medical care,” Sheeley said. He added: “The sheriff has the obligation as keeper of the jail to provide the necessary medical care.” Via telephone, Dr. Emily Chang, the Des Moines gynecologist tapped by Corizon to evaluate Bullington in April, testified that she recommended that the inmate first undergo physical therapy sessions before trying surgery. But Chang, who has never worked with a Polk inmate before, acknowledged that only about 10 percent of her patients with similar conditions choose that option over surgery. And she said the likelihood of physical therapy working on a prolapse as advanced as Bullington’s was “less than 50 percent.” Asked by Sheeley if she considered the upcoming trial as a factor before making her recommendation, Chang said she did not. Dr. Glenda Newell-Harris, regional medical director for Corizon Health in California, reviewed Chang’s notes and ultimately declined to authorize the surgery. But here’s the thing: As of Tuesday's hearing, no one at Corizon or the jail has initiated the physical therapy sessions Chang recommended in April. Those sessions promise to come with their own costs to the county for transportation and escorts by deputies. In the end, physical therapy could prove more costly to the county than surgery, said Frank Marasco, a top jail official. Her face drawn, Bullington testified briefly about her condition Tuesday, telling Farrell in a soft monotone that she already has tried Kegel exercises to try to fix the problem. “People don’t know what I’m going through,” she said. Marasco, who manages the jail’s medical contract as head of the sheriff’s planning and development department, said repeatedly during the hearing that cost “doesn’t play a role in making medical decisions” at the jail. Asked by Sheeley if he was trying to keep costs down, Marasco said: “I think we have a fiduciary responsibility to taxpayers. However, we would never avoid an expense if it’s necessary.” An online search for more information about stage III prolapses of the bladder suggests that it wouldn't be hard to find someone with a differing opinion about what’s necessary. An article about the condition, written by Dr. Matthew Barber of the the Cleveland Clinic, one of the top-ranked hospitals in the country, said some patients with severe prolapse do fine without treatment for years. But once they have difficulty emptying the bladder or other discomfort, he recommends surgery. “Typically, we recommend surgery to women who have stage 3 or 4 prolapse (i.e., prolapse that protrudes more than 1 cm beyond the vaginal opening with straining) or women with stage 2 prolapse who have bothersome symptoms,” wrote Barber, a former president of the American Urogynecologic Society. Bullington's condition is not life-threatening, but it will worsen over time, such articles suggest. At the heart of the debate is whether the surgery is a choice or an emergency. Judge Farrell said he will likely decide within a week what to do next. In Florida, Idaho, Indiana, Minnesota and Pennsylvania, Corizon has been investigated, sued or criticized for failing to provide adequate treatment or authorize more costly health care. The Florida Court of Appeals ruled that it was reasonable for jurors to conclude that the company, previously known as PHS before a merger, delayed medical treatment to save money. Last year, Corizon also refused to provide Polk County Sheriff Bill McCarthy with a copy of a report on inmate Jeff Cornick's suicide. And in August 2013, a Corizon nurse was supposed to be monitoring inmate Ieasha Lenise Meyers, who complained of being in labor. Meyers, 25, gave birth on the floor of her cell. Her cellmates assisted with the delivery while the nurse did rounds in other parts of the jail. Marasco said he's not aware of any situation in which Corizon failed to obtain medical help for an inmate because of cost. The company, the jail's health services provider since 2008, is being replaced by another Tennessee company July 1. But Marasco said the switch wasn’t performance-based. Correct Care Solutions, the low bidder, won the new contract. Marasco said Correct Care Solutions was chosen by consensus, in large part because it promised better training in mental health and suicide prevention for jail staff. The new contract calls for the company to be paid about $3.2 million in the first year — less than the $3.5 million paid Corizon this year, Marasco said. The new company plans to reduce staffing at the facility by about six hours a week, and shift more staff to nighttime hours when the jail can be flooded with new prisoners, Marasco said. The jail will have nurses on staff around the clock with psychiatrists, dental assistants, dentists and other medical professionals less frequently. The county pays for pharmacy costs and off-site medical services. Maher says her mother, a lifelong alcoholic and drug abuser, called her three times the night she allegedly shot Dennis. The first time, Maher didn’t pick up. The second time, Bullington said, she awakened to Dennis trying to suffocate her with a pillow. She also wanted her daughter to know she had a knife hidden under her pillow. Less than 10 minutes later, Bullington called her a final time that night. “She said, ‘I did it. I killed him,'” Maher said. “I told her to hang up right now and call police. And then I called police to make sure she did.” Bullington's case has all the signs of battered women’s syndrome. Abused as a child, she married at age 14 or 15, Maher said. “I can’t remember a time when my mom wasn’t addicted to something." One of Bullington’s boyfriends broke all her teeth and the bones in her face, then left her by the side of a road, Maher said. Maher said her mother tried to leave Dennis because of the frequent beatings, but she returned because he supplied her with drugs and alcohol. Bullington called police in April 2014 and said she "feared for her life" because Dennis held a loaded gun to her head. He also threatened to burn down homes of her family members, police reports show. A jury, of course, will ultimately decide what Bullington deserves as punishment. Maher says she wants her mother to have the surgery so she can finally go to trial. If the verdict sends her mother to Mitchellville women’s prison, she’s fine with that. That’s where she believes the healing will finally begin.

November 24, 2006 Des Moines Register
Polk County supervisors, concerned that a privately run jail medical clinic hasn't pinched pennies enough, have launched a search for someone to keep an eye on how it is operated. Supervisors voted unanimously this week to hire a new "health services administrator" to oversee the county's contract with Correctional Medical Services Inc., a St. Louis company. The job, intended to be filled by a registered nurse with managerial experience, will pay between $62,012 and $81,744 a year. County Administrator Michael Freilinger said the new employee will be expected to wrestle with the ever-expanding cost of medical care for more than 500 prisoners and help plan for the 2008 opening of a new 1,549-bed jail. Polk County authorities have watched inmate medical costs increase from $1.4 million in the budget year that ended in June 2003 to roughly $2.4 million projected for 2006-07. County officials say Correctional Medical has blamed much of the increase on drug costs. Correctional Medical, one of only a handful of private companies that run jail clinics, has managed medicine in the Polk County Jail since 1998. The company has faced several inmate lawsuits in recent years, mostly based on allegations of delayed care or the use of substitution drugs in a bid to contain costs.

June 9, 2005 Des Moines Register
The Polk County Board of Supervisors will pay $35,000 to settle a lawsuit filed by relatives of a man who died in the county jail after his arrest for reckless driving. Mark Girres, a 58-year-old diabetic, died in 2003. His daughters sued, alleging that sheriff's deputies and medical staffers from Correctional Medical Services of St. Louis ignored warnings about Girres' health and put off care. During the past decade, more than a dozen inmates or their families have alleged that officials delayed or denied treatment. Among them were two cases that the county also settled out of court: an HIV-positive man charged with driving drunk who spent 11 days in a coma after he said jail medical workers delayed treating his low blood pressure, and another inmate who said she suffered permanent tendon damage after she had to wait days for treatment of a knife wound to her hand. Girres, a retired tree-trimmer for the city of Des Moines, was arrested Sept. 19, 2003, after his car collided with a light pole, a parked vehicle and a fence at an Ingersoll Avenue gas station. Girres' daughters said the collisions were a sign he needed medical attention. Girres was booked Sept. 20. A guard noticed Girres seemed ill and recommended he be closely watched. The lawsuit alleged that Girres was moved but not treated. He died Sept. 22 at a hospital.

May 5, 2005 Des Moines Register
Polk County taxpayers will pay 20 percent more to provide medical services for the nearly 17,000 people that law enforcement officials expect to lock up next year. The county, which on average has reported a more than 5 percent annual inmate increase over the past decade, will pay $1.8 million for doctor visits, hospital stays, prescription drugs, dental care and mental health in the budget year that starts in July. That's $300,000 more than this year. For the seventh consecutive year, the county Board of Supervisors will hire Correctional Medical Services, a St. Louis company, to administer the jail health program. Supervisors have praised the company for consistent and quality care during the years. But both the company and the jail have been criticized by inmates and their families. After the 2003 death of Mark Girres, 58, an imprisoned Des Moines diabetic, his survivors alleged that jail officials knew about his illness but did not fully evaluate his health or give him needed care. Jail officials denied wrongdoing, and Iowa's ombudsman's office investigated that and other complaints but ruled that jail officials have made substantial improvements that will prevent future problems. Tracie Botts of Des Moines, who spent six months in jail last year on drug charges, offers a mixed assessment. She claims a fellow inmate endured constant pain from a stomach ulcer and was denied medication for months. At the same time, however, Botts said she was able to kick her addiction to crack cocaine thanks to treatment provided by the jail. "That other girl, she had this bleeding ulcer and was more or less ignored," Botts said. "I got the treatment I needed, and it worked for me. I'm a year clean and counting."

October 7, 2004 Des Moines Register
A Des Moines woman contends that Polk County Jail officials haven't kept a promise to make "substantial and meaningful" changes to medical policies she blames for her incarcerated son's suicide attempt last year. Audrey Rivas said a letter from the state ombudsman's office confirmed that jail officials acknowledged at least some mistakes prior to Robert Rivas' attempted Tylenol overdose. The admission came three months after the 2003 death of an imprisoned Des Moines diabetic, Mark Girres, 58, who allegedly was denied medical attention following his September 2003 arrest for reckless driving. A Polk County lawsuit claims jail officials did not evaluate Girres' health despite repeated warnings about his illness and erratic behavior before his death. Rivas said the two cases demonstrated a pattern of poor medical care at the jail. The ombudsman also faulted Correctional Medical Services, the jail's privately run medical clinic, for failing to adequately assess Rivas' need for a prescribed antidepressant, which the clinic had refused to provide. The lawsuit, filed by Girres' two daughters, accuses deputies and Correctional Medical of negligence.

September 29, 2004 Des Moines Register
Relatives of a 58-year-old diabetic arrested for reckless driving last year have sued Polk County Jail officials, alleging that deputies and a private medical company were negligent for allowing the man's illness to go untreated until he died. A spokeswoman for St. Louis-based Correctional Medical Services said patient confidentiality rules forbid any comment on Girres' case. She stressed that medical staffers "work very hard every day to meet the medical needs of inmate patients in Polk County." Court papers state Girres, who originally was booked into the Des Moines City Jail, was transferred to Polk County's custody about 1 p.m. last Sept. 20. A questionnaire filled out then shows Girres told jailers that he suffered from both diabetes and liver cancer but that no medications were required. Jailhouse reports state Girres was refusing food by the evening of Sept. 20 and "does not appear to be in good health." That night, according to the lawsuit, Girres was transferred into administrative segregation because he was "seemingly disoriented" and "acting and talking too crazy" to remain in a regular cell. "The family has reviewed all records pertaining to his incarceration," Girres' daughters said. "We are deeply saddened by the withholding of medical attention in spite of 12 separate documented instances in which medical attention was clearly warranted." By Sept. 21, Girres was talking to himself, defecating on himself, "bleeding from open wounds" to his arms and "incoherent," according to the lawsuit. A 2002 Des Moines Register article described more than a dozen allegations that Correctional Medical officials delayed or denied treatment to Polk County inmates during the company's first four years controlling a jailhouse medical clinic.

Pottawattamie County Jail
Pottawattamie, Iowa
Correctional Medical Services
December 20, 2005 The Daily Nonpareil
Pottawattamie County spends more than $650,000 a year on health care for inmates at the county jail, but a new way to save money might become a reality early next year. "It's one of the most substantial costs for the jail," said Supervisor Loren Knauss. "We are forced by federal and state laws to spend more on medical care for inmates than what we do for our veterans." The county has been paying a private firm, CMS, $55,000 a month or $660,000 a year to oversee health care needs for the county's prisoners. The firm, however, announced Monday it plans to cease its operations in February to concentrate on larger state and federal prisons. The Board of Supervisors gave permission to Sheriff Jeff Danker and others at the jail who oversee the inmates' health needs to look into the possibility of the county taking over the operation to save money. "It could be a bunch of savings," Supervisor Delbert King said. Under one possible alternative, the county would hire the three nurses and the administrator currently there as county employees and contract with a local doctor when needed. Inquiries will also be made to see if it's cheaper for the county to purchase prescription drugs locally. CMS, a national company, has its own drug buying policy. The staff provides 16 hours of health care daily for the more than 250 inmates currently housed in the jail. Knauss said this new procedure might save as much as $100,000 a year. "It's a big help to the taxpayers," King added.