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Alachua County Jail, Gainesville, Florida
January 13, 2005 WCJB TV20
An Alachua County inmate was still warm to the touch Wednesday when Alachua County Sheriff's deputies found him dead in his cell. Investigators say it was an apparent suicide raising questions about mental health care at the jail.

Delaware Department of Corrections
May 11, 2006 News Journal
State Sen. Harris McDowell III, D-Wilmington North, has added another bill to an assortment of pending measures designed to address the medical condition of inmates in Delaware's prisons. Senate Majority Leader McDowell on Wednesday introduced Senate Bill 306, which would require the state Medical Examiner's Office to investigate each death in a state correction facility and conduct an autopsy. The bill follows a series in The News Journal last fall that detailed a large number of deaths inside state prisons and inadequate medical care. The series helped prompt an investigation by the U.S. Department of Justice.

March 9, 2006 News Journal
After years of high inmate death rates due to HIV/AIDS, suicide and poor medical care, federal civil rights regulators have launched an investigation of Delaware's prison medical system -- a process that could take years to complete and forever change the way the state treats its 6,800 inmates. The investigation comes on the heels of a five-month preliminary inquiry by the Justice Department during which federal regulators interviewed many of the same medical experts, inmates and families of dead inmates who spoke to The News Journal late last year during the newspaper's six-month investigation of prison health care. As with the newspaper's investigation, the Justice Department uncovered significant problems at the Delaware Department of Correction. The federal investigation now may involve FBI agents and grand juries with subpoena power."Thank you, Jesus. I've been praying for this so hard," said Susie Wilson, whose son, Jermaine Lamar Wilson, was found hanging in his cell with blood-stained clothes and a gash on his head. It was Feb. 18, 2005 -- the day his family says he was scheduled to be released after serving time for robbery. Wilson's death is now the focus of a federal wrongful death lawsuit, which claims Jermaine Lamar Wilson was murdered while being held at the Delaware Correctional Center near Smyrna. The federal investigation will be conducted by the Special Litigation Section of the Justice Department's Civil Rights Division. A News Journal special report on inmate health care published in September revealed sometimes gruesome details of neglect, such as an inmate's massive brain tumor -- largely ignored by staff -- which led to his death, and an outbreak of flesh-eating bacteria. Other findings of the newspaper's six-month investigation were inmate death rates -- specifically AIDS-related and suicide -- far above the national norm. During the newspaper's investigation, reporters discovered that Minner and Taylor awarded a $25.9 million no-bid contract for inmate health care to Correctional Medical Services -- a private medical contractor with a history of litigation over how the company provides medical care. Minner and Taylor also refused to release -- publicly or to lawmakers -- an audit of prison health care they say prompted the emergency hiring of CMS. Former prison doctor Ramesh Vemulapalli, an AIDS specialist practicing in Dover, said the investigation is long overdue. Vemulapalli said he quit working in Delaware prisons because he was not allowed to provide adequate care. "I think the investigation will help make reforms in the prison system," Vemulapalli said. "It's a good thing. It will benefit the people of Delaware."

February 18, 2006 News Journal
Correction Commissioner Stanley W. Taylor Jr.'s failure to properly train his staff to recognize suicidal inmates and properly care for them allowed Christopher Barkes to hang himself in his prison cell in November 2004, a federal lawsuit contends. The lawsuit, filed in U.S. District Court in Wilmington by his family members, said the prison's former medical provider also failed to properly train staff to recognize and properly care for inmates who had made previous attempts on their lives. That medical provider, Arizona-based First Correctional Medical, or FCM, pulled out of its contract last year. During his time at the Young Correctional Institution in Wilmington, the suit said, Barkes told prison officials he had attempted suicide before. Prison staff placed him in a cell alone, though, with no suicide watch, the suit said. Barkes, 37, was found unconscious the following morning and taken to Christiana Hospital, where he died. Prison officials determined Barkes used his bedsheet to hang himself. Taylor often defends his department by noting it is accredited by the national commission, a process that cost taxpayers $12,400. Taylor, though, has declined to make public an audit by the commission on prison health care, saying it contains inmate medical information and peer reviews of doctors. Lawmakers, who have repeatedly asked for the report, even if elements are blacked out, are considering legislation to make it public. Barkes' case came to light during an investigation by The News Journal last year. The six-month investigation highlighted allegations by inmates of poor medical treatment for cancer, meningitis and hepatitis; a no-bid $25.9 million contract awarded to the current health care provider, Correctional Medical Services, based in St. Louis; and a comparatively high rate of AIDS-related inmate deaths and suicides over a four-year period. Another lawsuit filed by a prisoner highlighted in the newspaper articles was settled out of court in October. Anthony Pierce, also known to inmates as "the brother with two heads," was serving a 14-month sentence for a parole violation when a small lump appeared on the back of his head. At the time, a prison doctor employed by Correctional Medical Services said the marble-size lump was a cyst or an ingrown hair. The tumor kept growing, and on March 22, 2002, Pierce died from a "brain tumor, due to osteosarcoma of the skull," according to an autopsy report. The conditions revealed in the articles are the subject of an inquiry by the U.S. Department of Justice's Civil Rights Division. "Stan Taylor said that they follow the guidelines, and it is clear that they didn't," said Barkes' wife, Karen. She also said "it is discouraging that the lawmakers aren't doing anything to change the problems in the prisons." The lawsuit targets Taylor and FCM, along with prison warden Raphael Williams, the Department of Correction and unknown Correction Department and FCM employees. The suit, which alleges wrongful death and cruel and unusual punishment, seeks compensatory and punitive damages to be set by the court. Contact Esteban Parra at 324-2299 or Contact investigative reporter Lee Williams at 324-2362 or

February 16, 2006 Delaware State News
The legislature’s budget-writing committee on Thursday urged the head of the state Department of Correction to release a 2005 report evaluating prisoner medical care. Should the report stay under wraps, some of the panel’s members are ready to include language in the fiscal year 2007 budget bill forcing it to be made public. The audit, performed by the National Commission on Correctional Health Care, turned up enough deficiencies that DOC switched care providers. The contract with Arizona-based First Correctional Medical was terminated and the state signed a deal with St. Louis-based Correctional Medical Services. Legislators, the Delaware State News and other news organizations requested copies of the report last year under the Freedom of Information Act, but were denied.

January 26, 2006 Wilmington News Journal
Lee McMillan, whose husband nearly died in prison after flesh-eating bacteria attacked his body, wants to know why the state won't release an audit of Delaware's prison health care system. So do some legislators, who are backing a bill that would require the state to release the audit and similar reports -- as long as confidential information such as personal medical records is withheld. House Bill 320, sponsored by Rep. Nancy Wagner, R-Dover North, would make reports that are paid for with public funds open to the public under the Freedom of Information Act. The News Journal requested the audit, which cost taxpayers $12,400, while investigating AIDS-related inmate deaths and suicides of Delaware prisoners as well as reports of poor medical treatment for cancer, meningitis and hepatitis. Prompted in part by a series of News Journal stories, the U.S. Department of Justice is conducting an inquiry into the Department of Correction's management and inmate health care. In defending his record, Correction Commissioner Stan Taylor pointed to the audit, prepared by the National Commission on Correctional Health Care, but denied a Freedom of Information request for the report by the newspaper. Taylor and former Attorney General M. Jane Brady ruled the accreditation report was not a public document. Taylor, though, said the audit was critical of the work of First Correctional Medical, a Tucson, Ariz., company. In July, Gov. Ruth Ann Minner and Taylor awarded a $25.9 million no-bid contract to Correctional Medical Services of St. Louis to pick up the provision of medical care in Delaware's prisons. Rep. Pamela S. Maier, R-Drummond Hill, is a House co-sponsor who said she believes that "sunshine helps" in governmental affairs. "I think the public needs to know, and if they're not satisfied, we need to keep the pressure on the Department of Correction and [prison health care provider Correctional Medical Services] to improve the health of our prisoners."

November 18, 2005 Wilmington News Journal
A Department of Correction official said Thursday that Medicaid and its former medical service provider owe St. Francis Hospital less than $500,000 in past-due bills. That amount is half of what a committee reported they owed the hospital two months. But exactly how much Medicaid and Arizona-based First Correctional Medical, which provided services to the prison until July, owe St. Francis and other health care providers remains unknown, said Joyce Talley, the department's bureau chief of management services. It's also unclear what portion of the unpaid bills is owed by Medicaid and by First Correctional Medical of Tucson, Ariz. "I still don't have my arms around the whole thing," Talley said. First Correctional Medical's owner and founder, Dr. Tammy Kastre, did not return calls made to her firm Thursday.

November 8, 2005 Wilmington News Journal
Family members of dead, dying or grievously ill inmates lashed out at Correction Commissioner Stan Taylor on Monday night, accusing Taylor and the prison's medical vendor of causing illnesses and deaths by providing inadequate medical care to the state's 6,800 inmates. Some of those who testified said the state treats its inmates worse than animals. The public scolding occurred at an "informational" hearing called by Speaker of the House Terry Spence, R-Stratford, and Rep. Pamela S. Maier, R-Drummond Hill, who sought to educate lawmakers about prison conditions before the upcoming legislative session. "It's your facility -- clean it up," Matilda Carello, whose son is an inmate with Grave's disease, yelled at Taylor, who was sitting by her side. Also in the audience were representatives from Correctional Medical Services, the company Taylor recently awarded a controversial $25.9 million no-bid contract to run inmate health care. "CMS -- you're a liar," Carello said. "Stan Taylor -- you are a liar!" After about 50 witnesses from the public testified at the hearing, Spence said "it's time for a gut check." "We've lost confidence in the department," he said. "We've lost confidence in CMS." Spence called for an independent oversight panel for the department and CMS. Ann Mac, a nurse practitioner and CMS vice president of operations, told lawmakers and inmate family members that "delivering health care in prisons is a uniquely challenging but very rewarding field." Her message was not well received. "I am sorry, but the things being said from this lady -- this is not what's really going on inside," said Lee McMillan, who says her husband, an inmate, nearly died when flesh-eating bacteria ravaged his body. Monday night's hearing was scheduled after a six-month investigation by The News Journal found a high rate of AIDS-related inmate deaths and suicides over the past four years, and uncovered allegations of poor medical treatment for cancer, meningitis, hepatitis and other communicable diseases and bacterial infections. Prompted in part by the newspaper's series, the U.S. Department of Justice has launched a preliminary inquiry into the Department of Correction's management and inmate health care. Maryanne McGonegal, secretary of Common Cause, criticized Gov. Ruth Ann Minner for failing to address evidence of negligent inmate care. On Oct. 3, Common Cause of Delaware asked U.S. Attorney General Alberto Gonzales to open a federal investigation. "The lack of response by our governor is the strongest indication of the need for outside oversight of prison conditions," McGonegal said Monday night. Several of those who testified said after the hearing that Taylor should release a recent audit of inmate health care under the state's former prison medical vendor, First Correctional Medical. Performance audited: Taylor asked a medical accreditation firm to audit FCM's performance from December 2004 to January 2005. According to documents Taylor provided to lawmakers, the audit showed "several problems with medical administration and clinical practices including record keeping, utilization management, medical history and sick call follow-up." The News Journal submitted a request under Delaware's Freedom of Information Act for the audit, which cost Delaware taxpayers $12,400, but Attorney General M. Jane Brady denied the newspaper's request. Former CMS substance abuse counselor Denise Rodriguez said she supports punishment for those who break the law. "But that punishment should not be neglect, humiliation or death," Rodriguez said. Rodriguez, who worked for CMS at Gander Hill from 1999 to 2002, told The News Journal in a previously published story that a CMS official ordered her to falsify documents so state inspectors would not pull the company's license to run a prison treatment program. "Stan Taylor, I always told my clients that in order to make changes in your life, you have to hold yourself accountable," she told Taylor at Monday's hearing. "Someone needs to hold you accountable."

October 22, 2005 Delaware State News
The Medical Society of Delaware on Saturday urged lawmakers to create a prison health care oversight committee and implement mandatory HIV and hepatitis C testing for inmates. The medical society's voting body, the House of Delegates, approved the two prison health resolutions unanimously at the society's annual meeting, which about 240 physicians attended. Delaware's prison health care system has come under fire of late, with accusations of inadequate care prompting an inquiry by the U.S. Department of Justice's Civil Rights Division. The St. Louis-based Correctional Medical Services has a contract with the state to provide health care to inmates. Delaware physicians currently serve in an advisory capacity, but Dr. James P. Marvel Jr., president of the medical society and an orthopedic surgeon in Lewes, said they need actual authority to oversee the care provided behind bars. Physicians on the society's Prison Health Committee are responsible for reviewing the medical records of inmates who have died while incarcerated, Dr. Marvel said. "We're supposed to review the deaths. But we often don't have all the records available to us. "We're sort of working with one hand tied behind our back." The resolution calls for an independent oversight committee authorized to review the quality of health care services. The committee would consist of doctors, psychiatrists, nurses, lawyers, pharmacists, members of the Delaware Center for Justice, and representatives from the prison care provider, according to the resolution. Dr. Joseph F. Hacker III, chairman of the society's legislative committee and an upstate gastroenterologist, said the oversight body should report to the legislature, rather than the governor.

October 23, 2005 Wilmington News Journal
Democratic lawmakers want Correction Commissioner Stan Taylor to answer lingering questions about health care in his prisons. In a letter sent Thursday to Taylor -- signed by 16 senators and representatives -- the lawmakers requested both answers and a personal briefing by the commissioner "as soon as you are able to gather this information." "It is not intended as criticism of the administration," said Sen. Patricia M. Blevins, D-Elsmere, who signed the letter. "At this point, we are seeking information on policy and procedure." Attached to the letter were 21 questions, including what criteria are used to approve or deny an inmate's request for health care and policies regarding HIV testing and treatment. They also want to know what continuing medical responsibility the Department of Correction takes after a prisoner is released. The letter was sent after a series of News Journal articles highlighting AIDS-related inmate deaths and suicides over the past four years; a no-bid $25.9 million contract awarded this year to St. Louis-based Correctional Medical Services to manage health care in the state's prisons; and allegations by inmates of poor medical treatment for cancer, meningitis and hepatitis.

October 21, 2005 Wilmington News Journal
The Department of Correction's former medical provider owes nearly $1 million to St. Francis Hospital and late last month other state health care providers were boycotting the department's current provider because of past-due bills, according to documents obtained by The News Journal. The unpaid medical expenses were run up by First Correctional Medical of Arizona, which held the contract to provide inmate health care in Delaware prisons from 2002 until July. The firm's owner and founder, Dr. Tammy Kastre, did not return calls for comment. Delaware taxpayers may be asked to pay the prison's delinquent bills, state Auditor R. Thomas Wagner Jr. said. "The fact that the government is stiffing the public bothers me greatly," said Wagner, who is considering an audit of medical spending by the DOC. The $1 million owed to Wilmington's St. Francis was disclosed in the minutes of the DOC's Medical Review Committee, which is composed of correction officials and private medical providers. According to the minutes, CMS regional manager Mike Hooper told members of the committee the company is having difficulty contracting "with a number of providers in the community ... [and would] provide an updated list of vendors refusing to sign with CMS due to FCM."

October 18, 2005 Delaware News Journal
While in a state prison last year, Delaware's private health contractor gave Motrin to Ed Brittingham to treat the bacteria that was eating away at his flesh. A concerned guard eventually sent the inmate to St. Francis Hospital in Wilmington -- where doctors administered massive doses of antibiotics. Today, Brittingham is free of the bacteria that nearly killed him -- but he's still getting hospital bills. Current and former inmates are being billed thousands of dollars for medical care they received while incarcerated by the Delaware Department of Correction, which contracted with the Tucson, Ariz.,-based First Correctional Medical, a private health care provider. Brittingham's bills are estimated at $2,100. His common-law wife, Lee McMillan, says those bills are the responsibility of FCM, the private health contractor. "What happened to all the millions of dollars the state paid FCM to take care of Ed and the other inmates?" asked McMillan. "Where did all that money go?" Department of Correction spokeswoman Beth Welch, responding in an e-mail, wrote: "The DOC is aware of the billing issues. We have been pro-actively working with the Budget Office, the Attorney General's Office, the Medicaid Office and the sub-vendors to address outstanding FCM bills as well as bills being received by inmates and/or inmate's family members. Also, the DOC is working with several inmates and inmate's family members on this issue." Welch did not know the total amount FCM owes clinics and hospitals. "I've got an inquiry out," Welch wrote.

October 12, 2005 Delaware State News
Acting on advice from the Delaware attorney general's office, the Department of Correction on Tuesday rejected a request from the Delaware State News to provide a copy of an audit performed earlier this year on the prison healthcare system. After a State News reporter orally asked DOC spokeswoman Elizabeth Welch for the audit, she told the reporter to file a written request under the Freedom of Information Act. The DOC asked the National Commission on Correctional Health Care to perform the audit in January after the agency uncovered problems with the company providing medical care to prisoners. The audit's results led to the state terminating its contract with First Correctional Medical Delaware effective July 1. Commissioner of Correction Stanley W. Taylor, during an interview last week, declined to give specific examples of deficiencies in First Correctional Medical's performance. John D. Flaherty, a lobbyist for the good-government group Common Cause, said the audit should be released because of the public interest in the prison healthcare system and recent newspaper reports questioning the quality of care. "I would think they would want to err on the side of public welfare and release this document," Mr. Flaherty said. "I can see no reason why this should not be a public document."

October 5, 2005 Delaware State News
The U.S. Department of Justice will review claims that the state Department of Correction has exhibited a pattern of providing inadequate medical care to inmates. U.S. Attorney for Delaware Colm F. Connolly said Wednesday that the justice department's Civil Rights Division has opened a preliminary inquiry into the allegations. Mr. Connolly said the division would collect information and "see if it warrants a full-blown investigation." The inquiry, Mr. Connolly said, stems from a series of articles in a Wilmington newspaper, which he forwarded to the Civil Rights Division in Washington. Articles in The News Journal highlighted inmate suicides and AIDS-related deaths over the last four years, allegations by inmates of poor medical treatment and a no-bid $25.9 million contract awarded this year to St. Louis-based Correctional Medical Services to provide medical care to inmates.

October 5, 2005 Wilmington News Journal
The Civil Rights Division of the U.S. Department of Justice has opened a "formal inquiry" into medical care and other systemic issues inside Delaware prisons, U.S. Attorney Colm Connolly said Tuesday. A formal inquiry is a precursor to an investigation by the Justice Department. During an inquiry, the Civil Rights Division reviews allegations to determine merit. Depending on the findings, a formal investigation can be launched. The newspaper's six-month investigation highlighted AIDS-related inmate deaths and suicides over the past four years; allegations by inmates of poor medical treatment for cancer, meningitis and hepatitis; and a no-bid $25.9 million contract awarded this year to St. Louis-based Correctional Medical Services to manage health care in the state's prisons. Susie Wilson, whose son Jermaine died in a Smyrna prison, said a federal investigation is needed because the state is not capable of impartially investigating itself. "I believe it will make the [Minner] administration shape up or ship out," Wilson said. Wilson's son was found Feb. 18 hanging from a bedsheet in the Delaware Correctional Center eight days after court documents indicate he was supposed to have been released. Most inquiries focus on medical care. However, complaints about excessive force, mental health care, safety, AIDS care and screening, environmental health and safety, sanitation and food service also are covered. When problems are found, the Justice Department can sue the prison in federal court for relief. The Special Litigation Section, the arm of the Justice Department's Civil Rights Division responsible for enforcing CRIPA, has never lost a case.

September 30, 2005 Wilmington News Journal
The extraordinary four-part News Journal series about myriad problems within the Department of Correction health care system cries out for response from the governor and state lawmakers. The series detailed the spread of AIDS and other infectious diseases inside the prisons, high-rates of suicides and AIDS-related deaths, minimal oversight of medical care and numerous reports of inadequate medical attention to inmates' conditions. But instead of outcries, with only a few exceptions, the public is confronted with a deafening silence. Those whose legislative record would suggest they would embrace concern for the plight of inmates victimized by substandard health care are mute. Where are the liberal Democrats like Sens. Harris McDowell, Karen Peterson and Robert Marshall? Where is Gov. Ruth Ann Minner, who vowed last year to aggressively address prison correction officers' low pay and mandatory overtime? So far, we've heard from two potential Republican gubernatorial candidates, Sen. Charles Copeland of Greenville and House Majority Leader Wayne Smith of Brandywine Hundred, and conservative Sussex Democratic Sen. Robert Venables of Laurel. They certainly aren't among the usual cast of characters lobbying for prisoners' rights. The three called for various levels of investigations. Democrat Rep. Hazel Plant of Wilmington wants Correction Commissioner Stan Taylor fired and an outside investigation. Two other Republican officials, U.S. Attorney Colm Connolly and state Public Defender Lawrence Sullivan spoke out. Mr. Connolly said he passed on complaints. At least Mr. Sullivan has standing on the prison health issues since many of his clients have been affected. The silence of Gov. Minner and her Democratic leaders brings to mind the governor's comment last year in the wake of a kidnapping-rape-hostage incident involving prison counselor Cassandra Arnold. "This isn't something that is unique to Delaware," the governor said. "In prisons, you almost expect this to happen." No, governor, we didn't then, and we don't now.

September 30, 2005 Wilmington News Journal
A day after four Delaware lawmakers called for independent investigations of medical care in the state's prisons, Department of Correction Commissioner Stan Taylor admitted there were problems and promised to cooperate with any inquiry. "I am not saying that nothing is wrong," said Taylor, who met with some of Gov. Ruth Ann Minner's senior staff Thursday. "We take our responsibility seriously." Minner declined to specifically address a series of News Journal articles published this week that examine the state's AIDS-related inmate death rates -- the highest in the nation in 2001 and 2003; an inmate suicide rate in 2000 and 2001 that was twice the national average; reports of undiagnosed flesh-eating bacteria, poorly treated cancer, hepatitis, meningitis and pneumonia; and a no-bid $25.9 million contract awarded this year to St. Louis-based Correctional Medical Services to manage health care in the state's prisons. Outrage about the stories spread Thursday from Delaware's capital to community leaders. The Rev. Christopher Bullock of Wilmington's Canaan Baptist church said his congregation and other clergy plan to march outside the governor's mansion Monday, calling their protest the "March for Justice and Prison Reform in Delaware." "I'm doing this because it's a moral outrage that the Delaware prison system is sick, in need of healing and repentance," Bullock said. "And I'm concerned about the reputation of the state as it relates to how we treat these people." Sen. Robert L. Venables, D-Laurel, said the images of inmate mistreatment were hard to ignore. There have been similar problems with contract medical services in other state prison systems, Venables said. "I'd like to know how much those companies are making this year," he said. "I'd like to know how well the shareholders are sleeping, if they know what's being done to save money." Calling for investigations of prison medical care are Smith, Rep. Hazel D. Plant, D-Wilmington Central, Sen. Margaret Rose Henry, D-Wilmington East, and Sen. Charles L. Copeland, R-West Farms. U.S. Attorney for Delaware Colm F. Connolly said he has forwarded allegations of inmate abuse to the U.S. Department of Justice to review. Sen. James T. Vaughn, D-Clayton, is comparing contracts Maryland and Delaware have with Correctional Medical Services. Forming an independent committee to examine prison health care may be the smartest option, said Delaware Public Defender Larry Sullivan. He said the panel should include doctors and medical malpractice lawyers so the consequences of this kind of treatment are stated as strongly as possible in any report. "I believe that some of the decision makers may have no idea as to the extent of liability exposure the state may have, if this kind of practice is permitted to continue," Sullivan said. "Unless the possible and probable consequences of all of these events are fully understood, there may be an inclination on the part of some decision makers to remedy this 'on the cheap.' " During its six-month investigation of prison medical care, The News Journal submitted a Freedom of Information request to Taylor for the most recent audit report by the commission, which was completed in February. The request was refused. Taylor and Minner have pointed out that prison medical care is scrutinized by the Medical Society of Delaware. But Dr. James Marvel, president of the Medical Society of Delaware, said the state's account of his group's prison work may be overblown. "We don't have any plans to do anything," Marvel said. "We do not have an investigative body. Our prison health committee is simply advisory.

September 29, 2005 Wilmington News Journal
A Senate Republican leader and three fellow Delaware lawmakers on Wednesday called for independent investigations of medical care in the state's prisons. "We have a crisis now," said House Majority Leader Wayne A. Smith, R-Clair Manor. "The system is broken and it needs to be fixed. If I was governor, I would have immediately raked someone over the coals." Federal investigators also have been alerted to allegations of poor medical care provided to the state's 6,600 inmates. The bipartisan response follows a four-day series of News Journal articles detailing the spread of AIDS and other infectious diseases behind bars; the award of a no-bid $25.9 million contract for medical care approved this year by Correction Commissioner Stan Taylor and Gov. Ruth Ann Minner; high rates of AIDS-related deaths and suicides; gaps in independent oversight of the prison's private medical contractor and the prison's medical grievance process; and numerous allegations of inadequate medical care. Rep. Hazel D. Plant, D-Wilmington Central, asked to convene a special House committee to investigate prison medical care. "I would rather see a federal investigation, but if that takes too long, then we need an independent investigation," she said. "I want it to start yesterday." Taylor, Plant said, must go. In a written release to the newspaper, one of Minner's spokespersons wrote: "Providing quality health care services to an inmate population is a very demanding task and a very difficult service to deliver, but it is a program that Commissioner Taylor and the Governor have been working to improve for the past few years, and it will continue to be a priority in the years ahead." U.S. Attorney for Delaware Colm F. Connolly said he's known since September 2004 -- when a local defense attorney told him about poor medical care for a client -- about allegations of mistreatment within Delaware's prison system. "As a result of that complaint, we forwarded it to the Civil Rights Division in Washington," he said. "I've also forwarded the [News Journal] articles." Sen. Margaret Rose Henry, D-Wilmington East, wants to lead a Senate investigation into prison conditions. She hopes to organize a diverse panel that will include legislators, health professionals, prison reform advocates, prison staff and local citizens. She believes such a group should find the root causes of the breakdown in the health care system in our prisons, she said, and how it can be corrected.

September 28, 2005 Wilmington News Journal
There were two Jermaine Wilsons doing time at Gander Hill prison in Wilmington. They were young black men who were unrelated. One, in prison for a robbery charge, had served about three years and was due to be released in February of this year. His mother was picking him up. The other, doing time for violating parole stemming from drug charges, was facing new charges associated with a cocaine bust. He was scheduled in February to be transferred to the maximum security wing of the Delaware Correctional Center near Smyrna -- the state's roughest prison, built for the most incorrigible offenders. But corrections officials sent the wrong Jermaine Wilson to Smyrna. And days later -- when he should have been free, guards found 20-year-old Jermaine Lamar Wilson dead, hanging from a bedsheet in his cell. Because he had a cut on the back of his head, his family suspects he was murdered. "There was blood all over his clothes," said Laretta Wilson, Jermaine Lamar Wilson's aunt. "There was blood in his underwear and all over his pants. Maybe someone hit him on the back of his head?" The Delaware Medical Examiner's Office called the wound "superficial" and ruled the death a suicide. Wilson's family received little information from the Delaware Department of Correction. No apology. No excuse. Just Wilson's blood-soaked clothes. Correction Commissioner Stan Taylor declined to comment on specific inmate deaths, including Wilson's. During a six-month News Journal investigation, a former doctor and two nurses who worked in Delaware prisons and dozens of inmates and their families claimed prison health care in Delaware is dangerously substandard -- leading to needless deaths, prolonged suffering and the spread of infectious diseases inside and outside prison walls. Wilson's death raises a larger question: Are standards throughout Delaware's prison system too low? There are few safeguards in Delaware prisons: oDr. Janet Kramer, of Wilmington, an expert in prison health care, said inmates should be screened for hepatitis C and HIV -- but pretrial and convicted inmates are not routinely screened when they are sent to prison or when they leave. Delaware prisons have become incubators for new strains of the AIDS virus, creating a public health crisis, experts say. oFormer prison doctor Ramesh Vemulapalli says a private medical company ordered him to treat inmates for HIV or hepatitis C, but not both. Delaware led the country in two of the past four years in the rate of inmates dying of AIDS. oInmates in Delaware kill themselves at twice the national rate. Dr. Carol A. Tavani, a neuropsychiatrist and executive director of Christiana Psychiatric Services, said new inmates should be counseled in person about suicidal tendencies, not simply given a "contract" to sign promising not to kill themselves. oUnlike Pennsylvania and other states, Delaware does not have a medically trained state employee overseeing contract health providers. Maryland has its own statewide correctional accrediting agency, Delaware does not. oThe prison's grievance system is overseen by the medical vendor, not prison officials or an independent medical professional. oCommissioner Taylor awarded the current $25.9 million medical contract -- signed this year with Correctional Medical Systems (CMS) of St. Louis -- without putting the contract out for bid. Gov. Ruth Ann Minner approved the decision, but insisted it was a contract extension even though CMS replaced First Correctional Medical of Tucson, Ariz., a different company. oThe state occasionally discharges convicted inmates early so neither the state nor its prison health care contractor has to pay medical costs, leaving the payments to families or the federal Medicaid program. Neither federal prison regulators nor the public is told about inmates who die after such discharges. oThe state does not routinely conduct autopsies on inmates who die in prison or those hospitalized at the time of their death, a policy the president of the National Association of Medical Examiners believes prevents evaluation of the quality of prison medical treatment. And if it does conduct autopsies, the results are sent to the medical vendor -- not the prison. oDr. Robert Cohen, an expert in prison health care whom state and federal courts have appointed to monitor prisons in five states, said the state should investigate medical malpractice claims. Instead, the state's medical board occasionally takes complaints from inmates and their families about prison health care professionals, but it is only an advisory panel. The board's findings are confidential and given to the private medical vendor. Every institution in the Pennsylvania Department of Corrections has a correctional health care administrator whose role is to oversee the medical vendors and investigate grievances and other complaints made against the state's medical vendor -- Prison Health Services. Shirley Laws-Smith -- a registered nurse -- is the correctional health care administrator at SCI Chester. She has counterparts at every facility in the state. If she questions a vendor's procedure, she can take immediate action. "If they make a decision and I don't agree with it, I will contact the central office at the Bureau of Health Care Services," she said. Delaware's inmate grievance process is quite different. In Delaware, no one with any medical training oversees the actions of the medical vendor, and the vendor controls any complaints. When an inmate files a grievance about poor care, it goes straight to the vendor. When an inmate appeals the decision, the grievance eventually goes back to the vendor. All mental health workers in Delaware prisons are contract workers employed by medical vendors.

September 27, 2005 Wilmington News Journal
A Delaware prison inmate serving time for traffic violations -- including driving under the influence of alcohol -- Bernadette Fogell said trouble with her pregnancy started weeks before birth. Prison documents show that she complained to nurses at Delores J. Baylor Women's Correctional Institution in New Castle. But in a lawsuit filed against Delaware's prison medical provider and the state, Fogell claims nothing was done. "What could I do?" Fogell asked. "You're helpless. It's not like you can get in your car and leave looking for competent medical care." Her water broke at 11 p.m. on March 19, 2001. Several inmates on her wing changed Fogell into dry sweat pants. Two nurses arrived and one scolded her, Fogell claimed, suggesting that Fogell's water had not broken. Rather, the nurse suggested, Fogell had urinated in her pants. Fogell was taken to the infirmary, where she was left alone in a filthy room with no sheets, blankets or pillow, she claimed. Prison documents included in the federal lawsuit Fogell filed in 2001 against First Correctional Medical, the state, a local doctor and St. Francis Hospital in Wilmington (which has since been dropped from the suit) show that nurses checked on Fogell until 2:25 a.m. Those same records indicate that Fogell went unchecked between 2:25 a.m. and 8:30 a.m. "I just couldn't figure out why I wasn't going [to the hospital]," Fogell said. At 8:40 a.m. an ambulance was called, and Fogell was admitted to St. Francis Hospital, where doctors told her she would be transferred to Christiana Hospital. Health care workers said they would try to prolong the delivery to allow time for the transfer, Fogell said. It never happened. A doctor arrived about 4:30 p.m., more than 17 hours after her water broke. According to medical records, the doctor wrote there had been "no prenatal complications til now." An hour and a half later, "The nurse came in and told me they were inducing the baby," Fogell said. Twenty-two weeks after conception, Anna Lee was born at 11:27 p.m. -- 24 hours and 27 minutes after Fogell's water broke. Fogell cradled her newborn daughter, who was dressed in a light blue gown. The infant, whose eyelids were fused, wasn't breathing. Anna Lee jerked several times, and her heart continued to slow, medical records show. Fogell said she called for help, but claimed nurses nearby wouldn't respond. She placed her mouth over Anna Lee's tiny lips and nose and tried to resuscitate her. But the baby continued to fade. "There was no attempt to save her," Fogell claimed. "Nobody was doing anything. I kept crying and singing to her, 'You are my sunshine.' I just didn't know what else to do." As she held the baby in her arms, Fogell realized it would be the last time she ever saw her. The same doctor reached inside her womb and removed the placenta -- or at least he thought he did. Two hours after the doctor finished with what he thought was the last of the placenta, at 3:10 a.m., Anna Lee died. Days later Fogell contracted an infection that led to her being hospitalized again, where the remainder of her placenta was taken out. Prison officials and the state's medical vendor at the time, FCM, declined to comment.

September 26, 2005 Wilmington News Journal
Bernard Coston was taken to prison in March 2002 on charges he stole a $50 jacket from an elderly woman. Coston was released from prison 18 months later on a slab. Dirt and feces covered his body. Insects had been gnawing on his corpse. Diagnosed with AIDS before he went to prison, Coston spent his last four months in the infirmary of Wilmington's Gander Hill prison -- at least that's what is written on a state medical examiner's autopsy report. But Coston's sister, Victoria Trice, said she was told by a prison counselor that her brother wasn't in the infirmary, that he withered away, alone in a cell with no food or medical attention. He was too weak to bathe. "They are more humane to an animal than to my brother or anyone else who died in there," Trice said. "It's a disgrace," said Dr. David M. Cohen, an AIDS specialist with the Christiana Care HIV Wellness Clinic. "Because they're prisoners, the government has the right to take away their liberty. But they do not have the right to take away their health." Coston's death certificate states simply that he died of AIDS. The external examination from the autopsy paints a more gruesome picture: •"The scalp is dirty" •"Examination of the skin on the back reveals a layer of dirt" •"Dirt is noted under the fingernails" •"Fecal material is smeared on the buttocks." "It's obvious he got poor, poor, poor medical care," said Lynda R. Kopishke, a forensic nurse and branch director of Interim Health Care in Newark. At the request of The News Journal, Kopishke agreed to review Coston's autopsy report, prepared by Dr. Adrienne Sekula-Perlman, Delaware's deputy chief medical examiner. Kopishke found it hard to believe that Coston had been treated for four months in a prison infirmary. "I struggle to understand the inconsistencies surrounding these findings," Kopishke said. "If I did not know this individual was in the infirmary, I would wonder if he had been buried under dirt at some point in time." The last AIDS doctor employed in the state's prisons -- Dr. Ramesh Vemulapalli of Dover, an infectious disease specialist -- quit in 2003. The state's current private medical provider, St. Louis-based Correctional Medical Services, employs an infection-control nurse. Louis W. Chance Jr. died in 2003 -- seven days short of freedom. Chance, 37, was serving a six-month DUI sentence at the Webb Center, a work-release facility in Prices Corner, when he developed a severe headache. At his first medical visit, Chance told nurse Beverly Anderson that he had had a headache for three days, according to a medical malpractice lawsuit filed against the state and First Correctional Medical, Delaware's medical provider at the time, in U.S. District Court in Wilmington. Anderson gave him six Excedrin and sent him back to his cell. The next day, Chance reported no relief and was prescribed Motrin. After three more days, a correctional officer reported Chance was confused and had possibly "overdosed." Chance was transferred to Gander Hill prison in Wilmington, where, his attorney says, the pressure inside his head from cryptococcal meningitis affected his hearing. Unable to respond to nurses, Chance was reported to be disoriented, uncooperative and hostile. Officers subdued him, put him in a straitjacket and left him in a cell under suicide watch. Chance, who had not yet been examined by a doctor, was prescribed Ativan, Benadryl and Haldol. The drugs are used to treat panic attacks, allergies and psychosis, respectively. Together, they can calm a person. About three days later, Dr. Niranjana Shah, a contract physician with First Correctional Medical working at Gander Hill, prescribed Tylenol and a daily cup of coffee because, Chance's medical records state, caffeine helps combat headaches. On Sept. 18, 2003, Chance was sent back to the work-release facility at Prices Corner. Five days later, Chance died. Had Shah and Dr. Jose A. Aramburo followed protocol for a patient with HIV, Chance could have lived, claims Ken Richmond, a Philadelphia attorney representing the Chance family in the lawsuit against FCM and the two doctors. "It appears to be a concerted effort to avoid treating someone who was HIV-positive," Richmond charged. "This is gross negligence." Months before Chance got sick with cryptococcal meningitis, FCM employees performed a blood test on him, Chance's medical records say. He tested positive for hepatitis C and was given brochures on hepatitis and HIV, according to the lawsuit. About a quarter of people in the United States who have HIV also have hepatitis C, according to the CDC. Because HIV patients are especially susceptible to cryptococcal meningitis, Richmond said, FCM should have tried to rule out the condition before trying other treatments. "That's the sad part about this," he said. All four classes of antiviral treatments are available in Delaware prisons, said Dr. Vemulapalli, an infectious disease specialist who worked a little more than a year at the Delaware Correctional Center near Smyrna. But inmates, he said, did not always receive them. "Most patients who come to the hospital from the Department of Corrections are generally far too advanced," said Vemulapalli, who is now in private practice in Dover. "I've seen several cases from the prison -- all patients who have died -- that didn't get referred to the hospital at the appropriate time. They're not providing adequate care." Vemulapalli, who worked for Tucson-based FCM, claims company owner Kastre ordered him to treat AIDS or hepatitis C -- but not both, even though many patients have both. The reason, Vemulapalli said he was told, is that "it was too expensive to treat both."

September 26, 2005 Wilmington News Journal
Doctors and nurses at Gander Hill prison, in Wilmington, never treated Ed Brittingham for the flesh-eating bacteria that scarred his body. They thought the 47-year-old inmate had a broken arm. Nearing the end of his 13-year sentence for second-degree burglary, Brittingham was enrolled in a drug treatment program and was allowed to leave the prison for furloughs home and for work release. The frequent trips outside the wire, it turns out, exposed his wife, friends and the public to the lethal disease that was eating away his shoulder. Just one cough or sneeze could have spread the infection. Brittingham first noted an intense pain in his shoulder on a weekend furlough in December 2004. When he returned to prison the following Monday, he reported to sick call, which was managed by First Correctional Medical, a Tucson, Ariz.-based private medical company working in Delaware prisons under contract with the Department of Correction. At sick call, an employee with FCM gave Brittingham a sling, took some blood and scheduled a few tests. "When the X-rays showed I didn't have any broken bones, they wrote me up for faking," Brittingham said. "I knew it wasn't a broken bone. I told them this. They gave me Motrin, but the pain was pretty awful so I took a double dose. They wrote me up for that, too." Severe abdominal pain followed. There was blood in his urine. The medical staff assumed Brittingham was passing a kidney stone. They issued him a strainer and more Motrin. "I was drinking five gallons of water a day, but I never passed any stone," he recalled. "I kept trying to get to medical, filling out sick call slips." Brittingham stopped eating. He couldn't hold down food; the pain in his shoulder, stomach and leg were too intense. "On a scale of 1 to 10, it was a 20," Brittingham said. Necrotizing fasciitis, also known as flesh-eating bacteria, is a condition caused by strep A bacteria, which is the same bacteria that causes strep throat. Brittingham said, "They told me if I went to the hospital while on a home furlough, they'd consider it an escape, and I'd get sent back to prison to serve the remainder of my sentence." The prison staff gave the same warning to his wife, Lee McMillan, she said. "They told me if he had a heart attack and fell to the floor, I wasn't supposed to call 911," she said. "I was supposed to bring him back to the prison." Weeks passed. The pain became torturous. In January, Brittingham did the unthinkable. He ended a home furlough on his own and went back to prison early. The bacteria was eating its way through to the surface of the skin, causing massive red lesions on his leg, foot and shoulder. His face was swollen, and he was burning up with fever. He had difficulty communicating with his wife. It hurt to move, sit or lie in bed. Rather than heading to the prison infirmary, where his complaints had been ignored, Brittingham went to a prison guard, stripped off his clothes and showed him the lesions. "Thank God they thought they were blood clots, because they sent me to St. Francis Hospital," he said. "Once I got to the hospital I went blank. I was there for 11 days. I don't remember much." In late January, Brittingham was discharged from the hospital and transferred back to Gander Hill. "I spent my first four days without any pain meds, antibiotics, physical therapy or wound care information," he said. "My leg started swelling up again. I thought I was having a reoccurrence. I swear to God I didn't want to go through that again." Brittingham was eventually given medication and has since been released. He now lives with his wife in New Castle. The couple hasn't filed a lawsuit, but they want the prison staff and First Correctional Medical held accountable. "These people should be prevented from practicing medicine and from making decisions that affect people's lives," he said. "What they did to Ed was a crime," McMillan said. "If these prison doctors would have suffered like Ed suffered, it would have stopped." Brittingham spends his days looking for work. His wife has recently completed a medical transcriptionist course. They spend their free time researching necrotizing fasciitis on the Internet.

September 25, 2005 Wilmington News Journal
Some inmate deaths are harder than others for Drewry Fennell to discuss. Charles Blake's is the worst. Blake pleaded guilty in November 2000 to possessing cocaine within 1,000 feet of a school. Three years later, while at the Delaware Correctional Center in Smyrna, Blake became sick. "He had an operation on a kidney. They put a stent in the kidney to hold the ureter open. He was released back to the prison," said Fennell, executive director of the American Civil Liberties Union of Delaware. "He started calling his mom. He was in intense pain. He later passed the stent through his penis and died ... from that and other complications. They were treating him with an analgesic -- Motrin. They wouldn't send him back to the doctor. He lingered for weeks in the infirmary, before they sent him to the hospital." Blake died Sept. 7, 2003, at St. Francis Hospital in Wilmington. He was 36. Some seriously ill inmates are granted a medical discharge by the Delaware Department of Correction, a move that can shift the cost of mounting hospital bills to family members or Medicaid. In its former contract with First Correctional Medical (FCM), the state agreed to provide Medicaid to inmates who are hospitalized for more than 24 hours. But when this happened, the state was allowed to reduce its monthly payment to the medical vendor, so the state's overall expense remained the same. Shortly before her son died, Francine Anderson said, a friendly guard told her prison officials wanted to release Darnell to the family so his death would go unreported to federal prison regulators -- and so the family would be responsible for some of the medical bills. Anderson considered taking her son home from St. Francis Hospital, in Wilmington, but he died before she could arrange it. After an inmate dies, the medical vendors conduct an internal "peer review" led by the contract medical director -- not by an independent board. Occasionally, the vendor will bring in outside physicians to look at the patient's medical records, Taylor said. Under Delaware law, the entire process is confidential. Not even the inmate's family can see the findings. When the peer review is completed, the results stay with the medical vendor. It's not known what, if anything, the vendor does with the findings. When an inmate is autopsied, which happens in roughly 15 percent of prison deaths, the medical examiner's office does not send the report to Taylor or the warden. The autopsy reports go straight to the medical vendor.

September 25, 2005 Wilmington News Journal
Pierce was serving 14 months for a parole violation stemming from a burglary charge at the Sussex Correctional Institution in Georgetown when a small lump appeared on the back of his head. It was January 2001 and a prison doctor employed by a private medical contractor said the marble-size lump was most likely a cyst or an ingrown hair. Seven months later, when the growth had become like a second head, Delaware's contract prison medical director, Dr. Keith Ivens of Correctional Medical Services, stabbed the bulging tumor five times with an 18-gauge needle, withdrawing a bloody fluid. Rather than keeping the sample for analysis, Ivens emptied the syringe into a trash can, according to Michelle Thomas, a former prison counselor who was holding Pierce's hand during the examination. The News Journal gained access to Pierce's medical file through his family, and there was no record of a biopsy performed before cancer ate into the 21-year-old's skull. Asked about the case in a telephone interview, Ivens said, "I'm trying to remember who Anthony Pierce is." He declined to comment further. Near the end of Pierce's life, the tumor stretched the skin around his face, pulling his right eye closed, causing muscle spasms and crippling pain. The medical staff still ordered no tests or treatments, claims a lawsuit that Pierce's family filed against Ivens, CMS and the state of Delaware. On March 22, 2002, Pierce died from a "brain tumor, due to osteosarcoma of the skull," an autopsy report stated. A six-month investigation by The News Journal shows that the lack of care suffered by Pierce is all too common inside Delaware prisons. AIDS, hepatitis, flesh-eating bacteria and other communicable diseases percolate behind the wire. Inmates in their 20s and 30s die from diseases that people outside prison routinely survive. Like other states, Delaware has turned over health care inside its prisons to private companies specializing in inmate medical care. There are two significant differences, however: •Whether they have been convicted or are awaiting trial, inmates in Delaware depend on the state for medical care. In states with county and city jails, care in smaller facilities usually is provided through a local hospital or physicians' group. •National experts say most states employ a medically trained staff to monitor the medical vendors. Delaware does not. Here, the medical vendors oversee death investigations, regulate access to care, and control any complaints that arise over their work. Dr. Robert Cohen, an expert in prison health care whom state and federal courts have appointed to monitor prisons in five states, said all states are constitutionally required to provide adequate medical care for inmates. If Delaware "outsources" that responsibility, it is still obligated to monitor its medical vendors, Cohen said. That doesn't happen. The Medical Society of Delaware, a physicians group, is occasionally called -- at the warden's discretion -- to investigate an inmate death. Yet its investigation is led by the vendor's medical director. And the society's report is confidential under Delaware law; it remains in the custody of the medical vendor. "It's surprising to me that Delaware just lets the vendor do it by themselves," Cohen said. Under the current $25.9 million annual contract with Correctional Medical Services, state prison officials are indemnified against wrongful death and medical malpractice lawsuits. If an inmate or survivor sues the state, the medical vendor pays the state's attorney fees and any settlement. However, Cohen said, the indemnification will not protect the state from federal civil rights lawsuits filed by inmates or their survivors. "It's going to cost the state a lot of money in the long run," Cohen said. Correctional Medical Services of St. Louis held Delaware's $12.45 million annual contract from 2000 to 2002, when it asked to be released from its obligations. At that point, Taylor accepted a bid from First Correctional Medical, a Tucson, Ariz., firm, for a $16.44 million annual contract. FCM left the state in July after explaining that it wanted to be released from its contract. FCM's owner and founder, Dr. Tammy Kastre, did not return numerous calls for comment. Taylor would not discuss reasons for the departure, but added that FCM owes thousands of dollars in unpaid bills to private clinics, hospitals and physicians. The exact amount is in dispute. Taylor said he was forced to move fast to find a replacement. He turned to a company he knew well: CMS, the same company that cared for Anthony Pierce while his tumor grew to the size of a grapefruit. Delaware Gov. Ruth Ann Minner said the contract awarded to CMS was not a "no-bid" contract, as described by Taylor. She argued that, even though CMS asked to be released from its contract in 2002, forcing the state to hire another vendor, CMS' return to Delaware came by piggy-backing on the contract of the vendor it replaced, FCM. It's unclear how the "extension" resulted in an annual price hike of $9.5 million. Taylor declined to answer that question. CMS provides medical care for some 285,000 inmates in more than 360 prisons in 25 states. It is named in many lawsuits filed in state and federal courts across the country, although the exact number of suits filed against the 25-year-old St. Louis firm is difficult to obtain. There have been 53 lawsuits filed in Wilmington's U.S. District Court against CMS since 2000. Twelve are still active. Former CMS medical director Ivens, has been sued 15 times in U.S. District Court by Delaware inmates or their families. Each of the federal lawsuits against Ivens has been dismissed, but at least two state Superior Court court cases naming Ivens as a defendant remain active. Michelle Thomas, who worked for Spectrum, a CMS subsidiary that provided substance-abuse treatment to inmates, helped establish the treatment program that inmate Pierce attended before he contracted the cancerous growth on his head. "They're the scum of the earth," Thomas said of her former employer. She quit CMS shortly after Pierce died. Thomas said she watched in horror as Pierce's tumor grew. Thomas said she repeatedly questioned the medical staff about the lack of treatment, but she never got an answer. Yet Dr. Sitta Alie, the former medical director for FCM, who, like many of its employees, was hired by CMS when it took control of Delaware institutions in July, said this about the two companies: "They're both awful." Alie was an employee of FCM when interviewed by the newspaper. Contacted again after CMS took control, she declined to comment further. Before 1978, Delaware's Department of Correction had a long tradition of hiring its own doctors and nurses, or guards who were former military medics, to provide health care for adult and juvenile offenders. But two years after the 1976 U.S. Supreme Court ruling that inmates deserve health care equivalent to community standards, Delaware signed a contract with Sacred Heart Hospital of Chester, Pa., to provide care for state prisoners. In 1981, then Correction Commissioner John L. Sullivan hired Claymont-based Prison Health Services, following a national trend of states privatizing prison medical services. The new company was founded by Delaware nurse Doyle H. Moore, who had been Sacred Heart's prison health care program coordinator. A year later, PHS ended its 23-month contract, citing a spike in incarceration rates. Eleven private prison companies bid for the open contract. Decisions about performing medical tests or procedures on inmates in Delaware are not made here, but by company executives at the corporate offices. When an inmate dies in Delaware, the autopsy -- if there is one -- and other investigative reports go to the vendor, not to any state official. And Taylor does not review inmate autopsies.

August 30, 2005 AP
The family of an HIV-positive man who died while serving a six-month sentence at Gander Hill prison in Wilmington, Del., is suing First Correctional Medical, the prison system's health care provider, and two of its doctors over allegations that they did not take adequate steps to diagnose or treat the inmate's disease, the AP/WBOC reports. The lawsuit alleges that prison health care providers ignored 37-year-old Louis Chance's health complaints in September 2003 and should have ordered a CT scan or an MRI to help diagnose and treat his cryptococcal meningitis, according to attorney Ken Richmond, who is representing Chance's family. Chance became comatose and was admitted to a Wilmington hospital, where he died of the opportunistic infection. Family members said they were unaware that Chance was HIV-positive and said he might not have known his status either. "It's our belief that the death of Chance resulted from cost-containment policies," Richmond said. The inmate's relatives are among several critics of First Correctional and the Delaware Department of Correction who think health care providers are putting financial concerns before medical care. More than 40 lawsuits have been filed against Arizona-based First Correctional since 2002, when it was awarded a six-year contract to provide health care for Delaware's inmates. First Correctional pulled out of the contract in June after DOC officials requested an inspection of the provider by the National Commission on Correctional Health Care. DOC Commissioner Stan Taylor said the department's medical review committee and NCCHC identified "some issues" with First Correctional. Officials from First Correctional declined to comment.

August 29, 2005 WBOC
Louis Chance Jr., serving six months behind bars for his fourth drunken driving conviction but hoping to start a new life when he got out, was only a few weeks away from his release date when he began suffering severe headaches. The headaches grew so agonizing that Chance became disoriented and incoherent, but his family says his pleas for help from prison medical workers went mostly unheeded. Instead, according to a lawsuit the family filed in federal court, Chance was deemed uncooperative and hostile and accused of trying to overdose on pain medication. At one point, a doctor at Gander Hill prison in Wilmington prescribed "Tylenol and one cup of coffee per day," according to the lawsuit. More than two weeks after he first reported feeling sick in September 2003, Chance, 37, lapsed into a coma and was sent to a Wilmington hospital. He died of cryptococcal meningitis, an infection and swelling of the membranes surrounding the brain that is one of the opportunistic infections associated with HIV. Chance's family and other critics say too many inmates with HIV- and AIDS-related illnesses are dying because prison medical providers are more concerned about holding down costs than providing adequate medical care.
Department of Correction Commissioner Stan Taylor declined to comment on individual inmates' cases. Asked whether he was satisfied with First Correctional Medical Inc., the system's medical provider when Chance died, Taylor said noted the company maintained Delaware's National Commission on Correctional Health Care accreditation. The privately held company, based in Arizona, operates in a handful of other states. Its six-year contract with Delaware was worth more than $17 million a year. In June, First Correctional Medical pulled out of the contract, forcing the department to sign a $25.7 million-a-year, no-bid contract with its previous medical services provider, Correctional Medical Services of St. Louis. Ken Richmond, a lawyer suing First Correctional Medical and two of its doctors on behalf of the Chance family, said Chance's condition could have been diagnosed and treated had the contractor's doctors scheduled a CT or MRI brain scan. The end of First Correctional Medical's contract came after DOC officials requested an inspection earlier this year by the National Commission on Correctional Health Care. Taylor said both the NCCHC and the DOC's medical review committee had identified "some issues," but he declined to provide details. Since coming to Delaware, a move that more than doubled the number of inmates for whom the company was responsible, First Correctional Medical has been the target of more than 40 lawsuits, the vast majority filed by Delaware inmates. Several have been dismissed for a variety of reasons - including the fact that inmates must go through an internal grievance process before they can seek relief in the courts. Since January 2000, 190 Delaware prison inmates have died while in custody, many, according to DOC press releases, "after a lengthy illness."

North Coast Correctional Facility, Grafton, Ohio
September 10, 2009 Chronicle-Telegram
EMH Regional Medical Center is locked in a dispute with the private contractor that runs the North Coast Correctional Treatment Facility in Grafton over unpaid medical bills for inmates treated at the hospital. A lawsuit filed earlier this year accuses Utah-based Management and Training Corp. of failing to pay $628,193.81 in medical bills it racked up for inmates between September 2006 and February 2009. But Tim Reid, the company’s attorney, said Management and Training doesn’t actually owe the hospital the money. Instead, he said, a former subcontractor is responsible for the outstanding bills. Management and Training has been paying its bills since severing ties with Arizona-based First Correctional Medical in May 2008, Reid said. That company, he said, ran into financial problems and fell behind in paying the medical bills under a contract with the hospital. But Management and Training didn’t realize how much money was owed until after the lawsuit was filed in May of this year, Reid said. “We realized there was a problem, but we didn’t know the extent of the problem,” he said. First Correctional and the Ohio Department of Rehabilitation and Correction are not named as a party in the lawsuit, according to court records. Julie Walburn, an ODRC spokeswoman, said the prison system paid Management and Training about $15.4 million in fiscal year 2009 to operate the North Coast prison, which mostly houses prisoners convicted of drunken driving and other substance abuse crimes. “They’re responsible for providing medical care to inmates,” she said.

Pima County Jail, Pima, Arizona 
April 5, 2006 Arizona Star
Health care at the Pima County jail soon will be the responsibility of one of the nation's largest private providers of medical care in jails and prisons. The Pima County Board of Supervisors approved an $18.5 million, two-year contract Tuesday with St. Louis-based Correctional Medical Services. The company will replace First Correctional Medical, the Tucson-based company that has provided medical care at the jail since 2002, at the end of April. The contract represents an average 18.5 percent increase in the yearly cost of providing care at the jail. County Administrator Chuck Huckelberry said the increased cost was driven by several factors, including medical costs rising 7.5 percent a year, the jail population increasing 7 percent to 9 percent a year and the addition of seven full-time employees over the previous contract. Supervisor Richard Elias voted no after raising concerns about aspects of the contract. For example, the contract calls for medications to be distributed two times a day instead of three, a change that will save the county $300,000. Elias wondered what would happen to inmates with chronic conditions if they needed medication three or four times a day. "I just want to make sure we're not creating more liability by creating a situation where people aren't getting their meds," Elias said. Elias said later he also was worried about accountability and records transfers when dealing with an out-of-state company. "I have a lot of concerns about Correctional Medical Services," Elias said. "In the end, I would have been a lot more comfortable with a local provider." Correctional Medical Services runs 320 facilities with 250,000 inmates in 25 states. Former inmates and family members have accused the company of providing inadequate care and cutting corners to save money. Karen Russo, president of the Wrongful Death Institute, has served as a clearinghouse for those accusations. She said the company has a "facade" of providing health care. A 2000 audit by the South Carolina Legislature found problems with distribution of medicine, lack of planning for discharge of mentally ill patients and workers who did not have the right qualifications. Ken Fields, a spokesman for Correctional Medical, said many of the allegations were years old and false.

April 29, 2005 Tucson Citizen
The woman who hanged herself Sunday at the Pima County Jail was showing psychotic symptoms, a jail official said, and told a jail nurse that she had been taking prescription drugs for chronic pain and depression. Vickie Logan never saw a doctor in the jail who could have prescribed the medications for her, even though that is standard jail procedure, a jail official said. She also never saw a psychiatrist in the jail, even though inmates sent to the jail's mental health unit - as Logan was - routinely see a psychiatrist for a follow-up screening, the official said. Instead Logan, 42, was put in isolation - in a cell where she had contact only with jail staff and where her meals were delivered. She also was not put on suicide watch, even though she was "hearing voices and talking to people who were not there," said jail supervisor Capt. Judy Hendrickson. After 61 hours of isolation, Logan hanged herself Sunday and died Monday. The county jail's medical and mental health services are provided by First Correctional Medical Inc., a local private contractor. The nurse ordered Logan into isolation because she was "hearing voices and talking to people who were not there," Hendrickson said. The nurse who interviewed her didn't think she needed close supervision and so did not put her on suicide watch, which would have required jail personnel to check on her every five minutes, instead of every 15 minutes. Hendrickson said.

March 26, 2004
A woman whose son died when she went into premature labor and gave birth at the Pima County jail has begun the process of filing a million-dollar lawsuit against the county and the company that provides medical care at the jail.  An attorney for Valerie Lopez, 23, began sending notices of claim, legally required before a lawsuit can be filed, Wednesday to Pima County Sheriff Clarence Dupnik, whose department runs the jail; the county, including the Board of Supervisors; First Correctional Medical and the various nurses and corrections officers involved in the September 2003 incident.  The $1.75 million claim says Lopez's rights were violated by inadequate medical care and that she suffered serious injuries and emotional trauma when officials ignored her complaints of pain for 10 hours. They finally took her to the medical unit, where she pulled down her pants and gave birth on a table with only two Tylenol to ease her pain.  (Arizona Daily Star)

October 19, 2003
Valerie Lopez says she had problems convincing authorities at the jail that she was in labor. Changes are being made.  Valerie Lopez lay on her bunk at the Pima County jail. Nearly six months pregnant and just arrested for fighting with her brother, the 23-year-old didn't want to be in labor.  She called for help, the third time that night. But instead of being taken to a hospital, Lopez says she was moved to another cell because she was disturbing her cellmate, told to calm down and stay off her feet, and given only an aspirin for the pain.  Fifteen minutes later, she felt her son coming into the world.  She cried out again and says corrections officers and nurses finally believed her. They took her to the medical unit, where she says she pulled down her pants and gave birth after 10 hours of labor. And, there, Juan Carlitos Long, a boy with perfect fingernails and a tiny, beautiful heartbeat, died.  Jail officials say the Sept. 29-30 incident should have been handled better; that mix-ups helped cause it and they've made changes. They'll even ask the County Attorney's Office if criminal charges are merited.  But most of the decisions were made by nurses with the private company that cares for inmates under a contract with the county, a company with no major problems since taking over jail care in March 2002, amid allegations of improper care by previous workers.  Officials at First Correctional Medical defend their standards of care and point to a recent new accreditation the local operation received to show it provides a high level of care here. Still, Lopez wants to know why she wasn't taken to a hospital and why instead of the birthday parties she'd envisioned for her son, she had to plan a funeral.  (Yahoo News)