Mississippi: Prison health faces poor quality accusations

View from the door at blood on the floor at East Mississippi Correctional Facility where a mentally ill inmate had cut himself.

View from the door at blood on the floor at East Mississippi Correctional Facility where a mentally ill inmate had cut himself.

From Corporate Media

State corrections officials disregarded risk to the health and safety of young prisoners at the Walnut Grove prison, U.S. District Judge Carlton Reeves concluded in a scathing March 22, 2012, report on the then GEO Group-run facility.

The sum of “these actions and inactions” by those officials, GEO and Health Assurance, which was contracted to provide medical and mental health care, “paints a picture of such horror as should be unrealized anywhere in the civilized world,” he wrote.

Despite these words, the Mississippi Department of Corrections gave Health Assurance a contract to provide health care at East Mississippi Correctional Facility, paying the company $12 million over the past three years, according to state records.

In a lawsuit filed against MDOC in September, the ACLU called conditions at East Mississippi barbaric with a “callous denial of prisoners’ serious medical and mental health needs.”

Officials from the Jackson-based Health Assurance, which was started in 2001, disputed such claims, saying many inmates receive better access to quality health care behind bars than they do back home.

“The state gets an excellent bang for its buck, and we’re proud of the work we’re doing,” said Dr. Carl Reddix of Jackson, managing partner for Health Assurance, who served briefly on the state Board of Health. “Our staff thinks they’re doing an excellent job, and we agree.”

If medical care inside the prisons was as poor as being asserted, “you’d expect the whole medical community to be up in arms,” he said.

Dr. Terry Kupers, a plaintiffs’ expert in the lawsuit, found mental health care at the East Mississippi prison “grossly substandard” for the more than 1,000 inmates suffering from serious mental illness.

“The conditions in solitary confinement at EMCF are the worst I have witnessed in my 40 years as a forensic psychiatrist investigating jail and prison conditions,” he wrote.

He noted that on April 16, a mental health counselor concluded a dozing inmate was having no hallucinations, no suicidal thoughts and no mental health issues.

Kupers called such an assessment “ludicrous. How can a clinician assess the presence of hallucinations, suicidal thoughts and the patient’s ability to weigh risks and consequences when the patient is asleep during the examination?”

He wrote, “There seems to be a system-wide pattern of this kind of false documentation, which is quite dangerous.”

In another case, a 43-year-old inmate in 2013 was suffering from high blood pressure, a severe cardiac condition, schizophrenia and other health issues so severe he spent several months at the medical observation unit of the prison.

In November 2013, prison officials discharged him to an isolated cell.

On Dec. 4, 2013, he reported hallucinations, had a rope around his neck and told a counselor he had “nothing to live for.”

Nine more days passed before another counselor visited him, reporting that the inmate “did not appear to be in distress.”

On Dec. 17, he lit a fire in his cell to get medical attention, according to reports. A nurse noted his blood pressure was 140/98. Normal blood pressure is less than 120/80.

Two days later, a nurse reported his vital signs were stable, concluding he was in no distress.

The problem? He had already been dead for 10 hours, according to reports.

After examining this case and others at East Mississippi, Marc Stern, former assistant secretary of health care for the Washington State Department of Corrections, concluded dysfunction “permeates every essential aspect of the system; health care operations are broken at every level, and there is massive evidence of deliberate indifference on the part of medical and security staff at the facility as well as their supervisors.”

Stern, an expert for the plaintiffs, concluded such extreme dysfunction “can exist only if the statewide oversight system is also broken.”

In 2011, Madeline LaMarre, a correctional and nurse practitioner expert, evaluated health care at several Mississippi prisons, finding “serious problems with health care services.”

The plaintiffs’ expert called for meaningful oversight of medical care inside prisons. “Until MDOC implements such a program the medical and mental health (issues) noted in this report are likely to persist; resulting in preventable harm, including deaths,” she wrote.

Earlier this year, she returned to the East Mississippi prison, where she found “medical care had significantly deteriorated,” she wrote. “That MDOC had taken no action to correct deficiencies in light of these reports is truly shocking and demonstrates a callous indifference to the serious medical needs of inmates.”

She said her review found that virtually all of the prison’s “health care systems are broken or dysfunctional, resulting in actual and ongoing risk of harm to patients.”

Problems she found included:

A 25-year-old patient with metastatic testicular cancer who did not have timely access to urologist care following an abnormal ultrasound that showed a testicular mass.

A 64-year-old patient who lost his vision after undiagnosed and untreated diabetes. He had still not been evaluated or referred to a retinal specialist.

A 28-year-old patient with glaucoma, who was already blind in his left eye, lost vision in his right eye because he did not receive his glaucoma medication.

LaMarre wrote that she found a physician spent only 10 hours a week at Walnut Grove — far from the 40 hours called for by the contract.

“This is grossly inadequate for a population of almost 1,300 inmates,” she wrote. “As a result, nurses perform the majority of health care services to inmates.”

Reddix disputed allegations of poor medical care, saying plaintiffs have made “outrageous assertions that are refuted in the medical records.”

Other allegations by the plaintiffs have also been proven untrue, he said. “They said inmates had rats as pets at East Mississippi (prison), but nobody saw rats.”

Plaintiffs submitted photographs of what were identified as rodent droppings inside the prison.

Reddix said Health Assurance has done well in treating diabetic patients, but some unfortunately fail to change their diet or take their medicine — just as they do outside prison.

East Mississippi inmates who are mentally ill receive about 10,000 visits a month from the mental health staff, he said. Proof of good mental health care can be found in the lack of suicides since Health Assurance took over in 2012, he said.

If Health Assurance was providing poor care, there would be a higher than expected complication rate, he said. “Instead, it’s much lower than you would expect.”

Emergency room visits have also declined, he said.

As proof of Health Assurance’s good work, Reddix pointed to a report by an expert appointed by court monitors, Dr. Amanda Ruiz, who concluded that “although minor opportunities for improvement remain, adequate mental health care is being provided to the inmates of Walnut Grove.”

Plaintiffs’ questioned Ruiz’s report since she relied on data from AdminPros for some conclusions.

Gabriel Eber, staff counsel for the ACLU, said the health care “we’ve seen in Mississippi prisons is atrocious, and the responsibility lies squarely with the Department of Corrections to ensure prisoners get the care they need. To date, they have failed, and they continue to fail.”