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PLN editor extensively quoted in article re medical care at IL jail

State Journal Register, Jan. 1, 2007.
PLN editor extensively quoted in article re medical care at IL jail - State Journal Register 2007

Sheriff says recent deaths, hospitalization are not causes for worry; experts disagree


Sunday, December 16, 2007

Ryan McCrady may be on to something. "We're not good at running a hospital, but we are good at running a jail. We can't be everything," the Sangamon County administrator said last week.

The Sangamon County Jail is routinely overcrowded. It was built to hold 290 prisoners but at times has held as many as 425. And, says the sheriff's department medical supervisor, Lee Anne Brauer, inmates have more problems now than ever.

"One thing people aren't accounting for is that people are coming in to us sicker," she said.

Those factors present challenges.

But they present challenges to almost all jails, experts say. With three deaths at the Sangamon County Jail in less than three months, the sheriff's office may want to look into making some changes, those experts say.

"The pattern that winds up happening is that, typically, once they rack up enough bodies and they're sued often enough and had a couple million dollars in verdicts or settlements or injunctive relief, that's usually when things change and get a little bit better," said Paul Wright, editor of a publication called Prison Legal News. Wright has been writing about prison issues for 18 years.

No single agency has the responsibility for overseeing Illinois county jail medical units on a regular basis. The Sangamon County Jail isn't even solely responsible for its own medical operations.

"As far as our inspection, we make sure they have detailed records of medical supplies, paperwork and security issues," said Derek Schnapp, spokesman for the Illinois Department of Corrections. "If there are complaints of how an inmate was treated medically, that goes to DPR (the old abbreviation for what now is the Illinois Department of Financial and Professional Regulation, which oversees most medical professionals in the state). We let the experts decide."

Brauer said the standards for the jail's medical unit are set forth in Sangamon County rules and regulations. Those rules include requirements such as making sure sick call is available to all inmates, but no annual report by any agency determines whether those standards are being met.

Sheriff Neil Williamson staunchly defends the jail. He acknowledges there has been a spike in the number of deaths related to the jail but says that, like the stock market, there are highs and lows.

"I have had 170,000 people through this jail since I've been sheriff and (very few deaths)," Williamson said. "Can we put a finger on exactly what's happened here? No, no.

"You can't just look at a two-month window. It's not the whole picture," Williamson said.

The last jail-connected death was in 2004.

An informal tally of deaths involving recent jail inmates shows there have been nine since 1991, but three of those have happened since Sept. 28.

Brauer said she believes those deaths were unpreventable.

"Those who have massive (heart attacks) in the emergency room might be able to be saved. But many deaths are simply not preventable."

She said inmates often are uncooperative with jail staff members or aren't honest about their medical needs. Inmates sometimes use claims of illness to manipulate jail staff or to "break the boredom," she said.

McCrady, who used to work as comptroller for the sheriff's office, said the jail has a difficult population.

"The types of people who come into our facility are dealing with a multitude of life issues, not just personal and criminal," he said.

"I'm not making excuses, but someone in the jail is not always willing to tell their whole life story to a jail person or medical staff. The incidents going on are something we want to get addressed, too. But it's a difficult population to treat."

Wright, of Prison Legal News, said inmates are often in jail because they're poor, they don't have the money to make bond, and they probably also can't afford health care. Their medical needs are often discounted, he said.

"There can be a lot of callousness and disbelief about their medical care. (Corrections officials) can see heart attacks as a ploy for drugs," he said.

The most recent Sangamon County Jail death, that of Maurice Burris last week, happened under the watch of a private company the county recently hired to handle jail inmates' health care. Burris' medical care in the jail will be reviewed as part of the company's internal policies, Brauer said.

But the county in the past hasn't had any review process for deaths that occur in the jail.

Post-death reviews are fairly common in the health-care industry.

"There is a process called continual quality improvement that's used in health-care and other fields. It's a cornerstone of good health-care delivery," said Edward Harrison, president of the National Commission on Correctional Health Care. "You look in each instance if there was something that was done that could have been done better,"

Brauer said she might review the September death of Bobby Ray and the November death of A. Paul Carlock to see if there was anything the jail ought to have done differently.

"Anyone can improve the process," she said. "We can look at what happened in the other cases. We did already decide that, rather than having the (defibrillator) in main (the main section of the jail), we need one in the medical unit."

Harrison said jails sometimes ask entities such as the commission he heads to analyze their policies and procedures. The NCCHC has a set of standards developed specifically for local jails.

Brauer said, though, that the NCCHC's standards are too expensive to adopt and keep up. She said it would take two full-time employees just to make sure standards are being met.

But Wright said accountability is often a problem.

"The only thing jails tend to care about is that no one escapes. If someone escapes, people lose jobs over that," he said. "But killing someone through medical neglect - no one is really looking into that stuff."

About 4,000 people a year die in prisons or jails in the U.S., nearly all for medical reasons, Wright said.

Sangamon County has made recent changes.

The jail for years has had its own nursing staff - one registered nurse and three licensed practical nurses. The county also formerly contracted with a local physician and a local psychiatrist to work at the jail two hours per day two days per week.

The most recent doctors to hold those jobs were Dr. Joseph Maurer and Dr. Chauncey Maher, both of whom had contracts that started in 2001. Maurer was paid $7,000 per month, for a total of $84,000 per year, and Maher $4,000 per month, for a total of $48,000 per year, according to Jail Superintendent Terry Durr.

Brauer said a physician would see from seven to 14 patients in one two-hour period at the jail, and the psychiatrist might see between three and eight patients.

The county continues to have the same nursing staff, though it's currently one LPN short, Brauer said. She said services have not suffered because the county has a contract with a nursing agency to pick up the slack.

However, on Dec. 1, Sangamon County contracted with Peoria-based Health Professionals Ltd., a company that specializes in providing health care to correctional facilities. HPL, in turn, contracts with two doctors to provide the services previously provided by Maurer and Maher, Brauer said.

The contract is expected to save the county $300,000 a year over the next three years, McCrady said. Sangamon County will pay $269,482 a year to start, with small increases in each of the three years of the agreement.

McCrady said HPL has an umbrella malpractice insurance policy and, because it serves more people, can get drugs at a discounted rate. The company also can get better deals on other medical necessities, such as wheelchairs and walkers.

"It's economies of scale," McCrady said.

HPL was started in the mid-1990s by husband and wife Drs. Stephen and Theresa Falcon-Cullinan and others. Theresa Falcon-Cullinan is listed as president in secretary of state records.

Stephen Cullinan was one of 85 partners in the failed President Abraham Lincoln Hotel and Conference Center downtown. The hotel now is being operated by a company hired by the state. His ownership share was less than 1 percent, published reports said.

State campaign finance records show Cullinan and Falcon-Cullinan are regular contributors to Republican candidates. Williamson is a Republican, but he said last week he had never met Cullinan and has no political connections to him. There have been no donations to Williamson from Cullinan or his business, the campaign records show.

The county hopes that hiring HPL marks a change for the better, McCrady said.

"We have the same or better services for less money," he said.

"The job of working at the jail is the hardest job we have at the county. It's really tough. I've never done it, but I've been close enough to know I don't want to. People come to the county jail as punishment, not for punishment. The sheriff would never tolerate those kinds of activities - or the county board."

Wright said, in his experience, medical care can decline when corrections health-care companies take over because they are profit-driven companies and tend to cut services to increase profit.

Spikes in death rates, as Sangamon County is seeing now, can indicate major problems, he said. But the spate of deaths also could be a coincidence, Wright said.

"I don't think any corrections professionals would disagree that no one should be dying in government custody in county jails. They should be getting taken to the hospital. If they're that seriously ill, what are they doing in jail anyway?"

Some deaths are unavoidable, he said. People can drop dead of heart attacks in the best trauma center in the world. "It's their time," Wright said.

But when inmates are in a guarded facility being monitored, a death is more likely to be something else, Wright said.

"Typically, the cases in jail are a pattern of neglect - a situation that builds for hours, days and weeks before it gets to a point they die."

Sarah Antonacci can be reached _at 788-1529 or

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