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HRDC comment to DC Council re Corizon contract Dec. 2014

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Human Rights Defense Center
DEDICATED TO PROTECTING HUMAN RIGHTS

December 13, 2014

SENT VIA EMAIL AND FAX
TIME SENSITIVE

Phil Mendelson, Chairman
D.C. Council
1350 Pennsylvania Ave. NW, Suite 504
Washington, DC 20004
RE: Contract with Corizon for Medical Care at D.C. Jail
Dear Chairman Mendelson:
I am contacting you in reference to the Office of Contracting and Procurement’s award of the
medical care contract for the District’s jail system to Corizon Health, a for-profit company with
corporate headquarters located near Nashville, Tennessee.
I serve as the associate director of the Human Rights Defense Center, a non-profit organization
that advocates for the rights of people held in detention facilities, and I manage HRDC’s office
in Nashville. I am also the managing editor of HRDC’s monthly publication, Prison Legal News
(PLN). Over the past 20 years PLN has reported extensively on private, for-profit companies that
provide prison and jail medical services, and we have direct experience with respect to litigation
involving Corizon, as described below.
I am recognized as a national expert on private corrections-related issues. I have testified before
the U.S. House Committee on the Judiciary’s Subcommittee on Crime, Terrorism and Homeland
Security; have authored chapters in four books on criminal justice topics; and have presented at
numerous events about privatization in the prison and jail context, including a Congressional
briefing and Congressional Correctional Officers Caucus meeting.
HRDC opposes efforts to privatize medical care in the District’s jail system by contracting with
Corizon Health, which was formed in 2011 through the merger of Prison Health Services (PHS)
and Correctional Medical Services (CMS). Please excuse the length of this letter and exhibits;
we believe that contracting with for-profit companies such as Corizon is a serious issue that
deserves an equally serious response and consideration by policymakers.
Please reply to Tennessee office:
5331 Mt. View Road #130, Antioch, TN 37013
Phone: 615.495.6568 • Fax: 866.735.7136
afriedmann@prisonlegalnews.org
www.humanrightsdefensecenter.org

Phil Mendelson, Chairman
December 13, 2014
Page 2

Private prison medical companies operate along the same model as HMOs, in that they provide
managed care for prisoners and have a financial incentive to cut costs in order to generate profit.
Privatization may have its benefits in other fields; however, in terms of medical care, cutting
costs – which is often achieved by delaying care, denying care, understaffing or hiring less
experienced employees willing to work for lower wages – can have fatal consequences.
This is especially true in the corrections setting, where prisoners are literally a captive market
for private medical providers such as Corizon. Prisoners can not select their own physician, seek
a second opinion or go to a different clinic or hospital. They are totally dependent on the medical
treatment provided at their facility, and in a privatized system are at the mercy of companies that
cut costs in order to generate profit, as that is their corporate goal: To make money.
While most public officials have few concerns over companies making a profit, even within
the corrections setting, the human cost of privatized prison and jail healthcare has been widely
reported in terms of prisoner deaths, injuries, lawsuits and investigations. The track records of
private prison medical providers, including Corizon, speak for themselves and tell a tragic tale.
Although numerous egregious cases have been reported concerning the denial of medical care
to prisoners by for-profit companies, two deserve special mention.
On August 14, 2009, Ashley Ellis, 23, began serving a 30-day sentence at the Northwest State
Correctional Facility in Vermont, where medical care was provided by PHS, one of Corizon’s
predecessors. She suffered from chronic bulimia, depressive disorder and an opiate addiction
stemming from a back injury. Her doctor had sent her medical records to the prison, including
an order specifically directing that Ashley receive potassium.
Although she begged PHS employees for potassium (an over-the-counter supplement that costs
less than $10.00), she never received it. PHS staff failed to provide her with her medication and
Ashley died within two days, on August 16, 2009. The medical examiner wrote that her cause of
death was “Hypokalemic induced cardiac arrhythmia due to anorexia/bulimia nervosa and denial
of access to medications.” A subsequent investigation by Disability Rights Vermont found that
PHS was guilty of several contractual violations which contributed to Ashley’s death, including
staffing deficiencies. A copy of the cover page of the DRV report is attached as Exhibit 1. The
State of Vermont subsequently declined to renew its contract with PHS.
The second case involved Corizon predecessor CMS and a 22-year-old male Delaware prisoner,
Anthony Pierce, also known as “the brother with two heads.” Anthony suffered from a massive
tumor that protruded from his head, around the size of a grapefruit. Despite this very obvious and
serious medical condition, CMS staff failed to provide medical treatment for seven months, and
Anthony died as a result on March 22, 2002. Media reports about Anthony’s death, and about
inadequate care provided to other prisoners, resulted in intervention by the U.S. Department of
Justice in 2006 and a settlement agreement that required federal monitoring of Delaware’s prison
healthcare for three years. Attached as Exhibit 2 are X-rays of Anthony’s skull, which evidence
his obvious medical condition that went untreated by CMS staff. The State of Delaware declined
to renew its contract with CMS in 2010.

Phil Mendelson, Chairman
December 13, 2014
Page 3

These two individual cases are merely the tip of a much larger iceberg in which Corizon has lost
contracts and been investigated and successfully sued in a number of jurisdictions, as detailed in
a comprehensive PLN cover story published in March 2014. More recently, last September and
October The Palm Beach Post ran an extensive series on problems with privatized medical care
in Florida’s Department of Corrections, which is mainly provided by Corizon.
On September 26, 2014, Florida DOC Secretary Mike Crews sent a letter to Corizon indicating
the state would stop payments to the company unless it improved its provision of medical care.
“All too often, we are finding that these corrective action plans are not being carried out and that
the level of care continues to fall below the contractually required standard,” he wrote. “As of
this date, many of the most critical expectations including complete and full staffing, responding
to DOC concerns and reducing the number of grievance[s] are often not being met.”
It is not an exaggeration to say the D.C. Council’s decision with respect to medical care in the
District’s jail system is one of life or death. Research has found that privatization of healthcare
for prisoners leads to increased mortality rates: A study conducted by researchers at U.C. Santa
Barbara, published in Health Economics in November 2009, concluded that “a 13% increase
in percentage of medical personnel employed under contract increases [prisoner] mortality by
1.3%.” Extrapolating from that finding, contracting 100% of prisoner medical care to a private,
for-profit company would result in an estimated 10% increase in prisoner mortality. As one realworld example, shortly after Florida privatized healthcare in that state’s prison system in 2012,
the number of prisoner deaths increased to a ten-year high, according to news reports.
There is also the matter of public accountability and transparency. Whereas public agencies are
held accountable to the public through public records statutes, such laws often do not apply to
private contractors. On the federal level, for instance, the Freedom of Information Act does not
extend to private prisons that house federal prisoners – a shortcoming that is the subject of a bill,
the Private Prison Information Act (HR 5838), introduced in Congress last week. Thus, it is often
difficult for members of the public to obtain information about private contractors even when
they perform a governmental function and are paid with public taxpayer funds.
For example, Prison Legal News filed a lawsuit against Corizon (then operating as PHS) after it
refused to produce records related to legal claims against the company in Vermont – including
claims related to the death of Ashley Ellis, described above. The suit settled in February 2012
with Corizon agreeing to produce the requested records, which revealed the company had paid
$1.8 million in six cases. Those cases included claims of denial of medical and mental health
care to prisoners, negligence and medical malpractice. See Exhibit 3, attached.
Corizon is no stranger to litigation related to delaying, denying or providing inadequate medical
care. A search of the federal court docket system (PACER) indicates that at least 3,200 lawsuits
have been filed against Corizon since the company was formed in 2011.
In October 2014, the State of Arizona agreed to settle a class-action suit and institute extensive
improvements in prison medical care, which is provided by Corizon. One expert witness in that
case, Dr. Robert Cohen, wrote that Arizona’s prison healthcare system, “[A]s it currently exists

Phil Mendelson, Chairman
December 13, 2014
Page 4

under Corizon’s management, is disorganized, under-resourced, understaffed, and completely
lacking in the capacity to monitor itself and correct the systemic dysfunction that currently
exists.” See: Parsons v. Ryan, U.S.D.C. (D. Ariz.), Case No. 2:12-cv-00601-DJH.
Most recently, in a lawsuit removed to federal court just last week, the family of a New Jersey
prisoner who died at the Gloucester County jail alleged that Corizon staff failed to diagnose or
treat his lung cancer. Charles Goodlet was sentenced to 180 days for a probation violation; the
suit claims that medical staff at the jail diagnosed him with a chest cold and gave him over-thecounter medication. A judge ordered his release due to his worsening medical condition and he
was immediately diagnosed with lung cancer at a hospital. He died two months later, in March
2013. The attorney who represents his family said Corizon “never sent him for any additional
diagnostic testing or [did] anything to figure out what’s wrong with him.”
Based on the foregoing, HRDC objects to privatization of healthcare in the District’s jail system,
and requests that the Council not move for consideration of the Corizon contract. If the contract
is moved for consideration, we ask that you do not vote for the contract. Please note we take no
position with respect to the District’s current provider of prisoner medical services, Unity Health
Care, other than to observe that Unity does not have the profit motivation which has resulted in
many of the problems associated with for-profit prison medical companies.
In conclusion and in the interest of full disclosure, in addition to my extensive research into the
privatization of correctional services, which resulted in the book chapters and other reports and
articles I have authored, as well as my testimony before a Congressional subcommittee and
at other events, my knowledge about privatization stems from empirical experience, as I was
myself incarcerated at a privately-operated facility in the 1990s prior to my release in 1999. I
have therefore seen how privatization works both from an insider’s perspective as well as that
of an outside observer and expert. Although some might question the messenger, the message
regarding the risks posed by privatizing prison and jail healthcare is clear.
A copy of PLN’s comprehensive March 2014 exposé on Corizon is attached as Exhibit 4. Please
feel free to contact me should you require additional information; I am also available to provide
in-person testimony before the Council.
Sincerely,

Alex Friedmann
Associate Director, HRDC
cc: D.C. Council Members
D.C. Corrections Information Council
Exhibits Attached

EXHIBIT 1

AN INVESTIGATION INTO THE DEATH OF
ASHLEY ELLIS

DISABILITY RIGHTS VERMONT
(formerly Vermont Protection & Advocacy, Inc.)

141 Main Street, Suite 7
Montpelier, Vermont 05602
May 13, 2010

Tina Wood
Advocate/Paralegal

A.J. Ruben
Supervising Attorney

DRVT is the Protection & Advocacy System for Vermont

EXHIBIT 2

X-ray of inmate Anthony Pierce (cerebral tumor that went untreated by CMS staff).

EXHIBIT 3
Prison Legal News, December 2012, p. 16

PLN Settles Public Records Suit Against PHS in Vermont, Obtains
Settlement Payout Information
by Alex Friedmann
On February 21, 2012, Prison Legal News settled a public records lawsuit filed in Vermont state
court against Prison Health Services (PHS, now operating as Corizon Health, Inc.). As part of the
settlement PHS agreed to produce records related to its resolution of legal claims against the
company in Vermont, which included a total of $1.8 million in six cases.
PLN had filed suit against PHS on August 26, 2010 after the for-profit company, which provided
medical care for Vermont state prisoners until the end of 2009, refused to produce documents
pursuant to a public records request.
PLN requested copies of PHS’s contracts with government agencies in Vermont, records related
to settlements and judgments that PHS had paid as a result of lawsuits and civil claims, and
documents concerning costs incurred by PHS to defend against claims or lawsuits.
One of those claims involved the August 16, 2009 death of Ashley Ellis, 23, a Vermont prisoner
who died at the Northwest State Correctional Facility just three days into a 30-day sentence. PHS
employees had failed to give her potassium despite her repeated pleas for medical care and an
order from her doctor. The medical examiner cited “denial of access to medication” as a
contributing cause of her death. [See: PLN, April 2010, p.32].
Although PHS is a private company, PLN argued it was the functional equivalent of a public
agency because it provided health care to prisoners – a function that public employees would
have to provide if the state did not contract with PHS – and thus was subject to Vermont’s public
records law. The “functional equivalency” test has been applied to private companies that
perform public duties in at least eight states, including Florida, Tennessee, Maryland, North
Carolina, Oregon, Kansas, Ohio and Connecticut.
PHS denied PLN’s public records request, claiming that as “a private corporation” the company
“does not qualify as a ‘public agency’” within the meaning of Vermont’s public records statute.
“The state can outsource public functions and services such as health care for prisoners,” said
PLN editor Paul Wright, “but it cannot contract out the public’s fundamental right to know how
their tax dollars are being spent and the quality of services the public is getting for its money.”
He also questioned “why PHS refuses to release records that state agencies would have to
produce if the state were providing prison medical care.”
PLN’s public records lawsuit contended that “Prison Health Services, by virtue of its contractual
relationship with the Vermont Department of Corrections, was a public agency subject to
Vermont’s public records statute” because it was an “instrumentality” and functional equivalent
of a government agency. Further, PHS’s funding for its Vermont contract came “exclusively
from the Vermont DOC, and hence, the taxpayers.”

In settling the case in February 2012, PHS agreed to produce unredacted copies of “the general
releases it secured to settle claims or potential claims arising out of PHS’s provision of medical
care to inmates in the custody of the Vermont Department of Corrections” in six cases
responsive to PLN’s records request, including the Ashley Ellis case. The company further
agreed to pay $5,350 in attorney fees to the ACLU of Vermont but did not admit liability or
wrongdoing.
According to the records produced by PHS, the company paid $700,000 in February 2010 in a
pre-litigation settlement to resolve claims related to the death of Ashley Ellis. Ellis’ estate,
represented by Rutland attorney Shannon A. Bertrand, is also pursuing a separate lawsuit against
the State of Vermont, the Vermont DOC and various state employees. See: Gipe v. State of
Vermont, Vermont Superior Court, Rutland Unit, Case No. 515-7-11.
Additionally, in October 2010, PHS agreed to pay $950,000 to settle a federal lawsuit filed by
Christopher Barrett, a state prison guard who was attacked and injured by a prisoner in 2005 at
the Northern State Correctional Facility; PHS allegedly did not give the prisoner his prescribed
medication for a mental health condition, which resulted in the assault. Barrett was represented
by attorney David J. Williams. See: Barrett v. Prison Health Services, U.S.D.C. (D. VT), Case
No. 5:08-cv-00203-cr-jmc.
PHS paid $47,500 in December 2010 to settle the negligence and medical malpractice claims of
Agim and Fexhrije Sulejmani, related to Agim’s health care while he was incarcerated in 2006.
Despite repeatedly seeking treatment for a preexisting throat condition, PHS staff failed to
provide adequate medical care or diagnose Agim’s laryngeal cancer, which required him to have
an emergency tracheotomy and surgery after he was released from prison. The Sulejmanis were
represented by Hinesburg attorney Beth A. Danon. See: Sulejmani v. Prison Health Services,
Vermont Superior Court, Chittenden Unit, Case No. S1237-09.
In October 2011, PHS paid $45,000 to settle a lawsuit filed by Vermont prisoner Edward
Truszkowski, Jr., who claimed that PHS had failed to provide prescribed medication for his
Gastroesophageal Reflux Disease while he served a 30-day sentence at the Southern State
Correctional Facility. Truszkowski was represented by attorney Brian R. Marsicovetere. See:
Truszkowski v. Hofman, U.S.D.C. (D. VT), Case No. 5:11-cv-00006-cr-jmc.
PHS agreed in November 2007 to pay $32,500 to the estate of Robert C. Nichols due to Nichol’s
2004 death at the Chittenden Regional Correctional Facility. Although he was suffering from
heroin withdrawal and had ingested 80 bags of heroin soon after he was incarcerated, Nichols
was “not given immediate medical attention,” according to a lawsuit filed by his estate, which
led to his death. Nichols’ estate was represented by Peter F. Langrock with the law firm of
Langrock Sperry & Wool, LLP. See: Nichols v. State of Vermont, Vermont Superior Court,
Rutland Unit, Case No. 546-10-06.
Lastly, on June 1, 2007, PHS paid $25,000 to settle a pro se federal lawsuit filed by Vermont
state prisoner Peter Goodnow, who alleged inadequate medical care for a broken hand and
painful tooth while he was housed at the CCA-operated Lee Adjustment Center in Kentucky.
See: Goodnow v. Hofman, U.S.D.C. (D. VT), Case No. 1:06-cv-00124-jgm-jjn.

The settlements in the six cases totaled $1.8 million. This was the first known time that PHS had
produced records related to its resolution of legal claims against the company, which typically
include confidentiality provisions. PHS’s defense counsel in Vermont includes the Burlington
law firm of Dinse, Knapp & McAndrew, P.C. One of the firm’s attorneys, Shapleigh Smith, Jr.,
is the current Speaker of the state’s House of Representatives.
PLN was initially represented in its public records lawsuit by attorney David C. Sleigh with the
law firm of Sleigh & Williams, P.C., and subsequently by Dan Barrett with the ACLU of
Vermont. See: Prison Legal News v. Prison Health Services, Vermont Superior Court,
Washington Unit, Case No. 622-8-10.

Prison Legal News
EXHIBIT 4

VOL. 25 No. 3

Dedicated to Protecting Human Rights

ISSN 1075-7678

March 2014

Corizon Needs a Checkup: Problems with
Privatized Correctional Healthcare
by Greg Dober

C

From the Editor 	

18

parent corporation] will be unable to restore
metrics to levels commensurate with the
prior B1 rating over the near to intermediate term.”
Valitás Health Services is majority owned by Beecken Petty O’Keefe &
Company, a Chicago-based private equity
management firm. Beecken’s other holdings
are primarily in the healthcare industry.
On September 23, 2013, Moody’s
again downgraded Corizon’s debt rating
and changed the company’s rating outlook
from “stable” to “negative.” The following
month Corizon announced that it had
replaced CEO Rich Hallworth with Woodrow A. Myers, Jr., the former chief medical
officer at WellPoint Health. Hallworth,
who had been appointed Corizon’s CEO
in 2011, previously served as the president
and CEO of PHS. At the same time that
Hallworth was replaced, Corizon president
Stuart Campbell also stepped down.

Private Prison Racial Disparities 	

20

Prison Medical Care for Profit

When Victims Speak for Criminals 	

24

Texas Criminal Court Fees 	

28

CA Female Prisoners Sterilized 	

32

Michigan Parole Scrutinized 	

42

Introduction to the FTCA 	

44

Execution Drugs Hard to Find 	

46

A Look Inside Maine’s Supermax 	

48

Video Visitation in Jails 	

50

UNICOR Faces Criticism 	

52

Oregon Jail Death Lawsuits 	

54

News in Brief 	

56

orizon, the nation’s largest forprofit medical services provider for
prisons, jails and other detention facilities,
was formed in June 2011 through the merger of Prison Health Services (PHS) and
Correctional Medical Services (CMS).
In April 2013, the debt-rating agency
Moody’s downgraded Corizon’s nearly
$360 million worth of debt to a rating of
B2 – an indication the company’s debt is
highly speculative and a high credit risk.
According to Moody’s, the rating downgrade was due to an “expectation of earnings
volatility following recent contract losses,
margin declines from competitive pricing
pressure on new and renewed contracts,
and Moody’s belief that Valitás [Corizon’s

Inside

According to Corizon’s website, the
company provides healthcare services at
over 530 correctional facilities serving
approximately 378,000 prisoners in 28
states. In addition, Corizon employs around
14,000 staff members and contractors. The
company’s corporate headquarters is located
in Brentwood, Tennessee and its operational
headquarters is in St. Louis, Missouri.
The 2011 merger that created Corizon
involved Valitás Health Services, the parent
company of CMS, and America Service
Group, the parent company of PHS. The
Nashville Business Journal reported the deal
was valued at $250 million.
“Corizon’s vision is firmly centered
around service – to our clients, our patients

and our employees,” Campbell said at the
time. “To that we add the insight of unparalleled experience assisting our client
partners, and caring professionals serving
the unique healthcare needs of [incarcerated] patients.”
Corizon has around $1.5 billion in
annual revenue and contracts to provide
medical services for the prison systems in
13 states. The company also contracts with
numerous cities and counties to provide
healthcare to prisoners held in local jails;
some of Corizon’s larger municipal clients
include Atlanta, Philadelphia and New
York City (including the Rikers Island
jail). Additionally, the company has its own
in-house pharmacy division, PharmaCorr,
Inc.
The prison healthcare market has flourished as state Departments of Corrections
and local governments seek ways to save
money and reduce exposure to litigation.
[See: PLN, May 2012, p.22]. Only a few
major companies dominate the industry.
Corizon’s competitors include Wexford
Health Sources, Armor Correctional
Health Services, NaphCare, Correct Care
Solutions and Centurion Managed Care –
the latter being a joint venture of MHM
Services and Centene Corporation. Around
20 states outsource all or some of the medical services in their prison systems.
As Corizon is privately held, there is
little transparency with respect to its internal operations and financial information,
including costs of litigation when prisoners
(or their surviving family members) sue
the company, often alleging inadequate
medical care.
For example, when Corizon was questioned by the news media in Florida during

Prison Legal News

a publication of the
Human Rights Defense Center

www.humanrightsdefensecenter.org
EDITOR

Paul Wright
MANAGING EDITOR

Alex Friedmann
COLUMNISTS

Michael Cohen, Kent Russell,
Mumia Abu Jamal
CONTRIBUTING WRITERS

Matthew Clarke, John Dannenberg,
Derek Gilna, Gary Hunter,
David Reutter, Mark Wilson,
Joe Watson, Christopher Zoukis
research associate

Mari Garcia

advertising director

Susan Schwartzkopf
LAYOUT

Privatized Healthcare Problems (cont.)
a contract renewal, the company initially
tried to prevent the release of its litigation
history, claiming it was a “trade secret.”
In 2012, Corizon agreed to settle a
lawsuit filed against PHS – one of its predecessor companies – by Prison Legal News,
seeking records related to the resolution of
legal claims against the firm in Vermont.
Based on the records produced pursuant to
that settlement, PHS paid out almost $1.8
million in just six cases involving Vermont
prisoners from 2007 to 2011. [See: PLN,
Dec. 2012, p.16].
Companies like Corizon provide
healthcare in prisons and jails under the
HMO model, with an emphasis on cutting
costs – except that prisoners have no other
options to obtain medical treatment except
through the contractor.

Lansing Scott

Arizona DOC

HRDC litigation project

A former Corizon nurse had her
license suspended and is currently under
investigation by the Arizona State Board
of Nursing for incompetence. In January
2014, nurse Patricia Talboy was accused of
contaminating vials of insulin at three units
at the ASPC-Lewis prison, potentially
exposing two dozen prisoners to HIV or
hepatitis.
Talboy reportedly used a needle to stick
prisoners’ fingers to check their blood sugar
levels. She then used the same needle to
draw insulin from vials of the medication
utilized for multiple prisoners, possibly
contaminating the insulin in the vials. After
placing the vials back into inventory, other
staff members may have unknowingly used
them to dispense insulin.
“Every indication is that the incident
is the result of the failure by one individual nurse to follow specific, standard
and well-established nursing protocols
when dispensing injected insulin to 24 inmates,” Arizona Department of Corrections
(ADC) director Charles L. Ryan said in a
January 9, 2014 statement.
Talboy’s failure to follow procedures
was discovered after a prisoner told a
different nurse about the issue. Corizon reportedly delayed three days before publicly
reporting the incident; in a press release, the
company admitted that one of its nurses
had been involved in “improper procedures
for injections.” Talboy received her nursing

Lance Weber—General Counsel
Robert Jack—Staff Attorney
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3

license in August 2012 and became an RN
in June 2013; as a rookie nurse, Corizon
likely paid her less than more experienced
nurses.
Following the insulin-related incident,
the company was ordered to develop a comprehensive plan that includes “supplemental
training and competency testing procedures
for blood glucose testing and administration
of insulin,” as well as “nurse-peer reporting
education to ensure professional accountability” and “patient awareness education
on injection protocols.”
Granted, Corizon isn’t alone with
respect to such incidents. In August 2012,
a nurse employed by the ADC’s previous medical services contractor, Wexford
Health Sources, contaminated the insulin
supply at ASPC-Lewis through improper
injection protocols, potentially exposing
112 prisoners to hepatitis C. [See: PLN,
July 2013, p.1].
Corizon has a three-year, approximately $370 million contract to provide
medical care in Arizona state prisons, which
began in March 2013. The contract award
generated controversy because former ADC
director Terry Stewart was hired by Corizon
as a consultant; current director Charles
Ryan had previously worked under Stewart,
raising a potential conflict of interest. Ryan
denied any improprieties.
According to a report by the American
Friends Service Committee released in October 2013, titled “Death Yards: Continuing
Problems with Arizona’s Correctional
Health Care,” medical services in Arizona
prisons did not improve after Corizon replaced Wexford as the ADC’s healthcare
contractor. “Correspondence from prisoners; analysis of medical records, autopsy
reports, and investigations; and interviews
with anonymous prison staff and outside
experts indicate that, if anything, things
have gotten worse,” the report stated.

Florida DOC
In 2013, the Florida Department of
Corrections (FDOC) awarded Corizon a
five-year, $1.2 billion contract to provide
medical services to state prisoners in north
and central Florida. Wexford Health Sources was contracted to provide similar services
in the southern region of the state for $240
million. [See: PLN, June 2013, p.24]. The
wholesale privatization of healthcare in
Florida’s prison system followed a 2011
legislative decision to disband the state’s
March 2014

Privatized Healthcare Problems (cont.)
Correctional Medical Authority, which had
oversight over prison medical care. [See:
PLN, May 2012, p.30].
The contracts were part of the Republican administration’s initiative to expand
privatization of government services, including prison management and healthcare,
in spite of previous setbacks. In 2006, PHS
withdrew two months into an almost $800
million contract to provide medical care to
Florida prisoners; at that time, the company
said the contract was not cost-effective and
claimed it would lose money.
The 2013 contract awards to Corizon
and Wexford followed a two-year legal
fight. In 2011, AFSCME Florida and the
Federation of Physicians and Dentists/
Alliance of Healthcare and Professional
Employees filed suit challenging the
prison healthcare contracts, in an effort
to protect the jobs of nearly 2,600 state
workers.
On June 21, 2013 the First District
Court of Appeals approved the privatization of medical care in FDOC facilities,

overturning a ruling by the Leon County
Circuit Court. The appellate court noted
in its decision that “The LBC [Legislative
Budget Committee] simply moved funds
from different line items within the Department’s Health Services’ program, providing
additional funds for contracts that the
Department otherwise had the authority to
enter.” See: Crews v. Florida Public Employers Council 79, 113 So.3d 1063 (Fla. Dist.
Ct. App. 1st Dist. 2013).
Under the terms of the FDOC’s
contract with Corizon, the company must
provide medical care to Florida state prisoners for 7% less than it cost the FDOC
in 2010. When entering into the contract,
state officials apparently had few concerns
about the numerous lawsuits previously
filed against Corizon, and no hard feelings
toward the company’s predecessor, PHS,
when it terminated its 2006 contract to
provide medical services to Florida prisoners because it wasn’t profitable.
“Most people feel, as long as they
achieve their 7 percent savings who cares
how they treat inmates?” noted Michael
Hallett, a professor of criminology at the
University of North Florida.

Florida Counties
In a September 6, 2012 unpublished
ruling, the Eleventh Circuit Court of Appeals affirmed a $1.2 million Florida jury
verdict that found Corizon – when it was
operating as PHS – had a policy or custom
of refusing to send prisoners to hospitals.
The Court of Appeals held it was reasonable for jurors to conclude that PHS had
delayed medical treatment in order to save
money. See: Fields v. Corizon Health, 490
Fed.Appx. 174 (11th Cir. 2012).
The jury verdict resulted from a suit
filed against Corizon by former prisoner
Brett A. Fields, Jr. In July 2007, Fields was
being held in the Lee County, Florida jail
on two misdemeanor convictions. After
notifying PHS staff for several weeks that
an infection was not improving, even with
antibiotics that had been prescribed, Fields
was diagnosed with MRSA. PHS did not
send him to a hospital despite escalating
symptoms, including uncontrolled twitching, partial paralysis and his intestines
protruding from his rectum. A subsequent
MRI scan revealed that Fields had a severe
spinal compression; he was left partly para-

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Prison Legal News

lyzed due to inadequate medical care.
The Eleventh Circuit wrote that PHS
“enforced its restrictive policy against sending prisoners to the hospital,” and noted
that a PHS nurse who treated Fields at
the jail “testified that, at monthly nurses’
meetings, medical supervisors ‘yelled a lot
about nurses sending inmates to hospitals.’” Further, PHS “instructed nurses to
be sure that the inmate had an emergency
because it cost money to send inmates to
the hospital.”
At trial, the jury found that PHS had a
custom or policy of deliberate indifference
that violated Fields’ constitutional right to
be free from cruel and unusual punishment.
The jurors concluded that Fields had a serious medical need, PHS was deliberately
indifferent to that serious medical need, and
the company’s actions proximately caused
Fields’ injuries. The jury awarded him
$700,000 in compensatory damages and
$500,000 in punitive damages. [See: PLN,
March 2013, p.54; Aug. 2011, p.24].
More recently, the estate of a 21-yearold prisoner who died at a jail in Manatee
County, Florida filed a lawsuit in October
2013 against the Manatee County Sheriff ’s

Office and Corizon, the jail’s healthcare
provider. The complaint accuses the defendants of deliberate indifference to the
serious medical needs of Jovon Frazier
and violating his rights under the Eighth
Amendment.
In February 2009, Frazier was incarcerated at the Manatee County Jail; at the
time of his medical intake screening, staff
employed by Corizon, then operating as
PHS, noted that his health was unremarkable. Frazier submitted a medical request
form in July 2009, complaining of severe
pain in his left shoulder and arm, and a
PHS nurse gave him Tylenol.
Throughout August and September
2009, Frazier submitted five more medical
requests seeking treatment for his arm and
shoulder. “It really hurts! HELP!” he wrote
in one of the requests. PHS employees saw
him and recorded his vital signs. Despite
the repeated complaints, Frazier was never
referred to a doctor or physician assistant;
on September 9, 2009 his treatment was
documented as routine but he was placed
on the “MD’s list.”
An X-ray was taken on September
17, 2009 to rule out a shoulder fracture.

The X-ray was negative for a fracture, and
Frazier was not referred to a doctor. He
submitted two more medical requests that
month and five requests in October 2009
seeking treatment for his increasingly painful condition. The complaint alleges that in
total, Frazier submitted 13 medical request
forms related to pain over a period of three
months; he was seen by a nurse each time
but not examined by a physician.
On October 29, 2009, Frazier received
an X-ray to determine if he had a tendon
injury. An MRI was recommended and
he was transported to a hospital where an
MRI scan revealed a large soft tissue mass
on his shoulder. A doctor at the hospital,
concerned that the mass was cancerous,
recommended additional tests.
After being diagnosed with osteosarcoma, a form of bone cancer, Frazier
was returned to the jail and subsequently
treated at the Moffitt Cancer Center, where
he received chemotherapy, medication and
surgery. Despite this aggressive treatment
the cancer progressed and Frazier’s left
arm was amputated. The cancer continued
to spread, however, and he was diagnosed
with lung cancer in June 2011. He died

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Privatized Healthcare Problems (cont.)
within three months of that diagnosis, on
September 18, 2011.
In a letter to the attorney representing
Frazier’s estate, Florida oncologist Howard
R. Abel wrote that the lack of treatment
provided by Corizon at the Manatee
County Jail constituted “gross negligence
and a reckless disregard to Mr. Frazier’s
right to timely and professionally appropriate medical care.”
The lawsuit filed by Frazier’s estate
claims that Corizon was aware of his
serious medical condition but failed to
provide adequate treatment. In addition,
the complaint contends the company has a
widespread custom, policy and practice of
discouraging medical staff from referring
prisoners to outside medical practitioners
and from providing expensive medical
tests and procedures. Finally, the lawsuit
states that “Corizon implemented these
widespread customs, policies and practices
for financial reasons and in deliberate indifference to [the] serious medical needs of
Frazier and other inmates incarcerated at
Manatee County Jail.”
On January 10, 2014, U.S. District
Court Judge James Moody denied Corizon’s motion to dismiss the case. The
company had argued that the allegations in
the lawsuit failed to assert sufficient facts to
establish deliberate indifference, amounted
only to medical negligence and were insufficient to establish gross negligence, and

failed “to adequately allege a policy or
custom that violated Frazier’s rights.” Judge
Moody disagreed, finding the claims set
forth in the complaint were “sufficient to
establish a constitutional violation.”
The Manatee County Sheriff ’s Office
had better luck with its motion to dismiss.
The Sheriff argued the complaint did not
establish facts indicating that the jail had a
similar practice – like Corizon – of providing deliberately indifferent medical care to
prisoners. The court agreed and dismissed
the claims against the Sheriff ’s Office; the
claims against Corizon remain pending.
See: Jenkins v. Manatee County Sheriff,
U.S.D.C. (M.D. Fla.), Case No. 8:13-cv02796-JSM-TGW.

Idaho DOC
In February 2013, the Idaho Department of Corrections (IDOC) announced
it had reached a one-year extended agreement with Corizon to provide medical care
in the state’s prison system. However, the
Idaho Business Review reported that the
extension also resulted in a rate increase.
Then-Corizon president Stuart Campbell
informed the IDOC Board of Correction
that the company wouldn’t sign an extension for less money, stating the current
contract had become too costly. During the
preceding three years of the contract the
IDOC had incurred approximately 20% in
cumulative rate increases.
Both sides agreed that the contract
would run through December 2013 and the
IDOC would pay an additional $250,000.

It seems odd that Idaho was willing to
continue contracting with the company,
though, as the relationship between the
IDOC and Corizon has been a rocky one.
The quality of medical care at the Idaho
State Correctional Institution (ISCI) in
Boise has been an ongoing issue for nearly
three decades. The prison was the focus
of a class-action lawsuit filed on behalf of
prisoners alleging a variety of problems,
including inadequate healthcare. The lawsuit was known as the Balla litigation after
plaintiff Walter Balla.
In July 2011, after new complaints
were filed regarding medical care at ISCI,
U.S District Court Judge B. Lynn Winmill
appointed a special master, Dr. Marc F.
Stern, to assess the situation at the facility.
The court wanted Stern to confirm whether
ISCI was in compliance with the temporary
agreements established in the Balla case,
and to investigate and report on “the constitutionality of healthcare” at the facility.
Dr. Stern, a former health services
director for the Washington Department
of Corrections who also had previously
worked for CMS, one of Corizon’s predecessor companies, issued a scathing report
in February 2012. With the aid of psychiatrist Dr. Amanda Ruiz, Stern and his team
reviewed ISCI over a six-day period and
met with dozens of prisoners, administrators and Corizon employees.
Stern stated in the report’s executive
summary: “I found serious problems with
the delivery of medical and mental health
care. Many of these problems have either

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Prison Legal News

resulted or risk resulting in serious harm to
prisoners at ISCI. In multiple ways, these
conditions violate the rights of prisoners at
ISCI to be protected from cruel and unusual
punishment. Since many of these problems
are frequent, pervasive, long-standing, and
authorities are or should have been aware
of them, it is my opinion that authorities
are deliberately indifferent to the serious
health care needs of their charges.”
The report found that prisoners who
were terminally ill or in long-term care
were sometimes left in soiled linens, given
inadequate pain medication and went for
long periods without food or water. The
findings regarding sick call noted instances
in which prisoners’ requests either resulted
in no care, delayed care or treatment that
was deemed dangerous. Emergency care
situations had insufficient oversight, delays
or no response; inadequately trained medical staff operated independently during
emergencies without oversight from an
RN or physician. The report also found
problems with the pharmacy and medication distribution at ISCI.
In one case, a prisoner with a “history
of heart disease was inexplicably dropped

from the rolls of the heart disease Chronic
Care Clinic.” As a result, medical staff
stopped conducting regular check-ups and
assessments related to the prisoner’s heart
condition. A few years later the prisoner
went in for a routine visit, complaining
of occasional chest pain. No evaluation or
treatment was ordered and the prisoner
died four days later due to a heart attack. In
another case, Corizon staff failed to notify
a prisoner for seven months that an X-ray
indicated he might have cancer.
Dr. Stern’s report not only reviewed
processes but also staff competency and
adequacy. The report cited allegations that
a dialysis nurse at ISCI overtly did not like
prisoners, and routinely “failed to provide
food and water to patients during dialysis,
prematurely aborted dialysis sessions or
simply did not provide them [dialysis] at all
and failed to provide ordered medications
resulting in patients becoming anemic.”
Stern concluded that prison officials were
aware of this issue and the danger it presented to prisoners, but “unduly delayed
taking action.”
The mental health care provided by
Corizon at ISCI was found to be deficient

by Dr. Ruiz, who conducted the psychiatric portion of the court-ordered review.
The report noted that the facility had 1)
inadequate “screening of and evaluating
prisoners to identify those in need of mental
health care,” 2) “significant deficiencies in
the treatment program at ISCI” which was
“violative of patients’ constitutional right
to health care,” 3) an “insufficient number
of psychiatric practitioners at ISCI,” 4)
incomplete or inaccurate treatment records,
5) problems with psychotropic medications,
which were prescribed with no face-to-face
visits or follow-up visits with prisoners and
6) inadequate suicide prevention training.
The report concluded: “The state of
guiding documents, the inmate grievance
system, death reviews and a mental health
CQI [continuous quality improvement]
system at ISCI is poor. While not in and of
themselves unconstitutional, it is important
for the court to be aware of this and its possible contribution to other unconstitutional
events.”
In March 2012, shortly after Dr.
Stern’s report was released over the objection of state officials, Corizon disagreed
with its findings. The company retained

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Prison Legal News

7

March 2014

Privatized Healthcare Problems (cont.)
the National Commission on Correctional
Health Care (NCCHC) to review the
report. Corizon described the review as an
“independent assessment,” even though it
was paying NCCHC accreditation fees.
The NCCHC review consisted of a
three-person team assessing the facility
over a two-day period in April 2012. Unlike
Stern’s assessment of medical and mental
health care, the NCCHC team did not
interview prisoners or include a psychiatrist.
Regardless, the agency concluded that “The
basic structure of health services delivery at
ISCI meets NCCHC’s standards.”
Corizon stated in a press release that
Dr. Stern’s report was “incomplete, mislead-

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ing and erroneous,” and then-CEO Rich
Hallworth appeared in a video defending
the company. The NCCHC had previously
accredited Corizon’s healthcare services at
ISCI, thus in essence the NCCHC’s review
was self-validating the organization’s prior
accreditation findings. Also, according to
NCCHC’s website, two Corizon officials
sit on the agency’s health professionals
certification board of trustees.
Corizon’s criticism of Dr. Stern’s report
is just one example where the company has
objected to an independent, third-party assessment of its medical services. The Balla
case settled in May 2012 after 30 years of
litigation. [See: PLN, Feb. 2013, p.40].

deteriorate and die,” the complaint stated.
“That is just the attitude of these guys,
is saving money rather than providing
health care,” said Michael K. Sutherlin, the
attorney representing Wood’s family.
Prison officials reportedly moved
Wood among several different prisons and
hospitals, and at one point lost track of her
and claimed she had escaped even though
she was still incarcerated.
“She died a horrible death and she died
alone,” stated her father, Claude Wood. The
lawsuit remains pending. See: Williams v. Indiana DOC, Marion County Superior Court
(IN), Case No. 49D05-1401-CT-001478.

Indiana DOC

In an October 2013 Bangor Daily News
article, Steve Lewicki, coordinator of the
Maine Prisoner Advocacy Coalition, discussed the state of healthcare in Maine’s
prison system. “Complaints by prisoners are
less,” he said, noting that while medical services provided to prisoners are better than in
the past, there are still concerns. This relative
improvement coincided with the end of the
state’s contract with Corizon. The contract,
valued at approximately $19.5 million, was
awarded to another company in 2012.
A year earlier, the Maine legislature’s
Office of Program Evaluation and Government Accountability (OPEGA) completed
a review of medical services in state prisons.
The agency contracted with an independent
consultant, MGT of America, to conduct
most of the fieldwork, and the review included services provided under Corizon’s
predecessor company, CMS.
The OPEGA report, issued in November 2011, cited various deficiencies in
medical care at Maine prisons – including
medications not always being properly

Following a competitive bidding
process, Corizon was selected to continue
providing medical care to Indiana state
prisoners under a three-year contract effective January 1, 2014. The contract has a cap
of $293 million, based on a per diem fee of
$9.41 per prisoner.
Three weeks later, a lawsuit filed in federal court named Corizon and the Indiana
Department of Correction as defendants
in connection with the wrongful death of
prisoner Rachel Wood. Wood, 26, a firsttime drug offender, died in April 2012; the
suit, filed on behalf of her family, claims she
was transferred from prison to prison and
denied care for her serious medical conditions, which included lupus and a blood
clotting disorder.
“Notwithstanding the duty of the
prison medical staff to provide adequate
medical care to Rachel and to treat her very
serious life threatening conditions, prison
medical staff willfully and callously disregarded her condition, and allowed Rachel to

Maine DOC

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(213) 489-7715
March 2014

8

Prison Legal News

administered and recorded by CMS staff.
Although the company was notified of the
problem, no corrective action was taken.
CMS employees did not follow policies related to medical intake and medical records;
OPEGA reported that 38% of prisoners’
medical files had inadequate or inaccurate
documentation regarding annual physical
assessments, and that files were not complete or consistently maintained. The report
found 11% of sick calls reviewed were either
not resolved timely or had no documented
resolution. OPEGA also criticized CMS
for inadequate staff training.
At a January 2012 legislative committee hearing, state Senator Roger Katz
asked Corizon regional vice president
Larry Amberger, “My question to you is in
light of this history, why should the state
seriously be considering any proposal your
company might make to get this contract
back again?”
In response, Amberger criticized the
methodology used by MGT during the
assessment and said he believed Corizon
provided quality medical care. Questioning and challenging the findings of an
independent reviewer is the same tactic
the company used in Idaho. Regardless,
Corizon’s contract to provide medical care
to Maine state prisoners is now a part of
history.

Louisville, Kentucky
While some jurisdictions, like Maine,
have chosen not to renew their contracts
with Corizon due to performance-related

problems, in 2013 the Metro Department of
Corrections in Louisville, Kentucky (LMC)
offered the company a chance to rebid for
its $5.5 million contract to provide medical
care at the LMC jail. This time, however, it
was Corizon that said “no thanks.”
The rebid offer was made even though
seven healthcare-related prisoner deaths
occurred in a seven-month period in 2012
during Corizon’s prior contract, which
expired in February 2013. Nevertheless,
LMC and Corizon agreed to extend the
contract through July 30, 2013 on a monthto-month basis pending a formal rebid.
After the expiration of the month-tomonth contract extension, Corizon notified
LMC that it was no longer interested in
providing services to the corrections department and would not seek to rebid the
contract. LMC director Mark Bolton told
the Courier Journal he was “surprised” by
the company’s decision. What seems more
surprising is that LMC wanted to continue contracting with Corizon to provide
medical services in spite of the number of
prisoner deaths.
In April 2012, Savannah Sparks, 27, a
heroin addict and mother of three, was arrested and held on shoplifting charges at the
LMC jail. While withdrawing from heroin
she vomited, sweat profusely, could not sit
up, could not eat or drink, and defecated and
urinated on herself. Six days later she was
dead. According to the medical examiner,
her death was due to “complications of
chronic substance abuse with withdrawal.”
A subsequent wrongful death suit

alleged that Corizon and LMC employees were negligent in failing to provide
treatment for Sparks’ opiate addiction and
withdrawal. Corizon settled the suit under
confidential terms. See: May v. Corizon,
Jefferson County Circuit Court (KY), Case
No. 13-CI-001848.
Four months after Sparks’ death, on
August 8, 2012, another LMC prisoner,
Samantha George, died. A lawsuit filed in
Jefferson County Circuit Court claimed
that George was moved from the Bullitt
County Jail to the LMC facility on a charge
of buying a stolen computer. According to
the complaint, she told a Corizon nurse that
she was a severe diabetic, needed insulin,
and was feverish and in pain from a MRSA
infection.
The nurse notified an on-call Corizon
physician, who was not located at the facility and thus could not examine George
in person, to decide if she should be taken
to an emergency room. The doctor recommended monitoring George and indicated
he would see her the next day. George’s
condition rapidly deteriorated while she
was monitored by staff at the jail; she was
found unresponsive a few hours after being
admitted to the facility and pronounced
dead a short time later.
An autopsy concluded that George
died due to complications from a severe
form of diabetes compounded by heart
disease. According to the lawsuit, the Corizon doctor never saw George; among other
defendants, the suit named Corizon and
LMC director Mark Bolton as defendants.

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9

March 2014

Privatized Healthcare Problems (cont.)
The case was removed to federal court,
then remanded to the county circuit court
in October 2013. See: George v. Corizon,
U.S.D.C. (W.D. Ky.), Case No. 3:13-cv00822-JHM-JDM.
A few weeks after George’s death, Kenneth Cross was booked into the LMC jail
on a warrant for drug possession. According
to a subsequent lawsuit, upon Cross’ arrival
at the jail a nurse documented that he had
slurred speech and fell asleep numerous
times during the medical interview. Several hours later he was found unconscious,
then died shortly thereafter due to a drug
overdose. The lawsuit filed by Cross’ estate
alleged that employees at the LMC jail
were deficient in recognizing and treating
prisoners’ substance abuse problems and
that the facility was inadequately staffed
for such medical care.
After the deaths of Sparks, George,
Cross and four other prisoners in 2012,
LMC director Bolton said he believed
Corizon took too long to evaluate and

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treat prisoners at the jail. According to the
Courier-Journal, Bolton sent an email to his
staff in December 2012 regarding the prisoners’ deaths, stating, “Mistakes were made
by Corizon personnel and their corporation
has acknowledged such missteps.” He further indicated that Corizon employees – not
LMC staff members – were responsible for
the care of the prisoners who died. Six Corizon employees at the LMC jail resigned in
December 2012 during an internal investigation; they were not identified.
Bolton’s criticism was too little, too
late to prevent the deaths of the seven
LMC prisoners, though the jail has since
made improvements to its medical services,
including a full-time detox nurse and new
protocols for prisoners experiencing withdrawal. One could speculate that LMC’s
critique of Corizon might be a litigation
tactic, to deflect responsibility. The fact
remains that seven deaths occurred under
Corizon’s watch and, notwithstanding
those deaths, LMC was willing to renew
its contract with the company.
In January 2014, the Louisville Metro
Police’s Public Integrity Unit concluded
investigations into three of the deaths at the
jail, and criticized both Corizon and LMC.
The Commonwealth Attorney’s Office
found that Sparks’ and George’s deaths were
preventable; however, no criminal charges
were filed. Dr. William Smock, a forensic
examiner who served as a consultant during the investigations, stated with respect
to George’s death: “There is compelling
evidence of a significant deviation from the
standard of care and medical negligence on
the part of the medical providers.”
“I’m glad to see that the government’s
investigation matches exactly what our investigation showed, which is that her death

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March 2014

10

and others like hers is easily preventable,”
said Chad McCoy, the attorney representing George’s estate.

Minnesota DOC
After providing medical care to
Minnesota state prisoners for 15 years,
Corizon was not selected when the contract
was rebid in 2013 – despite having submitted the lowest bid. Instead, competitor
Centurion Managed Care was to begin
providing healthcare services in Minnesota’s
prison system effective January 1, 2014 under a two-year, $67.5 million contract.
Corrections Commissioner Tom Roy
said the contract with Centurion was
expected to “deliver significant savings to
taxpayers while improving the quality of
care for offenders.”
According to the Star-Tribune, nine
prisoners died and another 21 suffered
serious or critical injuries in Minnesota
correctional facilities due to delay or denial
of medical care under the state’s previous
contract, which had been held by Corizon
or its predecessor, CMS, since 1998.
That contract was for a fixed annual
flat fee of $28 million. A flat fee contract
provides an incentive for the contractor
to tightly control costs, as a reduction in
expenses results in an increase in profit. The
Star-Tribune found that many of the staffing arrangements negotiated in the contract
played a role in the deaths and injuries. For
example, the contract allowed Corizon
physicians to leave at 4:00pm daily and did
not require them to work weekends. During
off-hours there was only one doctor on call
to serve the state’s entire prison system, and
many of the off-hour consultations were
done telephonically without the benefit
of the prisoner’s medical chart. Under the

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contract, Corizon was not required to staff
most facilities overnight.
The Minnesota Department of Corrections was held liable for nearly $1.8 million
in wrongful death and medical negligence
cases during the period when the state
contracted with Corizon or CMS.
In October 2012, a jury in Washington
County awarded Minnesota prisoner Stanley Riley more than $1 million after finding
a Corizon contract physician, Stephen J.
Craane, was negligent in providing medical
treatment. The Star-Tribune reported that
Riley suffered from what turned out to be
cancer and had written a series of pleading
notes to prison officials. One read, “I assure
you that I am not a malingerer. I only want
to be healthy again.”
In May 2013, the state paid $400,000 to
settle a lawsuit over the death of a 27-yearold prisoner at MCF-Rush City. Xavius
Scullark-Johnson, a schizophrenic, suffered
at least seven seizures in his cell on June 28,
2010. Nurses and guards didn’t provide him
with medical care for nearly eight hours.
According to documents obtained by the
Star-Tribune, Scullark-Johnson was found
“soaked in urine on the floor of his cell”

Prison Legal News

and was “coiled in a fetal position and in an
altered state of consciousness that suggested
he had suffered a seizure.” An ambulance
was called several hours later but a nurse at
the prison turned it away, apparently due to
protocols to cut costs. Corizon settled the
lawsuit for an undisclosed sum in June 2013.
See: Scullark v. Garin, U.S.D.C. (D. Minn.),
Case No. 0:12-cv-01505-RHK-FLN.

Philadelphia, Pennsylvania
In Philadelphia, Mayor Michael A.
Nutter has been accused of being too loyal
to his campaign contributors, including
Corizon. The company donated $1,000
to Nutter’s 2012 campaign committee
several months before the city renewed
Corizon’s contract
to provide medical
care to 9,000 prisoners in Philadelphia’s
prison system. Further, PHS donated
$5,000 to Nutter’s
mayoral campaign
in 2008.
The contract
renewal would have

11

been routine except for the fact that Corizon’s performance in Philadelphia has been
far from stellar. In July 2012 the company
agreed to pay the city $1.85 million following an investigation that found Corizon was
using a minority-owned subcontractor that
did no work, which was a sham to meet the
city’s requirements for contracting with
minority-owned businesses.
The renewed year-to-year Corizon
contract, worth $42 million, began in
March 2013. Nutter’s administration
was accused of using the year-to-year arrangement to avoid having the contract
scrutinized by the city council; the city’s
Home Rule Charter requires all contracts
of more than one year to be reviewed by

March 2014

Privatized Healthcare Problems (cont.)
the council. Further infuriating opponents
of the contract, Corizon was not the lowest
bidder. Correctional Medical Care (CMC),
a competitor, submitted a bid that would
have cost the city $3.5 million less per year
than Corizon. Philadelphia Prison Commissioner Louis Giorla defended the city’s
decision to award the contract to Corizon
at a council hearing; however, he declined to
answer questions as to why the administration considered Corizon’s level of care to be
superior to that provided by CMC.
Three union contracts with Corizon
covering 270 of the company’s workers in
Philadelphia’s prison system expired on
November 26, 2013. Corizon demanded
benefit cuts, including changes in employee healthcare programs, to offset wage
increases promised under the company’s
contract with the city. A strike was averted
in December 2013 when the mayor’s office intervened and both sides reached a
settlement. The Philadelphia Daily News
reported that the new union contracts
provide wage increases but also include
a less-generous health insurance plan for
Corizon employees.
Since 1995, Corizon and its predecessor, PHS, have received $196 million in
city contracts. The company’s contract was
terminated for several months in 2002 as a
result of complaints that a diabetic prisoner
had died after failing to receive insulin.
The city renewed the contract anyway, cit-

ing affordability and pledging increased
oversight. The city’s law department estimates that Philadelphia has paid over $1
million to settle lawsuits involving claims
of deficient prison healthcare; the largest
settlement to date is $300,000, paid to a
prisoner who did not receive eye surgery
and is now partially blind.
Based upon the number of lawsuits
filed against Corizon alleging inadequate
medical care, its use of a sham subcontractor and the company’s treatment of its own
employees, it appears that maintaining the
status quo – not best practices – may be the
controlling factor in Philadelphia’s continued relationship with Corizon.

Allegheny County, Pennsylvania
On September 30, 2013, a prisoner
jumped from the top tier of a pod at the
Allegheny County Jail. Following an investigation, authorities refused to make public
their findings and declined to disclose the
prisoner’s injuries, citing medical privacy
laws. The prisoner, Milan Karan, 38, was
not transported to the hospital until the
following day.
A spokesperson for Corizon, which
provides medical care at the 2,500-bed
jail, defended the nearly 24-hour delay by
noting the prisoner “was under observation”
before being sent to a hospital.
  In December 2013, the Pittsburgh
Post-Gazette reported that Corizon was
having difficulty staffing the Allegheny
County Jail. When the newspaper requested
a comment from Corizon vice president

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Lee Harrington, Harrington claimed he
had no knowledge of staffing problems –
despite having previously received emails
from the facility’s warden about that exact
issue.
The staffing problems resulted in
prisoners not receiving their medication
in a timely manner. In emails obtained by
the Post-Gazette, Warden Orlando Harper
wrote to Harrington in October 2013, noting, “We are continuing to experience issues
pertaining to the following: 1. Staffing, 2.
Medication distribution.” Also, on November 17, 2013, Deputy Warden Monica Long
sent an email to Corizon and jail staff. “I
was just informed by the Captain on shift,
the majority of the jail has not received
medication AT ALL,” she stated, adding,
“Staffing is at a crisis.”
That crisis had been ongoing since Corizon assumed the medical services contract
at the facility on September 1, 2013. Before
the $62.55 million, five-year contract was
awarded, Corizon vice president Mary Silva
wrote in an email that it was imperative the
jail have “adequate staffing on ALL shifts.”
That promise was made despite Corizon
laying off many of the former employees
of Allegheny Correctional Health Services,
the jail’s previous healthcare provider.
Allegheny Correctional had provided
four full-time and one part-time physician
during its contract tenure. Corizon reduced
the number of doctors to one full-time and
one part-time physician. Allegheny Correctional also employed three psychiatrists
and one psychologist. Corizon’s contract

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Prison Legal News

requires that it provide one full-time psychiatrist and a part-time psychologist.
In January 2014, the United Steelworkers union (USW) filed a petition with the
National Labor Relations Board to unionize Corizon employees at the Allegheny
County Jail, including nurse practitioners,
RNs, physician assistants and psychiatric
nurses. USW representative Randa Ruge
indicated that the Corizon workers had approached the union for representation due
to intolerable working conditions.
“Our folks [Corizon employees] are in
danger of losing their licenses to practice
by some of the things that the company
has them doing,” she said. Ruge told the
Post-Gazette that the jail had run out of
insulin for more than a week and Corizon
supervisors had “countermanded doctors’
orders.”
Several weeks after the USW filed the
labor petition, a Catholic nun who worked
as an RN at the jail was fired by Corizon,
allegedly for union organizing activities.
Sister Barbara Finch was dismissed after
she openly expressed concerns about staffing, patient care and safety at the facility.
The USW filed an unfair labor complaint
against Corizon regarding Finch’s dismissal,
claiming she was terminated in retaliation
for her union activities.
“This is a clear case of intimidation
and union-busting at its worst,” said USW
President Leo W. Gerard. “Sister Barbara
has been an outspoken advocate of change
for these courageous workers and their
patients, and this kind of illegal and unjust

action, unfortunately, is par for the course
with Corizon.”
On February 14, 2014, Corizon employees at the Allegheny County Jail voted
overwhelmingly to unionize. “The next step
is getting to the bargaining table and getting Corizon to bargain in good faith and
get some changes made in the health system
at the jail,” said Ruge.
The previous week, Allegheny County
Controller Chelsa Wagner stated she had
“grave and serious concerns” about medical
care at the facility, including issues related
to staffing and treatment for prisoners with
certain mental health conditions. “I regard
the current situation as intolerable and
outrageous, and I fully expect necessary
changes to be urgently implemented,” she
wrote in a letter to Corizon.

Polk County, Iowa
On August 29, 2013, Ieasha Lenise
Meyers, incarcerated at the jail in Polk
County, Iowa on a probation violation, gave
birth on a mattress on the floor of her cell.
Her cellmates assisted with the delivery.
Earlier, when Meyers, 25, had complained
of contractions, a Corizon nurse called an
offsite medical supervisor and was told to
monitor the contractions and check for
water breaking.
Despite Meyers having been twice sent
to a hospital earlier the same day, and pleading that she was about to give birth, the
nurse did rounds in other parts of the jail.
Guards reportedly did not check on Meyers as required, even though the birth could

be seen on a nearby security monitor. Only
after the baby was born was medical care
provided. Sheriff Bill McCarthy defended
the actions of jail staff.

Corizon Employee Misconduct
Like most private contractors that
provide prison-related services, Corizon
tends to cut costs in terms of staffing and
operational expenses. As noted above, this
includes paying lower wages, providing fewer
or inferior benefits and hiring less qualified
workers who can be paid less. Sometimes,
however, these practices result in employees
more like to engage in misconduct.
At the Pendleton Correctional Facility
in Indiana, a Corizon nurse was arrested
and charged with sexual misconduct, a Class
C felony. The Herald Bulletin reported that
in April 2013, when Colette Ficklin was
working as a contract nurse for Corizon,
she convinced a prisoner to fake chest pains
so they could be alone in an exam room. A
guard told internal affairs officers that she
witnessed Ficklin and the prisoner engaging
in sex acts in the prison’s infirmary. [See:
PLN, Sept. 2013, p.17].
In March 2013 at the Indiana State
Prison in Michigan City, a Corizon practical nurse was charged with drug trafficking
and possession with intent to distribute.
Phyllis Ungerank, 41, was arrested and
booked into the LaPort County Jail after
attempting to smuggle marijuana into the
facility. [See: PLN, July 2012, p.50].
A Corizon nurse at the Volusia County
Branch Jail in Daytona Beach, Florida

(Void in New York)

Somers, CT.)

Prison Legal News

13

March 2014

Privatized Healthcare Problems (cont.)
was fired after officials learned she was
having sex with and giving money to a
prisoner. Valerie Konieczny was terminated
on December 18, 2012 when the jail was
contacted by the brother of prisoner Randy
Joe Schimp, who had written in a letter
that a nurse was having sex with him and
depositing money into his jail account. Investigators determined that Konieczny was
the nurse who had sex with Schimp at both
the Volusia County facility and another
branch jail in 2011.
In New Mexico, Corizon physician
Mark Walden was accused of fondling
prisoners’ genitals and performing prostrate
exams that were “excessive and inappropriate in terms of length and method.” At
times, Walden reportedly did not wear
gloves during the prostate exams. He was
accused of sexually abusing 25 or more male
prisoners while employed as a doctor at two
privately-operated facilities, the Guadalupe
County Correctional Facility in Santa Rosa
and Northeast New Mexico Detention
Facility in Clayton.

Lawsuits were filed against Walden,
Corizon and private prison operator GEO
Group, and Walden’s medical license was
suspended in December 2013. The suits
claim that Corizon allowed Dr. Walden to
work at the Clayton prison “despite knowing of the risk of sexual abuse and having
the ability to know that [he] was repeatedly
sexually abusing patients” at the Santa Rosa
facility. [See: PLN, Sept. 2013, p.47].

The Privatization Model
Economics professors Kelly Bedard
and H.E Frech III at the University of
California at Santa Barbara examined the
privatization of correctional medical services
in their research study, “Prison Health Care:
Is Contracting Out Healthy?,” published in
Health Economics in November 2009.
They concluded: “We find no evidence
to support the positive rhetoric regarding
the impact of prison health care contracting
out on inmate health, at least as measured
by mortality. Our findings of higher inmate mortality rates under contracting out
are more consistent with recent editorials
raising concerns about this method of delivering health care to inmates.”

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Today, five years after the Bedard-Frech
report was published, it has the benefit of
hindsight. Since the report was written, its
findings and conclusions have been reaffirmed in prisons and jails across the nation
that have contracted with private companies
to provide medical care to prisoners. Cost
reductions in the provision of correctional
healthcare tend to result in greater inefficiencies that lead to poorer outcomes.
Consequently, for-profit medical contractors
may actually be increasing morbidity and
mortality in prison and jail populations.
Many governmental entities are willing to outsource correctional healthcare
to private companies; reasons for doing
so include cutting costs, risk management
and removing healthcare duties from corrections departments. If Corizon’s record
with respect to providing medical care to
prisoners seems dismal, the company can
always defend its actions by stating it does
what it has been hired to do: Cut costs for
its customers. And those costs have been
rising due to an increasingly aging, and thus
medically-needy, prison population. [See:
PLN, Nov. 2012, p.22; Dec. 2010, p.1].
With respect to risk management,
litigation is not a compelling issue within
the prison healthcare industry and Corizon
views lawsuits as simply a cost of doing
business. “We get sued a lot, but 95% or
97% of cases were self-represented cases,”
ex-CEO Rich Hallworth was quoted in an
August 2013 article. He added that most
lawsuits settle for an average of less than
$50. Of course it is difficult for prisoners
to obtain representation to pursue litigation – unless it’s a wrongful death case, and
then usually their family or estate is doing
the suing.
Nor are the public agencies that contract with private medical providers greatly
concerned about their litigation records. In
fact, when Florida contracted with Corizon
and Wexford Health Sources to provide
medical care for the state’s entire prison
system, the Florida Department of Corrections didn’t ask the companies about their
litigation histories – such as lawsuits raising
claims of deliberate indifference, negligence
and medical malpractice.
“What really troubles me about this
is the fact that the department didn’t ask
these very basic, elemental questions any
system would ask,” observed ACLU National Prison Project staff attorney Eric
Balaban. “These two vendors were taking
Prison Legal News

over Florida’s massive health care system
and you’d think they would have asked hard
questions to determine if these companies
can provide these services within constitutional requirements.”
Even worse, the downgrading of
Corizon’s debt rating by Moody’s in 2013
creates a potential problem for the company’s service delivery model. The majority
of Corizon’s revenue is derived from contracts with state and local agencies that are
trying to reduce their budgetary expenses.
Given those fiscal pressures and competition from Wexford, Armor, Centurion
and other prison healthcare companies,
Corizon cannot easily increase its revenue
through contractual price increases. But
the company’s expenses are largely within
its control.
Unfortunately for prisoners, in order
to reduce costs Corizon will likely have to
curtail the quality or quantity of healthcare
services it provides. As noted above, this
can be done by reducing employee wages
or benefits; the company can also cut costs
through understaffing and by limiting
prescription medications or providing
fewer referrals to hospitals and specialists. A
growing trend is to use off-site medical staff
who consult with prisoners through telemedicine. [See: PLN, Dec. 2013, p.34].
The correctional healthcare industry,
comprised of only a few large companies,
is highly competitive. When one company
loses a contract, another is more than will-

Prison Legal News

ing to step in and submit a bid. What really
matters for most government agencies and
policymakers is the bottom line cost.
According to Dr. Marc Stern, the
court-appointed special master in Idaho,
“whoever delivers prison healthcare is
doing it on less than adequate funding
because that’s how much municipalities,
state legislatures and county commissions
are allocating.” He noted that privatization
can be good in some cases and bad in others,
depending on the level of oversight by the
contracting public agency.

15

When Corizon compromises medical
care to save money, such as curtailing the
use of ambulances for emergency transports,
reducing the number of on-site doctors or
sending fewer prisoners to outside hospitals
for needed treatment, government officials
typically fail to take corrective action and
deny responsibility for the resultant deaths
and injuries. Indeed, as with the Idaho
Department of Corrections and LMC in
Kentucky, they sometimes want to reward
the company with renewed contracts.
Why? Because continuity maintains

March 2014

Privatized Healthcare Problems (cont.)
cost control, which is the driving force
behind privatization of prison and jail
medical services.

Conclusion
The intent of this article was to review
Corizon’s performance and practices based
on publicly-available information, including
news reports and court records. Although
the company was formed in June 2011, its
two predecessor firms, PHS and CMS,
littered the news and judicial dockets over
the years with lawsuits and articles involving cases of inadequate healthcare. Thus,
the sins of Corizon’s parents, CMS and
PHS, are forever linked with the progeny
of their merger.
Such past misdeeds could be explained
away had Corizon adopted a new, postmerger culture that was removed from prior
practices under PHS and CMS. However,
many of Corizon’s mid-level and top executives – including ex-CEO Rich Hallworth,
former president Stuart Campbell, chairman Richard H. Miles and a number of vice
presidents – were previously executives with
PHS or CMS. It was during their tenure
at those companies that numerous cases
involving deficient medical care occurred.
The corporate culture of Corizon, as
well as its business model, appears to be
largely the same as those of its predecessors.
Therefore, the only thing that may have
changed as a result of the merger that created Corizon is the company’s name.
Gregory Dober is a freelance writer in healthcare and ethics. He has been a contributing
writer for PLN since 2007 and co-authored

Against Their Will: The Secret History of
Medical Experimentation on Children in
Cold War America, published by Palgrave in
2013. [See: PLN, Nov. 2013, p.36].
Sources: Bloomberg News, Forbes, www.
businessweek.com, Philadelphia Inquirer,
Philadelphia Daily News, The American
Independent, Pittsburgh Tribune-Review,
St. Louis Business Journal, www.browardbulldog.org, Miami Herald, WHAS-TV, The

Tennessean, Courier-Journal, Idaho Business
Review, Associated Press, The Arizona Republic, Maine Public Broadcasting Network,
Bangor Daily News, WANE-TV, Raton
Range, Des Moines Register, Star-Tribune,
The Nation, The Florida Current, www.usw.
org, KPHO-TV, WANE-TV, Tucson Citizen,
WCAV-TV, www.wdrb.com, www.modernhealthcare.com, www.cochs.org, www.wndu.
com, www.afsc.org, www.americanownews.
com

Florida County Agrees to Pay $4 Million
to Deceased Prisoner’s Estate
by Derek Gilna

N

icholas T. Christie, incarcerated
at the Lee County jail in Ft. Myers,
Florida, died on March 31, 2009 after being
repeatedly pepper sprayed by deputies while
strapped to a restraint chair. Following three
years of litigation, Lee County officials
agreed in May 2013 to pay a record settlement of $4 million to Christie’s estate.
The jail’s for-profit medical contractor,
Prison Health Services (PHS), now known
as Corizon, was named as a defendant in the
federal lawsuit and included in the settlement agreement.
The § 1983 suit raised claims related to
Christie’s death under the “Fourth, Eighth
and/or Fourteenth Amendments to the
United States Constitution, the laws of the
United States, and the laws of the State of
Florida.”
The complaint alleged that Christie
was “restrained to a chair with a hood over
his head and face for several hours in the
custody of the Lee County Sheriff, while
being detained on a misdemeanor trespass

charge,” and that medical staff at the jail
failed to provide him with adequate care
after he showed signs of respiratory distress
during and after that incident. Medical personnel, the lawsuit stated, “acted willfully,
wantonly, maliciously, and with reckless
and callous disregard for and deliberate
indifference to the serious medical and
mental health needs of Nick Christie, and
in a manner that shocks the conscience and
offends traditional notions of decency, all
of which led to his wrongful and untimely
death.”
According to the complaint, prior to
and during his placement in the restraint
chair, Christie disclosed to jail staff that he
had “certain serious medical conditions...,
including, but not limited to, Chronic
Obstructive Pulmonary Disease (COPD),
a heart condition, cardiovascular disease,
atrial fibrillation, obesity, gout, back pain,
constipation, and umbilical hernia, all of
which was recorded and documented in Mr.
Christie’s PHS medical chart/record.”

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March 2014

16

Prison Legal News

 

 

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