Prison health care is investigated
Kim Bell
Post-Dispatch
08/30/2003

Virginia Terry was thankful when her daughter, a drug addict suffering from bipolar disorder, got locked up at the women's prison in Vandalia, Mo., for a forgery conviction.

"I thought, at least she'd be safe," Terry recalls.

That changed when Terry's daughter, Al'Deana Simmons of Camdenton, began complaining, in letters and phone calls home, about the type of health care she was getting behind bars.

She said prison doctors changed her anti-depression medication. She cried about blinding headaches. And Terry will never forget what Simmons said in their phone conversation July 1, the day before she died of an apparent aneurysm.

"She said her head was sizzling and that she was going blind," Terry recalls. "The prison doctor saw her for 10 minutes and said nothing was wrong."

The case of Simmons, 33, is one of many being explored this summer by investigators with the U.S. Justice Department's Civil Rights Division in Washington. Investigators have been to the prison three times and interviewed 127 inmates about the medical treatment provided by St. Louis-based Correctional Medical Services.

They also have met in St. Louis with inmates' relatives, including Terry. She provided them with her daughter's letters and medical records.

CMS won its first Missouri contract in 1992 under then Gov. John Ashcroft, who now as U.S. attorney general heads up the Justice Department.

Yet, in a move rarely seen by the Justice Department, Missouri's prison system has denied the investigators the access they want. The investigators have wanted to see the infirmary and talk to prisoners and staff at the prison, about 70 miles northwest of St. Louis. Prison officials wouldn't allow it, instead telling federal investigators they could talk to prisoners only in the visitation area during normal visiting hours.

That kind of restriction to a prison setting is rare, happening only a handful of times in the Justice Department's 23 years of work using the Civil Rights of Institutionalized Persons Act.

The act was passed by Congress in 1980. It empowers the attorney general to investigate the conditions at these institutions and file lawsuits to remedy "a pattern or practice" of unlawful conditions.

A spokesman for the Justice Department declined to comment.

Tim Kniest, spokesman for the Missouri Department of Corrections, said investigators weren't permitted to "walk around unescorted" because of safety concerns. Kniest said that, if the investigators make arrangements with the Missouri attorney general's office, they can have a tour.

The investigators work with the Special Litigation Section of the Civil Rights Division. That section's job is to protect constitutional rights of people confined to institutions such as state-run nursing homes and prisons.

$80 million a year

Correctional Medical Services is the nation's largest prison health care provider. It has contracts to provide medical care for about 228,000 inmates and prisoners in 27 states.

In Missouri, CMS' current five-year contract, renewed in late 2001, covers medical and mental health care for the 29,500 prisoners in Missouri's 21 prisons. The cost to the state is about $80 million a year. It is based on a fixed per-day price (now at $7.50) for each housed inmate. That cost pays for everything from Band-Aids and aspirin to inmates' prescriptions and catastrophic health care.

There are about 1,700 female prisoners in the Vandalia prison. There are women prisoners in Chillicothe, but the federal investigators have not visited that prison.

CMS has been the subject of controversy in recent years. A five-month investigation by the Post-Dispatch in 1998 found more than 20 cases nationwide in which prison and jail inmates died as a result of alleged negligence, indifference, understaffing, inadequate training or cost cutting by private health care companies. Many of the cases involved CMS.

After the newspaper's investigation, the state Department of Corrections took several steps to change the way it monitors health care in prisons, including hiring a doctor to review all prisoner deaths.

CMS refers all news media calls to its public relations firm, Fleishman-Hillard. Becky Vollmer, speaking on behalf of CMS, said she could not comment Friday on the cases of specific inmates because of confidentiality. But she said the health care provider is cooperating with investigators.

"Our belief is, a fair review will show the health care services at the site are responsible and beneficial to the inmates served," Vollmer said.

Vollmer said she was unaware whether anyone from CMS had talked to federal investigators.

A death in 1999

The Justice Department investigators used the offices of the American Civil Liberties Union in St. Louis to interview several witnesses. The ACLU is conducting its own investigation into 51 complaints about health care in Missouri prisons. Those complaints range from allegations of suspicious deaths to botched medical care and lack of care.

Sara Gilpin of Joplin, Mo., met with federal investigators for three hours here and gave them her sister's medical records. Gilpin's sister Stephanie Rane Summers, 48, died in 1999 of liver failure and bacterial pneumonia. Gilpin says that her sister's hepatitis C went undiagnosed for 2 1/2 years and that she never was evaluated to be on a list for a liver transplant, although doctors outside the prison who evaluated Summers recommended that.

A CMS summary of Summers' medical history said that she was a "very difficult and manipulative patient" but that "her concerns were met with appropriate medical care." Gilpin testified before Missouri's Joint Committee on Corrections in 1999 and has filed a lawsuit in federal court in Springfield, Mo. "What's sad is four years later, it's still going on," Gilpin said.

CMS updated its response to the Summers case on Friday by saying, "A review of the records indicates that health care professionals conducted an aggressive treatment regimen to address this patient's multiple medical conditions." She was seen by specialists and hospitalized several times, CMS said.

Kniest said the Corrections Department has confidence in the medical care being provided. "We have our set of standards, based on recognized appropriate practices in the medical community, and that's the standard we hold CMS to. We maintain a very professional relationship with them."


Reporter Kim Bell:
E-mail: kbell@post-dispatch.com
Phone: 314-340-8115