By LEE WILLIAMS and ESTEBAN PARRA, The News Journal
Continued poor performance by the Department of Correction's medical vendor could hamper the department's efforts to get out from under supervision by the U.S. Justice Department, according to a new report by an independent monitor overseeing the state prison system.
Correctional Medical Services, a private company Delaware pays millions of dollars a year to provide medical care to inmates, suffers from a "lack of stable and effective leadership," independent monitor Joshua W. Martin III wrote in a 229-page report released Thursday.
"Moreover, there has been consistent turnover at staff-level positions, and, at [Young Correctional Institution] in particular, there is a problem with staff insubordination that needs to be addressed because it affects inmate medical and mental health services negatively," Martin wrote in his report. "The Monitoring Team has also faced difficulty in receiving consistent and accurate information from CMS."
While Martin found that the DOC has made some improvements, he concluded that many CMS staff lacked proper credentials or were working outside their areas of expertise: At the Delaware Correctional Center near Smyrna, a pathologist is practicing general medicine.
The monitoring team also found that for three months last year, no inmate at the Smyrna prison received a referral to an outside specialist because "the person who was assigned to schedule appointments for inmates was on sick leave, and CMS had failed to find a temporary replacement."
Inmate medical files were found stashed in boxes, while others were out of date, doctored or missing. At the Baylor Women's Correctional Institution, a book used to keep track of inmates suffering from highly contagious flesh-eating bacteria was lost, the data irretrievable.
Lisa Williams got out of the women's prison two weeks ago after spending six days there awaiting extradition to Maryland on a theft charge.
Williams was burned over 60 percent of her body when she was a child, after a lighter she was playing with set her dress on fire. Now 31, she dehydrates easily because of the burns.
When she overheated in a holding cell with 13 other women, just getting to the prison infirmary was difficult.
"I put in a sick call slip, but it was four days before it was addressed," she said.
The CMS nurse gave her an ice pack.
"She said I was just a crackhead withdrawing," Williams said. "I'm not on drugs. I was very sick. They assume everyone's a crackhead. I saw a girl have a seizure in the cell. They made her walk to the infirmary, once she stopped."
'Lack of supervision'
According to Martin's report, on several occasions the monitors were told about a practice or procedure staff believed was being adhered to, but "it often turns out that such practice or procedure is not, in fact, being followed in spite of the belief of the individual providing information. This is symptomatic of a lack of supervision of staff, and poor or nonexistent self-monitoring. The Monitoring Team recommends that CMS begin to self-monitor for compliance with DOC policies as soon as possible so as to be able to assess its own compliance, and provide the Monitoring Team with reliable information."
CMS corporate spokesman Ken Fields refused to be interviewed for this story. "I am not going to respond to any specifics," he said.
Fields also refused to allow CMS employees working in Delaware to be interviewed. "Our healthcare staff are focused on patient care rather than dealing with news media," he said in an e-mail. The "report shows clearly that, working together, the Delaware Department of Correction and CMS have made a great deal of progress enhancing the inmate healthcare system. The report also notes there is more to be done."
Department of Correction Commissioner Carl Danberg said the monitor's report was "fair and balanced."
"I've made it clear to CMS that I am not satisfied with the pace of progress, but CMS has been working cooperatively with us, and I will continue to hold them to the terms of the contract, and push for total compliance," Danberg said.
Danberg's fiscal year 2009 budget proposal includes $40 million for inmate medical care -- $38 million for CMS.
A call for change
Inmate advocates have urged Minner and other state leaders to sever the state's contract with CMS. Danberg would not say if that is an option.
"I will consider any change that I believe will lead to improvement of medical care, but at the moment, I'm not prepared to discuss the potential for changing vendors," Danberg said.
Martin, a Wilmington attorney and former judge, was selected in May by the Department of Correction and the Justice Department to serve as the state's first independent prison monitor. Martin oversees efforts by the Department of Correction to satisfy a settlement agreement with the federal government over "substantial civil rights violations" in four state prisons.
Martin declined to be interviewed for this story, as did Delaware Gov. Ruth Ann Minner.
In preparing his report, Martin, together with a team of medical and mental health professionals, reviewed Department of Correction policies and procedures, record-keeping, medication and laboratory orders, staffing and training, screening and treatment, access to care, chronic disease care, medication management, emergency care, mental health care, suicide prevention and quality assurance.
According to the mandates of the settlement agreement, the monitors must gauge compliance with 217 provisions. The settlement agreement, signed by Danberg, who at the time was Delaware's attorney general, and former Correction Commissioner Stan Taylor, called on the state to revamp its prison health care system and to report its progress regularly to the Justice Department. The agreement remains in effect for three years, although the state can get off earlier if it achieves "substantial compliance" with each portion of the agreement.
Martin found the state failed to comply with 17 of 217 total provisions, and was in substantial compliance with 31 of the 217. The state was said to be in partial compliance with the remainder of the requirements.
"The assessment of partial compliance that the Monitoring Team has used is a very broad designation and in some instances reflects minimal progress that the State has made in eliminating the constitutional deficiencies that motivated the parties to enter into [the settlement]," Martin wrote.
Advocates, families dismayed
Prison reform advocates, former inmates and their families didn't need Martin's report to reinforce their belief that inmate medical care in Delaware is poor.
Francine Wright, whose son died while an inmate, said she continues to hear complaints from families who have imprisoned family members.
"The medical care is not up to par," Wright said. "People are still not getting their medical treatment."
Wright's son, Darnell Anderson, was serving a four-year sentence when he was taken to Wilmington's St. Francis Hospital in 2004. During his hospitalization, doctors learned Anderson had pneumocystis carinii pneumonia, an AIDS-related infection that is usually preventable and treatable when caught early. He died at St. Francis.
"They need to fire the people over there who are not doing their job," Wright said.
Dover attorney Steve Hampton, who has represented inmates and their families in lawsuits against the Department of Correction, said the problems outlined in Martin's report should come as no surprise to DOC officials.
"Even with the monitor in place, very little real improvement is taking place," Hampton said. "Our state government officials have turned a blind eye to widespread human rights violations in a program for which they have oversight. It seems that they are not going to seriously address the problems at DOC unless forced to by the Justice Department."
Hampton represented the family of Anthony Pierce, who became known as "the brother with two heads" as an inmate at Sussex Correctional Institution because of a large tumor growing on his head. Pierce, who was being treated by CMS staff, died from the brain tumor in 2002.
The state settled a wrongful-death lawsuit in a confidential agreement last year.
Public health at risk
"This report tells me that the state is continuing to pay tens of millions of dollars for a health care program that routinely breaches the applicable standards of medicine, violates the human rights of inmates and puts us all at risk of serious infectious diseases," Hampton said. "The prisons have become incubators for all sorts of diseases such as MRSA, TB and hepatitis. These diseases are not stopped by prison walls. Allowing them to flourish in prison means they will eventually flourish on the outside."
Problems with prison health care and high inmate death rates, especially from AIDS, were examined by The News Journal in a series published in 2005. In March 2006, the Justice Department's Civil Rights Division launched its probe.
Minner tried unsuccessfully to derail the federal investigation. Her legal counsel at the time, Joseph C. Schoell, sent a letter to U.S. Attorney General Alberto Gonzales calling The News Journal's series "misleading."
The Rev. Christopher Bullock, a founder of the Delaware Coalition for Prison Reform and Justice, said it was time for the state to terminate its contract with CMS.
"Until CMS is replaced with a Delaware group -- for Delaware from Delaware -- there will be no significant or sustainable change," he said. "It's now time for the state to act in the best interest of Delaware and our reputation in this country."
MONITORING TEAM
Joshua W. Martin III, attorney -- monitor
Suzanne Hill -- attorney
Ronald Shansky, M.D. -- medical expert
Michael Puisis, M.D. -- medical expert
Roberta Stellman, M.D. -- medical expert
Jeffrey Metzner, M.D. -- medical expert
Madeleine LaMarre, M.N., A.P.R.N. -- medical expert
