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COVER STORY | Vol 6, No. 3, January 19, 2006
(Healthcare Behind Bars)

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Healthcare Behind Bars

by Duwayne Escobedo

Robert Boggon suffers a mental episode in a Dollar Tree store, which leads to his incarceration in the Escambia County jail. Despite at one point rocking on the floor of his cell and urinating on himself and displaying other odd behaviors, Boggon never receives a psychiatric evaluation during the 11 days he spends in the jail and only receives medication used to calm him down before his death Aug. 29, records and testimony reveal. Jail guards end up dragging the 65-year-old trucker from his cell to the shower, stripping him, shocking his wet body with a Taser Gun, then strapping his lifeless body to a restraining chair, wrapping a towel around his head and returning him facing the back of his cell several hours before he's found dead, a civil suit by Boggon's family alleges.

Hosea Bell, a homeless man, gets arrested Aug. 9 for urinating on a sidewalk outside Weis Elementary School. He's found mentally incompetent by a judge to stand trial Nov. 30 but 11 days later the 55-year-old is taken in handcuffs by a police car to Sacred Heart Hospital after appearing lethargic at the Escambia County jail. He dies at the hospital a few hours later.

Both cases are focusing the spotlight on healthcare provided to inmates at the Escambia County jail by Prison Health Services, the nation's largest for-profit inmate healthcare company, caring for about one in every 10 people behind bars.

Across Florida and the country the company based outside Nashville has come under fire the past year for spotty and sometimes lethal care.

Following the Boggon and Bell cases, the quality of the company's medical services is coming under fire locally.

David Craig, the Community Law Enforcement Oversight president, is blunt and concise in his assessment of Prison Health Services medical care for inmates.

"Given their less than stellar record, CLEO feels they would be more accurately named Prison Death Services," he says.

Todd LaDouceur, the Boggon family's attorney, says the federal wrongful death lawsuit may soon extend to Prison Health Services. It currently only names two of the company's nurses individually, Lisa Whitlock and Elaine Gregory.

"I've been through the Florida Department of Law Enforcement investigation and it appears Mr. Boggon never saw a doctor in his 11 days in jail," the civil rights attorney says. "Clearly, from everybody's testimony, this was someone who needed to see a doctor. I'm not sure how that works. There may be medical negligence here. The family is very concerned about his treatment and we don't want to close that avenue."

Sharon Giraud, a Mental Health Association of West Florida client advocate, says for years it has documented a number of cases that have alerted it to the possibility of systemic problems in the jail system's treatment, especially of the mentally ill.

"We are still very concerned," Giraud says. "There's all this publicity on a regular basis. We need special training to help them and law enforcement deal with mentally ill people."

Escambia County Jail Director Dennis Williams helped privatize inmate healthcare after Sheriff Ron McNesby took office in 2000, saying at the time that the jail's healthcare system then was fraught with deficiencies. Williams defends Prison Health Services, which currently is paid about $3.8 million to provide healthcare to Escambia County's jail.

"For Escambia County, they're doing very well," he says. "That's not to say there aren't places we could improve or that we get things right 100 percent of the time."


Prison Health Services is no stranger to controversy. Currently, it serves more than 310 jail and prison sites around the country, covering approximately 214,000 inmates in 37 states.

The Atlanta Journal-Constitution reported in December in a story on Prison Health that twice in the past four months, the Gwinnett County jail was sued by the families of inmates who died in controversial Taser-related scuffles with deputies. During the same period, two other inmates died—one killing himself with a metal jail key and the other dying in her cell, while her cellmates begged for medical care, the Atlanta paper found.

In Mississippi, the American Civil Liberties Union sued the company this summer, alleging that inmates of a Mississippi prison were misdiagnosed and received poor care.

The New York Times conducted a yearlong investigation of Prison Health Services, which has a $254 million contract in New York City, and reported its findings last February in a three-part series. The report found in two New York City jail deaths, and eight others across upstate New York, state investigators kept discovering the same failings: medical staffs trimmed to the bone, doctors underqualified or out of reach, nurses doing tasks beyond their training, prescription drugs withheld, patient records unread and employee misconduct unpunished.

In addition, the New York Times reported that substandard care by the company contributed to at least 15 inmate deaths in 11 Florida jails since 1992.

Several inmate deaths in Florida cost Prison Health Services three county contracts, millions of dollars in settlements, and an apology for its part in the 1994 death of Diane Nelson. The 46-year-old was jailed in Pinellas County on charges that she had slapped her teenage daughter. She suffered a heart attack after nurses failed for two days to order the heart medication her private doctor had prescribed.

In that case, the New York Times reports as Nelson collapsed, a nurse told her, "Stop the theatrics." The same nurse admitted later in a deposition that she had joked to the jail staff, "We save money because we skip the ambulance and bring them right to the morgue."

In 2004, a woman in the Hillsborough County jail sued Prison Health Services, blaming the company for the death of her newborn son from complications during delivery. The baby was born over an infirmary toilet at the Falkenburg Road jail.

And in Tallahassee, the family of Ruth Hubbs, who died at the Leon County Jail infirmary, recently earned a $350,000 settlement from Prison Health Services. The 39-year-old Hubbs, who suffered from bipolar disorder and drug addiction was found dead in the infirmary May 16, 2003, about a day after deputies reported seeing her sitting on the floor of her jail cell shirtless and yelling incoherently to herself. The company failed to take her blood levels, monitor or administer drugs she was prescribed and ignored red flags raised by a therapist and two jail guards.


Still, Prison Health earlier this month won the Florida Department of Corrections contract to provide healthcare to about 14,000 inmates in 13 South Florida prisons. The state will pay the company $792 million over 10 years.

The company's track record made some lawmakers wary, newspapers reported in South Florida.

"It all seems very suspect," Sen. Frederica Wilson, a Miami Democrat who sits on legislative panels dealing with criminal justice and corrections issues, told the South Florida Sun Sentinel. "We know the health care in the prisons already isn't what it should be. If this company is going to under-bid all the others, then I fear we can only expect greater disappointment."

Florida Justice Institute Executive Director Randy Berg, who has fought for prisoners' rights for 28 years, has battled the company twice for refusing to provide needed medical care to inmates and followed the company closely.

"They have a bad history of providing healthcare to inmates," Berg says in a telephone interview with the Independent News from his Miami headquarters. "It's an odd situation. The less healthcare they provide the inmate population, the more money they make. Its profit motives have always concerned me."

Michael Catalano, chairman, president and chief executive of America Service Group, which owns Prison Health Services, defends the company's service. He argues that the company actually reduces costs and improves the quality of care.

Catalano and company officials say its successes far outnumber failures and its policy is never to deny necessary medical care. And they say complaints result from the challenging work of inmate healthcare have mainly come from litigious inmates, disgruntled employees and overzealous investigators.

"(Our employees) choose to render a vital public health service in their own communities," Catalano says in a statement. "This is a high calling. Our patients must always receive appropriate medical care. There can be no compromise of this fundamental value. Our vision is to lead the correctional healthcare field in reputation and results, achieving the highest standards of operational excellence, clinical quality and client service."


A check of Escambia County Circuit Court records found two cases involving Prison Health Services, since it took over Escambia inmate medical care in 2001. In federal civil suits filed in the Northern District of Florida, 27 cases were filed against the company since 1995, records show.

The suits, many of which were dismissed for various reasons, largely tell of medications allegedly being withheld or claims of treatments of injuries being denied.

During the Coroner's Inquest into Boggon's death last month, one corrections officer testified that Boggon "seemed to have a lot of mental health issues. He didn't seem to respond."

Whitlock, a Prison Health nurse who found Boggon dead, testified that a counselor did see him. But Kimberly Cox, a corrections officer at the jail and a great niece of Boggon's, testified that a day before his death Prison Health nurses acted uninterested in her plea for them to order a psychiatric evaluation, which she said she was told had not been done.

Whitlock said on the stand at the Coroner's Inquest that Boggon would "bite, yell or spit," which prevented nurses from getting a complete diagnosis of him.

"He was very uncooperative," she testified. "He was only in there nine days. We were trying to help him. We did give him medication."

Sources close to the Bell case, say his pleas for medical attention went unheeded at the Escambia County jail, until corrections officers noticed a "major change."

Once transported to Sacred Heart, repeated requests of Prison Health Services from the hospital for Bell's medical records were ignored, sources say. No lawsuit has been filed to date in Bell's case.

Complaints of poor treatment, especially of the mentally ill, are not new to Escambia County jail. In 2003, Pensacola Junior College Police Chief Nancy Newland, then on the board directors of the Mental Health Association of West Florida, called on the jail to improve its healthcare services and training of jail employees.

Newland's brother, Harold Newland II, a paranoid schizophrenic, died in September 2002, shortly after being release from jail. Newland says he was denied his prescribed medicine while in jail, despite her waiting two hours to meet with a jail employee to bring his doctor's prescription and medication to the jail.

Without proper medication, schizophrenics' condition rapidly deteriorates and they exhibit bizarre behavior that might lead to further criminal charges.


More than two years later, Lakeview Center and the Mental Health Association are working with the Escambia County jail and other law enforcement agencies to implement a 40-hour training program started in Seminole County that creates Crisis Intervention Teams to better handle mentally ill people.

The Escambia County jail is planning on sending five corrections officers through the training in the beginning. The training includes a virtual reality schizophrenic machine, which allows police officers and others to experience what its like to suffer from the disorder.

Williams admits the jail is reviewing its handling of inmates after the Boggon and Bell cases. But he points out that Prison Health Services, as required by its contract with Escambia County, has earned and maintained national accreditation since 2003.

"We have reviewed our process," he says. "But are we doing anything that requires dramatic change? I don't think so."