NAARPR

May 19th, 2009 Report on IDOC Medical Care     Download PDF Version Here

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From Crisis to Catastrophe, Preliminary report on Illinois Department of Corrections Medical Care

By the Chicago Branch, National Alliance Against Racist and Political Repression

To the Illinois House of Representative Prison Reform Committee, May 19, 2009

Illinois prisons are a public health catastrophe waiting to happen.  Recently news media have discussed industrial hog farms as breeding grounds for new pathogens<!--[if !supportFootnotes]-->[i]<!--[endif]-->.  Not as broadly discussed is the potential of prisons as incubators of new and existing pathogens.  But the prospect is just as present<!--[if !supportFootnotes]-->[ii]<!--[endif]-->.  

Prisoners are dying in Illinois prisons as a result of the failure of the prison medical contractors and staff to adequately diagnose and treat diseases and acute and chronic conditions.  Moreover, they are dying behind closed doors, impervious to questions and without accountability to the public or to this committee.  The lack of preventive health care and appropriate response to what sometimes may appear as minor medical problems can lead to greatly increased costs to the State for crisis intervention later.   Most prisoners return to the community.  Many bring the diseases they contract in prison home with them.  This greatly multiplies the cost to the state and the community of our prison medical system.

A 2005 article in the New York Times quoted Dr. Michael Puisis: “It's almost like a game of attrition, where the companies will take bids for amounts that you just can't do it … They figure out how to make money after they get the contract.”<!--[if !supportFootnotes]-->[iii]<!--[endif]-->  Dr. Puisis was the Medical Director of the IDOC.  Dr. Puisis is a national expert and editor of “Clinical Practice in Correctional Medicine,” a collection of articles by doctors expert in the field. He resigned last month as IDOC Medical Director. 

There is no Medical Director now.  Does anyone have any control?  Is Wexford Health Source, Inc. now completely free to make money on prisoners with no accountability?  If they are accountable, to whom are they accountable?   When prisoners have to be taken to community hospitals for acute care, often due to the failure of Wexford to provide basic care, who pays – Wexford or the state?

The IDOC and the State have erected a wall around the system through which no information leaks.  President Barack Obama has declared an end to prisoner abuses and torture by the U.S. government.   But in Illinois such abuses may be going on in violation of the U. S. Constitution and its Eighth Amendment prohibition of “cruel and unusual punishment,” behind an impenetrable wall of silence. 

“You can ask – we won’t tell”

On three separate occasions the Alliance asked for information from the IDOC and received timely responses.  In October of 2004 Steve Karr, Manager of the Planning and Research Unit for the IDOC, responded to an August 2004 request for information regarding sick calls in prisons with a written reply that contained useful summary statistics.  Not all of our questions were answered, but there was an effort to provide the information requested.  A prior request for statistics regarding prisoner mortality was also responded to appropriately.  (The data was difficult to analyze due to the absence of standard reporting methods in the system.)   Similarly, a request in February 2004 for copies of state contracts with prison medical contractors produced copies of all the contracts.

Today, however, it is increasingly difficult to obtain any information about medical problems in the IDOC.  Freedom of Information requests are totally ignored in violation of the law which requires a response within seven days.  When questioned, a lack of staff is given as the excuse.  For example, on June 13, 2007 the NAARPR Chicago requested in a formal FOIA request,

<!--[if !supportLists]-->·         <!--[endif]-->The amounts budgeted for the current fiscal year for health and medical service contracts and other items related to prisoner medical care.

<!--[if !supportLists]-->·         <!--[endif]-->The amounts spent on the above items in the fiscal years 2000 and 1995.

On October 15, 2008 (over a year later) we asked why we could not get this information at a hearing of the Prison Reform Committee under HJR-80, and we were told by Mr. Karr that “there were so many requests for information.  We take them in the order we receive them.”  Now, 23 months later, we still have no reply.

Public health records go private

Not long ago a request for a copy of the death certificate for a prisoner who died in custody would be handled routinely by the County Coroner or Clerk of the county in which the prison is located.  Death certificates are important because they record the cause of death and list the immediate next of kin who have an interest in knowing more about the circumstances of the death.

Death certificates are no longer available.  After months of bureaucratic buck passing we were finally referred to TITLE 77: PUBLIC HEALTH / CHAPTER I: DEPARTMENT OF PUBLIC HEALTH / SUBCHAPTER e: VITAL RECORDS / PART 500 ILLINOIS VITAL RECORDS CODE / SECTION 500.20 ACCESS TO VITAL RECORDS, which states:

“Any custodian of vital records may furnish, upon the terms or conditions as he or she may prescribe under the Act, the Adoption Act, and this Part, when deemed in the public interest and not for purposes of commercial solicitation or private gain, copies of vital records or data from these records: to public agencies administering health, welfare, safety, law enforcement, or public assistance programs; and to private agencies, approved by the State Registrar, such as hospitals, public news media, abstract and title companies, and credit bureaus.”

Since the Alliance is a private agency, and in our mission to educate and inform the public we are a public news medium, we asked who the State registrar was and how one applied to be “approved.”  It took four months to get an answer.

The State Registrar is the Illinois Department of Public Health

No one is approved.

There is no one to whom application to be approved may be made.

If we feel this is incorrect we may sue for our right to access to an approval procedure.

New FOIA request

Gary Marx reported in the Chicago Tribune on May 6, 2009 on the murder of Joshua Daczewitz in Menard Correctional Center two years ago.  In relation to that and other stories of death through violence or neglect, on May 6, 2009 we filed another FOIA request with the department.  We have received no response.  We have specifically asked for

<!--[if !supportLists]-->1.                   <!--[endif]-->A list of all people who have died in the last 12 years while in custody of the Illinois Department of Corrections.

<!--[if !supportLists]-->2.                   <!--[endif]-->The cause of death in each case of people who have died in the last 12 years while in custody of the Illinois Department of Corrections.

This request was made in order to verify the statement of Sergio Molina, Deputy Director of the IDOC, quoted in the Chicago Tribune May 6, 2009, as follows:

“The Illinois Department of Corrections defended its safety record, saying only nine inmates have been killed in the last 12 years for a system that holds some 45,500 offenders.

"’These things can and will happen,’ said Sergio Molina, the corrections department's executive chief. ‘’We try to work diligently to make sure that these incidents don't happen, and I think the numbers reflect that we do a very good job.’”

This Committee has a right to answers to these questions also.  We believe the Prison Reform Committee can and should demand answers.

The data

Table 1 summarizes prisoner-patient medical chart reviews that have been completed by the NAARPR Chicago since October, 2008.  Some of these charts only go through dates prior to October 2008.

Diabetes is the condition most often treated inappropriately.  Among all cases examined, the IDOC’s own records, on their face, indicates appropriate care only 84.3 per cent of the time, and that the most cases of inappropriate care are for chronic conditions that are dangerous and life-threatening.

In addition there is an apparent tendency of overworked staff to inaccurately record results.  This calls into question the basic veracity of the reports.

Diabetes

Out of 17 cases of chronic diabetes with up to date medical charts reviewed so far by the NAARPR, only 9  (53 per cent) are managed appropriately.  Of the 8 not managed appropriately, 7 are prescribed insulin.  In two cases in which insulin is prescribed the patients refuse to allow themselves to be injected.  In letters they say they have seen prisoners receiving insulin die from the inappropriate dosage and timing of injections. 

All together we have communications from 70 prisoners with diabetes, all of whom claim their cases are being inappropriately managed.  Charts reviews have not yet covered most of these patients.

Of the seven cases mismanaged two are at Stateville, two at Danville, and one each from Tamms, Western Illinois, Big Muddy River, and Dixon. 

Accepted protocol for insulin use requires measuring blood sugar levels just before eating and administering a measured dose of insulin by injection, followed by eating a meal in which sugar content is measured and regulated.  Actual procedure in prison, documented in letters and verified by staff<!--[if !supportFootnotes]-->[iv]<!--[endif]-->, fails to meet this accepted protocol in five ways, with potentially serious and even fatal consequences.

<!--[if !supportLists]-->1.       <!--[endif]-->A pre-measured “standard dose” of insulin is injected at an arbitrary time.

<!--[if !supportLists]-->2.       <!--[endif]-->No blood sugar measurement is taken prior to injection.

<!--[if !supportLists]-->3.       <!--[endif]-->A meal in which the amount of sugar is not monitored is delivered to the prisoner and consumed at 3 or 4 am, regardless of the time of injection.

<!--[if !supportLists]-->4.       <!--[endif]-->Blood sugar measurement may be taken once daily.

<!--[if !supportLists]-->5.       <!--[endif]-->Blood sugar measurement is often not taken at all.

Medical records are not complete.  It is impossible to know for sure what is being done in many cases.  For example, medication administration records may indicate that at 9 am every day a patient has his/her blood sugar checked by a finger-stick blood test.  The record will show a technician’s initials in the check-box for that test every day.  Unrecorded is the exact time of each test (they are all in a row labeled “9 am”), or the quantitative measure of glucose level shown by the test.  There is no quantitative record of the management of the patient’s blood sugar on a daily basis, and indeed, there is really nothing but a set of initials in a checkbox beside each day to suggest that the test was actually performed.

For every diabetic prisoner to have a finger stick blood sugar measurement done at exactly 9:00 am every day would require a technician for every prisoner, standing at the cell door, using synchronized watches to assure that every prisoner gets tested at exactly the same time.  This is clearly not possible, yet these records are there in the prisoner charts.  The falsification of such records is a violation of law and ethics. 

We have learned, through sworn testimony in the case of Montell Johnson, that there is evidence that nursing and technical staff will routinely fill out such check box forms without actually performing the procedure being checked off. 

Hepatitis C

For many years the protocol for diagnosis and treatment of chronic hepatitis C virus was largely ignored.  A year ago, after then IDOC Medical Director Willard Elyea gave a sworn deposition in which he acknowledged that treatment was withheld in some cases in order to save money, a jury awarded 4 prisoners being held in Logan Correctional Center a judgment of $8 million.  Shortly after that Dr. Elyea resigned.  A new Medical Director updated the protocol for diagnosis and treatment of chronic HCV infection and directed that it be implemented.  The result has been an improvement in the care of prisoners suffering this potentially fatal disease. 

Individual cases – tales of horror

William Buhrmester

The case of William Buhrmester is a case in point.  We have heard today from members of Buhrmester’s family, who have recounted the tragedy of deliberate indifference that led to his untimely death.  Buhrmester almost died a year earlier in Robinson Correctional Center.  There, he was finally diagnosed with ulcerative colitis, and treated.  He gained weight and began to feel better. 

In January 2009 a prohibited magazine was found by Buhrmester in the common visiting area at Robinson left by someone unknown to him.  For possessing it, he was transferred to Menard Correctional Center and placed in segregation.  His medication was stopped.  Within two months he was dead, despite repeated pleas for help, grievances, and calls by his family members. 

Dr. Adrian Feinerman, the Medical Director for many years at Menard, has been sued 38 times for medical malpractice at Menard.  He is both a Pharmacist (051.025034-Active) and an MD (036.039778). His medical license is on probation.  Probation of his medical license began 1/29/09 and is for two years minimum, but it is indefinite.  Under the terms of the Consent Order signed by Dr. Feinerman, he “shall not prescribe any Schedule II Controlled Substances.”

William Buhrmester was serving a 9 year sentence for possession of less than 15 grams methamphetamine.  He was a drug user.  He was sentenced to be treated by Dr. Adrian Feinerman at Menard CC.  He was effectively given an extrajudicial sentence of death.  Dr. Feinerman remains the Medical Director at Menard CC.

Montell Johnson

Mrs. Gloria Johnson-Ester is here and has told you about the ordeal being suffered by her son, Montell Johnson.  Suffice it to say that had it not been for the intervention of the U. S. District Court and the vigilant and unrelenting campaign by Mrs. Johnson, Mr. Johnson would have died two years ago from blood infections introduced through infected bed sores.  These sores resulted from the failure of medical staff to turn Mr. Johnson every two hours, as prescribed by the attending physician, and the failure of the physician to do anything about this. 

Jeff Hubbell

Jeff Hubbell died on March 7, 2009.  He was paralyzed from his waist down.  He had terrible bed sores like Montell Johnson.  Unfortunately, what he did not have was a family able to intervene on his behalf.  There was no Federal Court involved in monitoring his care.  He just died.  He had been incarcerated only two years. 

Christine LaRocca

Anthony LaRocca has told you what happened to his wife, Christine, who is imprisoned at Dwight Correctional Center.  Because her projected “out date” was less than a year away from her diagnosis of breast cancer, Wexford denied her the surgery that can save her life.  Only through the pressure of her husband and friends, did the IDOC finally perform, two weeks ago, the needed surgery.  Whether it will have been in time to save her life remains to be seen.

Preston McDowell

People have been murdered in prison by guards and by other inmates.  Preston McDowell was killed by guards at Pontiac Correctional Center on October 13, 2003.  He died in OSF St. Francis Hospital in Peoria five days later.  The Peoria County Coroner held an inquest into his death, and it was determined to have been a homicide.  The State Police investigated the crime.  They interviewed a large number of prisoners who witnessed the murder.  The case has been closed.  No one has been charged or arrested.  Some of the guards named have been promoted and/or moved.  None have lost their jobs as far as we can tell. 

Lydell White

Lydell White was a prisoner at Stateville until his death on January 27, 2008.  He died of pulmonary hemorrhaging and necrotizing pneumonia according to his death certificate.  His medical chart shows that he suffered from pulmonary sarcoidosis which was well documented.  “Chronic pulmonary sarcoidosis may result in progressive (sometimes life-threatening) loss of lung function. Fatalities ascribed to sarcoidosis occur in 1 to 4% of patients.”<!--[if !supportFootnotes]-->[v]<!--[endif]--> 

According to eyewitness accounts, Lydell White lay on the floor of his cell for hours that night losing large amounts of blood from his mouth, while his cell-mate and others on his tier shouted for guards to come.  By the time they got there, he had died.  White’s medical records would indicate that he should have been monitored, and medical staff should have been prepared for a possible such emergency. 

The grievance procedure

Prisoners who feel they are not being given appropriate care for an illness or chronic condition have a single path for remedy: the grievance procedure.  The Prison Reform and Litigation Act of 1995, passed by Congress and signed by President Bill Clinton in 1996, requires that all available administrative remedies be exhausted before legal action can be initiated and considered by the courts.  For prisoners in the IDOC this is the grievance procedure.  The exhaustion of this procedure usually consumes a period of 9 months.  Grievances are routinely denied.  Patients may have suffered permanent damage or have died by the time this procedure has been exhausted. 

The only exception to this rule is when courts find that the prisoner’s condition made his/her completion of the process physically impossible.  For example, if a person loses the ability to write due to an injury to their hand or arm, or is paralyzed as a result of disease or injury, he or she is exempt from the exhaustion requirement.

Based on hundreds of prisoner accounts, this is the procedure.

Step One – prisoner files a grievance and gives it to his/her counselor.

Step Two – the counselor “investigates” the grievance.  In the case of medical problems this investigation consists of asking the medical staff whether it is valid.

Step Three - the counselor replies in writing to the prisoner that the medical staff says that care was appropriate and the grievance is denied.

Step Four – within 60 days of filing the grievance, the prisoner may appeal the denial to the Administrative Review Board in the Springfield office of the IDOC.

Step Five – the ARB “investigates” the grievance.  In the case of medical problems this consists of inquiring with the counselor and the prison medical staff whether the grievance is valid.

Step Six – the ARB upholds the original denial, citing the account of the counselor and medical staff.

If the counselor takes more than 60 days to complete Step Three the prisoner must start over, since the window for appealing to the ARB has closed. 

Prison health care is contracted to private HMO type providers.  There is a total lack of any objective independent review of prisoner complaints.  This means that the profitability of the contractor can take precedence over the adequacy of care when decisions are made regarding care.

Table 1: Analysis of medical charts of 108 prisoners in Illinois Department of Corrections reviewed since October, 2008

Conditions are in increasing order of percentage receiving appropriate care

(Some charts are older than October 2008)

Chicago Branch, National Alliance Against Racist and Political Repression

1325 S. Wabash Ave. Suite 105

Chicago IL 60605

312-939-2750

www.naarpr.org