Inmate death raises provider questions, possibility of change Written By Michelle Monroe Friday, October 30, 2009 Could local professionals serve prison? By MICHELLE MONROE Messenger Staff Writer ST. ALBANS TOWN — Vermont’s Defender General Matt Valerio would like to see changes made to the way Vermont arranges for health care for prisoners. The recent death of an inmate in the Northwest State Correctional Facility may provide the political momentum needed to make those changes happen.     Also, the private health care contractor for the Vermont prison system, Messenger research shows, has a history of troubling incidents in other states as well as involvement in a Chittenden County inmate’s death four years ago.     Ashley Ellis, 23, died in the Northwest Regional Correctional Facility less than 48 hours into a 30-day sentence for reckless and negligent driving after she was not provided with potassium needed to keep her heart functioning properly, according to a ruling by the medical examiner.     Ellis, who weighed less than 90 pounds, suffered from a severe eating disorder.     “This really didn’t need to happen,” Valerio said. “You shouldn’t be going in for a misdemeanor 30-day sentence and not coming out.”     Franklin County State’s Attorney Jim Hughes, as reported first in the Messenger yesterday, announced that he would not be pursuing criminal charges in the case.     The state contracts with a company called Prison Health Services (PHS) to provide health care to prisoners. PHS, whose Vermont contract will expire at the end of the year, has a long history in multiple states of deaths related to failure to provide medications or altering patients’ prescriptions when they entered prison in ways that were detrimental to the patient’s health.     In 2006, Vermont renewed its contract with PHS.     In 2005, PHS was implicated in the death of another Vermont prisoner. Robert Nichols died while housed at the Chittenden Regional Correctional Facility. Vermont Protection and Advocacy investigated his death and found that both DOC and Prison Health Services did not follow DOC procedures in caring for Nichols, who was suffering from depression and anxiety and was suffering heroin withdrawal at the time of his incarceration in the Chittenden facility.     While Nichols had been prescribed a course of medications to ease his withdrawal by a PHS physician, a physician had not seen him and there were no records to indicate that the PHS nurse on duty had administered his medication.     He died in his prison bed, after being in the prison for roughly 24 hours.     In their report on the Nichols case, VPA wrote that at the time of PHS’s hiring, “outside advocates and members of the public had serious concerns about Prison Health Service s… given their history of neglectful care of inmates around the United States.”     Vermont Protection and Advocacy, now called Disability Rights Now, is part of a national network of agencies created by Congress to protect the rights of the disabled.     In 2005 PHS was the subject of a New York Times expose of its handling of health care for children in New York City’s juvenile justice system and of adults in Rikers Island.     In May 2005, the company was involved in more than 1,000 lawsuits related to its treatment of prisoners, according to Prison Legal News, and had been the subject of investigations in Pennsylvania, Florida, Tennessee and Ohio.     A 2004 New York State Commission of Corrections investigation into the death of Brian Tetrault, 44, in the Schenectady County Jail found that Tetrault had died as the result of “grossly inadequate and incompetent treatment” for his Parkinson’s disease. PHS was the provider.     All of this happened well before Vermont renewed PHS’s contract to provide health care to imprisoned Vermonters. Information about PHS’s record was readily available to anyone with Internet access.     Some people in the criminal justice community are opposed to contracting for health care services, period, Valerio said. For a company like PHS, critics allege, maximizing profits can mean reducing spending on the very services they are contracted to provide.     In Vermont, for example, PHS was fined for staffing facilities with less expensive licensed practical nurses when their contract called for registered nurses.     PHS initially had an inmate advocate in Vermont whose job was to insure inmates were receiving the care they needed. But after PHS threatened to pull out of their contract early, leaving Vermont without a provider, the state allowed PHS to eliminate the position as a cost-saving measure, Valerio explained.     One advantage of contracting services with an outside provider is that the company can be fired easily for failures, Valerio said. State employees are harder to dismiss, he added.     Valerio suggests that one solution to the problem of providing adequate, cost-effective and accountable health care for prisoners would be for each prison to contract locally for health care services with a community health center, university hospital or other non-profit provider.     Such a model would also allow for a continuity of care for those prisoners who live near the prison where they were incarcerated after release. For prisoners with mental illnesses such continuity might help reduce recidivism, Valerio suggested.     Valerio would also like to see prescriptions issued by outside providers honored until a prison physician has seen the inmate. PHS has a pattern of not following through on outside prescriptions, according to Valerio.     Indeed, many of the deaths for which PHS has been faulted in other states involved a failure to follow through on outside prescriptions, including those prescribed for Tetrault, the man who died of Parkinson’s while in PHS’s care after six of the seven medications he was prescribed by specialists were eliminated by PHS.     The failure to maintain outside prescriptions has been a problem with other prison health care contractors, not just PHS, Valerio said.     Ironically, in Ellis’s case a PHS doctor had affirmed her prescription.     PHS didn’t stock the potassium she needed in their formulary, the prison pharmacy. In those circumstances, PHS was obligated to get the prescription from a local pharmacy.     According to public reports, a PHS nurse asked another nurse to obtain the medication, but the second nurse did not do so.     In announcing his decision not to prosecute, Hughes said he did not find cause to bring charges against any individual.     Asked if it was possible to press charges against a corporation, Valerio replied, “As a matter of law, clearly a corporation could be charged with a crime.”     Asked if a state’s attorney’s office was likely to have the resources to prosecute a corporation, Valerio said, “I think that it would be difficult.”

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