Delaware Hall of Shame

Delaware Department of Corrections
Correctional Medical Services (formerly run by First Correctional Medical)
April 5, 2008 News Journal
Fifteen current and former inmates at Young Correctional Institution filed a federal lawsuit Friday alleging their medical care while behind bars was not only negligent but amounted to cruel and unusual punishment. In at least one incident in 2006, a prison health care contractor allegedly used the same needle on multiple inmates, perhaps all 15, to draw blood and inject medicine -- exposing all to blood-borne diseases including hepatitis C and possibly HIV/AIDS. At least three allege they have contracted hepatitis and possibly other illnesses since that incident. Attorney Joseph M. Bernstein, who along with attorney Bruce Hudson is representing the 15, said he didn't know whether the woman identified in the lawsuit as "Nurse Beth" used the same needle to save money, because the prison hospital was short on supplies that day, because she made a mistake, or for some other reason. "Legally, it doesn't matter," said Bernstein. "They were still entitled to a minimum level of care." And just because a person is in prison, there is no lower level of acceptable care, he said. Although inmate Duane J. Williams was not named in the lawsuit, his family says the exposure led to the 32-year-old's death last month. Ken Fields, a spokesman for the prison's medical contractor, St. Louis-based Correctional Medical Services, said Friday the company was aware of the allegations in 2006 but said there was no evidence the nurse did what the lawsuit charges. He added that even if such a thing happened, it was unlikely -- and there is no evidence -- that any infection actually resulted. He acknowledged that the company did contact patients and offer follow-up blood testing, but said it only did so as a precaution because of the serious nature of the allegations against the nurse. Department of Correction officials did not return calls for comment Friday. The Rev. Christopher Bullock, senior pastor of New Canaan Baptist Church and co-founder of the Delaware Coalition for Prison Reform and Justice, said Friday the acts of the nurse and her employer CMS were potentially criminal. "We must decry this kind of behavior. It is not acceptable," he said. Bullock said the situation described in the lawsuit reminded him of the Tuskegee experiments in which hundreds of poor black men in Alabama were allowed, without knowing it, to suffer and die from syphilis by government doctors who were studying the disease's progression. He said inmates deserve to be treated humanely and their families should not have to put up with this kind of pain and anguish. The 15 inmates who filed the lawsuit were at various stages in the criminal justice system when they were exposed, Bernstein said. Some were being held for probation violations, some were serving sentences for drug violations or crimes such as theft, and some were being held pending a trial. Some have since gotten out of jail, but most remain incarcerated, Bernstein said. Normally, he said, a lancet is used to test a diabetic's blood, then a separate syringe is used to administer the insulin. Neither is supposed to be re-used. In this case, the inmates allege, the nurse used the syringe to test their blood, then used the same syringe to administer the insulin -- potentially contaminating the multi-use vial. She then re-used the syringe in the same way with other inmates, potentially compounding the spread of blood-borne disease. The 15 inmates say their rights were violated and are seeking compensatory and punitive damages and changes in prison medical care to prevent a repeat of the incident. Attorneys for the plaintiffs provided a copy of a memo given to the inmate patients sometime in the summer of 2006, which appears to acknowledge some kind of contamination incident. The "Patient Information Sheet" states a nurse "may have" used the same hypodermic needle to draw blood and to administer insulin, in violation of policy. "A few other inmate patients are now making the same claim," it states, with a handwritten notation adding that some have tested positive for hepatitis. The memo offers the inmates a blood screening to check for infection and says the unnamed nurse denied the charges and had left her job at Young Correctional. Bernstein said some of his clients who agreed to the blood screening were never told the results. Harry Williams, the brother of the inmate who died last month at a Philadelphia hospital, said Friday that his brother Duane, who was a diabetic and serving a three-year sentence on a drug and a weapons charge, had received the same Patient Information Sheet and that "Nurse Beth" was involved in his treatment in 2006 at Young Correctional Institution, formerly known as Gander Hill. Some 46 other diabetic inmates were treated from the same multi-use vial. Six subsequently tested positive for hepatitis, although prison officials said they could not definitively state that the illness was linked to the allegedly contaminated insulin. One month before the earliest date of alleged contamination, in March 2006, the Justice Department's Civil Rights Division launched an investigation of inmate health care in Delaware. That federal involvement followed a series of stories published in The News Journal detailing abuses and problems with inmate health care. The state later signed a settlement agreement with federal authorities promising to revamp and reform the prison health care system. In February of this year, a report on the progress of that reform by former Superior Court Judge Joshua W. Martin III gave the state and CMS poor grades. Bullock said Friday that CMS and its "incompetent and unethical" practices have to go. "The coalition will again be calling for the removal of CMS and we will be doing whatever is necessary -- demonstrations, protest marches -- to bring justice to an unjust system. Someone must be held accountable. We are talking about the lives of human beings," he said.

March 13, 2008 News Journal
An inmate mistakenly exposed to blood-borne diseases died Wednesday, months after his initial complaints of abdominal pain were ignored, his family says. "If I die, it's because of the prison," Duane J. Williams said just before he died, according to his brother. In 2006, a prison nurse administered a contaminated insulin shot to Williams. Because he wasn't tested for a variety of diseases and viruses prior to his incarceration for drug and weapons' offenses, it may never be known whether exposure to hepatitis, HIV and other infections contributed to his liver problems. But the prison medical staff's failure to act quickly when pain first developed, his family says, was a deadly mistake. "When I came into his room for the last time, I actually saw his breath leave his body," said Harry Williams Jr., Duane's brother. "I told him it was OK to let go. I saw the life go out of him. He's at peace. He is free now. He is definitely free." Four days before he died, Duane Williams, 32, told The News Journal that he first felt a pain in his gut over four months ago but the pain wasn't taken seriously until this month when a prison guard noticed Williams' eyes were turning yellow. The officer demanded that a nurse or doctor provide treatment or transfer the inmate to a hospital. Williams was taken to Wilmington Hospital and then Philadelphia's Albert Einstein Medical Center, where he died at approximately 1:30 a.m. His family requested an autopsy, but the exact cause of death remains unknown. "One of the doctors said he had acute hepatitis," his brother said. "But no one is telling us anything official." "He didn't deserve this," wife Megan Williams said through tears. "I will miss him very, very much."

March 9, 2008 News Journal
Gander Hill inmate Duane J. Williams is clinging to life in a Pennsylvania hospital, his eyes bright yellow from near-total liver failure. Severe abdominal pain, which he first reported over four months ago, wasn't taken seriously by the prison's medical contractor, Correctional Medical Services, until last week, he says. When a corrections sergeant noticed Williams' eyes, the officer demanded that CMS staff provide treatment or transfer the inmate to a hospital. Ten days ago, the inmate was taken to Wilmington Hospital, where he waited for a week before being transferred to Philadelphia's Albert Einstein Medical Center on Thursday night for specialized treatment. A diabetic, Williams was exposed to blood-borne diseases such as hepatitis in July 2006, when a former prison nurse drew insulin from a multidose vial with a syringe she had earlier used to obtain a blood sample from another inmate. The nurse, who resigned after the mistake was discovered, delivered insulin from that vial to Williams and 46 other diabetic inmates. Six have since tested positive for hepatitis, although prison officials can't definitively link their illnesses to the contaminated insulin. Most of the inmates, including Williams, were not tested for hepatitis before the exposure. To Williams, none of this matters. "My liver's failing me," he said. He doesn't know how long he will live if he doesn't get a transplant. "They won't tell me straight out," he said. Like the other exposed inmates, Williams has lived with the possibility he contracted hepatitis or HIV from the insulin shot. Because viral infections can take months to appear, nurses conducted a series of blood tests in 2006 to monitor the inmates' health. Williams, 32, was retested last week at Wilmington Hospital, but he says doctors tell him they don't know what caused his liver to fail. While hepatitis C can cause liver failure, it typically takes longer between exposure and failure than what Williams has experienced, according to Dr. Robert Fontana, an associate professor of internal medicine and medical director for liver transplant at the University of Michigan in Ann Arbor. The rarer former of hepatitis B, also can lead to liver failure, and progresses much quicker. Other medical circumstances can shorten or lengthen the progression of either strain. Sentenced to three years for drug and weapons offenses, Williams is dying six months before his scheduled September release. "He wasn't sentenced to death," said his mother, Teri Williams.

February 1, 2008 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."

January 4, 2008 News Journal
A former inmate who successfully sued the medical contractor for the state's prison system, without an attorney, has resolved his case out of court. Richard Mark Turner, 52, charged that Correctional Medical Services failed to provide him with adequate care in 2001 and 2002 to treat his hepatitis C. Attorney Jeffrey K. Martin, who is now representing Turner, said the resolution with CMS was "amicable" but confidential. He said Turner was pleased with the result. CMS spokesman Ken Fields said the case was settled to "to avoid further litigation." Neither side would say if Turner received money as part of the resolution. In March, District Judge Sue L. Robinson ruled in Turner's favor before his civil case went to trial, stating the undisputed evidence showed Turner's care was "obviously inadequate" and violated his rights. The result stunned legal observers because Turner won the case without formal legal assistance. At the time he filed the case, in 2003, Turner demanded $14.9 million. Martin joined the case several weeks after Robinson's ruling. The two sides agreed to settle the case following mediation sessions with Magistrate Judge Leonard Stark in late November and Tuesday entered a stipulation with the court to drop the case. In her March ruling, Robinson said CMS employees did not adequately instruct Turner on how to give himself injections of Interferon -- a form of chemotherapy -- and then "turned a blind eye" when they saw him improperly injecting himself three times a week for seven months. According to court papers, Turner injected himself in the same spot rather than in different locations -- as medically recommended -- resulting in serious infections. Martin said his client continues to suffer significant health problems as a result. Turner had been in prison on assault and reckless endangerment charges. He was released in 2006 but several months later ended up in a Pennsylvania prison on assault charges. Martin said Turner was released on the Pennsylvania charges in September and now lives in Sussex County. Turner has a second civil case pending in federal courts -- filed in 2006 -- alleging subsequent medical negligence by the state and CMS related to the infections. Turner also filed that case on his own, but Martin has agreed to now represent him in that matter as well.

July 6, 2007 News Journal
The state’s new prison monitor released his first semi-annual report today, which is highly critical of Correctional Medical Services, the Department of Correction’s medical contractor. In May, Joshua W. Martin III, a Wilmington attorney and former judge, was selected by the Department of Correction and the U. S. Department of Justice to serve as the state’s first independent prison monitor. As such, Martin will oversee the efforts made by the DOC in satisfying a settlement agreement with the federal government following an investigation that revealed “substantial civil rights violations” in four state prisons. Martin, together with a team of medical and mental health professionals, is monitoring 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. In addition, the team is providing technical assistance to assist the department with reaching or sustaining compliance with certain of the requirements under the memorandum of understanding. Martin spells out that his team’s compliance checks are in their initial stages, with more detail to come in subsequent reports. “This report primarily summarizes the obligations of the state under the MOA, the preliminary observations and recommendations the Monitoring Team has regarding the state's compliance with the MOA, and the monitoring team's plan of action for the coming months,” Martin stated in his report. However, the team did identify several problem areas, such as poor sanitation and chronic understaffing by Correctional Medical Services. “Staffing by the state's medical vendor, Correctional Medical Services, of its leadership positions is a serious concern,” the report states. “Without adequate and consistent leadership, it is very difficult for the state to implement and maintain the changes necessary to comply with the MOA.” The reason for the understaffing, Martin’s team discovered, was an unwillingness by Correctional Medical Services to spend money. “It is the monitoring team's understanding that CMS has had difficulty finding appropriate individuals to fill leadership positions. The monitoring team also has received information that tends to indicate that CMS' regional or national management has not been willing to take such measures as offering relatively small increases in pay in order to attract and retain individuals that would be qualified to fill the vacant positions, nor has CMS' regional or national management been particularly supportive of facility-level CMS management regarding staffing concerns.” Dover lawyer Steve Hampton represents several inmates and their families, including the young daughter of Anthony Pierce, who became known as "the brother with two heads" as an inmate at Sussex Correctional Institution. Pierce, who was profiled in a series of articles by The News Journal, was serving a 14-month sentence from an attempted burglary. “They’ve identified some problems such as horrible sanitation and understaffing, which are well known to anyone in the system,” Hampton said. “The question is, what’s being done about it. I don’t see any details. It’s just another report that describes deficiencies.” For six months in 2005, The News Journal examined conditions of care within the state’s prisons. In late September that year, the newspaper published a series of stories highlighting the findings in a special report.

March 31, 2007 News Journal
The contractor handling medical services for state prisons violated an inmate's constitutional rights in 2001 and 2002 through "obviously inadequate" care, according to a federal judge. Chief Judge Sue L. Robinson further found the evidence was so overwhelming that she granted inmate Richard Mark Turner's motion for summary judgment, meaning he has won his case without a trial. What makes the ruling even more remarkable, according to legal experts, is that Turner, 51, got the ruling in a lawsuit that he filed and argued without an attorney. "This is a very rare event," said Elizabeth Alexander, director of the American Civil Liberties Union's National Prison Project. Turner, who is now incarcerated in Bellefonte, Pa., could not be reached for comment. Prison officials and officials with Correctional Medical Services said Friday they had not read the ruling, handed down late Wednesday, and therefore could not respond directly to it. "We intend to review the judge's ruling in detail before taking any additional action," CMS spokesman Ken Fields wrote in an e-mail Friday. He also noted the case involves events that are more than five years old, a time when less was known about the treatment of hepatitis C, which Turner had. The U.S. Department of Justice found "substantial civil rights violations" in Delaware prisons last year, following a 2005 News Journal series on prison medical care documenting abuses in the prison. In December, the state signed a settlement agreement with federal investigators, promising to correct the problems. On Friday, Corrections spokeswoman Gail Stallings Minor said the department is continuing to address every issue identified in the report. According to Robinson's ruling, Correctional Medical Services violated Turner's rights when its employees failed to adequately train him in how to use a syringe to inject himself with Interferon -- a form of chemotherapy -- to treat his hepatitis C and "turned a blind eye" when they observed him improperly injecting himself three times a week for seven months. Turner injected himself in the same spot rather than in several different locations as recommended by the information sheet included with the medicine. As a result of the improper injections, Turner developed a serious infection, according to court papers.

January 16, 2007 News Journal
Legislation that would guarantee public access to any state agency report that was paid for with public money was released from a House committee today, on track for possible action by the full house this month. House Bill 5, sponsored by Rep. Nancy Wagner, R-Dover North, is virtually identical to legislation that passed the House unanimously last year but died in the Senate for lack of action. It was prompted by the Department of Correction’s refusal to release a performance audit of Correctional Medical Services, the contractor that provided medical services to the state’s prisons. State officials refused to release the audit saying to do so would reveal private medical information that federal privacy laws preclude from disclosure. The state also refused to release a redacted version of the audit that would have removed patient identities while retaining the audit's conclusions regarding CMS' performance. John Flaherty, lobbyist for Delaware Common Cause, told the House Sunset/Policy Analysis & Government Accountability Committee that House Bill 5 “essentially makes public what is already public.”

January 13, 2007 The News Journal
Demetrius Caldwell, a 24-year-old drug dealer, had been undergoing unspecified treatment for a month in the state's newest prison infirmary before he was found dead this week, laying on a mattress on the floor of his infirmary cell. A medical staffer had checked on him 25 minutes before he died. Prison officials ruled out meningococcal meningitis as the cause of death Friday, after naming it as a possibility Thursday evening. A less virulent strain of meningitis remains a slight possibility. "Everything's negative," said James Welch, the Department of Correction's health services administrator. "There's no trauma, no heart problems, no brain tumor. We're still waiting on toxicology. We can't find anything. We're as concerned as anyone else is." The length of time Caldwell spent in the state's prison infirmary and the lack of an explanation for his death point to the same medical deficiencies that prompted the U.S. Justice Department last month to find "substantial civil rights violations" in four Delaware prisons, said Senate Minority Leader Charles L. Copeland, R-West Farms. The federal investigation was prompted by a series of articles in The News Journal that revealed inadequate health care and questionable treatment within the prisons. In their report, federal prison regulators found "consistent backlogs with the respect to the treatment of chronic care inmates." Any inmate who has been in the infirmary for a month meets the "chronic care" definition and should have been taken to a private hospital, said Copeland, one of the co-founders of the Delaware Coalition for Prison Reform and Justice. "Someone should have recognized that the prison infirmary was not the place for him to be," he said. "The fact they failed to identify that re-emphasizes the legitimacy of the constitutional violations of prison health care performance." Federal investigators, who negotiated an 87-point settlement with the state to improve prison medical care, declined to comment about Caldwell's death. Correction commissioner nominee Carl Danberg said Friday that doctors from Correctional Medical Service, or CMS, the prison's contract medical provider, along with the Department of Correction's medical team, the Chief Medical Examiner's Office and Public Health are reviewing the case. "Additional outside expertise might be sought, depending upon what we find in the tests that are still pending," Danberg said. "We are following Department of Correction procedures and following Delaware law for a death in custody. All information is being turned over to the Medical Examiner."

December 31, 2006 The News Journal
Delaware Correctional Center near Smyrna is among the Delaware prisons looking at major changes in inmate health care after an investigation by the U.S. Department of Justice found the prison system guilty of civil rights violations. It's been more than a year since a coalition of concerned citizens, lawmakers and clergy marched on the governor's mansion and knelt in prayer asking for better health care for inmates in Delaware's prisons. They were galvanized by horrific conditions outlined in a series of stories in The News Journal, the first of which appeared in late September 2005 -- a series Correction Commissioner Stan Taylor charged was "sloppy reporting" in a five-page response the newspaper published. What's happened since will bring groundbreaking changes to Delaware's prison system: • On Friday, following a nine-month investigation, the U.S. Department of Justice announced that federal investigators found "substantial civil rights violations" inside four Delaware prisons. For example, the report noted, flesh-eating bacteria inside Gander Hill prison went undiagnosed and untreated, placing "inmates and staff at risk of acquiring the infection and passing it to others in the community." • Taylor and Attorney General Carl Danberg signed an 87-point agreement with the federal government that calls for sweeping changes in Delaware's penal institutions. The state promised to correct the deficiencies and "meet generally accepted professional standards." However, the state did not admit to violating any inmate's civil rights or breaking any other federal law. • The 55-year-old Taylor, who's served the past 11 years as commissioner, announced this month that he will retire on Feb. 1. On Saturday a prison spokeswoman announced that Paul Howard, Taylor's longtime bureau chief of prisons, is retiring the same day. Prison spokeswoman Gail Minor Stallings said Howard's departure had nothing to do with the federal report that orders the state to completely renovate its prison health care system. • Trial lawyers say the damning federal findings will serve as a road map for inmate lawsuits against the state. • Senate Minority Leader Charles Copeland, R-West Farms, said Saturday the federal government might have taken a "wait and see" approach, if the state had reacted once concerns about inmate care were first raised by the newspaper, and by the citizen coalition he co-founded. "If there had been a positive response from the state, the feds might have not felt the need to be the hammer," said Copeland, who estimates that changes ordered by the Justice Department will cost $20 million to $30 million more than the state already spends annually on prisons. • House Majority Leader Wayne Smith, R-Clair Manor, said he was disturbed about the agreement being signed in secret. "I am troubled that we (lawmakers) were not consulted about something this important. By signing this, the governor and the attorney general have obligated the state to spending money without the General Assembly's consent -- and I think we should have learned about this from them, rather than from a reporter." Copeland wasn't alone in suggesting that had state officials acknowledged serious problems existed, rather than denying their existence, the pain and suffering among inmates and their families -- as well as the final cost of taxpayer dollars -- would not have been as high. Sen. Karen Peterson, D-Stanton, an early backer of the federal probe who wrote a letter in support of the investigation to U.S. Attorney General Alberto Gonzales, said it's not as though the state pleaded no-contest to the federal charges of poor inmate health care. "It's worse than that," Peterson said. "They don't think they did anything wrong."

October 20, 2006 Wilmington News-Journal
Seven months ago, the U.S. Department of Justice opened an investigation of the prison health care system in Delaware -- where the rates of inmates dying of AIDS and suicide have been among the highest in the nation, and where hepatitis and skin infections are constant problems. Eleven months ago, a former inmate's breast cancer went undetected while she was forced to wait five months for a mammogram inside Baylor Women's Correctional Institution, near New Castle. Twelve months ago, an outbreak of Legionnaires' disease hit Sussex Correctional Institution, in Georgetown. And yet little has changed for the inmates, a coalition of prison advocates said Thursday. On the anniversary of the coalition's founding, leaders of the group gathered in Wilmington's Rodney Square to lament a year's worth of what they called inaction by the leaders of Delaware. There has been only "silence" from Gov. Ruth Ann Minner and "stonewalling" from the General Assembly, said co-founders of the Delaware Coalition for Prison Reform and Justice. "We are here today to continue to raise the issue in the consciousness of prison crisis in our state," said the Rev. Christopher Bullock, pastor of Canaan Baptist Church. "We are going to continue to fight on behalf of the voiceless, those incarcerated and their families." For six months in 2005, The News Journal examined conditions of care within the state's prisons. In late September 2005, the newspaper published a series of articles highlighting AIDS-related inmate deaths and suicides during the past four years; allegations by inmates of poor medical treatment for cancer, meningitis and hepatitis; and a no-bid $25.9 million contract awarded to St. Louis-based Correctional Medical Services to manage health care in the state's prisons. The series revealed: •Dr. Janet Kramer, of Wilmington, an expert in prison health care, said inmates should be screened for hepatitis C and HIV. But pretrial and convicted inmates in Delaware are not routinely screened when they are sent to prison or when they leave. Delaware prisons have become incubators for new strains of the AIDS virus, creating a public health crisis, experts say. •Former prison doctor Ramesh Vemulapalli said a private medical company ordered him to treat inmates for HIV or hepatitis C, but not both. •The state does not routinely conduct autopsies on inmates who die in prison or those hospitalized at the time of their death, a policy the president of the National Association of Medical Examiners believes prevents evaluation of the quality of prison medical treatment. And if it does conduct autopsies, the results are sent to the medical vendor, not the prison. •Dr. Robert Cohen, an expert in prison health care whom state and federal courts have appointed to monitor prisons in five states, said Delaware should investigate medical malpractice claims. Instead, the state's medical board occasionally takes complaints from inmates and their families about prison health care professionals, but it is only an advisory panel.

August 8, 2006 Wilmington News-Journal
The American Civil Liberties Union of Delaware filed a civil lawsuit today charging the state Department of Correction with refusing to provide information about how it treats prisoners for with illnesses such as HIV, hepatitis and high blood pressure. The ACLU, represented by Public Citizen, filed the suit in New Castle County Superior Court when the prison department denied its records request. According to the suit, prison officials claimed some information about treatment is “a trade secret” and “privileged or confidential” property of the prison’s medical contractor, St. Louis-based Correctional Medical Services, Inc. The lawsuit maintains that the withholding of documents relating to the correctional facility’s treatment protocols for certain illnesses and operating procedures for wellness visits is in direct violation of the Delaware Freedom of Information Act. The ACLU also said that corrections departments in other states have provided similar prison health care policy information to the public. The U.S. Justice Department’s Civil Rights Division started investigating prison health care in Delaware on March 8 -- a probe Correction Commissioner Stanley W. Taylor Jr. and Gov. Ruth Ann Minner opposed and lobbied to stop. Last year, The News Journal published a series of articles documenting inadequate medical care in Delaware prisons.

July 21, 2006 News Journal
As many as four dozen current and former inmates at the Young Correctional Institution may have been exposed to blood-borne diseases, including AIDS and hepatitis, by a former nurse accused of improper needle use. "This is a potential crisis in our community," said the Rev. Christopher Bullock, a founder of the Delaware Coalition for Prison Reform and Justice. "It goes to our original point, that when there is incompetent medical services provided to those who are incarcerated, it opens up Pandora's Box for things to happen of this nature." According to the Department of Correction, a licensed practical nurse who was hired April 10 used a diabetic needle and syringe instead of an individual lancet to obtain a blood sample from an inmate earlier this month. The nurse later used the same needle to draw insulin from a multiple-dose vial -- potentially contaminating the vial -- then used the vial to provide insulin to other inmates. Department of Correction Commissioner Stan Taylor said the procedure was completely inappropriate and something any health practitioner would be taught early not to do. "It is alarming because it is very basic medical protocol," he said. Taylor would not name the nurse but said she had resigned. The nurse was hired by St. Louis-based Correctional Medical Services, or CMS, the state prison's health care provider. A News Journal investigation of the state prison health care last year pointed out high rates of AIDS-related inmate deaths. The series, which looked at the quality of medical and mental health services, is central to an ongoing investigation of the Delaware prison system by a special civil rights team from the U.S. Justice Department. United States Attorney Colm F. Connolly refrained from commenting about the new allegations because of the ongoing Justice Department investigation. 'More of the ongoing tragedy' Dover Attorney Stephen A. Hampton, who has successfully sued the Department of Correction on behalf of inmates or their survivors who alleged improper care, said "this is more of the ongoing tragedy that is CMS and the DOC." Bullock said the investigation should be comprehensive and that all 48 people involved, as well as those with whom they have had contact, should be tested. "There needs to be a health alert within the prison and also in the community due to this unprofessional behavior by this particular nurse," he said.

June 11, 2006 News Journal
A 56-year-old Hockessin man hanged himself last month hours after he was taken off a suicide watch by the Department of Correction -- and despite warnings from family and mental health advocates of a recent suicide attempt. At 4:52 a.m. on May 30, prison guards found Thomas J. Burns hanging from a bedsheet in his cell. Burns had arrived at Young Correctional Institution on a forgery warrant. Only days before the prison suicide, Burns was released from Christiana Hospital, where he nearly died after trying to kill himself by mixing medication and liquor. Mental health advocates flooded the prison with phone calls, trying to alert the jailers that Burns would try to kill himself in the prison. Prison officials initially placed Burns on suicide watch -- a restrictive status involving constant surveillance during which Burns was allowed only a paper gown in his cell. But on Memorial Day, a counselor employed by the prison's private medical contractor, Correctional Medical Services, conducted a mental health evaluation and ordered Burns placed on the less-restrictive psychiatric observation. Burns was given several personal items -- including bedsheets -- and guards were supposed to check on him every 15 minutes. Hours later, he was dead. Suicide is the third-leading cause of death in prisons nationally -- behind natural causes and AIDS-related deaths, which are recorded separately from natural causes by the U.S. Bureau of Justice Statistics. According to the bureau's latest report, issued last month, Delaware's prisoner suicide rate for 2001 and 2002 was double the national average of 14 per 100,000 inmates. The quality of medical and mental health services inside Delaware prisons is central to an ongoing investigation of the Delaware Department of Correction by a special civil rights team from the U.S. Justice Department. High rates of inmate deaths from HIV/AIDS, mistreatment of cancerous tumors and the spread of flesh-eating bacteria are just some of the factors attracting federal scrutiny. Burns' death will be reviewed internally, said Correction Commissioner Stan Taylor, and the findings will be closed to the public. Burns' suicide is similar to previous deaths in Delaware prisons. As he was booked into Howard Young (then called Gander Hill prison) in 2004, Christopher Barkes told a mental health screener that he had attempted suicide before -- when he had earlier served time in Gander Hill. Barkes provided a list of drugs he was taking for depression, post-traumatic stress disorder and other forms of mental illness. Instead of placing Barkes on suicide watch, prison officials put him in a cell, alone and unsupervised. Hours later, Barkes hanged himself with a bedsheet. His widow, Karen, has sued the state over the death. "It is very disturbing that after Chris's suicide, they still aren't going to change anything," she said. "Chris died and nothing changes." According to the Department of Correction, 11 inmates have killed themselves since January 2000 -- most by hanging. Experts say effective mental health care can reduce the number of suicides in the state's nine prison facilities. In Delaware, Correctional Medical Services provides medical and mental health treatment. When an inmate arrives in prison, these CMS counselors use a form that has a series of yes/no questions to determine suicide risk. If the risk of suicide is high, they may require the inmate to sign a "suicide contract" promising not to kill themselves. Mental health experts have described these practices as antiquated and ineffective. Level of expertise. Neither prison nor Correctional Medical Services officials would name the counselor who evaluated Burns. They described the counselor as a "master's-level clinician." "You do not evaluate a person for suicide without a psychiatrist," said Rita Marocco, executive director of the National Alliance for the Mentally Ill in Delaware. "If a person has made a suicide attempt, it certainly must be a psychiatrist who makes the decisions. I believe they do not have qualified people doing these evaluations." Dr. Carol A. Tavani, a board-certified neuropsychiatrist and executive director of Christiana Psychiatric Services, agrees that a psychiatrist -- not a counselor -- should have conducted the evaluation. "When you have something of this seriousness, with this kind of history, especially when there's a prior attempt, that ratchets up the seriousness of the risk," Tavani said. "Evaluation of suicidality has to be done very carefully, and it's always the better part of valor to err on the safe side, particularly if there's previous history. Those calls are always safest when made by a psychiatrist, and I know they do have them." Patricia McDowell, Delaware's director of support and outreach services for the National Alliance for the Mentally Ill, told prison officials about Burns' recent suicide attempt and warned them he would try it again. After Burns' death, these officials stopped taking her calls. "We worked very carefully to get to the right people, to help someone at a very critical point in his life, and the very people we turned to let us down," McDowell said. "The system failed. His life ended."

May 19, 2006 Delaware State News
The General Assembly's budget committee approved creating three positions Thursday to provide additional oversight of the Department of Correction's inmate medical care system. The agency's handling of prisoner health care has come into question in the past year amid newspaper accounts and lawsuits questioning the quality. The positions, which will pay a combined $238,900 in salary, were created by the Joint Finance Committee as it approved the DOC's operating budget for fiscal 2007, which begins July 1. "We just want more oversight and supervision," said Sen. Nancy W. Cook, D-Kenton, a JFC co-chair.

May 19, 2006 News Journal
A bill that would require wholesale improvements in Delaware's prison medical system is dead for this year, crushed by a $30 million annual price tag attached to it by the General Assembly's staff. The demise of Sen. Margaret Rose Henry's reform bill, Senate Bill 291, came Thursday when the Joint Finance Committee included no money in the Department of Correction's budget for next year to pay for the improvements. The bill has been mired in the Senate Judiciary Committee, chaired by Sen. James Vaughn, D-Clayton, for months. Henry and Vaughn said the bill would not be considered this year, in large part because of the fiscal-impact report from the Controller General's Office. The committee, which is amending Gov. Ruth Ann Minner's proposed $3 billion budget for the year that begins July 1, did add some extra money for prison health care. The panel agreed to pay the state's private health care provider more for existing services, and for several positions to better oversee Correctional Medical Services. The panel added $2.9 million as an "inflation adjustment" for the CMS contract, raising the annual cost by 11 percent to more than $28.8 million. The multiyear contract was transferred to CMS without bidding last July on an emergency basis. The committee shifted $238,900 to Corrections for prison health care oversight by the Division of Public Health, and prison care reviewers. That extends changes begun last fall by Minner and Correction Commissioner Stan Taylor to address substandard prison care. Those steps followed the reports in The News Journal. This spring, articles detailed how a female inmate gave birth to twins in a toilet stall at Baylor Women's Correctional Institution in March. She said a prison nurse employed by CMS ignored her complaints of powerful contractions, which began 24 hours prior to the births. The reform bill also would require CMS to deliver records of inmate deaths within three days to the Medical Society of Delaware's Prison Health Committee for review, and make other records available to the state for audit. Inmate medical grievances would have to be sent to the Department of Correction, not to the medical service provider. But all of that would be costly, according to the fiscal analysis. Legislation that would make publicly funded reports open to public scrutiny -- including an audit of prison health care -- passed the state House this month without a vote against it. House Bill 320, sponsored by North Dover Republican state Rep. Nancy H. Wagner, would require the state to release the audit and other such reports, provided that personal information such as medical records is withheld. The bill faces an uncertain future in the Senate.

May 11, 2006 News Journal
State Sen. Harris McDowell III, D-Wilmington North, has added another bill to an assortment of pending measures designed to address the medical condition of inmates in Delaware's prisons. Senate Majority Leader McDowell on Wednesday introduced Senate Bill 306, which would require the state Medical Examiner's Office to investigate each death in a state correction facility and conduct an autopsy. The bill follows a series in The News Journal last fall that detailed a large number of deaths inside state prisons and inadequate medical care. The series helped prompt an investigation by the U.S. Department of Justice.

April 9, 2006 News Journal
Kimwayna "Kim" Allen gave birth to twins in a toilet stall at Baylor Women's Correctional Institution last month, after she says a prison nurse employed by Correctional Medical Services ignored her complaints of powerful contractions, which began 24 hours prior to the births. Each of the babies -- son Ny-Aire and daughter Ny-Bree -- weighed barely a pound. They are clinging to life in intensive care at Christiana Hospital, swaddled in tiny blankets inside incubators monitored around-the-clock by nurses. Even if Kim's daughter survives, her prognosis is poor. The likelihood of brain damage and mental retardation is high. Ny-Bree had no pulse and was barely breathing after delivery. Her tiny brain was starved of oxygen for about eight minutes, until two paramedic units and three ambulances raced into the prison grounds after the nurse called 911. The paramedics began CPR in the prison and continued all the way to Christiana, but Ny-Bree was still in very rough shape by the time they got her to the hospital. Kim, a 19-year-old who lives with her mother, has had to make monstrous decisions about her children's future. "They told me I should pull the plug on my daughter because she wasn't doing too well," Kim said. "I couldn't do it." The U.S. Justice Department's Civil Rights Division launched a federal investigation into prison health care in Delaware on March 8 -- a probe Correction Commissioner Stanley W. Taylor Jr. and Gov. Ruth Ann Minner opposed and lobbied to stop. Although Minner agreed to cooperate with the Justice Department, the governor told U.S. Attorney General Alberto Gonzales that the federal probe was not necessary. The bathroom prison deliveries occurred four days before the investigation was launched. Last year, The News Journal published a series of articles documenting inadequate medical care -- including prenatal -- in Delaware prisons. Neither Taylor nor Minner returned e-mail or telephone requests to talk about Kim or her twins, or the care she received before giving birth in the women's prison bathroom. On March 30, The News Journal made a request under the Delaware Freedom of Information Act for a copy of the policy and the lists required as part of the department's health care accreditation. Welch, in an e-mail response, wrote, "The DOC does not have a specific policy regarding the care of pregnant inmates." She couldn't explain why. Correctional Medical Services spokesman Ken Fields couldn't say how CMS staff should respond if a pregnant inmate complains of contractions. And he declined to provide a copy of the CMS policy regarding pregnant inmates. Fields said CMS employees make their own decisions. "Correction health care professionals are trained to address these types of issues using their own training and judgment, in their own assessment of each patient's condition to make decisions about the next step for treatment," he said.

March 9, 2006 News Journal
After years of high inmate death rates due to HIV/AIDS, suicide and poor medical care, federal civil rights regulators have launched an investigation of Delaware's prison medical system -- a process that could take years to complete and forever change the way the state treats its 6,800 inmates. The investigation comes on the heels of a five-month preliminary inquiry by the Justice Department during which federal regulators interviewed many of the same medical experts, inmates and families of dead inmates who spoke to The News Journal late last year during the newspaper's six-month investigation of prison health care. As with the newspaper's investigation, the Justice Department uncovered significant problems at the Delaware Department of Correction. The federal investigation now may involve FBI agents and grand juries with subpoena power."Thank you, Jesus. I've been praying for this so hard," said Susie Wilson, whose son, Jermaine Lamar Wilson, was found hanging in his cell with blood-stained clothes and a gash on his head. It was Feb. 18, 2005 -- the day his family says he was scheduled to be released after serving time for robbery. Wilson's death is now the focus of a federal wrongful death lawsuit, which claims Jermaine Lamar Wilson was murdered while being held at the Delaware Correctional Center near Smyrna. The federal investigation will be conducted by the Special Litigation Section of the Justice Department's Civil Rights Division. A News Journal special report on inmate health care published in September revealed sometimes gruesome details of neglect, such as an inmate's massive brain tumor -- largely ignored by staff -- which led to his death, and an outbreak of flesh-eating bacteria. Other findings of the newspaper's six-month investigation were inmate death rates -- specifically AIDS-related and suicide -- far above the national norm. During the newspaper's investigation, reporters discovered that Minner and Taylor awarded a $25.9 million no-bid contract for inmate health care to Correctional Medical Services -- a private medical contractor with a history of litigation over how the company provides medical care. Minner and Taylor also refused to release -- publicly or to lawmakers -- an audit of prison health care they say prompted the emergency hiring of CMS. Former prison doctor Ramesh Vemulapalli, an AIDS specialist practicing in Dover, said the investigation is long overdue. Vemulapalli said he quit working in Delaware prisons because he was not allowed to provide adequate care. "I think the investigation will help make reforms in the prison system," Vemulapalli said. "It's a good thing. It will benefit the people of Delaware."

February 18, 2006 News Journal
Correction Commissioner Stanley W. Taylor Jr.'s failure to properly train his staff to recognize suicidal inmates and properly care for them allowed Christopher Barkes to hang himself in his prison cell in November 2004, a federal lawsuit contends. The lawsuit, filed in U.S. District Court in Wilmington by his family members, said the prison's former medical provider also failed to properly train staff to recognize and properly care for inmates who had made previous attempts on their lives. That medical provider, Arizona-based First Correctional Medical, or FCM, pulled out of its contract last year. During his time at the Young Correctional Institution in Wilmington, the suit said, Barkes told prison officials he had attempted suicide before. Prison staff placed him in a cell alone, though, with no suicide watch, the suit said. Barkes, 37, was found unconscious the following morning and taken to Christiana Hospital, where he died. Prison officials determined Barkes used his bedsheet to hang himself. Taylor often defends his department by noting it is accredited by the national commission, a process that cost taxpayers $12,400. Taylor, though, has declined to make public an audit by the commission on prison health care, saying it contains inmate medical information and peer reviews of doctors. Lawmakers, who have repeatedly asked for the report, even if elements are blacked out, are considering legislation to make it public. Barkes' case came to light during an investigation by The News Journal last year. The six-month investigation highlighted allegations by inmates of poor medical treatment for cancer, meningitis and hepatitis; a no-bid $25.9 million contract awarded to the current health care provider, Correctional Medical Services, based in St. Louis; and a comparatively high rate of AIDS-related inmate deaths and suicides over a four-year period. Another lawsuit filed by a prisoner highlighted in the newspaper articles was settled out of court in October. Anthony Pierce, also known to inmates as "the brother with two heads," was serving a 14-month sentence for a parole violation when a small lump appeared on the back of his head. At the time, a prison doctor employed by Correctional Medical Services said the marble-size lump was a cyst or an ingrown hair. The tumor kept growing, and on March 22, 2002, Pierce died from a "brain tumor, due to osteosarcoma of the skull," according to an autopsy report. The conditions revealed in the articles are the subject of an inquiry by the U.S. Department of Justice's Civil Rights Division. "Stan Taylor said that they follow the guidelines, and it is clear that they didn't," said Barkes' wife, Karen. She also said "it is discouraging that the lawmakers aren't doing anything to change the problems in the prisons." The lawsuit targets Taylor and FCM, along with prison warden Raphael Williams, the Department of Correction and unknown Correction Department and FCM employees. The suit, which alleges wrongful death and cruel and unusual punishment, seeks compensatory and punitive damages to be set by the court. Contact Esteban Parra at 324-2299 or eparra@delawareonline.com. Contact investigative reporter Lee Williams at 324-2362 or lwilliams@delawareonline.com.

February 16, 2006 Delaware State News
The legislature’s budget-writing committee on Thursday urged the head of the state Department of Correction to release a 2005 report evaluating prisoner medical care. Should the report stay under wraps, some of the panel’s members are ready to include language in the fiscal year 2007 budget bill forcing it to be made public. The audit, performed by the National Commission on Correctional Health Care, turned up enough deficiencies that DOC switched care providers. The contract with Arizona-based First Correctional Medical was terminated and the state signed a deal with St. Louis-based Correctional Medical Services. Legislators, the Delaware State News and other news organizations requested copies of the report last year under the Freedom of Information Act, but were denied.

January 26, 2006 Wilmington News Journal
Lee McMillan, whose husband nearly died in prison after flesh-eating bacteria attacked his body, wants to know why the state won't release an audit of Delaware's prison health care system. So do some legislators, who are backing a bill that would require the state to release the audit and similar reports -- as long as confidential information such as personal medical records is withheld. House Bill 320, sponsored by Rep. Nancy Wagner, R-Dover North, would make reports that are paid for with public funds open to the public under the Freedom of Information Act. The News Journal requested the audit, which cost taxpayers $12,400, while investigating AIDS-related inmate deaths and suicides of Delaware prisoners as well as reports of poor medical treatment for cancer, meningitis and hepatitis. Prompted in part by a series of News Journal stories, the U.S. Department of Justice is conducting an inquiry into the Department of Correction's management and inmate health care. In defending his record, Correction Commissioner Stan Taylor pointed to the audit, prepared by the National Commission on Correctional Health Care, but denied a Freedom of Information request for the report by the newspaper. Taylor and former Attorney General M. Jane Brady ruled the accreditation report was not a public document. Taylor, though, said the audit was critical of the work of First Correctional Medical, a Tucson, Ariz., company. In July, Gov. Ruth Ann Minner and Taylor awarded a $25.9 million no-bid contract to Correctional Medical Services of St. Louis to pick up the provision of medical care in Delaware's prisons. Rep. Pamela S. Maier, R-Drummond Hill, is a House co-sponsor who said she believes that "sunshine helps" in governmental affairs. "I think the public needs to know, and if they're not satisfied, we need to keep the pressure on the Department of Correction and [prison health care provider Correctional Medical Services] to improve the health of our prisoners."

November 18, 2005 Wilmington News Journal
A Department of Correction official said Thursday that Medicaid and its former medical service provider owe St. Francis Hospital less than $500,000 in past-due bills. That amount is half of what a committee reported they owed the hospital two months. But exactly how much Medicaid and Arizona-based First Correctional Medical, which provided services to the prison until July, owe St. Francis and other health care providers remains unknown, said Joyce Talley, the department's bureau chief of management services. It's also unclear what portion of the unpaid bills is owed by Medicaid and by First Correctional Medical of Tucson, Ariz. "I still don't have my arms around the whole thing," Talley said. First Correctional Medical's owner and founder, Dr. Tammy Kastre, did not return calls made to her firm Thursday.

November 16, 2005 Wilmington News Journal
The Delaware Department of Correction has hired longtime HIV/AIDS educator and advocate James Welch from the Department of Public Health, to serve as the health services administrator for the state's prison system. Welch, a registered nurse, currently serves as the Department of Public Health's HIV/ AIDS/STD director in a program he created 20 years ago to coordinate prevention and treatment of HIV/AIDS and other diseases. "Jim will oversee the DOC's day-to-day medical operation," said Ed Synoski, the Department of Correction's deputy chief of the Bureau of Management Services, which oversees the department's medical services contracts. Taylor announced the creation of Welch's position during a public hearing last week called by lawmakers to examine a series of articles in The News Journal highlighting AIDS-related inmate deaths and suicides during the past four years, and allegations by inmates of poor medical treatment for cancer, meningitis and hepatitis. Prompted in part by the series, the U.S. Department of Justice has launched a preliminary inquiry into the Department of Correction's management and inmate health care. Welch previously has played a behind-the-scenes role in the inmate health care debate -- lobbying in 2002 against allowing Dr. Keith Ivens to remain as the prison system's medical director when Correctional Medical Services (CMS) of St. Louis, Ivens' employer, was replaced by another medical contractor. In July, Taylor brought CMS back to Delaware with a $25.9 million no-bid contract to manage inmate health care. In a sworn deposition, Kathy English, the former deputy bureau chief of management services for the Department of Correction, said Ivens was a frequent source of inmate complaints. English testified that Welch expressed "informal concerns" about the physician and told the incoming contractor to not allow Ivens to continue as medical director. The Rev. Christopher Bullock, pastor of Canaan Baptist Church in Wilmington, is one of the founding members of the Delaware Coalition for Prison Reform and Justice. "The DOC doesn't need to be hiring new people," Bullock said. "They need to be firing people. This appears to be another effort to cover up and conceal the real issue."

November 8, 2005 Wilmington News Journal
Family members of dead, dying or grievously ill inmates lashed out at Correction Commissioner Stan Taylor on Monday night, accusing Taylor and the prison's medical vendor of causing illnesses and deaths by providing inadequate medical care to the state's 6,800 inmates. Some of those who testified said the state treats its inmates worse than animals. The public scolding occurred at an "informational" hearing called by Speaker of the House Terry Spence, R-Stratford, and Rep. Pamela S. Maier, R-Drummond Hill, who sought to educate lawmakers about prison conditions before the upcoming legislative session. "It's your facility -- clean it up," Matilda Carello, whose son is an inmate with Grave's disease, yelled at Taylor, who was sitting by her side. Also in the audience were representatives from Correctional Medical Services, the company Taylor recently awarded a controversial $25.9 million no-bid contract to run inmate health care. "CMS -- you're a liar," Carello said. "Stan Taylor -- you are a liar!" After about 50 witnesses from the public testified at the hearing, Spence said "it's time for a gut check." "We've lost confidence in the department," he said. "We've lost confidence in CMS." Spence called for an independent oversight panel for the department and CMS. Ann Mac, a nurse practitioner and CMS vice president of operations, told lawmakers and inmate family members that "delivering health care in prisons is a uniquely challenging but very rewarding field." Her message was not well received. "I am sorry, but the things being said from this lady -- this is not what's really going on inside," said Lee McMillan, who says her husband, an inmate, nearly died when flesh-eating bacteria ravaged his body. Monday night's hearing was scheduled after a six-month investigation by The News Journal found a high rate of AIDS-related inmate deaths and suicides over the past four years, and uncovered allegations of poor medical treatment for cancer, meningitis, hepatitis and other communicable diseases and bacterial infections. Prompted in part by the newspaper's series, the U.S. Department of Justice has launched a preliminary inquiry into the Department of Correction's management and inmate health care. Maryanne McGonegal, secretary of Common Cause, criticized Gov. Ruth Ann Minner for failing to address evidence of negligent inmate care. On Oct. 3, Common Cause of Delaware asked U.S. Attorney General Alberto Gonzales to open a federal investigation. "The lack of response by our governor is the strongest indication of the need for outside oversight of prison conditions," McGonegal said Monday night. Several of those who testified said after the hearing that Taylor should release a recent audit of inmate health care under the state's former prison medical vendor, First Correctional Medical. Performance audited: Taylor asked a medical accreditation firm to audit FCM's performance from December 2004 to January 2005. According to documents Taylor provided to lawmakers, the audit showed "several problems with medical administration and clinical practices including record keeping, utilization management, medical history and sick call follow-up." The News Journal submitted a request under Delaware's Freedom of Information Act for the audit, which cost Delaware taxpayers $12,400, but Attorney General M. Jane Brady denied the newspaper's request. Former CMS substance abuse counselor Denise Rodriguez said she supports punishment for those who break the law. "But that punishment should not be neglect, humiliation or death," Rodriguez said. Rodriguez, who worked for CMS at Gander Hill from 1999 to 2002, told The News Journal in a previously published story that a CMS official ordered her to falsify documents so state inspectors would not pull the company's license to run a prison treatment program. "Stan Taylor, I always told my clients that in order to make changes in your life, you have to hold yourself accountable," she told Taylor at Monday's hearing. "Someone needs to hold you accountable."

November 7, 2005 Delaware State News
The state's correction chief and the medical company hired by the agency defended the level of medical care inmates receive Monday during a hearing at Legislative Hall. Commissioner of Correction Stanley W. Taylor and Ann Mack, vice president of operations for Correctional Medical Services, made their presentation to a hearing called by the House of Representatives' Health and Human Development Committee. Mr. Taylor and CMS have come under heavy criticism recently after news reports questioned the quality of care in prisons based on lawsuits and anecdotes from prisoners and their families alleging poor medical treatment. Scores of members of the public spoke at the hearing and ripped into Mr. Taylor and CMS. "I believe a person needs to be punished when they break the law of the land, but the punishment does not include neglect, humiliation and death," said Denise Rodriguez, a former CMS employee who worked at Gander Hill Prison in Wilmington. "Stan Taylor, I always told my clients that to make changes in your life, you have to hold yourself accountable. Someone needs to be held accountable." Dover residents Lynn and Robert Sadusky, who mentor a Delaware inmate, said the prisoner has relayed a series of complaints about health care inside the walls. The issues include, Mrs. Sadusky said, prisoners being overcharged for care, having their requests for medical attention ignored and misdiagnosis of conditions. The inmate she mentors has been waiting two weeks to be seen by a doctor to determine whether he is suffering from lung cancer, she said. "I understand this is a difficult population to serve, but I hope those at the top will fix these problems," Mrs. Sadusky told the committee. "Denial will not fix these problems, but that is what I am hearing tonight." The Rev. Christopher A. Bullock, chair of the Delaware Coalition for Prison Reform and Justice, said DOC should stop using out-of-state companies to provide medical care. CMS is based in St. Louis. Its predecessor, First Correctional Medical, is based in Arizona. Mr. Bullock advocated state support for creating a Delaware-based business to handle prison medical care. "Let us do what is right and what is just," said Mr. Bullock, who is the pastor at Wilmington's Canaan Baptist Church.

November 6, 2005 Wilmington News Journal
Sharon Wall, a waitress and bartender from Claymont, was arrested on Lancaster Pike in Hockessin around dusk 4 1/2 years ago. She had been involved in a minor accident, and a state trooper suspected Wall had been drinking. A breath test administered at the scene confirmed Wall was drunk and she was booked into Baylor Women's Correctional Institution, a 380-bed facility near New Castle that houses adult female inmates in Delaware. About a week after the arrest, Wall complained of pain near her breast. Suspecting she might have broken a rib and worried about a pea-size bump in her right breast, she was examined by a prison nurse employed by Correctional Medical Services (CMS), one of the largest prison health care companies in the country. In a record of the visit, on May 22, 2001, the nurse notes a "mass" of the right breast and suggests Wall be scheduled for a mammogram. In the days and weeks that followed, Wall repeatedly asked prison officials when the procedure would take place. Five months later, she rolled over in her cell bunk and was frightened by the size of the expanding mass. On Oct. 16, 2001, Wall sent a note to the prison's medical staff. "I am writing again to ask when I will be given a mammogram. ... It is a very big concern and I would like to know when it will be done. Please let me know something." According to CMS spokesman Ken Fields, mammograms for female inmates in Delaware are routinely scheduled within two weeks after an examination determines a test is necessary. The tests are performed in a mobile laboratory owned by the Division of Public Health. State records indicate that in 2001, the mobile mammography unit stopped at the Baylor prison three times -- Jan. 24, Feb. 20 and Oct. 19, the day Wall finally received the mammogram ordered by a nurse five months earlier. Fields would not comment on why it took so long. 'A fairly aggressive tumor" By the time Wall's test results were returned, and a diagnosis of cancer was determined to be likely, it was too late to save Wall's breast, says Dr. Irving M. Berkowitz. "It was a fairly aggressive tumor." The delay was inexcusable, said Berkowitz, Wall's oncologist. "That's wrong. That's bad medicine. No matter who it is, whether the person is 25 or 75, that's a little long." After weeks of requests from The News Journal to comment on Wall's care, Department of Correction spokeswoman Beth Welch said late Friday the prison is reviewing the case. "The care received by Miss Wall has raised some questions," Welch wrote in an e-mail. "We are discussing this issue with CMS." Treatment delays similar to Wall's have plagued Delaware's prison health care system over at least the past five years, according to inmates, civil rights advocates and a growing number of Delaware lawmakers. One of the key issues for lawmakers has been a $25.9 million no-bid contract awarded in July to CMS, the St. Louis-based company that held the prison's health care contract from 2000-2002, the period of Wall's incarceration and treatment. Corrections Commissioner Stan Taylor negotiated the current contract with CMS outside of the normally required competitive bid process and contract review, citing a national accreditation team report on "problems with medical administration and clinical practice" at First Correction Medical (FCM), a Tucson, Ariz.-based company that provided inmate care in Delaware from 2002-2005. Before Taylor brought CMS back to Delaware to replace FCM, Gov. Ruth Ann Minner approved the no-bid contract. Questions surrounding the contract, as well as reports of misdiagnosed tumors, Legionnaire's disease, high rates of inmate deaths due to AIDS and suicide and the unchecked spread of flesh-eating bacteria in Delaware prisons, convinced the U.S. Department of Justice's Civil Rights Division to launch an ongoing inquiry into the state's prison system. Six days before Christmas 2001, Wall -- destitute and in need of thousands of dollars of life-saving procedures -- was released from prison, put on a bus to Wilmington and ordered into home confinement. She moved in with friends. "I feel like my life was put in jeopardy," said Wall. "I did something wrong and should be punished. But I shouldn't have to pay with my life." On her first day out of prison in 2001, Wall contacted the American Cancer Society. She also wrote a will, believing she was going to die. The Cancer Society directed her to a Wilmington physician, Dr. Christopher J. Whitney. During an early examination, Whitney discovered portions of the tumor remained, a common complication. A second surgical procedure also failed to eliminate the tumor. A mastectomy was scheduled. On Feb. 5, 2002, Wall's right breast was removed during an operation that combined a mastectomy with reconstruction. Tissue from Wall's lower abdomen was used to form a new breast in a procedure called a TRAM flap, or transverse rectus abdominis muscle reconstruction. Today, Wall visits the doctor every three months to check for a relapse. So far, the cancer has not returned.

November 3, 2005 Wilmington News Journal
In a two-hour meeting Wednesday with the House Democratic Caucus, Correction Commissioner Stan Taylor said he had solutions to improve inmate health care in the state's prisons. Those solutions include seeking an additional $150,000 for contract medical consultants, two more full-time medical employees and a peer review by the Department of Public Health of 50 to 100 cases a year. Taylor answered questions about prison health care from the 15-member caucus for nearly two hours behind closed doors. He explained how St. Louis-based Correctional Medical Services was awarded a $25.9 million contract to replace First Correctional Medical of Tucson, Ariz., without the need for a competitive bidding process. According to the presentation, First Correctional Medical was awarded the Department of Correction contract in June 2002, but two years later, the prison's Medical Review Committee identified "problems with First Correctional Medical's performance." The Department of Correction asked its medical accreditation firm to audit First Correctional Medical's performance from December 2004 to January 2005. According to documents Taylor provided to the caucus, the audit showed "several problems with medical administration and clinical practices including record keeping, utilization management, medical history and sick call follow-up." The News Journal submitted a request under Delaware's Freedom of Information Act for this audit, but Attorney General M. Jane Brady denied the newspaper's request. Prompted in part by the newspaper's series, the U.S. Department of Justice has launched a preliminary inquiry into the Department of Correction's management and inmate health care. Taylor was accompanied by Mark Brainard, Gov. Ruth Ann Minner's chief of staff, and Robert Byrd of Wood-Byrd Government Relations, a Wilmington lobbyist firm. Bird said his firm was hired by Correctional Medical Services. Wood-Byrd has also lobbied for The News Journal.

October 30, 2005 Wilmington News Journal
A former drug and alcohol counselor who worked for Correctional Medical Services at Gander Hill prison claims company officials ordered her to falsify documents so state inspectors would not pull the company's license to run a prison treatment program. Denise Rodriguez, who worked for Correctional Medical Services at the prison's drug and alcohol treatment program from 1999 to 2002, said she would have been fired if she refused orders to fabricate entries contained in inmate files. "I was told to do progress notes on people who were not my clients," said Rodriguez, now a substance abuse counselor at the Latin American Community Center in Wilmington. "I told them I didn't want to falsify the charts." The order, she said, came from a supervisor at CMS, one of the largest correctional health care companies in the country. "I received a chart that wasn't touched for four months," Rodriguez said. "I was told to 'catch the chart up' using previous statements from the client." If an inmate had admitted a cocaine addiction, for example, Rodriguez said she was told to write that the client was making progress overcoming the problem -- without ever talking to the inmate about the addiction. Other documents were back-dated or altered with correction fluid, she claims. Rodriguez, a 37-year-old mother of three, said she decided to talk about her work at Gander Hill after reading a series of News Journal stories detailing problems with the delivery of health care to inmates in Delaware. The St. Louis-based CMS no longer runs the drug and alcohol program, called Key, but last July received a $25.9 million no-bid contract to provide health care for the more than 6,600 inmates in Delaware's prison system. Lucian Gambino, Rodriguez's former supervisor, said when he worked in the prison he was aware counselors were updating records at a furious pace and that other supervisors ordered the changes. Gambino worked in the Key program from December 2001 to December 2002. "I knew our people were trying to update records that were very delinquent, that had not gotten through the previous state licensure, or for some reason were just not completed at all," Gambino said. "The pressure on all of us was really great. We had lots of catch-up work to do. We had work that had not been done by folks from previous years." Gambino, however, said he never personally ordered anyone to do anything wrong. He, too, was acting under orders from the same CMS official named by Rodriguez, he said. When contacted by The News Journal, that official declined to comment. CMS administered the Key program from 1987 through June 2002 under a contract, worth as much as $1.6 million annually, that required a valid state license. If Delaware regulators uncovered falsified information, the contract would have been at risk. Rodriguez said she never received personal security or self-defense training. Despite the rigors of the treatment program, inmates with AIDS and other medical problems were forced to participate. "The AIDS patients had it the worst," Rodriguez said. "There were times they couldn't get out of bed, and the guards wouldn't let them go to medical. The guards made the decisions about who was sick. They decided who went to medical." "We were told to change the files when the inspectors were coming, or if we even thought they were coming," Rodriguez said. Reports over a period of five years, obtained by The News Journal, demonstrate a recurrence of either conflicting or missing information in patient charts. A sampling of the problems includes: oOn June 15, 1999: "The progress notes often did not include the actual date services were provided or the length of time the group was held. Notes frequently included non-clinical jargon, i.e. 'Client appears plugged into the process.' and anticipated treatment that is expected, i.e. 'I will continue to work with this client on his problems.'" oOn Nov. 28, 2000: "In one chart the notes were conflicting. The assessment section of the progress note summarized self disclosure statements made by the client, but the plan section of the same note stated that the client was not sharing and unwilling to do so. In one chart there were four weeks of progress notes that were blank except for dates that had been written at the top." oOn Jan. 25, 2001: "In ten charts the progress notes did not contain facts, impressions and anticipated treatment and at times reflected a lack of clinical knowledge and experience. For example, one note indicated, 'Being that I just started the caseload with this client I will need more time because I believe that he is mental.'" oOn Nov. 12, 2001: "In thirty charts (of the 33 examined) the progress notes did not reflect the progress being made in meeting current treatment plan goals." oOn Feb. 22, 2002: "In one chart the entire note for one week of services, over 13.5 hours of treatment, stated, 'Client attended participated in staff seminars and attended and participated in Encounter group to confront and address negative behavior and attitudes.'" oOn March 9, 2004: "In 21 charts (of 22 examined) progress notes were missing."

October 22, 2005 Delaware State News
The Medical Society of Delaware on Saturday urged lawmakers to create a prison health care oversight committee and implement mandatory HIV and hepatitis C testing for inmates. The medical society's voting body, the House of Delegates, approved the two prison health resolutions unanimously at the society's annual meeting, which about 240 physicians attended. Delaware's prison health care system has come under fire of late, with accusations of inadequate care prompting an inquiry by the U.S. Department of Justice's Civil Rights Division. The St. Louis-based Correctional Medical Services has a contract with the state to provide health care to inmates. Delaware physicians currently serve in an advisory capacity, but Dr. James P. Marvel Jr., president of the medical society and an orthopedic surgeon in Lewes, said they need actual authority to oversee the care provided behind bars. Physicians on the society's Prison Health Committee are responsible for reviewing the medical records of inmates who have died while incarcerated, Dr. Marvel said. "We're supposed to review the deaths. But we often don't have all the records available to us. "We're sort of working with one hand tied behind our back." The resolution calls for an independent oversight committee authorized to review the quality of health care services. The committee would consist of doctors, psychiatrists, nurses, lawyers, pharmacists, members of the Delaware Center for Justice, and representatives from the prison care provider, according to the resolution. Dr. Joseph F. Hacker III, chairman of the society's legislative committee and an upstate gastroenterologist, said the oversight body should report to the legislature, rather than the governor.

October 23, 2005 Wilmington News Journal
Democratic lawmakers want Correction Commissioner Stan Taylor to answer lingering questions about health care in his prisons. In a letter sent Thursday to Taylor -- signed by 16 senators and representatives -- the lawmakers requested both answers and a personal briefing by the commissioner "as soon as you are able to gather this information." "It is not intended as criticism of the administration," said Sen. Patricia M. Blevins, D-Elsmere, who signed the letter. "At this point, we are seeking information on policy and procedure." Attached to the letter were 21 questions, including what criteria are used to approve or deny an inmate's request for health care and policies regarding HIV testing and treatment. They also want to know what continuing medical responsibility the Department of Correction takes after a prisoner is released. The letter was sent after a series of News Journal articles highlighting AIDS-related inmate deaths and suicides over the past four years; a no-bid $25.9 million contract awarded this year to St. Louis-based Correctional Medical Services to manage health care in the state's prisons; and allegations by inmates of poor medical treatment for cancer, meningitis and hepatitis.

October 21, 2005 Wilmington News Journal
The Department of Correction's former medical provider owes nearly $1 million to St. Francis Hospital and late last month other state health care providers were boycotting the department's current provider because of past-due bills, according to documents obtained by The News Journal. The unpaid medical expenses were run up by First Correctional Medical of Arizona, which held the contract to provide inmate health care in Delaware prisons from 2002 until July. The firm's owner and founder, Dr. Tammy Kastre, did not return calls for comment. Delaware taxpayers may be asked to pay the prison's delinquent bills, state Auditor R. Thomas Wagner Jr. said. "The fact that the government is stiffing the public bothers me greatly," said Wagner, who is considering an audit of medical spending by the DOC. The $1 million owed to Wilmington's St. Francis was disclosed in the minutes of the DOC's Medical Review Committee, which is composed of correction officials and private medical providers. According to the minutes, CMS regional manager Mike Hooper told members of the committee the company is having difficulty contracting "with a number of providers in the community ... [and would] provide an updated list of vendors refusing to sign with CMS due to FCM."

October 18, 2005 Delaware News Journal
While in a state prison last year, Delaware's private health contractor gave Motrin to Ed Brittingham to treat the bacteria that was eating away at his flesh. A concerned guard eventually sent the inmate to St. Francis Hospital in Wilmington -- where doctors administered massive doses of antibiotics. Today, Brittingham is free of the bacteria that nearly killed him -- but he's still getting hospital bills. Current and former inmates are being billed thousands of dollars for medical care they received while incarcerated by the Delaware Department of Correction, which contracted with the Tucson, Ariz.,-based First Correctional Medical, a private health care provider. Brittingham's bills are estimated at $2,100. His common-law wife, Lee McMillan, says those bills are the responsibility of FCM, the private health contractor. "What happened to all the millions of dollars the state paid FCM to take care of Ed and the other inmates?" asked McMillan. "Where did all that money go?" Department of Correction spokeswoman Beth Welch, responding in an e-mail, wrote: "The DOC is aware of the billing issues. We have been pro-actively working with the Budget Office, the Attorney General's Office, the Medicaid Office and the sub-vendors to address outstanding FCM bills as well as bills being received by inmates and/or inmate's family members. Also, the DOC is working with several inmates and inmate's family members on this issue." Welch did not know the total amount FCM owes clinics and hospitals. "I've got an inquiry out," Welch wrote.

October 12, 2005 Delaware State News
Acting on advice from the Delaware attorney general's office, the Department of Correction on Tuesday rejected a request from the Delaware State News to provide a copy of an audit performed earlier this year on the prison healthcare system. After a State News reporter orally asked DOC spokeswoman Elizabeth Welch for the audit, she told the reporter to file a written request under the Freedom of Information Act. The DOC asked the National Commission on Correctional Health Care to perform the audit in January after the agency uncovered problems with the company providing medical care to prisoners. The audit's results led to the state terminating its contract with First Correctional Medical Delaware effective July 1. Commissioner of Correction Stanley W. Taylor, during an interview last week, declined to give specific examples of deficiencies in First Correctional Medical's performance. John D. Flaherty, a lobbyist for the good-government group Common Cause, said the audit should be released because of the public interest in the prison healthcare system and recent newspaper reports questioning the quality of care. "I would think they would want to err on the side of public welfare and release this document," Mr. Flaherty said. "I can see no reason why this should not be a public document."

October 5, 2005 Delaware State News
The U.S. Department of Justice will review claims that the state Department of Correction has exhibited a pattern of providing inadequate medical care to inmates. U.S. Attorney for Delaware Colm F. Connolly said Wednesday that the justice department's Civil Rights Division has opened a preliminary inquiry into the allegations. Mr. Connolly said the division would collect information and "see if it warrants a full-blown investigation." The inquiry, Mr. Connolly said, stems from a series of articles in a Wilmington newspaper, which he forwarded to the Civil Rights Division in Washington. Articles in The News Journal highlighted inmate suicides and AIDS-related deaths over the last four years, allegations by inmates of poor medical treatment and a no-bid $25.9 million contract awarded this year to St. Louis-based Correctional Medical Services to provide medical care to inmates.

October 5, 2005 Wilmington News Journal
The Civil Rights Division of the U.S. Department of Justice has opened a "formal inquiry" into medical care and other systemic issues inside Delaware prisons, U.S. Attorney Colm Connolly said Tuesday. A formal inquiry is a precursor to an investigation by the Justice Department. During an inquiry, the Civil Rights Division reviews allegations to determine merit. Depending on the findings, a formal investigation can be launched. The newspaper's six-month investigation highlighted AIDS-related inmate deaths and suicides over the past four years; allegations by inmates of poor medical treatment for cancer, meningitis and hepatitis; and a no-bid $25.9 million contract awarded this year to St. Louis-based Correctional Medical Services to manage health care in the state's prisons. Susie Wilson, whose son Jermaine died in a Smyrna prison, said a federal investigation is needed because the state is not capable of impartially investigating itself. "I believe it will make the [Minner] administration shape up or ship out," Wilson said. Wilson's son was found Feb. 18 hanging from a bedsheet in the Delaware Correctional Center eight days after court documents indicate he was supposed to have been released. Most inquiries focus on medical care. However, complaints about excessive force, mental health care, safety, AIDS care and screening, environmental health and safety, sanitation and food service also are covered. When problems are found, the Justice Department can sue the prison in federal court for relief. The Special Litigation Section, the arm of the Justice Department's Civil Rights Division responsible for enforcing CRIPA, has never lost a case.

October 4, 2005 Wilmington News Journal
A private medical company running health care in Delaware's prisons has settled a wrongful death lawsuit brought by the family of Anthony Pierce, a 21-year-old inmate known by cellmates as "the brother with two heads." Terms of the settlement were not disclosed. Pierce was serving 14 months for a parole violation stemming from a burglary charge when a small lump appeared on the back of his head. At the time, a prison doctor employed by St. Louis-based Correctional Medical Services said the marble-size lump was most likely a cyst or an ingrown hair. The tumor kept growing, though, and on March 22, 2002, Pierce died from a "brain tumor, due to osteosarcoma of the skull," according to an autopsy report. On behalf of Pierce's estate and his daughter Sardia, Dover attorney Steve Hampton filed suit against CMS on Sept. 29, 2004. The lawsuit had been scheduled for a jury trial next month. Hampton said Monday the case was "resolved to the satisfaction of all parties." Earlier this year, Delaware Correction Commissioner Stan Taylor awarded CMS a no-bid $25.9 million contract to replace outgoing prison medical contractor First Correctional Medical of Tucson, Ariz. Gov. Ruth Ann Minner approved the deal, although she called the CMS deal an extension of the old contract. Pierce's death was never reported to the public or to federal prison regulators by the Department of Correction because he was released to his family before brain cancer killed him.

September 30, 2005 Wilmington News Journal
The extraordinary four-part News Journal series about myriad problems within the Department of Correction health care system cries out for response from the governor and state lawmakers. The series detailed the spread of AIDS and other infectious diseases inside the prisons, high-rates of suicides and AIDS-related deaths, minimal oversight of medical care and numerous reports of inadequate medical attention to inmates' conditions. But instead of outcries, with only a few exceptions, the public is confronted with a deafening silence. Those whose legislative record would suggest they would embrace concern for the plight of inmates victimized by substandard health care are mute. Where are the liberal Democrats like Sens. Harris McDowell, Karen Peterson and Robert Marshall? Where is Gov. Ruth Ann Minner, who vowed last year to aggressively address prison correction officers' low pay and mandatory overtime? So far, we've heard from two potential Republican gubernatorial candidates, Sen. Charles Copeland of Greenville and House Majority Leader Wayne Smith of Brandywine Hundred, and conservative Sussex Democratic Sen. Robert Venables of Laurel. They certainly aren't among the usual cast of characters lobbying for prisoners' rights. The three called for various levels of investigations. Democrat Rep. Hazel Plant of Wilmington wants Correction Commissioner Stan Taylor fired and an outside investigation. Two other Republican officials, U.S. Attorney Colm Connolly and state Public Defender Lawrence Sullivan spoke out. Mr. Connolly said he passed on complaints. At least Mr. Sullivan has standing on the prison health issues since many of his clients have been affected. The silence of Gov. Minner and her Democratic leaders brings to mind the governor's comment last year in the wake of a kidnapping-rape-hostage incident involving prison counselor Cassandra Arnold. "This isn't something that is unique to Delaware," the governor said. "In prisons, you almost expect this to happen." No, governor, we didn't then, and we don't now.

September 30, 2005 Wilmington News Journal
A day after four Delaware lawmakers called for independent investigations of medical care in the state's prisons, Department of Correction Commissioner Stan Taylor admitted there were problems and promised to cooperate with any inquiry. "I am not saying that nothing is wrong," said Taylor, who met with some of Gov. Ruth Ann Minner's senior staff Thursday. "We take our responsibility seriously." Minner declined to specifically address a series of News Journal articles published this week that examine the state's AIDS-related inmate death rates -- the highest in the nation in 2001 and 2003; an inmate suicide rate in 2000 and 2001 that was twice the national average; reports of undiagnosed flesh-eating bacteria, poorly treated cancer, hepatitis, meningitis and pneumonia; and a no-bid $25.9 million contract awarded this year to St. Louis-based Correctional Medical Services to manage health care in the state's prisons. Outrage about the stories spread Thursday from Delaware's capital to community leaders. The Rev. Christopher Bullock of Wilmington's Canaan Baptist church said his congregation and other clergy plan to march outside the governor's mansion Monday, calling their protest the "March for Justice and Prison Reform in Delaware." "I'm doing this because it's a moral outrage that the Delaware prison system is sick, in need of healing and repentance," Bullock said. "And I'm concerned about the reputation of the state as it relates to how we treat these people." Sen. Robert L. Venables, D-Laurel, said the images of inmate mistreatment were hard to ignore. There have been similar problems with contract medical services in other state prison systems, Venables said. "I'd like to know how much those companies are making this year," he said. "I'd like to know how well the shareholders are sleeping, if they know what's being done to save money." Calling for investigations of prison medical care are Smith, Rep. Hazel D. Plant, D-Wilmington Central, Sen. Margaret Rose Henry, D-Wilmington East, and Sen. Charles L. Copeland, R-West Farms. U.S. Attorney for Delaware Colm F. Connolly said he has forwarded allegations of inmate abuse to the U.S. Department of Justice to review. Sen. James T. Vaughn, D-Clayton, is comparing contracts Maryland and Delaware have with Correctional Medical Services. Forming an independent committee to examine prison health care may be the smartest option, said Delaware Public Defender Larry Sullivan. He said the panel should include doctors and medical malpractice lawyers so the consequences of this kind of treatment are stated as strongly as possible in any report. "I believe that some of the decision makers may have no idea as to the extent of liability exposure the state may have, if this kind of practice is permitted to continue," Sullivan said. "Unless the possible and probable consequences of all of these events are fully understood, there may be an inclination on the part of some decision makers to remedy this 'on the cheap.' " During its six-month investigation of prison medical care, The News Journal submitted a Freedom of Information request to Taylor for the most recent audit report by the commission, which was completed in February. The request was refused. Taylor and Minner have pointed out that prison medical care is scrutinized by the Medical Society of Delaware. But Dr. James Marvel, president of the Medical Society of Delaware, said the state's account of his group's prison work may be overblown. "We don't have any plans to do anything," Marvel said. "We do not have an investigative body. Our prison health committee is simply advisory.

September 29, 2005 Wilmington News Journal
A Senate Republican leader and three fellow Delaware lawmakers on Wednesday called for independent investigations of medical care in the state's prisons. "We have a crisis now," said House Majority Leader Wayne A. Smith, R-Clair Manor. "The system is broken and it needs to be fixed. If I was governor, I would have immediately raked someone over the coals." Federal investigators also have been alerted to allegations of poor medical care provided to the state's 6,600 inmates. The bipartisan response follows a four-day series of News Journal articles detailing the spread of AIDS and other infectious diseases behind bars; the award of a no-bid $25.9 million contract for medical care approved this year by Correction Commissioner Stan Taylor and Gov. Ruth Ann Minner; high rates of AIDS-related deaths and suicides; gaps in independent oversight of the prison's private medical contractor and the prison's medical grievance process; and numerous allegations of inadequate medical care. Rep. Hazel D. Plant, D-Wilmington Central, asked to convene a special House committee to investigate prison medical care. "I would rather see a federal investigation, but if that takes too long, then we need an independent investigation," she said. "I want it to start yesterday." Taylor, Plant said, must go. In a written release to the newspaper, one of Minner's spokespersons wrote: "Providing quality health care services to an inmate population is a very demanding task and a very difficult service to deliver, but it is a program that Commissioner Taylor and the Governor have been working to improve for the past few years, and it will continue to be a priority in the years ahead." U.S. Attorney for Delaware Colm F. Connolly said he's known since September 2004 -- when a local defense attorney told him about poor medical care for a client -- about allegations of mistreatment within Delaware's prison system. "As a result of that complaint, we forwarded it to the Civil Rights Division in Washington," he said. "I've also forwarded the [News Journal] articles." Sen. Margaret Rose Henry, D-Wilmington East, wants to lead a Senate investigation into prison conditions. She hopes to organize a diverse panel that will include legislators, health professionals, prison reform advocates, prison staff and local citizens. She believes such a group should find the root causes of the breakdown in the health care system in our prisons, she said, and how it can be corrected.

September 28, 2005 Wilmington News Journal
There were two Jermaine Wilsons doing time at Gander Hill prison in Wilmington. They were young black men who were unrelated. One, in prison for a robbery charge, had served about three years and was due to be released in February of this year. His mother was picking him up. The other, doing time for violating parole stemming from drug charges, was facing new charges associated with a cocaine bust. He was scheduled in February to be transferred to the maximum security wing of the Delaware Correctional Center near Smyrna -- the state's roughest prison, built for the most incorrigible offenders. But corrections officials sent the wrong Jermaine Wilson to Smyrna. And days later -- when he should have been free, guards found 20-year-old Jermaine Lamar Wilson dead, hanging from a bedsheet in his cell. Because he had a cut on the back of his head, his family suspects he was murdered. "There was blood all over his clothes," said Laretta Wilson, Jermaine Lamar Wilson's aunt. "There was blood in his underwear and all over his pants. Maybe someone hit him on the back of his head?" The Delaware Medical Examiner's Office called the wound "superficial" and ruled the death a suicide. Wilson's family received little information from the Delaware Department of Correction. No apology. No excuse. Just Wilson's blood-soaked clothes. Correction Commissioner Stan Taylor declined to comment on specific inmate deaths, including Wilson's. During a six-month News Journal investigation, a former doctor and two nurses who worked in Delaware prisons and dozens of inmates and their families claimed prison health care in Delaware is dangerously substandard -- leading to needless deaths, prolonged suffering and the spread of infectious diseases inside and outside prison walls. Wilson's death raises a larger question: Are standards throughout Delaware's prison system too low? There are few safeguards in Delaware prisons: oDr. Janet Kramer, of Wilmington, an expert in prison health care, said inmates should be screened for hepatitis C and HIV -- but pretrial and convicted inmates are not routinely screened when they are sent to prison or when they leave. Delaware prisons have become incubators for new strains of the AIDS virus, creating a public health crisis, experts say. oFormer prison doctor Ramesh Vemulapalli says a private medical company ordered him to treat inmates for HIV or hepatitis C, but not both. Delaware led the country in two of the past four years in the rate of inmates dying of AIDS. oInmates in Delaware kill themselves at twice the national rate. Dr. Carol A. Tavani, a neuropsychiatrist and executive director of Christiana Psychiatric Services, said new inmates should be counseled in person about suicidal tendencies, not simply given a "contract" to sign promising not to kill themselves. oUnlike Pennsylvania and other states, Delaware does not have a medically trained state employee overseeing contract health providers. Maryland has its own statewide correctional accrediting agency, Delaware does not. oThe prison's grievance system is overseen by the medical vendor, not prison officials or an independent medical professional. oCommissioner Taylor awarded the current $25.9 million medical contract -- signed this year with Correctional Medical Systems (CMS) of St. Louis -- without putting the contract out for bid. Gov. Ruth Ann Minner approved the decision, but insisted it was a contract extension even though CMS replaced First Correctional Medical of Tucson, Ariz., a different company. oThe state occasionally discharges convicted inmates early so neither the state nor its prison health care contractor has to pay medical costs, leaving the payments to families or the federal Medicaid program. Neither federal prison regulators nor the public is told about inmates who die after such discharges. oThe state does not routinely conduct autopsies on inmates who die in prison or those hospitalized at the time of their death, a policy the president of the National Association of Medical Examiners believes prevents evaluation of the quality of prison medical treatment. And if it does conduct autopsies, the results are sent to the medical vendor -- not the prison. oDr. Robert Cohen, an expert in prison health care whom state and federal courts have appointed to monitor prisons in five states, said the state should investigate medical malpractice claims. Instead, the state's medical board occasionally takes complaints from inmates and their families about prison health care professionals, but it is only an advisory panel. The board's findings are confidential and given to the private medical vendor. Every institution in the Pennsylvania Department of Corrections has a correctional health care administrator whose role is to oversee the medical vendors and investigate grievances and other complaints made against the state's medical vendor -- Prison Health Services. Shirley Laws-Smith -- a registered nurse -- is the correctional health care administrator at SCI Chester. She has counterparts at every facility in the state. If she questions a vendor's procedure, she can take immediate action. "If they make a decision and I don't agree with it, I will contact the central office at the Bureau of Health Care Services," she said. Delaware's inmate grievance process is quite different. In Delaware, no one with any medical training oversees the actions of the medical vendor, and the vendor controls any complaints. When an inmate files a grievance about poor care, it goes straight to the vendor. When an inmate appeals the decision, the grievance eventually goes back to the vendor. All mental health workers in Delaware prisons are contract workers employed by medical vendors.

September 27, 2005 Wilmington News Journal
A Delaware prison inmate serving time for traffic violations -- including driving under the influence of alcohol -- Bernadette Fogell said trouble with her pregnancy started weeks before birth. Prison documents show that she complained to nurses at Delores J. Baylor Women's Correctional Institution in New Castle. But in a lawsuit filed against Delaware's prison medical provider and the state, Fogell claims nothing was done. "What could I do?" Fogell asked. "You're helpless. It's not like you can get in your car and leave looking for competent medical care." Her water broke at 11 p.m. on March 19, 2001. Several inmates on her wing changed Fogell into dry sweat pants. Two nurses arrived and one scolded her, Fogell claimed, suggesting that Fogell's water had not broken. Rather, the nurse suggested, Fogell had urinated in her pants. Fogell was taken to the infirmary, where she was left alone in a filthy room with no sheets, blankets or pillow, she claimed. Prison documents included in the federal lawsuit Fogell filed in 2001 against First Correctional Medical, the state, a local doctor and St. Francis Hospital in Wilmington (which has since been dropped from the suit) show that nurses checked on Fogell until 2:25 a.m. Those same records indicate that Fogell went unchecked between 2:25 a.m. and 8:30 a.m. "I just couldn't figure out why I wasn't going [to the hospital]," Fogell said. At 8:40 a.m. an ambulance was called, and Fogell was admitted to St. Francis Hospital, where doctors told her she would be transferred to Christiana Hospital. Health care workers said they would try to prolong the delivery to allow time for the transfer, Fogell said. It never happened. A doctor arrived about 4:30 p.m., more than 17 hours after her water broke. According to medical records, the doctor wrote there had been "no prenatal complications til now." An hour and a half later, "The nurse came in and told me they were inducing the baby," Fogell said. Twenty-two weeks after conception, Anna Lee was born at 11:27 p.m. -- 24 hours and 27 minutes after Fogell's water broke. Fogell cradled her newborn daughter, who was dressed in a light blue gown. The infant, whose eyelids were fused, wasn't breathing. Anna Lee jerked several times, and her heart continued to slow, medical records show. Fogell said she called for help, but claimed nurses nearby wouldn't respond. She placed her mouth over Anna Lee's tiny lips and nose and tried to resuscitate her. But the baby continued to fade. "There was no attempt to save her," Fogell claimed. "Nobody was doing anything. I kept crying and singing to her, 'You are my sunshine.' I just didn't know what else to do." As she held the baby in her arms, Fogell realized it would be the last time she ever saw her. The same doctor reached inside her womb and removed the placenta -- or at least he thought he did. Two hours after the doctor finished with what he thought was the last of the placenta, at 3:10 a.m., Anna Lee died. Days later Fogell contracted an infection that led to her being hospitalized again, where the remainder of her placenta was taken out. Prison officials and the state's medical vendor at the time, FCM, declined to comment.

September 26, 2005 Wilmington News Journal
Bernard Coston was taken to prison in March 2002 on charges he stole a $50 jacket from an elderly woman. Coston was released from prison 18 months later on a slab. Dirt and feces covered his body. Insects had been gnawing on his corpse. Diagnosed with AIDS before he went to prison, Coston spent his last four months in the infirmary of Wilmington's Gander Hill prison -- at least that's what is written on a state medical examiner's autopsy report. But Coston's sister, Victoria Trice, said she was told by a prison counselor that her brother wasn't in the infirmary, that he withered away, alone in a cell with no food or medical attention. He was too weak to bathe. "They are more humane to an animal than to my brother or anyone else who died in there," Trice said. "It's a disgrace," said Dr. David M. Cohen, an AIDS specialist with the Christiana Care HIV Wellness Clinic. "Because they're prisoners, the government has the right to take away their liberty. But they do not have the right to take away their health." Coston's death certificate states simply that he died of AIDS. The external examination from the autopsy paints a more gruesome picture: •"The scalp is dirty" •"Examination of the skin on the back reveals a layer of dirt" •"Dirt is noted under the fingernails" •"Fecal material is smeared on the buttocks." "It's obvious he got poor, poor, poor medical care," said Lynda R. Kopishke, a forensic nurse and branch director of Interim Health Care in Newark. At the request of The News Journal, Kopishke agreed to review Coston's autopsy report, prepared by Dr. Adrienne Sekula-Perlman, Delaware's deputy chief medical examiner. Kopishke found it hard to believe that Coston had been treated for four months in a prison infirmary. "I struggle to understand the inconsistencies surrounding these findings," Kopishke said. "If I did not know this individual was in the infirmary, I would wonder if he had been buried under dirt at some point in time." The last AIDS doctor employed in the state's prisons -- Dr. Ramesh Vemulapalli of Dover, an infectious disease specialist -- quit in 2003. The state's current private medical provider, St. Louis-based Correctional Medical Services, employs an infection-control nurse. Louis W. Chance Jr. died in 2003 -- seven days short of freedom. Chance, 37, was serving a six-month DUI sentence at the Webb Center, a work-release facility in Prices Corner, when he developed a severe headache. At his first medical visit, Chance told nurse Beverly Anderson that he had had a headache for three days, according to a medical malpractice lawsuit filed against the state and First Correctional Medical, Delaware's medical provider at the time, in U.S. District Court in Wilmington. Anderson gave him six Excedrin and sent him back to his cell. The next day, Chance reported no relief and was prescribed Motrin. After three more days, a correctional officer reported Chance was confused and had possibly "overdosed." Chance was transferred to Gander Hill prison in Wilmington, where, his attorney says, the pressure inside his head from cryptococcal meningitis affected his hearing. Unable to respond to nurses, Chance was reported to be disoriented, uncooperative and hostile. Officers subdued him, put him in a straitjacket and left him in a cell under suicide watch. Chance, who had not yet been examined by a doctor, was prescribed Ativan, Benadryl and Haldol. The drugs are used to treat panic attacks, allergies and psychosis, respectively. Together, they can calm a person. About three days later, Dr. Niranjana Shah, a contract physician with First Correctional Medical working at Gander Hill, prescribed Tylenol and a daily cup of coffee because, Chance's medical records state, caffeine helps combat headaches. On Sept. 18, 2003, Chance was sent back to the work-release facility at Prices Corner. Five days later, Chance died. Had Shah and Dr. Jose A. Aramburo followed protocol for a patient with HIV, Chance could have lived, claims Ken Richmond, a Philadelphia attorney representing the Chance family in the lawsuit against FCM and the two doctors. "It appears to be a concerted effort to avoid treating someone who was HIV-positive," Richmond charged. "This is gross negligence." Months before Chance got sick with cryptococcal meningitis, FCM employees performed a blood test on him, Chance's medical records say. He tested positive for hepatitis C and was given brochures on hepatitis and HIV, according to the lawsuit. About a quarter of people in the United States who have HIV also have hepatitis C, according to the CDC. Because HIV patients are especially susceptible to cryptococcal meningitis, Richmond said, FCM should have tried to rule out the condition before trying other treatments. "That's the sad part about this," he said. All four classes of antiviral treatments are available in Delaware prisons, said Dr. Vemulapalli, an infectious disease specialist who worked a little more than a year at the Delaware Correctional Center near Smyrna. But inmates, he said, did not always receive them. "Most patients who come to the hospital from the Department of Corrections are generally far too advanced," said Vemulapalli, who is now in private practice in Dover. "I've seen several cases from the prison -- all patients who have died -- that didn't get referred to the hospital at the appropriate time. They're not providing adequate care." Vemulapalli, who worked for Tucson-based FCM, claims company owner Kastre ordered him to treat AIDS or hepatitis C -- but not both, even though many patients have both. The reason, Vemulapalli said he was told, is that "it was too expensive to treat both."

September 26, 2005 Wilmington News Journal
Doctors and nurses at Gander Hill prison, in Wilmington, never treated Ed Brittingham for the flesh-eating bacteria that scarred his body. They thought the 47-year-old inmate had a broken arm. Nearing the end of his 13-year sentence for second-degree burglary, Brittingham was enrolled in a drug treatment program and was allowed to leave the prison for furloughs home and for work release. The frequent trips outside the wire, it turns out, exposed his wife, friends and the public to the lethal disease that was eating away his shoulder. Just one cough or sneeze could have spread the infection. Brittingham first noted an intense pain in his shoulder on a weekend furlough in December 2004. When he returned to prison the following Monday, he reported to sick call, which was managed by First Correctional Medical, a Tucson, Ariz.-based private medical company working in Delaware prisons under contract with the Department of Correction. At sick call, an employee with FCM gave Brittingham a sling, took some blood and scheduled a few tests. "When the X-rays showed I didn't have any broken bones, they wrote me up for faking," Brittingham said. "I knew it wasn't a broken bone. I told them this. They gave me Motrin, but the pain was pretty awful so I took a double dose. They wrote me up for that, too." Severe abdominal pain followed. There was blood in his urine. The medical staff assumed Brittingham was passing a kidney stone. They issued him a strainer and more Motrin. "I was drinking five gallons of water a day, but I never passed any stone," he recalled. "I kept trying to get to medical, filling out sick call slips." Brittingham stopped eating. He couldn't hold down food; the pain in his shoulder, stomach and leg were too intense. "On a scale of 1 to 10, it was a 20," Brittingham said. Necrotizing fasciitis, also known as flesh-eating bacteria, is a condition caused by strep A bacteria, which is the same bacteria that causes strep throat. Brittingham said, "They told me if I went to the hospital while on a home furlough, they'd consider it an escape, and I'd get sent back to prison to serve the remainder of my sentence." The prison staff gave the same warning to his wife, Lee McMillan, she said. "They told me if he had a heart attack and fell to the floor, I wasn't supposed to call 911," she said. "I was supposed to bring him back to the prison." Weeks passed. The pain became torturous. In January, Brittingham did the unthinkable. He ended a home furlough on his own and went back to prison early. The bacteria was eating its way through to the surface of the skin, causing massive red lesions on his leg, foot and shoulder. His face was swollen, and he was burning up with fever. He had difficulty communicating with his wife. It hurt to move, sit or lie in bed. Rather than heading to the prison infirmary, where his complaints had been ignored, Brittingham went to a prison guard, stripped off his clothes and showed him the lesions. "Thank God they thought they were blood clots, because they sent me to St. Francis Hospital," he said. "Once I got to the hospital I went blank. I was there for 11 days. I don't remember much." In late January, Brittingham was discharged from the hospital and transferred back to Gander Hill. "I spent my first four days without any pain meds, antibiotics, physical therapy or wound care information," he said. "My leg started swelling up again. I thought I was having a reoccurrence. I swear to God I didn't want to go through that again." Brittingham was eventually given medication and has since been released. He now lives with his wife in New Castle. The couple hasn't filed a lawsuit, but they want the prison staff and First Correctional Medical held accountable. "These people should be prevented from practicing medicine and from making decisions th