Alabama Department of Corrections
A settlement has been reached in a lawsuit against the state Department of Corrections and its former medical provider, claiming HIV-positive inmates at Limestone Correctional Facility were not given adequate health care.  The settlement, reached after several months of negotiations mediated by Magistrate Judge John Ott, was filed in the federal district court in Birmingham on Friday. The terms of the settlement, set to be signed at a hearing Wednesday, were not disclosed.  David Lipman, attorney for the four HIV-positive inmates named as plaintiffs in the suit, has argued that prison medical provider NaphCare Inc. did not adequately treat the inmates and ultimately hastened some inmate deaths in 2002.  The Department of Corrections has since changed medical providers.  (Gainesville Sun, May 25, 2004)

September 13, 2003
State prison officials, already contemplating the early release of 20 per cent of the inmate population to shave costs, now face a new problem: The price for providing adequate health care to the remaining prisoners may rise by tens of millions of dollars next year.  The increased costs became apparent as the state received bids on a new health care contract, a contract that prison officials say is better designed to comply with court orders and recent lawsuits.  The state, along with the current health care provider -- Birmingham-based NaphCare Inc. -- has been named in lawsuits for allegedly neglecting to provide adequate care for Alabama inmates during the last three years.  An Atlanta-based human rights group recently sued the state, alleging that the deaths of 38 HIV-infected inmates during a four-year period at Limestone Correctional Facility could have been prevented with proper care.  Gov. Bob Riley has proposed adding about $16 million to the Department of Corrections' $234 million annual budget.  "When you underfund something for decades, and this agency sees a population explosion of more than 1,000 inmates per year, you can't put a $16 million Band-Aid on it and think it's going to solve all of our problems," said Brian Corbett, spokesman for the Department of Corrections.  Prison officials say some of that money could help pay for the new health care contract. But much of the increase is expected to be eaten by the additional costs of housing prisoners out-of-state, a move made this year to comply with a court order to relieve severe overcrowding in state prisons.  State prison officials say they have no choice but to revise the requirements in the health care contract.  Corbett said Friday that even if the Department can pay nearly double what it did during the last three-year term, that amount won't be nearly enough to provide all the health care services the department would like.  Bids for the next three-year contract were submitted last week, the lowest nearly double that of the previous three-year term. The contract is scheduled to be awarded Oct. 6, Corbett said, after the Legislature approves the new state budget.  Seven different companies, including NaphCare, offered bids ranging from $150 million to more than $200 million for medical anor mental health services for the three-year period.  The previous three-year contract with NaphCare cost the state nearly $90 million. NaphCare's current bid is among the lowest, at nearly $155 million -- though NaphCare leaders said they could negotiate a less demanding contract for less money.  While NaphCare and the state do not openly criticize or blame the other for any negligence, each has a different perspective on how a new contract and an increase in funds would affect inmate care.  Corbett said the revised contract would give the state more control over care -- something lacking during the previous three years.  "The problem is not so much with NaphCare but with the contract itself," Corbett said. "The contract was not in the best interest of the state, because it was not specific enough. Staffing levels, administrative policy, standards of care, pool overages ... were not specific enough to give the department as much control as we desired."  In the old contract, Corbett said, NaphCare "determined all administrative policies regarding delivery of the health care. Therefore, they did not have to respond to requests as far as developing treatment protocols and procedures."  NaphCare spokesman David Davis said that an increase in spending on inmate care was not the answer to improving inmate health.  "It's not that more money means better health," Davis said. "It has to do with facilities, operations, health care, everything coming together.  "Any health care provider is limited by the facilities, the environment and the stipulations of the contract," Davis said. He would not elaborate on what specifically could be improved at Alabama prisons.  NaphCare maintains that it did not fail to do its duty as laid out in the contract during its three-year term.  (Al.com)

August 14, 2003
The quality and quantity of medical care for prison inmates is among state services hanging in the balance in the Sept. 9 referendum on Gov. Bob Riley's tax proposals.  Prison Commissioner Donal Campbell has notified more than 300 medical services vendors that they have until Sept. 10 - the day after the vote - to file written proposals for providing medical services for inmates during the next three years.  If the tax plan fails, "We're all going to have to go back and revisit our budgets and see where we cut and where we don't cut," said Deputy Commissioner Terrence Jones.  Jones, whose duties include overseeing inmate medical care, said the detailed 73-page request for proposals being sent to medical service vendors across the nation proposes more services and controls in some areas than the present contract with Birmingham-based NaphCare Inc. Unlike the present contract, the proposed new contract would allow the state to withhold money due to be paid to the company if required services are not provided, or to deduct the costs of bringing services up to standards, Jones said.  The proposed contract also would require more dental services for inmates and more inmate health education and training, and it would provide for termination of the contract for failure to secure or maintain personnel described in the contract, Jones said.  Campbell notified NaphCare on May 2 that its $29.5 million-per-year contract with the state would be canceled in 90 days, or about the first of August, but he has extended the contract on a month-by-month basis until a new contract is signed.  Campbell told members of the state Legislature's prison oversight committee several weeks ago that he can't sign a new medical services contract until he gets a budget for the fiscal year starting Oct. 1, and that won't happen until after the referendum.  Jones wouldn't say Tuesday how many of the more than 300 vendors invited to submit proposals have done so or have expressed interest in doing so.  NaphCare, whose services have been criticized by Chicago consultants Jacqueline Moore and Associates and which has been named as a defendant in inmate lawsuits, is among those vying for the new contract.  "Our hope is to continue to provide Alabama inmates health care as we do across the country," said NaphCar spokesman David Davis. "NaphCare is committed in providing quality and affordable health care to the Alabama inmate population in accordance with the stipulations in the contract with the Alabama Department of Corrections."  NaphCare filed suit against Moore and Associates last month, contending that their audit reports contained "numerous inaccurate and unsubstantiated statements and conclusions" that have damaged the company's reputation.  (Al.com)

March 15, 2003
The Birmingham company that holds the $30-million-a-year contract for providing medical treatment in Alabama prisons faces tough questions about cost overruns and the quality of its care.  The pressure on NaphCare Inc. comes from Donal Campbell, Gov. Bob Riley's appointee as commissioner of the Department of Corrections.  Campbell has had to ask the Legislature for $6.9 million to cover extra prison health care costs, even as his legal staff scrambles to defend lawsuits alleging that medical treatment of Alabama inmates is so bad as to amount to cruel and unusual punishment, forbidden by the U.S. Constitution.  Campbell recently met with NaphCare officials, wanting explanations for both the overruns and an outside monitor's reports that tend to substantiate inmates' complaints about lax care.  In 2000, prison health care in Alabama was provided by Correctional Medical Services of St. Louis, for roughly $26 million a year. But CMS had been working on a series of contract extensions, and because of rising costs and a growing inmate population wanted a new contract for more money.  The Department of Corrections invited CMS and other companies to bid on the work, and offers ranged from $38 million to $46 million.  At that point, finance officials in the administration of Gov. Don Siegelman bypassed the DOC legal staff and hired the Mobile law firm Miller, Hamilton, Snider & Odom.  But critics immediately questioned whether any company could make a profit and provide adequate medical care to 27,000 inmates for such a sum. Indeed, while the $30 million contract may seem large, it solidified Alabama's position as the state that spends the least per inmate on health care. Florida -- whose prisons, unlike Alabama's, are accredited by a national correctional health care board -- spends three times as much per inmate.  "The average state spends about $2,500 to $3,000 per inmate, and Alabama's spending a little over $1,000," said Ron Shanksy of Chicago, co-founder of the Society of Correctional Physicians. "You're off the charts."  Even before the state contract was signed in early 2001, Jefferson County officials were complaining publicly about NaphCare's performance in county jails in Birmingham and Bessemer. Last year, Jefferson, Morgan and Madison counties all parted ways with NaphCare, finding new jail health care providers amid complaints by inmates, family members and jail officials.  Last year also saw a rush of litigation against NaphCare and the state Department of Corrections, alleging inadequate medical care for Alabama prisoners. The Southern Center for Human Rights, an Atlanta based nonprofit legal group, sued on behalf of inmates at Tutwiler Prison for Women.  A wrongful death suit was recently filed against NaphCare and DOC in Montgomery County Circuit Court. The charge there is negligence in the sudden death of a 29-year-old Tutwiler inmate, Pamela Brown, in 2001.  In all these suits, NaphCare and DOC are co-defendants. One of the lawyers representing NaphCare is Giles Perkins. That has raised eyebrows in the legal community because Perkins, a former state Democratic Party official, is employed by the firm Miller, Hamilton, Snider & Odom and helped run the state prison health care contract negotiations won by NaphCare.  But reports by Jacqueline Moore & Associates, a Chicago consulting firm hired by the DOC to monitor NaphCare's performance, tend to back up some complaints voiced by Alabama inmates.  Perhaps most alarming was her assertion that the death rate among HIV inmates at Limestone was twice that of the national rate for such inmates.  At several institutions, she found high turnover and staff vacancies among medical personnel.  In her August 2000 review of Staton Correctional Facility, which provides medical care for nearly 4,000 inmates at four central Alabama prisons, she found that the sole physician had recently quit and six nursing slots were unfilled.  In an interview, Harrison described Moore's reports as "inaccurate," and went on to suggest she tried to steer Jefferson County's jail medical care contract from NaphCare to Prison Health Services, a Brentwood, Tenn.-based company she co-founded and for which her ex-husband still works.  She dismissed Harrison's charge that she was trying to help PHS. "I left that company in 1990," Moore said. "My ex-husband and I don't speak."  A former NaphCare dentist, Elcid Burkett, said medicine was hard to come by for health care professionals working in Alabama prisons. "I was buying my own peroxide," he said.  NaphCare is no worse or better than its predecessor CMS, according to Sam Eichold, a Mobile physician who serves on a prison medical oversight committee. He thinks the companies have done about as well as anyone can expect, given what Alabama pays per inmate.  "They cut corners," said Eichold, whose committee has expressed its own concerns to DOC. "That's how they make their profit."  (Mobile Register)

February 7, 2003
MONTGOMERY Medical consultants hired to review health-care services in Alabama prisons have reported what a lawyer for inmates calls "serious deficiencies."  The audit reports released Thursday were ordered last year by the Siegelman administration to monitor health care services provided to prison inmates by NaphCare, a Birmingham-based health management contractor.  Former Prison Commissioner Mike Haley and former Gov. Don Siegelman refused repeated requests last year to release the reports, conducted at eight Alabama prisons between May and August.  "This is totally consistent with what the prisoners have been telling us, that they have to wait for weeks for dental services, for things such as abscesses which are so painful that some of the women are pulling their own teeth," said Tamara Serwer of the Southern Center for Human Rights, which is representing inmates in a pending federal lawsuit. "These are serious deficiencies in health care services for Alabama prison inmates." (Al.com)

Jefferson County Downtown Jail, Beaumont, Texas
October 19, 2007 KFDM
A federal jury has ruled in favor of Jefferson County and two other defendants in a lawsuit filed by a former inmate. 47 year old Ronnie Tejeda filed the lawsuit against the county, NaphCare, Inc., the health-care provider at the county jail, and GEO Group, which manages the private jail downtown. Tejeda claimed a lack of medical care at the county jail, and an attack against him at the private jail, caused medical problems and injuries that led to the amputation of his legs. The plaintiffs argued Tejeda's health problems led to the amputations. County Attorney Tom Rugg tells KFDM News he's gratified by the jury's decision. "It was the single most significant lawsuit I've tried in 20 years in terms of the potential impact on the county," said Rugg. "If we'd lost, it would have cost the county multiple millions of dollars." Rugg said it was a tragic set of circumstances that cost Tejeda his legs, but Rugg says the plaintiffs believed all along Tejeda had been treated appropriately.

October 17, 2007 The Enterprise
Sheriff Mitch Woods, testifying Tuesday in a civil trial against Jefferson County and its jail health-care provider, declined to give an opinion about renewing the provider's contract. Defense testimony began Tuesday and could conclude today in Ronnie Tejada's civil lawsuit against the county, health care provider NaphCare Inc. and the private corrections company GEO Group. Tejada claims his leg amputations were required because officials ignored his diabetes for the 10 months he was awaiting trial on aggravated assault-family violence charges at the Jefferson County jail on U.S. 69. The 47-year-old man was rushed to Beaumont's Christus St Elizabeth Hospital in critical condition Oct. 5, 2005. Defense attorneys have argued no evidence exists the defendants knew of Tejada's deteriorating medical condition and chose to ignore it. "Every time Mr. Tejada put in a request he was seen, we responded to every complaint that he had," NaphCare's health services administrator for the jail, Dyni Brookshire, testified Tuesday. Documents shown to jurors indicate Tejada filed at least eight requests for medical treatment. Medical experts testifying for the plaintiffs have said jail medical officials missed or ignored signs Tejada was suffering from uncontrolled diabetes. When Tejada was admitted to the jail he told officials he had a history of diabetes but was not taking medication for the condition. An economist who testified Tuesday by deposition said lost earning capacity resulting from Tejada's amputations, combined with lifetime medical and housing costs, amounted to between about $4 million and $5.1 million dollars. The man's medical bills since he left the jail amount to $1,182,558.28. Tejada's attorneys have tried to prove the county should have known of NaphCare's alleged shortcomings, introducing evidence of two inmates who died of diabetic complications in the years before Tejada's hospitalization. "When you learned of this, did you suggest against renewing NaphCare's contract?" Tejada's attorney Jan Fox asked the sheriff, referring to the two deaths. "No ma'am," Woods said. Woods, the only witness called by Jefferson County Assistant District Attorney Tom Rugg, said he did not learn of Tejada's condition until he was reached by the inmate's ex-wife after guards rebuffed her attempts to visit Tejada in the hospital. She eventually was granted limited visitation. Under questioning from Fox, Woods said the county did not review the circumstances leading to Tejada's hospitalization or revise procedures to prevent such an event from recurring. NaphCare, the firm the county has paid about $12 million for providing jail health care since 2002, is seeking to renew its contract with the county. Jefferson County commissioners on Oct. 1 granted a one-month extension to review proposals from NaphCare and other providers. Fox appeared incredulous when Woods said he had not given commissioners his opinion on renewing the contract. "I will have some recommendations at a later time," Woods said. "Are you waiting to see what these people decide?" Fox asked Woods, gesturing to the jury. "No ma'am," the sheriff said.

Limestone Correctional Facility, Alabama
February 19, 2005 WPMI
Attorneys for 240 HIV-positive prisoners at Limestone Correctional Facility have accused prison officials of violating an agreement to improve their medical care. The north Alabama prison has no specialist for them and has constant gaps in medication, the attorneys claim in a contempt motion filed Thursday in U.S. District Court. The attorneys have asked U.S. District Court Judge Karon Bowdre in Birmingham to hold the state in contempt of court for failing to follow the April 2004 settlement in a lawsuit over inmate housing and medical care. Department of Corrections attorney Kim Thomas said Friday she couldn't comment on the motion until she has read it. According to the motion, two physicians, hired in the last eight months as part of the settlement, recently resigned. One of the doctor's memos detailed dozens of medical shortcomings, including a rat in the exam room and chaotic record-keeping. Dr. Valda Chijide wrote of being unable to care for patients because of disorganization in the medical unit and because prison staff has overruled her medical decisions. Once she walked in on a heart patient with chest pains who was trying to give himself nitroglycerin because no nurse was in sight, she wrote. "The law of diminishing returns sets in after riding on a skeletal staff and scanty resources for so long," Chijide wrote in a Jan. 25 letter to supervisors at Prison Health Services, the private prison medical company that Alabama contracts with to provide medical care at all state prisons. Now, one physician handles care for more than 2,200 prisoners, including the HIV Unit. A PHS supervisor in Montgomery also has been filling in, Keldie said. "The state is ultimately the one who is responsible for the medical care and the state should be forcing PHS to implement the settlement agreement that we've reached," said Joshua Lipman, a Southern Center for Human Rights attorney. "What they've done so far is pretty appalling."

May 25, 2004
A settlement has been reached in a lawsuit against the state Department of Corrections and its former medical provider, claiming HIV-positive inmates at Limestone Correctional Facility were not given adequate health care.  The settlement, reached after several months of negotiations mediated by Magistrate Judge John Ott, was filed in the federal district court in Birmingham on Friday. The terms of the settlement, set to be signed at a hearing Wednesday, were not disclosed.  David Lipman, attorney for the four HIV-positive inmates named as plaintiffs in the suit, has argued that prison medical provider NaphCare Inc. did not adequately treat the inmates and ultimately hastened some inmate deaths in 2002.  The Department of Corrections has since changed medical providers.  (Gainesville Sun)

March 19, 2004
Some of the sickest men in Alabama prisons live in drafty cells in a building with broken windows. They must stand in line in the middle of the night for their pills. And several have died prematurely because of gaps in medical care, according to a report released Thursday as part of a lawsuit against the prison system. Dr. Stephen Tabet, an infectious disease specialist from Seattle, first documented the harsh conditions at Limestone prison's HIV unit last year. When he returned for a follow-up visit, he found few improvements.  "More strongly than ever, I feel the Limestone Correctional Facility is in dire need of outside intervention and oversight," Tabet wrote after his Feb. 23 visit to the prison, where all of Alabama's male HIV-positive inmates, about 250 men, are housed. "Patients continue to die because of the failure of the medical system," he wrote.  The Department of Corrections strongly disagrees with the report's conclusions, a spokesman said.  "It is important to note that this report is written by a trial witness, hired by plaintiff lawyers," said DOC spokesman Brian Corbett.  Tabet has been reviewing HIV Unit medical care for the Southern Center for Human Rights, an Atlanta-based law firm representing HIV-infected prisoners in a class-action lawsuit against the state.  His August 2003 report documented conditions leading to 39 deaths since 1999. Thursday's follow-up looks at five new deaths in five months.  One patient dropped a third of his weight in five months, to 110 pounds, before dying in February. A doctor prescribed a high protein supplement for 35-year-old Gerald Lewis, but the kitchen wouldn't provide it.  Another man arrived at Limestone with active tuberculosis, but his medical records from another prison did not follow. Alfred Thomas, 42, was placed with all the other HIV patients, potentially exposing them to the disease. No one at Limestone knew about his TB until an autopsy following his October death.  Prisoner Nathan Sullivan began suffering with low oxygen levels a week before he died. "I am so sick, I can't even walk," he told a nurse who made notes in his files. "Inmate crying, praying to God to deliver him from his illness. Achy head to toe, nausea, headache, diarrhea after taking meds," she wrote.  Sullivan was suffocating, and died at a Huntsville hospital. Ambulance personnel initially refused to take him from the prison because of his oxygen level, according to the specialist's report.  One of Tabet's gravest concerns is lack of critical medication and middle-of-the-night pill call. "The pill line is a disaster," he wrote. Many medications were not on hand, and patients were sent away without them, Tabet wrote.  Not all bad news:  There have been some improvements since Tabet's first report.  Before, the HIV inmates lived in a crowded, converted warehouse. Currently, they live in cells in another building. But some of the windows are broken and covered with plastic or blankets. The doctor called the situation "unbearable for these immune-compromised patients."  The prison added a part-time physician to its previous staffing of one physician, but staffing remains below the National Commission on Correctional Health Care guideline of 110-physician hours per week for a prison with 2,200 inmates.  Since Tabet's first visit, DOC has switched medical contractors and spends more money on prisoners' care systemwide.  The department hired Tennessee-based Prison Health Services for medical care and Mental Health Management Services for mental health care in November. The 3-year contracts are worth $172 million. Previously, Birmingham-based Naphcare held the contract which costs the state $135 million over three years.  Prison Health Services officials issued a written response to the report, but declined to answer questions.  Company Vice President Larry Pomeroy described the medical care as appropriate and high quality.  "All clinical and operation policies implemented by PHS within the ADOC system, including the Limestone facility, are in compliance with national standards of health care delivery as established by the National Commission of Correctional Health Care," Pomeroy wrote.  Corbett at DOC said, "... we are in the process of addressing the complaints and resolving the issues in compliance with national health care standards as established by the National Commission of Correctional Health Care."  Alabama's prisoner health care costs remain the lowest in the country. The state spends about $5.50 per prisoner per day. The national average is $7.38.  Despite the new contract, much of the Limestone medical staff has not changed since before the lawsuit was filed, said Gretchen Rohr, an attorney with the Southern Center for Human Rights. "It's key they somehow show us that the new contract has been properly implemented," Rohr said. "We have not seen any evidence of this implementation."  The trial in the Limestone case has been scheduled to begin May 17 before U.S. District Judge Karon Bowdre.  (Al.com)

August 29, 2003
A health care contractor blasted for allegedly inadequate care of HIV-infected patients at Limestone Correctional Facility plans to bid for another statewide contract with the Department of Corrections on Sept. 10.  A 125-page report released Wednesday by Dr. Stephen Tabet, hired by plaintiffs in a lawsuit, said poor medical care and inadequate facilities caused or accelerated many HIV-related deaths at the Capshaw prison.  A spokesman for the contractor providing the Capshaw prison's health care, Birmingham-based NaphCare Inc., said his company is complying with all department requirements, but NaphCare's $29.5 million contract with the state, covering all state prisons, dictates staffing levels.  The Limestone prison houses 2,260 prisoners, about 200 with HIV.  Naphcare spokesman David Davis said his company has handled the DOC's health care only since March 2001. He said there have been only 14 HIV-related deaths at Capshaw since . Tabet discussed 38 deaths in his report, but many occurred before 2001.  "Dr. Tabet's engaged by, employed by, and I suspect wants to be employed again by, the plaintiff," Davis said.  "Obviously the plaintiff does not understand the contract that NaphCare operates under with the DOC, Davis said.  DOC Commissioner Donal Campbell notified NaphCare of his intent to terminate its contract shortly after Gov. Bob Riley appointed him to the post.  Davis said NaphCare will submit a bid higher than its current charges because of more stringent DOC requirements.  (Decatur Daily)

Westmoreland County Prison, Westmoreland, Pennsylvania
March 3, 2006 Tribune-Review
A federal judge has ruled against Westmoreland County and a company previously hired to run the local jail in a lawsuit filed by the family of a Sewickley Township man who committed suicide while behind bars in 2003. The ruling means the lawsuit can go forward. Westmoreland County, Cornell Companies Inc. and NaphCare Inc. had asked U.S. District Court Judge William L. Standish to dismiss the lawsuit. The lawsuit was filed last year by Renee L. Wright, who contends the county and prison officials acted recklessly by not preventing the April 18, 2003, suicide of her brother, Robert R. Steadman. Steadman, 33, hanged himself in his cell four days after he was incarcerated for failing to make a payment as ordered by a family court judge. Prison officials kept him in a regular cell even though he had been put on suicide watch during a previous jail stint four months earlier. In the lawsuit, his family contends that county and prison officials should have placed Steadman on suicide watch in a special unit with enhanced surveillance during his incarceration in April because he had been deemed a suicide risk only months before. The Steadman suicide was one of several at the county jail in recent years. The lawsuit cites three other inmate suicides that occurred between 2000 and 2003. A fourth inmate took his own life in 2004. In the aftermath of the Steadman case, the county cited financial reasons for replacing Cornell, took over management of the prison, and revised its policy regarding how it deals with potential suicide risks.