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PHS Responsible For Deaths Of New York Prisoners

by Michael Rigby

Prison Health Services (PHS) has killed another patient. According to a highly critical 10-page report released by the New York State Commission of Correction on June 23, 2004, the 2001 death of Brian Tetrault, a prisoner in the custody of the Schenectady County Jail, was the result of grossly inadequate and incompetent treatment of his Parkinson's disease. Health care at the jail was provided by PHS, a private, for-profit company based in Tennessee.

Tetrault, a long time sufferer of Parkinson's, was arrested for burglary, larceny, and harassment on November 10, 2001, and placed in the Schenectady County Jail. At the time of his imprisonment, Tetrault, 44, was taking a total of seven drugs to control the psychiatric and physical symptoms associated with the disease. Under the care of the Albany Medical College Parkinson's Disease and Movement Disorders Center (AMCH), the drugs had kept Tetrault alive for a decade.

But when Tetrault arrived at the jail, his medication regimen was drastically altered. Dr. W. Duke DeFresne, a PHS physician, discontinued all but one of Tetrault's medications, and even that was reduced. (Notably, none of the discontinued medications were found in the jail's pharmaceutical formulary.) Unthinkably, DeFresne made these changes without examining Tetrault--a violation of state law--and without consulting AMCH.

Severely under-medicated, Tetrault began a rapid decline that went unchecked by jail medical personnel. From November 13 to November 17 Tetrault languished in his cell, unable to sit up or maintain his personal hygiene, experiencing episodes of incontinence, suffering from skin breakdown, and exhibiting changes in behavior. Unbelievably, the nursing staff observed and recorded. Tetrault's deteriorating condition but failed to notify a physician until November 15--and even then he was not seen. In fact, Tetrault was not seen by DuFresne or any other physician after November 11, and was never seen by a psychiatrist, notes the report.

The neglect continued up until the time Tetrault was admitted to the hospital. On the November 16-17 nightshift, notes the report, a nurse claimed that Tetrault was uncooperative' with medication administration, resistant' to sitting up, [and] refused' to swallow...." This assessment was totally ludicrous, however, because by this time Tetrault's condition had so deteriorated that he was unable to cooperate with medication administration, could not sit up, and was incapable of swallowing. The report concluded that, The nurse's documentation of this as resistance and refusal is unprofessional to the point of misconduct.

On November 17, at 12:30 p.m., Tetrault was finally transported to Ellis Hospital where he was admitted to the Neurological Critical Care Unit. Tetrault was verbally unresponsive, had a large 2-inch decubitus ulcer on his left buttock, and suffered from severe dehydration. Sadly, Tetrault's one week in the care" of PHS turned out to be a death sentence. At the hospital Tetrault's condition continued to decline; he died at 2:55 p.m. on November 20, 2001.

The report blasted PHS and its employees for Tetrault's death and strongly suggested that they were directly responsible. According to the report, the abrupt reduction and withdrawal [of Tetrault's medication] was medically reckless, was directly implicated in the neuroleptic malignant syndrome that caused Mr. Tetrault's death, and represents flagrantly inadequate medical care by PHS, Inc. and its employees.

The report recommended, among other things, that PHS fire DuFresne for malpractice and gross incompetence; discipline six of the jail nurses for failing to adequately assess Tetrault's deteriorating condition and failing to provide basic supportive nursing care; require a doctor to be at the jail at least 4 hours a day, 3 days a week; and conduct a quality assurance inquiry into the mental health staff's failure to maintain a continuity of care.

The report further recommended that the Sheriff consider terminating the contract with PHS for its inability or refusal to oversee and require their employees to provide adequate care to a patient with a life threatening neurological disorder whose condition had deteriorated to a medical emergency." Obviously under pressure, the jail administrator, Major Robert Elwell said the county would not renew its contract with PHS when it expires in October 2004.

Also criticized by the report was the attempt of jail administrators to evade the reporting requirements of Tetrault's death. Although the Sheriff's Department received by fax a Release of Prisoner" order at 6:13 p.m. on November 20, the official record had been altered to show a false release time of 2:45 p.m.--10 minutes before Tetrault's death. What's more, jail administrators did not report the death until 20½ months later when it was ordered by the Commission.

For its part, PHS claimed that Tetrault's death was an isolated incident and not indicative of the company's health care. But the truth is, PHS is a sleazy company with a terrible track record. PHS has been investigated for providing shoddy medical care and for suspicious deaths in Pennsylvania, Tennessee [PLN, May 2002, p. 21], Florida, and Ohio [PLN, March 2001, p. 12]. PHS and its subsidiary, EMSA Correctional Care, have also been the subject of numerous lawsuits in New York, New Jersey [PLN May 2004, p. 20], Nevada [PLN, February 2003, p. 20] and Florida. [PLN, July 2003, p. 16]. At present, PHS and EMSA are mired in over 1,100 lawsuits. Including one for Tetrault's death.

The death of Victoria Smith, another New York prisoner, further illustrates the decrepit care of PHS. Smith died on February 16, 2002--less than three months after Tetrault's death--while under the care of PHS at the Dutchess County Jail. Her death was also the subject of a Commission report. That report concluded Smith's death resulted from a systemic breakdown of health care delivery services." Not only did Smith's arthritis go unmanaged, noted the report, but despite the detection of an abnormality" in her EKG, Smith's medication was not changed and she had to wait five days to see a doctor. According to the report, Smith wrote in a note to her father, which was found in her cell the night she died, that she had been evaluated by nursing five times relating to chest tight and burns,' and she needed to get out of jail to get help.'" As in the Tetrault case, the Commission recommended that the jail administrator consider terminating the services of PHS.

It should be noted that the care provided by other prison health care contractors is no better than that of PHS. These companies exploit the public's ill will towards prisoners while sacrificing quality care in order to save a buck and pocket the profit. The horror stories of prisoners who have suffered at the hands of these greedy corporations are too numerous to mention here. However, as part of an ongoing effort to expose the actions of these companies to public scrutiny, PLN has reported extensively on this issue. For more information, see PLN indexes or visit online at

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