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Michigan's Prison Health Care System Found Contemptuous

by David M. Reutter

"Step on a man's foot once, and a polite apology will do. Do it twice, and a profuse apology is in order. Do it thrice, and you have left the land of apology and entered the arena of self-defense." That saying is the beginning of U.S. District Court Judge Richard A. Enslen's order holding the Michigan Department of Corrections (MDOC) in contempt in the infamous Hadix litigation.

Hadix is a long-standing class action lawsuit that originated in 1980, challenging "a variety of unconstitutional conditions, including inadequate mental health care at certain designated Jackson, Michigan prison facilities". A 1985 consent decree addressed medical care for prisoners within the Hadix facilities, and promised each prisoner "medical services consistent with contemporary professional health care standards."

Since the consent decree was entered into more than two decades ago, the Court has held numerous hearings and entered several orders to enact a remedial plan. The Court, in a December 7, 2006 order, found that apart from "technical details, there continued at the time a mounting crisis in health care, which has fully consumed the resources of the parties, the Court, and the Medical Monitor in seeking resolution. We have been bailing, not sailing."

The Court's 61-page order made it clear that it intended to plug the holes in the MDOC's sinking ship. That diabetics were now allowed by MDOC to self-monitor their blood-sugar levels was cited as a huge success from past practice. Better HIV maintenance was noted to be an improvement, too. But the Court also mentioned several fiascos, including two that resulted in prisoner deaths.

The first issue came to light when the Medical Monitor, Dr. Robert Cohen, was advised by prisoners on May 31, 2006 that medication refills due since May 26 had not been filled. Nothing was being done to correct the situation by MDOC officials because the pharmacy computer system reported the unfilled orders as filled.

The delay in certain chronic medications, which had predictable bad outcomes, was attributed to the retirement of a pharmacist, the computer system's failure, and the delayed implementation of a new private pharmacy system for chronic medications. The problem was only solved by Dr. Cohen acting to have a new outside vendor, PharmaCorr Inc., provide emergency refills.

The first prisoner death occurred when prisoner P.H. died of complications of treatable hyperthyroidism after his care was neglected for over a year because Defendants perennially ignored both his need for medical care and for paranoia, which was causing him to refuse medical care. The second fatality was that of MDOC prisoner Timothy Souders, who died in a solitary confinement cell on August 6, 2006 due to dehydration.

[See related article in this issue of PLN, Michigan Prisons: Another Failure in Privatized Prisoner Health Care].

To remedy its medical treatment deficiencies, MDOC proposed a two-phase study of its health care system by a sub-contractor. The Court rejected that proposal, stating, "At this point, it would be speculative to predict either any success or improvement as a consequence of a distant study, particularly when such studies in the past have only served to cut timber and line file drawers."

The most remarkable testimony heard by the Court concerned delays in specialty care, with such delays being outside the time frame deemed medically necessary in 30 to 40 percent of all cases. The monitoring doctors, Dr. Cohen and MDOC Medical Director Dr. Pramstellar, randomly selected six cases. In two of those cases the delay caused prolonged pain but no imminent harm. The other four cases, however, found the delay presented the prospect of unnecessary suffering.

In all, the Court detailed 14 cases of prisoners' medical treatment, finding "a remarkable indifference to patient well-being." There were approximately 20 problematic cardiac cases. The Court found problems with prisoner access to health care, medical record deficiencies, treatment of methicillin-resistant staphylococcus (MRSA) infections, dialysis care deficiencies, surgical care, custody treatment, nursing issues, and medication issues. The Court found that these problems, which resulted in delayed or negligent care, "were a factor in patient deaths."

MDOC argued the "[treatment] failures do not show deliberate indifference to the class 'as a whole.'" The Court, however, held the malfeasance was "symptomatic," and caused many deaths. "Defendants may wish that by simply pointing out an obvious red herring -- that most people are not sick most of the time regardless of their medical treatment -- that they may wish away their involvement in this suit. It is not so. Wake up Dorothy. You are not in Kansas anymore," Judge Enslen wrote.

The Court found that staffing of medical positions was a significant problem. The computer system was also inadequate to track prisoner medical care and medication issuance. Then ensued a legal analysis.

When explaining the Eighth Amendment standard, Judge Enslen said that a prisoner serving a 2-10 year sentence deserves to do that sentence. "What he does not deserve is a de facto and unauthorized death penalty at the hands of a callous and dysfunctional health care system that regularly fails to treat life-threatening illness."

The prisoner plaintiffs requested contempt rulings for violations of six of the Court?s previous orders. The Court found contempt was not justified in four of those alleged violations. Specifically, the Court held the language of the Morality Review Process and autopsy reports was not specific enough for contempt. On the issue of processing specialist reports, the Court found substantial improvement and compliance.
Finally, no time limit was set to expand the MDOC's medical computer system.

The Court, however, held the state in contempt and imposed a $1 million fine based on two other issues. Contempt was entered due to MDOC's failure to adequately staff the Southern Michigan Correctional Facility to cover new clinical responsibilities for the dialysis program and to treat confinement prisoners. MDOC was also held in contempt for failing to employ a full time physician at the dialysis unit.

The Court ordered injunctive relief to cure these problems. The medical computer system was to be functional by February 1, 2007. A plan to add medical staff is to be presented, and another plan to address specialty care delay is required. Failure to hire additional medical staff will result in additional fines of $10,000 per day after the initial 120 day period.

Of special significance was the Court's creation of an "Office of the Independent Monitor." The monitor will have oversight over all prisoner health care, with the power to order treatment and address the adequacy of staffing. The monitor may act on prisoner grievances and no prisoner is to be transferred during the pendency of a petition for medical services submitted to the monitor. "Why do such a thing?" the Court asked. Because unlike a competitive marketplace, prisoners get only one choice of medical treatment: The treatment provided by Correctional Medical Services (CMS). "If you do not like it, you kite or grieve it, but you are too often told to pound sand." On February 2, 2007, Judge Enslen ordered the MDOC to transfer $100,000 in initial funding to the Medical Monitor's office.

The Court concluded by saying, "A new day has dawned for the Hadix facilities and prisoner medical care. Let us greet it with the joy that a new day demands. Those who curse it, and other progress, shall only resign themselves to pain, hardship and eventual irrelevancy." That new day apparently has not dawned for MDOC officials, however, who quickly appealed Judge Enslen's order.

The $1 million contempt fine was suspended and will be waived if the MDOC achieves compliance with the Court?s order within 120 days. On April 9, 2007, Leo H. Friedman, Division Chief of the Attorney General's Corrections Division, said the state had complied with the order within the specified time frame and no part of the fine had been levied, although the Court had not yet made final findings on that issue. See: Hadix v. Caruso, 465 F.Supp.2d 776 (W.D. Mich. 2006).

Additional sources: Grand Rapids Press; ACLU press release, Dec. 8, 2006

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Related legal cases

Hadix v. Caruso

Atkinson v. Way