Another Failed Experiment: Minnesota’s Private Prison Health Care Saves Money but Costs Lives
by David M. Reutter
Minnesota privatized its prison health care system in 1998 to achieve cost savings. While it has saved taxpayers money, it has exacted a toll of human suffering from prisoners subject to the profit-first motive of the private contractor. Since 2000, nine prisoners have died and another 21 have suffered serious or critical injury from the denial or delay of necessary medical care.
State officials have the ultimate responsibility for assuring prisoners receive medical care, but private contractors who deliver care make the day-to-day decision on who or if care is rendered. Minnesota has contracted with Corizon, the nation’s largest prison health care company. It has contracts with state prisons and local jails in 31 states. [See: PLN, March 2014, p.1].
Such contracts are for a fixed rate annually. The Minnesota contract pays Corizon $28 million each year, providing it with a strict incentive to cut costs. Cutting costs typically entail paying staff less and reducing the staff to the leanest levels possible.
Corizon’s prison doctors end their shift at 4 P.M., and they do not work weekends. There is no overnight medical staff to respond to medical emergencies. At all prisons other than the two that hold prisoners with severe medical complications, nurses end their shift at 11 P.M.
The lack of overnight care has proven deadly. Rush City prisoner Xavius Scullark-Johnson, 27, had a seizure one evening in June 2010. He was examined by a nurse before her shift ended. She did not contact Corizon’s on-call physician, who serves the entire state. Late that night, a guard contacted that physician after Scullark-Johnson continued to ail. The guard’s description led the doctor to order an ambulance to the prison. The order and the ambulance call, however, were countermanded by a nurse who arrived for the morning shift. Within hours, Scullark-Johnson had another seizure. The ambulance was called again, but it was too late. Scullark-Johnson later died.
A Minnesota Department of Corrections (MDOC) spokesman defended the on-call policy in a statement. He said the practice is “not only adequate for the needs of the [M]DOC health system; this is a common practice for clinics that meet the needs of many Minnesotans who live in rural communities.”
The lean staff creates daunting caseloads for prison health care workers. For example, Corizon has only one doctor at the Stillwater prison to care for 1,600 prisoners. The doctor and his small nursing staff see at least 40 prisoners daily, keep charts, and write prescriptions.
The other way of cutting costs to increase profits is to deny or delay medical care. Critics charge that Corizon’s business model includes a provision to reach confidential settlements when this tactic goes terribly wrong and the prisoner has family that sues, which is rare in most cases.
Minnesota has many cases that exhibit this tactic of cost cutting during its privatization period. Two deaths in 2000, only two years into the privatization contract, hinted at what was to come.
Prisoner Gregory Jennings went to the prison clinic in March 2000 complaining of blurred vision and symptoms of diabetes. Corizon staff scheduled him to see an optometrist. A week later, he returned to the clinic complaining of dizziness, a dry throat and headaches. The optometrist noted Jennings should be tested for diabetes, but the test was never done nor was Jennings scheduled to see a doctor.
The next day, Jennings was in a wheelchair with slurred speech and his eyes rolling upward. “States has pain everywhere,” a nurse wrote on his chart. Prison officials called an ambulance, but by the time Jennings arrived at the hospital he was in a diabetic coma. He died two days later at age 30. MDOC settled out of court for $150,000.
Eight months later, juvenile Michael Howard began complaining of excruciating pain in his head and neck at the RedWing juvenile prison. His complaints went on over a four day period. A nurse gave him Ibuprofen, told him to use an icepack, and noted he could see a doctor. She, however, didn’t check his vitals or notify supervisors.
Howard, 17, died the next night of a brain hemorrhage. Dr. Lawrence Lockman, a pediatric neuroscientist at the University of Minnesota, reviewed the case and said the cause of Howard’s death “was the failure to follow the most basic standard of care… treatment which likely would have saved his life.”
The Minnesota Board of Nursing found that a Corizon nurse, Thaloyce Minkens-Strader, denied or delayed medical care to prisoners eight times between 2007 and 2011. She refused to respond to one medical emergency because she was on dinner break. The Board also found on another occasion she refused a prisoner care because she was near the end of her shift and feared working late. She was suspended for eight days and eventually surrendered her license and retired.
The Board also twice disciplined Corizon nurse Betty Judd. In one case, she denied care to a prisoner suffering chest pain and was having trouble breathing. “It is very disturbing that in such a short period of time you were involved in another incident [of] poor decision-making that included failure to treat an offender,” her discipline letter said.
One former guard blamed the lack of staff for medical staff’s deliberate indifference to prisoners’ serious medical needs. “Stuff got dropped; they were apathetic and angry,” said Jane Eskelson, who retired after 20 years as an MDOC guard. “You’re just plain worn out at the end.”
Whatever the reason, at least six nurses have been disciplined for countermanding doctor’s orders, giving false statements, or denying emergency care. Court documents show MDOC and its staff have been found liable for nearly $1.8 million in wrongful death and negligence cases.
A Washington county jury awarded a prisoner $1 million in October 2012 after it found a Corizon physician, Dr. Stephen Craane, was negligent. The jury found Craane failed to properly treat prisoner Stanly Riley for what turned to be cancer. He wrote a serious of notes to officials begging for care. One read, “I assure you that I am not a malingerer. I only want to be healthy again.”
In another case, Craane said in a 2005 deposition that Corizon guidelines inhibited proper care. He recommended a prisoner be seen by a gastroenterologist, but Corizon officials overruled that decision. It turned out the prisoner had stomach cancer, which he later died from due to delay of care, said MDOC sources which direct knowledge of the case.
“[Corizon] wants to provide care in the least expensive ways possible,” said Dr. Marc Stern, an expert for an Idaho federal district court who reviewed Corizon’s performance in that state. “That company is not going to volunteer to give things it can’t afford just to help out. So, first and foremost, this issue falls on the shoulders of the public officials. In Minnesota, I would ask, ‘Do they hold the vendor’s feet to the fire?’”
Yet what incentive does Minnesota have to push the vendor? It is saving millions yearly through the contract, but has been found liable for only $1.8 million. Therein lies the problem with privatization of prison health care; it places savings over human welfare.
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