by David M. Reutter
A $2.1 million settlement has been reached in a class-action lawsuit alleging the Florida Department of Corrections (FDOC) and Corizon, the department’s former private medical provider, denied hernia operations to prisoners to save money.
Groin hernias are very common; it is estimated that the prevalence of such hernias is between 5 and 10 percent in the United States. Men have a 25 percent lifetime risk of developing a hernia, which can be very painful and worsen with activity or exertion.
“Routine and necessary activities such as walking, running, lifting, coughing, urinating, defecating, and even sitting up can cause the tissue to bulge out of the abdominal wall, causing intense and excruciating pain,” the class-action complaint stated. “If left untreated, a hernia can lead to serious complications, including the intestines becoming trapped in the scrotum or abdominal wall, which can lead to bowel obstructions, tissue necrosis, sepsis, the excision of intestines and even death.”
The only treatment for a hernia is surgery. The FDOC and Corizon, however, considered the surgery to be “elective” and gave prisoners a “hernia belt,” truss, jack, strap or binding devices to hold the bulging tissue in place. Such “treatment” not only does nothing to cure the condition but can actually be harmful and cause pain.
When an FDOC prisoner has a medical issue, he or she signs up for sick call and waits for a callout to see a nurse, who can refer the prisoner to a doctor. Referrals generally occur within two to four weeks. If the doctor believes a consult with a specialist is needed, a consult request is sent to Utilization Management (UM) for the FDOC and Corizon to either approve or deny the request. The same procedure applies if the specialist recommends a certain procedure.
“UM’s decision is often made by someone who is not a specialist in the area, and usually without ever seeing the patient or first consulting the prison doctor,” the lawsuit said. “Rather than making decisions based on medical judgment, however, defendants make health care decisions based on costs, in a way that prevents medical professionals from exercising medical judgment in deciding what treatment to provide and when it should be provided.”
Surgery was only approved for “emergency circumstances” and life-threatening situations. Most prisoners suffered from reducible hernias, meaning the bulging tissue could be pushed back into place. Those types of hernias were denied surgery, though they could “be just as painful, or more so, than [larger] hernias.” The lack of treatment could also lead to the condition becoming a permanently non-reducible and incarcerated hernia.
To end this practice, the Florida Justice Institute and the law firm of Kozyak Tropin Throckmorton filed a class-action suit in September 2015. There were two certified classes; the consult request subclass comprised an estimated 311 prisoners for whom a request for a surgical consultation and/or surgical repair of a hernia was submitted. The 1,637 estimated prisoners in the non-consult subclass were diagnosed with a hernia but due to FDOC and Corizon policies were not referred for a consult or surgery.
After two years of litigation, a settlement agreement was approved by the district court on September 11, 2017. It required the FDOC to issue a Health Service Bulletin concerning hernia treatment to include a referral to a surgeon and instructions that the surgeon’s recommendation “shall not be unreasonably refused.” It further required $2.1 million in payments to the class members, with the FDOC paying $150,000 and Corizon responsible for $1.95 million.
Each of the three class representatives (Tracy Copeland, Amado Perra and Archie Green) received $5,000. The members of the consult class each received $2,733.12, while the non-consult members received $519.21. The settlement further provided for $385,000 in attorney fees. See: Copeland v. Jones, U.S.D.C. (N.D. Fla.), Case No. 4:15-cv-00452-RH-CAS.
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