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After Needless Prisoner Deaths, Connecticut DOC Takes Over Prison Healthcare

by Matt Clarke

For 17 years, Correctional Managed Health Care (CMHC), part of the University of Connecticut, held a no-bid contract – worth $100 million annually – to provide medical services for around 13,400 prisoners incarcerated in 14 Connecticut Department of Correction (DOC) facilities.

But in 2016, the DOC flagged 25 prisoner medical cases that went horribly wrong, resulting in the deaths of eight prisoners. That persuaded state Senators Heather Somers and Michael McLachlan to call for a July 2018 hearing to investigate CMHC’s healthcare services. It also prompted the DOC to discontinue its contract with CMHC and begin providing medical care directly to prisoners in August 2018.

The testimony before the legislature shocked even tough-on-crime state Rep. William Petit, a pediatrician who was the sole survivor of a 2007 home invasion during which two ex-prisoners murdered his wife and daughter. Petit and other lawmakers were moved by testimony from family members of prisoners who received inadequate medical care, including:

• Michael O’Shea, 71, who was two months into a 120-day sentence for DWI when he died from an untreated illness in August 2011.

• Wayne World, paroled at age 39 in 2016 after his subcutaneous lymphoma had been misdiagnosed and treated as psoriasis for three years beginning in 2012. World filed suit over the misdiagnosis of his skin cancer, and accepted a $1.3 million settlement in August 2018. [See: PLN, Feb. 2019, p.32]. 

• Patrick Camera, whose near-continuous nosebleeds were diagnosed as stage four cancer of the face and nasal passages after a nine-month delay, ultimately leaving him wheelchair-bound at age 54 after several surgeries, chemotherapy and radiation.

Karon “KJ” Nealy, Jr., who was given Motrin to treat hair loss, a sore throat, rashes, headaches, excruciating joint pain, loss of appetite, fatigue and abnormal blood readings during 11 visits to the medical unit over a 10-month period before the 19-year-old died of total organ failure and a lung infection caused by undiagnosed lupus in July 2015, just before his two-year sentence would have ended.

“That’s not supposed to happen, not to a 19-year-old kid,” state Senator Douglas McCrory told Nealy’s mother. “We’ve got a lot of questions to answer, the legislature, the Department of Correction – we owe it to you.” 

Details of Nealy’s death, included in a DOC health services division review released in April 2019, revealed that CMHC doctors and nurses who treated Nealy had failed simple tasks, such as wrongly assessing vital signs and filing nursing notes out-of-sequence, while ignoring abnormal blood test results and refusing to address his severe pain and other symptoms. The report also said guards were unable to provide secondary care for Nealy due to staff shortages, and CMHC staff violated policies and medical professional standards.

Attorneys Devaughn Ward and Kenneth J. Krayeske, who represent Nealy’s mother, Keshanna D. Staten, in a wrongful death suit filed in August 2018, noted that the DOC and CMHC refused to provide public records concerning her son’s death for three years. See: Staten v. Semple, U.S.D.C. (D. Conn.), Case No. 3:18-cv-01251-VAB.

“He thought he had AIDS or cancer,” Staten said. “He had no idea what was happening to him. And for three years after he died I had no answers. It took an emotional toll on me – but to know how it really happened – this is even worse.” 

State auditors found that during the period CMHC was responsible for prisoner medical care, there was little legislative oversight. Auditors said lawmakers viewed the tens of millions paid to CMHC each year as a subsidy to the financially ailing health center at the University of Connecticut, known as UConn Health. 

Legislators also heard from Dr. Joseph Breton, who gave up a 15-year private practice to become a prison physician in 2015, where he took over Wayne World’s treatment, only to resign in January 2018. He was then offered and accepted the job of chief medical officer at the DOC, replacing Dr. Kathleen Maurer, whose nurse investigator, Tim Bombard, had discovered the cases that were flagged by DOC auditors. But after being deposed in May 2018 for the hearing before state lawmakers, Breton resigned the following month.

In his deposition, Dr. Breton called the utilization review committee (URC) – a team of CMHC doctors who decided whether a prisoner would receive specialized treatment outside of that available in the prison infirmary – the “biggest road block” to proper medical care. He also explicitly refuted CMHC’s assertion that state prisoners received the community standard of care, testifying that on the rare occasions the URC approved an appointment with a specialist, the prisoner would have to wait weeks for it.

“In the beginning, I can tell you that 95% of what I put in for the URC system was denied. So you begin to learn what they’re going to accept and what they’re not going to accept,” Dr. Breton stated. “And so I got very keen on just not putting in things that I knew were not going to go through.” 

Then-DOC Commissioner Scott Semple agreed that the amount of time the URC took to make decisions “sometimes was extremely problematic.” He added, “the discussions that we’re having internally is how can we create a mechanism where we can be much more responsive to the needs of the offender.”

Dr. Andrew Agwunobi, the CEO of UConnHealth, said it was losing roughly $5,000 per prisoner per year, which was why CMHC had asked the DOC to start managing its own prisoner healthcare. CMHC’s $100 million contract represented just under $7,500 per prisoner.

Numerous lawsuits have been filed by Connecticut prisoners and their survivors. On February 15, 2019, the Second Circuit Court of Appeals reinstated state prisoner James A. Harnage’s pro se federal civil rights lawsuit, which had been dismissed by a federal district court. Harnage, 49, claimed his medical needs were ignored for 24 months; consequently, his condition deteriorated, resulting in the need for surgery. See: Harnage v. Lightner, 916 F.3d 138 (2d Cir. 2019) [PLN, June 2019, p.46].

Commissioner Semple told legislators that more than 80% of the 650 staff members who had been working for CMHC transitioned to the DOC to continue providing medical care. But during his testimony, Dr. Breton cited inadequate staffing as one of the top two reasons – along with problems attributed to the URC – that caused state prisoners to receive inadequate healthcare treatment.

Employees can be required to work overtime, and refusal to do so can affect pay and promotions. Kara Philips, a nurse supervisor at the Corrigan-Radgowski Correctional Center, said she had worked up to 40 hours of overtime in some two-week pay periods.

“It’s exhausting,” said Philips, a single mother of two. “The kids miss me. It’s hard on anybody’s family life. You still have all your responsibilities at home.”

In March 2019, the state legislature’s Office of Fiscal Analysis reported the DOC had just 309 nurses on staff – one for every 43 prisoners – and only one doctor or physician assistant for every 579 prisoners. On weekends at the MacDougall-Walker Correctional Institution, a maximum-security facility, there were times when just one mental health employee was available for 1,950 prisoners, who are housed in separate buildings.

“I’m hoping that an inmate is not actively trying to complete a suicide in about seven minutes,” said Shirley Watson, a clinical social worker at the facility, referring to the time it takes her to shuttle between buildings. 

“Any provider who works in mental health would tell you, you don’t see patients for less than a 45-minute session once every two weeks,” added Kelly Schafer, a social worker at the Robinson Correctional Institution. “We’re seeing them once a month for 10 minutes.”

SEIU Healthcare 1199NE, the union representing healthcare workers, tallied 29 new hires in the first year after the DOC took over medical services from CMHC. But there were 47 workers who left during that period, the union said. It noted there was a need for 200 more employees in the prison system, but the DOC counted just 66 unfilled positions.

“It’s fair to say that we have been challenged with filling health care vacancies, but that doesn’t mean that we haven’t seen progress,” said DOC spokesperson Karen Martucci, adding prison officials had plans to add 20 new medical providers in the spring of 2019.

“We need to markedly, markedly increase providers in the facility and increase nursing staff so nurses aren’t working double shifts weeks on end,” Dr. Breton, the DOC’s former chief medical officer, told state lawmakers.

The Connecticut legislature voted for an extra $22 million for DOC healthcare in early 2019, in addition to the $72 million already budgeted. But prison officials still have no metrics to compare the quality of the DOC’s medical care to the services previously provided by CMHC. 

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Sources: courant.com, ctmirror.org, law.com, correctionalnews.com