Death Sentence: Prison healthcare costly, ineffective

Arizona taxpayers pay $125 million a year to Corizon, a company contracted to provide healthcare to Arizona's inmate population. A 12 News investigation revealed there are questions about whether the company is driving up its profits at the expense of taxpayers.

What's more, billing records show the Department of Corrections is spending millions more to defend itself from a 2012 class-action lawsuit filed by Perkins Coie, Jones Day, the ACLU's National Prison Project, Arizona Center for Disability Law, the American Civil Liberties Union of Arizona, and the Prison Law Office out of Berkeley, Calif.

That filing accuses the department of not providing adequate medical care, mental health care and dental care to prisoners.

The state hired Struck, Wieneke & Love PLC, a private law firm in Chandler, to handle its defense. Legal billing records show taxpayers have already paid the firm $2,988,910.68 as of April, 2014.

In an interview, Dan Pochoda, the legal director for the ACLU of Arizona, says the defense of the lawsuit was given to a private firm too quickly. He questions why the Attorney General's Office is not defending the case.

"The Attorney General's Office, they have a section that does the defense for this specific agency, in this case the prison systems, as they do for other agencies and presumptively it should start off obviously with the AG," he said. "You know it's going to be a significant expense once we go outside. These are profit-making firms just like the health-care provider is a profit-making provider. Their bottom line is making more money."

That's nearly $3 million in public money to a private firm defending the Department of Corrections against allegations its private healthcare provider is doing an inadequate job.

Questions about inmate care

We reviewed records from March through October 2013 and found at least 16,000 medical delays, ranging from not treating an HIV-positive prisoner to inmates not getting antipsychotic medication.

Why should taxpayers care? Every day Corizon is on the job, we pay on average $339,000, whether it does its job or not.

Teresa Short worked as a patient care technician for Corizon at the state prison in Tucson. She resigned in March and has since had trouble dealing with the death of an inmate she cared for.

That inmate was James Copeland. Copeland was serving time for failing to register as a sex offender.

Copeland was diagnosed with dementia and kidney disease. He was a dialysis patient housed in the medical unit where Short worked at the prison. Copeland had a vascular catheter inserted in his chest, which is a port for dialysis.

That device prompted Short to warn her colleagues on several occasions after she caught Copeland disturbing its cap. Short was nervous and believed due to his dementia he needed constant supervision or he might compromise the catheter. She was very skeptical about Corizon's decision to house Copeland there rather than in a hospital.

A Corizon nurse's progress notes on Copeland on November 19, 2013 reveal signs of dementia. The nurse wrote that Copeland became agitated and stated "he wants to go that way, pointing to the other end of the unit," and pulling on the lines attached to medical equipment such as his vascular catheter and blood-pressure monitor.

On November 23, the nurse writes of Copeland's state, "confused and needs frequent directions and orientation."

Red flags ignored

Short says Copeland would pull on oxygen lines during dialysis treatment, would pull on his vascular catheter lines and would stand up all the time when he was supposed to be sitting down receiving treatment.

Reports show Short checked on Copeland at 4 a.m. on November 28, 2013. That was Thanksgiving Day. He was hungry and asked for food.

The security check log shows a corrections officer accounted for all inmates being alive and well in that wing of the prison at 4:46 a.m.. Copeland displayed no unusual behavior.

At 5:25 a.m., Short went to Copeland's cell to give him some food and discovered him lying on his bed in a pool of blood.

"When I walked into the room, I was stepping on blood clots that were the size of livers, I mean they were huge," said Short.

Copeland had done what Short predicted, ripping off the cap which covers the catheter opening.

Short says she could see blood on the walls and even Copeland's shoe print in blood near the door.

"I felt like I failed him," she said.

The Department of Corrections Inmate Death Notification says medical responders performed life-saving techniques on Copeland. Pictures taken by DOC's investigation team show patches from a heart defibrillator on the inmate's chest.

The report shows an AED (automated external defibrillator) was utilized, but did not recommend shock. Medical staff determined not to perform CPR due to the fact that Copeland had bled out and there was not a sufficient amount of blood left to try to resuscitate.

Short says all of his options were gone.

Delays after death

According to the DOC's criminal investigative report, Nurse Brenda Hinton and Nurse Robin Sheppard pronounced Copeland deceased at 5:45 a.m. Nurse Hinton was directed by the on-call doctor, a Dr. Barciaga, to call 911.

The report states there was a disagreement among Hinton, Sheppard, and Barciaga. The Tucson Fire Department, which has a station across the highway from the prison, did not arrive on scene until 6:58 a.m. and pronounced Copeland deceased.

The report does not detail what the disagreement was about, but makes it sound like the two nurses were arguing about whether to call 911 or disobey the instructions of the on-call doctor.

On December 30, 2013 the Pima County medical examiner listed the cause of death as exsanguination - fatal blood loss - due to an uncapped vascular dialysis catheter. The manner of death was ruled accidental.

In a statement to 12 News, DOC Director Charles Ryan says, "All inmate deaths are investigated criminally and administratively. This process involves a review conducted by Corizon, a review by ADC, as well as an independent report by the county medical examiner. This investigative process determined conclusively that the death of inmate Copeland was accidental; a fact independently corroborated by the Pima County medical examiner.

"At the time of the incident, the unit was appropriately staffed and inmate Copeland's welfare was documented on a regular basis. He was discovered unresponsive by a certified medical technician who immediately alerted an ADC correctional officer and the on-duty RN and LPN. Each of these investigations determined that the death of inmate Copeland was accidental and none raised any concerns about the medical protocols for inmate Copeland either prior to or following his death."

According to DOC monitor reports, prepared monthly by staff in the Department of Corrections' Department Health Services Contract Monitoring Bureau, a problem with infirmary staffing was identified on October 30. Just weeks later, Copeland died at a time when staffing levels at the infirmary were still inadequate, according to Short.

"We're the ones who have to carry the burden when something is preventable and we cannot prevent it because we don't have enough people to supervise the ones that need supervision the most," she said.

Teresa Short says she was compelled to blow the whistle. If not for Copeland, for the people footing the bill.

"The taxpayers need to really see what's happening to people," she said. "I think most people would be disgusted. They care about the bottom line, they care about the dollar."

Copeland's death just the tip of the iceberg

According to the Department of Correction's own monitors, Corizon failed to deliver timely medical care at least 16,000 times during an eight-month period in 2013.

In fact, some of the documentation shows the provider was not providing any healthcare. These cases include:

• At the prison in Tucson, an HIV-positive inmate received no treatment.
• Chemotherapy for two other inmates was delayed.
• An inmate had to have a craniotomy after falling 33 times because he wasn't supervised in the infirmary.
• At the Eyman facility, Corizon failed to reorder chronic-care medication for dozens of prisoners.
• No timely treatment for an inmate with prostate cancer.
• In Yuma, mentally ill prisoners had not been seen by doctors since December, 2012.
• Psychotropic medications were not renewed.
• At Perryville, the women's prison, long delays to see the doctor once prisoners were referred by nurses.

"They're examples of what you see month after month after month," said Corene Kendrick, an attorney for the Prison Law Office in Berkeley, Calif.

"If I were a taxpayer, someone who feels very tough on crime, I would be outraged by this because it's taxpayer money that's going into the pockets of a corporation," she said.

Kendrick is one of the attorneys behind the class-action lawsuit filed by the ACLU and the Prison Law Office against the Arizona Department of Corrections. The suit alleges inadequate medical, mental health, and dental care.

Kendrick contends no effort is being made by the Arizona Department of Corrections to hold Corizon accountable for the violations when the evidence, she says, is overwhelming in the reports being made by DOC's own monitors.

Which brings us to four inmates who've been granted medical parole in the last six months by the Arizona Board of Executive Clemency.

Huggins and Kanabar have already died.

Dean Vocke was given six months to a year to live. Before he was medically paroled, Vocke had ten months left on his sentence for vehicle theft when he complained about back pain in October, 2012.

Vocke gave 12 News permission to review his medical records for our reporting; we are not publishing them due to the amount of personally identifying information they contain.

His first appointment was cancelled because no provider was available. X-rays taken at the end of February showed bone abnormalities consistent with cancer. The nurse requested an MRI.

"They wouldn't do an MRI, they kept denying an MRI, denying an MRI," Vocke said. "They didn't want to spend the money."

At the end of May, 2013, medical staff ordered CT scans, but Corizon denied it. Finally, at end of July, 2013 a CT scan was performed.

It confirmed Vocke had cancer which now had spread to his hips and his spine.

"And finally [the cancer] ate my pelvis and my hip away," said Vocke.

In September a second CT scan showed the cancer spread to his abdomen and one of his kidneys.

Medical records show there was an eight-month delay in treating Vocke, because of Corizon's actions.

"It was kidney cancer that could have been 95 percent survivable and now they're saying I can't survive it whatsoever," Vocke told us.

Vocke's physician sent a request to the Arizona Board of Executive Clemency for early release due to imminent death.

From that request, the clinical summary and prognosis read:

"Inmate Vocke has been diagnosed with renal cell carcinoma with metastasis to the bone. He underwent a right nephrectomy and will start chemotherapy in a few weeks. This is a very aggressive form of cancer and his oncologist and onsite Medical Director for ASPC-Tucson have both recommended clemency. Since inmate Vocke is wheelchair bound and in the advanced stage of the disease, he is not considered a threat to society.

"Because of the aggressive and advanced nature of his cancer, he is not expected to survive this illness. The oncologist has indicated that for this type of cancer, about 50% of patients may survive up to six (6) months while about 35% may live up to one year."

The physician indicated Vocke has a life expectancy of six months or less.

On October 31, 2013 the Board of Executive Clemency commuted Vocke's sentence. He was granted medical parole, so he can die surrounded by family. His wife Laurie says it's torn them apart.

We tried to seek comment from Corizon on the many issues outlined in our reporting.

Susan Morgenstern, a spokeswoman for Corizon asked us to supply her with the documentation we obtained under Arizona's Public Records Law. We requested the quarterly and monthly monitoring memos and reports referred to above, known as MGAR (short for Monitoring-Green-Amber-Red) reports.

In response to our questions, Corizon provided these answers via email:

• Mr. Copeland. You asked about the investigation into the tragic death of Mr. Copeland. As I believe you know, it has been investigated and officially determined to be an accident. It's been thoroughly reviewed by several agencies; and the care provided and protocols followed were all appropriate.
• As you know, HIPPA [sic] prevent health care providers such as Corizon from providing any medical details about specific individuals to you or anyone else. But I can assure you that we are always willing to review individual care plans to be sure appropriate care is provided.
• As for your very general allegations, we would be happy to check into them and provide information if you could give us enough detail to do so. You referenced delays in care and prescriptions; can you give us the specific instances you are talking about (date/time/location/documentation)?
• You've also talked about four unnamed inmates who were medically paroled and alleged they did not receive proper care. If you will give us the names of these individuals, we will review their medical records to ensure they received proper care.
• Finally, you've alleged there are staffing shortages, but that is simply not accurate. When the transition to Corizon occurred in March 2013, we immediately assessed the staffing and began an aggressive recruiting and training program. Today all current staff levels exceed the contract requirements.
• We believe that Corizon is providing quality care to the patients we treat every day, and we stand behind our medical professionals who work inside the correctional facilities.

Corizon responded with a second statement after we provided more specific information.

Teresa Short: A former Corizon employee alleges lack of care, staffing shortages, and that she was "set up to fail."

• Corizon is first and foremost a health care provider, whose top priority is the health and safety of patients. To that end, we practice evidence-based medicine as prescribed by licensed medical professionals and focus on providing quality health care.
• The vast majority of our current staff levels exceed the contract requirements. For example, since the time of the MGARs provided you, the staffing for mental health care at the Yuma facility has increased substantially.
• We not only empower our employees to succeed in fulfilling our mission, we also require them to meet the highest standards of conduct and professionalism.

MGAR Reports: Various allegations

• As you know, MGAR reports are monitoring tools meant to raise issues that are then addressed and resolved. By design, they capture issues requiring attention at a specific moment in time, some of which are immediately resolved. The MGARs provided you are now 8-9 months old.
• In addition, Corizon is prohibited by HIPAA from discussing individual patient cases, just as any other health care provider or hospital is restricted.
• But it's important to note that Corizon care follows the guidelines of the NCCHC and the ACA, which are the correctional industry standard.

Complaints from patients who were medically paroled

• Again, HIPAA prevents Corizon from discussing details of individual patient care.
• As a health care provider focused on quality, we stand behind our dedicated medical professionals and the treatment plans they provide to patients.
• The process for inmate compassionate discharge is initiated by the inmate or the family and is considered by the Board of Executive Clemency, not Corizon nor the ADC.

Expired Licenses

• Our staff has all necessary and appropriate licenses, so this allegation is simply not true.

Thanks,

Susan Morgenstern
senior vice president