Medical Claims and Malpractice in Correctional Healthcare
The mounting number of deaths of imprisoned immigrants over the past few years has highlighted the government’s deeply flawed response to the immigration crisis. The medical gulag of immigrant detention has also drawn attention to the increasing privatization of America’s prison system and the consequent problems.
Recent prisoner protests over deficient medical care at a West Texas detention center for "criminal alien residents" underscore the severity and persistence of the human rights problems associated with the massive incarceration of legal and illegal immigrants. Investigative reports by the New York Times and the Washington Post have documented the medical services scandal that wracks the immigrant detention system.
However, the complicated character of America’s new private/public prison complex—which brings together federal agencies with local governments and a welter of private contractors and subcontractors—has led to a lack of clarity about who is primarily responsible for the humane care of imprisoned immigrants.
Reflecting the federal government’s new immigration enforcement policy, immigrants (both legal and illegal) are being imprisoned for violations of immigration laws. The new policies criminalizing illegal immigration and visa overstays have flooded the judiciary and penal systems. The combination of the immigrant crackdown and the jailing of drug-law violators has been a boon to the private prison industry, which holds most federal prisoners in privately operated or privately owned detention centers.
An array of prison industry contractors are prospering as the result of federal and local government contracts to hold and care for prisoners and detainees that are technically under government custody. This is the case at the Reeves County Detention Center, a county-owned prison complex that lies on the outskirts of the downtrodden town of Pecos in West Texas.
Immigrants imprisoned there repeatedly protested the quality of medical care in December through early February. According to one news report, after the first disturbance on Dec. 12, the county commissioners authorized the funding for another fence to be erected around the part of the prison complex that had been taken over by protesting inmates.
Persistent Complaints of Deficient Medical Care
Complaints about medical care at the Reeves County Detention Center aren’t new. In 2007 an inmate went on a hunger strike protesting inadequate medical care.
|Reeves County Detention Center|
The Dec. 12 prisoner protest started when inmates saw the body of Jesus Manuel Galindo removed from solitary confinement. Inmates contend that Galindo did not receive medical attention for his epileptic seizures.
The Galindo family says it has filed a lawsuit against the Reeves County Detention Center. David Galindo, the dead inmate’s brother, told a reporter after the second riot that started Jan. 31, "The reason they’re having riots is because their personnel is doing the wrong thing just like they did to my brother."
After the second disturbance started, an inmate called the media. The Pecos prisoner said that the protest began when prison officials placed Ramon Garcia, 25, in solitary confinement after he complained of dizziness and feeling ill. "All we wanted was for them to give him medical care and because they didn’t, things got out of control and people started fires in several offices," said the inmate, who declined to give his name for fear of reprisals by officials.
Lana Williams, a family friend of Garcia, told KFOX TV in El Paso that his medical neglect had been a problem since August 2008. "He’s gotten to the point where he can’t walk down the hall without holding on to the wall, and this has been going on and getting progressively worse," said Williams. Garcia told her he was being placed in solitary confinement whenever he complained about feeling ill.
Juan Angel Guerra, a South Texas attorney who was the former district attorney in Willacy County, says some 200 inmates at the immigrant prison have enlisted his services to address their concerns about medical and other abuses.
During the week of the second riot that started on Jan. 31, the county kept the prison on "lockdown," denying access to reporters and all others, including Guerra. Neither the county, which owns the prisons, nor GEO Group, which runs the prison, released any information about the concerns of the rioting prisoners, simply saying in brief releases that the "issues" were being resolved.
Similarly, the Bureau of Prisons (BOP), which contracts with Reeves County to hold the immigrant prisoners, ignored public requests for information.
The National Network for Immigrant and Refugee Rights suggested that member organizations sign a letter to the inspector general of the Justice Department (DOJ) asking for an investigation. The Feb. 4 letter stated:
- "At least five immigrant detainees have died at the Reeves County Detention facility in the past three months; many as a direct result of medical negligence and abuse by guards and other detention staff."
- "Detainees are routinely denied medical attention or care, and are punished and/or ridiculed for complaining or requesting medical attention for delicate and life-threatening conditions."
- "Detainees are routinely punished with solitary confinement if they complain about a medical condition or the deplorable living conditions, including unsanitary conditions due to overcrowding and under-maintenance, and rotten food cooked in insect- and rodent-infested kitchens."
A full week after authorities said that they restored control over the prison, County Attorney Alva Alvarez sent a letter to Guerra denying his request to meet with his clients. "We are doing everything possible to meet your request," Reeves County Attorney Alva Alvarez wrote. "However, since the facility was destroyed, there is no secure place for you to meet with your clients at this time."
Along with Guerra, family members traveled to Pecos from throughout the country to demand access to the prison. Even though the prison had been secured by officials and conditions returned to near normal, according to the county judge’s office, Guerra and family members were still denied permission to visit inmates.
"We are just asking them to let Juan Guerra in so he can see our prisoners so he can bring us news about them. We are very worried about them," said Maria Reynaga. "This would have never happened in a government-run prison or state-run prison. This is what happens when a private prison like GEO is making billions of dollars," Guerra said.
Reeves County Detention Center is not a maximum-security prison. It has been variously described by prison officials as a minimum or low-security facility—hence the "detention center" designation. The immigrants detained at the Pecos prison are not violent criminal offenders but rather immigrants, often legal ones albeit noncitizens, who have been convicted generally of nonviolent felonies like drug possession and various immigration violations.
Leader in Correctional Healthcare
Although Reeves County owns the prison and the Federal BOP is the legal custodian, the immigrant inmates are in the day-to-day care of two private contractors. GEO Group runs and manages the detention center, while Physicians Network Association (PNA) is contracted to provide medical services.
|PNA CEO and president|
Vernon “Trey” Farthing
PNA was founded in 1991 by Vernon "Trey" Farthing to provide medical services to the Lubbock County Jail. Paralleling the growth of the private prison industry, PNA has become a business of 450 employees with two dozen medical services contracts in Arizona, New Mexico, and Texas. Dr. Farthing, a Lubbock physician, boasts that PNA is a "leader in correctional healthcare."
Correctional healthcare firms like PNA work closely with such private prison companies as Corrections Corporation of America (CCA), GEO Group, Management and Training Corporation (MTC), and Emerald Corrections. PNA contracts mainly with MTC and GEO Group, with which it has 10 contracts (six in Texas). In a list of references presented to Reeves County commissioners during contract negotiations, PNA included GEO Group and MTC among its references.
Farthing and his associates oversee PNA’s small correctional healthcare empire from the firm’s headquarters in Lubbock. It also has offices in Raymondville, Texas where it provides medical services to the large immigrant detention center in Willacy County that is run by MTC.
Farthing’s connections to MTC extend back to its three-year stint as the main healthcare provider at the Santa Fe County Detention Center, which MTC operated. Farthing made occasional jailhouse visits to Santa Fe, traveling from Lubbock in the company’s jet.
When seeking the renewal of the Reeves County contract in 2007, PNA submitted what was at best a misleading statement about its history of providing correctional healthcare. PNA told the county commission that it was "proud of its record of no substantiated grievances in any facility" and that it had "never had a contract canceled or been removed from a facility." Four years earlier, PNA services to another county with a privately run detention center were the subject of a scathing Justice Department report, after which PNA canceled its contract.
PNA’s Medical Gulag
It shouldn’t be surprising that long-running complaints about medical care abuses sparked the inmate protests at the Reeves County Detention Center. Six years ago the Justice Department found widespread medical abuses at another county-owned, privately run adult detention center, where the same subcontractor, Physicians Network Association, was also the the medical services provider.
Concerned about civil rights violations at the detention center, the Justice Department sent a study team from its Civil Rights division to investigate the jail in May 2002 to determine if there were violations that could be prosecuted under the Civil Rights of Instiutionalized Persons Act (1997).
On March 6, 2003 the Justice Department sent a letter and a long report of its findings to Santa Fe County, which owned the jail and contracted with MTC to operate the jail. The county had an intergovernmental services agreement (IGSA) with the Justice Department to hold detainees waiting trial who were under the custody of the U.S. Marshals Service and the Bureau of Indian Affairs. MTC subcontracted the medical services part of the IGSA contract to PNA.
Summarizing its findings, the Justice Department stated: "We find that persons confined suffer harm or the risk of serious harm from deficiencies in the facility’s provision of medical and mental health care, suicide prevention, protection of inmates from harm, fire safety, and sanitation."
In its report, the Justice Department team specified 52 actions that were needed "to rectify the identified deficiencies and to protect the constitutional rights of the facility’s inmates to bring the jail into compliance with civil rights standards." Thirty-eight of the 52 identified deficiencies related to medical services. (See sidebar.)
The Justice Department report concluded: "The Detention Center, through PNA, provides inadequate medical services in the following areas: intake, screening, and referral; acute care; emergent care; chronic and prenatal care; and medication administration and management. As a result, inmates at the Detention Center with serious medical needs are at risk for harm."
The Justice Department’s investigation was sparked by the suicide of Tyson Johnson in January 2002 at the Santa Fe County Detention Center. Johnson, who was awaiting a hearing on charges of stalking, was a longtime sufferer of severe claustrophobia.
In a New York Times (June 6, 2004) story on the Justice Department’s investigation and MTC, Suzan Garcia, Johnson’s mother, said that she had tried to contact the jail because she was concerned about her son’s psychological condition. "I called the jail and asked to speak to a doctor, but they said they didn’t have a doctor," Ms. Garcia said. "When I asked to speak to the warden, they just put me on hold and then the phone would disconnect."
According to the Justice Department’s finding and associated reports, Johnson had asked to see a psychologist, but the 580-inmate jail didn’t have a doctor, let alone a psychologist or a psychiatrist. So Mr. Johnson tried slitting his wrist and neck with a razor, and when that failed, as the New York Times reported, he told the jail’s nurse, Sheila Turner, "Today I am going to take myself out."
A guard, Crystal Quintana, told investigators that the nurse replied, "Let him." Ms. Turner denies this, her lawyer said.
As the New York Times recounted: "Ten minutes later, Mr. Johnson, 27 and with no previous criminal record, was found hanging from a sprinkler head in a windowless isolation cell where he was supposedly being closely watched."
Despite being placed on suicide watch, Johnson hung himself with a "suicide-proof" blanket inside the isolation cell. His family contends that instead of tending to his psychological problems, the medical staff neglected him and taunted him.
The NYT story by Fox Butterfield described the state of mental healthcare for which PNA was responsible:
"The nearest doctor on contract was in Lubbock, Texas, a two-hour plane flight away, and he visited the jail on average only every six weeks, seeing only a few patients each time," the report found. The nurse had an order in her file to spend no more than five minutes with any inmate patient, which the report said was not enough time.
"There was no psychologist or psychiatrist, and although the nurse had no mental health care training, she was distributing drugs for mentally ill inmates," the report said.
"The jail did have a mental health clinician, Thomas Welter, who was employed by Physicians Network Association, a subcontractor. But he never did any evaluations of mentally troubled inmates," the report said. Instead, he boasted to them about his own history of drug use, according to a recent deposition by Cody Graham, who was then warden of the Santa Fe Jail. Not long after Mr. Johnson hanged himself, Mr. Graham escorted Mr. Welter to the gate and told him "not to come back."
In an investigative report on the death of one inmate, "Dying In Jail," the Santa Fe Reporter (April 2, 2003) recounted the medical neglect and faulty diagnosis leading to the death of Jimmy Villanueva. The article quotes the county’s jail monitor, Greg Parrish, as saying that the majority of grievances from both inmates and their families focused on lack of access to healthcare and needed prescriptions.
Villanueva, who died in a local hospital from a metastasizing chest cancer that PNA hadn’t diagnosed, arrived in the jail after the Justice Department investigators had left, but according to the newspaper, "Villanueva’s case exemplifies what the DOJ and others have characterized as a health system that puts inmates at serious risk."
This was not the first time that a county that contracted PNA for medical services at its jail found itself subject to civil rights investigation and attendant lawsuits. In 1998 the Lubbock County Jail overhauled its practices after two suicides and a civil rights suit filed by a former detainee. Jail officials told Lubbock’s Avalanche Journal that they decided to revamp inmate screening and medical treatment procedures to better identify potentially suicidal or mentally ill prisoners.
Pattern of PNA Medical Malpractice
The Justice Department found a pattern of gross medical care deficiencies at the Santa Fe Jail. Among its findings were the following:
PNA and MTC Leave Town
Neither MTC nor PNA stuck around Santa Fe to help the county resolve its problems with the Justice Department. Both MTC and PNA said they had to terminate their contracts because they were losing money.
Soon after the Justice Department issued its findings in March 2004 on medical care and other problems at the Santa Fe County Detention Center, PNA pulled out of its contract with MTC. A year later in April 2005, MTC announced that it had "chosen to end this contract because it has not been possible to operate profitably. Under two different contracts and with two different medical providers, MTC and both medical providers have lost money."
Before the private prison companies terminated their unprofitable contracts, their personnel left town. MTC asked Warden Cody Graham to leave his job in Santa Fe, and he transferred to another MTC county jail in Gallup, New Mexico. According to the heart-rending investigative story in the Santa Fe Reporter on the death of a jail inmate because of deficient medical care, PNA’s regional medical consultant left at the same time as the warden. That PNA supervisor was Katherine Graham, wife of the MTC warden.
A story in the Albuquerque Journal (June 28, 2004) on the "tough negotiations" following "state and federal audits slamming the facility for inadequate medical services" reported, "PNA will not return if and when the county and MTC reach a new agreement, jail administrators have said."
County Commissioner Paul Duran recommended that the county would do a better job running the jail. He noted that the Utah-based MTC was not providing enough medical staffing or case managers to deal with inmate needs. "I think it’s the profit element that is the root of all these problems." The county did take over management of the jail after MTC left, and worked with the Justice Department to rectify its findings of deficiency.
Judith Greene, director of Justice Strategies, a national advocacy group, echoed Commissioner Duran’s observation. She told the New York Times, "This goes to the heart of the problem in the private prison business. You get what you pay for."
Getting Cost-Effective Care in Pecos
PNA has provided medical services at the Reeves County Detention Center since 2002. At a commissioners’ court meeting in November 2002, prison officials explained why it was necessary to contract with an outside provider rather than rely on the local doctors and hospital.
Warden Rudy Franco told the meeting that of the many problems encountered in the prison "the hardest has been medical." That’s because the inmates have a tendency to be more demanding. According to Franco, as reported in the Pecos Enterprise (11/25/02) a provider not accustomed to dealing with inmates would inadvertently provide the inmate with medication and other medical provisions that he doesn’t necessarily need.
For the county commissioners worried about healthcare expenses, the decline in surgeries, outside medical visits, and x-rays was impressive. As Franco explained, in the first four months of the PNA contract, compared with the previous seven months, the number of outside medical visits dropped from 59 to four, the number of surgeries decreased from 15 to two, and the total incidents of medical services declined from 3,148 to 222.
"We had 101 x-rays and we now have had four since we went with PNA," exclaimed Franco.
Asked by commissioners about the comparative costs, Asst. Warden Tommy Duncan said, "That’s a $400,000 savings" with PNA.
Duncan said later that the county will also save money because PNA would be installing the communications technology that would allow inmates to consult with a doctor through "television" rather than incurring the expense of on-site visits.
Private Prison Firms and Providers
The close ties between the private prison companies and the correctional medical services firms are evident in one of the prison industry’s main promotional organizations, namely the Association of Private Correctional & Treatment Organizations (APCTO).
PNA Vice President Jean Brock is the new president of APCTO, which says it "represents the interests of organizations that provide an increasingly broad array of correctional and treatment services." Over the past three years, APCTO’s leadership has included the executives of the major private prison firms—CCA, GEO Group, Emerald, MTC, and Cornell Companies—as well the executives of such correctional healthcare firms as PNA, Correct RX Pharmacy Services, and Addus Healthcare.
In Pecos, inmate complaints about healthcare are commonly dismissed as whining and grandstanding. "They don’t have to work, they have all their utility bills paid, they get to play five hours a day, and plus they get medical attention," said one county official. "If only the whole county should have it so good!"
When asked about the liability that the county may face if the inmates take their cases to court, County Attorney Alma Alvarez said she was not worried, noting that GEO and PNA had recently secured accreditation for the prison from both the American Correctional Association and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
After visiting the prison herself, she said that she is confident the medical care is up to or above standards. She acknowledged, however, that she never spoke to any of the inmates about the quality of medical care, but only to the administration.
Concerning the prisoner complaints made during the riots, Alvarez said, "They want to be media stars. They call the media from their cell phones and tell these stories because they want to be famous. It’s like they want to be on American Idol."
Noting that she was of immigrant origin herself, Alvarez said she had little sympathy for the protesting prisoners. "They are living well in there. Just imagine if they were in prison across the border in a Mexican prison," she exclaimed.
But it’s the comparison to conditions just outside the prison that really annoys the county attorney. "Inside the prison they are getting medical care far superior to what most people of this county get," she observed. "And they even want dental care! Go and ask people here in Reeves County when they last had their teeth cleaned."
What also bothers Alvarez and many Reeves County residents is that the rioting inmates were destroying county property that the taxpayers would need to pay for. "This is going to cost us," said County Treasurer Linda Clark. "It will take away from the small profit we make on the prison."
The multimillion dollar contract with PNA doesn’t seem to bother the county. Before 2002 the county subcontracted with local care providers and foreign medical graduates (FMGs) to meet its obligations under its contract with the BOP. However, concerned about mounting costs and worried about the renewal of the BOP contract, the county hired PNA to assume responsibility for all medical, psychological, and dental care.
That contract is now costing the county nearly $8 million a year in addition to the $800,000 it pays in medical liability insurance. That’s a large sum in a county where one in three lives in poverty, and the total county budget is only $79 million.
Reeves County pays PNA $5.85 per day per inmate for its services. While few county residents are aware of what they are paying in correctional healthcare, there appears to be widespread resentment that immigrant prisoners are getting better care than they, as U.S. citizens and county taxpayers, receive.
GEO Group and PNA have refused to comment on inmate complaints about the poor quality of correctional healthcare at the immigrant prison, and some 200 prisoners and their families vow to take legal action against the public/private prison complex.