Dec 2 6:00 PM

Arizona's privatized prison health care under fire after deaths

Lori Clarine holds a picture of herself (right) with her daughter, Regan.
Lori Clarine holds a picture of herself (right) with her daughter, Regan.

SAFFORD, Ariz. — Rylan is a healthy and hungry 5-month-old baby girl who now lives with her grandmother Lori and the rest of her family in a small Arizona farming town.

It's a world away from where she was born: the state prison complex near Phoenix, where her mother, Regan Clarine, is still locked up.

“She's very fun-loving. Very hyper, fun to be around, kind of always the leader,” Lori Clarine*, Regan’s mother, said about her daughter. “Regan was the one that I knew would be sneaking out the window by the time she was 3 years old. I would say, ‘You know, she's going to be our problem.”

Two years ago, when Regan was 18, she was arrested for having prescription painkillers illegally and charged with possessing a narcotic for sale. The court sent her to drug rehab, where she met and started dating Rylan's father. She found out she was pregnant just two days before a judge sentenced her to two and a half years behind bars.

“She holds her emotions very well but once she's talking to me alone, it's complete devastation,” Lori* said.

Regan was transferred from county jail to Perryville State Prison, where Lori said she was denied prenatal care.

Lori showed a note from Regan, saying she was advised by a doctor to get an ultrasound to check for any possible problems with her pregnancy.

“She did not get that ultrasound,” Lori said. “I believe had they done the ultrasound they would have known they had the wrong date.”

Lori said she believes the prison medical staff induced Regan early, which might explain why Rylan was born small.

“It just infuriates me,” Lori said.

After 48 hours in labor, Regan had to have a C-section. Lori said the medical staff didn't stitch the wound shut. Instead, they dressed it with butterfly bandages.

“They sent her back to the prison and for the first two days things are going OK,” Lori said. “But by about day three she's noticing it's oozing. It's not looking right, it's looking infected.”

Lori said doctors refused to see Regan – and it got worse from there.

“Regan woke up one night and something just told her to get up,” Lori said. Her daughter was covered in blood. "Her clothes were soaked. So she was terrified and she just screamed for you know a guard to come help her. And they came took her to see a nurse. And you know, the nurse said, ‘Well, come back at 10.’”

Regan was sent back to her cell instead of going to the hospital.

“She would cry because it scared her so much to be able to look inside her body was just freaking her out,” Lori said.

After two weeks of living with an open wound, Regan was sent to the prison hospital.

“I truly believe I could have lost my daughter had they not given her antibiotics” before her delivery, Lori said.

Regan spent five weeks in the hospital and, slowly, the wound healed. But her ordeal was not over.

“They decided she had been there long enough, that she could go back to her yard,” Lorisaid. “But it was still open a little bit. And so they decided that the best thing to do for this would be to pack it with kitchen sugar … we're talking sugar that you get from, because they donate it from McDonald's from Burger King, you know? They're standing there ripping open these little packs of sugar and filling that wound.

“I called my brother who is a doctor and I said ‘Sean, they're talking about pouring sugar into Regan and have you ever heard of this?’ And he said no way are they putting sugar in her wound. He said it's just got to be some medical term like maybe it's medicine with glucose in it. He said, ‘it's probably just a nickname of something. Nobody would pour sugar in a wound. So don't worry about it.’”

Sugar was used to treat wounds before the advent of antibiotics in the early 1900s, but it's no longer accepted medical practice. America Tonight asked the Arizona Department of Corrections to comment on Regan’s care, but they declined.

While we were talking to Lori, Regan called from prison and described her ordeal living with the fist-sized opening in her abdomen.

“It was the worst pain I’d ever felt in my life,” Regan said.

When she did get care, she described seeing medical staff putting sugar in that wound.

“They were taking the kitchen sugar and pouring it inside and putting wet gauze over it and taping it,” she said.

We asked Regan if she actually saw prison officials opening up McDonald’s sugar packets and pouring the sugar inside her wound. “Yeah,” she said, adding that she was worried if it was sanitary.

“I was scared,” she said. “You know, it’s prison, maybe these packets are old, if there's something spilled on them and it dries, you know.”

Spending less on health care

Regan is not the only inmate alleging mistreatment. The ACLU filed a lawsuit against the Arizona Department of Corrections in March 2012, alleging that prisoners are at serious risk of "pain, amputation, disfigurement and death."

It cites examples of prisoners being told to pray to be cured or drink energy shakes to treat cancer symptoms.

The ACLU says the treatment amounts to cruel and unusual punishment and that it violates prisoners' constitutional rights.

“People are often sent to prison for two-year, three-year sentences that have turned into death sentences because of the absence of the basic minimal care,” said Dan Pochoda, legal director for the ACLU in Arizona. He says in his forty year career, he’s never seen a worse prison healthcare system.

A year and a half ago, the state handed over prison healthcare to a private, for-profit company. Legislators who supported the privatization promised that it would save taxpayers money, while maintaining adequate levels of care for inmates. At least 27 other states have also privatized prison health care, rewarding private companies for keeping costs down.

But there are studies showing prisoners could be suffering as a result. An October report from the American Friends Services Committee in Arizona found that since the state privatized its prison health care, medical spending in prisons dropped by $30 million and staffing levels plummeted. It also found a sharp spike in the number of inmate deaths. In the first eight months of 2013, 50 people died in Arizona Department of Corrections custody, compared with 37 deaths in the previous two years combined.

Tony's story

After his cancer, inmate Tony Brown's pain medication was switched from morphine to less-powerful Lortab.
After his cancer, inmate Tony Brown's pain medication was switched from morphine to less-powerful Lortab.
America Tonight

One of the inmates who died since the state privatized care was Tony Brown, who was serving a 10-year sentence for aggravated assault and was due to be released in September.

“They were supposed to come down for Thanksgiving this year,” his daughter Jenna Jumper said. “He never got to meet my husband and he wasn't there when I got married, so they were going to come visit.”

Brown had been diagnosed with esophageal cancer, but his medical records show it was in remission. He had been prescribed morphine for the pain. But in October 2012, the prison ran out of morphine. The medical staff switched him to Lortab, a weaker painkiller.

In a video taken by prison guards and obtained by America Tonight, Brown is seen just after he was put on the new medication writhing in pain while handcuffed to a gurney. His medical records show that guards told nurses his condition was worsening and that he "needed to be checked out." But there is no record of medical staff visiting his cell. In another video, a prison chaplain checks on Brown at his wife Jami Brown’s request.

“Inmate Brown, I spoke with your wife earlier today,” the chaplain is heard saying. “Can you communicate with me please? I’d like to speak with your wife later on. Is there something I can tell her?”

Brown, face down on a bunk, barely moves and doesn’t respond. A guard can be heard saying, “Is it me or does this just not feel right to anybody else?”

Two days after Brown first started complaining of pain, medical staff had still not visited him, so the guards intervened and started CPR. Nurses came to assist, but 40 minutes passed before they realized no one had called an ambulance.

Eventually, an ambulance came and took Brown to a hospital. A day later, he died. Two days after his death, his widow Jami said she finally received a call back from the private prison health care company, Wexford.

“My husband passed away on Monday and I got a call from Wexford Medical on Wednesday wanting more information so that they can make sure he's seen,” she said. “I was pretty upset because I was like, ‘What are you talking about? He's dead.’”

“He may have been a prison inmate, but my dad was no different than the governor or the guy that you interviewed or you or me,” his daughter said. “My biggest thing is that if people would stop to realize that he did have family and that he did have a child and he did have a wife and he had plans.”

The official cause of death was listed as complications from cancer. But Brown's family is suing Wexford, claiming he died from lack of adequate medical care. An attorney for Wexford issued a statement to America Tonight on the matter.

"Due to federal health care privacy laws and the pending legal claim, we are very limited in what we can say about the circumstances surrounding this inmate’s tragic death," Ed Hochuli said in the statement. "Based on the limited information we have at this time, though, I am very confident Wexford Health and its employees acted appropriately, and further investigation of this claim will demonstrate and prove the lack of any wrongdoing or negligence by Wexford Health.”

Privatization proponent

State Rep. John Kavanagh
State Rep. John Kavanagh
America Tonight

State Rep. John Kavanagh wrote the legislation that privatized Arizona's prison health care. We asked him whether he thought it had put inmates in danger.

“I mean, people die in prisons,” he said. “I receive a lot of handwritten notes from prisoners. I receive emails from prison families with all sorts of allegations of crazy behavior. And then, you call the prison people up and they usually have a reasonable explanation for it.”

Kavanagh said Regan’s story didn’t sound like a “true allegation,” adding that it “sounds ridiculous.”

“You know prisoners have 24/7 to think up allegations and write letters,” he said. “I'm not saying that some of them can't have a basis in fact. But you got to take them with a grain of salt or in the case of the hospital, with maybe a grain of sugar.”

We asked Kavanagh who would listen to prisoners’ concerns over their medical care.

“There's no shortage of prison advocacy groups and ACLU attorneys who at the drop of a dime will file a lawsuit,” he said. “I think most people who get into [class-action lawsuits] wind up with nothing and the lawyers walk away in limousines with their trunks full of cash.”

There are signs though, that Wexford, the private health company that was providing care at the time of Brown's death, was aware of the problems. America Tonight obtained a copy of a PowerPoint presentation written by top Wexford executives for a meeting with the Arizona governor's office in November 2012 – four months after the company started providing care in the state. It warned that the care it and the Department of Corrections were providing was "not compliant with … constitutional requirements" and that "the current class action lawsuits are accurate." It recommended an overall operational cleanup, staffing reassessment and the appointment of a governor’s office liaison.  

The PowerPoint presentation also says that the department's "transparency" policy with the media could "encourage negative press."

Wexford was already in the spotlight for another incident just two months earlier. At a prison west of Phoenix, more than 100 inmates may have been exposed to hepatitis C. According to the Department of Corrections, a contractor nurse used dirty needles to deliver medication. Four months later, Arizona severed ties with Wexford and awarded the three-year, $369 million contract to another private healthcare company: Corizon, the largest prison healthcare company in the country. Corizon has similar contracts in 29 states, but it has faced problems in many of them. In fact, in the last five years, Corizon has been sued for malpractice 660 times.

Corizon’s no-bid contract

Arizona Democratic House minority Leader Chad Campbell said the Legislature didn't properly vet Corizon before signing the contract.

“I think the most concerning to us was the previous company when they started to lose that contract, the current company that got the contract didn't even have to go through a public process of any kind to get this contract,” he said. “No bid. Nothing. It was deemed an emergency situation by Department of Corrections so they didn't have to go through the normal process. But more interesting than that was this company that got the contract had just hired the former head of the Department of Corrections who was the mentor of the current head of Department of Corrections.”

Campbell said that is not the only tie that members of Arizona’s state government have to private prisons. Charles Coughlin, the former campaign strategist for Ariz. Gov. Jan Brewer, runs a lobbying firm called HighGround Public Affairs Consultants, which represented one of the country’s largest private prison companies. HighGround donated $5,000 to Jan PAC, Brewer's super PAC.

The governor's office declined America Tonight’s request for an interview and referred us to Kavanagh, who said the allegations that Brewer accepted bids because of personal relationships were “baseless.”

“I think they're propaganda,” he said. “I mean, people say to me I've gotten campaign contributions from private-prison people. Well, yeah. I got from a lobbyist who represents them but that lobbyist also represents 40 other clients in different industries. It's smoke and mirrors. It's a façade.”

Campbell said that multiple people and corporations are profiting from the privatization of prison health care.

“They're profiting on taxpayer dollars and to me, if I'm going to hand out money to a private entity, I want to make sure it's being spent wisely,” he said. Campbell is now calling for an investigation.
Corizon defended its level of care. "These patients receive care that meets their health care needs and satisfies constitutional requirements," it said in a statement to America Tonight, adding that it has a rigorous quality control program to make sure its health care meets federal and Arizona Department of Corrections guidelines. "In addition, the ADC maintains a dedicated internal audit team of over 30 health care professionals whose sole purpose is to monitor Corizon’s delivery of care," the company added. (Read Corizon's full statement here.)

In the meantime, allegations of wrongdoing continue to mount. According to the American Friends Service Committee report, an inmate at the Whetstone Unit of the Arizona State Prison Complex tested positive for tuberculosis in August. But Corizon did not test other prisoners, even those who were doing community service outside the complex.

Hoping to survive prison

Regan Clarine
Regan Clarine
America Tonight

As for Regan, she still has six months left on her sentence. The separation has been tough on the family, but what's worse is their fear that prison health care could be a death sentence.

As their allotted time for a phone call wound down, Regan asked her mother if she would be making the four-hour drive that weekend.

“I'm gonna lose you. I love you honey,” Lori said. “I'm coming on Saturday with Rylan. And you don't…”

An automated message cut her off when their time limit was up.

“Oh, that's so frustrating when you can't finish talking,” Lori said. “It's even tougher leaving. Her first visit with [her baby], my husband held Rylan up and she could just see Rylan's big blue eyes and she just started running and grabbed her and held her as tight as she could. It's very been hard. We all miss her very much.”

* Correction added April, 28, 2014: An earlier version of this article had an incorrect first name for Lori Clarine.

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