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America Tonight
SAFFORD, Ariz. — Regan Clarine found out she was pregnant just two days before she was sentenced to two and a half years behind bars for possessing a narcotic for sale. Giving birth to her baby daughter while she was incarcerated at the state prison complex near Tucson was an experience she says nearly killed them both.
Clarine says her first indication things were not right with her health care was when she asked prison officials for an ultrasound. She was worried she wasn't gaining enough weight, but they never gave her one. Instead, Clarine said that after about nine months, prison doctors sent her to the hospital to induce labor, but when the baby still didn’t come, they performed a cesarean section against her wishes.
When Clarine went back to her cell, her C-section wound re-opened.
“It was big enough for me to put my fist in there,” she said. “It was the worst pain I’d ever been through in my life.”
Clarine said she alerted guards, but they refused to let her see a doctor, leaving her on the prison yard with a gaping wound for two weeks. When she finally saw medical staff, she said they told her that she was lucky to be alive. They treated her with a wound vacuum. Then, she said, they employed an antiquated medical treatment.
“They decided to use sugar … like McDonald’s sugar,” she said. “They would open it and pour it inside [the wound] and put gauze over and tape it up. And I had to do that for like three weeks.”
Clarine’s story is one of dozens. Like many other states, Arizona privatized its prison health care system two years ago. In a six-month investigation, “America Tonight” found disturbing cases of inadequate treatment, and evidence that Wexford Health Sources, the first private company Arizona contracted to provide prison health care, was aware that it was violating prisoners’ constitutional rights.
Arizona’s system is currently run by Corizon Health, the largest private prison health care provider in the country. Now, for the first time ever, one of its former employees is blowing the whistle about its failures.
Teresa Short was a patient care technician for Corizon, but lost her job in late March for refusing to go to work while suffering from a case of scabies she caught from a prisoner. Short said she thought it would be unethical to treat patients while she was still contagious. She had already infected a family member, she said, and feared her son could contract it and bring it to his high school. According to Short, Corizon and Arizona prison officials have been trying to cover up the outbreak, which now includes the original prisoner and seven staff members. (Read Corizon's response.)
But the most persistent problem at Corizon, Short said, was staffing.
“We have a lot of dementia patients that take time in feeding,” she said, “and because of the short staff we'd have to stand there for hours to try to feed them and it was just not permitted.”
Sometimes, those patients would go unfed, she said. Others who were incontinent would sit for hours in their own feces, she said. And still others died.
Short described one dementia patient who had a vascular catheter in his arm for dialysis treatments. He didn’t understand what it was and kept playing with it, she said, so she repeatedly told senior staff he needed additional supervision. Instead, they sent him back to his cell, alone. At 5 a.m., she went in to check on him.
“[I] could smell blood before I even went into the room,” she said. “And when I turned on his light, it looked like somebody had been murdered. There was blood all over the room. I screamed for help.”
Short said the man had unplugged the catheter and quickly bled out. If Corizon had employed more staff to monitor patients, she said, he might still be alive.
There are some numbers to back up Short’s claims. Since the state privatized its prison health care, medical spending in prisons dropped by $30 million and staffing levels plummeted, according to an October report from the American Friends Services Committee, a Quaker social justice organization. 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.
According to a 2012 lawsuit filed by the American Civil Liberties Union, the health care in Arizona’s prisons now amounts to cruel and unusual punishment, with prisoners at serious risk of "pain, amputation, disfigurement and death.” The suit cites examples of Arizona health officials telling prisoners to pray to be cured and drink energy shakes to alleviate cancer symptoms.
“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 said in his 40-year career, he’s never seen a worse prison health care system.
In an emailed statement, Corizon spokeswoman Susan Morgenstern said that the company could not discuss individual cases because of privacy laws, but that “the vast majority of our current staff levels exceed contract requirements,” and that their care follows the guidelines of the National Commission on Correctional Health Care and the American Correctional Association.
“Our goal is always to provide quality care while being good stewards and making the best use of public funds,” she wrote.
“As for lawsuits, we treat hundreds of thousands of patients in millions of healthcare encounters each year,” she added. “… The majority of lawsuits are brought by inmates without an attorney representing them and are dismissed or resolved prior to trial.” (Read the company’s full statement.)
Tony Brown is another inmate who died since Arizona privatized its prison health care. He was serving a 10-year sentence for aggravated assault and was due to be released last 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 was in remission from esophageal cancer, according to his medical records, and had been prescribed morphine for the pain. But in October 2012, the prison ran out of the drug. 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 taken two days later, a prison chaplain checks on Brown at his wife’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?”
The guards started CPR and nurses came to assist, but 40 minutes passed before they realized no one had called an ambulance.
He died in a hospital the next day. Two days later, his widow Jami Brown said she finally received a call back from Wexford, the private prison health care company in charge at the time.
“My biggest thing is that if people would stop to realize that he did have family,” his daughter said, “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.
In a statement, Wexford attorney Ed Hochuli said he couldn’t discuss details of the case because of the lawsuit and health care privacy laws, but wrote: "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.”
But there are signs that Wexford was aware of 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 … 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."
Prison officials deny any problems with privatized care. Richard Pratt, the interim director of the health services division of Arizona’s Department of Corrections, told “America Tonight” that staffing levels since privatization were “basically the same.”
“Corizon staffing levels have been coming up on a monthly basis to the point even last month the hours that they were working with their existing staff exceeded the contract requirements,” he said.
He also denied there was a scabies outbreak, as Teresa Short had charged.
But Pratt emphasized that privatizing health care wasn’t a decision made by the Department of Corrections.
“It was legislated and mandated and it was the law,” he said. “So we were forced to do this.”
Legislators who supported the privatization promised that it would save taxpayers money, while maintaining adequate levels of care for inmates. The majority of states have privatized prison health care, rewarding private companies for keeping costs down.
“I mean, people die in prisons,” said state Rep. John Kavanagh, who wrote the legislation that privatized the state’s prison health care. “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 Clarine’s story about being treated with sugar didn’t seem 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.”
Kavanagh was also dismissive of the ACLU lawsuit. “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,” he said.
Before Tony Brown’s death, Wexford was already coming under fire after a contract nurse exposed more than 100 inmates to hepatitis C by using dirty needles to deliver medication, according to the Department of Corrections. Four months later, Arizona severed ties with Wexford and awarded the three-year, $369 million contract to Corizon, which has similar contracts in 28 states, according to its website. But it has faced problems in many of them; in the last five years, Corizon has been sued for malpractice 660 times.
Arizona Democratic House Minority Leader Chad Campbell said the Legislature didn't properly vet Corizon before signing the contract.
“No bid. Nothing,” he said. “It was deemed an emergency situation by Department of Corrections so they didn't have to go through the normal process.”
Campbell also noted that Corizon had just hired the former head of the Department of Corrections, who was the mentor of the current head of the department.
That’s not the only tie that members of the state government have to private prisons. Charles Coughlin, the former campaign strategist for 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.
Then in late March, Kavanagh allocated $900,000 in state funding to the private prison company GEO Group Inc., even though the Department of Corrections said it wasn’t needed, according to the Arizona Republic.
“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,” said Campbell, who is now calling for an investigation.
The governor's office declined a request from “America Tonight” for an interview and referred us back 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.”
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.
Earlier this month, Regan Clarine completed her sentence. “America Tonight” met her as she was released into the waiting arms of her father, Paul.
“It’s one of the happiest days of our life,” he said. “Hopefully we’ll never have to do this again.”
They drove to a nearby hotel to reunite with the rest of the family, including her 11-month-old daughter, Rylan.
They’d met a handful of times on brief prison visits, but Rylan didn’t recognize her mother. Still, Clarine was happy to see her so healthy.
She responded to Kavanagh’s allegation that she was probably making up her story with a laugh, saying, “That’s crazy. I don’t think I could even come up with something like that … Sugar?”
To add insult to injury, her mother, Lori, said the prison has billed her $2,000 for Rylan’s birth. She is disputing the charges but fears it could hurt her credit if she doesn’t pay them. She says privatized prison health care simply isn’t working.
“You know, she got her just punishment,” Lori said. “But, oh my goodness, they're still human beings. Take care of them.”
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