Prison Medical Care Comes Under Scrutiny

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(Host) The state is reviewing its multi-million dollar contract with a company that provides health care to Vermont prison inmates. The company, Correctional Medical Services of St. Louis, is the focus of several Vermont lawsuits that allege poor care. State regulators have also filed a number of disciplinary charges against nurses who have worked for the company.

VPR’s John Dillon has this report.

(Dillon) Vermont pays $6 million a year to Correctional Medical Services of St. Louis. The company acts as a health maintenance organization, or HMO, in Vermont’s nine prisons. It’s under growing criticism for allegedly failing to provide quality care to inmates.

Two recent reports have said that CMS failed to provide prompt medical attention to a seriously ill inmate. The prisoner was 47-year-old Neil Prentiss who suffered from a number of health problems, including a hernia, poor circulation, and liver disease.

(Ed Paquin) “We looked at all the medical records that were there and Mr. Prentiss had made a number of requests, and stated pretty strongly that he was having problems over I think it was close to a three week time.”

(Dillon) Ed Paquin is executive director for Vermont Protection and Advocacy, a non-profit organization that represents people with disabilities. Prentiss was a client of the group when he died.

The report says Prentiss was seriously ill and asked to see a doctor seven times over an 18-day period in late 2002. But the records show that he was not examined until he was taken to a hospital emergency room. He died about three weeks later.

Paquin says his organization hears many complaints about prisoner health care.

(Paquin) “The department really needs to have ongoing supervision of a contract that looks at quality control, that looks at timeliness of delivery of services and whether or not people are getting what they need when they need it. And we have reason to believe that it’s been lacking. Prentiss was perhaps an extreme example, but I don’t think it’s an isolated example.”

(Dillon) Several lawsuits also allege that CMS has failed to provide adequate care to inmates. The most recent suit alleges that CMS employees delayed treatment of an inmate’s infected arm for months. The bone infection ultimately led to emergency surgery, according to the lawsuit. David Sleigh is a St. Johnsbury attorney whose firm filed the case.

(Sleigh) “The company appears willing to make very detailed promises about the level of care that they’re going to provide inmates. It seems that there is a pattern of not delivering on those promises.”

(Dillon) Allegations of poor care by CMS personnel are also spelled out in cases on file at the state Board of Nursing. A review of board records shows that over the past four years it’s investigated or disciplined at least ten nurses who work in prisoner health care. The charges have led to license suspensions in three cases, and conditions – such as requirements for additional education or supervision – imposed on other CMS nurses.

Most of the cases involve medical error, such as nurses giving prisoners the wrong prescription drugs. Several cases allege that the nurses failed to deliver care in a timely manner. In one charge filed this spring, the Board of Nursing says a CMS nurse told a female prisoner who was having a seizure to “cut this out, you’re faking.”

But CMS spokesman Ken Fields says that in some cases the company blew the whistle on its own employees.

(Fields) “While we can’t comment on the specifics of these personnel matters, we can say that licensed health care professionals with CMS actually reported to the Vermont Board of Nursing several of the nurses you asked about.”

(Dillon) CMS and state officials point out that a national panel that oversees prisoner health care has accredited Vermont’s prisons. They say that’s not an easy task, and it shows that the institutions do provide quality health coverage. Fields says that the Neil Prentiss case, the inmate who died under CMS care, should not detract from the company’s record.

(Fields) “Those are allegations regarding one case and there are at any given point, I believe, about 1,600 inmates whose health care needs are being met by the Department of Corrections and its partnership with Correctional Medical Services, and overall the record is excellent.”

(Dillon) Yet the state is re-evaluating the entire way it provides medical and mental health treatment to prisoners. The review was prompted by a highly critical report from the state auditor’s office and a separate state investigation this spring into the deaths of seven inmates in state custody. Steve Gold is corrections commissioner.

(Gold) “They led to our seeing the need to amend the current contract to see that we were doing a better job of timely response, given the pressures that are on the system and on the contractor.”

(Dillon) Gold says the state will also hire a new director of medical services to oversee health care in the entire prison system.

The four-year contract with Correctional Medical Services expires this February. The state is now working on a new contract proposal that includes more stringent reporting and accounting requirements.

For Vermont Public Radio, I’m John Dillon in Montpelier.

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