The state of Virginia spends an average of $5,300 a year per inmate for medical care in prisons, and that cost has been rising 5-7 percent per year, but taxpayers may not be getting their money’s worth, and people locked up for minor crimes could be paying with their lives.
Virginia’s Department of Corrections prohibits recording of interviews in many of its prisons, but inmates who were recently released paint an alarming picture of neglect and indifference. At the Indian Creek Correctional Center in Chesapeake, 47-year-old Steven Jowers recalls what happened to his friend Fly.
“The doctor at Indian Creek said, ‘Oh, you have a kidney stone, or there’s nothing wrong with you.’ I watched him lose like 50 pounds in like three months, and Fly was sick. He was really sick, and they took him to the infirmary, and he never came out. Pancreatic cancer. Stage four. They never went and tested him. They never did anything. Three weeks later, a friend of mine - Gary Graves - went to medical, 7 or 8 o’clock in the evening and said, ‘I’m having chest pains. I’m not feeling well,’ and they gave him two Advil and told him to sign up for sick call, sent him back to the building. Well at five o’clock in the morning, when they woke everybody up for count, he was dead. He had a heart attack during the night.”
We asked the department to discuss these and other cases, but the director’s office declined, and while officials have been very cooperative in answering our Freedom of Information Act requests, the state often cites medical privacy in refusing to supply details. It could not, for example, confirm or deny Jowers' stories, but many critics say medical care is withheld to save money.
Hope Amezquita is a staff attorney with the American Civil Liberties Union of Virginia. She says about half of the state’s prisoners get care from a private company hired by the Department of Corrections.
“It doesn’t take a rocket scientist to know that their mission is to make money. They’re a for -profit company. It may be cynical of me to say this, but you can’t make more money unless you cut services and treatment and staff.”
The state’s main contractor for medical services disagrees. Nashville-based Corizon began providing prison care in May, so it is not responsible for the problems we described earlier. The company, which refused our request for an interview, says it keeps expenses down through economies of scale, emphasis on preventive medicine and efficiencies it’s developed as a company focused solely on correctional care.
On its website, the firm says prisons and jails save an average of 15% by hiring Corizon. It also boasts an excellent record of fighting off lawsuits, with 91% of inmates getting no compensation.
In a written response to our questions, Corizon would not discuss the ideal ratio of medical staff to inmates, saying only that each prison is different, but the state of Virginia has just 40 doctors to care for 30,000 prisoners.
Day to day, it depends on about 700 nurses. Some of them hold licensed practical degrees which require as little as one year of training.
These LPNs are allowed to keep records and medical histories, perform CPR and administer basic care. They cannot make diagnoses or prescribe medication. When that’s needed, an LPN must contact a supervising registered nurse who, in turn, must contact a doctor.
Nurses are supposed to see prisoners’ requesting a visit immediately if the matter is urgent or within three days if it is not. In fact, many inmates told us it could take a week or more to see someone.
And if they’d recovered by the time their appointment rolled around, former inmate Steven Jowers say they were still charged a $5 co-pay. Now that might seem like a minor matter.
“But in prison when you make 28 cent an hour, five dollars out of a $20 check a month is a lot of money.”
Some prisoners don’t have a job, so the state forces them to go into debt and will take what's owed if a relative sends money to buy food or personal care products. The co-pay may discourage people from getting medical help until their condition gets worse, is more expensive and more difficult to treat, but prison administrators argue that's the way it works in the outside world, and inmates need to learn “social responsibility.”
It’s difficult to say how good prison healthcare is - whether provided by a private company or the state - in part because the DOC has no database. It’s repeatedly asked the legislature for money to install a system of electronic medical records. That would allow it to spot problems and worrisome trends, but state lawmakers have refused to allocate the money.
Prisons do undergo a healthcare audit every three years - conducted by a professional association or the Department of Corrections -- but Delegate Patrick Hope of Arlington says that doesn’t tell the whole story, and getting inside to inspect and talk with inmates is not easy.
“I try to get information from the prisons, and I have to work really hard. Two years ago, when I wanted to go to Red Onion, we were initially told, no we couldn’t.”
Red Onion is one of two super max prisons in Virginia - correctional centers where inmates can be locked in solitary confinement for years - having minimal human contact. That, too, is a subject of concern for critics of the state, who say many of those in segregation are mentally ill and need treatment. We’ll look at that subject in our next report.
Sandy Hausman's reports on medical care in Virginia prisons was done as a National Health Journalism Fellow at the University of Southern California's Annenberg School of Journalism.
