On April 24, 2014, Madaline Pitkin died of detox-related dehydration after seven days begging for help in Washington County jail. For most of the preceding day, she detoxed alone from heroin, in her cell, having been arrested in Tualitin and jailed on minor drug charges. “Please help,” she pleaded in notes to jail medical staff, “heroin withdrawal.” And later, “I am in full withdrawal and really need medical care.” She described her symptoms: “heart beating so hard I can’t sleep,” but Washington County medical staff essentially ignored her. Her final plea scrawled in her last note: “Can’t hear, seeing lights, hearing voices. Please help me.” She died a completely preventable death the next morning, just 26 years old. An IV and competent medical staff would have saved her life.
The case settled in early December 2018, after Madaline Pitkin’s parents sued Washington County jail and Corizon Health Inc., the for-profit medical provider responsible for medical services at the jail at the time. Corizon – the largest privatized medical care provider in jails and prisons in the country – settled for $10 million.
In the initial civil complaint filed by the Pitkin family, attorneys noted that before she died, Pitkin was vomiting. Deputies noticed they had to replace her clothes, but no doctor was called to examine her and there was no change in medication. An initial evaluation to gauge her heroin withdrawal scale was performed incorrectly. The only doctor on staff saw her only once and was fired the day before her death. Pitkin died on the floor of the medical observation unit, no doctors were present or available at the jail that day.
In a statement following the settlement, Corizon CEO Steve Rector conceded the medical staff failed Pitkin, but portrayed the failure as aberrant stating: “The amount of this settlement is unprecedented for our company and reflects how far removed the facts of this case are from our standards and expectations of care.” Washington County also distanced itself from Corizon, firing the company following Pitkin’s death and the media accounts that followed, and quickly hired another for-profit medical services company, Alabama-based NaphCare, which has a history of litigation regarding substandard medical practices and the resulting body count parallels Corizon’s.
Although the Pitkin settlement is the biggest payout for Corizon in Oregon to date, it is far from the first. With contracts in Oregon jails across the state, Corizon has made enormous, multi-million dollar payouts over mistreatment and preventable deaths in Oregon jails as a direct result of neglect and substandard care.
In 2015, parents of a Eugene man with paranoid schizophrenia received a $7 million settlement against the Lane County jail and Corizon. Kelly Conrad Green II ran into a wall at the Lane County jail, in the throes of a psychotic episode. Green was not taken to the hospital for six hours after his catastrophic spinal injury left him paralyzed. Once at the hospital, he was diagnosed with a broken neck. He was released from jail a respirator-dependent quadriplegic and died 10 months after his release from the jail, at 28 years old.
In the suit brought on behalf of Green’s estate, attorney Eldon Rosenthal claimed Corizon’s practices of assessing mentally ill prisoners was inadequate, and that the medical staff purposefully delayed treatment and referrals to save costs.
Clackamas County
Bryan Perry died a from effects of an overdose in the Clackamas County jail in 2016. Perry’s death made national news because of the brutality and gruesome treatment by jail staff who were recorded mocking him as he died. At just 31, Perry -- an army veteran and Purple Heart recipient -- died an agonizing death in another Corizon serviced jail.
According to the lawsuit filed by Portland attorney John Devlin in October of this year, Perry died from cardiac arrest after four hours of severe withdrawal and inadequate or no treatment by Corizon staff. Corizon staff spent a total of less than five minutes with Perry before his death. Jail staff knew Perry was “tweaking.” Upon arrest and booking he showed the signs of methamphetamine intoxication such as uncontrollable twitching. Jail staff classified him upon booking him into the jail as under the influence of “meth/bath salts.” It took five guards to hold Perry down and get him into a chair. He could not stand by himself and was incoherent.
The particularly galling details of Perry’s treatment were memorialized in real time by a guard’s cellphone recordings and video cameras at the jail. According to the civil rights complaint, guards were recorded mocking Perry as he flailed in his cell, in the throes of an overdose, laughing at his thrashing body as he succumbed to an overdose. In one cellphone video, a deputy notes Perry was in custody on a probation violation for drugs. Another deputy says Perry should “go to the schools” as “the new DARE.” The group laughs and a deputy says: “That would be fantastic.” Another deputy adds: “You could just wheel him in in a cage and wheel him back out.” “Look what I got for show and tell today,” jokes a deputy.
Perry’s girlfriend, Brigette Mountsier, was arrested and incarcerated at the same time with Perry at the jail. She also suffered the effects of drug intoxication, including uncontrollable bodily movements observed by jail staff. Staff saw her walk a few steps into the center of the cell “where she fell straight on her head.” Staff put her into a restraint chair and left her outside the medical office. Video show Corizon medical staff chatting and laughing with jail staff next to Mountsier in the restraint chair.
Since Perry’s death, no one has been fired, despite a stark record of cruelty and liability for Perry’s nightmarish, avoidable death. As in Washington County, Clackamas fired Corizon after public outcry, and the medical services contract was picked up by NaphCare. Perry’s case is pending in federal court.
Lane County
In Lane County, two people formerly incarcerated in the county jail sued separately in 2013 and then 2016, both citing failure to provide basic mental health care while in custody. In 2013, Mark Kemp settled with Corizon and Lane County for $500,000 after mistreatment and medical neglect for his serious mental health needs while in custody. In 2016, former National Guard soldier Angelo James Fricano was booked on minor charges related to an alleged scuffle at the Oregon Country Fair. The charges were dropped, but Fricano suffered 15 days in custody while experiencing a full-blown psychiatric episode as a result of a medication reaction. Despite being incarcerated on an involuntary psychiatric hold, Corizon staff did not send Fricano to a hospital for psychiatric care or provide care. Jail staff pepper sprayed Fricano and put him in solitary confinement to control him.
Corizon
Corizon, based in Tennessee, trumpets its credentials on its website: “As the correctional healthcare pioneer and leader for 40 years, Corizon Health provides client partners with high quality healthcare … that will improve the health and safety of our patients … and better the communities where we live and work.”
In fact, as a corporate entity, Corizon is fairly new, formed in 2011 following a merger of the two then-largest private medical services correctional companies in the U.S., Prison Health Services and Correctional Medical Services. PHS and CMS have long histories of litigation based on abuse and medical neglect, with devastating accounts for scores of unfortunate prisoners under their watch. In 2006, a federal judge in Michigan admonished CMS: “You are not coat racks who collect government paychecks while your work is taken to the sexton for burial … The days of dead wood in the Department of Corrections are over, as are the days of CMS intentionally delaying referrals and care for craven profit motives.”
According to a 2016 piece in The Guardian, “Over the past five years Corizon has been sued more than 1,300 times, according to analysis by financial research firm PrivCo. Alongside several wrongful death lawsuits, Corizon has also faced legal action over sexual misconduct of its doctors and nurses, including a female employee who paid inmates for sex.”
After so many lawsuits and damning headlines, the merger between PHS and CMS re-branded the companies. The optimistically named “Corizon” resolved associations with its scandal-ridden forebears.
The re-branding measure was a change in name only. The practices of any private prison industry – undercutting staffing salaries and resources across the board to win the contract – did not change with profits over quality health care as the guiding force. Corizon did not respond to a request for interview.
Jail medical staffing audit in Washington County
Following the Pitkin death and public outcry, Washington County scrambled to publicly address the outrage. The county re-initiated an independent jail audit and the jail fired Corizon, which had two years left to the contract. The audit, conducted by Washington County auditor John Hutzler first in 2012, focuses primarily on staffing issues.
The 2012 audit found serious deficits at the jail under Corizon, which held the contract for jail medical services since 1998 (in its earlier incarnation as Prison Health Services, and as Corizon 2011 on). The audit said Washington County Corizon had failed to comply with adhere to medical standards, including providing qualified medical staff in adequate numbers. The audit found Corizon routinely used less qualified staff as apparent cost-cutting measures. The audit also found Washington County failed to forecast or provide sufficient funds to administer the jail health contract. Overall, Corizon failed to meet the medical standards required by the National Commissions on Health Care a significant percentage of the time. The audit authors noted Corizon delayed and denied access to certain records, reports and personnel during the audit.
Until Pitkin’s death, the audit went unaddressed, its recommendations unimplemented. A follow-up audit conducted six months after Pitkin’s death found only 8 of the audit’s 27 recommendations for compliance with accepted jail medical standards were adhered to at the troubled jail.
After Pitkin’s death, Washington County and the jail engaged in a flurry of activity. In addition to engaging a follow-up audit, the jail fired Corizon and quickly contracted with another for-profit medical services company – Birmingham, Alabama-based NaphCare.
In the November 2015 follow-up to the Washington County Jail audit, auditors found NaphCare had not implemented recommendations regarding adequate staffing, time reporting or remedies for understaffing. Washington County also had not implemented the vast majority of the recommendations in monitoring provider performance. Pitkin’s death was more than a year and a half prior, and the WCJ and County had failed to make significant improvements in the jail health system, other than to change up the contract health provider.
It is significant that the auditors put forth scathing reports highlighting the poor standard of medical care at WCJ, but the recommendations for change are just that: recommendations only, with no enforcement mechanism for the fundamental changes needed. Pitkin needed more protections than the toothless recommendations provided.
NaphCare
NaphCare, like Corizon, has a long, documented history of civil rights and medical negligence suits against them, and a body count arising from substandard medical care and neglect in Alabama, Las Vegas, Virginia, Texas and Washington state jails.
NaphCare regularly swoops in to take over troubled providers’ contracts in the wake of scandal. Similar to its speedy acquisition of the Washington County jail contract, NaphCare picked up a no bid, multi-million dollar contract right after a prisoner died in Washoe County, NV. In the next two years, 13 prisoners would die – 10 under the under the NaphCare contract – a rate 5 times the state average.
In 2017, NaphCare also picked up a troubled jail health contract for over $5 million in Spokane, Wash., after a number of prisoner deaths. Shortly after it took over, jail nurses accused NaphCare of delaying care to cut costs. One prisoner went 40 days with an untreated broken elbow. Since it’s takeover, eight prisoners have died over a 14-month period between 2017 to 2018, at least three by suicide, the rest mostly drug or alcohol withdrawals.
When asked how NaphCare’s protocols and policies in Washington and Clackamas counties differ from Corizon, Chief Legal Officer Brad Cain responded they had improved protocols specific to opioid withdrawal and increased mental health staff at the Clackamas jail, in specific. Cain distanced NaphCare from the privatized model beholden to investment bankers and shareholders and said the company is instead a “family run business” who “answer only to our patients and our clients”.
Family business or not, NaphCare has a disturbing and recent history of prisoner deaths for lack of medical care across the country. In 2015, 24-year-old Jamycheal Mitchell died in his cell covered in feces, his legs severely swollen at the Hampton Roads Regional Jail in Portsmouth, Va. Mitchell, who had been diagnosed with bipolar disorder and schizophrenia, had languished in his cell for weeks before he was discovered. By the time he was discovered covered in filth, dead in his cell, he had spent three months in jail on pending charges for stealing $5 worth of snacks from a convenience store. His family filed a pending $60 million suit against NaphCare and the county, alleging the medical staff ignored his symptoms of severe health impairment – like rapid weight loss – until he withered away and died of medical neglect. The suit is still pending.
Following public outcry, the County fired NaphCare and gave the contract to Correct Care Solutions, a Nashville, Tenn., based private medical care company. Correct Care are owned by the foremost titan in the private prison industry, Geo Group, who also carry the contract for healthcare in immigrant-only prisons and other U.S. prisons across the country.
One year after Mitchell’s death, Henry Clay Stewart Jr. died at the same jail in Virginia from a ruptured stomach ulcer. For days, Stewart begged medical and jail staff for help. “I have blacked out two times in less than 24 hours” the 60-year-old wrote to jail staff on Aug. 4, 2016. Stewart died alone in a feces covered cell days later. A nearby prisoner later said he was vomiting blood for weeks.
Following the deaths of Mitchell and Stewart, the Virginia Department of Justice performed a two-year investigation that concluded in late December 2018. The DOJ concluded the jail violated the Eighth Amendment prohibition against cruel and unusual punishment:
“After carefully reviewing the evidence, we conclude that there is reasonable cause to believe that conditions at the Jail violate the Eighth and Fourteenth Amendments of the U.S. Constitution. Specifically, we have reasonable cause to believe that the Jail fails to provide constitutionally adequate medical and mental health care to prisoners, including by placing prisoners with serious mental illness in restrictive housing for prolonged periods of time under conditions that violate the Constitution. We also have reasonable cause to believe that the Jail violates the ADA by denying prisoners with mental health disabilities access to services, programs, and activities because of their disabilities.”
The DOJ also found a profound lack of transparency and accountability among jail and medical staff regarding the conditions leading to the deaths of Stewart and Mitchell. Requests for medical records from the jail made by Stewart’s family attorney have been denied. The Stewart family settled the suit in July 2018 for $625,000.
NaphCare was also sued by the parents of Matthew Smith, a 48-year-old man with Crohn’s disease who died of a sepsis infection in a Tacoma, Wash., jail in 2016. The lawsuit alleged NaphCare failed to give him his medications or notice his worsening symptoms. Just before he died, blood work showed severe kidney failure.
Other suits involved sexual assault of female prisoners in 2014 in a Cincinnati jail, cancellation of an Alabama contract due to “dangerous and extremely poor health care.” Although NaphCare lost the jail contract in its own state, it has managed to profit elsewhere, and appears poised to absorb as much jail business in Oregon and Washington as it can.
Cheaper, faster, less
Medical services in jails and prisons are notoriously poor, in all settings, state and private. Privatized jail services are the worst of the worst because of routinely inadequate and under qualified staffing. To save on salary costs, physician assistants replace doctors, licensed practical nurses replace nurses – skill and quality goes out the door with profit incentivized medical care. Highly skilled medical staff such as doctors who are willing to work for a lessor salary in a jail, where they are also working fewer hours, may be unable to work elsewhere in the private sector. It is not uncommon to find doctors and other highly skilled medical staff working in jail or prison settings with records of discipline in other states.
The turnstile nature of jails lends itself to less formal complaints filed and less oversight by regulatory agencies. The marginalized, disenfranchised populations who land in jail overwhelmingly have little to no resources to challenge the conditions of their confinement. They are a captive patient base, with no choices, obliged to suffer the conditions of their confinement.
Some may argue people incarcerated in jails and prisons have little standing to complain. They got themselves in trouble, goes the argument. That stance ignores decades of constitutional law and basic notions of human rights. Regardless of the circumstances of a person’s confinement, an incarcerated person is due adequate medical care. Deprivation of that basic level of care, and knowledge of its deprivation, is cruel and unusual punishment under the Eighth Amendment of the state and federal constitutions. Whether incarcerated on pending charges or convictions, most would agree people in jail or prison should not receive a death sentence by medical incompetence, like Madaline Pitkin and Bryan Perry.
One remedy available to anyone incarcerated in an Oregon jail or prison is to file for a writ of habeas corpus. Latin for “you have the body,” the fundamental legal tool requires the jailer to produce the prisoner to a judge, and allows the prisoner to demand adequate medical care, or other conditions of confinement. In Oregon, an attorney may be appointed if the pro se writ raises enough cognizable legal issues to get the case started. If the prisoner is indigent, an attorney can be appointed also. This type of legal tool is arcane and unknown in most circles, even among attorneys. But it is a powerful and available tool to require the jail or prison to provide the medical care due – one of the only tools available to prisoners in a state with no public interest legal aid for prisoners.
Lawsuits generally have individual, but not systemic impact. Applying pressure to lawmakers to oversee, regulate, audit and, ideally, divest in privatized prison services would be the most effective path to systemic change. For a short time before the current federal administration, politicians at the state and federal level began to distance themselves from privatized prisons, generally. Association with private prisons became disfavored, stigmatizing. Even President Obama and Hillary Clinton distanced themselves in 2015 and 2016 from the industry, giving hope to many the era was in decline. The industry now enjoys a boom, with the current administration propping up the private prison industry with exponential growth as immigrants and their families are imprisoned across the country in private immigration jails.
As long as for-profit companies are allowed to benefit from human suffering, that suffering will only increase as the profit motive necessarily informs decision-making. No one deserves to die like Madaline Pitkin, Bryan Perry or Jamycheal Mitchell, alone on a jail cell floor dying from a treatable, routine ailment.
Tara Herivel is an attorney who represents indigent prisoners in their post-conviction and habeas corpus cases. She is also the co-editor and co-author of “Prison Profiteers: Who Makes Money From Mass Incarceration” (The New Press: 2008), and “Prison Nation: The Warehousing of America’s Poor” (Routledge: 2003).