For a link to the Criminal Justice Committee hearing on Febuary 2nd, go to: http://thefloridachannel.org/videos/2215-senate-criminal-justice-committee/
Contents
- A few
thoughts regarding the 2/2 Criminal Justice Committee hearing and recent
developments
- Notes
on positive provisions in SPB 7020
- Concerns
regarding implementation and other issues
- News articles
from Miami Herald and Palm Beach Post
A Few Thoughts
I wanted to share my thoughts on SPB 7020 and concerns
regarding its potential implementation. It is imperative to have accountability
and transparency in the Florida Department of Corrections (DOC) and the Office
of the Inspector General (OIG). I found it disturbing that newly appointed DOC Secretary Julie Jones would
require investigators to sign what amounts to a gag order after she spoke about
implementing strategies "so that our department is both transparent and
accountable" in her remarks to the Criminal Justice Committee on February
2nd.
I doubt Julie Jones came up with a confidentiality agreement
on her own. One only need look to those who would gain from continued secrecy,
less accountability, and lack of transparency for the source behind this
blatant attempt to avoid answering charges. I would go so far as to say Jones
is being manipulated at the highest levels of the DOC and OIG. Instead of
pulling off the festering band-aid one painful hair at a time, why not yank it
off completely - sooner rather than later. Open the books and let the
wrongdoers suffer the consequences.
Julie Jones's many assurances of improvements in the DOC sounded
a bit hollow in contrast to the anecdotal accounts from numerous relatives who
have loved ones on the inside. I'm being updated on a weekly basis regarding
all manner of abuse, beatings, and possible homicides occurring throughout Florida prisons. Just
this week for example, inmate Richard J. Wilson, #705776, was reportedly set up
by a guard to be brutally beaten by other inmates. The person who told me this got
the account from their loved one in Suwannee CI and requested anonymity out of fear of
retaliation. They tried to find out if Wilson was
in a Jacksonville
hospital, to no avail.
Regarding chemical agents, both Julie Jones and Inspector General Jeff Beasley
made assurances detailing a series of checks and balances to prohibit the
unauthorized gassing of inmates. Beasley implied there could be little unauthorized
use of chemical agents due to all the "internal controls." He
mentioned a "conspiracy" of many as a way to undermine these
controls. I submit that not only are there "conspiracies," but the
widespread falsification of reports regarding the punitive use of chemical
agents. In my unit, guards regularly backed up their criminal actions with
outright fiction.
I hear about punitive gassing of inmates practically every
week. I suspect thorough investigations would reveal startling malfeasance
regarding this widespread abuse. Please refer to news articles: After Florida inmate’s lethal gassing, claims of cover-up
and Inmate's gassing death detailed in Florida
What does it say about the OIG and the DOC that the only
people doing any serious investigations are the newspapers? Despite all the
heavily redacted documents, we've learned about numerous suspicious deaths.
There is no dispute Darren Rainey was put into a scalding hot shower by COs to die - begging for his life. Over two and a half
years later, no officer has been charged with a crime. Upper level officers and
administrators who covered up Rainey's killing have not been charged either.
Accountability? Consequences? Transparency?
Notes
Key Positive Proposals affecting FL DOC and Office of the
Inspector General:
- 60 days gain time credits as educational incentive
- Reporting Sexual Abuse and Harassment
- Review Inmate Grievance procedures
- Crisis Intervention Training for COs who work in psychiatric settings
- Monitor 'use of force' episodes, follow up care for involved inmates
- Annual 'use of force' statistics
- Use of force documentation signed under oath
- Prohibiting guards with inappropriate use of force episodes from working with mentally ill inmates
- Protections for inmates and employees from retaliation
- Establishing officer staffing requirements in mental health treatment facilities
- Identification of blind spots or areas where staff or inmates may be isolated and the deployment of video monitoring systems and other monitoring technologies in such areas
- Assess safety and security technology, make recommendations to update video systems
Provisions for private healthcare providers:
1. Felony
offenses for medical neglect of an inmate
2. Anonymous
reporting of inmate abuse directly to the Office of the Inspector General
3. Consequences
for not reporting abuse of inmates by COs
Concerns
- My
primary concern is that 7020 calls for current DOC and OIG personnel to
carry out the new directives. These are the same high level command staff,
administrators, and inspectors who bungled investigations and covered up
crimes. 7020 depends on the same line officers who abused, tormented,
beat, and in some cases tortured and killed inmates. The DOC is failing in
a number of critical areas. Might the solution be to enlarge the scope of
Senator Bradley's Oversight Committee (BOC) to take over some of these
functions? For a look at Senator Bradley's bill proposing an Oversight Committee, go to: https://www.flsenate.gov/Session/Bill/2015/0212
- The OIG,
FDLE, and DOC have botched investigations in the past. How would the same
personnel be compelled to do first rate investigations that result in
prosecutions? Clearly, personnel within the FL DOC have conspired to cover
up the killing of inmates by correctional officers. Not to mention unlawful
beatings and punitive use of chemical agents (gassings). How deep into the
hierarchies of the DOC will investigations be conducted to hold those
accountable who have protected guards and covered up their crimes? Who
will investigate? Perhaps BOC.
- The
best indicator of future behavior is past behavior. I don't trust the OIG,
the FDLE, or the FL DOC to conduct impartial investigations. The only
investigators, so far, that can be trusted are the four whistleblowers who
uncovered the truth about Randall Jordan-Aparo. I suggest a meeting with inspectors
- With regard to sexual abuse and rape investigations, will rape kits be made available along with the timely testing of them? In the civilian world, women are made to wait months and even years in some cases due to the lack of funding to test rape kits. In fact, women who have been raped ended up paying for the testing themselves.
- A toll-free anonymous hotline, unmonitored by DOC personnel, to report sexual abuse, harassment, staff neglect, beatings, and a whole host of unlawful conduct could be accessible through inmates' payphones. Guards would be required to stay out of earshot.
- Mental health treatment: Requiring officers to have Crisis Intervention Training to work with the mentally ill is a great first step. Prohibiting those with two or more use of force notations from working in a psych setting compliments the CIT. It makes sense to include psychological testing for these specific guards as well. My overall concern is how the mentally ill are tracked and provided for starting in our county jails. One solution is to collaborate with jails to identify and begin treatment at the county level. Continuity must be carried over to prison. Once incarcerated in state prisons, the chronically mentally ill must be separated from the general population. A stand alone reception center for them would seem a logical first step. By the way, how long would an officer have to be free of use of force notations to work in a psychiatric setting? A year might by appropriate depending on the severity of the use of force in a CO's file.
- Treatment of the mentally ill: There should be a provision in 7020 prohibiting the placement of the mentally ill in solitary confinement. A growing number of studies are finding long-term negative affects for relatively healthy inmates. For the mentally ill, the aftereffects of solitary can be catastrophic and permanent. In addition, treating the mentally ill who are locked down for 23 hours a day would be problematic. http://www.apa.org/monitor/2012/05/solitary.aspx
- Regarding the grievance process review: How will grievances be collected, analyzed, and acted upon? Historically, DOC personnel and guards have minimized, discounted, and destroyed grievances. Aggrieved inmates were taunted and retaliated against. Inmates are the eyes and ears about what happens inside FL prisons. Their formal and informal grievances must be taken seriously. In my experience, inmates in my unit accurately reported the abuse of men in cells adjacent to them. The inmate Harold Hempstead filed 90 grievances regarding the scalding death of Darren Rainey. They were ignored or no action taken. It wasn't until the Miami Herald reported the brutal killing that anything was done. The DOC cannot be trusted. I suggest Bradley's Oversight Committee take over the grievance process until such time the DOC is rid of abusers and the personnel who support them. A similar function the BOC could assume is the handling of legal mail. I received a letter this week from an inmate who suggested his legal mail was unsealed at his prison. Two pages were missing in a court filing.
- Regarding use of force investigations: Most, if not all, of the use of force incidents in my unit were written up in a way to justify guards' unlawful behavior. The system as it stands now is riddled with loopholes whereby creative guards can cover up their crimes in writing. Again, I do not trust the DOC or the OIG to investigate use of force incidents in any meaningful way. Again, perhaps Bradley's Oversight Committee could be tasked with this as well.
- With regard to private health providers: The penalties for withholding medical treatment are substantial and will hopefully compel nurses and doctors to treat inmates humanely in the future. However, concerning past maltreatment, how far up the hierarchies of Corizon and Wexford will investigations proceed to hold accountable those who conceived profit driven strategies that end up in de facto torture of inmates with painful, severe medical issues. Throwing a few doctors and nurses to the wolves will not solve the problem. Despite assurances from Corizon and Wexford they offer the finest medical care for inmates, the opposite is true. Many in my unit filed numerous sick calls that were not addressed in a timely manner or at all. One man on my caseload suspected he had an abdominal tumor - his solution - swallow batteries and razor blades so an operation had to be done. Surgeons found the tumor, by the way. Please read the Palm Beach Post articles regarding the horrors and pain inflicted on inmates.
- Currently,
private providers of medical and mental health services to
- With
regard to cameras: Having all blind spots covered and overlapped by
multiple cameras is a good start. However, depending on the DOC to
monitor, maintain, and preserve footage would be problematic. In my unit,
Darren Rainey was shown being put in the shower and then the video tape or
CD mysteriously malfunctioned. There was no mystery there - guards or DOC
personnel sabotaged surveillance footage. While DOC personnel may monitor
cameras in their respective prisons, I would suggest an offsite (Bradley's
Oversight Committee) facility independent of the DOC and IG's office to simultaneously
monitor and store footage from all prisons in
News Articles
After Florida
The 2010 death of an
inmate in a prison in the Panhandle is being investigated once again amid
questions about the original investigation.
BY JULIE K. BROWN
08/30/2014 8:54 PM
Randall
Jordan-Aparo died weeping and gasping for breath on the concrete floor of his
prison isolation cell, naked except for his white boxer shorts.
Incensed that he had cursed at a nurse, guards at Franklin
Correctional Institution in the Panhandle fired nine blasts of noxious gas into
his 13-by-8 cell through a slot in the door and, ultimately, left him there,
sobbing.
“I can’t breathe, I can’t take it no more, please help me,’’ he
pleaded.
Five hours later, the 27-year-old was found lifeless, face-down on
the bare slab. His mouth and nose were pressed to the bottom of the door, as if
trying to gulp fresh air through the thin crack. His hair, legs, toes, torso
and mouth were dusted with a faint orange residue, a byproduct of the gas.
A paperback Bible was under his shoulder.
The Florida Department of Law Enforcement sent two investigators,
Michael Kennedy and Michael DeVaney, to look into what had occurred. Their
conclusion, summarized in one paragraph: The “disciplinary actions” taken by
guards had no bearing on the death.
“They just said he got sick,’’ Jordan-Aparo’s father, Thomas
Aparo, recalled being told by corrections officials.
Four years after the September 2010 incident, Jordan-Aparo’s
death, and the Florida Department of Corrections’ and FDLE’s highly
questionable account of how and why it occurred have spawned a federal
investigation, a new probe by FDLE and an uprising by staff in the prison
system’s inspector general’s office. Four inspectors say their boss, Inspector
General Jeffery Beasley, threatened them at last year’s Christmas Party, saying
he’d “have their asses” if they didn’t quit poking their noses into the case,
court papers say.
Meanwhile, at least three Franklin Miami
An investigative detour
The Jordan-Aparo case is one of a growing number of deaths being
scrutinized by criminal investigators, part of a scandal that has embarrassed
the head of the Department of Corrections, Secretary Michael Crews, and begun
to tar those closer to Gov. Rick Scott.
The current investigations grew out of a 2013 probe of “garden
variety” corruption at Franklin Aubrey
Land
Inmates at Franklin
Intrigued, the inspectors began digging. They interviewed inmates,
studied the use-of-force report, the video captured by surveillance cameras,
audio of the incident and photographs of Jordan-Aparo’s body. Among their
findings:
• A claim by prison staffers that Jordan-Aparo was being
“disorderly” before his death was false.
• Initial reports downplayed the fact that Jordan-Aparo was complaining about experiencing extreme pain and simply wanted medical attention, preferably in a hospital.
• Contrary to claims that his cell had been decontaminated after the gassing, photos clearly showed residue everywhere — orange smears on the floor, in the sink and in the toilet bowl. There was a dense orange cloud above the bunk where Jordan-Aparo would have sat.
• Although reports said Jordan-Aparo was issued a fresh set of clothing after the gassing, he was dressed only in dirty, orange-stained boxers.
• Nobody assigned to investigate the matter administratively from the Department of Corrections watched the “use of force” video showing Jordan-Aparo being gassed.
• Initial reports downplayed the fact that Jordan-Aparo was complaining about experiencing extreme pain and simply wanted medical attention, preferably in a hospital.
• Contrary to claims that his cell had been decontaminated after the gassing, photos clearly showed residue everywhere — orange smears on the floor, in the sink and in the toilet bowl. There was a dense orange cloud above the bunk where Jordan-Aparo would have sat.
• Although reports said Jordan-Aparo was issued a fresh set of clothing after the gassing, he was dressed only in dirty, orange-stained boxers.
• Nobody assigned to investigate the matter administratively from the Department of Corrections watched the “use of force” video showing Jordan-Aparo being gassed.
Their conclusion: Jordan-Aparo died as a result of medical
negligence and the “sadistic, retaliatory” use of chemical agents on a sick and
helpless inmate who did nothing wrong. And that staff reports following the
death contained inconsistencies, errors, omissions and outright lies.
According to the four inspectors who went to Franklin Franklin
The photos were taken as evidence. A lawyer for the corrections
officer later complained.
For that, they were told, they were now being targeted.
Relations between the inspectors and their boss deteriorated
further, culminating in the alleged encounter during the 2013 Christmas party.
The inspectors went above Beasley’s head, approaching Secretary Crews and,
ultimately, the governor’s chief inspector general, Melinda Miguel. They sought
whistle-blower status, essentially a guarantee that they would not face
retaliation for bucking the chain of command.
In a meeting with Miguel that was tape recorded, with permission,
by Land, he detailed what he called the Jordan-Aparo cover-up, other corruption
within the department and the retaliation he and others were subjected to by
Beasley. Miguel denied whistle-blower status to Land and to the others, who had
similarly requested protection.
The four filed suit in federal court in July of this year. In the
lawsuit, which names Miguel, her deputy, Beasley and his deputy as defendants,
the four say they faced retaliation for trying to investigate alleged
departmental wrongdoing, which is their job.
Recently, two more inspector general staffers came forward,
claiming that they, too, were subjected to threats and intimidation after
telling their bosses and Miguel about possible criminal misconduct by prison
staff. One of them, inspector James Padgett, claimed that Beasley and deputy
Kenneth Sumpter committed perjury and obstruction of justice while trying to
squelch other investigations.
In a written statement Friday, Miguel said she and corrections
staff are cooperating with the investigation into Jordan-Aparo’s death, adding
she has “zero tolerance for unethical or abusive behavior’’ in the department.
Crews, in a written statement, said that he is cooperating as
well, and working hard to make it clear that “fabrication, lies, deception,
retaliation or other unethical behavior’’ will not be tolerated in the system.
Neither Miguel nor Crews would talk about the case with a Miami
Herald reporter.
Culture of ‘impunity’
In May, the Herald began a series of articles about prison deaths
with the story of Darren Rainey, a 50-year-old mentally-ill inmate at Dade
Correctional Institution south of Homestead
After he defecated in his cell and refused to clean up the mess,
Rainey was herded by corrections officers into a locked, closet-like shower and
left there, subjected to a stream of unbearably hot water for as long as two
hours until he collapsed and died. His pleas for mercy went unheeded, according
to inmate witnesses.
Unlike the Jordan-Aparo case, where the recent allegations have
been made by highly regarded staffers, the complaints about Rainey’s treatment
came from fellow inmates, who witnessed what went on or heard his screams and
sent a string of letters and grievances to prison department leaders. They were
ignored. The June 2012 death went uninvestigated for nearly two years, until
the Herald began interviewing inmates in May.
In the wake of the Herald’s reporting, Crews fired Dade
Correctional Warden Jerry Cummings and his deputy, Royce Dyke. The guard
suspected of being primarily responsible for forcing Rainey into the shower, a
beefy former college lineman, resigned in July. To date, no one has been
criminally charged. At a pair of news conferences, Crews vowed reforms, not
only at Dade Correctional, but across the prison system.
When they filed suit, the prison system inspectors attached copies
of the Herald stories on the questionable deaths of Rainey and other inmates to
support their claim that the department isn’t exercising due diligence in
investigating suspicious inmate deaths.
Howard Simon, executive director of the ACLU of Florida, said
despite Crews’ promises of reform, the state’s prison system isn’t likely to change
until people are held accountable and prosecuted.
The problem, he said, is not one incident but “a culture within
the [Department of Corrections] in which guards feel they can kill inmates with
impunity.’’
Two brothers
Life was not easy for Jordan-Aparo even before he landed in the
bleak confines of Franklin Correctional. Shawn Jordan-Aparo, his younger
brother, said their birth father was a drug dealer who sexually abused him and
his older brother from the time they were little. Their mother, he said, was a
drug addict who was in and out of prison and was never able to take care of
them.
At the ages of 5 and 7, the boys began a nomadic life that Shawn
says took them to 28 different foster homes over the next five years,
“We got to the point that we didn’t even unpack our stuff. We just
skipped from home to home,’’ he said.
Both boys suffered from a genetic blood disorder,
Osler-Weber-Rendu (HHT) syndrome, a treatable but little-known disease that
causes abnormal blood vessel formation in the lungs, liver, skin and brain that
often leads to chronic nose-bleeding and lesions on the skin and around the
mouth.
Shawn said he and Randall ended up in an orphanage in Tampa
“I just knew it would be hard for them to be adopted at their
age,” Thomas Aparo said. “I wanted to give them a second chance.”
But by then, the boys were teenagers, and after spending most of
their young lives tethered to foster care, the lure of new-found freedom was
too tempting. They struck out on their own and began getting into trouble.
“Neither one of us knew anything about drugs, sex, school, friends
that get you trouble, having a work ethic. No one really taught us all those
things.
“We were always kind of on our own. We weren’t bad people. We did
what we had to do to survive. We stole food from Walmart — no gang-banging or
violent things,’’ Shawn said.
He said Randall was like a father figure, taking care of him and
sometimes taking the fall when they got into trouble.
While both served time in prison on and off, they remained in
touch.
In 2010, with Randall doing a stretch at Franklin and Shawn on the
outside, the brothers started planning a new life. They spoke on the phone
three months before Randall’s death.
“He was talking like he was happy. He was saying ‘I’m almost out
and maybe we can get together and change.’ And three months after that — bam —
he is dead.’’
At first, Shawn said, the family was told that Randall had
suffocated in his cell. Then they were told he died of internal bleeding. But
nothing seemed to make sense because, Shawn said, Randall was in good health
the last time he spoke to him.
After the memorial service, Shawn heard from an inmate’s mother.
She said her son had written her from Franklin
Anguish and anger
A week before Jordan-Aparo’s death on Sept. 19, 2010, he began
experiencing bleeding problems, Department of Corrections records indicate. On
Sept. 15, senior registered nurse Pamela Housholder noted that Jordan-Aparo had
complained of back pain after falling while playing basketball on the prison
grounds.
Over subsequent days, Jordan-Aparo collapsed several times and was
taken at least three times to the infirmary, where nurses did little to help
him, records show. He had a fever of 102, told the medical staff his lungs and
his heart were hurting and that he was having trouble breathing.
At one point, nurse Martha Greene performed an electrocardiogram,
but admitted she wasn’t good at reading the results. She said his heart was
working fine.
Greene contacted the prison doctor, who instructed her to start an
intravenous application and keep the inmate in the infirmary. After several
unsuccessful attempts at inserting the IV, they gave up and left Jordan-Aparo
in the infirmary overnight, records said.
The next morning, at 4 a.m. Sept. 18, Greene and LPN Lucy Franklin
examined Jordan-Aparo, who complained he was in pain and needed to go to the
hospital.
Jordan-Aparo, becoming agitated, at one point blurted: “I am going
to sue your f------ ass. I need to go to the hospital!’’
Greene summoned Capt. Mitchell Brown, who without consulting a
doctor, decided to remove Jordan-Aparo from the infirmary and place him in an
isolation cell — No. 1104 — for causing a “disturbance,” prison records said.
“Ain’t nobody comin’ to help you,’’ a guard known as Big Jit told
Jordan-Aparo, according to witnesses. He then ordered the inmate to “man up’’
and shut up.
Jordan-Aparo’s file was then reviewed. Although his disease could
cause respiratory difficulties and the department was aware of his affliction,
the file indicated that he “had no known medical condition that would be
exacerbated by the use of chemical agents.”
At 11:25 a.m., after receiving approval of Col. Timothy Copeland,
the duty warden, Lt. Roland Austin gave the order to gas Jordan-Aparo.
First he was given a “final statement,” telling him why he was
being gassed. Then, with video surveillance cameras rolling, Officer James Hamm
sprayed three one-second bursts of OC, a concentrated form of pepper spray,
striking Jordan-Aparo in the upper torso, Hamm
At 11:59, Hamm
In all, Jordan-Aparo was subjected to 600 grams of chemical agents
in a confined space.
Sven-Eric Jordt, a professor of pharmacology at Duke University
“Obviously, the agent was sprayed directly onto the inmate and may
have deposited on his skin, clothing, eyes and mouth at much higher
concentrations, with less of it airborne, making the concentrations that much
higher,’’ he said.
The guards said they “escorted’’ Jordan-Aparo to a decontamination
cell, although inmates would later say that Jordan-Aparo was dragged.
Photographs and other evidence raise questions about whether he was
decontaminated at all.
“He was orange,’’ one inmate told investigators two years later.
“I can’t take it, I can’t take the gas, I can’t breathe’’
Jordan-Aparo said, according to another inmate interviewed by prison system
inspectors in 2013.
Jordan-Aparo was so weak after a shower that guards had to put him
in a wheelchair to take him back to his cell. Photographs of his body reviewed
by the four inspectors in 2013 show that, despite visiting the shower, he was
clearly still coated with residue.
If he and his cell were not properly decontaminated, Jordt and
other experts said, Jordan-Aparo would have continued to be exposed to the
chemicals, breathing in the toxins — until breathing would become almost
impossible.
At about 12:30 p.m. he was taken to the infirmary and examined.
Nurse Ola Riley couldn’t get a blood pressure reading because the inmate was
uncooperative, prison records said. But she did record wheezing in the lower
right lobe of his lung. She and nurse Franklin then contacted the on-call
physician, Dr. Mohammad Choudhary, who instructed them to try again to take his
blood pressure. Instead, they allowed the guards to take Jordan-Aparo back to
his isolation cell.
Nearly two hours later, reports say, Riley and Franklin went to
the inmate’s cell in a repeat attempt to take his blood pressure. Jordan-Aparo
was unable to move, refused to cooperate and wouldn’t sign a release form, so
the nurses left, records said.
At 4:30 p.m. Sgt. Kevin Hampton tried to give Jordan-Aparo his
dinner tray and found him sprawled on the floor. He refused to eat. Asked if he
was OK, Jordan-Aparo purportedly gave a thumbs-up sign.
Even healthy inmates are supposed to be checked every 30 minutes,
but it’s not clear whether anyone looked in on Jordan-Aparo from 4:30 until the
time his body was found at 6:08 p.m.
The Herald also reviewed hundreds of documents, including letters
and emails, showing that the prison’s then-warden, Diana Andrews, and Miguel
had been told from at least 2011 that there were lingering questions about the
way Jordan-Aparo had died.
On the night of his death and the following day, another Franklin
Bullins and Donovan began contacting prison officials, repeatedly
writing letters. Bullins, who was also a member of the corrections officers’
labor union, said she began receiving threats from her bosses that her job was
in jeopardy.
In April 2011, two years before the four inspectors approached
Miguel, she contacted the chief inspector general to request whistle-blower
protection. The request was denied, the inspectors’ lawsuit says. She was subsequently
fired in a dispute over medical leave.
Dueling doctors
Dr. Lisa Flanagan, the medical examiner who did the autopsy on
Jordan-Aparo, didn’t attribute his death to the application of gas. She wrote
that the cause was “complications of multiple cardiac and pulmonary abscesses’’
and mentioned the gas only as an explanation for the staining of Jordan-Aparo’s
skin.
But in a post-autopsy meeting with FDLE investigators, Flanagan
noted that had Jordan-Aparo received timely and proper medical care from the
onset of his sickness, he may not have died.
Dr. John Balmes, an inhalation injury expert with the University of California
“He had a fever. He passed out. He had a serious blood-born
infection and they gave him an irritant gas that can cause fluid in his lungs,”
said Balmes, who reviewed records at the request of the Herald. “They gave him
something that made him sicker and that gas contributed to his death.’’
Cyril Wecht, a nationally known forensic pathologist who also
reviewed the records at the Herald’s request, called the case one of the worst
he has ever seen in terms of how many people were involved .
“This prisoner’s abscesses didn’t develop overnight, and for him
to have been in the [infirmary] and then to be gassed ... the people who have
ignored this in some ways are even more ignorant than the horrible guards and
nurses,’’ said Wecht, who has been involved in various high-profile cases, including
reviewing the deaths of John F. Kennedy, Robert Kennedy, Elvis Presley and Anna
Nicole Smith.
Despite evidence of medical neglect and excessive force, no one
was charged with a crime. The state attorney’s office for Franklin County
The FDLE report said: “Though inmate Jordan-Aparo did complain
numerous times of medical problems commencing four (4) days prior to this
death, it is not the scope of this criminal investigation to address those
issues.”
That was based on the information available at that time, said
FDLE spokeswoman Gretl Plessinger. When new information became available, the
case was reopened and it remains active, she said Saturday.
Suspended with pay are Sgt. Hampton (aka, “Big Jit’’) Lt. Austin
and Randall Johnson. A fourth guard, Terry Whitlock, was fired in 2012, though
it’s not clear if that was connected to the Jordan-Aparo case, and prison
system officials declined to explain.
The on-call doctor, Choudhary, held a temporary certificate to
practice medicine in an area of critical need — in this case, the prisons. Five
months after Jordan-Aparo’s death, while on call at the Alachua County Jail in Gainesville
He was later found passed out drunk behind the wheel of his car,
according to state Department of Health records. A review by the state medical
board resulted in a reprimand and a fine, but he kept his license. There is no
criminal arrest on his record.
One of the nurses who examined Jordan-Aparo, Patricia Lemon, had
her license put on probation for three years prior to coming to Franklin Florida
3 months too late
Jordan-Aparo, who was serving a 19-month stretch for credit card
fraud and drug possession when the guards gassed him, would have been released
three months later had he lived.
Instead he was cremated, with the remains sent home to Thomas
Aparo in Palm Harbor
Aparo, who had drifted apart from Shawn and Randall, declined to
discuss Randall’s death.
Randall Jordan-Aparo’s brother, Shawn, had plenty to say. He is
angry.
“There is no reason he should have passed away, no reason he
shouldn’t have been to the hospital,” Shawn said. “I never got a chance to say
goodbye.’’
Inmate’s gassing death detailed in Florida
Joining a chorus of criticism of Florida ’s prison system,
four investigators filed a whistle-blower complaint against their employer.
BY JULIE K. BROWN 07/07/2014
Four investigators with the Department of Corrections have accused
the state of Florida of running a prison system rife with corruption, brutality
and officially sanctioned gang violence — and of retaliating against them when
they tried to expose what was going on.
The four filed a federal whistle-blower complaint on Monday
alleging that state prisoners were beaten and tortured, that guards smuggled in
drugs and other contraband in exchange for money and sexual favors, and that
guards used gang enforcers to control the prison population. They claim those
actions were either tacitly approved or covered up.
For weeks, the Miami Herald has reported on claims of abusive
treatment by corrections officers, as related by inmates, nurses and a
psychotherapist, primarily at Dade Correctional Institution, where an inmate
was herded into a scorching hot shower and left until he collapsed and died.
Now claims of abuse are coming from DOC investigators, the persons charged with
rooting out such abuses.
“We have zero tolerance for unethical behavior, and take any
allegations of abuse seriously,” said Melinda Miguel, Gov. Rick Scott’s chief
inspector general. “An investigation into these allegations is currently
active, and upon the conclusion of the investigation information will be made
publicly available.”
In the complaint and accompanying documents, veteran investigator
Aubrey P. Land described the death of a 27-year-old inmate, Randall
Jordan-Aparo, who was found lifeless — a Bible next to his head, his body
coated with yellow chemical gas — at Franklin Correctional Institution in
September 2010.
According to Land ,
Jordan Franklin
Jessica Cary, a spokeswoman for the DOC, said the agency had not
yet seen the lawsuit so it could not comment.
To date, no one has been criminally charged or held
administratively responsible in the death of Jordan-Aparo.
“I’ve done this for 30 years. My skin don’t crawl very often,’’
Land told Miguel in a taped interview in March.
“They killed that damn kid [Jordan-Aparo]. He laid there for five
days begging for help.’’
In their lawsuit, Land and fellow investigators John Ulm and Doug
Glisson concluded that the DOC’s 2010 Jordan-Aparo death investigation “was
either intentionally misleading or the Department of Corrections’ investigators
at the scene in 2010 had been grossly negligent.’’
The case is one of several DOC inmate deaths that remain under
investigation. The fourth plaintiff, David Clark, was not involved in the
Jordan-Aparo case, but investigated others.
In May, the Miami Herald reported on the death of Darren Rainey, a
mentally ill inmate at Dade Correctional placed in an excruciatingly hot
shower, allegedly as punishment for defecating in his cell. As with
Jordan-Aparo, Rainey, 50, is said to have begged for help before he died. A
fellow inmate said guards who placed him in the closet-like chamber taunted him
by asking: “Is the shower hot enough?’’
After two years, Miami-Dade police have yet to complete their
probe, and Miami-Dade Medical Examiner Bruce Hyma has not released the cause of
death. The Department of Corrections suspended its investigation but says it
has reopened the matter, at least to look at how showers are used in the prison
system.
The American Civil Liberties Union of Florida, as well as church
and human rights groups, have asked for a U.S. Justice Department probe into
the Rainey case.
Dade Correctional inmate Harold Hempstead, a burglar serving more
than 100 years, repeatedly wrote letters to the office of DOC Inspector General
Jeffery Beasley providing details about the death of Rainey, who was serving a
two-year term for drug possession, and the alleged scalding of other inmates.
Convicted killer Mark Joiner also wrote a letter, saying he helped clean up the
“crime scene’’ and was ordered to discard evidence.
In an interview with the Herald, Joiner said he placed pieces of
Rainey’s skin that had peeled off his body into a shoe. A guard told him to
throw the shoe away, he said. Neither Hempstead
nor Joiner was interviewed by police or the DOC until the Herald began writing
about Rainey’s death.
Land told Miguel he learned about Jordan-Aparo’s death when he was
sent to Franklin
“We got inmates down there that are getting their throats slashed
on a regular basis,’’ Land said, according to a transcript of the Miguel
interview filed with the lawsuit. “Their faces slashed, beat down with locks
and socks; tremendous amount of contraband allegations that staff is ordering
this and bringing in contraband and being paid and everybody we’re talking to
is saying, ‘You know they killed that kid.’ ”
“So finally, I had heard enough. And I said, go back and start
looking at all the deaths. Nobody would give me a name. And I find Randall
Jordan-Aparo and immediately bells and whistles start going off. This thing
ain’t pretty.’’
In an interview with the Herald, Jordan-Aparo’s father, Thomas
Aparo, said prison officials and the Franklin County medical examiner told him
that his son had died of an “infection’’ that, he said, they likened to a cold.
In reality, the 27-year-old suffered from a rare blood disorder
that was noted in his prison medical file, according to records obtained by the
Herald. He had been ill for weeks prior to his death, begging for medical
attention as he increasingly grew weaker.
When he could barely breathe, walk or talk, he demanded that the
prison’s nurses take him to the hospital. They allegedly refused, even after
consulting by phone with doctors and other medical staff.
Jordan-Aparo became angry, and cursed the nurses, threatening “to
sue their asses’’ if they didn’t get him to the hospital, records show.
The nurses called the guards, claiming Jordan-Aparo was being
“rude.” The guards placed him in a steel-walled solitary-confinement cell.
“The next day, the captain comes down there and gasses him, and
gasses him and gasses him,’’ Land told Miguel.
He was sprayed so much that photographs show the outline of his
body surrounded by mustard-colored gas all over the cell walls.
The prison’s supervisors and guards fabricated reports saying that
their use of chemical agents was justified because Jordan-Aparo was “causing a
disturbance.’’ Land, who said he viewed video footage of the inmate’s last hours, said the
inmate was too sick to cause a disturbance and that all he wanted was to go to
the hospital.
Land said Beasley had interfered with an earlier probe of his
involving a corrections officer whose brother worked under the DOC inspector
general. Land told Miguel that Beasley had cited “professional courtesy’’ as
cause not to pursue a case against the officer, who was accused of accepting
bribes and sexual favors in exchange for giving a woman access to a prisoner
with whom she was having a romantic relationship.
Land said he refused to go along.
“I’m not going to be bullied over this,’’ Land told Miguel. “And
I’m going to tell the Jordan-Aparo story.’’
He further told Miguel that by October 2013, with the Jordan-Aparo
probe complete, he and fellow investigators Ulm
The investigators say DOC Secretary Michael Crews told them that
if they wanted whistle-blower status — a form of protection from administrative
sanctions — they should take their concerns to Miguel.
Land said he was referred by Miguel to the Florida Commission on
Human Relations, which investigates discrimination and sexual harassment as
well as whistle-blower-type complaints.
The FDLE confirmed that the FBI
and the U.S. Attorney General are investigating Jordan-Aparo’s death
________________________________________
POST INVESTIGATION: PRISONERS DYING FOR
CARE
Privatizing prison health
care leaves inmates in pain, sometimes dying
Updated: 6:05 p.m. Friday, Sept. 26,
2014
By Pat
Beall - Palm Beach
Inmates called her Red, for the thick auburn hair her
beloved older sister once painstakingly curled.
Smart as a whip at 9, Donna Pickelsimer was troubled in
her teens, struggling with alcohol in her 20s and, at 52 a convict, sentenced
to 15 years behind bars.
Under the care of Florida
Handing off prison inmate medical care to for-profit
companies was designed to deliver tens of millions of dollars in taxpayer
savings beginning in 2012.
But for inmates, it has come with cold-blooded
consequences, a Palm Beach Post investigation found.
Post
investigation: Prisoners dying for care
Just months after all medical care in state prisons was
privatized, the count of inmate deaths spiked to a 10-year high in January and
continued at a record pace through July.
Doctors have expressed alarm. The number of seriously ill
prisoners sent for outside hospital care is on track to drop by 47 percent from
2012, the last year for which the state handled medical care. Inmates say
prescription painkillers are abruptly replaced with over-the-counter drugs such
as ibuprofen.
Pickelsimer’s undiagnosed lung cancer was treated with
Tylenol and warm compresses.
Serving time for manslaughter, “Donna did something wrong,
and she went to prison to pay for what she did,” said Pickelsimer’s sister,
Beverly Clancy. “But she was not sentenced to death.”
Following weeks of questions from The Post about inmate
deaths, Florida
“The level of care continues to fall below the
contractually required standard,” wrote DOC Secretary Michael Crews. Problems,
noted Crews, had begun almost as soon as Corizon took over inmate care for the
vast majority of state prisoners.
“We are currently in the process of evaluating Secretary
Crews’ concerns, and will work in a spirit of collaboration to address them,”
said Corizon spokeswoman Susan Morgenstern. “Corizon works hard every day to
deliver quality care to our patients,” she added. “We take that responsibility
very seriously.”
Only dollars and cents
Forking over millions of dollars to pay for inmate health
care never has been politically popular. And when Gov. Rick Scott, a former
hospital conglomerate executive, campaigned in 2010 on saving tax dollars by
turning over prison medical care to for-profit companies, lawmakers embraced
the idea.
In 2012, the state inked inmate health care contracts
totaling $1.3 billion with two companies: Wexford Health Sources for care at
nine major prisons and Corizon Inc. for approximately 44. In addition, the
companies care for inmates at prison annexes, work release centers and two
centers for new inmates — roughly 100,000 prisoners in all.
Brenda V. Smith, a law professor at American University
“You have to be concerned about how you are getting these
cheap rates.”
No state is under a legal obligation to provide inmates
with excellent medical care.
They are, however, legally bound to provide adequate care
by the U.S. Constitution’s ban on cruel and unusual punishment.
“I admit I was one of those saying, ‘Hey, they’re in
prison, they can’t expect a lot,’ ” said Sandra Bustin, whose nephew was given
over-the-counter painkillers such as Aleve for bone cancer. “But even basic
care was missing.”
Bad numbers
In fact, inmate deaths are sharply up, according to
state-supplied mortality data.
Data analyzed by The Post excluded deaths from homicides
and accidents. Included are deaths from natural causes, such as disease and
infection, as well as suicides and deaths in which the cause is listed by the
state Department of Corrections as “pending.”
Suicide, a tiny portion of the deaths in all years, is
considered a medical issue, as psychiatric care is part of the private
companies’ health care contracts. The “pending” category, which occurs most
frequently in 2014, is almost always determined to be a death from natural
causes, 15 years of prisoner death records show.
Among the The Post’s findings:
·
In January, roughly 100 days after medical privatization was fully
phased in, the monthly inmate death count shot to a 10-year high of 36.
·
Inmate deaths for the first seven months of this year totaled 206,
also a 10-year high when compared with the first seven months of any other year
and an 18.4 percent increase from the first seven months of 2012, when the
state handled medical care.
·
When the state was in charge of all or most medical care, the
monthly count of inmate deaths reached or topped 30 a total of 15 times in 10
years. That includes one year where the monthly death count hit 30 twice and
topped 30 twice. This year, deaths topped 30 a total of four times in just
seven months.
·
At the current rate of deaths, 2014 will have about 5 percent more
deaths than the 313 recorded in 2012, the previous high.
Some deaths are expected: Age 50 is considered elderly
among inmates, the result of little or no health care prior to prison.
“Many of our patients have not had access to health care
before they see us and are already suffering from addiction, mental issues and
chronic conditions such as diabetes and hypertension,” said Susan Morgenstern,
a spokeswoman for Corizon. “We are not always able to restore them to full
health again.”
Any number of factors can push mortality rates higher,
such as an influx of older inmates, pointed out DOC spokeswoman Jessica Cary.
And, said Cary
“This is a snapshot in time,” she said of the 2014
numbers. “While we are continuing to monitor the number of deaths and their
causes very closely, another year or more of information is needed to identify
a trend.”
However, Crews’ Sept. 26 letter to Corizon makes clear the
agency expressed concerns about shortcomings in medical care, nursing, mental
health and administration fewer than 90 days into the company’s contract.
Repeated meetings have yet to fix the problems, Crews
wrote, and now, the state is considering financial penalties. Payment will be
withheld for each prison where Corizon fails to meet 80 percent of auditing
standards. If a prison fails multiple audits, Corizon may have that facility
cut from its contract.
Different suits, same complaints
Even as the state was quietly meeting with Corizon last
year, inmates and doctors were voicing concerns.
Three private-practice doctors outside the Florida
It wasn’t a perfect system when the state was in charge,
said one, but now: “We order surgery and they don’t come in. They are dying
before they get to surgery.”
At Memorial Hospital in Jacksonville, a once-busy ward
designed to house more than two dozen prison inmates now holds as few as three
or four a day, doctors say.
State numbers confirm the sharp dropoff: In the first
eight months of this year, Corizon and Wexford sent just 1,009 inmates to
outside hospitals. At that pace, the number of inmates referred to hospitals
this year will plunge 47 percent from 2012, when DOC handled health care.
George Horn is among those waiting for surgery. The
Columbia Correctional inmate was left with space where his right hip joint
should be, according to his federal lawsuit. Horn’s artificial hip joint was
surgically removed in early 2013, one of three surgeries needed to treat an
infection. Wexford first approved, but later denied an operation to replace the
bone, leaving Horn, who has six years left on an 11-year burglary sentence,
without a hip joint.
Horn said he recently was told he would get another
surgical consult, eleven months after the surgery was originally planned.
Tylenol for nerve pain
The Post reviewed more than 350 federal lawsuits brought
by a Florida
“In our litigious society, people file lawsuits for many
reasons of their own,” said Corizon’s Morgenstern. “I can tell you that the
majority of lawsuits filed against us are dismissed or resolved before they
ever go to court.”
However, lawsuits alleging serious medical complaints
tended to describe the same types of problems: fewer consults or treatment by
outside specialists, Tylenol and ibuprofen prescribed for overwhelming pain and
medication abruptly changed or withdrawn.
For instance, several Florida
A 60-year-old Florida
Separately, an inmate with a narrowing of spaces in the
spine said state doctors prescribed Neurontin for three years to treat related
nerve pain. “All that changed in November 2013,” he said, after Corizon began
providing care. “I was told that the Aleve they gave me to replace the
Neurontin I was on was the only thing I was going to get.”
When the inmate asked why, the doctor wrote first that the drug was no longer
approved; when the inmate persisted, the physician changed the explanation,
writing that the inmate no longer met criteria for getting the drug.
Crutches, shoes
One blind prisoner who has trouble walking was prescribed
orthopedic shoes in 2008, legal documents show. Such shoes can retail for as
little as $99. DOC regularly filled his prescription beginning in 2009. This
year, when it was time to replace the shoes, Corizon’s doctor refused, the
inmate said in written grievances filed at the prison.
In another case, an inmate’s leg prosthesis was taken from
him by state guards. The amputee was given crutches. Corizon
authorized a new prosthesis— the inmate’s $10,000 device was lost — but in a
federal suit, the inmate says five months lapsed before it was delivered. All
the while, the muscle in what remained of his leg was withering.
When the inmate did get the device, it wasn’t fitted, said
Randall Berg, executive director of the Florida Justice Institute, a legal
advocacy group. As a result, “The stump became raw and infected and finally
after some pressure from us they gave him antibiotics,” he said.
Federal law bars the state, Corizon and Wexford from
discussing an inmate’s health.
However, DOC’s Cary
In incidents involving Wexford, said spokeswoman Wendelyn
Pekich, “We are confident we and our employees acted appropriately. For those
instances still pending, we believe further investigation will demonstrate and
prove the lack of any wrongdoing or negligence.”
Dramatic cuts
Determining whether medical care is appropriate and
necessary is a key component of containing medical costs. And Corizon’s bid for
Florida business emphasized the successes of
its own cost containment strategies with a series of dramatic cuts: In Maine in 2011, Corizon
said, “We have developed a new working definition of ‘medically necessary
care,’” which cut visits to health care providers outside the prison by 30
percent.
In New Mexico, a new system
of monitoring psychiatric drug prescriptions slashed monthly costs from
$180,000 in 2007 to less than $30,000 in 2011, an estimated taxpayer savings of
$2.1 million a year.
“You can overtreat,” she said. For instance, the state may
have over-prescribed psychiatric drugs. Fewer ER visits may mean a company is
improving preventive care.
Fewer outside consults might mean that mobile X-ray and
ultrasound services are being brought to the prison. “Making quality specialty
and diagnostic services available within the prison facilities reduces the need
for inmate patients to travel to community hospitals,” points out Wexford’s
Pekich. That’s what Corizon did in Arkansas
Seizing control
But Bedard’s research on 1990s-era mortality rates also
found deaths rose slightly in prisons where care is provided by private
companies, “and that leads to a whole host of questions.”
The same year Maine
In Idaho, where psychiatric drug use dropped by 13 percent
in 2011 and prisons had one of the lowest rates of inmate hospitalization in
the country, a 2012 report by a court-ordered monitor was so
critical of Corizon’s care at one prison that the state sought to keep it
sealed.
The cost of not getting health care right can wipe out
taxpayer savings: States are usually sued right along with the health care
companies, and inmate lawsuits rack up a state’s legal defense bills.
Equally problematic is that federal judges overseeing
class-action cases can seize oversight from the state and dictate details of
care. That’s what happened in Florida in 1972,
when a prisoner’s handwritten lawsuit prompted federal judges to oversee Florida
The substandard health care at the heart of that case was
provided by the state, not private companies. However, William Sheppard, a Jacksonville
Sheppard doesn’t doubt the companies are saving the state
money. But, he says, cases like Pickelsimer’s exact another price: “How much
does it cost your soul to watch these people die?”
Staff writer Kavya
Sukumar contributed to this story.
2 private health care firms
Two companies won contracts in 2012 to provide medical care
to the state’s prison inmates; privatization was complete by the end of 2013.
Corizon Inc./Valitas Health Services
HQ: Brentwood ,
Tenn.
Incorporated: 2011, following a
merger between the corporate parents of PHS Correctional Healthcare and
Correctional Medical Services. Corizon Inc. and Corizon Health are the
subsidiaries of Valitas Health Services, which is majority-owned by a Chicago
Annual revenue: $1.4 billion
Provides health care for 362,000 offenders in 27 states
Florida prisons: Regions I and II; Central Florida
Reception Center; Avon Park, Hernando, Lake, Polk, Sumter and Zephyrhills
prisons and their annexes, work camps, road prisons and work release centers.
Wexford Health Sources Inc.
HQ: Pittsburgh
Incorporated: 1991
Provides health care and other services for about 165,000
offenders/ residents in 13 states
Annual revenue: Not publicly
available
Florida prisons: South Florida Reception
Center; DeSoto Annex, Hardee, Arcadia, Charlotte, Okeechobee, Martin,
Everglades, Dade and Homestead prisons and their annexes, work camps, road
prisons and work release centers.
Source: Florida Department of Management Services, company
reports, Moody’s Investor Services
Award-winning prison reporting
Palm Beach Post investigative reporter Pat Beall won the 2014 Hillman Foundation award,
a national investigative journalism award. Her eight-month multipart series, “Private Prisons: Profits, Politics, Pain,”linked
a nationwide pattern of human rights abuses to corporate cost-cutting.
DOC warns Corizon
Following weeks of questions from The Post about inmate
deaths, Florida
Award-winning prison reporting
Palm Beach Post investigative reporter Pat Beall won the 2014 Hillman Foundation award,
a national investigative journalism award. Her eight-month multipart series, “Private Prisons: Profits, Politics, Pain,”
linked a nationwide pattern of human rights abuses to corporate cost-cutting.
DOC warns Corizon
Following weeks of questions from The Post about inmate
deaths, Florida
_______________________________________________
Privatizing prison care:
Warm compresses, day of rest for cancer lumps
Posted: 12:00 a.m. Saturday, Sept.
27, 2014
By Pat
Beall - Palm Beach
Even as lumps bulged from Donna Pickelsimer’s upper arm
and back, Hernando prison’s medical staff prescribed Tylenol and hot compresses
to treat her undiagnosed lung cancer.
Unable to bear the pain, Pickelsimer at one point wept
that she wanted to cut her arm off.
That prompted solitary confinement.
Six weeks later, she was dead.
It’s likely Pickelsimer never knew she was dying.
Post
investigation: Prisoners dying for care
Neither did the Corizon nurses and Haiti-educated doctor
treating her, according to more than 800 pages of medical records provided by
her family to The Palm Beach Post.
Some records omit information, or provide conflicting
information. On s, dates are changed.
But available records show that Pickelsimer was weeks from
death before malignancy was first mentioned and the cluster of lumps beneath
her skin fully documented.
For four months, Pickelsimer begged for relief. Unable to
dress herself or bathe, her arm hanging at her side, Pickelsimer’s unrelenting
pain and worsening symptoms were variously treated as a rotator cuff injury, a
cold and pockets of fluid which could be massaged away.
“I don’t know if medical could have prevented her death,”
wrote Lisa Key, another inmate. “But they definitely could have prolonged her
life and kept her out of so much pain.”
Cough, then pain
Serving 15 years on a manslaughter charge, Pickelsimer
could have a tough exterior. So when she admitted feeling sick, Key was
concerned.
“It started with a cough about a year ago,” Key wrote to
Pickelsimer’s sister. “All medical would do was listen to her lungs and tell
her they were clear. “
In February, a nurse noted that Pickelsimer, for 35 years
a two-pack-a-day smoker, reported a chronic cough which had already lasted
three to four months.
Less than four weeks later, when the cough got so bad
other inmates complained, Pickelsimer was back in the clinic.
She had lost weight. She had pain in her back. She was
given cough syrup.
When she began having trouble getting out of bed, she was
allowed to take either Tylenol or ibuprofen.
The pain grew. “She couldn’t move her arm at all without
screaming,” Key said. “She kept calling medical emergencies, but the nurses
kept saying she was lying and that it was all in her head.”
Lumps began pushing their way to the surface of her skin.
Nurses said they didn’t want to look at them, Key said.
Warm compresses
In mid-April, Pickelsimer was prescribed warm compresses.
Her blood pressure shot to 162/104, above the threshold considered dangerous by
Corizon. She was given two shots of painkillers plus a steroid, ibuprofen and
aspirin.
On April 17, she was prescribed warm compresses.
On April 18, a doctor authorized one day of bed rest.
On April 21, she was prescribed ibuprofen and compresses.
She lost 12 pounds. Other inmates started doing her
chores. She needed help dressing and bathing. She struggled to walk.
About this time, Pickelsimer was undergoing a battery of
IQ tests. “I don’t know what is happening to my body,” she told the tester.
“Extensive complaining,” wrote the tester afterwards. “Speech monotonous.”
On April 25, she returned to the clinic in tears, her eyes
bloodshot, unable to raise or bend her red and swollen arm. She received a shot
for pain relief, a warm compress and permission to stay in bed for a day.
On May 2, she said that she was in so much pain that she
wanted to cut her arm off. “I want to die,” she told nurses. She was locked in
an isolation cell.
However, alarmed at the lumps on Pickelsimer’s arms, a
nurse called the doctor. He recommended that Pickelsimer massage the lumps and
keep her arm elevated.
Delayed MRI
On May 5, an ultrasound technician found a mass in her
arm. An MRI was recommended.
It was a week before the test was approved.
Pain spread to her back and hip. And Key noticed a new
symptom. Her friend had become almost childlike, she said. Her vision was
blurred.
On May 23, an MRI scan found a suspicious mass and
recommended more testing.
Testing time, though, had run out.
On May 28, Pickelsimer was admitted on a stretcher to Lake Butler
“I walked in, and it was horrible. I couldn’t believe it,”
said her sister, Beverly Clancy. “Her left arm was full of lumps. They were all
over her side.”
Eight days after being admitted, she got a chest scan.
Pickelsimer drifted in and out, but not because she was on
powerful pain medication. Initially, she was given a form of Tylenol, said her
sister. Morphine was not authorized for a week, records show.
A doctor’s nighttime note on June 7 showed that
Pickelsimer’s blood pressure was falling. She no longer responded to painful
stimuli.
Shortly before dawn, she died.
The following day, results of her chest scan were stamped
received.
“Animals are treated better,” her sister said.
______________________________________________________
Privatized care:
Ibuprofen as bone cancer destroys inmate’s spine
Posted: 3:00 p.m. Saturday, Sept.
27, 2014
By Pat
Beall - Palm Beach
At first, Anthony Carvajal thought it was just a simple
slip and fall. Serving five years on theft and firearm charges, the 44-year-old
was in the kitchen of a prison work-release center when his legs buckled.
After a large lump emerged on his spine, he was told by
Corizon medical staff that it was a pulled muscle. He was given ibuprofen.
When a nurse got a reflex after tapping his knee, Carvajal
said, he was told to come back after he was paralyzed, “because there’s nothing
wrong with you.”
Months passed. Carvajal began losing weight.
And the pain was unrelenting. As one doctor later described
it, the pain would have been the equivalent of someone twisting Carvajal’s
spinal vertebrae until they broke, then wrenching them out of his back.
Post
investigation: Prisoners dying for care
Carvajal lay in his bunk and prayed to die.
Frantic, Carvajal’s father deluged the prison with phone
calls and letters seeking help. The elderly Carvajal was told nothing was
seriously wrong.
Six months after Corizon medical staff began treating
Anthony Carvajal’s crippling back and leg pain with over-the-counter
painkillers, a social worker called Henry Carvajal. His son had multiple
myeloma. The bone cancer was slowly destroying his spine.
By one estimate, early treatment might have given Carvajal
as much as another 10 years. When he was released from a Tampa
So far, he is beating those odds. Authorized for
compassionate release by the state Parole Board, Carvajal is living with his
father outside of Tampa
Corizon recently settled with Carvajal for undisclosed
terms. No suit was filed. Details are confidential. But, said Carvajal attorney
Jack Gordon, it was a “cooperative resolution. Corizon did the right thing.”
_______________________________________________________
No hip joint or
painkiller, inmate lives in a wheelchair
Posted: 3:00 p.m. Saturday, Sept.
27, 2014
By Pat
Beall - Palm Beach
When the lights go out at Columbia Correctional prison,
George Horn hunkers down in his wheelchair and tries for a few hours of rest.
Sleeping in his bunk is unthinkable.
The 53-year-old says he can lie only on his left side and
only for about 30 minutes before the pain kicks in.
Horn has no hip joint.
Relief isn’t available. Prescribed morphine for two years
as the joint rotted, Horn was forced off the painkiller cold-turkey.
Post investigation:
Prisoners dying for care
Horn’s troubles started well before Wexford Health Sources
took charge of his medical care, but it is Wexford that left him without a hip
joint.
Serving time on an 11-year burglary sentence, Horn’s
defective artificial hip joint became infected. Two private-practice
specialists hired by the Department of Corrections prescribed surgery to
replace the joint. That didn’t happen.
Instead, over the next several months, a state prison
doctor drained pus from the hip, said Horn. Antibiotics failed to stem the
infection. He was placed in a prison unit providing relief to terminally ill
inmates.
In February 2013, he was sent to Kendall Hospital
The same two doctors who had recommended hip surgery 19
months earlier saw Horn on a stretcher. They asked how the surgery went, said
Horn. “When I told them I hadn’t had it, they thought I was joking,” he said.
Seven days later, a specialist operated. But the delay was
costly for Horn and taxpayers alike: Instead of a joint replacement, complex surgery
was required to save Horn’s badly infected leg from amputation. And instead of
one surgery, another three surgeries would be needed.
The last surgery would replace Horn’s hip joint, as the
defective one had been removed.
Wexford, which by then was providing medical treatment at
the prison housing Horn, authorized the procedure.
Then it unexpectedly required another opinion.
The new doctor said he would not operate on Horn.
Wexford subsequently denied Horn’s surgery, leaving him
without a hip joint.
For two years, Horn said he had been given liquid morphine
to deal with the pain.
However, a Wexford doctor abruptly stopped the painkiller. “She said she would
not be a drug dealer,” Horn recalled. Morphine had been found as contraband at
the prison, and, according to Horn’s suit, the doctor said she would not be
giving it out any longer.
In addition to significant and prolonged flu-like
symptoms, rapid withdrawal from morphine can be dangerous, triggering
everything from increased heart rate to decreased blood sugar levels. Symptoms
can linger for weeks. The longer the use, the more severe the symptoms.
They can be reduced with medical assistance. Horn said he
got none.
Horn has been transferred to a prison where Corizon
handles medical care. Recently, he said another consultation with a surgeon had
been approved.
“Being in prison is my punishment to pay my debt to
society.” said Horn. “I messed up.” But, he said, “I’m a prisoner, not a
monster.
“It’s a terrible thing to say, but I wish God would take
me.”
____________________________________________________
State hired prison health
firm despite record of horrific deaths
Posted: 3:00 p.m. Saturday, Oct.
25, 2014
By Pat
Beall - Palm Beach
Long before Florida
But as Florida Idaho Maine
None of that made its way into Corizon’s 2,300 page bid for the Florida
In fact, none of the criticisms and incidents should have
come as a surprise to state officials. High-profile deaths and lawsuits linked
to Corizon and the two companies that merged in 2011 to create it — Prison
Health Services and Correctional Medical Services — span more than a decade.
Many were in Florida
Booked into the Volusia County Jail on a misdemeanor
charge, Tracy Veira died in 2009 from forced, and
untreated, opiate withdrawal; she had been left alone in a cell for the last
four days of her life. The same year, Collier County Jail inmate Joan Graeber
lost her baby after staffersdelayed treatment for a blood condition lethal to the
fetus.
Between 2002-2004, when Corizon handled medical care at
the Palm Beach County Jail, two inmates died when medicines were withheld,
including one HIV-positive prisoner treated with Tums. Judges released two
others so they could get medical care. The health department threatened legal
action if a potentially deadly infection racing through the jail wasn’t brought
under control.
Two cancer-stricken Florida
state prison inmates were treated with Tylenol and ibuprofen by Corizon
staffers this year as their undiagnosed disease spread, The Palm Beach Post reported last month. One inmate died in June. A
second is dying.
This, too, was not a first for Corizon: In 2010, Manatee County
State: Corizon fully disclosed
Corizon believes details of those and other cases did not
have to be divulged, and that it stayed well within the terms of what the state
wanted to know. “Corizon Health is confident that its bid was responsive,”
company spokeswoman Courtney Eller said.
Late last month, after The Post identified a spike in inmate
mortality rates, Corrections Secretary Michael Crews formally warned
Corizon its contract could be pared back or payments withheld unless medical
treatment improved.
The warning was based on “serious concerns” about inmate
health care, Cary
While not specifically addressing the written warning,
Corizon’s Eller said that “we have implemented a number of improvements over
the past year. We look forward to continuing that progress in the future.”
But attorney Randall Berg, who sued both DOC and Corizon
on behalf of an amputee inmate who could not get a prosthetic leg, remains
skeptical of both the company and DOC.
“When one has to sue DOC and Corizon to get inmates’
hernia surgeries, prosthetic legs, artificial knees; finally the secretary does
something,” said Berg, executive director of Florida
“Corizon has been a disaster and in breach of contract
since assuming the contract.”
Post investigation:
Prisoners dying for care
Other states’ criticisms
Citing the need to slash costs, the Legislature voted to
hand off state prisoners’ medical, psychiatric and dental care to private
companies in 2011. By late 2013, privatization was complete.
Today, Corizon and Wexford Health Sources share
responsibility for roughly 100,000 Florida
It’s not surprising that Corizon and the two companies
that merged in 2011 to form it — Prison Health Services and Correctional
Medical Services — would come under fire. Prison care is difficult and
prisoners are litigious. Inmates can, and do, fake illness. They don’t
necessarily need to fake, though: Prisoners frequently suffer complex and
chronic diseases, as well as mental illness and serious dental problems. It’s
why even a 50-year-old Florida
Even so, bidders for the Florida
However, nowhere in Corizon’s bid documents are details of
five five court settlements, a critical federal report on the death of an
immigrant detainee, a Maine report detailing
shortcomings in that state and in 2010, renewed federal oversight of an Idaho
·
Between 2007 and 2009, Corizon spent more than $6.6 million to
settle suits brought by three pregnant women who lost their unborn babies and a
fourth whose baby sustained permanent brain damage.
·
In 2011, U.S.
immigration officials commissioned a formal inquiryinto the fatal
heart attack of an immigrant detainee who was held in two jails, including a
jail in Albany , N.Y. Albany
·
In 2010, a doctor hired by Corizon quit after six months at an Idaho
·
A 2011 Maine
ER trip: Money for ‘foolishness’
In two other back-to-back legal settlements not found in
Corizon’s bid documents, the company’s nurses faulted company practices.
In 2007, 25-year-old Brett Fields was serving time in the
Lee County Jail on two misdemeanor charges when he came to the infirmary with a
red, pull-filled lump on his arm. Corizon’s medical staff prescribed
antibiotics.
It didn’t help. Fields’ arm remained swollen. Back pain
followed, then uncontrollable twitching in his legs. Four weeks into his
confinement, Fields couldn’t walk or uinate. He had no knee reflex. He was
given Tylenol.
Crawling to a toilet, Fields’ lower intestines fell out of
his bowels. A nurse appeared, accused him of faking, had him placed on a sheet
and dragged to a medical observation cell.
The same nurse later testified that Corizon supervisors
“yelled a lot” about nurses sending inmates to hospitals. Staff was told to
make sure doctors decided whether inmates needed an ambulance, she said, “because it cost …
so much money every time we take somebody to the ER.”
If a doctor makes the call, she said, “that way, there’s
not any unnecessary money spent for foolishness.”
Reluctance to use emergency transport was repeated in Minnesota
In Fields’ case, the delayed call for emergency treatment
came as an untreated, antibiotic-resistant infection spread to his spine. There, it created
an abscess, damaging his spinal nerves. When finally sent to a hospital, he was
rushed into surgery, but as doctors, a jury and an appeals court later agreed,
help came too late to avert permanent damage. He remains partly paralyzed.
A jury awarded Fields $1.2 million in damages.
Protocols not followed
In the fall of 2013, as Corizon’s billion-dollar state
contract was being implemented, the company was settling another lawsuit
brought by the family of a county jail inmate, one which also involved
disturbing statemrnts by acompany nurse.
Tracy Veira told medical staff she was taking prescribed
opiates when she was booked into the Volusia
County
Opiate withdrawal can be managed. Untreated, it can be
deadly. Almost immediately, Veira no longer could eat or keep down liquids. In
the space of a week, she dropped 20 pounds, according to court documents.
Confined to an isolation cell, Veira
spent much of four days alone, throwing up volumes of noxious green fluid.
She died of dehydration. The cell was so fouled that even
an hour after her death, workers had trouble remaining in it.
One of three nurses on duty the night before Veira died,
Inga Jones, described seeing Veira lying across clinic chairs, pale, slurring
her words and twitching while the supervisory nurse read a book.
Jones believed Veira needed to get to a hospital. So did
another nurse. Neither was in charge, though.
Jones also believed Veira had not been seen by a doctor
and was not checked after she was locked into her cell.
But that was the norm, Jones said in court papers. “Drug
and alcohol withdrawal protocols were routinely not followed,” wrote Jones.
“Many times I recalled returning to duty and finding a patient in full-blown
detox.”
Cruel and unusual
Inmates are not legally entitled to excellent care. They
are, however, legally entitled by the U.S. Constitution’s ban on cruel and
unusual punishment to adequate care.
“A prisoner who receives a sentence of 2-10 years,
deserves to do 2-10 years,” wrote a Michigan
The judge was overseeing a Michigan
Among the cases cited: A psychotic 21-year-old strapped to
a concrete slab for four days when the heat index hovered at 100. He died of heat and thirst.
A doctor saw him once, according to court documents, but
did not take his vital signs. On the fourth day, a nurse detected a “faint”
pulse — but prison video shows he then left the cell. The inmate died an hour
later.
After hearing details of the death, the judge ordered
multiple changes,writing that, “The days of deadwood in the
Department of Corrections are over, as are the days of CMS intentionally
delaying referrals and care for craven profit motives.”
Killer forces change
Because a federal judge in the Costello case was persuaded
that overcrowding was linked to poor health care, state prisoners had to be
released and expensive new prisons built. The state’s bond rating was
threatened by the ongoing litigation.
The court relinquished control only after Florida
In 2011, the same year state lawmakers voted to put health
care in the hands of for-profit companies, they eliminated money for CMA,
effectively abolishing it.
Some money was restored in 2012. CMA began inspecting
prisons again in 2013.
Several got good marks. For instance, treatment at
Hernando Correctional prison was equivalent to community standards, the team
wrote, and medical staff deserved to be commended. Inmates, they
wrote, “were generally satisfied with health care.”
Two months after the CMA review, Hernando inmate Donna
Pickelsimer was taken to a state prison hospital to live out her last days. For
months, medical records show, Pickelsimer’s painful, spreading lung cancer was
treated with Tylenol and warm compresses by Corizon staff, even as bulges
appeared on her chest, back and arm.
When Pickelsimer complained of pain, she was placed in an
isolation cell.
CMA’s report did not reference any inmate with lung
cancer. However, sandwiched between praise for the medical staff were
observations that cancer treatment for two women wasn’t carried out. Months
after a cancer specialist prescribed a round of testing, one inmate was still
waiting on the screenings.
The other woman’s prescribed follow-up treatment related
to ovarian cancer had been denied by Corizon. There was no record that the
prison doctors offered any alternate plan of treatment.
‘It makes anybody cry’
Despite the criticisms and high-profile cases, privatizing
to manage burgeoning inmate medical care costs remains popular. In the past 12
months, Corizon has inked contracts valued at more than $1 billion with jails
or prisons in California , Kansas ,
Georgia and Minnesota
In Indiana
Inmates said Wood, 26, was bleeding from her eyes and nose
when prison medical staff directed an ambulance to take her, not to a hospital,
but to a long term care facility.
Dead on arrival, Wood had more than 3,600 nanograms of the
antidepressant Citalopram in her system, said her father, Claude Wood. The
recommended dosage is no more than 120 nanograms. A medical examiner ruled her
death was a result of “therapeutic misadventure” — medical error.
“Why did state officials blow this off?” asked Wood of
Indiana’s decision to hire Corizon. “It makes anybody cry, what they’ve done.”
What The Post found
In a Sept. 28 story, reporter Pat Beall documented horrors
and a downward spiral in care since private companies took over prison health
care in Florida
·
Two inmates with fatal cancers were treated with Tylenol and
ibuprofen as their disease spread. One died in June. The other is not expected
to live beyond this year.
·
The number of inmates being sent to outside hospitals is sharply
down. At the current rate, admissions will drop by 47 percent compared with the
last year state corrections officials oversaw medical care.
·
In January, inmate deaths from causes other than murder or
accidents hit 36, a 10-year high. Deaths for the first seven months of this
year totaled 206, a 10-year high when compared with the first seven months of
other years.
More at mypalmbeachpost.com
Death at the Palm Beach County Jail - An interactive
timeline
As part of its continuing series on prison health care,
The Post has published more than 3,200 pages of source documents, including
lawsuits and the companies’ response to them; court depositions and
transcripts; bid proposals; contracts and audits.
They can be read at:
mypalmbeachpost.com/dying-for-care-documents/
Pleaded to murder
to avoid jail care
Writhing in abdominal pain but given only antacids, Kevin
Coleman sat for three weeks in the Palm Beach County Jail, awaiting his second
trial in a murder. New evidence likely would exonerate him. But he pleaded no
contest to the charge, leaving him a felony record but releasing him for time
served, to make sure he didn’t go back.
__________________________________________________
Prison medical suits show
patterns: Meds stopped, treatment delayed
Posted: 3:00 p.m. Saturday, Oct.
25, 2014
Prisoners are notoriously litigious, one reason why
Corizon and the companies that merged in 2011 to form it — Prison Health
Services and Correctional Medical Services — are named in several hundred
lawsuits and reports examined by The Palm Beach Post.
Some suits are clearly frivolous — an injured thumb, for
instance.
However, cases involving serious injury or death typically
allege the same type of problems: key medications stopped or changed, fatal
delays in diagnosis or treatment, and failures to react promptly to clear-cut
crises.
Some occurred before Florida
The repeated lapses in care, say critics, represent a
pattern.
Federal privacy laws bar Corizon from discussing health
issues of individuals. But in court documents, the company has argued that it
acted appropriately.
In suits involving legal settlements, Corizon has not acknowledged
fault.
Among the cases:
Permissions to die
According to a pending class-action lawsuit filed on behalf of Alabama prisoners
by the Southern Poverty Law Center, five ill inmates were persuaded to sign Do
Not Resuscitate forms without understanding what they were signing. One inmate was
blind. In another instance, the suit alleges, life-saving care was withheld
from an inmate because he had signed a DNR. He survived.
Fetus denied care
When 15-weeks-pregnant Joan Graeber entered the Collier County
Ruptured aorta
According to other inmates, his mother and his girlfriend,
Andy Henriquez, 19, had reported difficulty speaking, breathing and walking for
several days when he was placed in solitary confinement at New
York ’s Rikers
Island
This month, the Associated Press reported a 36-year-old
man died screaming for help in solitary confinement at Rikers after being
denied anti-seizure medication by Corizon staff. It was one of 15 deaths in
five years, including Henriquez’s, the AP said were linked to medical care.
Skin sloughs away
In Minnesota
Untreated paralysis
A paranoid schizophrenic, Kelly Green rushed headfirst
into a cement wall while in court. According to a pending lawsuit, for the next
several hours Green lay in his own feces, unable to move and having lost control of his bowels.
Nurses called by guards stated that as long as he was breathing there was no
emergency. Green had a fractured neck and spinal cord injury. He died from
complications of the resulting paralysis. Corizon maintains it provided
appropriate treatment and has denied the lawsuit’s description of key symptoms.
Heart meds delayed
Irene Bamenga, a French citizen who overstayed her tourist
visa and was attempting to return to France ,
was arrested by immigration officials and jailed until they could send her to France Albany ,
N.Y. U.S.
Unfilled prescription
Ashley Ellis died within 48 hours of being admitted to a Vermont
Hands, feet amputated
In a separate case, Michigan
Fatal heroin withdrawal
In a Louisville ,
Ky Sparks
Reports of withheld food, water
In early 2012, a court-appointed monitor’s report on medical care at an Idaho
“It is more likely than not that authorities were aware of
the potential danger to the safety of patients for several months but unduly
delayed taking action to protect them,” wrote the monitor. A state
investigation, he said, “strongly suggests that the delay was based on
financial rather than patient safety or labor relations considerations.”
Corizon and the state vehemently disagreed with the
findings. Corizon commissioned its own study, which found conditions met
constitutional muster, and Corizon last year won an Idaho
Details of these lawsuits and others, with Corizon’s
responses, can be read at mypalmbeachpost.com/dying-for-care-documents.