Concerns Growing Over Inmates’ Medical Care [Courant]

Article as it appeared in the Hartford Courant

Concerns over medical treatment in state prisons — including inmate deaths where errors in medical protocol were noted in records — have grown so rapidly in recent months that officials hired an expert to review 25 problem cases and are exploring whether to replace UConn Health as provider of prison medical care.

In May, state auditors faulted the DOC’s $100 million-a-year, no-bid agreement agreement with UConn Health and its correctional health care unit. Quality controls are substandard and UConn Health is policing itself, the auditors reported. Lawmakers have long criticized the 17-year-old arrangement as being long on cost, short on accountability and unlike any other agency-vendor relationship in the state.

Against this backdrop, the Department of Correction has brought in an outside prison consultant to examine a group of 25 medical cases, including eight deaths, “that have led, or are anticipated to lead to, litigation … involving the delivery of medical care in DOC correctional facilities.”

At the moment, eight wrongful-death claims are pending against the DOC in state or federal court, or the claims commissioner’s office.

Independent of the state review, The Courant investigated DOC summary reports of all of the hundreds of inmate deaths from 2009 to 2015 and identified 14 in which correction investigators noted violations of medical protocols. Included are cases in which inmates reported symptoms such as difficulty breathing, pneumonia, or pounding headaches, and died within several days. None of the deaths were attributed directly to a specific medical error.

“The larger question that these cases raise is: What was the course of care?” said Daniel Barrett, legal director of the ACLU in Connecticut. “How did the inmate get to the point of collapsing and dying? The most helpful analysis isn’t what the DOC and the medical contractor do in an emergency; it is how the system responds to the initial request for care. Was a condition ignored for days?”

In statements to The Courant, the DOC said it “accepts the auditor’s findings related to” the agreement with UConn Health’s Correctional Managed Health Care, or CMHC.

Asked to respond to the 14 cases identified in The Courant’s review, the correction department said in a statement: “Violations and/or deficiencies within a death-investigation conclusion are always a concern for our agency. Although none of these cases arose to a threshold requiring the placement of a Correctional Managed Health Care employee on administrative leave, the Department of Correction remains committed to ensuring that our contracted provider is delivering the highest level of medical and mental health care to the offender population.”

The Courant also provided UConn Health with the 14 cases it identified. In a statement, UConn Health officials defended the performance of their doctors and nurses. “In reviewing the 14 reports, some of which go back several years, it is clear that there were no cases in which the investigators reported that the medical or mental health care contributed to the inmates’ death,” the statement said.

“CMHC investigates all deaths to ensure appropriate care was provided and to improve processes even when there is no evidence that there was any contributory factors in the death,” the statement continued. “As a DOC contractor subject to patient privacy laws, UConn Health will need to defer all additional comments on this matter to the DOC.

The DOC refused a Courant request for the prison consultant’s report on the 25 medical cases, citing attorney-client privilege. The newspaper has filed a complaint with the state Freedom of Information Commission.

A key state lawmaker said a crisis in medical care behind the prison walls is almost inevitable.

“There’s always been a simple reason for this no-bid contract: It’s a subsidy for UConn Health, and it’s wrong,” said Sen. Leonard Fasano, of North Haven, the Senate’s top Republican. “When you’ve got custody of people, you have a moral obligation to take care of their health needs. The fact that you want to give a subsidy to UConn Health can’t be driving this. It has to be price and quality, and you’ll never get that without a competitive bid.”

Records show the correction department has sent out a request for feedback from other potential contractors “related to health care delivery” in the prisons. These information requests can serve as the prelude to putting a contract out to bid.

“As we proceed through the [information-request] process to evaluate available health-care systems, we have extended the current contract with CMHC through December of this year as a short term measure,” the correction department told The Courant.

The department paid Criminal Justice Institute, Inc., with a local office in Middletown, $63,000 to assess the medical care provided in the 25 cases, and to advise the DOC on strategy. The DOC’s death reports are terse, like the one summarizing the death of inmate James Manforte on Oct. 13, 2012, at the Bridgeport Correctional Center:

“The medical panel conducted several medical-staff interviews concerning the care of inmate Manforte … and violations of CMHC [UConn Health’s Correctional Managed Health Care] policy were noted.” The violations are is not explained.

The wrongful-death lawsuit filed in Manforte’s case is more expansive.

It said the 42-year-old, who was jailed for his second drunken-driving conviction, had complained of difficulty breathing on Oct. 9, 2012. On Oct. 12, he complained again. On Oct. 13, at 7:55 a.m., “he reported to the infirmary that he could not breathe.” A little more than an hour later, Manforte was dead. The autopsy found he died of cardiomyapathy — a disease of the heart muscle. The lawsuit said doctors and nurses never gave him a proper initial exam, “never addressed his signs and symptoms” and “failed to refer him immediately for medical care.”

The Manforte case is set for trial in September, one of the eight death cases in various stages of the legal process.

The 14 reports identified in The Courant’s review note breaches in medical and nursing procedures.

After inmate Peter Fraioli died of cardiovascular disease at the Bridgeport Correctional Center on January 2015, the correction department found that his care “was not in consort with DOC or [UConn Correctional Managed Health Care] policies and procedures. Several medical staff were found to be in violation … and were disciplined regarding the scope and quality of medical care.”

The Fraioli summary went on to say that “CPR was not administered in accordance with current regulations and the AED pads were not properly attached to the upper torso during the [emergency].”

In another case, Karon Nealy Jr., died at the Manson Youth Institute in Cheshire on July 27, 2015, of pulmonary aspergillosis — an infection in the lungs that afflicts people with lung problems, such as asthma.

The correction department’s summary said “numerous concerns regarding CMHC policy/protocol” were found. The report says “a corrective action plan was submitted [by UConn Health] to DOC Health Services.”

In inmate Janet Rippel’s death at the York Correctional Center in Niantic on Jan. 17, 2015, an advanced practice registered nurse “did not follow proper protocol for opiate withdrawals” and a doctor “did not follow proper protocol for follow-up assessment based on inmate Rippel’s symptoms.”

On Jan. 3, 2014, inmate Paul Brown told a woman on the other end of a recorded telephone line that he thought he had pneumonia. On Jan. 8, Brown was screened for flu-like symptoms by medical-staff members checking for sick inmates.

Four days later, on Jan. 12, 2014, Brown died of pneumonia and respiratory failure.

“[M]edical care was not rendered in accordance with CMHC and applicable DOC directives,” read the correction department’s summary report on Brown’s death. “Nursing staff did not follow protocols or perform a full assessment to determine if the continuation of flu screening was appropriate.”

In the audit of the correction department, the reviewers said one of the faults of the relationship between the correction department and UConn Health is a lack of oversight.

The agreement “places [UConn Health’s correctional health care unit] in the role of evaluating its own performance, which is inconsistent with practice in other areas where deaths in the course of governmental actions are subject to independent review.”

The audit said the DOC “does not have adequate … documentation” of the medical-quality reviews done by UConn Health, adding that “this creates uncertainty regarding the degree of quality review conducted, and does not provide necessary support for DOC’s expressed concerns regarding the quality of care.”

As a result, the correction department lacks the assurance it needs “that health needs are being met … effectively to prevent worsening and more costly complications, and mitigate the risk of litigation from allegations of medical malfeasance.”

Barrett, of the ACLU, said a prison medical system is broken when it compounds the health problems of inmates.

“People are sent to prison to be incarcerated, not to suffer from poor medical care,” Barrett said.