Keith Dean has a manila envelope that causes him a lot of grief and regret, but he can’t throw it out. On his front porch, by the light of a single lamp next to his front door on a quiet street in Gary, Ind., he turns the envelope over in his hand.

“I always looked at this envelope on the outside when I’m going through my office trying to organize, throw away stuff I don’t need but I never threw this away. I just kept it in a file,” said Dean.

But Dean hasn’t looked at the envelope for a couple years and can’t actually remember what’s in it. He knows it was some medical stuff from his brother in prison but when he opens the envelope he is surprised to find a letter from his brother as well. He pulls it out and reads from it to me.

“‘This doctor has endangered my life by failing to provide me with the proper follow ups and examinations. I need to get out of this facility before something happens to me, man.’  That was dated Feb. 5, 2011. Almost a month later, he passed away,” Dean said with his eyes downcast.

What are families supposed to do?

Kevin Dean was 49 when he died. Keith Dean said his brother used to complain all the time that he needed medical care and the prison wasn’t giving it to him. Once Keith called the prison and was told that his brother was receiving proper care. Beyond that he wasn’t sure what he was supposed to do. He still doesn’t know.

“He was sending me this to show me that definitely, there’s something wrong, and they’re not taking the proper steps as far as his medical care and I just didn’t, I didn’t know it was as bad as it was,” said Dean. “I just didn’t believe it. I figured you’ll be alright, you’ll be okay and I have to live with that. I just wished I had a paid attention, man.”

IDOC: Care is 'adequate'

“We do our job constitutionally and legally. Is it the best health care in the world? No, but it is adequate and that’s our job,” said Illinois Department of Corrections spokesman Tom Shaer in a recent interview at the State of Illinois building in Chicago’s Loop.

Between 80 and 100 people die behind bars in Illinois every year. The average age of the people who die is 54. The Department of Corrections said it carefully reviews every death, but information on deaths provided to Illinois Public Radio was scattershot and incomplete.

Illinois Public Radio has been reviewing IDOC records regarding deaths in custody in 2011 and 2012 and we’ve found some cases that seem especially egregious.

For example, according to an incident report by a nurse at the Vandalia prison, on October 2, 2011 an inmate named Anthony Rencher went to the health care unit at 2 a.m.

In her report the nurse notes Rencher was complaining that he didn’t feel well and couldn’t walk. The nurse then wrote, “but he could walk.” I go over the nurse’s report with IDOC spokesman Tom Shaer. Here’s our exchange:

“She says no abnormal findings," I said. "She says she observes him in the waiting room for an hour. At 3 a.m. he requests to go back to his cell. To me that make very eminent sense. He goes for medical care, he doesn’t get any, there’s no tests run, there’s nothing being done…”

“Let me ask you this right now,” Shaer said.

“Well, let me finish,” I said.

“No let me finish," Shaer said. "So you just decided that the reason he asked to go back to his cell is that he didn’t get the treatment, rather than he may have been feeling okay. How do you know why he made that decision? You just presumed that he decided that because he didn’t get the care he sought so that’s why he went back to his cell. How do you know he didn’t decide to go back because he no longer had symptoms?”

“Because he died two and a half hours later,” I said.

“Okay," Shaer asked. "How do you know that he had symptoms at the time, two and a half hours before his death?”

According to the report, after sitting in the waiting room in the prison’s health care unit for an hour at three in the morning, Rencher returned to his cell where he died. Shaer said unfortunately many of us know people who die unexpectedly without any warning signs.

“To say that he went there and got no treatment is inaccurate. That’s just not accurate,” said Shaer. “If he’s in the healthcare unit being seen by a medical professional he is getting treatment and this inmate did.”

To be clear, Shaer is a press spokesman, not a doctor. Dr. Louis Shicker, the medical director of Illinois’ Department of Corrections, refused to talk with us about the $100 million in medical care he oversees.

IDOC: Documentation is difficult

Two years ago, after hearing complaints about health care, Illinois Public Radio submitted a Freedom of Information Act request for incident reports for all inmate deaths in the Department of Corrections. The department denied the FOIA, and fought it through an appeal to the attorney general of Illinois, saying it would be too burdensome. They said it would take months to collect the information because it’s kept at all the different prisons around the state.

When Illinois Public Radio threatened to sue, the department did finally hand over documents, but the records were incomplete to say the least, and did not even reflect all the deaths that occurred. For example, the department said  97 inmates died in 2011 but the records handed over to Illinois Public Radio as part of a legal proceeding stretching out over the course of a year reflect only 79 deaths, omitting 18.

“Eighteen out of 97, we don’t feel, is indicative of a major problem with getting you the information you’re entitled to. But I would say anything less than a hundred percent is not satisfactory. There are different levels of being unsatisfactory. This is a moderate level of dissatisfaction that we have and we’re looking into it but I can’t tell you why you asked for 97 and got 79,” said Shaer.

ACLU: Don't count on IDOC stats

“If you say you look at every death and analyze what happened and how to fix it, that should be readily available and if it’s not, what does that tell you?” said Benjamin Wolf, the associate legal director of the ACLU of Illinois. 

“I also don’t think any of the department’s statistics are ones that I would count on as being accurate,” he said.

The ACLU is one of the parties in a federal class action lawsuit over health care in prison.

“When we decide whether to jump into a major class action we want to make sure it’s a good commitment of our limited resources, including our limited staff, and this problem emerged as one of the most serious civil liberties problems in this state,” said Wolf.

Wolf said before deciding to join the health care case the ACLU did some research. They hired experts in correctional health care to go through lots of records and policies and data.

"It looked to them like there were very serious problems and very serious deficiencies including some deficiencies that may have caused people to die,” Wolf said.

As part of the class action suit, the court has now appointed an expert who is doing a review of health care inside Illinois prisons. It means an independent doctor has access to all the medical records and death reviews and is going into the facilities as well.

“I think we’re going to learn that the department’s excuses for these things and defenses for a lot of these things are not persuasive and that their system is in fact deeply flawed and dangerous to the inmates,” said Wolf.

Wolf said, when the expert report becomes public, Illinois citizens will have a much more accurate picture of health care inside Illinois prisons.