Poor Health Care Reported at State Prisons

Illinois pays a private firm millions to take care of the medical needs of prisoners, but evidence suggests the care is terrible and painful for prisoners.

John Maki is having a hard time believing the findings of his own organization’s year-long study of health care in Illinois’ prisons. Maki is the director of the John Howard Association, a non-partisan prison watchdog group in Illinois that just completed a year-long study of health care in state prisons.

The study found that last year the State of Illinois signed a 10-year, $1.4 billion contract with Wexford Health Sources, a private company that provides health care, but Maki said no one in Illinois audited the company’s previous performance in the state before signing the enormous contract.

“You know it’s one of those things, it feels bizarre that it’s not out there. It feels like surely someone must have done some kind of audit, right?  Kind of like, right?” said Maki. “That has to be there, and there should be some kind of public account of how this money’s being spent and there’s not. And again, if the John Howard Association can’t find it and this is what we do, then certainly no ordinary citizen is going to find it.”

Maki said he went to the state’s auditor general, who said they don’t audit private contracts. He asked people at the Department of Corrections, who said the contract was handled by the state’s Department of Healthcare and Family Services, but when he went to Health and Family Services they sent him back to IDOC -- the Department of Corrections.

“Well, as a taxpayer I want to know how my tax dollars are spent. In particular, in our prison systems, which are very expensive and which there’s very little oversight of, and to me that raises questions about good government,” Maki said.

In response to Maki’s report, an IDOC spokeswoman emailed a statement saying Wexford got the highest score of four vendors who competed for the contract. IDOC would not provide anyone to talk to us about that process or even to talk in general terms about the $1.4 billion deal.

Maki said there is some troubling history that makes the lack of contract oversight even more negligent.

Five years ago, Donald Snyder, the former head of the Department of Corrections pleaded guilty to accepting $30,000 in bribes from a Wexford lobbyist. Wexford was never accused of wrongdoing, and in an email a company spokesman said they actively cooperated with the investigation into the bribery scheme. But leaving that history aside, Maki said there are even more immediate questions that need to be asked.

“Every year, we communicate with about three thousand inmates and their family.  By far, the most complaints we hear are about medical care,” he said.

<strong>A handwritten federal lawsuit</strong>

Chris Clingingsmith is suing the Illinois Department of Corrections in federal court, but he is representing himself and his lawsuit actually looks kind of like a grade school project. There are not computers in prison and Clingingsmith cannot really type anyway so he drew lines on blank paper and then neatly hand-printed out his federal complaint.

“I just figured that whatever happened to me wasn’t right," Clingingsmith said. I decided that I don’t think all that fancy jargon on there needs to be involved with legal work. I just write it how it needs to be written and send it."

Clingingsmith’s lawsuit lays out his story of what happened to him in the prison in East Moline, Illinois, where he was doing a seven-year sentence for racking up several DUIs. He was attacked by an inmate and knocked to the ground.

“I’m like on my back and I’m blocking his hits and then he kicked me in the ribs and I dropped my arms because it hurt,"  he said. "So when I dropped my arms he raised up and stomped me right in the face with his boot and I kinda went out for a few seconds.  It knocked me out, I guess.".

When he was able, Clingingsmith said he went to guards and told them that he had fallen and hit his face on a counter.

“If you know anything about the gangs and stuff in prison, you don’t want a gang after you, especially when you’re a non-gang member," Clingingsmith said. "I’m not affiliated with anything so I wasn’t about to go tell the supervisor that this guy whooped me in the kitchen."

Clingingsmith said the guards knew the truth about the assault because they had video of it and they sent him to solitary confinement for lying about it. While in segregation he complained about his injuries and asked to see a doctor.

“I was nauseous, I had migraine headaches, my jaw hurt, I couldn’t sleep, I had blood in my urine. I was just a mess,” said Clingingsmith.

Clingingsmith said when he went to the doctor, the doctor looked at him for just a couple minutes and gave him some aspirin but that was it. He continued to complain and got another appointment a couple days later.

“They took me back to the doctor this time, and he was kinda being, I don’t know a good word for it other than pissy," he said. "I told him I got a broken jaw again and he goes, well how do you know you got a broken jaw? Where did you get your medical degree?”"

<strong>"You have a broken jaw"</strong>

Clingingsmith was sent back to solitary and several weeks later was transferred to a higher security prison, something he thinks was a punishment for “lying” about how he was injured, but that punishment ended up being a blessing because a dental assistant took his complaints seriously and took some x-rays.

“It happened to be where I was sitting in the dentist’s chair they have one of those x-ray lights and I’m in the chair and she comes back with the x-rays and she slides it into that light thing and she leans over and I lean over and we’re both looking at it together and she goes, 'Oh my gosh. You have a broken jaw.' and I said, ‘I know,’ and she goes, ‘That’s ridiculous,’” Clingingsmith recounts.

At that point, Clingingsmith got good care but it was drastic, requiring his face to be cut open. He said the doctor used a hammer to re-break his jaw and then put titanium plates, a tension band and six screws into his face.

The operation was eight weeks after his jaw was originally broken.

In that time Clingingsmith said he lost 60 pounds because he couldn’t eat. His medical records show that for weeks after the surgery, saliva and water leaked out of his neck where the cuts were made.

Clingingsmith said all that could have been avoided if Dr. William Rankin at the East Moline prison would have diagnosed him and wired his jaw shut when the injury first happened. That is part of the reason Clingingsmith is suing, but because he is no longer in prison he can’t utilize the expertise of other inmates in the law library and his case is starting to fall apart.

According to IDOC, Dr. Rankin still works at the prison, but a spokeswoman declined to comment further because the case is still in court. Wexford refused comment for the same reason. Rankin said he also did not think it was wise to talk because of the ongoing lawsuit.

Clingingsmith thinks Rankin’s medical license should be taken away.

“If he can’t even diagnose a broken jaw when somebody comes in the office and said, ‘Hey, doc, my jaw is killing me. I think it’s broken, I’m sure it’s broken,’" Clingingsmith said. "I don’t think he should be doing that job.  That’s not the right gig for him. He should be doing something that he wants to do."

Alan Mills with the Uptown People’s Law Center isn’t surprised about Clingingsmith’s case.

“It’s absolutely representative of the level of care," Mills said. "That sort of delaying of treatment until things get worse is typical,” said Mills in a windowless room at his low-rent office on Chicago’s north side.

Mills brings a lot of lawsuits on behalf of prisoners. He has filed a federal class action lawsuit over medical care. He often sues solely for injunctive relief, which simply means he’s not looking for money, he just wants to force a change in the conditions. That is what he’s looking for in the medical class action suit.

As part of that case Mills has collected horror stories from prisoners.

He said one of his clients was complaining about ear aches for a year and every time he saw the doctor he was treated with antibiotic ear drops. Turns out he had cancer. Mills said another man, a diabetic, got a blister on his foot.

Mills said he was not given the proper medication and the blister turned into a sore and because of the man’s poor circulation the wound got worse and worse until recently doctors had to cut off a large part of his foot down to the bone.

“So a small problem which should have been easily solved at the beginning was left to sit and literally fester for months on end until it became a huge problem and that unfortunately is what we see all the time in the Department of Corrections: putting off care that would be very simple at the beginning and putting it off and putting it off and putting it off until it becomes a serious problem which nobody can ignore any more," Mills said.

In an emailed statement, a Wexford spokesman said, “We assure you that Wexford Health holds our employees accountable just as any other company would.”

The spokesman added that Wexford has no incentive to provide bad care because that would result in expensive lawsuits. But Mills thinks Wexford tries to delay care until the inmate is released and is no longer their problem, though he puts most of the blame not on the private health provider, but on IDOC.

<strong>Watching out for prison health care</strong>

Mills said the private health care contract “can work but only if there’s a good quality control and somebody watching Wexford to make sure that they actually provide a good level of care and the department has not provided that sort of oversight at all.  Their contract provides for that sort of monitoring but they don’t in fact do it.”

By email, an IDOC spokeswoman said, “The department monitors Wexford through a comprehensive and continuous quality improvement process that includes monthly reviews.”

It is tough to know exactly what all that means. The Illinois Department of Corrections has repeatedly refused could explain in practical terms how they monitor Wexford, citing pending litigation. But, of course, there are always lawsuits pending against the Department of Corrections - that doesn’t mean there can’t be any discussion of how they oversee a billion-dollar contract.

The spokeswoman did write that the department’s medical director visits each site once a year. As for the doctors and their performance, she said Wexford is responsible for reviewing and disciplining them because they are Wexford employees. That seems to underscore Mills’ point.

“You have to enforce a contract or it doesn’t mean anything," he said. "There’s nobody holding them accountable other than the courts.”

John Maki with the John Howard Association said that is unfortunately true.

“Right now we’re relying on court cases to provide oversight, which should be taking place at the institutional level," Maki said. "If we get to the point of litigation, the problem's already happened, right? Someone’s already suffered grievous injury. We want to prevent injury."

Maki said there are some doctors and medical staff who do heroic work. Exhibit ‘A’ could be the dental assistant who immediately took x-rays of Clingingsmith’s jaw and got him the care he needed. But Maki said other staff might not be as good, and without oversight to enforce standards the system is relying on the goodwill of staff or court cases.

“Here’s what court cases can’t do," Maki said. "They can’t create a more effective system. They can chip away at it, they can restore someone who’s been hurt but they’re not good at building better systems of oversight. We need government to do that.".

Maki said there are a lot of questions about this contract and about the kind of health services inmates are getting--and there are few answers. It’s been my experience that this lack of oversight is part of a pattern with the Department of Corrections. It’s hard to know what’s going on in the prisons, facilities far away from Chicago, locked behind bars and layers of wire fencing.

For many months IDOC and Governor Pat Quinn have refused and continue to refuse requests to visit prisons. The information we do get from IDOC comes from emailed statements that aren’t always terribly clear or helpful.

John Maki’s concern with the health care contract could apply to much of what goes on in the Department of Corrections.

“It’s kind of like what Reagan said: 'Trust but verify.'  We need to verify this thing," Maki said. "We need to go in and make sure that what they say they’re doing, they’re actually doing. Right now all we’re doing is trusting. There’s no verifying going on.”

Maki said given the history and all the complaints about health care and how much it’s costing the state, that just doesn’t make sense.

As the state’s prison watchdog, Maki’s official recommendation is that the governor and legislature fund an independent audit of health care in the prisons to make sure that inmates are actually getting the care that taxpayers are paying for them to get.