Health Care

Kansas prison health contractor fails to provide enough psychiatrists, medications

Locked in solitary confinement in a prison in rural Kansas without his schizophrenia medication, Anthony Downing says he grew paranoid, fearing the guards were poisoning his food.

When he could take it no longer, he started launching himself off the metal frame of his bed, kicking at the windows in his cell again and again until men in protective gear came in and dragged him out.

“I broke the windows,” Downing said, “and they told me I was getting transferred and I was like, ‘Thank God.”

Downing, now out of prison, was serving time at Ellsworth Correctional Facility, a small institution in central Kansas. It’s one of several mostly rural facilities where the state’s health care contractor, Corizon Health, has fallen well short of the contract’s requirements for staffing key mental health positions, according to documents The Star obtained through an open records request.

The documents, which covered Corizon’s performance from July 2015 through December 2018, showed that almost 20 percent of the 10,000 inmates across the state prison system were on psychotropic medications during that time.

But prisons in Ellsworth, Norton, Winfield and Hutchinson went months at a time without Corizon reporting any hours worked there by psychiatrists, the medical providers most qualified to prescribe and calibrate those medications. Some of the other prisons during that time reported some psychiatrist hours but not the amount the contract called for.

“That’s pretty shocking,” said Eric Balaban, an attorney with the ACLU’s national prison project. “How were they renewing meds for prisoners who were there?”

Anthony Downing2.JPG
Anthony Downing says his mental illness was known when he entered Ellsworth Correctional Facility, yet he never got his medications when he was there. Andy Marso

Corizon spokeswoman Eve Hutcherson said the documents provided to The Star didn’t accurately reflect actual distribution of staff within the prisons.

The company moved its psychiatrists around from one facility to another, she said, and their hours may have been reported for their home base rather than the places they actually worked.

“To suggest that any of these facilities had no coverage whatsoever is just plain inaccurate,” Hutcherson said via email.

She said the company’s behavioral health professionals also used tele-psychiatry, which is conference calls or video-conferencing for therapy sessions between doctors and patients who aren’t in the same place. Confidential patient care records show psychiatry hours being provided at prisons where the Department of Corrections staffing documents show none, she said.

Corizon psychiatrist staffing.JPG
A sample of a Corizon monthly performance report that shows the company being docked $6,500 for providing no psychiatrist hours at Ellsworth Correctional Facility. Kansas Department of Corrections

But there’s other evidence that the company was well short of staff, particularly in mental health, throughout the prison system as a whole. From July 2015 through December 2018 the state levied nearly $6.5 million in under-staffing penalties against Corizon, and a significant chunk of it was for psychiatry shortages.

During a legislative hearing last year, Viola Riggin, who leads a team at the University of Kansas Medical Center that evaluates Corizon’s performance, told legislators the team flagged psychiatrist staffing in western Kansas as a problem area.

“We worked with Corizon, called them in and said you need to work in this specific area to get staff and they sent a recruiter to work on that and it’s been mitigated,” Riggin said.

But the records obtained by The Star show psychiatrist shortages persisting at Winfield and Ellsworth — and extending to the Kansas Juvenile Correctional Complex in Topeka — throughout 2018.

And a Department of Corrections audit presented to legislators in February showed Corizon job vacancy rates of up to 18% in the Kansas prisons, with nurses and mental health professionals making up about half the openings.

Jeanny Sharp, a spokeswoman for the corrections department’s new leadership under Gov. Laura Kelly, said in a March email that staffing continues to be an area of emphasis.

“Our medical team is attempting to reach out to colleges to recruit more medical providers,” Sharp said. “However, medical care in a corrections environment isn’t something being taught in medical school, (and there are) clearly a few more barriers to recruitment efforts.”

Joel Dvoskin, a clinical and forensic psychologist who co-wrote a 256-page handbook on mental health care in prisons, said the psychiatrist shortages didn’t surprise him.

“Everybody in the U.S., correctional and otherwise, is having trouble recruiting psychiatrists,” Dvoskin said. “There simply aren’t enough psychiatrists in the U.S. … It’s not OK. I’m not saying it as an excuse or that it’s acceptable, but I sure understand why they’re having so much trouble.”

Dvoskin also said private companies like Corizon should have an edge in recruiting psychiatrists because they aren’t constrained by state employee pay scales.

Dvoskin said the national psychiatrist shortage is particularly acute in rural areas, in part because states are competing with VA medical centers, which have raised their psychiatrist salaries and gone on a hiring binge in recent years.

He said at one point California was offering $300,000 salaries to get more psychiatrists into its prisons (in Kansas the average psychiatrist salary is more like $200,000).

The staffing documents obtained by The Star show that at Ellsworth, Norton and Hutchinson, Corizon filled in some of the vacant psychiatrist hours with psychiatric advanced registered nurse practitioners.

Dvoskin said that’s a common solution, but not as desirable as having full-fledged psychiatrists.

“You can’t have all your hours filled by nurse practitioners, but you can have some of them,” Dvoskin said.

Winfield didn’t report any hours worked by psychiatric advanced registered nurse practitioners. It’s possible that primary care doctors were prescribing psychotropic medications there, but Balaban said that wouldn’t be ideal.

“For a short period of time, in a pinch, you could have a physician do that, but that’s pretty poor mental health treatment,” Balaban said. “On the streets you wouldn’t go to your family physician for psychotropic meds.”

Downing’s experience shows what can happen when those meds aren’t delivered.

Downing said his mental illness was known when he entered Ellsworth and had actually factored into getting his sentence reduced. But he said he never got his medications when he was there.

“They didn’t do anything at all,” Downing said. “I told them I need my meds and they said I didn’t need them, or have a problem or whatever. … I tried to tell them if I had my medication I would do a lot better but they wouldn’t listen to me.”

Instead he acted out and ended up in “the hole,” which only made things worse.

“In solitary it’s like being in hell,” Downing said. “I had all kinds of visions of people trying to kill me. I wouldn’t eat. I didn’t eat for several days cause every time I took a bite I would get physically sick.”

His condition spiraled quickly until the day he tried to kick out the window.

Then he was transferred to a dedicated mental health unit at the Lansing Correctional Facility, one of the biggest prisons in the state.

It was like night and day, he said.

“Corizon in Lansing is totally different,” Downing said. “It’s totally different than in Ellsworth.”

Downing lived in a Topeka homeless shelter for several months after getting out of prison in August. But even while trying to find housing for himself, his thoughts drifted back to the inmates he used to live with.

“They really should do something about the psych part of Ellsworth,” Downing said. “The people that are still there, I feel sorry for them.”

Related stories from Kansas City Star

Kansas City Star health reporter Andy Marso was part of a Pulitzer Prize-finalist team at The Star and previously won state and regional awards at the Topeka Capital-Journal and Kansas Health Institute News Service. He has written two books, including one about his near-fatal bout with meningitis.