Government & Politics

What is $2 billion buying Kansas and Missouri in prison health care? Few people know

Prison health care company in Missouri and Kansas offers little transparency

Hundreds of inmates in Missouri and Kansas have filed suits against Corizon Health alleging substandard care.
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Hundreds of inmates in Missouri and Kansas have filed suits against Corizon Health alleging substandard care.

Shermaine Walker’s son died of a rare fungal brain infection last year in a Kansas prison, and since then she’s been trying to find out whether the prison’s private health care contractor could have stopped it.

That same contractor, Corizon Health, oversees inmate care in Missouri prisons. A state legislator there contends Corizon staff misdiagnosed his uncle’s cancer. He’s also asking how that happened.

Corizon’s contracts with the corrections departments of Kansas and Missouri are worth almost $2 billion combined over 10 years — yet there’s little transparency about how that money is being spent.

“In my time I’ve not experienced a specific report in terms of Corizon or their performance in their contracts,” said Kansas Rep. Russ Jennings, a Republican from Lakin who is chairman of the House Committee on Corrections and Juvenile Justice.

Jennings said that’s not unusual for state contractors, but Corizon is not a run-of-the-mill vendor.

As the largest for-profit prison health care provider in the country, Corizon is a lightning-rod for criticism from prisoners, their family members, the American Civil Liberties Union and others who say it takes public money and provides little care. All in an effort, they say, to maximize its profits.

Hundreds of inmates in Missouri and Kansas have filed suits against the company alleging substandard care.

Susan Lawrence, a physician from California and expert witness in correctional medical malpractice cases, said Corizon, like most prison health care companies, has a bad reputation.

“I have never heard of one that people say, ‘You know, they do a really, really good job,’ ” Lawrence said. “They’re private, their goal is to make money, so they put policies in place that aren’t necessarily (intended) to benefit the patient,” she said.

The company says they’re providing high-level care in difficult environments, and for every lawsuit there are more inmates satisfied with their care.

“Reporting about correctional health care often focuses on a single patient and that patient’s allegation of poor care,” Corizon spokeswoman Martha Harbin said via email. “I would be happy to provide you with a file containing the many, many cards and notes we have received from patients.”

But only a few people outside of the prisons know what’s going on inside the infirmaries.

The Kansas Department of Corrections, or KDOC, has a small clinical team from the University of Kansas Medical Center reviewing Corizon’s work. And the department collects some data on services provided and medical outcomes. The Missouri Department of Corrections does not.

Neither state produced any data in response to requests from The Star.

Both state contracts have minimum staffing requirements for Corizon set in the contracts and the Kansas contract has financial penalties if Corizon does not meet certain performance benchmarks.

But KDOC did not respond when asked what, if any, penalties it had handed down. An open records request for that information is pending.

Missouri’s contract has no performance penalties or bonuses.

Karen Pojmann, the communications director for the Missouri Department of Corrections, said Corizon gives no annual report to the department and there’s no way for the department to provide data on inmate health outcomes.

“Part of the challenge is that our database system is antiquated and it’s very hard to generate those types of reports,” Pojmann said.

Karen Russo, a consultant for families of inmates, has for decades studied both Corizon and its previous iteration as Correctional Medical Services. The company changed its name after merging with another prison health care provider in 2011.

Russo, the founder of the Wrongful Death and Injury Institute in Kansas City, said the company has a checkered past that state leaders ignore because contracting out provides them some insulation from lawsuits.

“(Legislators) don’t do anything and this has been going on since 1975,” Russo said. “I could take an article from 1975, I could square it up with 2017, change the date and the numbers and the names and that’s it. ... There’s no accountability.”

But Corizon is now coming under more scrutiny in both Kansas and Missouri.

In response to Shermaine Walker’s story about her son’s brain infection death, Kansas Senate Minority Leader Anthony Hensley from Topeka said the state should consider not renewing the company’s contract when it comes up in July 2019.

Missourinet, an online news consortium of radio stations, reported in February that some Democrats in the Missouri Legislature are also having second thoughts about Corizon. They include Missouri Rep. Bruce Franks Jr., who said Corizon staff misdiagnosed his uncle’s prostate cancer as ulcers and his uncle died shortly after leaving prison. Franks didn’t respond to an interview request.

Absent public data, it’s hard to know how Corizon is doing beyond anecdotes — positive ones provided by the company and negative ones from people like Walker, Franks and the inmates themselves.

The lawsuits

In Kansas and Missouri, 283 medical malpractice lawsuits have been filed against Corizon since 2011, including one brought by Walker that’s still pending.

Walker, from Wichita, says her son broke down physically and mentally, eventually drinking his own urine, while the infection ate away at him over months in the Hutchinson Correctional Facility.

“It was something to see this happening and know nobody was helping him,” Walker said. “It was unbelievable.”

Corizon has said it sympathizes with Walker, but can’t release more details about her son’s case because of patient privacy laws.

Harbin, the Corizon spokeswoman, said the number of suits filed against the company is not high, given that the company’s employees had millions of patient visits over that time period.

“Lawsuits are a fact of life among doctors in the United States and even more so when you consider the highly litigious nature of corrections,” Harbin said via email. “The presence of a lawsuit is not necessarily indicative of any wrongdoing or the merits of the case, and the statistics bear this out.”

Harbin said less than 10 percent of the concluded suits resulted in any kind of settlement. The remaining 90 percent resulted in a verdict in Corizon’s favor, were dismissed, or were administratively closed.

Harbin also provided copies of a dozen praise-filled notes, including one from a Lansing Correctional Facility inmate who said the Corizon staff compassionately removed a lump from his shoulder under local anesthesia and then sent it to a lab for testing and cleaned the wound for 12 days after.

But Russo said the lawsuits represent a small sample of inmate complaints, because prisoners can’t file suit until they’ve gone through the corrections department’s grievance process. She said the suits are easy for Corizon to swat down because it’s hard for prisoners to keep up with paperwork deadlines and court fees unless they get court-appointed legal counsel.

Russo also said even most attorneys don’t understand the challenge of taking on a health care provider that has control of all of a patients’ health records and can prevent the patient from seeking a second opinion.

“These cases are not straight-line medical malpractice cases,” Russo said. “They are much more complex.”

The federal suits against the company brought by inmates in Kansas and Missouri contain a range of complaints, from the common to the bizarre.

Multiple suits claim that Corizon employees classified medical conditions as “cosmetic” in order to avoid providing care, including one by Philip Vitello who said staff at the Missouri state prison in St. Joseph denied him surgery to remove a tumor on his shoulder.

Vitello was not appointed counsel, but a magistrate judge ruled last month that Michael Toney, a prisoner at the Kansas state prison in El Dorado, should be. He’s now being represented by a Wichita law firm.

Toney’s suit alleges that he suffered from bloody, painful bowel movements for months while Corizon staff members did nothing but prescribe him an ineffective hemorrhoid cream.

When they finally referred him to a doctor outside the prison system, that doctor diagnosed him with “rectal fissures” that would require surgery. By that point Toney said his condition had gotten so painful that he requested a liquid diet because “to plaintiff, losing 40 pounds is better than passing a solid stool.” But Corizon still didn’t get him the surgery.

Lawrence, the physician and expert witness, said Toney’s claims sound frighteningly plausible to her.

Lawrence spent three years working for another for-profit prison health care provider in federal immigration detention centers. She said at one facility an inmate came to her saying he had been complaining to the nursing staff about his rectal bleeding for more than a year.

“So I did a physical exam and he had a rock-hard liver due to metastasization,” Lawrence said. “He had cancer. He had rectal cancer. ... When he pulled up his shirt you could see the outline of his liver. I had never seen anything like it.”

Lawrence said the nursing staff had not only ignored the man’s complaints, they had also recorded him exercising in the prison yard, to try and build a case against him needing care.

“They had videotaped him working out and said ‘How can he possibly have terminal cancer?’ Well, people can,” Lawrence said. “(But) it was the attitude of a lot of providers that they were just malingering.”

Alternatives

The U.S. Supreme Court has ruled that prisoners must be provided health care, and Kansas and Missouri, along with many other states, privatized that responsibility decades ago. But some states take a different approach.

A study published in 2013 by the Pew Charitable Trusts and the MacArthur Foundation found that when New Jersey and Connecticut contracted directly with their state university medical centers to provide prison health care it resulted in improvements in several areas, as well as cost savings that went back to the states.

Harbin said those results haven’t been duplicated elsewhere.

“There is enough evidence of challenges in state and university-run prison health services (Texas, California) to demonstrate that these are not superior systems of care,” Harbin said via email.

The same Pew study quoted Viola Riggin, KDOC’s director of health care services, as saying that Kansas’ system of privatized care backed up by oversight from the University of Kansas Department of Family Medicine provides the best of both worlds.

“The key is oversight, and our data collection system allows me to track which inmate did not receive a physical exam, and if not, why not,” Riggin told Pew and MacArthur.

KDOC did not make Riggin available for an interview for this story.

A KU Medical Center spokeswoman said the center’s role is to review Corizon’s staffing levels and staff credentials, check inmate health care grievances that reach the corrections secretary level and look into all inmate deaths.

Missouri used to have an oversight contract with Jo Riggs, a nursing professor at the University of Central Missouri. Riggs said her work was initially funded through a state grant but about three years ago the state dropped the grant and renegotiated its contract so Corizon would pay her instead.

“I have found that they met or exceeded the performance expectations on most of the indicators I was measuring,” Riggs said.

Riggs said she’s taking time off from the project in 2018. Harbin said Corizon is looking for a replacement and in the meantime is still vetted by the National Commission on Correctional Health Care, an accreditation group.

Jennings, the chairman of the Kansas House’s corrections committee, said there’s another step his state could consider to add more oversight of Corizon.

The former head of the state’s juvenile justice administration, Jennings served on a “corrections ombudsman’s board” in the 1980s that had the authority to investigate inmate and prison staff complaints. He said the board was disbanded long ago, but the legislature could consider bringing it back.

“It might be something to revisit and have a conversation about,” Jennings said.

Andy Marso: 816-234-4055, @andymarso

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