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Cruel and Unusual Health Care

How Mississippi prisoner Jamie Scott's life sentence could turn into a death sentence.

| Thu Mar. 25, 2010 6:00 AM EDT

Rasco lives in Pensacola, Florida, where she cares for her daughters' five children while they are behind bars. Since Jamie and Gladys went to prison, Rasco's husband of 30 years died of a heart attack; another daughter died of congestive heart failure; and her oldest son was away for several years serving with the Army in Iraq. In a letter to supporters last year, Jamie wrote: "When I think of the word 'strongest,' I think of my mother. She is 4 feet 9 inches tall and has the strength of Job in the Bible."

Rasco lacks the time and financial resources to visit her daughters often, but in mid-February, she managed to make the trip to Mississippi. When she visited the prison, along with Jamie's 18-year-old son, Jamie was feeling sick but was able to make it to the visiting room. When Rasco returned two days later, she found Jamie in a cell attached to the infirmary. "She was real weak," Rasco said. "She couldn't walk."  An infection appeared to have developed at the site of Jamie's catheter, which had filled with blood and pus. Nurses reportedly told Rasco that Jamie should be in the hospital, but the paperwork hadn't been done.

Rasco said that when she entered her daughter's cell, Jamie was sitting on the edge of a hospital bed with dirty linens, near a toilet and wash bowl that had not been cleaned. Prison staff arrived with a plate of food—a hamburger swimming in grease, rice, squash, a piece of cornbread, and a cookie—but Jamie said it looked so bad she couldn't eat it. The doctors at the hospital had given her a list of foods she should eat, including meat, fish, and vegetables, but they were not available, and she did not have permission to purchase food at the prison commissary. (That permission has since been granted.) So Jamie sat on her grimy bed eating a Snickers bar. "She sat right there with me," Rasco said, "and tried to give me a piece." Knowing it was the only nourishment her daughter was likely to have, her mother declined.

Since Rasco's visit, Jamie was back in the hospital for a day after experiencing chest pains following dialysis. Last week, she collapsed and was rushed to hospital, where doctors told the family an infection from an improperly placed shunt had spread through her body. At that point, according to the family, a hospital doctor stepped in and barred the prison from taking Jamie back into her cell, noting that she could die if denied hospital care. As of Wednesday, Jamie is back in prison. Her mother visited her there recently, and according to a person familiar with the case, reported Jamie was very weak and could scarcely walk due to an emergency catheter placed in her groin. She is scheduled to return to the hospital in the next few days, where doctors will prepare her for an operation next week that will attach a permanent fistula or shunt into her body to make kidney dialysis possible. Requests by Mother Jones last week to interview Christopher Epps, the state commissioner of corrections, were denied.

The best medical option for Jamie would be a kidney transplant. Studies show that patients in their thirties who receive successful transplants live considerably longer than those who remain on dialysis. Rasco said that when Gladys Scott, 34, learned of her sister's kidney failure, she immediately offered to give Jamie a kidney. Gladys says that CMCF staff told her that state prisoners don't qualify as donors, and that a transplant would be too expensive, though there is no indication that their statements reflect official MDOC policy. Rasco said that she was hoping the prison would at least let Gladys care for Jamie—feed her and bathe her—as inmates are sometimes allowed to do for ailing relatives. When Rasco last spoke to her, Gladys had not received the necessary permission.

Chokwe Lumumba, a longtime activist and attorney who also serves on the Jackson City Council, is representing the family in the medical matter. In an interview, Lumumba said, "Our first idea is to get some medical attention into the jail. Asking for a private doctor to go in there and see her." But what Jamie really needs, he told me, is "to be in hospital until a kidney transplant."

Singletary, the MDOC's spokesperson, replied to several email inquiries regarding Jamie's care. In one email, she wrote that "MDOC cannot comment on any specific medical condition or treatment for an inmate." In another, she referred to patient privacy laws when asked whether a kidney transplant was being considered for Jamie Scott. Regarding transplants for state prisoners in general, Singletary said that "the state would pay for a needed and necessary transplant" and would do so "when evaluated the Dr. as needed [sic]." Singletary added in another message: "Dialysis units are fully operational with no malfunctions documented in the past several years." She restated the MDOC's policy that "chronic, but stable, medical conditions are not eligible for conditional medical release consideration."

Jamie's care is in the hands of Wexford Health Sources, a Pittsburgh-based private company that provides prison medical services. Wexford's record includes lawsuits by prisoners and current or former employees in at least six states, as well as allegations involving racial discrimination and improper gifts to public officials. In 2006, the Santa Fe Reporter investigated Wexford, which supplied health care to some 6,000 New Mexico prisoners, and discovered widespread complaints, among them that Wexford "refuses to grant off-site visits for seriously ill inmates." The story concluded that "the company's insistence on the bottom line over the care of its charges causes inmates to suffer, sometimes with lasting, even fatal, results. The investigation prompted hearings on prison health care in the New Mexico state legislature, and in December 2006, Governor Bill Richardson ordered the New Mexico Corrections Department to find a new health care provider.

Wexford's reported resistance to allowing inmates access to offsite treatment is particularly relevant to Jamie's case and the potentially dangerous delays she has experienced before being sent to the hospital. The same issue surfaced in a 2002 case in Pennsylvania, where a 26-year-old prisoner named Erin Finley suffered a fatal asthma attack in prison while under Wexford's care. According to the Wilkes Barre Times Herald, Finley's family eventually received a $2.15 million settlement after their lawyer presented evidence showing that "Finley desperately sought medical care for severe asthma she had had since she was a child, but she was repeatedly rejected based on a prison doctor's belief that she was 'faking' her symptoms." On the day of her death, Finley was taken to the prison infirmary several hours after complaining that she was having trouble breathing. A physician's assistant examined her and told the doctor she needed to go to a hospital, "but he refused to see her and left the prison at 2:40 p.m. Twenty minutes later, Finley lost consciousness and stopped breathing," according to the Times Herald. She was finally sent to the hospital—only to be pronounced dead.

In Mississippi, where Wexford took over health care for the majority of the state's prisoners in 2006 under a three-year, $95 million contract, the Jackson Clarion Ledger reported in November 2008 that "a search of the federal court system found more than a dozen open lawsuits filed by inmates against MDOC on medical issues." At Central Mississippi Correctional Facility—the prison where the Scott sisters are housed—the sister of a dead inmate said she watched her brother waste away for months from inadequately treated Crohn's Disease, an inflammation of the digestive tract. "He literally starved," Charlotte Boyd said of her brother William Byrd, who died in November 2008. "We watched him turn into a skeleton." Boyd told the Clarion Ledger that people might lack sympathy for prisoners like her brother, a convicted rapist, but "even a dog needs medical attention." She said she believes that "if they are doing him that way, they are going to let somebody else die, too."

In fact, Mississippi has one of the highest prisoner death rates in the nation, according to a review of prison statistics carried out by the Jackson Clarion Ledger's Chris Joyner. The death rate in 2007 was 34 percent higher than in 2006—the year Wexford took over the MDOC's medical care. A December 2007 report conducted by the Mississippi Legislature's Joint Committee on Performance Evaluation and Expenditure Review (PEER) concluded that inmates were not receiving timely and adequate medical treatment from Wexford. Among other things, the report found that Wexford "did not meet medical care standards set forth under its contract with the state" and "did not adhere to its own standards in following up on inmates with chronic health problems." When questioned about the report and the high prisoner death rates, the Clarion Ledger reported, corrections commissioner Epps "said he is satisfied with the contractor's performance." The budget presented by Epps for the coming fiscal year, which begins on July 1, shows a request of $37.4 million to Wexford for medical services.

In response to questions about care provided by Wexford, MDOC spokesperson Singletary wrote: "Jamie Scott is receiving quality medical care for her condition. Wexford provides basic medical care for all inmates at MDOC prisons. Inmates are sent to hospitals if the need for hospital care arises." Singletary stated that such decisions are made by the attending doctor at the prison, a Wexford employee. Wexford did not respond to requests for comment.

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