Audit: Prison health care poor

13th February, 2003
The Birmingham News
Stan Bailey

MONTGOMERY: A medical consultant's audit of health-care services in Alabama prisons found "dangerous and extremely poor quality health care" at Limestone Correctional Facility at Capshaw.

Reports from visits Oct. 1 and Nov. 8 by Chicago-based Jacqueline Moore and Associates said the death rate from AIDS at Limestone is more than twice the national average in prisons and that efforts to control infectious and communicable diseases at Limestone were not adequately monitored or reported. Most of the state's inmates with AIDS are confined at the north Alabama prison.

"A lack of adequate monitoring (and) reporting of infection control efforts and vital statistics in regards to infectious (and) communicable disease is dangerous and extremely poor quality health care," said the report. It was prepared last year for the Siegelman administration but was not released until this week by new Prison Commissioner Donal Campbell.

Medical services in Alabama prisons are provided by NaphCare, a Birmingham-based health management contractor.

Lee Harrison, president of NaphCare, said in a prepared statement Wednesday that some comments in the Moore audit report "are unsubstantiated and misleading." Harrison said the quality of health care provided to inmates at Limestone "continues to be of the highest quality" and often is better than care available to residents of the state.

The report by Moore and Associates said the AIDS dorm at Limestone, where all the Alabama prison system's known AIDS inmates are located, is an old warehouse with high, leaky ceilings and double bunks so close together that they foster infection among AIDS-infected inmates.

"Based on the information available, it appears that six deaths this year are attributable to AIDS and three were caused by liver disease," the report stated. The AIDS death rate of 0.23 deaths per thousand at Limestone is more than twice the national prison AIDS death rate as reported by the American Correctional Association and is about twice the expected rate, the report said.

Harrison said NaphCare's death rate for inmates under its care is "actually one-third the rate for the general population."

"This means that inmates under our care often live longer and have a higher quality of health care than members of most Alabama communities," Harrison said.

The audit report said medical records at Limestone sometimes list the wrong cause of death and that there should be an immediate halt to what the consultants said is the illegal practice of giving medication prescribed for one inmate to "whoever needed it."

Chronic-care inmates:

Chronic-care inmates, according to the report, said they go as long as seven or eight months without seeing a doctor, and diabetes patients get only monthly rather than daily blood sugar tests.

"This policy is contrary to community standards of care, and since at least one death at this facility during the last year was due to ketoacidosis (a condition caused by dehydration and a lack of insulin), it is recommended that the facility review clinical guidelines published by the American Diabetic Association and the National Commission on Correctional Health Care and adjust their policy accordingly," the report stated.

One inmate, identified in the report only by prison number, "had a hernia for four months the size of a grapefruit before he was finally sent for a surgical appointment," and another inmate "complained of stomach pain for four months before a barium swallow was performed," according to the report.

The cause of one inmate's death was listed as cardiac arrest, but the inmate's medical summary showed that he had pneumonia and ketoacidosis. Another death, listed as being caused by cardiac arrest, actually was caused by "gastrointestinal bleeding because of end stage liver disease," the report said.

The audit report drew immediate criticism by Tamara Serwer of the Southern Center for Human Rights in Atlanta, which is representing Alabama prison inmates in lawsuits over conditions at Limestone and at Tutwiler Prison for Women. A Moore and Associates audit released last week showed similar deficiencies in medical services at Tutwiler.

"Extremely dangerous infection control policies in a population that already has compromised immune systems is extremely alarming," Serwer said of the Limestone report. "It is not surprising, therefore, that the death rate is remarkably high. The failure to review causes of death and to develop ways to prevent future deaths means that this high fatality rate will almost assuredly continue."

Brian Corbett, a spokesman for the prison system, said officials were asking NaphCare "to do what's required" under its contract with the state.

"Based on the audits, we're asking NaphCare to follow up on any deficiencies," he said.

The report by Moore and Associates was one of several based on audits conducted last year at several Alabama prisons and which made similar findings. Former Gov. Don Siegelman and his prison commissioner, Mike Haley, refused repeated requests to release the reports.