Florida prison officials didn’t ask, companies didn’t tell about hundreds of malpractice cases

By Dan Christensen, BrowardBulldog.org prison

The Florida Department of Corrections awarded a five-year, $1.2 billion contract to provide medical care for thousands of state prisoners in north and central Florida to Corizon, a Tennessee company that was sued 660 times for malpractice in the last five years.

Nearly half of those cases remain open. Of those that are closed, 91 – one in four – ended with confidential settlements that Corizon declined to discuss. Corizon began work in August providing care at 41 correctional facilities.

A second contractor, Pittsburgh-based Wexford Health Sources, signed a five-year, $240 million contract in December to provide medical services to state inmates in nine institutions in South Florida.

Wexford, however, was hit with 1,092 malpractice claims – suits, notices of intent to sue and letters from aggrieved inmates from January 1, 2008 through 2012. Records say Wexford settled 34 of 610 closed matters for a total of $5.4 million, as well as another case that ended in a $270,000 jury verdict against the company.

The Department of Corrections, headed by Secretary Michael D. Crews, hired Corizon and Wexford to lead Florida toward millions of dollars in savings promised by the massive privatization of inmate healthcare enacted by Gov. Rick Scott and the Republican-controlled Legislature.

Along the way, however, the corrections department never asked the corporations bidding for those lucrative jobs to disclose their litigation histories — how often they’d been accused of malpractice, where those cases were filed and the outcomes.

Neither Crews nor Dr. Olugbenga Ogunsanwo, the assistant secretary for medical and health services, agreed to be interviewed for this story. Corrections spokeswoman Misty Cash, however, called the state’s contracting process “comprehensive.”

Florida Corrections Secretary Michael D. Crews

Florida Corrections Secretary Michael D. Crews

“The selection of Wexford and Corizon was transparent,” she said. “Both companies provided the required and requested documentation as outlined in the procurement and bidding process.”

Government agencies elsewhere in Florida typically require corporate bidders to provide litigation histories in order to assess the quality and reliability of their services, as well as their ability to limit potential liability.

Prisons are obligated under the Eighth Amendment to provide prisoners with adequate medical care.

The problematic litigation histories of Corizon and Wexford raise questions about the quality of inmate care promised by those companies and paid for by Florida’s taxpayers.

“What really troubles me about this is the fact that the department didn’t ask these very basic, elemental questions any system would ask,” said Eric Balaban, a staff attorney for the National Prison Project of the American Civil Liberties Union. “These two vendors were taking over Florida’s massive health care system and you’d think they would have asked hard questions to determine if these companies can provide these services within constitutional requirements.”

BrowardBulldog.org obtained the litigation records from the Broward Sheriff’s Office using Florida’s public records laws.

BSO obtained them from Corizon and Wexford during their unsuccessful bids this summer to provide healthcare services for inmates at the Broward County Jail. Each company complied, to varying degrees.

Prison companies don’t like to discuss lawsuits filed against them, and neither Corizon, created by the 2011 merger of competitors Prison Health Services and Correctional Medical Services, nor Wexford would comment for this article.

LITIGATION AS ‘TRADE SECRET’

Corizon, in fact, initially tried to block the release of its litigation history by claiming it was exempt from disclosure as a “trade secret.” The company rescinded that claim in late August, after its work for the state had begun and after being told litigation was being contemplated by this news organization to force disclosure.

While Corizon told BSO it had been sued 660 times, it did not provide the requested list of cases.

One example, however, can be found in the court file of 24-year-old Brett Fields.

Fields was sent to the Lee County Jail on July 6, 2007 after being convicted of two misdemeanors. He was healthy, except for a bump “about half the size of a tennis ball” on his left arm – the result of a spider bite, the court records say.

On Aug. 6, after a month of sporadic, ineffective and “lax” treatment by Corizon staff, Fields “felt his back go sore and numb.” The next day, his legs began to twitch uncontrollably, with the pain becoming unbearable after midnight on Aug. 8, records say.

Fields could no longer walk by the time he saw a physician’s assistant about 9 a.m. who checked Fields’ his leg and foot reflexes and found none. Fields was given Tylenol and returned to his cell.

Early on Aug. 9, Fields “felt his intestines escaping from his rectum.” Fellow inmates begged Corizon’s staff to take him to the hospital. Instead, nurse Bettie Joyce Allen “obtained some K-Y Jelly, and pushed the intestines back in,” the records say. Hours later, at a local hospital, doctors found an abscess compressing his spine.

A jury awarded Fields $1.2 million in 2011 after finding Corizon solely responsible for what happened. The award included $500,000 in punitive damages. Fort Lauderdale attorneys Gregg Lauer and Dion Cassata represented Fields.

The verdict was  upheld last year by an appeals court that observed prompt treatment “could have averted permanent damage to his legs, but he did not receive that treatment because Prison Health (Corizon) delayed his treatment.”

PROBLEMS ACROSS THE U.S.

In addition to the lawsuits and claims filed against them, Corizon and Wexford both have faced withering official criticism about the delivery of care to inmates.

  • Idaho – In 2011, the Associated Press reported that Corizon was fined $382,000 by the state “for failing to meet some of the most basic health care requirements outlined by the state.” Last year, an expert appointed by a federal judge to review Corizon’s medical care at one prison near Boise found “inhumane” conditions.
  • Pennsylvania – Corizon paid a $1.85 million fine to Philadelphia after investigators determined the company had used a front company as a subcontractor to meet city requirements for minority-owned vendors.
  • Maine – In 2011, a state agency review of Corizon’s operations there found that the company maintained medical records poorly and had failed to fulfill contract obligations. The head of Maine’s American Civil Liberties Union later told the state’s Public Broadcasting Network that those problems rose to “a systemic constitutional dimension.”
  • Mississippi – In December 2007, the joint legislative committee criticized Wexford and the state’s Department of Corrections for failing to ensure that all inmates received timely access to quality medical care. Wexford was also assessed more than $930,000 in fines for maintaining staffing levels that were not in compliance with contract minimum – fines the committee said had not been collected.
  • Arizona – Wexford and the state’s corrections department agreed in January to terminate Wexford’s medical services contract in the wake of accusations the company improperly dispensed medicine to inmates and wasted state resources, according to the Arizona Republic. Wexford was awarded a three-year contract seven months earlier. Arizona hired Corizon to replace Wexford.

Florida has had its own problems with the two companies.

In 2006, Corizon, then known as Prison Health Services, backed out of a 10-year state prison healthcare contract saying it wasn’t making enough money. The company had won the contract only months before with a bid that was millions lower than its competitors.

In 2004, Florida legislative auditors called Wexford’s medical care “problematic,” according to the Miami Herald. In 2002, the newspaper reported that the Florida Correctional Medical Authority had reprimanded Wexford the year before for poor medical care following the deaths of two inmates.

Florida let bygones be bygones when it hired Corizon and Wexford to help achieve the 7 percent in cost savings mandated for privatization by the legislature. Corrections spokeswoman Misty Cash said taxpayers would save $3 million a month because of those contracts.

Some contend Florida’s emphasis on savings has eclipsed questions about the quality of the medical care for inmates that taxpayers are purchasing.

Michael Hallett is a professor of criminology at the University of North Florida in Jacksonville who has written about prison privatization. He said quality of care simply isn’t much of a concern when it comes to prisoners.

“Most people feel, as long as they achieve their 7 percent savings who cares how they treat inmates?” he said.

Amid intrigue and suspicion, Broward sheriff to award $145 million jail healthcare contract

By Dan Christensen, BrowardBulldog.org 

Broward County Jail

Broward County Jail

Broward Sheriff Scott Israel is expected soon to award a contact worth as much as $145 million over the next five years for the delivery of healthcare services to the county’s approximately 5,000 jail inmates.

The road to a deal has been full of turns, with intrigue and suspicion around every curve.

Seven companies submitted sealed proposals last month in what amounted to a second round of bidding after BSO canceled its initial solicitation last March. The cancellation, after proposals were received, opened and bidders shortlisted, allowed vendors to see each other’s prices and plans.

Three companies are on BSO’s current shortlist: incumbent Armor Correctional Health Services, Corizon Health (formerly known as Prison Health Services) and Wexford Health Sources.

One that’s not: Nashville-based Correct Care Solutions, a previous finalist with a five-year price that was $8.5 million lower than Miami-based Armor’s offer. Correct Care did not get a single vote from the three-person BSO selection committee that evaluates proposals and makes a recommendation to the sheriff.

Bid records obtained by BrowardBulldog.org using Florida’s public records law also show that Armor has lowered its one-year price for comprehensive medical, dental and mental health care by $400,000 since learning it was previously underbid. Still, its current proposal of $26.7 million is $1.9 million higher than its nearest remaining competitor, Corizon, which also cut its bid price. It is also $1.5 million, or nearly six percent higher, than the $25.6 million it currently charges BSO.

Wexford was the highest bidder at $26.8 million.

Each company also offered slightly lower price options if BSO agreed to assume more risk for providing certain offsite services that are now covered.

CONTRACT UP TO FIVE YEARS

The bidding is for a three-year contract with two one-year renewal options. Last time, BSO’s bid specifications called for bidders to supply annual pricing for five years. This go-round, only one-year prices were sought.

The lack of specificity about prices beyond the contract’s first year makes it difficult to compare costs over the term of the deal, and offers BSO – and Broward’s taxpayers – no assurances as to future contract costs.

“Even though price proposals were provided, the entire contract, including contract amount, is subject to negotiation,” said sheriff’s spokeswoman Keyla Concepcion. “Subsequent years after the initial year will be negotiated based on the contract amount for the initial year.”

The sheriff’s pricing formula for the contract’s later years, if there is one, was not disclosed.

In the initial round of bidding, the vendors calculated price by tacking on between 3.5 and 4.0 percent for each additional year. Armor, for example, offered BSO a five-year price of $145.6 million.

Five-year prices were not provided this time. But using the same factors, Armor’s projected five-year price would be $2 million less than it bid six months earlier.

Here’s a comparison of the projected five-year proposals for the current finalists compared with their original five-year price offers:

Current                                  November 2012

Armor:        $143.6 million                         $145.6 million

Corizon:      $130.0 million                         $133.6 million

Wexford:     $144.6 million                            did not bid

While BSO would save millions by accepting Corizon’s bid, there are numerous considerations in choosing a vendor, including staffing and care management.

One key tool to evaluate the competency and reliability of vendors is to require them to disclose their recent litigation history.

LACK OF TRANSPARENCY

In various ways, transparency is an issue is BSO’s current inmate care solicitation.

Most significantly, BSO does not post proposals online or solicit public input. By law, proposals are secret for 30 days after they are opened, or until BSO announces an intended decision. After that, they are available, but not online.

Broward Sheriff Scott Israel

Broward Sheriff Scott Israel

Transparency is also a problem regarding the vendors’ litigation histories, an indicator of past performance and competency.

Armor supplied BSO with a 14-page list of 150 malpractice lawsuits that it said were filed against it in Florida and elsewhere since 2009, including 22 cases in Broward.

Armor did not provide BSO with requested case numbers, and identifies plaintiffs only by their initials – making it difficult to track cases. But in its proposal, Armor noted that while nearly half of those lawsuits were dismissed it has never had a judgment against it and “we have settled only nine lawsuits companywide since 2004.”

A record of 150 lawsuits in three years, most filed by aggrieved inmates without a lawyer, is not a confidence builder. But it is at least a record that’s available for the public to see and scrutinize.

BSO has declined to release the litigation histories submitted by Corizon and Wexford, indicating without elaboration that they are exempt from disclosure under Florida’s public records laws. Corizon asserted in its proposal that its court litigation history is “confidential and proprietary.”

BrowardBulldog.org has asked BSO to reconsider its decision and release the records.

Questions about the inmate healthcare procurement are not confined to the proposals themselves.

One of the three members of BSO’s selection committee who voted to recommend Armor is Dr. Nabil El Sanadi.

El Sanadi is BSO’s chief medical director. He is also chief of emergency medicine for Broward Health.

CONFLICT OF INTEREST

El Sanadi had an apparent conflict of interest when he cast a vote for Armor. The reason: Broward Health, his employer, wants Armor to win the contract.

Armor’s proposal, which includes Broward Health’s endorsement, says that it currently contracts with Broward Health to provide 24-hour hospital services to county inmates.

Should Armor prevail it “will continue to use…the North Broward Hospital District (Broward Health), encompassing Broward Health Medical Center, Broward Health North and Broward Health Coral Springs,” says Armor’s proposal.

Another disturbing, yet unconfirmed report from insiders says that another top BSO official had a private meeting with one vendor’s representatives during the “cone of silence” period when such contact is illegal.

Then there is the presence of William Rubin, a paid lobbyist for both Armor and BSO.

The sheriff’s lawyer, Ron Gunzburger, has said Rubin has been told that neither he nor his Fort Lauderdale firm, The Rubin Group, can lobby BSO on behalf of Armor. Rubin, however, is a friend and supporter of Israel and Rubin’s contract with BSO does not prohibit such lobbying.

Sources have said Rubin is working with ex-Sheriff Ken Jenne, who first hired Armor in 2004 after receiving substantial campaign contributions from Armor and its owner Dr. Jose Armas, to help Armor prevail. Jenne later served time in federal prison on unrelated corruption charges.

Armor is currently supporting Jenne’s son, Evan Jenne, in his run for a state house seat from South Broward. On June 17, the company contributed $500 to Jenne’s campaign.

The Rubin Group contributed $500 to Evan Jenne’s campaign in March.

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