Punishment by neglect

click to enlarge Henry Carvajal with his son Anthony. - Chip Weiner
Chip Weiner
Henry Carvajal with his son Anthony.

Anthony Carvajal says the pain was so bad, the only thing he had to look forward to some mornings was guessing which bone he might break.

While serving three to five years for grand theft and possession of a firearm (and already a convicted felon), Carvajal was in a pre-work release program at the Kissimmee Transit House last August when he slipped and fell while working in the kitchen.

He thought he had ruptured a disc, but the Department of Corrections (DOC) ignored a racquetball-sized protrusion on Carvajal’s back and simply prescribed him 60 days’ worth of ibuprofen.

His symptoms intensified to the point that Carvajal felt compelled to leave work-release and return to prison — the Central Florida Reception Center in Orlando — for care. But he was put into the general population — not the infirmary — and his health continued to worsen.
Now the 44-year-old Tampa resident is dying of multiple myeloma, a cancer of the blood cells that he was not informed he had contracted until April 16 — six months after hospital officials incorrectly diagnosed him with osteoporosis.

Carvajal’s medical care has been provided since his fall last August by Corizon, a Tennessee-based medical services provider for prisons, jails and other detention facilities. Serving approximately 377,000 inmates in 28 states, the for-profit company touts itself as the largest of its kind in the nation.

There are serious issues with Corizon, however, that Florida health officials either didn’t know about or ignored when they authorized the company to take over all health services for the DOC in the northern part of Florida in 2013 — like the fact that the company had been sued over 600 times for malpractice in the previous five years.

Anthony Carvajal’s father, Henry, and Al Kahmi, father of another inmate who suffered, are now speaking out about a healthcare system they believe is substandard and dangerous.

Republicans in the Florida Legislature had been pushing for privatization of the prison’s healthcare system for years, and that push accelerated after Rick Scott was elected in 2010. “If we can provide a great service at a better price, then we ought to be doing that,” the governor said.

Under its contract, Corizon must offer care to the Florida inmate population at 7 percent less than what the program cost in 2010. But considering that healthcare expenses have risen steadily for years in nearly every sector, the question of how decent care could be provided at a lower price doesn’t seem to have been asked by anyone in power.

Al Kahmi doesn’t think the terms of the contract are realistic at all. He claims his son Terry’s health has been compromised by the substandard treatment he’s received for multiple hematomas (a type of internal bleeding that is either clotted or results in forming clots). Terry is currently being treated at the DOC's Reception and Medical Center in Lake Butler, in conditions that resemble something “out of the 19th century,” his father claims.

Kahmi says that when his son started vomiting blood last month, guards came by and claimed he was faking. He says his son threw up so much a doctor told him he was down to only two pints of blood.

Kahmi says he intends to sue both Corizon and the Department of Corrections. “Just because someone is referred to by a number and not necessarily a name does not make them any less than anyone else on the outside. They still should have responsible and compassionate medical care ... [W]e also seek action for all those in these deplorable conditions — Civil War-like conditions.”

Some legislators say the deck was cleared for sub-par care when the state’s Correctional Medical Authority was disbanded. Created in 1986 as a response to litigation over the treatment of inmates, the agency monitors healthcare in state prisons, and was eliminated in 2011. At the time, Tampa/St. Pete-based Democratic Senator Arthenia Joyner argued that the quality of care that inmates received would be diminished a great deal if Florida got rid of the agency, and that the state could be exposed to legal liability because of that failure. Funding was reestablished in 2013, but Joyner now questions the agency's effectiveness.

Although Scott didn’t want the CMA to disband, he was a fervent supporter of privatizing health care in the corrections system. And though the Legislature’s attempts to do so were rejected by two courts, the First District Court of Appeals a year ago allowed the plan to go through. Last August, the state awarded a five-year, $1.2 billion contract to Corizon to provide medical care for prisoners in North and Central Florida, and to Wexford Health Services to handle medical services to inmates in nine facilities in South Florida.

Shortly after, in October, a Miami Herald story revealed that at the time that contract was awarded, Corizon had been sued 660 times for malpractice since 2009.

“The problem I see is that Corizon is a privately held company with little transparency,” says Tampa Democratic Representative Janet Cruz. “There’s no information about the cost to litigation to prisoners that allege inadequate care. They claim that they can keep all of that private because they claim it’s a trade secret. They operate under an HMO model and an emphasis on cutting costs. It’s unfortunately prisoners’ only option for care.”

Deborah Golden is director of the D.C. Prisoners’ Rights Project of the Washington Lawyers Committee for Civil Rights and Urban Affairs. She says that by postponing treatment of inmates until they’re released from jail, privatized for-profit companies like Corizon benefit shareholders, which is a corporation’s legal obligation, even if in the long run that ex-felon has to come back and get on Medicaid in the private sector.

Golden is currently litigating a case in Virginia claiming that the state’s Department of Corrections failed to provide healthcare to female prisoners in Fluvanna County. The Prisoners’ Rights Project says that women are dying as a result. She says that doctors were making changes to patients’ treatment protocols based on costs, not on medical needs.

In Arizona, a former Corizon patient care technician named Teresa Short told Al Jazeera America that Arizona prisoners have died because there weren’t enough medical staff on duty. In 2012, when the private company Wexford handled prisoner healthcare, the American Civil Liberties Union filed a suit, claiming Arizona’s prisons amounted to cruel and unusual punishment, with prisoners at serious risk of “pain, amputation, disfigurement and death.”

click to enlarge Anthony Carvajal. - Chip Weiner
Chip Weiner
Anthony Carvajal.

In Florida, Corizon took over
at the same time that Anthony Carvajal’s health started to disintegrate in prison. He said that in his first Corizon check-up in Orlando, the nurse practitioner stuck needles in his legs and saw no movement. But when she tapped his knee and saw a reflex, she said simply, “Well, you can come back when you’re paralyzed, because there’s nothing wrong with you.”

He knew there was something wrong with him, even though he was denied pain medication. He began losing the strength in his left leg, and was given a wheelchair. That was then taken away because of legal concerns — he could still walk — so he used a walker.

He also began having tremendous pains in his stomach, and endured approximately 17-20 days without a bowel movement. He says that “everything stayed in my upper intestines,” and thus when he was given a rectal exam, it didn’t show any abnormalities in his lower intestines. Because the doctor didn’t see anything in the lower tract, she didn't believe there was anything wrong with him.

“She was pretty much calling me a liar. But why would I lie about that? I’m not even in a prison environment. I’m pretty much in the free world,” he says, since at the time he was in work release.

In late October he was diagnosed with osteoporosis. At the same time, his father Henry wrote a series of emails to Danielle Warren of Corizon, writing that “he needs to be in a medical environment not in a jail cell where he can be treated for his medical issues!”

But Anthony was not taken to a medical environment for several more months.

Ultimately Carvajal lost over 60 pounds in three months. Yet no one bothered to check whether there could be something else wrong with him. He said it wasn’t until March of this year that he was given Ultram for pain relief. That’s when he suffered another fall and was unable to walk at all.

In mid-April, Henry wrote letters to Governor Scott, Senator Bill Nelson, Congresswoman Kathy Castor, and Representative Janet Cruz, who tells CL that she contacted both the state’s Office of Executive Clemency and the Department of Corrections about what it would take to get a medical release to bring Henry’s son home.

Just a few days later, Anthony Carvajal was sent to Memorial Hospital in Jacksonville. A CT scan of his lumbar spine showed “metastatic disease” involving the lower thoracic spine, lumbar spine, sacral spine and left iliac bone. A CT scan of his chest revealed a large mass eroding his ribs.

He was diagnosed with multiple myeloma. Cancer.

Henry Carvajal says he remembers when he received the call from doctors in Jacksonville, and was initially thrilled that his son was finally getting some care. “Finally, they’re giving him some help,” he said to himself. But the nurse on the other line wasn’t finished. “Bad news,” she continued. “He’s got cancer that’s metastasized, and he doesn’t have more than two months to live.”

Anthony was sent to the state prison in Lake Butler. In a letter written to J.R. McClellan, assistant warden for the Florida State Prison, Carvajal’s aunt, Sandy Bustin, wrote that the transport guard who drove Anthony to Lake Butler told him “he hoped Anthony would choke on his own vomit and die, that it would save the taxpayers and himself a lot of money and trouble.” McClellan responded that it was DOC policy “that we practice zero tolerance for inmate abuse and believe in treating people with civility and respect,” and said he would forward the allegations to the DOC’s Office of the Inspector General for review. (A call to the inspector general’s office found that no investigation had taken place.)

Henry Carvajal got his day before the state’s Parole Board on April 30 in Tallahassee, where he requested compassionate release for his son. That was granted, and Anthony was sent to Tampa General Hospital on May 2 (he was supposed to be sent to Moffitt Cancer Center but there was no room for him there).

Henry Carvajal claims that a doctor at TGH told him that while Anthony’s cancer was not curable, it was treatable, and that if it had been diagnosed in April and he'd been given a bone marrow transplant, “he could have had a 15-to-20-year lifespan.”

Shortly thereafter, Anthony was transferred to Melach Hospice House in Temple Terrace. In late May he was transferred to his father’s home in Seminole Heights, where he talked to this reporter on May 30. At a recent visit to Moffitt, he was diagnosed with 14 multiple fractures up and down his spine and in his rib cage.

Speaking with a noticeable rasp but never showing weariness, he spoke for about 45 minutes about his experience, which still befuddles him.

“They’re not really getting healthcare,” he says of anyone who gets sick in the Department of Corrections, adding that even prisoners of war can be checked upon by the Red Cross. Regarding Corizon, he says, “Nobody’s looking after them. I hate to say it, but they have the bedside manner of a concentration camp.”

CL contacted the Correctional Medical Authority, the DOC and Corizon for comment.

“Patients or family members may not always agree with the actions taken, but we rely on the medical judgment of physicians to determine what medical care, medication, and other treatments are needed and stand behind their judgment and practices,” replied Susan Morgenstern, a spokesperson for Corizon. “While we cannot discuss specific details of patient care because of confidentiality restrictions, we have reviewed the case of Mr. Carvajal. Our review indicates that Corizon provided regular, ongoing, appropriate and compassionate care to him until his release.”

The DOC's Jessica Cary responded in an email that, while she couldn’t discuss Carvajal’s case, DOC Secretary Michael D. Crews “has maintained a clear message to Wexford/Corizon leadership that inmate care is the number one priority.”

Cary says there are 191 performance measures in the state’s contracts with Corizon and Wexford that are checked by 17 different contract monitors who visit each state institution twice a year. She adds that the DOC’s performance measures require 90-100 percent achievement of outcome to be met, compared to the CMA (that looks for 80 percent).

CL made several phone calls to CMA Executive Director Jane Holmes-Cain. She did not return our calls. (Senator Joyner tried to reach Holmes-Cain after speaking with CL, but she was also unsuccessful.)

Anthony Carvajal certainly was no Boy Scout, having been in and out of the justice system dozens of times since he was a teenager. But he insists he’s not a bad person. “I’ve made bad decisions and bad choices,” he said last month. “It’s easy for me to
say that, but if anybody were here who knows me, they would say that because I really and truly am. I’m at peace with myself and my Lord.”

And he says of his time at Lake Butler, “You’re basically placed there to pass away.”

Deborah Golden is aware that the constituency for supporting prisoners’ rights in any capacity may be limited, but says it should be the most basic constituency because “it’s not about prisoners, but about who we are as an American society and what we meant when we adopted a Constitution that said we would treat the least among us with dignity and respect.

“It’s not about what we do to prisoners, but what gets done in our name.” 

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