Miami Herald (MH) - Sunday, August 25, 1991
Ellen McGrarrahan; Herald Capital Bureau

TALLAHASSEE - Within the last two years, 17 inmates have died preventable deaths in Florida's prisons, investigators report. Deaths of another 31 of the 190 inmates who died during that time period were deemed "problematic."

That was just one of the shortcomings court appointed inspectors have found in the quality of medical care offered to the 45,000 men and women behind bars in Florida's prison system.

The problems run the gamut.

At Florida Correctional Institution, in May, an inmate broke her ankle. It took prison doctors a month to diagnose the problem and put her leg in a cast.

At Sumter Correctional, doctors treated an inmate for jock itch and the flu for months without detecting the ailments' underlying cause -- AIDS. The inmate died 13 days after doctors figured out what was really making him ill.

Though it has gotten better, nobody is contending that Florida's prison health care is well. It's a system that must deal with a disadvantaged and dangerous clientele. The men and women who enter the portals of the Department of Corrections bring with them a witches' brew of illnesses and ailments, some of which they could not afford to have treated as free people -- and some of which they leave with again when their time is up.

And soon, it'll be a system all on its own. For Florida is set to settle a longstanding lawsuit that, for 19 years, has provided court supervision for the quality of medical care offered to inmates.

Soon, the Department of Corrections is expected to regain control of prison health services for the first time since 1972, when inmates filed suit, saying conditions were so bad they were unconstitutional. The resolution of the suit does not mean prison health care is free of problems. Rather, it means Corrections, for the first time in nearly two decades, will be solely responsible for solving those problems.

And that won't be an easy task.

"There are going to be problems. All health care systems have problems," said Corrections Secretary Harry Singletary.

"It's a very high-risk population," said James Howell, chief of the Correctional Medical Authority, an agency established by the state to monitor health care in prisons. "We're really seeing alot of the underclass, as they revolve in and out."

"It's a very demanding type of medicine," said John Birk, of correction's Office of Health Services.

In a way, the state prison system is a world unto itself. At any one time it holds as many people as Coral Gables -- but twice as many as that flow in and out of it every year, carrying with them diseases and weaknesses and unresolved problems that make prison health issues community concerns.

Those in charge of medical care for the Department of Corrections must work as if they were running a huge, statewide hospital from some offices in Tallahassee. Over 2,200 health care workers are employed in state prisons. Each of the state's correctional institutions has a trained professional available round the clock.

And increasingly, prisons are providing care to inmates who bring with them diseases that have gone undiagnosed or untreated on the outside.

Some of the diseases are communicable, like AIDS and tuberculosis. Those two ailments that have increased dramatically among drug users, a group well-represented behind bars.

In the Department of Corrections, the rate of exposure to tuberculosis is higher than in the state as a whole, monitoring reports show. And the number of inmates with AIDS far exceeds the number of beds set aside for those ill with the disease, according to a recent report by the state agency charged with monitoring medical care in prisons.

As of April, there were 133 inmates with full-blown AIDS in the prison system, but only 24 beds at a special health unit designed for those with the deadly virus.

Despite growing numbers of inmates with the communicable diseases, Corrections does not have exact totals for those infected. The department does not keep a total on inmates with the HIV virus, and its AIDS numbers are sometimes unreliable, according to infectious disease specialist Catherine Folsom.

"I'm not sure our numbers are totally accurate," said Folsom.

It's only this year, in fact, that Corrections has had epidemiology experts at all. That's something the Department is working on, Birk said. Folsom was to go to a national conference on infectious diseases in March, but there wasn't the money for it. This time, they're aiming for October.

And medical problems posed by infectious diseases are not the only wrinkles in prison health care.

The system continues to be hampered by salaries that are too low to keep top-notch professionals, according to the Correctional Medical Authority's 1991 report.

In one year alone, the Correctional Medical Authority found, 40 percent of prison nurses and 37 percent of doctors left -- in part because salaries are low. "It is virtually impossible for the department to maintain adequate staffing patterns in institutional clinics without the ability to hire and retain medical care staff at a competitive salary rate," the 1991 report notes.

They're working on that, Birk said, in part by concentrating on recruiting doctors with lure of a 40-hour schedule and Florida's warm weather. "It's paying off," he said.

Care for women inmates, too, is not what it could be, monitors report. Entry forms are designed solely for male inmates, the Correctional Medical Authority found. This year a committee was formed to look at health care for women in prison -- at least 80 of whom at Florida Correctional Institution alone were pregnant last time monitors visited.

And in prisons, inmates with mental health problems are sometimes disciplined rather than treated by guards who mistakenly perceive the symptoms of mental illness as simple unruliness. At Marion Correctional Institution in 1989, for example, guards used Mace and other disciplinary actions to subdue an inmate later sent to a crisis stabilization unit for mental help.

But specific problems in health care behind bars are not, paradoxically, germane to the settlement of the lawsuit. Those involved in the suit say that Corrections will never have a problem-free system. Rather, it's the department's ability to heal itself -- to find and solve its problems -- that has brought the different sides to the verge of settlement.

For in the end, that's been the achievement of 19 years of court supervision: an admission from Florida that inmates deserve adequate medical care.

And for that, inmates can thank Michael Costello.

At the time when Florida State Prison resident Costello first filed suit in 1972, health care in prisons was "primitive," Butterworth said.

The department had no centralized system to give inmates care. Rather, each prison operated on its own. There was no credentialling system to check up on applicants' degrees, no cost-saving measures like collective bidding for outside medical care, and no supervision or coordination of care from the state level.

And, perhaps most important, there was no admission from those who ran the prison system that inmates deserve a level of care equal to that on the outside.

Now, after 19 years of litigation, there is that recognition -- and a system in place to deal with problems as they arise.

"What needed to be done was a showing that we really did care about the quality of medical care, and that we would follow up on it and do it right whether or not the court would force us to it," said Lieutenant Governor Buddy MacKay, who has helped resolve the suit.

"Nothing is ever going to be one hundred percent correct," said Butterworth. "You need a commitment to correct the situation and correct it quickly. That's what's there."

The Correctional Medical Authority, which will assume the role the court monitors have played for nearly two decades, monitoring health care -- but this time, from the inside of state government, rather than the outside.

And will it succeed in maintaining the progress that's been achieved?

"My name, and my word, and my integrity is on the line," said Corrections Secretary Singletary, "that what we have done will be maintained."

Here are case histories of some inmates whose deaths have been deemed preventable or questionable by the Medical Survey Team:

* On June 21, 1990, at 8 a.m., an inmate arrived at the Central Florida Reception Center from the Orange County Jail. He had a history of severe asthma, was on three asthma medicines and had a record, during his prior incarcerations, of being hospitalized for breathing problems.

At 1:30 p.m., a worker at the reception center noticed the inmate was having difficulty breathing. He was taken to the the center's emergency room and given oxygen, but no anti-asthma medicine. Later, he was taken to a hospital emergency room where efforts to restore his breathing punctured his lung. He died the following day. The Medical Survey Team faulted the center for "withholding potentially lifesaving treatment."

* A 32-year-old inmate, admitted to the prison system in 1983, was diagnosed with an acute hepatitis infection in 1989. He began complaining of headaches in March 1990. In April, he said the headaches were much worse. Two days later, he passed out and was placed in Charlotte Correctional Institution's infirmary.

By May, he was having difficulty swallowing, and was lethargic. He was transferred to a hospital, where he died of meningitis. The Medical Survey Team found that the death could have been prevented or at least delayed with a quicker diagnosis.

* A 45-year-old inmate complained of chest pains to a nurse at Liberty Correctional Institution in April 1990. She diagnosed "chest wall pain" and recommended Motrin and heat. Early the next morning, he came back to the clinic, complaining of chest pain. Twenty minutes later, he had a heart attack and died.

"The Medical Survey Team finds blatant disregard for evaluating chest pain," the report states. "This inmate was not afforded the examination and testing as would be considered community standard."

* A 56-year-old inmate entered prison in November 1987 weighing 300 pounds. He had wildly fluctuating blood pressure and diabetes. He died of a brain hemorrhage. The inspectors ruled his death preventable, saying the inmate had never been put on a diet, counseled about the dangers of salt or had his blood-pressure medicine adjusted.

CAPTION: PHOTO inside of prison tier (PRISON-FLORIDA-UNION CORRECTIONAL), guard in tower (PRISON-FLORIDA-GLADES CORRECTIONAL)

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