THE PRISON THAT CARE FORGOT

Inadequate Medical Treatment Continues to Plague OPP

In 2013, Orleans Parish Sheriff Marlin Gusman settled a class action suit brought by inmates at Orleans Parish Prison alleging brutal conditions at the jail violated their civil rights.

Federal Judge Lance Africk approved a sprawling document called a consent decree, outlining the terms of the settlement, under which Gusman and the Orleans Parish Sheriff’s Office pledged to address serious violence within the jail facility, as well as sanitary and health care issues. They also agreed to allow independent monitors to regularly assess conditions.

“During the course of the fairness hearing [evaluating the proposed settlement], the evidence, including credible witness testimony, exposed stark, sometimes shocking, deficiencies in OPP’s medical and mental health care system,” the judge wrote. “Inmates with mental health issues are housed in deplorable conditions. Mental health units smell strongly of feces, urine, and rotting organic matter. Several inmates had floors and walls smeared with feces when [correctional mental health expert Dr. Bruce Gage] visited, and many cells had ‘evidence of the detritus of several days’ food and utensils.’ Such unsanitary conditions can cause or exacerbate illness. Moreover, ‘mental health units, including those designed for suicide monitoring, were patently not suicide proof.’”

Newly arrived inmates were frequently taken off prescribed psychiatric drugs when they arrived at the jail, leading to physical and mental health issues; health care staffing was “dramatically insufficient;” and medical records had “serious deficiencies,” Africk wrote. Inmates at risk of drug withdrawal or with serious psychiatric issues went without timely treatment, with what appeared to Dr. Gage to sometimes be fatal consequences, according to the judge’s ruling.

“In his report, Dr. Gage stated that in several cases, including instances of inmate suicide, an initial referral to psychiatry could have changed the outcome of the cases,” according to the ruling.

In the roughly six years since the consent decree, even persistent critics of the jail complex (which mostly houses people awaiting trial) say health care at the facility has to some extent improved. The most recent report from the monitors inspecting the facility—which now includes a main building known as the Orleans Justice Center and a secondary structure called the Temporary Detention Center—points guardedly to recent improvements.

“In summary, the Monitors find that safety, medical and mental health care, and environment conditions of inmates held in both the Orleans Justice Center (OJC) and the Temporary Detention Center (TDC) has made meaningful and noteworthy improvement since the previous assessment report provided to the Court in August 2018,” they wrote in a March report. “While there is still significant work to be done to properly staff the facility, curb violence, and improve medical and mental health care, the trend is positive.”

Yet critics continue to point to deficiencies within the jail health care system, including calling into question the deaths of five inmates in the past two years. Some also question whether the Sheriff’s Office and the jail’s contracted health care provider, Nashville-based Wellpath, provides adequate care for inmates in need.

“We don’t really have faith that this group knows how to properly care for people in jail,” said Sade Dumas, executive director of the Orleans Parish Prison Reform Coalition (OPPRC).

Prisons and jails are constitutionally obligated to provide health care to the people they incarcerate, according to Supreme Court precedent. “Jail and prison inmates are the only group of Americans with a constitutional right to health care,” said reform advocate and OPPRC member Leslie Molson. “They’re the only people in America who actually do have a right to health care, but they’re not getting it.”

Wellpath and the Sheriff’s Office did not respond to interview requests.

In 2014, a company called Correct Care Solutions (CCS), which later merged to form Wellpath, signed a roughly $83 million, five-year deal with Gusman’s office to provide health care at the jail. As its then-name suggests, the company specialized in providing medical care at prisons, jails, and similar facilities. Almost immediately, the deal was controversial: then-New Orleans Inspector General Ed Quatrevaux critiqued the Sheriff’s Office for holding meetings behind closed doors to select the health contractor, and then-Mayor Mitch Landrieu’s administration soon sought to have the contract voided, saying the city, not the Sheriff’s Office, should be party to the contract.

It was more than just a jurisdictional scuffle: While the Sheriff’s Office runs the jail, the city is responsible for much of its funding and in a legal filing called the contract “financially crippling.” Officials said the cost per inmate was substantially more than that paid to CCS by other urban jails or by neighboring Jefferson Parish to its jail health provider. Africk declined to overturn the contract and criticized the city for not proposing a viable alternative to provide adequate health care at the jail.

“The court will not permit the Orleans Parish Prison to fall short of constitutional standards because of inadequate funding by the city,” the judge said, according to a report in The Advocate at the time. “Until there is some other viable proposal on the table, the CCS contract is the only existing means of providing medical and mental health care, and the city must continue paying for it.”

But since then, a number of incidents have led critics to question whether CCS and the Sheriff’s Office are providing adequate care.

In October 2017, a 32-year-old man named Narada Mealey died while apparently suffering from opioid withdrawal. A lawsuit brought by his family alleges CCS and jail officials ignored pleas from Mealey and relatives he contacted outside the jail to give him adequate care, failing to take him to the hospital until he died of complications from a perforated gastric ulcer, which the complaint in the case alleges is “a known risk for people who are detoxifying from opioid abuse.” CCS medical staff also didn’t monitor his vital signs, in defiance of their own opioid withdrawal protocols, the lawsuit alleges. In court filings, CCS and Gusman have denied the allegations in the lawsuit.

The following month, 27-year-old Evan Sullivan died in the Temporary Detention Center of what was initially reported as apparent natural causes, though he was later found by the Orleans Parish Coroner’s Office to have died from acute aspiration pneumonia and heroin intoxication.

A third inmate, 41-year-old Dennis Edwards, died in December 2017 after a CCS charge nurse allegedly declined to allow him to be sent to the hospital. CCS and Gusman denied allegations in a lawsuit brought by his family, saying his death was the result of a lack of adequate medical care. Officials said at the time he was on an opioid “detoxification protocol,” The Advocate reported.

Several months later, nurse Natalie Henderson filed a lawsuit against the Sheriff’s Office and CCS, alleging she was fired by CCS in violation of Louisiana whistleblower protection laws for raising concerns about Edwards’ treatment and treatment of nursing staff by inmates, including inmates allegedly exposing themselves to her and touching her buttocks. Several inmates have been charged in connection with those alleged assaults, with at least one pleading guilty, the Times-Picayune reported last year.

Henderson’s attorney Joseph “Jay” Albe Jr., whose firm also represents Edwards’ sister, declined to make Henderson available for an interview, citing the ongoing suit. She previously told a Times-Picayune reporter she believed Edwards could have potentially been saved had he been brought to the emergency room. Her supervisor declined to do so, Albe told me.

“She had not been there very long, and there was definitely a very strained relationship with her supervisor because she wouldn’t just go along with the program,” he said. “He basically told her to get out of his face, and within about an hour is when Mr. Edwards coded [had a cardiac emergency].”

Dangers from violence in the jail and problems administering health care can reportedly go hand-in-hand. An Orleans Parish jail inmate named Terrence Rollins, who uses a wheelchair, represented himself in filing a federal lawsuit in June alleging inadequate care for infected bedsores. In medical records included with the legal complaint, a nurse alludes to “security issues” in a note to Rollins.

“The medical department can only provide care if security is adequate, and on June 7th the rationale for your wound care not being completed on both the day and the night shift was due to security issues,” the nurse wrote.

In May 2018, another inmate named Kentrell Hurst died while apparently detoxing from alcohol and opioids, two days after being arrested for allegedly shoplifting from a grocery store. A lawsuit filed by the 36-year-old’s family alleges CCS nursing staff ignored her complaints of severe pain and vomiting and didn’t follow their own opioid withdrawal protocol or properly monitor her vital signs.

“A check of Ms. Hurst’s vitals, as was required by [clinical opiate withdrawal syndrome] protocol and warranted by her reported symptoms, would have shown that Ms. Hurst was in a medical crisis that required immediate hospitalization,” according to the complaint. “However, these defendants ignored their duties to Ms. Hurst, as well as her repeated pleas for help.”

Yet another death came in December 2018, when 28-year-old Edward Patterson died while awaiting trial for attempted murder. Attorney Eric Santana, who is representing Patterson’s family, said Patterson was found to have died from an overdose of what’s believed to be fentanyl smuggled into the jail. Exactly how quickly he was discovered and what care he received remains unclear, Santana said, and the family plans to file a lawsuit in the coming weeks. “We haven’t even got clear answers as to whether he was on a medical dorm,” Santana said.

In May, Mayor LaToya Cantrell’s administration announced that the city had inked a 90-day extension of the contract with the company now called Wellpath, following a previous nine-month extension signed last September. At the time, the city indicated it intended to move forward with a longer-term extension, a proposal that drew ire from reform advocates.

“There should have been more effort from the city of New Orleans to look for different health care providers and I’ll even say to look for a local provider,” Dumas said. “We outsource so many services in New Orleans to people who are out of town, when we could look in town and see what we have and actually work with people who are connected to the community.”

In the case of mental health, officials have done just that: Last year, what was then CCS signed a contract with the Tulane University Medical Group to provide psychiatric care at the jail, including potentially by video conference, as well as at Elayn Hunt Correctional Center, a state facility in St. Gabriel where some inmates from Orleans Parish with serious mental health issues are currently sent. “The addition of resources from Tulane University has been particularly helpful in providing mental health care,” the monitors wrote in March.

To be sure, medical care issues in jails aren’t limited to New Orleans or Louisiana. Earlier this year, Wellpath was the subject of a scathing series of CNN reports that found the company, which now serves more than 500 facilities, had been sued over more than 70 deaths within five years amid complaints of inadequate care, failure to adequately diagnose and treat illnesses, and failure to transfer patients to emergency rooms when needed. Critics and former employees said the problems stemmed from the company’s focus on the bottom line, an allegation company officials denied. They told the network Wellpath has been sued less than “national, non-correctional, health care entities” and that it “seeks to control costs not by restricting care, but by providing efficient, effective, medically-appropriate care.”

And, reform advocates say, some problems with correctional healthcare in New Orleans and nationwide could be addressed by general criminal justice reforms, like jailing fewer people awaiting trial on minor charges and providing adequate, non-prison facilities for people with mental health problems.

“Corrections officers were never meant to be social workers or psychologists or psychiatrists,” said Janet Hays, founder of the mental health advocacy organization Healing Minds NOLA.

Nor have complaints about terrible conditions and health care in Orleans Parish jails arisen only in recent years. A report by Andrea Armstrong, a law professor at Loyola University, traced often horrific treatment in local jails back to the 1700s, when Black inmates in particular were routinely mistreated. Overcrowding, deliberate abuse, poor hygiene, and minimal health care have perennially been an issue, she writes.

“There was a period in which there were no incoming health examinations at all,” she said in an interview. That led to unnecessary exposure to infectious diseases, which inmates can continue to suffer from and unwittingly spread even after they’re released. Mental health care likely wasn’t any better: In 1970, after a federal judge found conditions in the jail unconstitutional, the Times-Picayune reported that “disruptive psychotic prisoners are sometimes moved into a hallway by the main gate and chained to the bars.”

The jail didn’t hire a full-time medical director until 1990, according to Armstrong’s report, when newspaper reports say then-Sheriff Charles Foti also agreed to get every incoming inmate a physical within a week of arrival in response to litigation at the time. Still, complaints of deaths from inadequate medical care would continue into the following decades, and so far, decades of court rulings and settlements have seemingly only made limited progress at fixing the jail system’s issues.

“We are seeing improvements—the question is [what happens] after the consent decree provisions have been met and are deemed completed and the independent monitors leave,” Armstrong said. “If we look at history, what we’ll see is conditions rapidly deteriorate and there will have to be another lawsuit filed.”

One challenge will come if the state prison system no longer houses Orleans Parish inmates with severe mental illness at Elayn Hunt. The agreement between the Orleans Parish Sheriff’s Office and the state ends in April 2020. The Sheriff’s Office has asked the city to expand an existing cap of the capacity of the parish jail so that people with, experiencing, or perceived to be experiencing mental illness can be jailed locally in a new facility called “Phase III,” but the City Planning Commission voted to recommend the limit stay in place. The City Council, which has the final say, is scheduled to take up the issue November 7.

The OPPRC and other groups have also sued the Sheriff’s Office, saying its use of a so-called Temporary Detention Center past when it was supposed to be decommissioned violates a city ordinance. The suit is scheduled to be heard this month.