Medical Neglect

Sunday, October 22, 2017

Medical neglect and criminally negligent homicide are issues that have plagued prisons in the United States from coast to coast in recent decades. In modern discourse, this harm is often blamed on private prison organizations. It is absolutely true that medical neglect, and criminally negligent homicide, are rampant in private prisons, but they are also prevalent in state and federally run institutions.

Alaska is no exception to this trend.

In the time that Clayton Allison has spent in the Alaska prison system, he has been subjected to, and has witnessed, medical neglect on a nearly unbelievable scale. Numerous times, he has advocated on behalf of another inmate who was being neglected. It is a horrifying and frustrating experience; which, often leaves inmates feeling like they are seen as less than human.

Medical Neglect

High Fever

Nearly a year ago, Clayton fell prey to this negligence personally, and sadly, the cause usually boils down to paperwork.

In the outside world, people have come to use the phrase “there’s an app for that” to indicate that there is an application that can be used for just about any task an individual wants to do on a smartphone or tablet. In the prison system “there’s a form for that.” This includes medical help.

If an inmate needs to be seen for some kind of medical concern, they have a form they must fill out requesting to be seen. There is other paperwork that can be filed to expedite a medical concern, if the inmate believes that that concern is an emergency. These forms have to not only be received, but be fully processed by medical staff, before an inmate is actually allowed to be seen by medical staff.

When Clayton fell sick nearly a year ago, he submitted paperwork on the first day. It seemed to be a common cold, and he was hesitant to file the necessary forms because on previous occasions it had taken multiple days to actually be seen by a nurse. He feared he may be recovered before even being seen, and still be charged a fee for service anyway. However, the onset of the illness on this occasion seemed fairly extreme; so, he elected to file the paperwork and see if he was still stick by the time they got around to him.

A couple of days into the cold, Clayton began to run a very high fever. Fortunately, he had a personal supply of Tylenol to use to try and keep the fever at bay; which, he had purchased through the commissary. Most inmates do not have access to such a luxury; especially inmates who are indigent (who have no personal money of their own). The fever eventually grew so bad that, even with taking the Tylenol, Clayton attempted to lower his body temperature by: stripping down; soaking his towel with water; and laying the towel across his body in his bunk. He literally felt like he was boiling alive.

It is important to note that, although fevers are common, very high fevers can have very serious consequences. An extremely high fever over a prolonged period of time, can leave a person deaf, blind, or with other more subtle permanent damage. Avoiding neglect of a medical issue like this can be as simple as actually taking the inmates temperature.

On the third or fourth day of his illness, Clayton received confirmation paperwork back from the facility that his medical paperwork had been processed, and he should appear before the nurses at the morning pill call line. He did as he was instructed, but when he arrived, he was told that they did not have his paperwork. It didn’t matter what paperwork he had received, and even brought with him as evidence. They wouldn’t see him. The nurse did not even so much as take his temperature while he was standing in front of them.

The guards became increasingly concerned with the severity of Clayton’s fever. He was visibly red. One of them even approached the nursing staff, on Clayton’s behalf, asking for help, and for him to be checked out. Apparently, the result was the guard getting “screamed out” by the nurse for interfering, and Clayton still being denied treatment.

After a couple more days, Clayton’s fever eventually broke. He had fought it off with everything he had: Tylenol, bed rest, and a wet towel. A day and a half after the fever broke, medical informed him again that his paperwork had been processed, and he could be seen. They even commented that he didn’t seem to be running a fever. This was eight days after he filed his initial paperwork, and four days after he’d been told it was processed.

A fever may not seem like it amounts to medical negligence, but in reality, that impression can only truly be determined by the outcome. If Clayton had been struck blind or deaf, what would the opinion be then? However, this is only Clayton’s personal experience. The negligence that occurs at the facility goes far beyond that.

Abdominal Infection

One of the other major issues that occurs within DOC is denial, or prolonged delay, of access to surgeries that are medically needed by inmates, or recommended by their personal physicians. When someone arrives in the prison system, DOC takes over responsibility of payment for that person’s medical needs, including people who arrive with pre-existing conditions. This is true even if that person could independently afford services.

One of the inmates in Clayton’s mod, who we will call Pedro, is a good example of this type of complication. Pedro has Crohn’s disease, and before he ran afoul of the law and wound up in prison, he required surgery to disconnect his intestines and use an ostomy bag. His doctors had informed him at the time that he was only supposed to use the ostomy bag for a year, and then come back in for an additional surgery to reconnect his intestines and attempt to use them again. However, once he arrived in prison, DOC was unwilling to make arrangements for the necessary surgery.

Part of the delay came from Pedro being in an unsentenced status. Then, after sentencing occurred and it was determined that Pedro would spend many years in prison, the battle continued. Clayton assisted Pedro in battling through the paperwork process, and trying to get access to the much needed surgery. Pedro didn’t even know if having his intestines disconnected for multiple years could lead to an inability to have the reconnection surgery he needed. Eventually, he was able to get permission to have the surgery three years after first arriving at the prison.

The days leading up to Pedro’s surgery had been both exciting and frightening. He would be taken to the hospital for surgery, and afterwards would go into the medical segregation mod at the prison during his recovery. The surgery seemed to go well, and after leaving medical segregation, he ended up back in Clayton’s mod once again.

Within a week or two, Pedro started developing symptoms that were concerning.

The extremely large incision on Pedro’s stomach began weeping clear fluid, and at first he was unsure whether this was normal or not. Then, by the next day, the incision began instead leaking pus. The entire surface of Pedro’s stomach grew fiery red and inflamed, and he spiked a high fever. It took two days before he was even seen by medical after filing his emergent paperwork.

Then, when he was seen, he was told it would “probably take a few days” before an appointment could be secured with the person who had done the surgery. He was given an injection of antibiotics, a prescription for pain medication, and sent back to his cell. The pain medication he was prescribed is one he cannot even take because of the Crohn’s disease, but he was marked down as refusing medication for pain; despite his pleas for an alternative.

Clayton and his wife know the seriousness of an abdominal infection that severe. Years ago, Clayton’s brother-in-law had developed appendicitis, at 11 years old, which was initially painless. Without pain as a warning, his appendix had burst and filled his abdomen with an infection that had also grown over a two day period before the problem was discovered. After a mere two days of leaving the infection unchecked, the young man’s fever had spiked to more than 105° and he had been rushed into surgery. The surgeon ultimately had removed more than 10 pounds of infection from inside his abdomen, and said the brother-in-law had been lucky to still be alive all those years ago.

With this context, Clayton and his wife were shocked that Pedro was not immediately being taken to a hospital, and terrified that Pedro could also pass away from this obviously severe abdominal infection; which was not even being constantly monitored. He could spike a debilitating fever, or pass away from the infection in the middle of the night while he had no one paying strict attention but his own cellmate. In contrast, Clayton’s brother-in-law had required constant monitoring in the hospital post-surgery, for more than a week, to ensure that his body was beating back and ridding itself of the infection.

When Pedro saw medical the next day, the infection still seemed to be rolling at full steam, and growing steadily worse. He continued to weep infection from the surgical site. He was given another injection, and given additional oral and topical antibiotics to apply directly to the wound.

Pedro was not transported to the hospital until he did manage to get an appointment with the surgeon several days later. It turns out, a loose staple had fallen inside of his abdomen during surgery, and was the source of the infection he was now battling. They elected to leave the staple inside, instead of opting for yet another surgery to remove it; unless it triggers another infection later on down the road.

If it does, however, Clayton and Pedro have no belief at this point that medical will respond with any form of urgency.

Facial Paralysis

Another man in his mod who also works with Clayton in the kitchen, and who we will call Caleb, was suddenly struck the Friday before last with partial paralysis on one side of his face. At first, Caleb had believed he was falling sick, then had a sudden severe headache and pain in his face that he couldn’t explain. The paralysis set in quickly after.

Clayton and many of the other men in the mod feared that Caleb was having a stroke. The paralysis was severe, affecting both his eye and his mouth on that side. The pain was a persistent headache. Caleb filled out the paperwork, and flagged it as an emergency request to see medical.

Then, he waited.

He worked his shift in the kitchen the next day, Saturday.

He worked his shift in the kitchen on Sunday.

On Monday, Clayton was furious that Caleb still had not been seen by medical. Caleb is generally a soft-spoken and introverted person, and it seemed that no one had even noticed his ailment. Clayton went with Caleb to one of the stewards (a staff member who is not an inmate) in the kitchen, and pointed out Caleb’s distress; emphasizing that the paralysis only appeared to be getting worse.

The steward was visibly shocked, and quickly brought it to the kitchen supervisor’s attention. The kitchen supervisor seemed nearly disbelieving that Caleb had been having such severe symptoms for such a long period of time without being seen, and personally walked him down to medical to insist that Caleb be evaluated immediately.

After work, Clayton was shocked to see that Caleb was right back in the mod. As soon as the kitchen supervisor had left, the nurse on shift had explained that they had received Caleb's paperwork, but not processed it yet, and would not see him until his paperwork had been processed.

Caleb had literally been standing in front of them, with one side of his face drooping to the point of drooling, and they hadn’t bothered to check him out; much less transport him to a hospital for evaluation.

At this point, the men in the mod were convinced that Caleb had either had a massive stroke, and was at major risk of having continued mini strokes, or was at risk of dying from some phenomenon they did not understand. Caleb was, in fact, being blatantly ignored. Clayton had learned from another inmate that one of the medical supervisors from DOC was supposedly at Goose Creek that day, but would only be there for a few more hours.

It was the best possible time for Caleb to be seen by someone, but no one was willing to see him.

Clayton, Caleb, and another inmate who could confirm the length and severity of Caleb’s ailment, approached the CO in the mod. They tried to use every argument they could think of to explain that Caleb needed to be recognized as a medical emergency, and at a minimum, taken to medical if not directly to the hospital. They argued that if the guard did not have the ability to simply look at Caleb with his eyes and confirm that he had no intracranial bleeding - which of course is a talent no human being has - then he needed to be immediately evaluated for stroke.

“It’s like you look at these people, and you realize that they’re gonna have to do more paperwork for what you’re asking them to do,” Clayton had said at a visit later, “and you know they don’t want to. I’m standing there, thinking, what if my friend is dying and you don’t want to take the time or inconvenience out of your day to deal with it? It makes you feel less than human.”

The guard seemed very disinclined to help, but eventually conceded.

When Caleb was taken to medical again, he was immediately taken to a hospital for evaluation. Appropriate imaging was done to check for stroke or other brain injury. Ultimately, Caleb was diagnosed with Bell’s Palsy; a condition that usually onsets as a reaction to a virus, and causes severe enough swelling around the facial nerve to induce the paralysis and the other symptoms that Caleb was experiencing.

Caleb left the hospital with: the name of a diagnosis he did not understand; an explanation that he needed immediate medications he had not been given; and no instructions whatsoever of what he could do to alleviate his symptoms on his own.

When explaining to the other inmates in the mod what happened at the hospital, Caleb admitted he didn’t even understand whether he should go to work the next day. He did not know if he should be resting, or if rest even mattered. He didn’t know what to do about the pain he was continuing to experience.

The nurse at the hospital had emphasized to the guards with him that he needed to start steroidal medications immediately, to reduce the risk of the paralysis in his face becoming permanent. Nothing was administered at the hospital, or sent back with him. When he arrived back in medical at the prison, they informed him that the medication was not carried on hand, and would have to be ordered.

He had no idea how long it would be before it arrived, and he would finally be able to access the medication he supposedly needed immediately.

Caleb came to Clayton, and asked him to ask his wife to research the illness that night online, and find out if there was anything that Caleb could do himself. The next morning, they called and learned that there were indeed a couple of minor things Caleb could do to try and rehabilitate his condition. Online resources recommended applying moist heat to his face to relieve pain, as well as taking ibuprofen to try and reduce the swelling. It was also recommended to use eye drops to prevent severe dry eye from setting in due to interference with the eye’s natural habit of blinking, and patching the eye at night to prevent damage. Caleb was comforted to learn that even without proper treatment, the condition was likely to resolve itself within a few weeks.

He did not learn any of that from the hospital staff, or anyone at the prison. He learned it through the spouse of a friend with access to the internet, and a willingness to help.

Can you imagine for a moment… how frightened you would be if half your face was completely paralyzed, and you did not understand what was wrong? 

What about if you knew you needed medicine, and you did not know if or when you would get it? 

Would you be stuck this way forever? 

What if you had been taken care of the way they said you needed to be?

DOC Medical is Playing Russian Roulette with Human Lives – And Losing

The incidents described above all have a couple commonalities. First, DOC was negligent in its response to serious medical problems inmates were having; which it was ill equipped to handle or properly evaluate on its own. Secondly, DOC got lucky. They were lucky that Clayton’s fever did not cause permanent damage which would’ve allowed him to sue them for medical negligence. They were lucky that Pedro’s infection, left unchecked for multiple days with no one monitoring him but his cellmate and the “wellness checks” for consciousness, did not result in his death; which could have easily been considered criminally negligent homicide. They were lucky again that Caleb was experiencing Bell’s Palsy, instead of a stroke; which could’ve easily been a potentially fatal condition they chose to go days without even evaluating. 

They are not always so lucky.

Unfortunately, this pattern is only a continuation of the neglect DOC, and other government officials, are already fully aware of.

In the 2015 report, Alaska Department of Corrections: An Administrative Review, medical services are listed as a known supervision problem, and inappropriate medical response was listed as a factor in multiple inmate deaths which occurred in DOC’s custody.

“Under the current organizational structure, superintendents of Alaska’s correctional facilities do not supervise all employees staffing their facilities. Most medical and mental health staff report to a manager or director in the department’s central office. Consequently, while the superintendent of each facility is morally and legally responsible for all lives within the facility, the superintendent does not have line authority over personnel who have significant responsibility for keeping inmates and staff safe. … Negative consequences of this divided command structure became evident when the Review Team investigated several deaths that occurred in department facilities.” – Excerpt from Page 3

When looking at the details of the deaths that were reviewed, the same pattern illustrated by Clayton’s examples above, becomes clear.

• In the death of Mr. Mosley on April 4, 2014, it was evident that the facility he was being housed in was ignoring his mental and physical deterioration up until the time of his death. 
• Mr. Murphy was admitted on August 13, 2015, for his own safety due to intoxication in a public place, but due to a misunderstanding of policy he was held long after no longer being intoxicated, when he should have been released on August 14. Mr. Murphy interacted with multiple medically trained staff members, and reported having continual chest pains for an extended period. Yet, EMTs were never called and Mr. Murphy died of the complications before his release. 
• Mr. Joseph was admitted, and died on August 26, 2015, during yet another protective hold. The review team notes that, “Mr. Joseph was highly intoxicated and did not appear to be medically stable enough to be detained in a prison setting. He was unable to walk or stand.” Yet, they not only failed to bring him to a hospital setting for appropriate medical monitoring, but they also failed to intervene in the assault by other inmates which led to his death. 

The tragic case of 24-year-old Kellsie Green, occurred shortly after the release of the report. She died in January 2016 in the Anchorage jail, detoxing from heroin. Kellsie’s cellmates reported requesting help for her before she died. The Alaska Correctional Officers Association disputed that, claiming the cellmates were aggravated by her presence and wanted her removed from the cell. Regardless of the tone of their pleas, the officers’ attention was drawn to Kellsie’s situation before her death, and proper medical care was not rendered.

'All Inmates Say They Are Dying'

Some individuals confronted with such a review, including apparently the medical staff themselves, respond with the ludicrous question about whether or not inmates are “faking” their symptoms. The more important question should be, what could happen to the inmate if they are NOT. Do hospitals decide by glancing at you standing on their doorstep whether you should be seen, or if you are faking? Or do they run tests to confirm whether things are going on that cannot be observed by the naked eye?

In the case of Mr. Mosley’s death after mental deterioration, the report mentions that, “Referrals to mental health were not well documented. One correctional officer told the Review Team that a blunt conversation with mental health staff did not go well; the officer was told they were fed up with Mr. Mosley’s behavior and he was essentially the correctional officer’s problem.”

Clayton witnessed something similar with a cellmate last year. The man was someone who was well educated, and well spoken in his lucid periods. However, after being in the cell with him for less than a day, Clayton came to the conclusion that he was suffering from some form of mental illness or impairment like dementia. The man would regularly: randomly begin talking to people who were not there; have hallucinations about things that were happening in the mod (like planes taking off and snow falling); and bruise himself severely while thrashing and screaming in his sleep. This same man was housed with Clay in the solitary-confinement-like conditions of the SMU at the time; an environment known to cause and worsen mental illness.

Clayton soon learned the man had been “kicked out” of the mental health mod at GCCC after being accused by medical staff of “faking” his mental illness.

“There is NO WAY anyone can fake this level of illness,” Clay had said adamantly, desperately wanting to seek better conditions for the man. “He doesn’t even understand where he is. You can’t fake screaming all night, every night, for weeks without showing other signs. He thought I was his ex-wife the other day.”

It was obvious at times, the man didn’t even know where he was; which led Clayton and others to wonder why he was being held at the prison at all, and if his charges could have to do with the mental illness itself.

Interestingly, the same staff who had accused the man of faking his mental illness, also claimed he was faking physical injury at the time. He had reported falling out of his bunk and hurting his hip. The man walked around in the SMU for more than two weeks complaining of the same persistent pain before a CO in the SMU no longer bought the mental health mod’s claim, and sent him back to medical for evaluation.

It was reported to Clayton that the man’s hip had been broken in two places the entire time. No doubt the mental illness and physical injury were equally “faked.” The COs in the SMU, after discovering this, did not want to even recommend returning him to the mental health mod, for fear of continued neglect.

No Charges Filed

It is important to note that intentional neglect which directly leads to an individual’s death is specifically a crime in Alaska – criminally negligent homicide. Yet, we are not aware of a single individual that has been prosecuted in Alaska for the multiple deaths which have occurred as a result of neglect in state institutions.

This is particularly interesting, considering Clayton himself was wrongfully convicted on this charge when there is no actual physical evidence that a crime was even committed. In contrast, there is literal video footage and internal documentation of the inmates being neglected to death by multiple staff members, and we can find no record of charges even being filed.

The medical neglect and criminally negligent homicide experienced in prisons across the United States is abhorrent. It is important, however, that we do not isolate this issue down to private prisons alone. Whether run by the federal government, a state government, or a private institution, all of them seem hesitant to provide appropriate medical care for the individuals in their charge.

Any other form of long-term care facility that had these kinds of regular incidents occurring, would be charged with criminal abuse and shut down by the very same governments that are willfully committing the activity themselves. As a twisted business model, scraping by with too few resources, they are willfully ignoring the health concerns of inmates while they’re in the early stages of illness or injury that could be resolved more easily, and at less cost. Instead, public funds are being used only when illnesses and conditions have got grown so great that they now require thousands of more dollars to treat, and may in fact have already caused irreversible damage to the individual.