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COVID-19 in Maryland Justice

Advocates: Critical Medical Care Is Lacking in State Prisons During Pandemic

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Martina Hazelton has a family member with severe hypertension who is incarcerated at a state correctional facility near Cumberland.

Before the pandemic, Hazelton said, a nurse saw her family member and took his blood pressure every week. Now he struggles to even get his prescriptions refilled.

“It’s required, from what I understand, that they only give you a certain amount of medication and then there’s like a sticker or something that he’s supposed to turn in that signals to them [that] I’m out of medication, it’s time for you to call me back up,” said Hazelton, a co-founder of the Lifer Family Support Network.

According to the Department of Public Safety and Correctional Services’ Clinical Services and Inmate Health Operations Medical Records Manual, physicians can only supply inmates with 30 days’ worth of medication. When their prescription is up, health services staff scan barcodes on the prescription refill sticker to order more.

But, the manual states, medication to manage chronic conditions may be dispensed in 120-day stores. This exception is meant to be used in case chronic care patients can’t see their physicians within their regularly scheduled 90-day health exams, which is what happened to Hazelton’s incarcerated relative.

She said he called her when he was down to his last two pills, so she told him to turn in his refill sticker. 

“That’s when he received the memo saying, ‘We’re basically suspending all chronic care and if you are having, you know, like, pain, you should get a Motrin from the commissary,’” Hazelton said.

A memo dated March 30 issued from Corizon Health, the Maryland Department of Public Safety and Correctional Services’ health care provider, alerted persons incarcerated in facilities across the state that its staff would “only be seeing patients with urgent health problems.”

“If you are in chronic care, the provider will review your chart when your visit is due,” the memo read. “If he/she feels a visit is necessary you will be called to the dispensary. If he/she feels your condition is stable, your medication will be renewed and you will be scheduled to be seen at your 90 day visit if the health crisis has resolved.”

Del. Debra Davis (D-Charles) asked Public Safety and Corrections Secretary Robert L. Green about the memo and what care was being provided during a briefing that the House Judiciary Committee held in May.

“We have chronic care clinics that are part of a standing protocol and medical protocol,” the secretary told her. “I’m unfamiliar with the letter with Corizon.”

Davis said she has attempted to nail down details from the Department of Public Safety and Correctional Services about what health care services are being provided to inmates since the pandemic hit, but has received none of the documents she requested. 

“I was elected to the General Assembly to advocate for all Marylanders, including those who are incarcerated, their family members, and the dedicated women and men who serve our state as correctional officers,” Davis said. “My concerns were valid on March 23 and they remain valid today, given that over 1,000 incarcerated people and correctional staff have caught this deadly virus and nine of them have lost their lives.”

But two months after the briefing with Green and over 120 days since Gov. Lawrence J. Hogan Jr. (R) declared the state of emergency, Davis still has questions.

Del. Debra Davis (D-Charles)

“The question remains, are inmates and correctional officers receiving basic health care during the pandemic? How would CORIZON’s staff determine which chronic cases are early-stage COVID and which are urgent care without a timely consultation and diagnosis? How can we trust that their handling of the universal testing is accurate and thorough when in reality they must isolate and care for all positive patients –putting a strong incentive in place for underreporting? How can the MD General Assembly determine what is fact and what is fiction when the Secretary himself acknowledges he never saw notice about denial of chronic care when he testified to my committee in early May?” she asked in an email to Maryland Matters. “Maryland taxpayers will be on the line for any future litigation — and any wrongful death — and it is my responsibility as a state delegate to call out their neglect.”

The department says that it is still fulfilling its commitment to provide chronic care services for the nearly 60% of incarcerated Marylanders who need them.

DPSCS is committed to assuring that its contract provider delivers contractually obligated and necessary critical healthcare services to the entire population, consistent with CDC guidelines regarding healthcare services delivered during the  COVID-19 pandemic, as well as non-COVID-19 healthcare needs consistent with community healthcare guidelines related to congregate populations,” Department spokesman Mark Vernarelli said in a statement. “DPSCS provides ongoing monitoring of the contractor provided services through its own on-site Agency Contract Monitors and works to ensure that the contract provider’s required self-monitoring is done as well.”

Hazelton said that, after she made a series of phone calls on her family member’s behalf, he told her he received his medication, but no physician saw him.

She said the care he received was limited before “but it’s non-existent now.”

‘Absolutely, they are not’

Corizon is a private health care provider, with contracts with correctional facilities across the United States. The company entered into a five-year, $680 million flat-rate contract with Maryland in late 2018.

As it sought bids to replace the corrections department’s former health care provider, Wexford Health Services, the state indicated that the contract awardee would be responsible for operating a “comprehensive chronic care program,” which was to include medical services for asthma, cancer, cardiovascular issues, diabetes, dialysis, epilepsy, hypertension, infectious, autoimmune and rheumatic diseases, and other conditions. 

A department Secretary’s Directive issued on June 7 indicates that several of these conditions are considered to increase the risk of contracting COVID-19 among the incarcerated population.

According to the request for proposals issued in July 2017, stable chronic care patients are to be seen at least every three months to review their medication and treatment plans. Incarcerated individuals who have had three or more off-site emergency room visits related to their condition are to be seen monthly.

The request for proposals also states that the contract awardee must ensure that medical staff is prepared to treat incarcerated individuals in the face of catastrophic situations, including “severe weather, natural disasters, pandemics, and other emergencies,” and would be responsible for creating emergency management plans for each scenario.

“The Contractor, as part of its Emergency Management Plan, shall plan for mass outbreaks of infectious disease, showing plans for the use of the available respiratory isolation beds as well as other areas in the various facilities, in collaboration with [the Department of Health and Mental Hygiene] and [the Maryland Institute for Emergency Medical Services Systems],” it reads.

Per the 2017 document, the department has 39 respiratory isolation beds, with the potential for an additional 24. This does not include any potential respiratory isolation beds that may have been created at pop-up COVID-19 field hospitals at facilities across the state.

Even so, it appears as though Corizon Health has some protection under its December 2018 contract for delays in services “that arise from unforeseeable causes” beyond their control, including “acts of God, acts of the public enemy, acts of the State … fires, floods, epidemics, quarantine causes beyond the control and without the fault or negligence of either the Contractor or the subcontractors or suppliers.”

Corizon Health officials said they are still delivering the care that patients with chronic conditions need during the pandemic.

“We are continuing to provide the services needed to appropriately care for our patients with chronic care issues while adapting for CDC guidelines regarding the pandemic,” Corizon Health spokeswoman Eve Hutcherson told Maryland Matters in an email. “Additionally, providers continue to review patient records and care plans for chronic care patients on a regular schedule and update medication orders and other care instructions where necessary.”

But advocates dispute the claim that thousands of Maryland prisoners are receiving care for their chronic illnesses.

“Absolutely, they are not,” said Julie Magers, the director of the Maryland Prisoners’ Rights Coalition

Magers said that in Maryland correctional facilities, chronically ill individuals are supposed to be scheduled to see a doctor every three months, but because of the pandemic they aren’t being seen at all.

“They’re already not providing a standard of care which would be minimally acceptable in the community,” Magers said. “Now, due to COVID, they’re not going to these appointments at all. They’re not receiving physical therapies at all. We’ve had reports of people not receiving chemo at all.”

Magers said that the situation is very much the same when it comes to mental health treatment, adding that a quick glance at a paper file every few months by a medical professional does not meet the minimum standard of care and will not keep people safe and well.

“That’s not how mental health works, that’s not how medical health works,” Magers said. “Somebody could have symptoms next week that they didn’t have today.”

Magers conceded that there are exceptions, and that some incarcerated patients have received “intermittent appointments” for dialysis and that, for the most part, people are receiving their prescribed medications.

This isn’t the state’s first go-around with accusations of inadequate health care in correctional facilities. A federal court case that dates back to 1993, Duvall v. Hogan, was re-opened several times, alleging unsafe living conditions and improper health care for Maryland prisoners held in the Baltimore City Detention Center.  

The case was last reopened in 2015. Settlement of the case, which called for an update to the facility’s medical system, was approved in 2016.

The Baltimore City Detention Center has since closed.

‘Cracks in the system’

Last month, Green appeared before the Board of Public Works requesting approval of an emergency contract that could have tacked an additional $30 million, for unspecified costs related to COVID-19, onto the state’s flat-fee contract with Corizon.

The emergency contract, which the department entered into in early April, was unanimously rejected by the board. Instead, the board agreed that the state would pay for the months that it owes and will reimburse Corizon Health for future COVID-19 expenses after reviewing auditable “receipts for additional COVID related medical service expenditures that are being performed outside of the contract scope of work,” said Comptroller Peter V.R. Franchot (D).

Green called the contract a “point-in-time decision,” noting that the department was attempting to act quickly as it saw coronavirus cases skyrocket in prisons across the country.

The most vocal opponent to the contract was Franchot, who alleged that Corizon Health underbid the state by $50 million in pursuit of the contract.

“I guess the concern here is that we’re simply reimbursing this company for its own failures as far as implementing the contract that they signed to and agreed,” Franchot said during the meeting, “and there we are paying extra money and attributing it to COVID-19.”

As of July 6, the Department of Public Safety and Correctional Services was reporting 620 confirmed coronavirus infections among inmates and 448 among staff. Eight inmates and one correctional officer have died of COVID-19. 

Magers said that she and other advocates “do not and will not” agree with the case confirmations reported by the department and are confused about the emergency contract for COVID-19 services if people behind the wall are being denied chronic care treatment. 

“That’s the reason why the advocates are in an uproar about the [contract] increase because if they produce this [memo] and we have evidence showing that they’re not actually doing their contract care, then what do they need the increase for?” she asked. “That’s not been answered.”

Asked if money previously spent on the provision of chronic care services was being spent on the pandemic, Hutcherson said that discussions with the department surrounding COVID-19 expenses are ongoing and “unrelated to the provision of chronic care.”

Magers said that the Board of Public Works needs to survey all of the state’s financial records with Corizon Health, to ensure that incarcerated individuals in need of medical treatment aren’t being left out in the cold.

“It is a waste of money — it’s an economic waste — however, it’s also an inhumane way to treat people,” Magers said. “These are constitutional violations.”

Hazelton said that the COVID-19 pandemic has shown the “cracks in [the] system.”

“This system was broken, but it’s completely clear now this isn’t working, and that Corizon is … they’re not even meeting the base requirement of the healthcare behind the wall,” Hazelton said. “And that should be dealt with and every taxpayer in Maryland should be upset.”

Since the onset of the pandemic, her incarcerated relative has developed another persistent health issue. Hazelton said he put in sick call slips to see a physician for two weeks and received no response.

When he was seen, his treatment left her confused.

His health problem: inflamed varicose veins with a family history of blood clots. The department’s solution: an X-ray.

Baffled as to why medical providers would “do an X-ray on soft-tissue,” Hazelton said her family member will likely need an MRI to get to the root of the problem, which she says the department may be reluctant to do because he’ll have to be transferred.

“It’s going to get to the point where now I’m going to now have to start emailing and start calling,” she explained. “And again, this is for someone who has a family member.”

“There are so many people who do not.”

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Advocates: Critical Medical Care Is Lacking in State Prisons During Pandemic