THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Thursday, May 9, 1996 TAG: 9605090375
SECTION: FRONT PAGE: A1 EDITION: FINAL
SOURCE: BY LAURA LAFAY, STAFF WRITER
LENGTH: Long : 264 lines
The dialysis unit at the Greensville Correctional Center was dirty, David Frank Jones told his lawyer in a letter last year. Pools of fluid and piles of bloody sheets lay on the floor. Untrained technicians watched television when they were supposed to be monitoring patients on machines. It took weeks to see a doctor. Prescribed medicine was given irregularly.
``Since I've been in the infirmary . . . seven people have died,'' Jones wrote on Jan. 25, 1995, ``five or six of them were on dialysis. . . Something is wrong here and needs to be corrected.''
On March 30, 1995, Jones became a statistic, dead at 42 of blood poisoning from a gangrenous diabetic foot ulcer. The Front Royal inmate had been serving a 10-year sentence for aggravated sexual assault.
Less than two months later, on May 4, Harry Anderson, a diabetic mechanic from Norfolk, died of kidney disease. Three days after that, a 25-year-old dialysis patient named Terrence Braithwaite died of high blood pressure.
A fourth dialysis patient, 38-year-old Holley Foster, died of blood poisoning in July. A fifth, Alexander Dinkins, 33, died of high blood pressure in August.
At least eight patients at Greensville's 20-patient dialysis unit died during an 11-month period that began in December 1994 - a fatality rate of about 40 percent. The annual death rate for such patients outside of prison is 12 to 20 percent.
Dialysis is a way of removing toxins from the blood. Normally, the kidneys perform this function, flushing toxins out in urine. Barring a transplant, people with kidney failure will die without dialysis. Forty percent of people with insulin-dependent diabetes end up on dialysis.
The deaths at Greensville prompted two studies. The first, by a doctor whose name was not made public, commended the facility's dialysis unit. The second, by the director of Eastern Virginia Medical School's Diabetes Institute, is said to be critical of the unit but is being kept secret.
In March 1995, Correctional Medical Services Inc., a private St. Louis-based company under contract to provide medical care at Greensville, ended its relationship with a Georgia-based dialysis company it had hired to care for dialysis-dependent inmates at the prison.
``It was for business reasons,'' said CMS spokeswoman Susan Adams. ``It was not related to their performance at Greensville.''
But families and friends of the inmates who died tell horror stories about medical indifference, incompetence and neglect. The claims are difficult to substantiate. Citing privacy laws, Department of Corrections officials will not release medical information about the dead inmates. Citing security reasons, they will not allow reporters into the medical care facilities at Greensville.
Why did so many dialysis patients die? There is no clear answer.
Each of the deaths was ``natural,'' according to the state medical examiner's office. In a report released in November, a nephrologist from the University of Virginia School of Medicine did not find ``the causes or circumstances of death of these dialysis patients out of the ordinary.''
The nephrologist described the facility as ``clean.'' ``My overall impression of the dialysis unit was that there were no deficits in patient care,'' he wrote of his Sept. 17, 1995, visit.
``Personnel were courteous with many years of dialysis experience between them. . . I interviewed three patients and would characterize their attitudes as argumentative.''
The nephrologist would accept no compensation for his report, he wrote. Instead, he expected CMS to make a donation to Camp Holiday Trails, a camp near Charlottesville for children with chronic diseases.
He asked that his name be withheld. ``It is adequate,'' his report concluded, ``that the Division of Nephrology at the University of Virginia School of Medicine is identified as the source of this review.''
CMS and the Virginia Department of Corrections agree.
``I think we really need to look at the report that was generated by U.Va.,'' Adams said. ``That study did not find any causes or circumstances of these deaths to be out of the ordinary. It also found there was no deficit in patient care and that the quality of dialysis was up to industry standards.''
Walter Apperson, a 42-year-old inmate at Greensville, believes he is still alive because he knows so much about dialysis. He has been undergoing dialysis for 13 years, and at Greensville since 1990. Apperson remembers Harry Anderson. And Terrence Braithwaite. And Richard Hayth, who died on Dec. 31, 1994.
Before their deaths, Apperson wrote in a recent letter to The Virginian-Pilot, the three men ``seemed to be slowly losing their minds.''
``It started with them scratching all the time, saying bugs were on them. Then, over the weeks, it progressed to them talking to themselves extremely loud and stealing all the guaze and tape in the unit, putting it in their pockets without realizing it and seeming surprised it got there when the nurse asked for it back.''
Apperson believes the three had aluminum poisoning. All of the Greensville inmates under the care of Southeast Dialysis of Georgia (a subcontractor hired by CMS) last year were routinely given an aluminum-containing antacid called Basaljel, he said. Basaljel, according to Dr. Thomas McCune, a Norfolk nephrologist, is administered to dialysis patients who, because of improper diets, have developed dangerous levels of phosphorous in their blood.
But while Basaljel decreases phosphorous levels, it can raise aluminum levels. Therefore, the medication must be carefully monitored. Too much aluminum can result in confusion and ultimately death, McCune said.
``Aluminum is a possibility,'' said McCune after reviewing Apperson's letter. ``The way he describes how they got confused does go along with aluminum toxicity. That can happen from the use of Basaljel, the way he describes it. . . The dialysis supplier should have an adequate filtering system to make sure no trace elements are in the water used for the bath. It's part of routine checking.''
Greensville, which holds 2,900 inmates, is the state's largest prison. It is also the only prison in Virginia where medical care is provided by a private company. This year, state taxpayers will pay CMS $7.7 million to care for the inmates at Greensville. The company has a five-year contract that began in 1992.
In 1993, the care provided by CMS at Greensville was criticized in a report by the Joint Legislative Audit and Review Commission.
The report called the company's efforts ``a failure'' and denounced the Department of Corrections for failing to adequately monitor the contract. CMS, the report said, was not complying with the contract and was depriving inmates of sufficient access to medical care. In addition, it stated, CMS employees did a poor job of keeping records and controlling costs.
The U.S. Supreme Court has ruled that prison officials have a constitutional obligation to provide inmates with medical care. In Virginia, however, state law allows the Department of Corrections to use lower staffing standards of care than for those outside prison.
According to Steven Bricker, a Richmond lawyer who has spent 20 years filing wrongful-death suits in prison cases, ``lower standards'' mean that minimally trained employees provide most of the care under the supervision of a few registered nurses.
``There is a massive weak link in the system,'' said Bricker. ``Nursing care is critical to take care of sick people. It's fine to operate, but if you don't have good nursing care afterwards, you're going to die.''
Garry Lilly was serving a three-year sentence for violating his probation as a habitual offender when he met Alexander Dinkins last spring at Greensville. The two men were in different pods, but Dinkins' cell was next to the cell of Lilly's friend, Steven Whitehead. Whenever Lilly went to see Whitehead, he saw Dinkins, too.
When they met, Lilly recalled, Dinkins, 33, took medicine for high blood pressure but was otherwise ``in great shape.'' Until Aug. 22, 1995. On that day, in the late afternoon, Lilly said, Dinkins began yelling for the officer on duty, pounding on the door of his cell.
``He kept say, `Man, I don't feel good,' '' Lilly recalled in a telephone interview. ``He kept trying to get the guard to get them (medical personnel) over there. And medical sent two or three message back by phone telling the guard to tell him to take some Tylenol and they'd see him in the morning.''
All night long, Lilly said, Dinkins pounded and screamed. After breakfast, Lilly stopped by Dinkins' cell to see how he was doing.''
A few hours later, after the prisoners were counted at noon, Lilly went to Whitehead's cellblock and saw medical personnel in front of Dinkins' cell.
``But then, all of a sudden, there comes the captain, the lieutenant, two or three sergeants and the nurses,'' he said. ``So I figured something was wrong, and I looked into Alexander's cell and he was lying on the floor and they was doing CPR on him and he was dead.
``Whitehead told me later he didn't hear no noise coming from there during count time. They counted the man even though he was dead and lying on the floor.''
Dinkins' cellmate, Johnny Dwayne Wyatt, died a month after Dinkins. He was not a dialysis patient. According to Lilly, Wyatt, 35, had chronic epilepsy and ``was constantly falling out.''
``He was supposed to wear a helmet, but he said they wouldn't let him have it because a certain part of it had a piece of metal in it that could be used as a weapon,'' Lilly said.
In September 1995, as he was leaving the mess hall after breakfast, Lilly saw medics wheeling Wyatt down the sidewalk toward the medical unit.
``He had some blood on the front of his clothes and little bit on the side of his face and the side of his head,'' remembered Lilly. ``And I yelled to him, `You done fell out and busted your head again, ain't you? And he shook his head, yeah, and kind of gave me a grin look. Like, `Yeah, I done done that again.' The next day, the message came back he was dead.''
Wyatt died of ``natural causes'' on Sept. 27, 1995, said Department of Corrections spokeswoman Amy Miller.
Ron Angelone, director of the Department of Corrections, feels that the medical care provided to Virginia inmates has been unjustly criticized. Inmates, he said in a recent interview, get better health care than ``the majority of the people in the United States.'' In addition, he said, inmates are notorious for neglecting their bodies. Then, once they are locked up, they blame the department for their medical problems.
``These people come in with absolutely no care done to them by themselves or professionally by others for years, and then all of a sudden you want our doctors to - poof! - change their life,'' he said.
``Think about it. We don't deal with a healthy group of people . . . (so that) our doctors (are) able to continue their good health care. We have to start where (they have) gum disease. Where they've had diabetes all their life and they haven't done a thing but shove candy bars down their stomachs. And then we've got to make the miraculous change and when we can't because their body won't do it 'cause they neglected it for so long, we're held accountable. I mean that is incredible.''
For every inmate who dies, many more are saved, said Angelone.
``Nobody works in prison every day to say, `What can I do to kill an inmate today?' `What can I do to neglect my call as a nurse or a doctor and screw up something?' `I want him to die, so I'll just neglect him.'
``You know, the picture (is) painted of everyone in corrections as we're goons. That all we want to do is hurt people. That we come to work every day wanting to hurt people. We don't want to hurt people. We don't want them hurting themselves, others, staff or the public.''
Harry Anderson, 58, worked as a mechanic at Big Al's Mufflers & Brakes in Norfolk. He had diabetes for nine years before he went to prison for receiving stolen property and selling cocaine. Almost at once, said his stepson, Gary Worrell, he began to go downhill.
``They had a real problem with his diet,'' said Worrell. ``They didn't give him what he needed, and that affected him big time. He was going through seizures and blackouts. He needed dialysis every other day, but they let him go sometimes three days at a time without any at all. They said it was because he was uncooperative. . .
``One time, he had a seizure and went to (Medical College of Virginia in Richmond). And when he came back they didn't have a bed for him so they put him in the infirmary. And all his possessions were lost. . . He was always saying how cold he was.''
Anderson died May 4, 1995, of ``natural causes.'' Three weeks after his death, his family received a letter from the Parole Board. If they could get a doctor to confirm he only had three months to live, the letter said, the board would consider paroling him.
A second review of the care given to dialysis patients at Greensville, said to be more critical than the first, was recently completed by Dr. Leon Paul Georges, the director of the Diabetes Institute at the Eastern Virginia Medical School.
In response to Georges' report, CMS has decided to review the records of all diabetic inmates at Greensville, according to a letter sent to the Department of Corrections by a CMS doctor. In addition, the letter said, the company plans to send a nurse to a five-day training session and ``renew'' ``efforts in dietary management.''
David Jones was diagnosed with diabetes at 18 and began taking insulin injections at 22. According to medical records made when he first went to prison in 1991, his condition was ``well maintained.''
In June 1994, Jones was moved from Bland Correctional Center to Greensville. In August, he was admitted to the prison infirmary with a bleeding ulcer on his left foot. ``I was begging for dialysis treatment or for someone to shoot me,'' he wrote in a letter to his lawyer. On Aug. 29, he got his first treatment.
Almost from the start, things went wrong. He had problems with his fistula - the place where the tube is inserted for dialysis. He was sent to Medical College of Virginia, where doctors implanted a temporary catheter, but it was removed after he developed an infection.
For three weeks in October, he had to have a catheter implanted near his groin and removed each time he got treatment. A new graft was implanted at MCV, but it stopped working at Greensville. The ulcer on his foot got worse.
``This will be an on-going problem that won't be corrected by nothing short of surgery,'' Jones wrote to his lawyer, David Cosby of Richmond.
Concerned, Cosby wrote to the prison's warden. On Feb. 21, the warden wrote back:
``Mr. Jones is being followed by our Medical Director who has consulted an orthopedic and general surgeon regarding a chronic ulcer on his left foot. The care of his ulcer is complicated by his diabetes. Surgical intervention is not recommended at this time.''
Four days before Jones' March 30 death, his wife and son went to visit him at Greensville. Jones was having trouble walking. It took him 45 minutes to make the short trip from his cell to the visiting room, Charlene Jones remembered. And when he got there, he was shivering.
``We both gave him our jackets because he was so cold,'' she said. ``He had a real high fever and he said his foot hurt and he was out of breath. Usually, we stayed about five hours because it's a three-hour drive. But that time, we cut it short because he said he felt so bad. At least he's not suffering now, and he's at peace.'' ILLUSTRATION: Photos
DAVID JONES
DIED: MARCH '95
HOLLEY FOSTER
DIED: JULY '95
HARRY ANDERSON
DIED: MAY '95
RICHARD HAYTH
DIED: DEC. '94
KEYWORDS: PRISONS GREENSVILLE CORRECTIONAL CENTER
MEDICAL CARE by CNB