AZ Republic: Ignore the prisons at our own peril...

 AZ Department of Corrections

(November 1, 2010)

Excellent editorial from the folks at the AZ Republic. They've been doing a great job covering the prisons this past year - which takes a lot of courage for mainstream media to do  in this town.

This exposure incident is potentially devastating for those men affected - up to 20% will likely die from liver cancer or cirrhosis as a result, if they don't get successfully treated. Hep C is epidemic in our state prisons already, though -that incident was a drop in the bucket compared to the 12,000 already infected (almost 6,000 confirmed cases alone, compared to less than 200 with HIV/AIDS...it's pretty bad).

As long as they aren't treating addictions inside or doing an aggressive harm reduction campaign, though, the disease will continue to be spread by needles among IV users and tattoo recipients - 95% of whom ultimately return to the community, becoming a serious public health concern. One of the things that could do most to reduce the incidence and impact of Hep C in the community is to provide adequate substance abuse treatment and Hep C education, screening and treatment in prison, but neither is really happening.

According to the DOC 75% of prisoners are coming in with serious substance abuse issues, yet they aren't providing substance abuse treatment for more than 4% of the total prison population in a year - not even for all those guys being sent off to DUI prison, where everyone thinks we pay for a special treatment setting so they don't relapse and kill someone on the road next time. Coming into the mess we already have in the DOC medical system, I don't see how Wexford is going to do any better by prisoners - especially those with Hep C - AND turn a profit.

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Out of sight, out of mind

Sept. 8, 2012 01:26 PM
The Republic | azcentral.com

On Aug. 27, a nurse working for a company called Wexford Health Sources Inc. administered a dose of insulin to a diabetic patient who has hepatitis C, a deadly and extremely infectious liver disease.

The nurse then inserted the needle into another vial of insulin to draw still more of the drug for the patient.

She put that second vial, and the remainder of its contents, onto a shelf with other vials of insulin.

You can well imagine where this health-horror story is going: More than 100 other diabetes patients who later were given insulin treatments may have been infected with hepatitis C.

Mistakes happen. Including potentially tragic ones like this. But there is a bit more to this story.

Wexford is a private company that just this spring won a $349 million, three-year contract to provide health services to Arizona's nearly 40,000 prison inmates. The nurse, who already was under investigation for providing slipshod care, worked for Wexford at the Arizona state prison at Buckeye.

State rules require health-care providers, including those working out of prisons, to alert county and state health authorities about a potential outbreak of an infectious disease within five business days.

Wexford alerted public health officials of the incident on Sept. 4, more than a week afterward -- and only after Wendy Halloran of 12 News learned what happened from an inmate's family and The Republic's Craig Harris broke the story online.

In Arizona's seemingly inexorable march toward privatizing ever more of its prison system, this incident is but one more red flag about the pitfalls of that policy.

Sure, it was an accident. Accidents happen. But are more such accidents occurring at prisons whose profit motives tempt supervisors to cut corners?

Corner-cutting appears to have been a factor in the escape of three prisoners on July 30, 2010, from a Kingman prison operated by Management & Training Corp. A faulty alarm system appears to have contributed to the incident, during which the escapees murdered a New Mexico couple.

Another private contractor hired by Arizona, GEO Group Inc., has lost at least 27 of its prisoners around the country since 2004, including one from a facility in Florence, albeit from mostly low-security facilities.

The Wexford incident, however, raises a still more unsettling concern: Are there more accidents and incidents than we know about? Is Wexford's slow-mo reaction to following established protocol evidence of other incidents being swept under the rug?

The state Legislature's most ardent Republican critic of private prisons, Mesa Rep. Cecil Ash, argues that private prisons "are the wrong business model" for exactly that reason: "They are out of sight, out of mind."

If private-prison operations were cheaper to operate, that might mitigate the more minor operational concerns. But they are nearly 10 percent more expensive to operate. Lawmakers like them because of the up-front cost savings on construction, which the private firms often bear.

Legislators need to take this Wexford incident for what it is: stark evidence that transparency is a serious issue with private prisons.

Prisons are out of sight, out of mind, at our peril.

Parsons v Ryan: Suicide Prevention Day, 2012, AZ DOC.

Remembering the suicide victims of Jan Brewer 

and Charles Ryan at the Arizona Department of Corrections.

 

 "SOS from Arizona's Other Death Row"

Firehouse Gallery and Cafe, Phoenix

June 2012

This is the state of suicide prevention in Arizona's Department of Corrections, under Director Charles Ryan. I hope the DOC responds to this critique with a detailed description of what else they're doing to reduce the rate of despair and violence that's driving Arizona prisoners to kill themselves at twice the rate than the national average for state prisoners. I want to know what the training consists of. So do the families who have already suffered a death in custody - as well as the loved ones of those mentally ill prisoners fighting to be safe and well in custody now. How have the conditions described below changed since Parsons v Ryan was filed?

If you have a loved one in prison with a serious mental illness whose safety or sanity you fear deeply for, please feel free to contact me. I'm just an artist and activist - I'm not a lawyer or professional anything, but I can refer you to resources in your community, and connect you with other families who share your struggle. 

Have your loved ones write me as well. 

Arizona Prison Watch  /  PO Box 20494  / PHOENIX, AZ 85036

thank you again to all the attorneys working on this case...but most of all, to the prisoner-litigants who had the courage to put their names and faces to the abuses and neglect going on behind bars in this state...

Peggy Plews 

480-580-6807

arizonaprisonwatch@gmail.com

Parsons V Ryan (p. 47)

2. Defendants Deprive Suicidal and Self-Harming Prisoners of Basic Mental Health Care

82. Defendants have a policy and practice of housing prisoners with serious mental health needs in unsafe conditions that heighten their risk of suicide. In FY 2011, there were 13 suicides in ADC prisons, out of a population that averaged 34,000 during that time. That is a rate of 38 suicides per 100,000 prisoners per year, more than double the national average suicide rate in state prisons of 16.67 per 100,000. Three prisoners committed suicide in one week in late January 2012, including a 19-year-old woman.

83. One factor responsible for such a high suicide rate is Defendants’ policy and practice of maintaining suicide watch facilities that offer no meaningful treatment. Usually the only people who interact with prisoners on suicide watch are correctional officers who check on them periodically, medication assistants who dispense pills, or psychology assistants who talk to them through the front of their cell. Plaintiff Swartz did not receive psychotherapy for more than two months in the summer of 2011 while on suicide watch at the Lewis facility. After he swallowed glass and was taken to an outside hospital, the hospital psychiatrist recommended that he be taken to an inpatient mental health unit. These units are in the Phoenix complex. Instead, Mr. Swartz remained at Lewis where he continued to harm himself. He finally was moved to the Phoenix inpatient unit almost three months after the hospital psychiatrist had made that recommendation, but after a short period of time he was again returned to Lewis. Plaintiff Thomas did not see a psychiatrist for 11 months despite being placed on suicide watch multiple times.

84. Defendants also have a policy and practice of holding suicidal and mentally ill prisoners in conditions that violate all notions of minimally adequate mental health care and basic human dignity, and are not compatible with civilized standards of humanity and decency. Suicide watch cells are often filthy, with walls and food slots smeared with other prisoners’ blood and feces, reeking of human waste. Mental health staff show a lackof professionalism and little compassion for prisoners enduring these conditions: for example, prisoners in suicide cells are taunted for being in “the feces cells.” When Plaintiff Swartz complained to a LPN about the unhygienic conditions of the suicide cell at Lewis, the LPN described him in the mental health notes from the encounter as “bitching about cleanliness – germs and disease.”

85. Defendants have a policy and practice of keeping suicide watch cells at very cold temperatures. Prisoners are stripped of all clothing and given only a stiff suicide smock and a thin blanket, making the extreme cold even harder to tolerate. Plaintiffs Rodriguez and Verduzco report that the suicide smock used in Perryville barely comes to the top of female prisoners’ thighs, so both their legs and arms are exposed to cold air. Many prisoners are also deprived of mattresses and as a result must sleep on bare steel bed frames, or on the floor made filthy with the bodily fluids of prior inhabitants. Plaintiff Brislan spent several weeks in a frigid suicide cell with no mattress.

86. Defendants have a policy and practice of exposing prisoners on suicide watch to gratuitously harsh, degrading, and damaging conditions of confinement. Prisoners are given only two cold meals a day, and are denied the opportunity to go outside, brush their teeth, or take showers. The only monitoring prisoners receive in suicide watch is when correctional officers force them awake every ten to 30 minutes, around the clock, ostensibly to check on their safety. In some suicide cells, bright lights are left on 24 hours a day. The resulting inability to sleep aggravates the prisoners’ psychological distress.

87. Mentally ill prisoners on suicide watch complain of correctional staff behavior that interferes with any therapeutic effect of being on suicide watch, including harassment, insults and taunts, and the excessive and practically sporting use of pepper spray. Prisoners at the Perryville suicide watch units, including Plaintiff Verduzco, have jerked awake when awoken by staff on the “safety checks,” and are pepper sprayed for allegedly attempting to assault the officers. Guards in the Perryville suicide watch units also frequently pepper spray female prisoners in their eyes and throats when they are delusional or hallucinating. Plaintiffs Rodriguez and Verduzco have asthma and rely upon inhalers, and they have had asthma attacks from the regular use of pepper spray in the women’s suicide watch unit. On multiple occasions after she was pepper sprayed in the eyes, nose, and mouth, Ms. Verduzco was dragged to a shower, stripped naked, and sprayed with extremely cold water to rinse away the pepper spray; she was then left naked to wait for a new vest and blanket. A prisoner in the Florence prison’s suicide watch unit reports that while there he was handed razor blades to swallow by other prisoners, and told “just die right away.” He started to swallow the blades, and security staff pepper sprayed him while he coughed up blood, and did not provide other emergency response.

88. Defendants’ policy and practice of holding suicidal prisoners in excessively harsh conditions does not prevent but rather promotes self-injurious behavior. Plaintiff Brislan has cut himself numerous times with razors and pieces of metal while on suicide watch at multiple prisons, including Tucson, Lewis, and Eyman’s SMU 1 and Browning units. At the Tucson prison, staff put him on suicide watch in a cell with broken glass on the floor which he used to cut himself. During another stay in suicide watch, Mr. Brislan was given a razor blade that he used to deeply lacerate both of his thighs. While on suicide watch in the Lewis prison during the summer of 2011, Plaintiff Swartz, on separate occasions, swallowed multiple foreign objects, including two large staples, plastic wrap, a piece of glass, a lead-head concrete nail, a spork, two pens, sharpened paper clips, a metal spring, a steel bolt, and two copper wires. As with Plaintiff Brislan, Mr. Swartz’s repeated suicidal gestures and ability to access dangerous objects while on suicide watch confirms that he was not being properly monitored and that any mental health treatment he might have been receiving was inadequate.

89. Defendants also have a policy and practice of improperly using the suicide watch cells to punish prisoners for alleged disciplinary infractions. An Eyman prisoner who went on a hunger strike to protest prison policies, but did not display signs of mental illness or distress, was put in a suicide watch cell for several weeks and was told by a mental health provider, “If you weren’t on this hunger strike, you wouldn’t have to live in the feces cell.”

UPDATE: ASPC-Lewis Hep C exposure incident.

excellent report by Craig Harris at the AZ Republic is at the bottom.

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Bury Hep C, Not People.... 

Wexford Health Sources, Phoenix (JULY 2012)

Wexford connection for prisoner health information:

toll free 1-855-890-6307, or email your request to azcorrections@wexfordhealth.com. 

This media release comes to us this afternoon from Wendy Halloran at KPNX Channel 12 News. They will be covering the story tonight at 5pm and 6pm. Wendy was recently nominated for an Emmy for her investigation of the highly preventable suicide of Tony Lester.

Hep C is already a leading killer in our state prisons. Nearly 6,000 prisoners are already diagnosed with it, and another 20-30% of the prison population likely have it but don't know it yet...

From: LAMOREAUX, BILL [mailto:BLAMOREA@azcorrections.gov]
Sent: Tuesday, September 04, 2012 11:35 AM
To: Halloran, Wendy
Subject: RE: MEDIA REQUEST FROM WENDY HALLORAN AT 12 NEWS

Ms. Halloran:

On August 27, 2012, a potential exposure event occurred at the Arizona State Prison Complex – Lewis while administering medication. A vial of medication, which may have been compromised with a previously used syringe, was subsequently used to treat additional inmates.

Review of this event determined the potential exposure to Hepatitis C and involved up to 105 inmates. As a result, these inmates were notified and are currently being screened for infectious diseases as per protocol in such an exposure event. An independent laboratory, under contract with Wexford, will provide continued medical monitoring and testing of these potentially exposed inmates over the next several months. All patients will be informed of the results of the testing.

The medical protocols related to this potential exposure have been reviewed to ensure that subsequent events do not occur. The initial event remains under review by Wexford Health, the contracted provider responsible for inmate health care.

The nurse who violated the basic infection control protocols is an employee of a staffing agency under contract with Wexford Health. Wexford has banned the nurse from working under any of its contracts and has also requested that the individual be referred to the State Board of Nursing for investigation.

Regards,

Bill

---------from the AZ Republic------------

Prison nurse tied to hepatitis C exposure

by Craig Harris - Sept. 4, 2012 11:12 PM
The Republic | azcentral.com

A nurse for the new medical provider for Arizona prisons may have exposed 103 inmates at the Buckeye state prison to hepatitis C by contaminating the prison's insulin supply, and state and local health officials were not alerted for more than a week.

Officials with the state and Maricopa County health departments, who confirmed to The Arizona Republic on Tuesday that they had not been informed by Wexford Health Sources Inc. of the problem, said they will launch investigations into the incident.

Official notification of the Aug. 27 error only came late Tuesday afternoon, hours after an inmate's family member had told 12 News of the potential health risk.

State rules require health-care providers and correctional facilities to notify health departments within five business days of a hepatitis C diagnosis, treatment or detection.

Wexford said it suspended the nurse on Aug. 27, immediately after learning the person "had violated basic infection-control protocols while administering medication that day."

"In talking with the Department of Health Services, they believe it should have been reported first to the county," Corrections Director Charles Ryan said late Tuesday. "That is a question we will have of Wexford -- as to the lack of notification or an explanation as to why that did not occur.

"The department has concerns about this issue, and we will be having further discussions with Wexford in terms of this requirement and some other issues as well."

Ryan said the incident occurred when a diabetic inmate who also has hepatitis C was administered a routine dose of insulin by the nurse on Aug. 27. The needle used on that inmate was inserted into another vial to draw more insulin for the same inmate.

Ryan said the contaminated needle was inserted into a vial which was then put back among other vials in the prison's medication refrigerator. It got mixed up with other vials used throughout that day to administer insulin injections to more than 100 other diabetic inmates. Later that day, Ryan said, officials realized that the vial that potentially had been tainted with hepatitis C may have been used to dose other inmates.

At that point, the nurse in question was suspended and prison officials sought to determine how many inmates may have been exposed.

All the vials of medicine were destroyed after the discovery.

Wexford spokesman Larry Pike on Tuesday minimized the potential exposure of other inmates. He said that the company acted "expeditiously" to identify those who were potentially affected and that the company believes the potential for their exposure was small.

Though corrections officials and Wexford declined to name the nurse, the Arizona State Board of Nursing identified her as Nwadiuto Jane Nwaohia. She has been under state investigation since June 2012 for unsafe practice or substandard care, but the board would not provide additional information on the nature of the previous problem.

Corrections officials first acknowledged the matter Tuesday morning after 12 News asked about the incident at the Arizona State Prison Complex-Lewis, which houses 5,382 inmates in minimum- to maximum-security facilities.

Hepatitis C is the leading cause of liver transplants and causes liver cancer. Seventy-five to 85 percent of people with hepatitis C develop a chronic infection, according to the U.S. Centers for Disease Control and Prevention.

Shoana Anderson, head of the state Office of Infectious Disease Services, said one of the biggest dangers for those infected with hepatitis C is "it sits in the liver quietly, and 20 years later, a person can develop severe liver disease."

Anderson and Jeanene Fowler, a spokeswoman for the Maricopa County Department of Public Health, said Wexford should have notified them of the issue.

"It's extremely disturbing that something like this could happen. It calls for a thorough investigation to determine all of the surrounding causes of the mistake or the negligence," said Don Specter of the Prison Law Office, a prison watchdog group based in Berkeley, Calif.

Ken Kopczynski, executive director of the Private Corrections Working Group in Tallahassee, Fla., called the incident "scary" and said it shows a lack of oversight by corrections officials.

"This is a problem with privatization," Kopczynski said. "They are just accepting who Wexford will hire."

Wexford, which has previously lost contracts for poor service in other jurisdictions, this spring won a $349 million, three-year contract to provide health care for Arizona inmates. The company began providing services for nearly 40,000 Arizona inmates on July 1.

In a written statement, the Pittsburgh-based company said it suspended the nurse immediately upon learning she "may have compromised a vial of medication by placing it in contact with a previously used syringe."

Wexford, in its statement, said a local staffing agency assigned the nurse to the prison complex. The company said that at no time was the same syringe and needle used on more than one patient and that no staff members were exposed.

Wexford said it reported the nurse to the state nursing board for investigation, but that did not occur until late Tuesday afternoon, after the news had been reported. The company also banned the nurse from working under any of its contracts in the future. Wexford provides health-care services nationwide to roughly 124,000 inmates and other residents at more than 100 institutions.

The state said inmates exposed were notified and are being screened for infectious diseases. An independent laboratory under contract with Wexford will provide continuing medical monitoring and testing of the potentially exposed inmates over the next several months, the state said. All patients will be informed of their results, though Ryan noted that some inmates may previously have been exposed to hepatitis C.

Before the problem at the Buckeye prison, Wexford had issues in other states. Clark County, Wash., declined to renew a contract with Wexford in 2009 at its county jail and juvenile-detention center after complaints that Wexford was not dispensing medications to inmates in a timely fashion.