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Old 05-11-2003, 11:14 PM
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Lightbulb Department of Corrections figures show state's prison death rate is higher

Inmate deaths: A fact of life

Department of Corrections figures show state's prison death rate is higher
than in most other states


Staff Reporter
Timothy Olliff had only a few months left on his Alabama prison term for
marijuana possession. But in February, he caught a cold and couldn't shake

By the time prison health care workers sought emergency help for him on Feb.
23, he was, according to a Department of Corrections incident report, so ill
that fellow inmates had to carry him to the gate of Elmore Correctional

Olliff died three days later at Montgomery's Baptist South Hospital. He was
43. Neither hospital officials, nor DOC officials, nor officials at NaphCare
Inc., the health care provider for Alabama prisons, would comment on his

But Olliff's sister, Diane Aman, said hospital doctors told her he had
pneumonia and the worst stomach infection they'd ever seen. They also told
her, she said, that prison health care workers waited too late to get him to
the hospital.

"They had no right to do that boy like that," said Aman, who has hired a
lawyer in preparation for filing a wrongful death suit. "I don't care what he
had done."

While questions remain about Olliff's case, it's a matter of record that
Alabama ranks last among states in per-inmate spending for health care and
faces class action lawsuits alleging gross negligence of inmates' medical

Fundamental problems:

Less well known is that Alabama's cash-strapped, overcrowded prison system
has seen more than its share of inmate deaths, with slow and spotty
investigations into the causes. The death toll has been particularly high
during the two-year tenure of NaphCare, which just had its contract
terminated by new DOC Commissioner Donal Campbell amid cost overruns and
audits suggesting fundamental problems with health care delivery in Alabama

A review of previously unpublished DOC statistics, released after repeated
requests by the Mobile Register, shows the prison death rate in Alabama far
outpaces that of most other states.

Last year, for example, Alabama had 88 inmate deaths out of an "in-house"
prison population (excluding those in county jails awaiting a state prison
bed) of about 24,000. North Carolina -- with much higher spending for health
care in prisons -- had 61 deaths among 32,000 inmates.

Across the country, state prisoners have been dying at an annual rate of
about 23 per 10,000, according to the latest U.S. Department of Justice
study. The Alabama rate has exceeded that national rate in each of the last
four years, and has been above 35 deaths per 10,000 in three of those four.

(The numbers exclude deaths by execution, but include the very occasional
death by accident, suicide or homicide. The vast majority are from some form
of illness.)

NaphCare questions:

At a DOC medical advisory committee meeting on Feb. 4, 2002, Dr. Sam Eichold
of Mobile asked why Alabama was seeing so many prison deaths. NaphCare
officials told him, according to minutes of the meeting, that death numbers
were running about the same as when previous health care providers had the

But DOC statistics show Alabama had 61 inmate deaths in the 12 months before
Birmingham-based NaphCare took over as health care provider, and 87 deaths
from March 1, 2001 through Feb. 28, 2002 -- NaphCare's first year in charge.

In NaphCare's recently completed second year, the total rose to 95. Though
Alabama's prison population continued to grow, the death rate did too, to 39
per 10,000 inmates in the company's second year as DOC health care provider.

No other state with a large prison system had that high a death rate during
2000, the last year for which the Justice Department has compiled
state-by-state statistics.

While Alabama's overall inmate death rate is high, its death rate for HIV
inmates is even more out of line with the norm in state prison systems.

In calendar year 2002, according to DOC, Alabama had 12 HIV inmate deaths.
That's out of an HIV inmate population of about 280, almost all of them males
segregated in Dorm 16 of north Alabama's Limestone Correctional Facility.

That same year, Florida had 43 HIV inmate deaths out of an HIV population of
2,845, said Yolanda Murphy, spokeswoman for the Florida Department of
Corrections. In other words, Florida had 10 times as many HIV inmates as
Alabama but only three and a half times as many deaths.

'Worrisome trend':

Throughout the country, HIV inmate death numbers have dropped sharply in
recent years, as drug regimens have improved. The numbers have dropped more
modestly in Alabama, one of the few states to segregate HIV inmates.
Alabama's 2002 total of 12 HIV inmate deaths actually represented an increase
of four over the previous year.

"That's a worrisome trend," said Dr. Anne De Groot, physician director of the
THIV Research Lab at Brown University Medical School in Rhode Island and
co-editor of the HIV &Hepatitis Prison Education Project newsletter. "People
are living with HIV now. It's just like diabetes or hypertension. It can be
managed, and people live for a long time."

Neither Campbell nor NaphCare officials would agree to an interview on the
subject of inmate deaths. A DOC spokesman in Montgomery, Brian Corbett, said
the agency is concerned about the number of deaths, including those of HIV

But even as Alabama inmate death numbers have climbed, investigations into
the causes of such deaths have become more sporadic.

Mortality reviews drop:

As recently as five years ago, nearly every Alabama inmate death was followed
by an autopsy, said Corbett and other DOC officials. Separately, a physician
for the prison health care provider would have about 30 days to prepare a
"mortality review," including the inmate's medical history while in custody.

All that information would be turned over to the DOC's medical advisory
committee, which meets a few times a year and reviews inmate deaths to make
sure that care was adequate.

But recent audits by Jacqueline Moore &Associates, a consulting firm based
in Chicago and paid by DOC to evaluate health care delivery in Alabama
prisons, found no mortality reviews on file at some prisons where there had
been inmate deaths in the last year.

Under NaphCare, some mortality reviews have been late and some haven't been
done at all, Corbett confirmed. (NaphCare did not respond to a request for
comment about mortality reviews.) Autopsies, too, have become less common,
because of budget problems faced by the state Department of Forensic

"We used to do it in every case," Andrew Redd, a DOC lawyer, said of
autopsies. "We do it now in the worst cases."

The director of the Department of Forensic Sciences, F. Taylor Noggle, agreed
that lack of money has hampered his agency. He said the agency's main mission
is investigation of suspicious deaths, and that an inmate whose death appears
to be explained by recent medical history would not be a priority for an
autopsy. He said state pathologists are required by law to perform inmate
autopsies when ordered to by a district attorney, and do so promptly.

But even then, Noggle acknowledged that some inmates get only an "external
examination," not a full autopsy that involves opening up the body and
examining organs for signs of disease or injury.

Fear of HIV:

With HIV inmates, the Department of Forensic Sciences practice has been to
provide external examination only. That way, Noggle explained, there's less
risk that state pathologists might contract the disease.

Experts elsewhere expressed amazement at that reasoning.

"There have been a ton of autopsies on HIV-infected persons," said Edward
Harrison, president of the National Commission on Correctional Health Care,
an accrediting agency for prisons. "People all over the country do it

Dr. Michael Bell, president of the National Association of Medical Examiners,
an association of death investigators, agreed that risk to pathologists is no
reason to avoid conducting an autopsy on an HIV inmate. Pathologists
routinely take "universal precautions" in conducting autopsies, he said,
because they don't know what infectious diseases they might encounter.

"Here in Broward County (Fla.) we do autopsies on inmates regardless of their
HIV status," said Bell, deputy chief medical examiner for Broward County. The
state of Florida, he said, requires an autopsy after every inmate death. "If
they're using that excuse (safety of pathologists), that's kind of lame."

Bell also said that external examinations usually offer only limited insight.

"You strip them of their clothing, look at the outside of the body and guess
as to the cause of death. That's all that is," Bell said of an external
examination. "It's not a reasonable substitute for an autopsy."

De Groot -- of the HIV &Hepatitis Prison Project -- said the absence of
autopsies for HIV inmates in Alabama means "patterns of opportunistic
infections" might have escaped attention.

"If you're trying to find out why they have this uptick in the number of HIV
deaths, then that (an external examination) is not going to help you," she

At the Register's request, she reviewed a Department of Forensic Sciences
external examination report on HIV inmate Kelvin A. Harris. Harris, 44 and
serving time for murder, dropped dead while working in the kitchen of
Limestone Correctional Facility on Sept. 12, 2001. The report notes that he
had high cholesterol levels and attributes his death to "cardiac
insufficiency secondary to cardiac arrhythmia" with HIV infection as a
secondary cause.

Insufficient information:

But De Groot said that without an internal examination, it's impossible to
know what killed Harris. She added that if it was heart failure, and high
cholesterol was a factor, "there's treatment for that. You have to raise
questions about why the guy died and whether he received adequate care."

(The deputy medical examiner who signed Harris' external examination report,
Dr. J.R. Glenn, referred questions to Noggle. Noggle could not be reached for
follow-up questions about the Harris case.)

Minutes of the meetings of DOC's medical advisory committee show that members
have complained bitterly over the last few years about the scarcity of
autopsies -- including autopsies of HIV inmates -- as they review inmate

Without autopsies, Eichold said in a recent telephone interview, "you bury
your mistakes."

The medical advisory committee has its own problem -- timeliness.

The committee is supposed to be evaluating "recent" inmate deaths, Corbett
said. But because of the large number of deaths, and because of the delay or
absence of autopsies, the committee has been conducting some reviews long
after the fact.

For example, on April 18, 2002 the committee reviewed the death of
56-year-old inmate Henry Jenkins Frye, who was serving time for second-degree
robbery. Meeting minutes show that Dr. Calvin Johns, a committee member from
Montgomery, expressed doubts that enough had been done to treat Frye's
diabetes and hepatitis.

Frye died at Hamilton Aged &Infirmed Center, a north Alabama prison, on May 2
, 2000 -- nearly two years before Johns' assessment. Even the earliest
post-mortem comments would have been useless to Frye, but committee members
said timely death reviews can provide important feedback to the DOC and its
health care provider, and possibly save others' lives. By the time Frye's
review occurred, DOC had changed health care providers from Correctional
Medical Services of St. Louis to NaphCare.

DOC itself has compiled no data on the illnesses known or believed to have
claimed the lives of Alabama inmates, apart from counting the number of HIV
inmate deaths. The agency produced a list for the Register of every inmate
who had died in recent years, but could not cross-reference the list to a
cause of death.

"We don't have the funds to do some of the data collection we'd like to do,"
Corbett said.

The Moore &Associates audits point to various problems that could contribute
to the high death numbers, including lapses in care of chronic diseases such
as diabetes, shortages in medicine and understaffing in doctors and nurses.

DOC, NaphCare sued:

Even before Campbell made those audits public earlier this year, prisoners'
rights groups had sued DOC and NaphCare, alleging grossly inadequate care of
HIV inmates and women inmates in Alabama. A more recent suit claims that
treatment of Alabama's diabetic inmates fails to meet constitutional

On May 2, Campbell sent a letter to NaphCare, announcing its contract with
DOC would be terminated in 90 days. Campbell canceled the contract under a
"convenience" clause, and gave no reason for the action. Corbett said the
problem was not NaphCare's performance "per se," but rather the terms of the
contract, which he said Campbell felt hampered DOC's ability to enforce
health care policy changes.

But Campbell has had to ask the Legislature for an extra $6.9 million to
cover cost overruns NaphCare legally shifted to the state under the terms of
the contract. NaphCare officials acknowledged earlier that in their first
meeting with Campbell he was frank in expressing concern about issues raised
in the Moore &Associates audits.

An official request for bids for a new prison health care contractor is
expected soon. But critics insist that Alabama, which faces a budget crisis
affecting education and other essential services, won't have adequate prison
health care until it spends considerably more money.

For years, Alabama has trailed the nation in per-inmate spending for health
care, according to prison medicine experts and the latest comparative
studies. Factoring in recent cost overruns, Alabama has been spending about
$1,300 per inmate annually, less than half as much as Georgia.

Whether that translates into lethally inferior care in Alabama is unclear,
but the disparity does have obvious consequences in access to doctors.

For example, Georgia employs about one doctor for every 1,100 inmates, said
Dr. Joseph Paris, medical director for that state's prison system. Through
NaphCare, Alabama has lately had about one doctor for every 3,000 inmates,
according to information the company provided the Register for an earlier

The Alabama prisoners' class action lawsuits all complain of delayed or
denied care. So does a wrongful death suit filed against DOC and NaphCare by
the family of Pamela A. Brown.

Brown was serving a second-degree robbery term at Tutwiler Prison for Women
near Montgomery when she died suddenly on March 14, 2001. She was 28. The
suit charges that while at Tutwiler she tried and failed to get medical
treatment for a heart condition, severe headaches and blackouts.

There was a full autopsy in Brown's case. Along with attributing her death to
coronary hypoplasia (abnormally small arteries supplying the heart), the
report notes that she had a "history of tightness of the chest during the
last several months" and collapsed in the prison yard on Feb. 27, 2001.

The report adds that she was scheduled to have an echocardiogram -- a key
test for determining heart defects -- "around the time of her demise."

(Capital Bureau Reporter Sallie Owen contributed to this report)
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