Three Dead Prisoners in Alabama Highlight Struggling Jail Healthcare System

Nikki Listau was arrested at her home in Madison County, Alabama, on the morning of March 10, 2013. She was pronounced dead two days later, after suffering blunt-force trauma and internal injuries when she rolled off her bunk in county jail during a seizure caused by delirium tremens.

Deundrez Woods was booked at the Madison County Jail on June 24, 2013 and was dead two months later from gangrene that allegedly wasn't treated while he was behind bars.

Tanisha Jefferson died in the very same jail of bowel obstruction on Halloween 2013, less than three weeks after she was arrested. All three could have been saved had they been given proper medical care, which they were denied, according to three recent lawsuits.

These three have more in common than the fact they all died in Madison County Jail in Huntsville. They are emblematic of a growing problem in America's prisons and jails, in which prisoner healthcare is being cut like any other item on a balance sheet.

The allegations surfaced in three lawsuits filed this month on behalf of Listau, Woods, and Jefferson against Madison County and Advanced Correctional Healthcare (ACH), the company contracted to provide healthcare services for Madison County Jail.

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"You've got one death and that was bad enough and, depending on the circumstances, you might or might not wonder if it represents a systemic problem, but then you have these other deaths," Hank Sherrod, the attorney behind all three lawsuits, told VICE News. "Jails have a lot of problems with systemic medical care, with pressure to save money. Contractors like Advanced Correctional Healthcare can get contracts and sometimes don't provide very good care."

Sherrod stated that in order to win contracts from county and state correctional departments, contractors have to come in with low bids, cutting costs wherever they can. Those cuts are often made to healthcare provisions.

"I doubt anyone intended for any of these folks to die, but the culture of the jail has got to the point of lack of caring that day in, day out you're rolling the dice with people's lives," Sherrod continued, adding that he's gone to trial against other healthcare contractors in the past.

Advanced Correctional Healthcare didn't respond to questions from VICE News about the Alabama cases or about winning contracts to offer health services.

The lawsuits allege that not only is Advanced Correctional Healthcare concerned with costs related to inmate healthcare, but that its business model is based on cutting medical costs.

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"In order to control costs, defendant ACH, with the knowledge and consent of defendants Madison County… staffed the Madison County Jail inadequately, hired sub-standard medical personnel willing to put costs over inmate health and safety, denied inmates medications, and delayed or denied medically-necessary referrals to outside providers, including necessary medical treatment like that denied Woods," states the court complaint in Woods' case filed on October 14. The two other complaints contain similar language.

"ACH's business model, reflected in the agreement, succeeds by underbidding the competition and implementing severe cost control measures, the necessary result of which is unnecessary inmate suffering and liability claims," the Woods complaint alleges.

Prisoners are constitutionally entitled to a community level of healthcare, meaning care that is similar to the standard of care that would be available to them if they were free, David Fathi, director of the American Civil Liberties Union's National Prison Project, told VICE News. But the rise of privatized healthcare in corrections systems has diminished the quality of care prisoners are receiving, he said.

"The legal entitlement is clear, the problem is that prison and jail and healthcare is barely-adequate-to-dismal in general," Fathi said. "With increasing privatization you have private corporations making decisions on healthcare. These are entities whose first and top priority is to earn a profit and one way to earn a profit is to cut corners."

Many states and municipalities are turning toward private firms to corral the skyrocketing cost of prison and jail healthcare, which increased 49 percent between 2001 and 2008, the last period of time such data was available, according to a report from the Pew Charitable Trusts published this year.

Pew found that the 44 states that participated in the study spent $6.5 billion on prison healthcare in 2008 out of $36.8 billion in total correctional spending that year. Higher healthcare spending is due mainly to a larger and aging prison population, the study said. Pew suggested that to cut costs, states could look to outsourcing healthcare, which many states have done. Cue the rise of companies like Advanced Correctional Healthcare and its peers.

Since some prisons and most jails have limited or nonexistent medical facilities, sick prisoners often have to be sent to outside specialists for care. These outside specialists are an added expense to the healthcare budget and often are considered a luxury that prisoners don't get.

In Madison County, Jefferson complained to jail employees for days about abdominal pain, asked to see the doctor numerous times, and even filed a medical complaint, according to court documents. When she finally was allowed to see the jail's doctor, he apparently misrepresented her condition and prescribed her laxatives, despite symptoms such as vomiting and rectal pain.

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The complaint filed on Jefferson's behalf claims she would have been saved if she had been allowed to see an outside doctor. Instead, she died of bowel obstruction. The same claim was made in the cases of Woods and Listau.

Madison County officials didn't return calls from VICE News seeking comment on the three cases against them. Sherrod said he expects the lawsuits will be ongoing for some time and predicted that they won't go to trial until 2016 at the earliest. But other cases on prison healthcare have revealed a gaping issue.

A lawsuit against Arizona prisons was settled earlier this month and now the Arizona Department of Corrections is required to change its healthcare system. Case documents show that 13 of the prisoners who died in the state system in 2013 received "care that was grossly deficient."

Dr. Robert Cohen wrote in his report: "In some of these cases, the poor care clearly caused or hastened their death, while in others this is very likely, but would require an autopsy review to confirm."

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Fathi said the poor prison healthcare in the US is perpetuated by the private healthcare contractors, which are more concerned about the bottom line than about the prisoners they are hired to care for.

"I've been doing this work for 25 years, and it seems like private healthcare is more common than it used to be and it's my sense that it continues to increase," he said. "It's theoretically possible to write a contract to have sufficient oversight and monitoring that would protect prisoners, but I've never seen a situation in which that has happened."

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Follow Payton Guion on Twitter: @PaytonGuion

Image via Flickr