In Illinois prisons, getting sick can be a death sentence 

When Rubin Watts arrived at the Dixon Correctional Center infirmary in 2007, his legs and feet were red and swollen, with stinking open wounds that were oozing pus and a bloody discharge. He had a skin infection called cellulitis and a history of mental illness.

Shortly before Watts’ arrival in the infirmary, he’d been seen naked in his cell, obsessively washing the floor and trying to eat his jumpsuit and a blanket, according to a lawsuit filed by his family. Once in the infirmary, he chanted, screamed, called nurses “mommy” and “daddy” and urinated on himself, according to the lawsuit and the Illinois Department of Financial and Professional Regulation, which licenses and disciplines doctors.

A doctor noted that Watts appeared in no distress the day after he arrived at the infirmary, even though the staff that same day wrote that he was yelling and restless and repeatedly pulling on IV tubes, according to IDFPR records. Three days after Watts was admitted to the infirmary, a doctor concluded that muscle damage likely had occurred from the infection. He wasn’t responding to simple commands. His legs became cool to the touch. His mind wasn’t any better.

“Sitting on the floor, drinking out of the toilet,” the staff observed after Watts had spent nine days in the infirmary, according to IDFPR records. “Ulcers healing well and dry,” a physician observed that same day and also noted that Watts’ body temperature had dropped – the staff recorded it at 93.2 degrees.

In the next few days, Watts smeared feces on his legs, through his hair and all over his infirmary room, according to IDFPR records and the lawsuit filed by his next of kin. But there were signs of progress, according to staff notes. His sores had crusted over. On Dec. 10, 2007, the staff noted that his vital signs were stable. “(C)ellulitis resolving well with decreased open areas of skin,” the staff observed in notes.

Watts died the next day. Watts succumbed to sepsis caused by cellulitis, with bacteria found in his heart, lungs and kidneys and dead tissue in his pelvic wall and loin muscles. No one had summoned an infectious disease specialist while Watts was alive, nor was his prescription for an antibiotic changed when he didn’t improve. Even as Watts chanted and smeared feces, a psychiatrist reduced a prescription for Risperdal, a drug used to treat schizophrenia and bipolar disorder. He wasn’t taken to a hospital, even though a nurse had filled out a transfer form four days before he died.

The state paid $50,000 to settle a lawsuit brought by Watts’ family. Wexford Health Sources, the company that holds the contract to provide health care in Illinois prisons, also settled a lawsuit, but how much the company paid isn’t a matter of public record.

Dr. Rajender S. Dahiya, a Wexford employee, was a defendant in court and a respondent in a complaint fielded by IDFPR, which reprimanded the physician and issued Dahiya a $1,000 fine. He remains a physician in good standing in the state of Illinois.

Cockroaches, toothaches

The Watts case isn’t unusual in the Illinois Department of Corrections, according to lawsuits that have resulted in verdicts and settlements paid to inmates or their next of kin during the past decade.

Lawsuits alleging horrific care are buttressed by a recent report from a courtappointed panel of experts that was led by the former medical director for the state prison system (“Experts blast prison health care,” IT, May 28, 2015). Health care in Illinois prisons is so poor that it constitutes cruel and unusual punishment, the panel found. The findings are part of a class-action lawsuit filed by inmates who demand improvement that hasn’t resulted from more than 1,300 lawsuits against the state in the past 10 years and nearly 120 settlements and verdicts paid over that same period of time.

In a written statement emailed in response to an interview request, Nicole Wilson, corrections spokeswoman, said that the state is working on improvements to health care in prisons. The state has already increased staffing in some areas, Wilson wrote, and is working on improvements in record keeping and as well as creating a “robust quality assurance program.” Wilson wrote that the state hopes to gain accreditation at many prison facilities from the National Commission on Correctional Health Care (NCCHC), a nonprofit body established to improve health care in correctional facilities.

“The IDOC has always been and continues to be open to suggestions for improvements and willing to take the necessary actions when appropriate,” Wilson wrote. “We contend that leadership and clinicians within our healthcare units are qualified and properly credentialed, that chronic illnesses are appropriately treated and that the IDOC is providing constitutionally adequate care.”

Accreditation by the NCCHC doesn’t guarantee that prison health care will pass constitutional muster, according to the report from the expert panel that was led by Dr. Ronald Shansky, former IDOC medical director who served on the NCCHC board for a decade. NCCHC accreditation, while valuable, focuses mainly on administrative issues, according to the expert panel, and Illinois needs to address clinical care.

On the whole, substandard treatment hasn’t cost taxpayers very much.

Take out a $12 million verdict awarded in 2013 and the state has paid less than $704,000 over the past decade in 116 cases, most of which were settled out of court. It works out to less than $6,100 per case. It’s not clear how much Wexford has paid. But settlement amounts don’t begin to indicate horrors both small and large.

Consider the case of Darnell Cooper, who awoke at Stateville Correctional Center in Joliet to find cockroaches biting his face in 2012. He waited more than a week before he got ointment to treat the bites. When he asked Marcus Hardy, then the warden, to have his cell sprayed for roaches, the warden, according to a lawsuit filed by Cooper, replied, “You’re asking a lot, aren’t you?” The cell was never sprayed, according to the lawsuit.

Cooper, who also alleged that he contracted a painful toe fungus due to filthy conditions that included sewage in a shower, settled his lawsuit last year for $12,000. Hardy was promoted and now oversees adult prisons in central Illinois.

Francisco Gonzalez, who is serving a 45-year sentence for methamphetamine convictions, waited months for treatment at Stateville in 2010 after the pain started and a dentist found a hole in a tooth. He filed grievances and told Hardy, the warden, that his tooth hurt.

While Gonzalez waited for dental care, another tooth broke and infection set in. He was given Tylenol and an antibiotic. Three months later, and nine months after Gonzalez first complained of pain, a dentist extracted the broken tooth and the one with a hole. By then, Gonzalez needed a filling in a third tooth. He got one seven months later. The state settled the case for $7,000.

‘Money is not going to replace a human life’ The case of Montell Johnson is as absurd as it is sad.

Convicted of murder for a Macon County killing, Johnson’s death sentence was converted to a 40-year term in 2003, when former Gov. George Ryan commuted all death sentences in the state. By then, Johnson had developed multiple sclerosis. By 2007, he was bedridden and unable to speak. His mother, Gloria Johnson-Ester, communicated with her son by having him close his eyes while she recited the alphabet. When she got to the appropriate letter, he would open his eyes and so, slowly, would spell out what he wanted to say.

Johnson reached an advanced stage of dementia at Dixon Correctional Center and developed bedsores down to the bone – he told his mother that the sores had become infested with maggots, according to a lawsuit brought by his mother, who had power of attorney to make medical decisions for her son.

“The doctor wrote that he had recommended a feeding tube, but Montell refused it,” recalls Harold Hirshman, attorney for Johnson-Ester. “Since he couldn’t feed himself, he nearly starved to death. He got down to 70 pounds or less.”

With his condition deteriorating, Johnson was sent to the University of Illinois Medical Center in Chicago. U.S. District Court Judge Suzanne B. Conlon in 2007 barred the Department of Corrections from returning him to prison from the hospital, saying that the plaintiffs had a substantial chance of prevailing, and without adequate medical treatment, Johnson’s life was in peril.

After the hospital told the court that Johnson was doing better, he was sent to a long-term care facility and, eventually, to Sheridan Correctional Center. Former Gov. Rod Blagojevich saw the folly of incarcerating an invalid and so granted clemency in the fall of 2008. But Johnson wasn’t freed.

California, where Johnson had been serving a life sentence for murder before he was extradited to Illinois in the 1990s, wanted Johnson back so that he could spend the rest of his life in prison.

“He was bedridden,” recalls Alan Mills, executive director of the Uptown People’s Law Center in Chicago that is representing inmates in the class-action lawsuit against the state. “He couldn’t talk. He couldn’t move. He kind of did the blink-and-grunt thing, which only mom could interpret because she’s mom. There was no reason for this guy to be in prison.”

At the time, California was under pressure to reduce its prison population. In 2009, a federal court ordered the state to reduce the number of inmates by 27 percent within two years as a means of improving poor health care in California prisons that constituted cruel and unusual punishment.

“It was absurd,” Hirshman says. “Since California can’t take care of the sick people it already has, the idea of them taking an incredibly sick person back was ridiculous.”

Johnson-Ester sued California and a deal was cut. In exchange for Johnson’s promise never to return to California, California authorities agreed that they would not seek his return to prison. He was released in 2011 and now lives with his mother in Chicago.

Nine months after her son was freed, Johnson-Ester settled her case against the state of Illinois alleging substandard medical care for $75,000. It was the largest amount the state has paid in the past decade to settle a lawsuit alleging poor medical care in state prisons.

“Everybody tells me I should have held out (for more money), but I preferred to have my child,” Johnson-Ester says. “I was scared that he wasn’t going to make it. The money won’t help me at all. Money is not going to replace a human life.”

Hirshman has since settled another lawsuit, he says for six figures, which would make the Chicago lawyer one of the state’s most successful litigators in cases alleging poor medical care in prisons. Settlement agreements are public records, but state prison officials declined to provide a copy, saying that the settlement has not been “finalized.” The case involved William Stellwagen, who was serving a six-year sentence for home invasion.

Stellwagen, a drug abuser and alcoholic for most of his life, was dying of liver disease when his wife sued the state in the fall of 2013, asking that a judge order him freed so that her husband could spend his final days with her in California. She told the court that her insurance would cover the cost of hospice care. But prison officials, including Dr. Louis Shicker, medical director for the Illinois Department of Corrections, assured the court that IDOC would provide hospice care as needed, and Stellwagen remained in prison.

Stellwagen died on Feb. 11, 2014, but litigation continued. Contrary to Shicker’s promise to the court, Stellwagen had not received hospice care in his final days, according to court records. He remained in the Dixon Correctional Center infirmary as his skin yellowed. He became forgetful, confused, subject to hallucinations and prone to falling. “I feel the worst I’ve ever felt,” he told a nurse two weeks before he died.

After not hearing from her husband in five days and not having calls returned by prison staff and doctors, Stellwagen’s wife flew to Illinois from California and found her husband incoherent in a Dixon infirmary bed. He had fallen at least once, records show, and it appeared that he might have suffered a broken nose. An IV port in his arm led to nothing. His blood pressure was so low due to dehydration that an attempt to administer pain medication via an IV drip failed According to the lawsuit, a doctor injected a painkiller in Stellwagen’s hip at the request of his wife.

As Stellwagen’s wife sat with the dying man, the room grew cold, and he was covered with just one thin blanket. According to the lawsuit, his wife had to beg the staff for a second blanket. Stellwagen died hours later.

‘Everybody knows how bad it is’

Hirshman and other lawyers who have sued the state and Wexford Health Sources, a Pittsburgh-based company that holds the contract to provide health care in state prisons, say there are several barriers to bringing successful lawsuits. For one thing, Hirshman says, finding good cases can be difficult. For another, neither the state nor Wexford gives up easily.

“The way the system works, the state has Wexford shielding it from most liability and Wexford is tenacious about saying ‘Nobody did anything wrong,’ and there are insufficient lawyers who are willing to take on these kinds of clients,” Hirshman says.

Michael Kanovitz, a Chicago attorney who in 2013 won a $12 million verdict against the state – the most, by far, a plaintiff has won from the state in the past 10 years – says that lawyers share the blame for low payouts. Too often, he says, attorneys for inmates aren’t preparing well enough to go to trial.

“There is an assumption in the…bar that these cases aren’t particularly meaningful – no one is going to listen to a prisoner,” Kanovitz says. “That’s a prejudice we’re trying to disprove. And we certainly disproved it in Ray Fox’s case.”

Fox, a nonviolent drug offender incarcerated at Stateville, suffered a brain aneurysm in 2007 after seizures that began when he was denied his prescription for an anti-seizure medication. In addition to the $12 million verdict against the state, a judge awarded Fox’s legal team $1.5 million in fees and costs. Wexford settled for $3 million. Fox survived but has the mental capacity of a five-year-old. The state went to trial after settlement talks broke down.

“We knew that Ray’s injuries were very serious,” Kanovitz says. “We treated them not the way that the system often treats prisoner injuries. Our settlement demands were high only because that’s what they should be for any human being.”

That health care in Illinois prisons needs dramatic improvement is no secret, Kanovitz says.

“Everybody – everybody – in the system knows how bad it is,” Kanovitz says. “The judges know how bad it is. The prison officials know how bad it is. But the private attorney bar has not stepped forward to take them to task the way they should be.”

Mills, the lawyer who has sued the state alleging that health care in Illinois prisons violates the constitutional rights of inmates, says that low settlements discourage lawyers from taking cases. Even a $12 million verdict isn’t much, he says, considering that Wexford’s contract with the state is worth $1.5 billion over 10 years.

“On a $1.5 billion contract, a $12 million verdict is a rounding error, and there’s only one of those,” Mills says. “The courts are not awarding big-money damages – there’s no political will. … I know that Wexford has people who are loss managers, and they know perfectly well how much they’re going to have to pay based on the quality of care they provide. They’re a for profit company. That’s their obligation: to their stockholders.”

Kanovitz says that privatizing prison health care is a bad idea.

“The economic incentives of the entities that are entrusted is to give as little care as possible,” Kanovitz said. “They’re in an industry where they don’t think they will be scrutinized. Even if the worst-case scenario happens, juries won’t care that much. So they are emboldened.”

Wexford did not respond to a request for comment.

Mills says that he’s lost hope that individual lawsuits will force reform.

“That’s why we switched and are doing the class-action case,” Mills said. “The damage cases are never-ending, and they’re not going to change the system.”

‘Without medicine I will never be cured’

About recover (sic), today I went to the doctor and now that I said it hurts this and that, the doctor doesn’t let me speak, and I told the doctor: With all respect, I come here because I feel bad, not to yell at me, I’m not a child, I am an adult 53 years old. And the doctor told me “I did the tests that had to be done and you have nothing.” I said “I only know how I feel and I need care.” And the doctor said “What you need is a psychiatrist.”

For months, Alfonso Franco in letters to relatives chronicled what it’s like to die of cancer in prison. How difficulty with defecation is dismissed as simple constipation and treated with milk of magnesia and advice to get more exercise. How the skin turns yellow and pounds melt from your body and blood appears in your urine and stool. How nausea during a visit with a prison doctor results in an x-ray and an opinion that it’s hemorrhoids. How the appetite disappears and the pain increases to the point of becoming unbearable, but no painkillers are prescribed.

“As I tell you, I don’t think this is anything serious, but without medicine I will never be cured,” Franco wrote in a letter to his wife that was translated from Spanish and provided to Illinois Times by a lawyer for Franco’s family.

Franco’s complaints began with constipation in the fall of 2010. He had already started to lose weight. In the summer of 2012, he was hospitalized after Dr. Rosalina Gonzales, a Wexford employee, noticed a mass on his liver. By then, he was in diapers and having dozens of bowel movements each day. He had lost more than 50 pounds.

Doctors outside the prison determined that Franco was in the final stages of colon cancer that had spread to his liver and lungs. It was, by then, a hopeless case. Franco was sent back to prison from the hospital. He died at the age of 53, one month after his cancer diagnosis and nearly two years after he complained of constipation coupled with weight loss, classic symptoms of colon cancer.

Timothy Shay, attorney for Franco’s family, says that Franco, who was serving time for cocaine possession, would be alive today if he had received a colonoscopy when he first complained of constipation.

“This guy was going to the bathroom 50 times a day and nobody had a eureka moment that he needed to go to the Taylorville hospital,” Shay said.

Gonzales’ license to practice medicine in Illinois expired last year. At last report, Shay says, she was in the Philippines and unavailable for a deposition.

There is no shortage of job opportunities at Wexford. According to the company’s website, there are 60 openings at prisons within 50 miles of Springfield, including more than 40 positions at Logan Correctional Center in Lincoln. On its website, the company tells would-be employees that the company pays for malpractice insurance and there is a “steady income with no need to look for new patients.”

“At Wexford Health, our philosophy is that health care should not be a luxury for anyone,” the company says in its online pitch to applicants.

Contact Bruce Rushton at [email protected].