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Howard S. Grossman, P.A.
Prison Healthcare Litigation 1-877-SEE-JUSTICE
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Jail inmate goes untreated, ends up in intensive care By TODD RUGER todd.ruger@heraldtribune.com
SARASOTA -- Orestes "Rusty" Rendon started his 90-day sentence for driving without a license at the Sarasota County jail. He finished it Nov. 14 in a hospital intensive care unit -- unable to speak, eat or walk.
Hit on the head with a branch and stung more than a dozen times by hornets while working on a road crew, Rendon filled out forms requesting to see a doctor as his eyes crossed and the pain in his head worsened.
It took at least six days for him to get to the doctor, who immediately sent Rendon to the emergency room at Sarasota Memorial Hospital..
Before that, nurses had been giving him Tylenol.
The nurses "thought it was a migraine," Rendon wrote in a notepad from his hospital bed two weeks ago, still unable to speak or walk.
"They think everyone is trying to get one over on them, that I was trying to get out of work."
Complaints like Rendon's have been made repeatedly against Prison Health Services Inc., a private company contracted to provide medical treatment to inmates across the country, including at county jails in Sarasota, Manatee and Charlotte.
There have been at least 15 inmate deaths in 11 Florida jails in cases where the company appears to have provided inadequate care since 1992, a New York Times investigation reported early this year.
The three local counties have recently extended contracts or say they're satisfied with Prison Health Services despite the national reports and several local cases in which the company gave questionable patient care.
One former Sarasota jail inmate sued in federal court in July, saying nurses accused him of "faking it" when he told them he felt paralyzed after being thrown head-first into a wall by a corrections officer.
Doctors later found he had severed two vertebrae, and he now suffers from near-complete paralysis, with some use of his upper extremities, court records show.
In another federal lawsuit, filed this month, an inmate in Hillsborough County says her newborn son died in 2004 after nurses from Prison Health Services dismissed her labor pains and sobbing as "mood swings."
She gave birth over a jail toilet, the umbilical cord wrapped around her son's neck. Nurses who were untrained and unfamiliar with resuscitation and care of newborn infants initially refused to call 911, the suit claims.
And in Manatee County, nurses did not provide treatment to an inmate who died in 2004 after having four epileptic seizures over two days.
Rendon's sister, Victoria Rendon, said that as her brother lost control of his eyes, he started to realize something was seriously wrong but he couldn't persuade the nurses to let him see a doctor.
"He was perfectly OK before this happened," she said while visiting her brother, who remains at Sarasota Memorial Hospital after spending nearly a month in intensive care. "Now he's like this, for driving without a license."
Criticism and response
Prison Health Services defends its reputation. The company is one of several private firms that take over jail or prison health care -- and the resulting lawsuits -- from government officials.
Prison Health Services says it provides health care to a jail and prison population that has its challenges, including a high rate of diseases and conditions that may have gone undiagnosed or untreated.
Many of the patients have kidney and liver problems from drug or alcohol abuse.
"The patients we treat typically have had less access to health care and they are less healthy than the general population," said Susan Morgenstern, a Prison Health Services spokeswoman.
The New York Times published a report in February showing that Prison Health Services' medical treatment likely led to dozens of deaths nationwide. Judges and sheriffs criticized the health-care company. Families and whistle-blowers are suing.
Morgenstern said Friday that 76 percent of the inmate lawsuits filed against the company are dismissed by the courts before going to trial, and the vast majority of the remaining suits result in decisions in favor of Prison Health Services.
And the company gets sued at a rate 70 percent lower than overall rates of lawsuits against other prison health care providers across the nation, as determined by the U.S. Department of Justice, she said.
"Our dedicated health-care professionals work hard every day to provide quality care for inmates," she said. "We're committed to quality care for our patients and that's our focus."
"It's a tough, tough job."
Sarasota County paid approximately $2.3 million this year for inmate health care at the jail, which averages about 800 inmates a day. Charlotte County is paying $1.4 million for about 485 inmates a day and Manatee County is paying $4.2 million for about 1,400 inmates a day.
Manatee County officials say Prison Health Services was the only company to bid when the contract went up for bid in 2002. The county plans to extend the contract through March 2007 before accepting bids again.
Charlotte County said it has contracted with the company for about 10 years and is satisfied with its services.
Sarasota extended its three-year contract for a fourth year, through September 2006, and has not yet decided whether to extend the contract for another year after that.
Inmate: Delay made it worse
There is no known cause or cure for Guillain-Barré syndrome, which doctors now believe affected Rendon. However, therapies can lessen the severity of it and accelerate the recovery in most patients.
"It's not the cause of the disease but the fact that I was under their care when it did happen," Rendon wrote. "This is a major disease ... might have some lasting problems."
The disease is rare, and can be triggered by an infection. It causes the body's immune system to attack the nervous system for up to four weeks.
How long it takes to get treatment can affect the severity of the damage, said Sarasota neurologist Dr. Gregory Hanes.
Some people get a mild case that needs no treatment. In severe cases, people die if they are not put on a respirator. A full recovery can take several years, he said.
"The sooner you stop it, the sooner the body can then mend itself," Hanes said. The longer treatment is delayed, "then your body has to recover from a worse place."
Rendon remembers getting hit on the head with a tree branch while on a work crew and says he lost consciousness for about five minutes. That was the day before he got stung at least 12 times by hornets and requested medical help on Oct. 17, he said.
A jail medical record shows he was given doses of Benadryl and Tylenol for three days.
Those jail records also show he put in two more medical requests specifically complaining about his head pain and vision on Oct. 23 and Oct. 24. His eyes were starting to cross, he said.
Rendon told visiting family that he had double vision and headaches and had been putting in a request every day to see the doctor. He did not go out on the work crew that week.
By Oct. 25, Rendon's eyes were severely crossed and he told family he feared something was seriously wrong with him, but he only received Tylenol from the jail staff, he said.
Rendon remembers requesting the doctor every day, but said he didn't get examined by a doctor until Oct. 29 -- and the doctor immediately sent him to the hospital.
"He told me it scared him," Rendon wrote.
On a physician's order sheet from the jail provided to the family, the jail doctor wrote, "Send to SMHx -- STAT."
When Rendon was admitted to the hospital on Oct. 29, the doctors thought he had suffered a stroke or had meningitis.
Jail medicine
Inmates at the Sarasota jail sometimes don't see a doctor for several days because doctors have so many requests to see them, the sergeant in charge of the jail's medical area said.
"There's so many people here," Sgt. Patrick Smith said.
The two doctors who are subcontracted to provide exams at the jail are there four or five times a week, Smith said. There are six nurses on duty during the week and four nurses on duty on the weekends.
Jail correction officers are allowed to call for nurses or doctors in emergency situations, but otherwise inmates must fill out a request form to see a doctor.
Sarasota County Sheriff's Office spokesman Lt. Chuck Lesaltato said corrections officers are not qualified to make medical calls and have to go "based on what professionals are telling us in that field.
"That's why we have medical staff there," Lesaltato said. "We go based on what they're telling us."
Prison Health Services Inc. declined to comment on Rendon's case, citing patient confidentiality laws, but company officials said they would look into his situation after the newspaper provided a signed release from Rendon on Wednesday.
Rendon said he'll have to stay at Sarasota Memorial Hospital through Christmas. He faces what could be years of therapy to regain the ability to walk, talk, swallow and control his eyes.
Victoria Rendon said she wants the county to pay for her brother's hospital treatment and his rehabilitation. Those costs are high, and will continue for rehabilitation and prescriptions even after he is sent home, she said.
Real or faking it?
Several lawsuits filed against Prison Health Services claim nurses accused prisoners of faking illnesses out of boredom or to avoid work.
At the Sarasota jail, inmates must pay $5 from their commissary accounts per nurse visit unless it is an emergency, Smith said.
Other agencies have also instituted a fee for inmate health services in response to what's known in the business as "malingering," said Edward Harrison, president of the National Commission on Correctional Health Care in Chicago.
It happens with some amount of frequency, but there are no studies to show it happens more often in jails than in emergency rooms or public health clinics in the "free" world, Harrison said.
But instead of charging for nurse visits, the commission encourages infirmaries to try to find out why a prisoner is faking, and get them to stop.
Smith and Lesaltato said there were no changes in Sheriff's Office policies or medical services after the 2003 incident with the inmate who had two fractured vertebrae.
A former corrections officer, Matthew O'Kon, was acquitted on a charge he intentionally slammed Gerrese Daniels into the wall of the Sarasota County jail on June 5, 2003.
Two nurses examined him and determined he was "faking it" when talking about not being able to move his legs, because his arms and legs moved without any response of pain and because he moved his legs when a sharp object was stuck in his foot, the lawsuit claims.
A jail nurse cleared the 22-year-old Daniels to continue in a prison transport van, though he had no feeling in much of his body, according to reports.
Upon arrival at the Central Florida Reception Center, state medical staff airlifted him to an Orlando hospital, where it was discovered he had severed the fourth and fifth vertebrae in his back, the lawsuit claims.
In 2004, PHS fired two nurses and its medical director at the Manatee County jail after the death of an inmate who should have been taken to a hospital.
Nurses watched for two days as the unresponsive prisoner, Tony Myrick, had at least four seizures and fell critically ill. Myrick, 41, died in the jail infirmary.
PHS officials said then that with more than 1,500 inmates to care for, "unfortunate outcomes" are part of the business.
Also last year, PHS fired a nurse practitioner and reprimanded two nurses at a Hillsborough County jail over the death of an infant born there.
An inmate had complained of abdominal pains for nearly 12 hours before giving birth, but no one called 911 until after the baby was born. The baby boy died before reaching Tampa General Hospital.
In Charlotte County, Prison Health Services fired a jail nurse who was arrested in November on a charge that she brought prescription drugs to an inmate she planned to marry.
TIMOTHY C. NIES, ESQ. Howard S. Grossman, P.A. 1098 N.W. Boca Raton Boulevard Boca Raton, Florida 33432 Toll-free: 800-940-8048 Phone: 561-368-8048 Fax: 561-391-1193 E-mail: Click here
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