When inmate William Kent Dean complained of blood clots in his urine, a prison doctor said he might have kidney stones—or cancer. He waited four months for a diagnosis of advanced kidney cancer and another three months for the surgery he needed to survive.
"I definitely thought I was dying in prison," says Dean, who was released from the Taylorville Correctional Center on Jan. 28 after serving 10 years for a cocaine conviction.
The 59-year-old from Ottawa also recently won an $11 million jury verdict against Wexford Health Sources, the private company that gets more than $1.4 billion from Illinois to provide health care services to 40,000 state prisoners. The jury found that Wexford deliberately delayed Dean's medical tests and treatment, says his attorney Craig Martin. In a statement, Wexford said it provided Dean with "appropriate care" and intends to appeal the judgment.
The Illinois Department of Corrections now faces several class action lawsuits and multiple individual cases brought by inmates and former prisoners alleging that inadequate medical care, including delayed treatments, has led to poor and sometimes fatal outcomes. A recent review by a court-appointed expert of 33 death records from 2016 and 2017 found more than half—58 percent—were preventable or possibly preventable.
In one instance, a 24-year-old with mental illness got no medical treatment after he was seen swallowing two plastic sporks, lost 54 pounds and complained of abdominal pain. The inmate eventually died due to esophageal perforation, according to the expert's report.
Wexford performs a dual role, providing health care to inmates while also managing the cost of care like an insurer. A key cost management tool is its trademarked "collegial review" process, which aims to ensure all care is medically necessary by having its off-site doctors approve or deny all non-emergency requests made by the clinicians who examine prisoners. Outside the prison system, such preapproval of clinician recommendations isn't always required.
A report by court-appointed monitor Dr. John Raba highlights flaws in Wexford's process. The former medical director of Cermak Health Services, which provides health care to the Cook County Department of Corrections, is helping to overhaul the state's correctional health care system as part of a 2019 settlement.
Raba's examination of annualized data from 26 of 30 state facilities found that more than 2,000 requests for specialty consultations and testing—about 11 percent—were denied or delayed by off-site Wexford doctors with no patient contact. Collegial review potentially puts inmates' health at risk by making it harder to access off-site specialty care and delaying treatment, Raba wrote.
Inmate advocates say certain aspects of the Wexford contract, such as a provision that docks the company for exceeding an annual hospital utilization threshold, could deter appropriate medical care.
"You need to find ways of incentivizing quality," says Camille Bennett, director of the corrections reform project for ACLU of Illinois. "As it's currently set up, the contract basically incentivizes cost saving."
The Illinois Department of Corrections did not make someone available for an interview. But spokeswoman Lindsey Hess said in an email that bids will be solicited prior to Wexford's 10-year contract expiring in 2021. "We continue to engage in discussions with Wexford regarding changes to the current collegial review process," Hess said, adding that "any changes would require a contract amendment."
Pittsburgh-based Wexford, which has provided medical services to prisoners in the state since 1992, declines to comment on the contract.
Some observers say a new contract, or even a new provider, wouldn't make a huge difference in the quality of care without additional funding. Illinois spent $3,619 per inmate during fiscal year 2015, up 4 percent from 2010, according to a recent report by Pew Charitable Trusts. The 49-state median was $5,720.
"Well-run, forward-thinking prison health care systems are vital to state aims of providing care to incarcerated individuals, protecting communities, strengthening public health, and spending money wisely," the Pew report says. "Likewise, poorly performing systems threaten to make states less safe, less healthy, and less fiscally prudent."
The state is making changes to improve health care among inmates, including an immunization program and an electronic medical record system.
In addition to addressing collegial review, Raba in his report recommends discharging older prisoners who no longer pose a risk to society.
"The infirmaries are becoming filled with patient-inmates who are confused, incontinent, and require assistance with the basic activities of daily living including dressing, feeding, bathing, and toileting," Raba wrote, noting that 19 percent of inmates are age 50 or older.
Dean, meanwhile, is settling in at home, spending time with his wife Cynthia and his first grandchild—born three weeks before his release. He says he's glad his case and others seem to be spurring change in the correctional health care system.
"Every time I'd go to (the oncologist), I'd say, 'Doc, I need 48 months. . . .I gotta make it out.' He'd just laugh it off and say, 'We'll see what we can do,' " Dean says. "I got to finally thank him."
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Flaws in Illinois prison health care exposed - Crain's Chicago Business
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