Case highlights prison medicine concerns
By BRENT CURTIS Staff Writer - Published: September 20, 2009
When Ashley Ellis arrived at the state women's correctional facility in Swanton last month, she expected her medications to be there.
After all, the 23-year-old's family had made calls and forwarded doctor's notes and prescription information to the Department of Corrections weeks in advance of Ellis' Aug. 14 arrival at the jail.
But Ellis' grandmother has said corrections officials she spoke to just before her granddaughter went to jail didn't know about the prescriptions, and told her Ellis could face sanctions if she showed up the jail with her prescription drugs in hand.
The cause of Ellis' death two days after she arrived at the jail still is unknown, pending the results of a toxicology test. However, her grandmother and many of Ellis' friends and family believe Ellis was denied medicine for her eating disorder, and they are convinced the lack of medications was a factor in her death.
It remains to be seen whether they're right about Ellis' cause of death.
However, there is a consensus among watchdog groups and key members of a legislative committee set up to oversee the state's corrections system that there are problems with the delivery of medicines and medical treatment in state prisons.
"It's been a problem for a number of years," state Defender General Matthew Valerio said. "There should be a way for people to get their meds. Unfortunately, this is a problem that goes back decades. It's not unique to this current administration."
Valerio's office includes the Prisoners' Rights Office.
But DOC officials said corrections staff and medical staff from the private company that contracts with the state to provide health care services at Vermont's prisons are doing the best they can meeting the needs for a challenging group of patients.
"Some offenders don't answer questions truthfully or fully," said Dr. Deloris Burroughs-Biron, health services director for DOC. "It leaves the intake person in the dark."
"Intake" is a process every Vermont inmate undergoes whether they're new arrivals off the street, post-conviction offenders arriving to serve their sentence, people on furlough or probation returning to jail or prisoners transferred from one jail to another.
The process involves searches for contraband, evaluations for potential suicidal behavior and a question and answer session about medical needs and prescribed medications.
DOC policy requires all incoming inmates to be interviewed by a nurse who collects information and then tries to verify prescriptions by calling the pharmacy that filled them, Burroughs-Biron said.
For people incarcerated off the street, that process is the only way to determine an inmate's medical needs. For offenders who know they're going to jail days or weeks in advance, Burroughs-Biron said verifications can be made in advance and medicines can be ordered before they arrive.
Asked about the complaints made by Ellis' family, Burroughs-Biron said she couldn't comment on an ongoing investigation.
However, she said many problems could be cured through better communication.
During her two years as director, Burroughs-Biron said she has tried to get the word out that her office needs to know about people with "complicated medical conditions" on their way to jail.
Generally speaking, she said her attempts to foster dialogue have failed.
"I've attempted to speak to public defenders, police and anyone else bringing us patients," she said. "It's important for us to know when someone has a complicated history. … Unfortunately, I haven't had a lot of feedback."
But Valerio said the state's public defenders have been contacting Burroughs-Biron's office about client medical issues — most notably in Ellis' case.
"(Public defender) Mary Kay Lanthier contacted Burroughs-Biron herself (one week) in advance," Valerio said.
According to Valerio and members of Vermont Protection & Advocacy, a group that defends the rights of people with disabilities and mental health issues, the policies that Burroughs-Biron described aren't always adhered to.
Valerio said he has seen a number of former inmates who have "deteriorated" inside the state's prison system because their medical needs weren't met or they were denied medicines for lengthy periods of time.
"The issue goes deeper than verification," he said referring to the DOC emphasis on making sure the drugs inmates say they are taking are what they're actually prescribed. "Issues of cost cutting and institutional inertia exist."
As an example of cost-cutting, Valerio said inmates have less access to doctors on weekends than on weekdays.
But Burroughs-Biron said Valerio's example shows a "lack of familiarity" with the delivery of health care services in prison settings.
"In general, there are nurses in the facilities 2-4/7 so there's always someone there to take care of the population," she said. "But it's not often if ever that you find a corrections facility with a 2-4/7 doctor on hand. We have doctors on call all the time to approve medicines but they're not in the facility."
At Vermont Protection & Advocacy, executive director Ed Paquin and supervising attorney A.J. Ruben said deviations from DOC policy contributed to a number of complaints and a handful of inmate deaths during the last decade.
Of the roughly 200 inmate complaints the VPA receives every year, only a small percentage prove justified, Paquin and Ruben said. But when the complaints are justified, the pair said failure to follow departmental policy is usually a factor.
"Very often, policies are not followed," Ruben said. "When you see that over and over, it makes you wonder if there's a culture in DOC that knows there's no consequences if you don't follow policy."
Ruben and Paquin said VPA officials meet with Burroughs-Biron once a month to talk about concerns. But while they said the DOC medical director was good at troubleshooting, they said it would be more reassuring if they didn't need to call about problems in the first place.
"It's not the way to run things," Ruben said. "We shouldn't have to be calling."
The concerns of the VPA and Valerio are well known to members of the legislative Corrections Oversight Committee.
That committee, made up of members of the House and Senate Judiciary committees as well as representatives from related House and Senate committees, has had recurring discussions about shortcomings in the DOC health care system for years, according to committee chairwoman Alice Emmons, D-Springfield.
From Emmons perspective, the delivery of medical care is hindered by a number of factors unique to a prison sentence.
First on her list are security issues which patients at regular medical clinics never have to deal with.
But beyond that obvious issue are some more subtle complications such as an "antiquated" computer system at DOC that Emmons said she believes impairs communications between private doctors, DOC and Prison Health Services, the company that contracts with corrections to provide medical services.
"Medical files don't follow inmates from facility to facility," she said. "My hunch is there are issues with that."
Also muddying the waters, she said, is the need to keep spending on pharmacy drugs within contracted amounts — spending that Emmons said probably ought to be higher.
But increasing spending for inmate's health care needs is an uphill battle, she said.
"The public is very resentful that offenders receive medical care at all," she said. "There are a lot of people who think if someone goes to jail, they don't deserve that but most of them will be out at one time or another and if we don't take care of their health issues inside we'll have bigger problems down the road."