AIDS deaths have decreased by 75 percent in four years at Limestone Correctional Facility.

“When I came here in ’93 we had more deaths than those coming in,” said Eric Howard, one of five HIV-positive inmates who were complainants in a 2002 suit against prison officials and health services provider NaphCare for treatment practices that they contended amounted to “cruel and unusual punishment.”

“It was a real sad time,” said Howard. “You get close to people and it becomes like a network of family members. Of course, you are sad when they die.”

Last year, there were three deaths in the “Special Needs Population” – as HIV/AIDS inmates are now designated. At the time the Southern Center for Human Rights filed suit on Nov. 15, 2002, on behalf of Howard and fellow inmates Antonio Leatherwood, Jerry Sanford, John Levins and Michael Patrick they said that 12 inmates had died in the previous year. Prison officials disputed that number, saying nine had died that year, which they said was not an unusual number.

The inmates officially settled their suit June 24 when court monitor Dr. Joseph Bick signed a release on the settlement agreement.

“Dr. Bick referred to us as a model program, that we had made a great metamorphosis,” said Alabama Department of Corrections Associate Commissioner of Health Services Ruth Naglich.

One of the state’s solutions was to fire NaphCare and hire Prison Health Services in November 2003 under a three-year, $142.7 million contract. NaphCare, in turn, blamed the state for limits of food, shelter and medical services, according to an Aug. 1, 2005, New York Times story.

Naglich, a registered nurse, became associate commissioner in October 2004, after having worked on and off with the Department of Corrections since 1978, either as a consultant, contract monitor, or regular employee. At one time, she worked for 18 months for Prison Health Services as vice president for sales and marketing at the company’s headquarters outside of Nashville.

“I’m not appointed; I’m a merit employee,” said Naglich. “I applied along with all the others. I took a written test and was placed on a register in the personnel office until there was a position.”

PHS is the nation’s largest commercial provider of medical care to inmates; however, according to the New York Times, the company has been criticized by judges, government overseers, and whistle-blowers, and has paid millions of dollars in fines and settlements. Naglich’s department imposed fines against Prison Health totaling $580,000 for failing to meet some performance standards in the first year she was on the job.

New Prison Commissioner Richard Allen said PHS’s contract has been extended for one more year, and then the contract will be re-bid.

“The governor met with Prison Health Systems last fall and read them the riot act,” said Allen. He said that although the suit has been settled, the DOC continues to “hold their feet to the fire.” He went on to express confidence in Naglich, saying she is “very, very skilled.”



Complaints

The five inmates alleged in their 2002 suit that the prison system, and then, health care provider NaphCare failed to provide “minimal end-of-life treatment”; had “inadequate and untimely response to HIV medical emergencies”; provided “inadequate and inhumane living conditions”; and failed to provide inmates with competent medical specialists.

More specific complaints cited included an untreated or inadequately treated epidemic of boils. They also complained about being housed in a drafty, leaking, rat and vermin infested former warehouse structure. The inmates said their “sick call” slips sometimes went unanswered for days or not at all. Medication was administered in an untimely manner and food was inadequate.

The inmates contended that medical personnel often refused to touch dying patients and care fell to fellow inmates.

Inmates also complained about the lack of dialysis facilities and excessive delays in treating other illnesses. One inmate complaint continues to be about the high turnover in doctors that interrupts continuity of care.



%Prison Commissioner Allen said recently that, “Prisoners are the only segment of the population who have a constitutional right to health care.”

Allen said the system has gone in three years from spending $44 million a year up to the present $80 million, which equates to spending $3,000 per inmate in the system. One of Gov. Bob Riley’s mandates to Allen when he accepted the post in February was to get a get a handle on “soaring inmate healthcare costs.”

A multi-faceted plan focuses on reversing inmate growth. The system is depending on sentencing reform and community centers to keep offenders out of prisons.

There are now 267 inmates in Limestone’s Special Needs Unit. Tutwiler Prison for Women houses 21 HIV-positive inmates, and Kilby Prison for Men houses one.

“The (HIV) population has increased because of the recent intake from the county jails,” said Ronald Cavanaugh, DOC director of treatment. “It usually is stable at from 247 to 250.”

Cavanaugh, who was named as one of the defendants in the 2002 suit, said inmate treatment is augmented through a partnership between the prison system and the Alabama Department of Health-HIV/AIDS Division. The health department provides educational workshops, monthly and quarterly outreach to Limestone and Tutwiler, planning and transitional services and community referrals for released inmates.

HIV inmates have also been moved into two dormitories and out of the drafty, vermin-infested building.



Inmates speak

Inmate Howard, 37, of Birmingham, who came to Limestone for the second time in 2001, is serving a 17-year sentence for first-degree robbery and possession of a forged instrument. He said that treatment continues to have its “ups and downs” since he and the others filed suit.

“Generally, we receive our antiretroviral medication on time,” said Howard, who also had knee surgery for torn ligaments two years ago. “For myself, I basically get the attention I need.”

Howard also said the food, “is a lot better than it used to be. We get double portions because of the toxicity of the medication.” He said they are also provided between-meal snacks of bologna, milk or hotdogs.

Naglich said the prison has an on-staff registered dietician who consults with the University of Alabama in Birmingham on inmate diet requirements. She said the antiretroviral medication interferes with absorption of calories and nutrients, so HIV-positive inmates require more food and more frequent meals.

Inmate Darryl Floyd, 41, is serving a life sentence as an habitual offender out of Elmore County. He said that sick calls are no longer postponed and dental care is more available. He also said hygienic conditions have improved.

“We want to stay clean with our conditions, so everything is fine,” said Floyd.

However, Floyd said he would “like our doctors to stay a little while longer. I heard one of the doctors is leaving. They don’t seem to keep a doctor long.”



Physician turnover

Infectious Disease Specialist Nancy Garcia is leaving after just 15 months, as is an internal medicine specialist.

PHS Administrator Larry Hynes said that the internal medicine doctor got another offer out of state and Garcia’s contract was up. “It wasn’t renewed because they couldn’t come to an agreement on terms,” said Hynes. “They just decided to go their separate ways.”

Garcia followed Dr. Valda M. Chijide (pronounced CHIJ-i-day), who left after barely three months, according to the New York Times, who wrote that she was suspended after complaining in writing about conditions at Limestone. Chijide had complained about unsanitary conditions, inadequate staffing, and lack of quarantine facilities for inmates with TB or hepatitis C, among other things.

Registered Nurse Brandon Kinard, PHS regional clinical manager, said that with 30 percent of the prison population infected with hepatitis C, it is impossible to isolate all of them. As for air-borne infectious diseases, such as TB, the prison infirmary has a “negative air pressure” room for those suspected of contagious diseases. The facility is inspected by the University of Alabama Health and Occupational Services annually, Naglich said.



Need hospice care

Inmate Ivory Cooper, 48, who is serving a 16-year sentence for theft and forgery, said care is “100-percent better” since the suit. “They’re seeing to my needs. If I complain, they take care of it.”

Cooper said that if there is a way to improve care it would be in hospice services. He said that he and Howard have gone through hospice training and used to administer to dying inmates. “We would sit with them and tend to their needs the best we could,” said Cooper. “At one time, a guy died by himself.”

However, Kinard said because of the suit’s settlement agreement, inmates can no longer take part in patient medical care, and hospice care is considered medical care. He said PHS hospice care is “nurse-driven, rather than inmate-driven.”

But Cooper wants to see that changed. “Eric and I have become very good friends,” he said of Howard. “If I knew Eric was on his last leg I would want to be with him. There was one guy and we took him up and hand him baptized and saved just before he died. I hope that I helped him find the Lord and peace.”

Kinard said that he had started the first inmate hospice program when he was at Hamilton Correctional Facility in Marion County. “I think it’s wonderful,” he said.

However, Hynes said it’s now the law that inmates cannot tend to dying patients.

Of the three Limestone AIDS inmates who died in the past year, one died in a Louisiana acute care facility and two in a North Carolina facility run by PHS.