The Real Cost of Prisons Weblog

Tutwiler Prison care on mend

"There is a system in place to administer medications, but it remains broken," Puisis wrote.

Puisis, an expert in correctional health care, was appointed in 2004 to monitor the medical agreement from a class action lawsuit settled on behalf of Tutwiler inmates. The DOC switched medical providers shortly before the agreement was signed, replacing Birmingham-based Naphcare with PHS.

The lawsuit, filed in 2002 by the Atlanta-based Southern Center for Human Rights, also produced a settlement that governs overall conditions at the prison.

In the June 2004 federal court settlement, the Alabama Department of Corrections agreed to dozens of improvements in medication, dental care and mental health care for almost 1,000 women housed at the state's only prison for women.

Sweeping changes called for everything from better sanitation to cut down on insects to quicker responses to inmates' complaints of painful medical problems left untreated for months.

A year later, Puisis is lukewarm in his evaluation. He says the prison is in "partial compliance," but repeats concerns he's voiced all year. Among them, women housed in the segregation unit filed repeated sick call requests that were ignored.

One woman, who filed four complaints about abdominal pain since February, was found to have a hemorrhaging cyst in March. The potentially malignant cyst has not been removed, and she has not been seen since August. "This is an excessive wait to evaluate this potentially life-threatening condition," Puisis wrote.

An example of "partial compliance" was the administering of medicines. He gave the DOC credit for refurbishing the medication room. But prisoners still miss doses, sometimes because they are away from their dorms at work during pill call. "I was especially concerned with medication for persons on preventative therapy for TB. One record indicated that the patient has received only 25 percent of doses," Puisis wrote.

The patients with the most missed medication were on antibiotics, which can lose their effectiveness if not taken properly.

The settlement requires four years of monitoring. Puisis will continue to visit once a quarter - with his expenses paid by the state - unless medical care improves next year and he finds the prison in "substantial compliance" for three consecutive visits, according to the agreement.

Exact costs of those visits, and of the improvements to date, were unavailable Friday. The total costs of renovation have not been calculated because more work is planned, said Brian Corbett said, spokesman for the DOC.

"We believe we have done well given the limitations of funding and the age and limited size of the Tutwiler facility. All Tutwiler-related issues were not created overnight, and they all are not going to be resolved in a 12-month time period," he said.

Corbett added, "Generally speaking, medical treatment provided at Tutwiler is some of the best and most consistent treatment these women have ever had. At times they come to us very sick, under-diagnosed and under-treated. They have greater access to specialists and daily care compared to the majority of individuals receiving medical care under the state's Medicaid programs."

Year in contract:

PHS has another year in its three-year contract with the state. The Brentwood, Tenn.,-based company's contract is worth $142 million.

Earlier this year, the Alabama DOC withheld $1.2 million in payments to PHS as a result of understaffing at some of the prisons. A March report from Puisis cited poor, incomplete or substandard medical care as contributors to three women's deaths at Tutwiler.

No deaths were reviewed in the latest report.

"Without question, patient care at Tutwiler has improved," PHS spokeswoman Susan Morganstern said.

She added that the company has increased the staff, including the addition of a specialist to treat women with HIV. "PHS and ADOC already have resolved or are in the process of resolving the remaining areas of concern in the October report. We look forward to Dr. Puisis' next report, which we are confident will reflect these efforts as well," she said.

E-mail: ccrowder@bhamnews.com FILEA federal court monitor says medical treatment at Tutwiler Prison for Women in Wetumpka remains sketchy for many prisoners.

© 2005 The Birmingham News