By JON FRANK, The Virginian-Pilot
November 4, 2002
VIRGINIA BEACH -- On an April morning in 2001, Kathy S. Kearns died lonely and afraid in her city jail cell. Fellow inmates said her belly was so swollen that she appeared to be pregnant with twins. Instead, she was bloated with more than 80 pounds of excess water weight, 2.6 gallons of it in her abdomen, as her body struggled with liver cancer, hepatitis C and cirrhosis.
Had she been free, Kearns likely would have been in a hospital.
But the 43-year-old woman, jailed for driving under the influence, had no say about her medical care. The way she died left her family outraged and prompted local and federal investigations.
Why, they asked, did she die in her cell? Could better care have prolonged or saved her life? Are other inmates with similar chronic illnesses receiving the care they need?
The questions prompted Sheriff Paul Lanteigne to re-examine his jail's $1.65 million annual contract with Correctional Medical Services, a St. Louis-based company that provides inmate health care to thousands of prisoners nationwide.
In July 2001, the company's yearly contract was changed to a month-to-month status. It was finally renewed for a full year this summer after investigations into Kearns' death cleared both the jail and CMS.
Unhappy with care, Norfolk fired provider
The company maintains that it provides excellent care to inmates in Virginia Beach and did nothing wrong in the months leading up to Kearns' death.
``She saw health-care professionals regularly, including a doctor,'' said CMS spokesman Ken Fields.
The company, however, has faced similar criticism in Virginia before.
In the summer of 2000, the state assessed more than $900,000 in penalties against CMS, which at the time provided health care in Virginia's prisons, according to published reports.
Problems ranged from not giving inmates timely referral visits to doctors to not assessing medical conditions within 48 hours of inmates entering prisons, which is a Virginia Department of Corrections regulation.
CMS also failed to have a dentist at one prison and a psychiatrist at another.
A state auditor said then that the company was ``often in noncompliance with service standards in the contract.''
Kearns' father, John E. Barkley, does not know how often his daughter saw a doctor while in jail during the last four months of her life. What he does know is that an outside physician, Virginia Beach surgeon Dr. Richard D. West, recommended to jail officials in January 2001 that Kearns have a hernia operation. The procedure was never done.
Lanteigne's review cleared his department and CMS, but the sheriff concedes that ``it would have been better for her to die in a hospital than in a jail cell.''
He runs the 1,100-inmate jail and said he depends upon CMS to make medical decisions.
``I certainly don't try to supersede a doctor's opinion,'' he said.
Although the investigations, including one by the FBI, are closed, Kearns' father presses on. He has filed a $5 million lawsuit in federal court against Lanteigne, CMS and others in his quest for answers and justice.
Problems with medical care surfaced at the jail three years before Kearns died.
That's when 21-year-old inmate Bilal Golson found a pingpong-ball-sized mass on his back.
Jail doctors ``did not treat or attempt to diagnose'' the growth, according to a federal lawsuit his family filed two years ago in Norfolk.
Golson reported the growth to jail officials on Nov. 20, 1998, and was granted a doctor's visit inside the jail one week later, the suit says.
He did not receive a biopsy until Dec. 18 at Sentara Virginia Beach General Hospital, and only after a CMS doctor had tried to drain the growth with a needle, the suit says.
The biopsy administered by an outside doctor confirmed Golson's greatest fear: The tumor was among the most virulent of all cancers -- rhabdomyosarcoma.
By then, the mass had grown to the size of two cantaloupes.
``He looked like the Hunchback of Notre Dame,'' recalled his sister, Dionne Whitley.
Her brother died in April 2000 -- 10 months after his release from the jail for medical reasons. He had never been convicted of the malicious wounding and trespassing charges for which he had been locked up in October 1998.
In a May 2000 letter to Whitley's attorney, Dr. L.D. Britt, chairman of Eastern Virginia Medical School's Department of Surgery, wrote: ``There is no doubt that this patient's medical course could have been significantly altered had he had earlier intervention.''
Whitley withdrew the lawsuit in April because of difficulties lining up an expert witness. She has since re-filed it.
Lanteigne wasn't the sheriff at the time, but CMS was the jail's medical provider. Like the company has in the Kearns case, CMS maintains that it did nothing wrong with Golson.
Fields, the CMS spokesman, said Golson received treatment ``consistent with accepted standards of medical care.''
Yet other inmates confronting serious illnesses share the concerns raised after the deaths of Kearns and Golson.
Their medications have been mixed up and their conditions misdiagnosed, according to interviews with several inmates and a review of their medical records.
Their complaints range from a woman who said she wasn't properly treated for a broken foot to a diabetic who was given the wrong amount of insulin and became ill. Two inmates said they were refused anti-depressant medications that had been prescribed to them and a third said she initially was denied a hepatitis C test and then taken off anti-viral medications that she had been on before she was incarcerated.
Jail and medical officials say the health care is adequate and meets national standards. That care, however, has contractual limits and can be expensive.
Prisoners in Virginia Beach who have hepatitis C are not treated with drugs unless they are already on the medications when first jailed, said Dr. Gary Campbell, a regional medical director with CMS.
That is in conflict with the standard set by the National Institutes of Health, which recommends that drug therapy be given to hepatitis C sufferers.
Campbell said expensive therapy for hepatitis C is not started because jail stays tend to last no more than 12 months. Therapy must be continued longer to be effective, he said.
Hepatitis C is a liver disease that has become an epidemic in jails and prisons. And the treatment is expensive -- as much as $40,000 per year, according to government physicians. But recent studies show it can cure up to 50 percent of those infected.
CMS is protected from having to treat the highest-cost illnesses. The Virginia Beach contract limits the company to $20,000 each year on any one inmate. After that, the city must pick up expenses.
Such caps are becoming more common as inmate health-care costs rise, said Robert E. Lehman, health services administrator at the Norfolk City Jail.
Officials said the Virginia Beach cap is high enough to guarantee adequate care for all conditions short of those considered catastrophic.
Some inmates and their families remain unconvinced.
``They are coldhearted and callous to anyone who is in there,'' said George Cornell, whose 32-year-old son, George II, initially was denied anti-depressant medication while he was locked up for assaulting a police officer. He was jailed during parts of 1999 and 2000.
``I think the whole place is a concentration camp,'' Cornell said. ``Once the doors close, nobody knows what goes on.''
In recent years, CMS has faced scrutiny in Hampton Roads and elsewhere.
In 1994, Norfolk Sheriff Robert McCabe dropped the contract his department had with the company. Jail officials attributed the move, in part, to the company's failure to contain the threat of infectious diseases, particularly tuberculosis.
CMS blamed the problems on ``larger and more chronic issues,'' such as crowding in the jail, inadequate funding and outdated facilities.
McCabe ultimately hired a medical team from Norfolk Community Hospital.
In 1995, faulty dialysis machines in Alabama prisons led to the death or injury of 10 inmates and resulted in lawsuits that were settled confidentially by CMS in 1999, according to news reports.
The prisoners became sick after workers for a CMS subcontractor, Southeast Dialysis, put the wrong chemical in their machines, published reports show.
``We believe the mistake made by Southeast Dialysis personnel was unacceptable, and therefore, we took steps to terminate that company's contract in Alabama and other states,'' CMS officials wrote in a prepared statement.
Today, CMS' presence in South Hampton Roads is limited to Virginia Beach and the Hampton Roads Regional Jail in Portsmouth. There are no recorded complaints about medical care at the regional jail.
But complaints in Virginia Beach have continued since Kearns died.
The Endependence Center, which acts as an advocate for people with disabilities, intervened in April on behalf of an inmate who claimed she was denied medication for migraine headaches and several other medical conditions during her incarceration.
According to Kelly Maxwell, an Endependence Center coordinator in Virginia Beach, the woman also was denied a doctor's appointment until ``after her release was scheduled.''
Jails often model their care after health-maintenance organizations.
Nurses or in-house doctors respond first when an inmate raises a medical concern or faces an emergency. Inmates are taken to outside specialists when jail doctors don't see satisfactory results.
When inmates arrive in Virginia Beach, they are screened by a medical staffer before they are assigned to a cell -- a typical procedure at local lockups.
Beth Holcomb has been in charge of CMS' Beach operations for close to 12 years. She has on her staff a physician, a social worker, a mental-health worker, a medical assistant, a secretary and 16 nurses.
At daily meetings, the staff discusses cases requiring special attention. If outside specialists are needed, appointments are scheduled.
Although many inmates complain about the care, there are those who praise it.
``They have been wonderful to me,'' said Clarence Moore, an inmate jailed for driving without a valid license who suffers from high blood pressure.
Moore said he received routine screenings and saw a doctor regularly while in jail.
Lehman, the health administrator at Norfolk's jail, said the key is balancing cost concerns with care. Lehman works for Prison Health Services Inc., a Tennessee company that serves more than 400 jails and prisons nationwide.
``If you follow the managed-care model,'' he said, ``the money will always take care of itself.''
Experts said improving the situation for inmates is difficult for three reasons: Budgets are tight, the inmate population suffers from high rates of disease and standards for care vary widely.
Rates of hepatitis C are 15 times higher in jails and prisons than in the general population, according to the National Institutes of Health. HIV infection rates are about 10 times higher.
Medicines for as many as eight HIV-infected inmates in Virginia Beach during a recent month cost between $6,000 and $8,000, Holcomb said.
Outside jails, hepatitis C sufferers such as Kearns should ``expect to be treated'' with anti-viral therapies, according to Dr. Adrian Di Bisceglie, a professor of internal medicine at St. Louis University who has studied the disease for the National Institutes of Health.
Patients on the outside suffering from the extreme fluid retention and abdominal swelling Kearns experienced would be hospitalized, said Dr. Theodore Reiff, a former medical professor at Johns Hopkins University in Baltimore and a retired physician living on the Peninsula.
``If she had come to any hospital emergency room in that condition, there would have been no hesitation,'' Reiff said. ``She would have been promptly admitted.''
The trouble is, many inmates enter jails unhealthy, which makes diagnosis and treatment even more difficult.
Once they're locked up, inmates actually have better access to care than they did on the outside, CMS' Fields said. ``It is sad but true.''
In the end, Kearns' death may never yield a satisfactory explanation for her friends and family.
Family members claim that she was denied care ordered by at least one physician four months before she died.
In January 2001, deputies took the woman to the outside doctor who recommended that she have her hernia repaired. Medical records show that was never done.
A test that screens for cancer in patients with liver disease was ordered. It, too, was never done, according to the records. The cancer was discovered during an autopsy.
Fields said the cancer test ``would not have changed the treatment she received nor led to an improvement of her condition.''
It's unclear whether any medical procedure would have prolonged her life.
In part, that's because Kearns' lifestyle contributed greatly to her medical condition, her father said. She suffered from the addictive use of several substances, including alcohol.
During her final year of life, Kearns was in and out of jail. She was serving a 14-month sentence for several convictions, including DUI. The sentence began in April 2000 and was scheduled to end on May 5, 2001.
Nonetheless, during her final days, her family became frantic.
Her father tried unsuccessfully to alert officials by phone and fax to his daughter's worsening condition 10 days before she died. He was assured that she was receiving proper care.
The day she died, Kearns was scheduled to see a specialist outside the jail.
But while she waited in her cell, Kearns received no special attention beyond diuretic medication and pain relievers, even though her cellmate tried to get help, according to jail interviews.
Kearns herself cried for help in the hours leading to her death as she became incoherent and struggled to breathe, said a fellow inmate, Kristi Potts.
Those hours haunt Potts, who maintains that the jail staff did little to help Kearns.
``It still upsets me to talk about it,'' Potts said recently. ``They acted like they couldn't do anything for her.''
Minutes before Kearns died, a jail deputy placed a 911 call that lacked specific information, according to a tape obtained through a Freedom of Information Act request.
A sheriff's deputy told dispatchers, ``I don't know what is wrong. She is not breathing well, I know that.''
By the time emergency officials arrived, it was too late.
``I just want to know why my daughter wasn't sent to a hospital, where she would have been more comfortable and more cared for,'' Barkley said.
He has yet to bury his daughter's ashes. He won't do that, he said, until he gets some answers.
Reach Jon Frank at 446-2277 or firstname.lastname@example.org