Two in every five inmates in US prisons have a chronic medical condition. Terrell Griswold, due for release last year, was one.
On 28 October 2010, Lagalia Afola received a phone call from the Bent County Correctional Facility, a private prison operated by the Correctional
Corporation of America (CCA), informing her that her 26-year-old son, Terrell Griswold, was dead. Terrell was serving a three-year sentence for
burglary and was due to be released in early 2011. Sadly for him, and for his grieving family, he never made it home.
The autopsy report stated that Terrell died as a result of "hypertensive cardiovascular disease" and that he had a clinical history of hypertension,
for which he refused to take medication. His mother found this conclusion hard to accept and, after months of persistent enquiry, was finally
provided with at least some of her son's medical records. Upon reviewing the records, she discovered that her son had been suffering from a
blockage in his prostate that prevented him from urinating properly, causing chronic kidney damage, and which, she believes, ultimately
contributed to his abrupt demise.
This blockage in Terrell's prostate was discovered on 3 December 2009 by Dr David Oba, an attending physician at the CCA prison. The doctor
noted at the time that inmate Griswold reported having had problems passing urine for the past two months:
"He has the urge to void but sometimes is unable to void at all, other times he has a very weak stream but is able to void."
The doctor also noted that he had discussed with the patient that "he may have a chronic sub-acute prostatitis", which he planned to treat with a
30-day cycle of ciprofloxacin (Cipro). If there was no improvement he wrote that "he may need an eval [sic] with cystoscope with urology."
According to the records seen (pdf), Terrell was never treated by an urologist during his entire stay at the CCA facility, and it appears he did not receive the Cipro for almost six months. On 27 January 2010, Terrell had a follow-up visit with a nurse. The nurse's report of the visit reads as
"I/M (inmate) to medical to discuss non-compliance re: HCTZ & Lisinopril. (Both drugs were to treat hypertension and high blood pressure). Per I/M he has the meds in cell but states he forgets to take meds. I/M agrees to take meds as ordered."
She goes on to write:
"I/M also reports he never received Cipro for his urinary problem." She reviews his charts and confirms that the Cipro was never ordered. Following this visit, there are several "Refusal of Treatment Medical Release Forms" dated 5, 13 and 24 February, 10 and 15
March, which appear to have been completed on Inmate Griswold's behalf but which he "refused to sign".
There appears to be no record of any visits with the medical team regarding his urinary complaint for several months. His next visit with a nurse
(other than to deal with an issue regarding a swollen knee), according to the records I reviewed (pdf), was on 16 August 2010. The nurse notes
again that "I/M non-compliant re: medication regimen. Last pick up 5/14/10." This note is somewhat at odds with Terrell's monthly medication
records, which list all the medications he is taking each month. In May, June and July, the listed medications include HCTZ, Lisinopril and Cipro. If
what the nurse stated on 16 August 2010 was true, that Griswold had not picked up his medications since 14 May 2010, then why did the records
list all these medications (including Cipro) for the intervening months?
Whatever the explanation, it is clear from what followed is that Terrell Griswold's urinary complaint never went away.
Close to midnight on 22 October 2010, Terrell declared a medical self-emergency (pdf) and was taken from his cell to the prison clinic. He
complained of "diarrhea, dizziness, tingling in his fingers and feet, has an odd smell in nose like bleach or ammonia, feels like his throat is closing up, has acid reflux when awake and pain in epigrastic area." He did not see a doctor because the doctor was not there; but the doctor did prescribe Bactrim, an antibiotic used to treat infections, over the phone. The nurse noted on her report that inmate Griswold was instructed to take his meds as ordered, told to follow up in 24-48 hours if no better, and was sent back to his cell. She ticked the box that said "no acute distress".
On 24 October 2010, Griswold got to see the doctor. But according to the records, the doctor performed no tests, did not take a blood pressure
reading, and simply wrote the words "UTI" (urinary tract infection) in the assessment section. During this period, Terrell's cellmate later reported
that he was making frequent attempts to urinate.
Three days later, on 27 October 2010, Griswold began vomiting in his cell and was sent to the nurse at 7.30pm. The nurse informed her patient
that his antibiotic was making him sick. She ordered him to return to his cell and wrote: "He did not show any outward signs of distress that would
have warranted he needed emergency treatment."
Eleven hours later, at 6.30am, Terrell Griswold was found slumped over his toilet bowl, lifeless. His condition finally warranted emergency
treatment (pdf) and the full capacity of the CCA's medical team kicked in; CPR was administered, the patient was rushed to hospital, where he was
pronounced dead at 7.24am. It was noted on his death certificate that his bladder was full of urine.
When a prisoner is deprived of their liberty by the state, they cannot provide themselves with food, water or medical care. For this reason, the state has to assume the responsibility for meeting those basic needs. A private prison that is run for profit has the same obligation to meet these basic needs; otherwise, the prisoner would be deprived of life, a violation of their most basic constitutional rights.
I asked Steve Owen, the senior director of public affairs for the CCA, if he felt that Terrell Griswold had been provided with adequate medical care.
He would not comment on Griswold's specific case, citing privacy reasons, but he sent a fact sheet (pdf), which, he said, "summarizes both the
scope and commitment to quality inmate healthcare services that our company provide and to which our government partners hold us
The fact sheet claims, among other things, that every CCA facility is equipped with a fully-staffed, state-of-the-art medical clinic, which is available for inmate access 24/7; that all care-related decisions are made solely on a medical basis, entirely independent of impact on CCA profits. It also states that CCA facilities utilize an innovative computer program that automates medical records, pill call and pharmacy services, which reduces paperwork and wait times.
Lagalia Afola wrote to Dr Leon Kelly, the coroner who performed her son's autopsy, detailing her objection to his initial conclusion that her son had
died of "hypertensive cardiovascular disease". When he reviewed the new information, the coroner issued a revised autopsy (pdf), listing
obstructive uropathy as one of the causes of death. Dr Kelly told me that he believed the successive urinary episodes led to kidney failure, which
"certainly contributed to [Terrell's] sudden cardiac death".
At this point, however, the cause of death is of less concern to Mrs Afola than the fact of it. "My son was sentenced to three years for burglary," she
said. "It was not supposed to be a death sentence."
According to bureau of justice statistics (pdf), around 4,000 inmates died in prison and jails (both public and private) in 2009; and over half of those deaths were illness-related. A comprehensive nationwide survey on the health and healthcare of US prisoners carried out by Harvard Medical
School researchers (pdf) found that over 40% of US inmates were suffering from a chronic medical condition, a far higher rate than other
Americans of similar age. Of these sick inmates, over 20% in state prisons, 68% in jails and 13.9% in federal prisons had not seen a doctor or
nurse since incarceration.
One of the authors of the study, Dr Andrew Wilper, told me they did not include private prisons in their study because, to the best of his knowledge,there was no data available. In his view, he added, "the private prisons like it that way."
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