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Summers, meanwhile, lapsed into a coma. On September 1, Gilpin learned her sister was dying. When Gilpin and Beverly Walker drove up from Joplin, they were unprepared for what they saw.
Because Summers was an inmate, a security guard had been posted at the door to her hospital room. Inside, Gilpin recalls, her sister lay comatose in bed. Summers was bloated with 80 extra pounds of fluid, pushing her weight up to about 300 pounds. And her body was held hostage not only by medical monitoring equipment, but by a chain connected to shackles on each leg.
When Gilpin demanded that the chains be removed, she says, she was informed she'd first have to sign paperwork granting her custody of Summers, which was on its way. Her sister's medical parole had finally been granted.
It took three or four hours to free her sister from the physical constraints. Ten hours after that, Gilpin says, Stephanie Summers was dead, with the imprints from the shackles still embedded an inch deep in her legs.
Sara Gilpin had always assumed the doctors and nurses in the prison infirmary worked for the Missouri Department of Corrections. It wasn't until after her sister died that Gilpin learned that the caregivers were employed by a private company.
Correctional Medical Services, also known as CMS, is a St. Louis company founded in 1979 and headquartered on Olive Boulevard in Creve Coeur. Over the course of 24 years, CMS has become the nation's leading provider of prison medical care, with 6,000 employees and 450 independent contractors in 27 states looking after approximately 225,000 inmates. The company operates like a health-maintenance organization for the incarcerated, receiving a fixed amount of money per inmate to manage and provide for all medical needs. As a privately held firm, CMS isn't required to disclose financial information, but infoUSA, a service that compiles business data, estimates annual revenues at $500 million to $700 million.
"The doctors and nurses who choose to work in prisons and jails do so because they believe they can make a positive difference in the lives of patients," Dr. Louis Tripoli, chief medical officer for CMS, writes in a statement provided to the Riverfront Times for this story. "Over the past two decades, numerous enhancements have been made in correctional health care and CMS has served an important role in those efforts."
Of course, inmates don't comprise the healthiest segment of the population, especially when it comes to infectious diseases. States Tripoli: "In my experience as a physician working in corrections, it is clear that many patients come into correctional facilities not having had regular access to healthcare prior to their incarceration."
CMS landed its first five-year contract with the Missouri Department of Corrections in 1992. According to MDOC spokesman Tim Kniest, the state paid the company roughly $3.70 per inmate per day during the first year of that original contract, which was renewed on a year-to-year basis. In 1997 the contract was renewed for another five-year term, and a third five-year agreement was inked in December 2001. For fiscal year 2002, the state paid CMS nearly $51 million; in fiscal year 2003 the figure approached $80 million. For the current fiscal year CMS is charging the state $7.84 per day to cover the medical, dental and mental-health needs of each prisoner.
Kniest says the contract has worked well for MDOC. "We were not able to compete with the private sector in paying salaries, so we had a lot of vacancies and a lot of deficiencies in our medical services," he explains. "We felt that entering into a contract with a private concern would offer us better medical coverage for the offenders."
One advantage is that the budgeting process is streamlined. "We pretty much know how much money we're going to spend in a given year on medical services," says the MDOC spokesman. "If you're on the HIV protocol for drugs, it costs the Department of Corrections the same amount as if you were getting aspirin for a headache. If an inmate has to go out to a hospital for any special surgery or test or anything like that, it is all covered."
CMS has received its own share of coverage, in the form of critical news coverage and lawsuits. In 2001 the state of Virginia canceled its contract with the company after fining CMS $900,000 for a number of violations, including failure to provide timely care to inmates. Over the past several years, news stories detailing allegations against CMS have appeared in the St. Louis Post-Dispatch, the Columbia Daily Tribune and the Des Moines Register, among others; most recently, the August issue of Harper's magazine contained a story that took the company to task for its care of inmates suffering from hepatitis. and earlier this year, an Illinois jury hit CMS with a $1.75 million verdict after an inmate committed suicide. The victim's family had alleged that the medical staff had failed to place him on suicide watch even though he'd indicated to numerous employees that he was suicidal. (The verdict is being appealed.)
Now CMS' performance in its own backyard is being challenged as concerns -- and deaths -- mount at the women's prison in Vandalia. Family members, inmates and religious activists who volunteer at the facility allege that long delays for medical tests, treatment and medication have caused unnecessary and agonizing deaths. In May of this year the U.S. Department of Justice announced it had opened an investigation into the Vandalia prison; at the same time, the American Civil Liberties Union of Eastern Missouri is looking into more than 50 claims of inadequate healthcare at the facility. Neither the Department of Justice nor the local ACLU will discuss the ongoing probes in depth, but from medical records and interviews with former inmates and with the families of deceased prisoners, Riverfront Times has learned the following: