03/12/04

CARLA CROWDER
News staff writer

Some of the sickest men in Alabama prisons live in drafty cells in a building with broken windows. They must stand in line in the middle of the night for their pills. And several have died prematurely because of gaps in medical care, according to a report released Thursday as part of a lawsuit against the prison system.

Dr. Stephen Tabet, an infectious disease specialist from Seattle, first documented the harsh conditions at Limestone prison's HIV unit last year. When he returned for a follow-up visit, he found few improvements.

"More strongly than ever, I feel the Limestone Correctional Facility is in dire need of outside intervention and oversight," Tabet wrote after his Feb. 23 visit to the prison, where all of Alabama's male HIV-positive inmates, about 250 men, are housed. "Patients continue to die because of the failure of the medical system," he wrote.

The Department of Corrections strongly disagrees with the report's conclusions, a spokesman said.

"It is important to note that this report is written by a trial witness, hired by plaintiff lawyers," said DOC spokesman Brian Corbett.

Tabet has been reviewing HIV Unit medical care for the Southern Center for Human Rights, an Atlanta-based law firm representing HIV-infected prisoners in a class-action lawsuit against the state.

His August 2003 report documented conditions leading to 39 deaths since 1999. Thursday's follow-up looks at five new deaths in five months.

One patient dropped a third of his weight in five months, to 110 pounds, before dying in February. A doctor prescribed a high protein supplement for 35-year-old Gerald Lewis, but the kitchen wouldn't provide it.

Another man arrived at Limestone with active tuberculosis, but his medical records from another prison did not follow. Alfred Thomas, 42, was placed with all the other HIV patients, potentially exposing them to the disease. No one at Limestone knew about his TB until an autopsy following his October death.

Prisoner Nathan Sullivan began suffering with low oxygen levels a week before he died. "I am so sick, I can't even walk," he told a nurse who made notes in his files. "Inmate crying, praying to God to deliver him from his illness. Achy head to toe, nausea, headache, diarrhea after taking meds," she wrote.

Sullivan was suffocating, and died at a Huntsville hospital. Ambulance personnel initially refused to take him from the prison because of his oxygen level, according to the specialist's report.

One of Tabet's gravest concerns is lack of critical medication and middle-of-the-night pill call. "The pill line is a disaster," he wrote. Many medications were not on hand, and patients were sent away without them, Tabet wrote.

Not all bad news:

There have been some improvements since Tabet's first report.

Before, the HIV inmates lived in a crowded, converted warehouse. Currently, they live in cells in another building. But some of the windows are broken and covered with plastic or blankets. The doctor called the situation "unbearable for these immune-compromised patients."

The prison added a part-time physician to its previous staffing of one physician, but staffing remains below the National Commission on Correctional Health Care guideline of 110-physician hours per week for a prison with 2,200 inmates.

Since Tabet's first visit, DOC has switched medical contractors and spends more money on prisoners' care systemwide.

The department hired Tennessee-based Prison Health Services for medical care and Mental Health Management Services for mental health care in November. The 3-year contracts are worth $172 million. Previously, Birmingham-based Naphcare held the contract which costs the state $135 million over three years.

Prison Health Services officials issued a written response to the report, but declined to answer questions.

Company Vice President Larry Pomeroy described the medical care as appropriate and high quality.

"All clinical and operation policies implemented by PHS within the ADOC system, including the Limestone facility, are in compliance with national standards of health care delivery as established by the National Commission of Correctional Health Care," Pomeroy wrote.

Corbett at DOC said, "... we are in the process of addressing the complaints and resolving the issues in compliance with national health care standards as established by the National Commission of Correctional Health Care."

Alabama's prisoner health care costs remain the lowest in the country. The state spends about $5.50 per prisoner per day. The national average is $7.38.

Despite the new contract, much of the Limestone medical staff has not changed since before the lawsuit was filed, said Gretchen Rohr, an attorney with the Southern Center for Human Rights. "It's key they somehow show us that the new contract has been properly implemented," Rohr said. "We have not seen any evidence of this implementation."

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