For more than 20 years, the state of Florida and lawyers representing prisoners wrangled over inmates' health care, resulting in nearly a decade of federal-court oversight of health services in the Department of Corrections.
Now, lawyers who represented prisoners in the mid-1970s say conditions may be worse today than they were when attorneys for Michael Costello, an inmate at Florida State Prison, convinced a federal judge that inadequate health care amounted to a violation of Eighth Amendment protections against cruel and unusual punishment.
"It's going backwards, backwards, backwards," said Jacksonville lawyer William Sheppard, one of the lawyers in the landmark Costello v. Wainwright lawsuit. Sheppard played an integral role in the settlement of the case, which included a court-appointed special master and monitor to ensure that prisoners received the health care they needed.
"It was the number of people that were dying, and that really caused the federal court to appoint the special master back in the 1980s who worked for 10 years to enforce the order," Sheppard said. "It's not going to get better. It's going to get a lot worse. And when it gets to the breaking point, there are going to be lawsuits. It's as simple as that."
Less than two years ago, private companies took over health care for the state's 100,000 inmates. But newly appointed Department of Corrections Secretary Julie Jones is now threatening to cancel the companies' contracts, renegotiate or put them out to bid again.
"The department has maintained a clear message that the care of inmates is the number one priority in the provision of health-care services. I have personally met with our health-care contractors to express my expectations of excellence in quality care. I will continue to take steps to ensure that the department's expectations are met and that all parties are held to the highest standards of transparency and accountability. Anything short of timely, effective and appropriate health care will not be tolerated," Jones, who took over as secretary less than three weeks ago, told The News Service of Florida on Wednesday.
Jones, appointed by Gov. Rick Scott to take over the agency in the aftermath of reports of questionable inmate deaths and brutality by prison guards, told the Senate Criminal Justice Committee on Tuesday that she is in discussions with Corizon Health and Wexford Health Services about possibly terminating the contracts, which would require 60 days notice from the agency or 120 days notice from the companies.
Corizon is being paid $1.2 billion over five years to provide health care to more than 74,000 prisoners in North and Central Florida, as well as part of South Florida. Wexford will receive $240 million over the same period for health care for about 15,000 inmates at nine South Florida facilities.
Jones also accused the companies of failing to live up to the agreements and of putting inmates at risk by providing inadequate health care.
"Wexford Health appreciates and shares Secretary Jones concerns about the level of prison health services being offered. However, we are confident the overwhelming majority of those concerns do not apply to the 15,000 inmates under our care in South Florida," Don Hulick, director of operations for Wexford Health Care in Florida, said in a statement.
Jones' threats came just months after the two companies were promised extra money in exchange for agreeing not to walk away from the contracts.
On July 29 --- less than four months before Scott, who pushed for the privatization, was re-elected --- former Department of Corrections Secretary Michael Crews quietly agreed to pay the companies another $3.2 million to stay on the job for another year.
In the amendments signed by Crews in late July, the state agreed to pay Corizon an additional $2.9 million and Wexford an extra $300,000. Both companies complained that they had not received medical cost-of-living increases --- about 3 percent --- which were contingent on authorization by the Legislature, which did not approve the hikes. Crews used money set aside by the Legislature in the budget for growth in the prison population to underwrite the contract amendments.
Two months after he inked the contract amendments, Crews threatened to stop payments to Corizon, saying the Missouri-based company failed to follow through after audits revealed shortcomings in multiple areas, including medical care, nursing and staffing.
"We consider it our mission to care for patients as we would our own family --- with integrity and respect --- and to deliver the very best treatment possible despite often challenging circumstances. We take this responsibility seriously and remain steadfast in our commitment to creating and strengthening a culture of patient safety. We share Secretary Jones' commitment to patient care and look forward to working with her and her team in this endeavor," Corizon spokeswoman Susan Morgenstern said in an email.
Jones's scrutiny of the contracts came in tandem with her push for more oversight of prison health care. Right now, Jones and lawmakers rely on the Correctional Medical Authority to audit the companies, which are then responsible for fixing their own shortcomings. The Correctional Medical Authority doesn't have the ability to impose fines or other punitive measures on the vendors.
The Correctional Medical Authority was created in 1986 as part of the settlement in the Costello case. The state's prison health system stayed under federal oversight until 1993, when a judge decided that the federal government could relinquish its role as long as Florida remained committed to using monitors like the authority to ensure that prisoners' rights were not being violated.
In the midst of deciding to privatize prison health care in 2011, lawmakers shuttered the agency by eliminating its $717,000 budget. That same year, Scott vetoed a measure that would have done away with the authority, calling it a "valuable layer of oversight." The next year, House and Senate leaders allocated $580,000 to revive the agency, shrunk from 12 workers to six with an oversight board of seven governor-appointed members.
But critics of the revived authority say the agency no longer has the power it held when U.S. District Judge Susan Black agreed to end federal oversight.
Sheppard said his office receives requests for assistance almost daily from inmates who say they are unable to get medical services ranging from treatment for chronic illnesses like multiple sclerosis to more run-of-the-mill conditions like hernias.
The complaints echo those he fielded three decades ago at the height of the Costello litigation, Sheppard said in a telephone interview.
"It's the same piece --- they don't treat me. It's getting access, and then once you get access it's being seen properly and then what the doctor orders, you don't receive," Sheppard said. "You've got a lot of people dying and you've got a lot of unexplained deaths that are floating around here."
Last year, 346 of the state's 100,000-plus inmates died behind bars. More than half of those deaths --- 176 --- were initially unclassified, meaning that state investigators had no immediate explanation for the causes of death. According to the Department of Corrections website, 146 inmates died due to heart attacks, cancer, gastrointestinal diseases or other medical problems.
"To me, it seems like (Florida) would be ripe for a lawsuit now. That's if the federal government doesn't step in first," said Mike Manguso, a senior research fellow at the Tallahassee-based Project for Accountable Justice.
Manguso worked for the Department of Corrections for nearly three decades and served as a policy analyst for governors Jeb Bush, Charlie Crist and Scott.
"(Inmates) don't deserve a little bit less than someone on the outside. They deserve to be treated as humans. It's just ridiculous. The state has a responsibility. If we have custody of them, under the constitution, we're required to give them a certain level of care," he said.
