Mentally ill prisoners are dying. Are private health care companies to blame?
Watch the CBSN Originals documentary produced in partnership with Type Investigations, "The Perils of Private Prison Health Care," in the video player above.
Mariam Abdullah had dreamed of becoming a firefighter, but that dream ended only six weeks after her 18th birthday when she died by suicide in her prison cell, seven months before her scheduled release date. It wasn't an isolated incident. Abdullah's death was part of a pattern of neglecting inmates with mental illnesses in the Arizona prison system while under the care of its private health care contractor, Corizon Health, Inc.
While serving a 3-year sentence at Arizona's Perryville Prison for her role in an armed robbery, Abdullah, whose family immigrated from Iraq when she was a child, had been diagnosed with mental illnesses including mood disorder, bipolar disorder and narcissistic personality disorder.
In the same period, she attempted suicide 15 times. So, when she bit her own wrist on July 10, 2016, a psychiatrist at the prison recommended she be put under suicide watch, a type of segregation where inmates are stripped of all objects and clothing, given a thick smock to wear, and continuously monitored to ensure they do not harm themselves.
"Perryville did what unfortunately happens in a number of badly run prison systems," said Craig Haney, co-creator of the Stanford Prison Experiment and a professor at the University of California, Santa Cruz, who conducted inspections of Arizona prisons to study the psychological consequences of solitary confinement. "When there are inadequate mental health resources and inadequate mental health programs, persons who are mentally ill tend to be shunted off into isolation units for management and control."
On July 15, 2016, after five days on suicide watch, Mariam was released back into the general population. She killed herself in her cell four days later.
One year prior to Abdullah's death, a settlement was reached between the Arizona Department of Corrections and the American Civil Liberties Union, Prison Law Office and a few other organizations meant to avoid this very scenario. The case, Parsons v. Ryan, was a class action lawsuit filed against the Arizona Department of Corrections for failing to provide adequate mental health care, medical and dental care. In the settlement, the Arizona Department agreed to comply with 103 performance measures, including one that required a licensed clinician to visit mentally ill minor inmates every 30 days.
Arizona is one of many states that hires private correctional health care companies to provide their inmates with medical care. One reason for this model is that the upfront cost of health care per inmate tends to be less under private contractors. In 2015, the state of Arizona ranked sixth nationwide in lowest per-inmate spending on prison health care.
David Fathi, director of the ACLU's National Prison Project, says these companies are looking to make a profit from the amount of money they receive from the state government, which gives them "a powerful, indeed overwhelming, incentive to deny care."
At the time of Abdullah's death, Corizon Health had held the contract with the Arizona Department of Corrections since 2013 and was responsible for complying with the performance measures outlined in the 2014 settlement under Parsons v. Ryan. "It appears from court documents that I got, in fact [Abdullah] wasn't really seen at all; that there were sporadic visits," says Lisa Armstrong, a reporter with Type Investigations who became interested in Abdullah's case in 2016.
In a statement, the Arizona Department of Corrections said it expects contracted health care companies to follow the law: "While the Arizona Department of Corrections (ADC) will not comment on pending or ongoing litigation, as in the case of Ms. Abdullah, the Department of Corrections expects the State's contracted health care provider to provide every inmate with the constitutionally mandated health care to which they are entitled."
Former Corizon employees in Arizona have come forward with allegations that the system is badly run. Dr. Angela Kenzslowe, a psychologist who worked for Corizon at Perryville prison, quit her job after just three months there, claiming "I felt my license was at risk. I felt that I didn't have the autonomy that was needed as a licensed psychologist to be able to run mental health the way it needed to be run."
A nurse, Jose Vallejo, who worked for Corizon Health at Eyman prison in Arizona, said he witnessed several inmates causing themselves harm and did not feel qualified to provide proper mental health care. After sending multiple requests for additional resources to Corizon's management that resulted in no changes, he claims he put in his two week's notice but was fired a few days later. A Corizon spokesperson says he was "terminated from his position for failure to perform required duties".
Corizon declined to provide an official statement, but a representative responded to an inquiry into how often and how long they expect their mental health staff to meet with inmates with the following: "Patients are evaluated (visit frequency and visit duration) based on their needs (i.e., the severity of their symptoms and progress in treatment), their individualized treatment plans, and evidence-based community and correctional standards of care."
According to the ACLU's David Fathi, because there are only three major players in the correctional health care industry — Corizon, Wexford Health and Centurion — issues like those Kenzslowe and Vallejo raised may keep recurring. "The problem is when you have only three players, it does become kind of a revolving door among those three players, or a game of musical chairs, and all too often things don't really change in a meaningful way," says Fathi.
Arizona ended its relationship with Corizon in January 2019 and hired Centurion, a company that faces a class action lawsuit in Mississippi for providing inadequate mental health care at a facility where at least six prisoners died in 2018.
In response to a request for comment, Centurion directed CBS News to an op-ed written by their CEO. In part, it stated: "Our job, put simply, is to improve the quality and accessibility of care throughout Arizona's correctional system, and we will do this by hiring the right people and building a culture of supportiveness, professionalism and accountability."