Dirty Work

by Eyal Press

  When she formed the Forgotten Majority, the brutality of Florida’s prisons was not high on Judy Thompson’s agenda, not least because she had no idea how brutal they were. Then she started receiving letters like the ones that she spread on the table at the coffee shop where we met. In one of them, a prisoner described going to a captain to seek protection from gang members who had threatened him. The captain responded by telling him that if he did not shut up, “he would spray me (pepper spray) and … knock my teeth out,” the prisoner wrote. I’d contacted Thompson because I wanted to know how unusual the abuses at Dade were. Although Dade was an extreme case, physical and verbal abuse was not unusual at all, she told me. Most of the letters she got were from prisons in northern Florida, she said. In Thompson’s view, it was not a coincidence that the farther north one went, the less ethnically diverse the staff became. At a penitentiary near Jacksonville, two COs were convicted of plotting to kill a Black prisoner. The guards were members of the Ku Klux Klan.

  For years, the inhumanity of Florida’s prisons attracted little notice. But in the wake of Darren Rainey’s murder and the wretched conditions described in the Herald and other news outlets, a small group of advocates started pushing for change. One of these advocates was George Mallinckrodt, the psychotherapist who had gotten fired after voicing complaints about the abuses at Dade. Another was Thompson, who, in March 2015, attended a legislative hearing in Tallahassee, chaired by Senator Evers, to address the rampant, sometimes-lethal violence in Florida’s prisons and jails. As usual, Thompson came to the hearing with some prisoners’ letters, including one she had received two years earlier from Mark Joiner, a prisoner who had been at Dade and who had contacted her a few months after Darren Rainey died. In his letter, Joiner described the sadistic abuses meted out to patients in the prison’s Transitional Care Unit, including the “scalding hot water” that had been used to torture Rainey and other mentally ill people. When Thompson first read the letter, she didn’t believe it, she told me, because the allegations were “too heinous.” Then Joiner wrote again, repeating the same charges, at which point she realized he was telling the truth. One section of Joiner’s letter had particularly moved Thompson, a passage in which he compared the impunity granted to the guards who killed Rainey to the life sentence he’d received for his crime (Joiner had been convicted of murder). At the hearing in Tallahassee, Thompson decided to read this section aloud. “I’ve come to the conclusion that one is prosecuted for murder depending on who you are,” Joiner wrote. While some murderers were “committed to DOC for life,” the letter continued,

  others collect a paycheck from same and go home daily, free to continue the behavior at another time. One day, I wonder if the people of this state and the nation will look back at this time … and say, How could this go on? Law enforcement knew this, representatives in state government were aware of it, yet it just continued on.

  After Thompson finished reading, some corrections officers also testified about the untenable conditions in Florida’s prisons—the overcrowding, the understaffing, the low morale. Their words made an impression on some of the lawmakers on hand, among them Senator Evers, who spent the rest of the spring promoting a sweeping prison reform bill. The bill included provisions to bolster staffing at prisons and to increase penalties for officers who engaged in abuse. It also called for establishing an independent oversight commission that would monitor DOC facilities by conducting surprise inspections and identifying problems before they metastasized.

  In other Western countries, monitoring prisons in this way was not unusual. In the United Kingdom, for example, there were three separate layers of oversight: the Inspectorate of Prisons, which carried out unannounced inspections of all detention facilities; the Prisons and Probation Ombudsman, which investigated complaints; and boards of local citizens that conducted additional reviews. The goal was “not to play gotcha,” said Michele Deitch, an expert on prison management who teaches at the University of Texas at Austin, but to detect problems early. “It’s preventive.” Creating strong oversight mechanisms also reflected a belief that the public would be better served if, like other large institutions (banks, nuclear facilities), prisons were subject to independent scrutiny. In the United States, a different view prevailed. Prisons were “the ultimate enclosed institutions, completely lacking in transparency—to the public, to the press, to everyone,” said Deitch. Instead of preventive mechanisms, the model for remedying problems in the United States, historically, was through court-ordered consent decrees, settlements that resulted from class-action lawsuits filed against states whose jails or prisons were plagued with systemic deficiencies. One shortcoming of this approach was that it invariably came after the fact, “once things have already hit rock bottom,” noted Deitch. Another was that the improvements tended to be short-lived. Once officials complied with the court order, attention shifted elsewhere. Then the problems resurfaced, especially in states where prisons were left to monitor themselves.

  At the panel hearing chaired by Senator Evers, several officers spoke about why the inspector general’s office—which was part of the Florida Department of Corrections—could not be entrusted with oversight. “We’re no longer to the point where we can police ourselves adequately,” said an officer whose investigations of abuse had been sabotaged. After leaving Tallahassee, Judy Thompson felt optimistic that the question Mark Joiner posed in his letter—how could a civilized country allow such things to go on?—would be answered by affirming that they must not go on. Then Thompson watched the Florida House of Representatives present its own reform bill—a bill that stripped out all of the meaningful provisions in Senator Evers’s version, including the proposal to create an independent oversight commission, on the grounds that this would give the DOC “a bad tag.” In the end, nothing passed, save for a few toothless measures that Governor Scott approved at the last minute through an executive order.

  When we met, I asked Thompson how much she thought Florida’s leaders cared about the abuse of prisoners in light of all this. She pointed to the latest pile of letters she’d gotten. “Not enough,” she said with a sigh, “not enough.” Then she added, “If, in fact, Governor Scott feels he doesn’t have to take action on this, he’s probably right about that, because the average person who’s not impacted by incarceration couldn’t care less.”

  “MANDATE BY DEFAULT”

  One reason the average person ought to care about incarceration is that it is a collective undertaking—financed by taxpayers, presided over by legislators and judges, audited by inspectors who work for the state. However inaccessible and hidden from view they are, jails and prisons are public institutions. Yet in Florida, as in many other parts of the country, it isn’t so simple. Before going into politics, Rick Scott had served as the CEO of Columbia/HCA, a for-profit hospital chain. Along with staff cuts, one of the ways that Scott proposed to lower spending on prisons after he became governor was by contracting out services to the private sector. When Harriet Krzykowski worked at Dade, her employer was not the Florida Department of Corrections. It was Corizon, a company based in Brentwood, Tennessee, and, later, Wexford, which was based in Pittsburgh. For these firms, the sordid business of punishment was just that—a business, and a potentially lucrative one in a state with nearly a hundred thousand people behind bars. In 2012, the same year Darren Rainey was tortured and killed, Wexford and Corizon were awarded five-year contracts worth a combined $1.3 billion to deliver psychiatric and medical care to incarcerated people in Florida.

  As I discovered on my visit to Dade, one consequence of privatization was to push what happened inside prisons further behind the scenes, into the hands of companies that felt no obligation to answer for their conduct. I came to the prison at the invitation of the DOC, which after repeated requests finally agreed to let me tour the facility in the company of Glenn Morris, the new assistant warden. When I asked Morris if I could talk to some of the mental health counselors in the TCU, however, he said this decision
was not up to him. It was up to Wexford, to which the state had transferred responsibility. From Morris’s office, I called a DOC spokesman in Tallahassee who confirmed that I would have to obtain permission from the company. I proceeded to call Wexford, reaching a media relations officer in Pittsburgh who told me that no one on the Wexford staff was available to talk to me. Because I was already at Dade, I would be happy to wait until someone was available, I told the Wexford spokesman. No interview would be granted, he said.

  Wexford declined to answer any questions about the abusive practices that took place at Dade. Corizon was a bit more forthcoming. Dr. Calvin B. Johnson, the company’s chief medical officer, told me that all of the company’s employees went through an orientation that introduced them to a set of “company-wide values” encapsulated by the acronym SMART—Safety, Motivation, Accountability, Respect, and Teamwork. If mental health counselors witnessed unethical conduct, they were given multiple channels to report it, he added, including an anonymous hotline routed to corporate headquarters. This information came as news to Harriet Krzykowski, who told me she had never heard of the motto SMART when she worked at Dade. She was equally unaware of the anonymous hotline. Beyond the warning she received not to antagonize security, she couldn’t recall any directives during or after her orientation about what to do if she witnessed abuse. Her observation was echoed by several of her former peers, including George Mallinckrodt, who said there was “never any guidance, any training, any protocol, zero from Corizon, not only in regard to what abuse was but how to report it.”

  One danger of relying on the private sector to provide mental health services in prisons is that companies may have an incentive to hide problems that might jeopardize their contracts. Another is that the drive to minimize costs could undermine the quality of care. Not long after Florida privatized medical services in its prisons, Pat Beall, a reporter at The Palm Beach Post, published an investigative story that detailed how the experiment was playing out. Seven months into the trial, Beall found, the number of deaths in custody across the state had soared to 206—a ten-year high. Among the deceased was a female prisoner who had been given Tylenol and warm compresses for lung cancer. Other prisoners complained that their prescription painkillers were suddenly replaced with cheaper substitutes, like ibuprofen. Meanwhile, the number of prisoners with serious illnesses who had been sent to outside hospitals had fallen dramatically, by 47 percent, which lowered costs but endangered lives. “We order surgery and they don’t come in,” a doctor told Beall. “They are dying before they get to surgery.”

  What Beall found in Florida echoed what investigations had turned up in other states. In 2012, a court-ordered investigation found “serious problems with the delivery of medical and mental health care” at a prison in Idaho, where patients under Corizon’s care were left in soiled linens, denied access to food and water for days, and given the wrong medications. The report characterized the deficiencies as “frequent, pervasive and longstanding” (Corizon dismissed its findings as “misleading and erroneous”). In Kentucky, the families of several prisoners filed lawsuits after seven people died within a year at a jail where Corizon delivered the care, among them a severe diabetic who developed an infection and was kept at the facility rather than taken to an emergency room.

  But privatization didn’t merely imperil the health of incarcerated people. It could also compromise the well-being of the staff delivering the care, forcing them to make decisions based on cost considerations rather than on medical need. In 2014, at a jail in Chatham County, Georgia, a man named Matthew Loflin pleaded to be sent to a hospital after experiencing shortness of breath and passing out in his cell. Dr. Charles Pugh, an on-site Corizon physician, asked one of the company’s regional medical directors for permission to transfer Loflin. The request was denied. In the days that followed, as Loflin’s condition worsened, Dr. Pugh and two Corizon nurses repeatedly asked for permission to send Loflin to the hospital, to no avail. Eventually, Dr. Pugh arranged to have Loflin see a cardiologist, in the hope that he could send Loflin to the emergency room. By the time this happened, Loflin’s blood pressure had plunged, and he lost consciousness again. Shortly after he was finally admitted to a hospital, he died.

  Dr. Pugh’s experience was described in “Profits vs. Prisoners,” an investigation of Corizon conducted by the Southern Poverty Law Center. The investigation opened with an account of another case, involving a prisoner in Oregon named Kelly Green who broke his neck during a psychotic episode (Green was schizophrenic). Instead of sending Green to the hospital right away, Corizon staffers released him from jail and then drove him to a hospital so that someone else could admit him. This arrangement, known as a “courtesy drop,” spared the company from having to pay for the hospital stay, at the expense of incarcerated people whose care was delayed. Like Matt Loflin, Green ended up dying, a death his family was convinced could have been avoided if he had been taken to the hospital immediately (the family ended up suing Corizon, which denied any wrongdoing).

  The Southern Poverty Law Center report suggested that, thanks to privatization, nurses, doctors, and psychiatrists were routinely thrust into such roles, pressed to do the dirty work of keeping costs down for companies that were paid a flat rate for their services, meaning that “every dime saved on prisoner care is a dime added to the company’s bottom line.” In a declaration submitted in court on behalf of the family of Kelly Green, Dr. Pugh described the pressure this generated as unrelenting. “Once or twice a week, there were telephone conferences I was expected to attend with the Corizon regional medical director regarding who was in the hospital and what was going on with patients in the hospital,” he wrote. “There was a constant demand to monitor all hospitalizations, to avoid hospitalizations, to request prompt hospital discharges and minimize hospital stays.” Some staff members presumably lost little sleep about succumbing to these demands, either because they had become desensitized to the needs of the incarcerated people in their care or because they wanted to avoid antagonizing their superiors. The latter concern was a valid one. After the death of Matt Loflin in Georgia, Dr. Pugh and the two nurses who had requested that he be transferred to a hospital shared their concerns about patient safety with a sheriff. According to the Southern Poverty Law Center investigation, all three were subsequently fired.

  * * *

  “A special burden of accountability accompanies grants of public authority,” observes John Donahue in his authoritative study, The Privatization Decision, which examines the circumstances under which contracting out public services to for-profit companies is warranted. While privatization can make government more efficient, this is not the only criterion by which it should be judged. Equally important is “fidelity to the public’s values,” Donahue maintains, including how well privatization “deters opportunism and irresponsibility and promotes faithful stewardship.”

  Judged by this standard, contracting out medical services in Florida’s prisons was a flagrant betrayal of the public’s trust. Yet a case could be made that it was nothing of the sort—that, to the contrary, Wexford and Corizon delivered exactly what the public expected and perhaps secretly desired. Treating prisoners humanely was not what impelled officials in Florida and other states to embrace privatization after all. Saving money was. “It’s a decision that’s best for the taxpayers,” a DOC official stated at the time. The contract Florida awarded to Wexford and Corizon obligated the companies to spend 7 percent less than the state had. How could this obligation be met without endangering lives? Few people bothered to ask. To deter profiteering, John Donahue argues that private companies entrusted to perform public functions should be subject to vigorous oversight, particularly for tasks whose outcomes are hard to measure. Florida adopted a laxer approach. One year before privatizing prison care, it gutted the Correctional Medical Authority, an independent agency created in 1986 to monitor the quality of medical care that prisoners received.

  To be sure, the Wexford and Corizon contract
did not explicitly state that profiteering at the expense of vulnerable patients would be tolerated. But as Everett Hughes noted in his essay on dirty work, when it came to the treatment of certain “out-groups,” spelling such things out wasn’t necessary, particularly when distance and social isolation could achieve the same result. “The greater their social distance from us,” Hughes observed of these out-groups, “the more we leave in the hands of others a sort of mandate by default to deal with them on our behalf.” The mandate by default given to Wexford and Corizon was to provide grossly substandard care at minimum cost. For the companies’ CEOs and shareholders, this arrangement had its advantages, boosting earnings and revenue. For the on-site staff left to do the dirty work of arranging “courtesy drops” for people like Kelly Green, it was another matter.

  As it happens, neither Wexford nor Corizon ended up doing this work in Florida for long. Pat Beall’s exposé in The Palm Beach Post finally prompted some lawmakers to call for greater oversight. In 2015, after state inspectors issued a scathing report about the quality of care delivered by Corizon at a women’s prison in Ocala, where patients were cut off from psychiatric medications and improperly placed in isolation cells, Corizon opted not to renew its contract with the state. Two years later, after investigators found “life threatening” deficiencies at another prison where Wexford was in charge, the DOC announced that it was ending its contract with the firm. The glaring deficiencies had persuaded officials in Florida to adopt a new approach, it appeared. But the new approach turned out to be a familiar one—a no-bid contract that was soon awarded to another private company, Centurion of Florida, that was viewed more charitably in Tallahassee, perhaps because of the charity it disbursed to state lawmakers. Before receiving the contract, Centurion gave $765,000 to the Florida Republican Party and another $160,000 to “Let’s Get to Work,” the political committee of Rick Scott, who, in 2018, ran for Senate and won.