Rex Bess Jr. wasn't your average Lee County Jail inmate.
He had leukemia, needed chemotherapy and a bone marrow transplant.
But Bess' mother, Linda Bess, says Prison Health Services, the private, for-profit company that provides health care at the Lee County Jail, wouldn't let her son have either one. Bess, 29, was acquitted of burglary and assault charges Aug. 14 and was freed. Four days later, he died.
The sheriff's office doesn't keep statistics on the number of inmates who die in jail or shortly after getting out. But Bess' death is not the only inmate death in recent years that left relatives wondering why:
The family of Glenn P. Walker of Estero was outraged when an autopsy report released Dec. 12 confirmed he died Sept. 5 in jail from a heart attack triggered by heroin withdrawal. Records show Walker, 47, told the jails medical staff when he was processed that he was an addict with a history of heart problems. He died two days after being confined, and his relatives say they'll never understand why his pleas for help reportedly were ignored.
The family of 59-year-old Roy Van Green of North Fort Myers has been seeking answers for more than two years about why he died on Oct. 18, 2000, after having a heart attack in the jail caused by blood clots related to his 'immobility'.
On Dec. 10, 2000, Robert W. Grimenstein, 33, of Punta Gorda died three hours after being released from the jail.
Grimenstein, who was infected with HIV, developed pneumonia after being incarcerated about a month for allegedly scamming a cab driver out of $60.
Lawrence Pomeroy, Prison Health Services' senior vice president for marketing, said the company has a policy against discussing 'inmate-specific cases.'
Sheriff Rod Shoap and his officers say they can't discuss specific cases because of confidentiality laws. But they express confidence in Prison Health Services.
'"They're accredited, and their contract is reviewed by an independent consultant on a monthly basis," said Maj. David Bonsall, chief of the sheriff's operations division. "These things on occasion do occur. That doesn't prove anybody did anything wrong."
Such assurances don't do much for Linda Bess, 47, of east Fort Myers, who believes her son was denied medical care for so long he had no chance to survive.
Attorney John Mills of Fort Myers represented Bess at his trial. "He was obviously sick," Mills said. "He had lost his hair. He was pale, thin. During breaks in the trial, he had to lie down on the floor in the holding cell."
"After Bess was released, We went to the doctor the next day," Linda Bess said. "The doctor said the jail should have put him in the hospital a month before that for another chemotherapy. He had knots under his arms the size of golf balls."
According to Pomeroy, Prison Health Services hasn't had a patient in Lee County in recent months who was a 'clinically appropriate candidate' for a bone marrow transplant." Linda Bess said that's probably because Rex Bess didn't get his chemotherapy.
Bess had a criminal record that could have cost him life in prison if he'd been convicted. Linda Bess doesn't believe that justifies what she says was the poor medical treatment he received.
"Just because he was locked up, does not mean that his life has to be taken like this," she said. "You never know what tomorrow holds for you in life."
After Grimenstein's death, representatives of the sheriff's office met with local AIDS patient advocates and health care providers and the sheriff's office promised to monitor health care in the jail more closely.
Company's motives questioned
But complaints voiced by inmates persist, as do the lawsuits filed by the lawyers who represent them.
Dr. Bob Schwartz, medical director at the AIDS Resource Council of Southwest Florida, has had concerns about medical care in the jail for years.
Schwartz believes one of the problems with for-profit companies providing medical care in jails and prisons is they tend to have a 'neutral' attitude toward patients.
"They're neutral to outcomes," Schwartz said. "There needs to be more of a commitment to individual patients and more of a sense that the outcome is of utmost importance."
Attorney J. Michael Hussey of North Fort Myers is more blunt. He believes Prison Health Services is motivated primarily by money and cuts costs wherever possible to increase profits. "We don't think there is health care," Hussey said. "We think there is an appearance of health care. What's disguised poorly as health care, we don't think is health care. ... They've got to make money. They're in it for the profit."
The jail's 1,200-plus prisoners include many federal inmates housed under a contract with the U.S. government.
Assistant U.S. Public Defender Martin DerOvanesian said there have been concerns raised at his office about jail health care, too.
"In the past, we have had situations where we have filed motions to have clients moved to federal prison medical facilities so we could be sure they got adequate medical care," DerOvanesian said.
Jean Byassee, Prison Health Services' chief legal officer, said the company's critics should "come in and deliver medical care in a correctional facility for a couple days."
"We try to do the best job we can," Byassee said. "We are really dedicated to our patients. It's a really challenging area. We are really proud of our employees."
Byassee said the company is subject to human error just like any other health care provider. And when errors occur, "We are very sorry for the families. But we feel like we do a good job."
Based in Brentwood, Tenn., Prison Health Services was a small company when it was founded in 1978.
It's grown into the nation's largest medical care provider for people behind bars with 6,900-plus employees and more than 400 contracts in 39 states and the District of Columbia.
The company took over care at the Lee County Jail and stockade in January 1999 after buying out EMSA Correctional Care, which had provided the jail's health care since 1995.
Richard D. Wright, Prison Health Services' vice chairman of operations, said the company was able to obtain "first-time accreditation of the Lee County Jail by the National Commission on Correctional Health Care, the nationally recognized standard-setting body for correctional health care."
"We also operate in full compliance with all requirements of the Florida Commission on Accreditation for Corrections and Florida Model Jail Standards," Wright said.
Under a contract with Lee County that runs through September 2005, Prison Health Services will be paid $3.1 million this year to provide a medical director, nurse practitioner, dentist, psychiatrist and about 40 other nurses and administrative employees for the jail and stockade.
Pomeroy said the reason Prison Health Services has grown so large "helping its parent company, American Service Group, haul in $551 million during 2001, is because it can cut health care costs at a jail or prison while improving care to inmates.
He points to the company's work in Indiana, where a study showed it helped the state save $36 million over a four-year period.
"In addition to the savings to taxpayers, at the same time the overall quality and delivery of health care services was significantly improved as evidenced by PHS achieving first-time accreditation of all Indiana Department of Corrections sites by the National Commission on Correctional Health Care," Pomeroy said.
Industry experts say there's another reason local governments across the country have been turning jailhouse medical care over to private companies: It reduces their exposure to malpractice lawsuits filed by inmates who claim they received poor treatment.
Pomeroy says Prison Health Services has hundreds of satisfied customers.
But the company appears to spend nearly as much time fighting controversy and lawsuits as disease.
In June, for example, Prison Health Services was the target of protest marches in Philadelphia staged by people upset over inmate deaths in that city's jails. And in April, a report issued by the comptroller of New York City heavily criticized the company and questioned whether Prison Health Services should be allowed to do business in New York state.
During testimony before a New York City Council subcommittee on April 29, Deputy Comptroller Greg Brooks said Prison Health Services has been "the subject of widespread criticism throughout the country."
"We're not experiencing the problems that they're having in other jurisdictions," Bonsall said. "I can't respond to what's going on in other jurisdictions. You can't paint everybody with the same brush."
Prison Health Services faces a steady stream of lawsuits filed by inmates, former inmates and inmates' survivors.
The company inherited one of the lawsuits it now faces in Lee County when it bought out EMSA.
Hussey filed that lawsuit in U.S. District Court in April on behalf of a former inmate who claims botched medical care in jail left him paralyzed from the waist down. Hussey said he gets so many inquiries from people complaining about jail health care he "can't handle it all."
"The stuff I hear and I see tells me that something's wrong," Hussey said.
The News-Press gets its share of complaints, too.
On Sept. 2, for instance, inmate Eduardo Vasquez wrote to the paper saying he suffers from hepatitis and was prescribed Interferon before he was jailed.
"Presently I am spitting out blood and my condition is getting worse," Vasquez wrote. ".. I've been told that this jail or prison does not supply that medication."
The News-Press began sending written inquiries to the sheriff's office Sept. 13 about medical care in the jail.
The vast majority of the questions posed were never answered, including a question on whether Interferon is dispensed.
Many of the complaints across the nation regarding Prison Health Services relate to medications inmates receive "or don't receive". Inmates often claim they don't get their pain pills, their insulin or their heart medicine.
According to his autopsy, Walker, the inmate who died during heroin withdrawal, had a prescription for blood pressure medicine. The autopsy found none of it in Walker's body.
Michael Maloney, 54, of North Fort Myers, said he's not surprised. Maloney was in the jail during 2000 on a domestic violence charge and says he never got the medication he needed for hepatitis and high blood pressure.
"They told me, "If you die, we'll notify your next of kin," Maloney said.
Maloney also claims the jail's health care providers are often slow in responding to inmates' needs. He tells of a prisoner who was bitten by a poisonous spider and didn't get help for five or six days.
"By the time they got around to treating him, he had a hole in the back of his neck I could have stuck my thumb in," Maloney said. "It was that big and that deep."
Sheriff stuck in the middle
Bonsall says complaints against Prison Health Services are investigated, but never amount to much.
"You'll get the same complaints at any other jail," Bonsall said. "We can't do anything about the fact that people complain. We look into it. But everything we can find is that the service is appropriate."
Shoap said the jail can't allow inmates to bring their own medications into jail or accept medications from family members because "you can't guarantee its pureness."
Prescriptions, Bonsall said, are filled by the jail's contract pharmacy "the same day they are written by the physician."
Defense attorneys who deal with inmates say they hear the same complaints over and over.
"It always takes people a week or two weeks to get their medications," said Mills. "That's a constant, constant complaint."
Schwartz said inmates "including those who need drugs to combat AIDS" often aren't given the medications prescribed for them by their outside physicians.
"If you come in on medicines, you should stay on those medicines," he said.
The same, he said, goes for inmates who were seeing specialists before they were incarcerated: â€œThey should be brought to that individual so their care can be ongoing.â€
Schwartz said he's not sure what the answer is for jail medical care because most of Prison Health Services' competitors have been subjected to similar criticism.
"I don't know what we would get to replace them," Schwartz said. "My concern is this problem isn't easy to solve as long as there isn't a state agency or a governmental agency to treat these people."
Schwartz said Shoap "is not at fault in this."
"His options are limited," Schwartz said. "The sheriff's choices need to be expanded to more committed agencies.
Schwartz said the AIDS Resource Council would be happy to care for jail patients with AIDS. But he believes as long as a for-profit company is responsible for the bulk of the inmates, it's "a system that will not work."
"Whoever provides medical care at the jail has three responsibilities," Schwartz said. "They shouldn't work for the person paying the bills. They have to work for the patient because the patient's interest is paramount. They have an overwhelming responsibility to the families. And they have an overwhelming responsibility to the public health."
Modified: March 30, 2005