An ongoing federal civil rights lawsuit alleges in less than one month at Indiana’s Dearborn County Detention Center, jail staff neglected the obvious and critical medical needs of a 69-year-old inmate, allowing his conditions to deteriorate so severely he would later spend nearly 200 days recovering in hospitals and nursing homes.

Advanced Correctional Healthcare and one of their doctors, Dr. Nadir Al-Shami, were responsible for the medical care of inmate Timothy Strayer. They are no longer named in the ongoing lawsuit he filed two years ago, but the company’s policies and the conduct of their staff lay at the heart of this story.  As a result, the Strayers now potentially face hundreds of thousands of dollars in medical bills.

But Strayer is not the only inmate to have suffered under the Advanced Correctional Healthcare regime. A three-month Shadowproof investigation uncovered multiple allegations of misconduct at various jails served by the company and, specifically, Dr. Al-Shami.

Dr. Al-Shami has been sued in multiple states because ACH physicians are what is known as “circuit riders.” They serve as the site physicians for more than one jail at a time, managing the healthcare of hundreds of inmates. These doctors are also on-call to fill in for one another in the event they can’t make their shifts.

Although ACH contracts stipulate their site physicians are supposed to visit their jails once a week, the majority of their day-to-day care is provided over the telephone because the doctors usually live far from the facilities to which they are assigned. Under this arrangement, inmate complaints are often first evaluated by the jail’s staff. If a nurse or medical assistant can’t manage the complaint on their own, they call the site physician.

Analysis of statements by ACH officials indicate the company believes the key to efficiency in so-called “correctional health care” is discerning when and when not to treat an inmate’s medical issue. This includes decisions to discontinue or alter prescription medications ACH deems, in their own words, “inappropriate” for use on the inside.

ACH’s contracts are especially attractive because they provide medical services at a substantially reduced cost compared to what local governments would pay to provide care on their own. Because ACH’s clients are most often cash-strapped local sheriff’s offices looking to control their booming spending on inmate health care, it’s imperative companies like ACH deliver their services at a discount.

But there is a high cost associated with the seductive savings of privatized inmate healthcare. Some evidence of this has been reported by local news outlets over the years, but for the most part they have gone largely unnoticed. For instance, in 2014, the company was accused of “[withholding] the most basic medical care in order to save money, banking on the insurance of the medical contractor to cover any resulting lawsuits.” This included the case of a 19-year-old inmate who died of gangrene, naked on the floor of his cell, while in jail for stealing Star Wars DVDs and attempting to pass a fake $100 bill.

Earlier this year, I covered the story of another inmate named Brandon Clint Hacker, whose mother sued Advanced Correctional Healthcare and Doctor Nadir Al-Shami after her son died from heroin withdrawal at the Madison County Detention Center in Kentucky.

Dr. Al-Shami’s actions as told through multiple federal complaints further illustrates how the cost-saving policies of private inmate healthcare companies can have devastating effects.

Kenneth Collins

In November 2013, Kenneth Collins initiated a federal civil rights lawsuit against the city of Seymour, Indiana, several local police and jail officers, Dr. Nadir Al-Shami and Advanced Correctional Healthcare over “inadequate medical care” following his arrest and incarceration the year before.

According to the complaint, Collins had been arrested on August 12, 2012, for driving under the influence with a Blood Alcohol Concentration (BAC) of 0.28. Collins anticipated he would undergo alcohol withdrawal and requested to be taken to the hospital. Despite Jackson County Jail’s policy of not booking inmates with a BAC over 0.25, Collins claims Officer Cornwell held him in the station and falsely stated he had taken the inmate to the emergency room, where doctors had cleared him to go to jail.

Withdrawing from alcohol, Collins experienced severe delirium tremens, which is usually considered a medical emergency and has a high mortality rate. But two days after his arrest, on August 14, Collins was still in his cell, not in a hospital. A guard reported “Collins was talking to someone but was housed by himself.” When the two spoke, the officer noted Collins “knew where he was but was indifferent about who I was and his surroundings.”

Collins met with licensed practical nurse (LPN) Amber Easterday on August 15. She noted her patient appeared to be “paranoid and delusional” and described an encounter in which Collins told her, “I can’t get away from the door, because they’ll bust it down. I know they are there.” She had also reported Collins had told other jail staff he was on an elevator but had “called the wrong number.”

Dr. Al-Shami was unavailable when Easterday called that day, so she spoke with the next ACH doctor on-call, referred to only as “Dr. Butler,” who advised her to administer a one-time dose of Haldol and take Collins to the hospital if his condition did not improve in two hours. Dr. Al-Shami called back and Easterday said his condition was not improving. She was unable to take his vital signs. He was taken to the hospital for “acute dillusions [sic] (alcohol withdrawal).” The hospital allegedly did not want Collins discharged, but the jail insisted he be returned.

A jail log entry filed at 5:35 AM on August 16, 2012, stated, “Collins has been getting worse all night long.” Collins’ was not sleeping and had been found standing on top of his bunk.

A log dated August 17 stated an officer had been unable to take Collins’ vital signs for ten days “due to his physical state.” He was placed on a daily regimen of Librium, a sedative. Another log from that day prescribed treatments for a wound he had sustained on his shin and noted the Wound Care unit was “unable to see inmate Collins until his mental status and detoxing improves.”

On August 19, an officer reported Collins, “believed he was in the room of a house and [couldn’t] fix it.” Another officer witnessed Collins prodding at his leg wound using a broken piece of his eye glasses. The glasses were taken from him and his leg was cleaned and bandaged.

Just over one week after Collins had been incarcerated, logs from August 20 claimed Collins was “still talking like he is somewhere else” and told staff he believed “two kids [were] going around stealing stuff.”

By August 22, jail records indicate Collins was being taken to the shower in a wheelchair. Observation logs from that day indicate that, between 6:00 AM and 7:15 AM, he was “laying on floor naked.” He was given dextrose tablets because he had not been eating his food.

The next day, at around 10:00 AM, Nurse Easterday filed a report stating Collins was “unable to converse or maintain eye contact.” She wrote:

[Collins] is not able to stand or sit up without assistance. Appears to have urinated on himself. Skin is damp and yellow tinged. Was able to get him to take his medication with assistance, as well as eat 3 bites of a peanut butter sandwich. […] I called Dr. Alshami [sic] concerning his altered mental status and overall condition. Dr. Alshami [sic] advised to take him to the ER for labwork, fluids and further evaluation for possible liver failure. Inmate was taken to ER via ambulance, and officer T. Baxter followed. Nothing further at this time.

By now, Collins was suffering from broken ribs and seizures, as well as hypothermia, hypertension, acute respiratory failure, dehydration and acute kidney injury. He was released on his own recognizance that day after being taken to the hospital; liability for his medical care was transferred to him from the county.

According to the lawsuit, Collins was “sedated, put on a ventilator, and given treatment to raise his body temperature. He was kept in the ICU until September 4, did not regain consciousness until September 8, and was discharged from the hospital on September 12th.”

The lawsuit maintains Dr. Al-Shami allowed Collins’ condition to deteriorate so much so that he suffered “unnecessary injuries that he would not have otherwise experienced.” It alleges the inadequate medical care Dr. Al-Shami provided to Collins “was objectively unreasonable and constituted deliberate indifference to his serious medical conditions.”

In an affidavit, Dr. Al-Shami contended there was nothing inadequate about his care, and that he was never contacted about Collins during the five day period from August 18-22, in which Collins’ condition dramatically deteriorated.

Dan Brewington

Dan Brewington is an Ohio blogger, who was jailed in 2011 for intimidating a judge after he spent two years criticizing the handling of his divorce and custody proceedings on his website. After a controversial trial, he was sentenced to two and a half years in jail and subsequently became a patient of Dr. Nadir Al-Shami.

Brewington was at Dearborn County Jail at the same time as Timothy Strayer. He remembers telling another inmate Strayer looked like he was dying. “You knew it wasn’t right,” he told me in an interview this past spring. “You could just get that vibe in the jail, that people were concerned about him. There’s no way [jail and medical staff] could say they didn’t know.”

Brewington was personally familiar with the quality of healthcare being provided by Advanced Correctional Healthcare’s Dr. Al-Shami. In a blog post from September 2011, Brewington claimed his prescription regimen was changed substantially upon his arrival in jail. He said Dr. Al-Shami altered his prescription for Ritalin without consulting with his prescribing physicians, writing, “[Dr. Al-Shami] had to consult with a prescription reference book to determine what average Ritalin dosages [sic] actually were before he altered the dose of my prescribing physician, who specializes in treating adults diagnosed with ADHD.”

Brewington also said Dr. Al-Shami changed the scheduling of his doses, prescribing one of his twice-daily doses of Ritalin at night despite the fact that insomnia is a common side effect of the drug. He said he suffered from withdrawal after his medication was abruptly reduced upon his incarceration.

Danny Ray Burden

Danny Ray Burden was the brother of Mark Burden, Detective Sergeant for the Kentucky State Police. He was sentenced to jail on March 27, 2013. When he arrived at the Grant County Detention Center, he told the intake nurse he was “medically diagnosed as an insulin dependent diabetic and also suffered from Chronic Obstructive Pulminary Disease (COPD) and anxiety/panic attacks.” Burden received treatment for all three of those conditions prior to his incarceration.

According to the Virginia Mason Medical Center, normal blood sugar levels range between 70-140mg/dL. Before he was booked at the jail, the lawsuit states Nurse Kiefner took Burden’s blood sugar level. It was 336mg/dL. A glucose level as high as Burden’s should have provoked an immediate emergency medical intervention.

Kiefner called Dr. Al-Shami, who upon learning of his blood glucose level directed Kiefner to administer an insulin injection. However, she failed to administer the injection.

At 12:41 PM, Burden was seated for booking and given food. The deputy began asking him questions, but Burden was “increasingly lethargic to the point of nodding off and becoming incoherent and inconsistent with his answers.” About an hour and fifteen minutes later, Burden was struggling to stay alert and requested insulin, but that request was not met.

Burden began “coughing profusely.” The deputy stopped the booking process and asked him if he needed emergency medical attention. Burden said he did and also told the deputy he suffered from panic attacks and claustrophobia. The nurse advised ACH staff of the request for medical attention, but staff “failed and refused” to comply.

The nurse came to the booking area to take his vital signs, all of which should have indicated he was experiencing a medical emergency. Instead of sending him to the hospital, she allowed the booking process to continue.

Fifteen minutes later, his booking was suspended because Burden “was unable to stay awake and coherent in order to complete the process.” The complaint alleges Chief Warrant Officer McCarthy decided Burden should, at that point, be put in a detox cell.

McCarthy directed another officer to assign inmate trustees to watch over Burden. Around 3:00pm, the trustees found him unconscious on the floor. They tried to wake him but could not. The deputy arrived on the scene and made an unsuccessful attempt to wake Burden. Another deputy came and attempted to wake Burden by “knocking on his cell door, calling [his] name and, once inside the cell, banging on the sink with his keys.” Those attempts failed as well.

The officers requested medical assistance and a nurse came on the scene with smelling salts, which did not revive him. Another nurse came but could not wake Burden. It was not until about twenty minutes after inmate trustees initially found Burden that emergency medical services were contacted. When EMS arrived, they tried to resuscitate Burden but could not. He was admitted to the hospital for “altered mental status and cardiac arrest.”

Burden’s mother contacted the jail and was told her son had been taken to the hospital. Officials allegedly told her she had to come to the jail before the hospital “to sign a release bond,” despite the fact that this is not actually required by law. They did not inform her that her son was dying.

Burden’s mother did as she was told and went to the jail first. The lawsuit states “by taking the time to divert her travels to the [jail] to sign the ‘bond,’ she never saw her son conscious or alive again.” He was pronounced dead on April 4.