Two ongoing federal lawsuits against for-profit jailhouse medical contractor Armor Correctional Health Services (ACHS) describe lengthy delays and negligent care that put inmate health in jeopardy.

State and local officials across the nation privatized inmate medical services in recent years following skyrocketing medical costs associated with a steady rise in the number of people incarcerated each year. Companies like ACHS sign lucrative agreements that promise to deliver medical care to inmates at a lower cost than governments can provide themselves. Today, the South Florida-based company currently holds several multi-million dollar contracts to provide medical care to over 40,000 inmates and prisoners in Florida, Georgia, Nevada, New York, Oklahoma, South Dakota, Virginia and Wisconsin.

In court filings, however, the company is alleged to have baked financial disincentives into its contracts which encourage staff not to give inmates access to emergent and off-site treatments. One such agreement, prepared for the Milwaukee County Sheriff’s Office, states ACHS takes responsibility for “all Inmate costs associated with hospitalization, off-site and on-site specialty services, inclusive of diagnostic procedures and emergency transportation services incurred subsequent to becoming an inmate.” These procedures are expensive, and governments are attracted to the idea of having the liability fall elsewhere.

The stories told in the following lawsuits, however, bring to light the consequences of such cost-containment policies.

Scott Birdwell

On May 29, 2015, inmate Scott Birdwell filed a federal lawsuit against Tulsa County Sheriff Stanley Ganz, the Tulsa County Board of County Commissioners, and a nurse and physician at the Tulsa County Jail. ACHS is the contracted medical provider at this jail.

Birdwell said he needed medical treatment after an inmate attacked him in the laundry room in June 2014. He had a gash above the eyebrow that required stitches, as well as other injuries to his face. Despite repeated requests, Birdwell was not taken to the hospital.

Instead, an ACHS physician took ninety minutes to give Birdwell twenty three stitches, in part because he used the wrong anesthetic for the procedure. While he sat there, the doctor joked that, “[a]n experienced E.R. doctor would have had these stitches in about twenty minutes” and that he “should have studied plastic surgery more.” Birdwell’s other injuries were ignored.

Birdwell was taken back to his cell and instructed to return to the medical unit in five days to have the stitches removed. But ten days went by before Birdwell was finally presented to the medical unit, where he again told the doctor his injuries went beyond the gash on his face. He reported pain in his head and loss of vision.

Medical staff disregarded these complaints and an ACHS nurse, who stated she had never removed stitches before, proceeded to remove Birdwell’s without the doctor’s supervision. The nurse “ripped the sutures back open, resulting in the laceration splitting open.” ACHS staff had allowed enough time to pass that his skin had grown over them.

“There is a longstanding policy, practice or custom at the Jail of [the Tulsa County Sheriff’s Office] refusing to send inmates with emergent needs to the hospital for purely financial purposes,” the lawsuit states. “This practice has been continued under ARMOR as part of the structure of its business model.”

Christopher Datta

In March 2015, 23-year-old Christopher Datta sued ACHS, Dr. Frantz Simeon, Nurses Sonja Carstens, Lisa Burk, James Atkinson and Lara Ennis. Burk, Atkinson and Ennis were employed by ACHS.

Datta had first been arrested for possession of marijuana and Xanax in September 2013. During his intake medical exam, an ACHS nurse was informed of the serious back condition from which he suffered: spinal stenosis and a bulging disc. The jail had his prior medical records and documented his back problems in his their own records.

He was sentenced and placed on probation, only to be re-arrested the following year for a probation violation. Back at the jail, he repeated his medical intake exams with the same nurses and they again noted his condition. The nurse then asked Datta if he had health insurance, and he said he did not. He was placed in general population because he was able to walk and was “in relatively good physical condition” at the time, considering his history of back problems.

Just a few days after being placed in general population, Datta’s back began to bother him and the pain was getting worse. By 7:00 PM on April 17th, 2014 — six days after he had been brought to the jail — Datta said “when he would lie down, sharp pain would shoot down from his lower back into his right buttock and right leg.”

He asked a guard to take him to the medical unit, but the guard responded that since he was not having a seizure or a heart attack, “he could wait.”

He sat in pain for two hours until officers decided to take him to the medical unit, where he sat in a wheelchair for two more hours until the nurse on duty that night began examining him. His lower back was causing him severe pain, and “he could not feel his right leg except for a burning sensation, and his right foot was cold and turning blue.”

The ACHS nurse told him she believed he had a pinched nerve and applied Bengay and hot towels to his lower back. The nurse also gave him generic aspirin. He asked to go to the hospital but was rejected and returned to general population.

Datta suffered through the night and into the next morning, when he slipped in the shower as other inmates were helping him in the bathroom. He was even worse the next day, when nurses noted he was “anxious and shaking and had elevated blood pressure, among other things.”

The nurse called Dr. Simeon who ordered blood pressure medications and stated that he could be kept under observation in the medical unit.

The following morning, Datta screamed for help for hours before a nurse moved him to a cell with a steel door so “he and other nurses and officers did not have to listen to [him].”

He banged on the walls and doors until he passed out from the pain.

Datta later told a nurse he “could not feel anything below his waist or move his legs appropriately.”

The nurse tested and confirmed this by rubbing a sharp object against his feet, which he said he could not feel. Nurses contacted Dr. Simeon again, who ordered Datta’s Aleve be swapped out for Motrin.

In another incident, Datta was left laying naked on the floor, screaming in pain in a pool of his urine and feces after nurses refused to help him get from his wheelchair to the toilet. He was given a wet towel to clean himself with and was taunted and harassed while being ordered to get back into his wheelchair. Nurses refused his request for a shower that night, saying he had to wait until the next day. Datta slept mostly sitting in his wheelchair because the pain of laying down was too much for him to bear.

Dr. Simeon saw Datta in person for the first time the following day. He took X-rays, reviewed his medical records and provided medication for nerve pain as well as a knee brace and crutches. He allowed Datta a second mattress, but refused his requests to be taken to the hospital. He was placed back in a cell in the infirmary.

On April 23, Datta was released and ordered placed under house arrest. The Judge gave him permission to go to Sarasota Memorial Hospital first, where his back condition was to be examined by doctors. Within minutes, he was ordered to have an MRI, which revealed a large disk herniation and cauda equina syndrome. He would need emergency surgery and would spend over a month in the hospital to recover and rehabilitate.

The lawsuit states that Datta now has “permanent and profound neurological deficits, as a result of the several day delay in receiving appropriate medical care for his condition while an inmate at the jail.”

It claims these are the consequences of ACHS’s “widespread policy” encouraging staff not to send inmates off-site for emergency care or specialized treatment.