A new lawsuit filed in the Buchanan County Circuit Court in Missouri [PDF] alleges for-profit inmate medical contractor Advanced Correctional Healthcare (ACH) and jail officials violated state laws and the Constitution in their substandard delivery of healthcare to an inmate suffering from serious conditions related to a traumatic brain injury. The inmate alleges his critical prescriptions were withheld and altered, and an injury to his head was left untreated for days until he developed paralysis on the right side of his body.

The lawsuit also claims jail healthcare contracts, like the one between ACH and Buchanan County, institutionalize medical neglect in order to contain costs.

ACH is an Illinois-based company that makes millions of dollars each year through jail contracts it holds with county governments across the midwest. ACH doctors and medical staff have been named in numerous lawsuits involving inmate deaths, illnesses and injuries.

What sets this lawsuit apart is that two of the ACH staff that worked at the Buchanan County Jail and were named in the lawsuit also occupy high-level positions within the company. Dr. Gregory Rakestraw is an ACH executive, serving as the company’s Corporate Medical Director. Zachary Grimes is a Registered Nurse and ACH’s Director of Medical Operations, Northern Division. Rakestraw was a site physician for Buchanan County and Grimes was its medical director.

Despite the fact that ACH leaders were directly involved in the delivery of healthcare to inmates, the conduct described in the lawsuit closely aligns with descriptions from ACH patients in other jails.

Tyler Fee

On July 5, 2015, 25-year-old Tyler Fee of St. Joseph, Missouri, was arrested for third degree assault and brought to the Buchanan County Jail. Fee suffered from a variety of serious medical conditions, including seizures, depression, muscle spasms, and severe panic attacks associated with a traumatic brain injury he sustained two years before his arrest. All of his conditions, however, were under the control and supervision of his physician.

According to the lawsuit, officials at the Buchanan County Jail noted Fee had a “major mental illness” during his intake medical exam, and were given access to a record of his treatments and prescriptions prior to his incarceration. Fee’s father also called the jail to inform staff of his son’s medical needs, advising ACH’s Licensed Practical Nurse Christy Barron that “if [he] suffered a blow to the head, he needed to be thoroughly examined.” That same day, Fee’s father delivered his son’s medications directly to the jail.

Nonetheless, all of Tyler’s medications were withheld for fifteen hours before Nurse Barron called Dr. Rakestraw. Without examining Fee or inquiring as to his medical history, Dr. Rakestraw refused to continue three of his medications and declined to provide adequate substitutes for the conditions they had been treating.

The next day, the jail called Fee’s father and told him Tyler would not have access to his usual regimen of drugs. The jail official on the phone allegedly grew angry with him when he tried to explain how serious his son’s medical conditions were, and how badly he needed his treatments continued.

Two days later, Fee was taken to the medical unit after a “possible seizure.” Nurse Barron did not contact a doctor, instead placing Fee in a ‘medical observation’ solitary confinement unit. Within thirty minutes, Fee suffered another seizure or a panic attack, falling and hitting his head in the process. He was then placed on suicide watch.

When ACH Licensed Practical Nurse Ann Slagle came to visit him four hours later, she noted Fee was crying on the floor and asking for a blanket. Nurse Barron, Nurse Slagle and others working at the jail allegedly did not contact a doctor about Fee’s condition.

Fee was then placed on different medications than the ones he had been previously taking by the jail’s other ACH site physician, Dr. Jay Riseman, who declined to examine him in-person or have him sent to see medical professionals off jail grounds.

Systemic breaches

“ACH’s business model, reflected in the agreement, succeeds by under-bidding the competition and implementing severe cost control measures,” the lawsuit states. “The result of which is unnecessary inmate suffering and liability claims (dealt with through liability insurance).”

“The agreement,” writes Fee’s attorneys, “requires ACH to provide substantial insurance coverage, to name the county and the sheriff as additional insureds, and to indemnify the sheriff, the county, and their agents and employees in connection with any claim related to health care services.”

ACH and jail staff in Buchanan County have allegedly established “a custom or policy of delaying or denying necessary medical treatment to avoid liability for inmate medical bills,” particularly by denying access to medication and outside medical providers, as well as by understaffing the jail and hiring “sub-standard medical personnel willing to put costs over inmate health and safety.”

Jail officials “assist ACH in controlling costs” by releasing inmates who need outside medical treatment and by letting ACH decide when an inmate can go to the emergency room or seek treatment elsewhere.

This system, which has no real oversight measures, effectively gives ACH a carte blanche to abuse inmates. The county “provides no mechanism for reporting and accountability regarding the quality of inmate health care,” and have “trained correction personnel to defer to ACH regarding medical matters.”

Obviously injured

On July 9, Fee was observed bleeding from his nose in his isolation cell. His condition had visibly deteriorated. The lawsuit states that it should have been obvious to anyone, including a layperson, that Fee was in dire need of medical attention.

Fee told Nurse Slagle that his head was hurting, and she responded that he had a “goose egg” on top of his skull. She directed him not to press down on it.

Although he had been suffering from his head injury for over twenty eight hours and had a history of traumatic brain injury, virtually no action was taken to treat or examine him by ACH officials. Nurse Slagle contacted Dr. Riseman after their encounter, but the doctor allegedly gave no new orders for the patient.

Fee was observed sleeping for much of the next two days. On July 11, he was again seen by Dr. Riseman, who did not examine his head but noted his excessive sleeping and “poor comprehension and vocabulary.”

The inmate was returned to general population and called his father, telling him about his head injury and pain. His father called the jail and demanded medical attention for his son. Nonetheless, three full days would pass before Fee was seen by medical staff. His condition would deteriorate even further during that time.

Not only did Fee’s right arm become partially paralyzed, but his right hand had balled into a fist. He was dragging his right foot on the ground, struggling to walk. Guards ridiculed him, one of whom called him a pussy. Other inmates, including Fee’s cell mate, tried unsuccessfully to convince staff to treat him.

A car to the emergency room

By July 14, just two weeks after he entered the Buchanan County Jail, Fee’s father noticed his son’s voice sounded strange on the phone. His father again contacted the jail to complain about his son’s health. Jail officials decided to bring Fee back to the medical unit, but he was unable to walk and required the assistance of another inmate to get there.

Medical staff then decided to transfer Fee to the emergency room at Mosaic Life Care, but opted to take him there in a car instead of by ambulance. At the hospital, Fee underwent a CT scan that found “a large depressed skull fracture and intracranial hemorrhage and a cerebral contusion on the left side.”

Late that evening, doctors at Mosaic called Fee’s father to inform him his son had a skull fracture and would require surgery the following day. Bone fragments would need to be removed from his skull and a metal plate was to be installed.

But before the surgery, the lawsuit alleges that officials from Buchanan County released Fee on bond in order to avoid paying for his medical expenses, which were now the inmates’ responsibility. After over a week recuperating in the hospital, Fee was prescribed extensive therapy, which is ongoing today.

A pattern Of misconduct?

The lawsuit states that Fee’s case cannot be taken as an isolated incident, alleging the defendants knew these practices were harmful to inmates’ health because of “inmate complaints, communications from correction officers, from their own observations, from common sense, [and] from other lawsuits.”

Indeed, like other private inmate medical contractors making millions (if not billions) off of such business plans, ACH has faced, and continues to face, a significant number of lawsuits — all of which contain allegations very similar to those made by Fee:

Timothy Strayer, like Fee, was released on his own recognizance before undergoing surgery and stuck with his medical bills.

Dan Brewington had his medications changed, and ACH officials essentially watched Kenneth Collins descend into the deadly depths of delirium tremens. Danny Ray Burden — a diabetic — couldn’t keep his eyes open when he was being booked but was placed in a detox cell and left alone until he died.

William Weintraub‘s conditions were similarly ignored, and he died of a perforated ulcer.