A federal lawsuit claims officers and medical staff at the Madison County Jail in Huntsville, Alabama, deliberately ignored the urgent medical needs of Roy Lee Davis. His case follows a familiar pattern of behavior by officials at the Madison County Jail and those working for the private medical contractor Advanced Correctional Healthcare.

In fact, the arguments made by his attorneys [PDF] echo those of many other lawsuits and investigations, which conclude ACH’s contracts are structured to incentivize profits over inmate health, limit liability for medical neglect, and empower the company to deny basic treatments and care for inmates.

He suffered from alcohol withdrawal unassisted for three days before a nurse determined he had delirium tremens, which can be fatal. However, instead of sending him to the hospital and treating his condition as a medical emergency, medical staff opted to keep him in medical isolation, where his condition deteriorated.

Davis was hospitalized for three days after officials eventually decided to release him on recognizance, shifting the financial burden of his medical bills from the county to Davis.

ACH has a habit of relying on unqualified medical personnel and doctors with rap sheets that in some cases span several states. Some of the defendants in Davis’ case have been implicated in other cases of inmate injury and death.

*

Roy Lee Davis entered the Madison County Jail in July, 2014, an alcoholic, but he was never identified by jail medical staff as a person likely to experience withdrawal.

“For unknown reasons,” the lawsuit states medical personnel failed to identify Davis as suffering from withdrawal even though his symptoms escalated in severity each day. When he was finally seen by a nurse, Davis was hallucinating, confused, and had hand tremors. He was diagnosed with severe delirium tremens by a “licensed practical nurse.”

The National Institute of Health notes individuals suffering from delirium tremens may need to be kept sedated in a hospital while they recover. But the “licensed practical nurse,” who has far less training, education and certifications than higher-paid “registered nurses,” determined Davis should be placed in a medical observation cell.

The site physician, Dr. Arthur Williams, was called. Without seeing his patient, Williams ordered Davis be given medication.

Davis’ condition “should have been treated as a medical emergency,” and medical staff knew such a condition is life-threatening. ACH had trained jail staff on the seriousness of delirium tremens and provided videos on the topic.

“Nevertheless,” they argue, it was Madison County’s custom to “attempt to manage severe [delirium tremens] at the jail.”

Numerous jail officers and nurses saw Davis over the next few days as his condition worsened. Davis reportedly fought for days to be removed from medical isolation. Three days after being placed there, he was unable to walk and had become “largely unresponsive.”

The lawsuit states, “Jail management personnel, with the knowledge and approval of [Jail Administrator Steve Morrison], contacted court personnel in order to get [Davis] released from the jail and avoid sending him to the hospital and incurring the costs of the hospitalization.”

Davis was taken to the emergency room at Madison Hospital by his family after his release. He was then transferred to Huntsville Hospital, where he received medical care for three days.

*

Just before 2010, ACH established a contract with Madison County. The company underbid the competition by marketing their services as a way for sheriff’s departments to control one of the biggest and fastest growing expenditures they face: inmate healthcare.

For Madison County, ACH agreed to pay up to a $200,000 per quarter cap on inmate healthcare expenses. The county would pay for anything beyond that cap, and if ACH provided care below the cap, they were allowed to pocket the difference.

ACH agreements give the company total control over medical issues at the jail. Officers are trained to universally defer questions, comments, and complaints about medical care to ACH staff, “regardless of the severity of the inmate’s condition.” It states that “Correctional officers who have contacted emergency personnel directly have been disciplined.”

With that control, ACH has been known to alter inmate prescriptions, delay and deny basic care, and refuse to send inmates for offsite treatment—all of which would go toward the $200,000 per quarter cap and eat into potential profits.

The company delegates important medical duties to staff who lack the requisite training or certifications, such as ‘medical assistants’ and LPNs.

According to the lawsuit, while the company forbids officers from making any interventions in inmate medical care, it still relies on “untrained correctional officers to monitor seriously ill inmates who are placed in medical watch,” who are not versed in “what signs to look for,” or how to “document while monitoring inmates under suicide or medical watch.”

Meanwhile, the county and jail officials are protected from liability should anyone get hurt or die. ACH purchases substantial insurance coverage and its agreements indemnify the sheriff, county, and its agents and employees.

“Under the contract, as long as correctional officers let ACH medical personnel make medical decisions, correctional officers are indemnified by ACH’s insurance carrier.”

Madison County Jail does not evaluate inmate medical care. There are no mechanisms for reporting and accountability, and the jail has made no effort to establish any such mechanisms.

With this lack of transparency and accountability, the lawsuit argues ACH has “destroyed or altered records, including email, electronic medical records, and the electronic jail management system in an effort to cover up the true circumstances of the deaths and minimize any potential liability.”  They say evidence of this was raised during litigation in the cases of Woods, Jefferson, and Listau.

Similar allegations were made against the company in Colorado.

The lawsuit further alleges ACH “intentionally created an electronic medical records system that allows ACH personnel to alter records after a death or other significant adverse event and that does not preserve the audit trail information that would permit the details regarding alterations to be known.”

No investigations were opened by Sheriff Dorning into these deaths. Dorning believes the responsibility for deaths and the initiative to make change lies with ACH. But the lawsuit notes, “Alabama law vests final policymaking authority for inmate medical care in Dorning, as the representative of Madison County.”

“Dorning, in turn, via the agreement with ACH and longstanding practice, has delegated final policymaking authority regarding inmate medical care to ACH, and, therefore, he is liable for ACH decisions.”

*

Williams, Advanced Correctional Healthcare, and the Madison County Jail are no stranger to lawsuits involving inmate healthcare, and more specifically, withdrawal.

In May, Shadowproof reported the story of Whitney Elizabeth Foster, who suffered irreversible brain damage and other severe injuries after Williams permitted her to withdraw from her prescription medicines at the Madison County Jail.

Just a few months after Davis’ encounter with ACH at Madison County Jail, Alabama news outlets reported the stories of Tanyatta Woods, Tanisha Jefferson, and Nikki Listau—three patients of Williams who died at the Madison County Jail.

Woods, 19, died after a wound on her foot was left untreated and became gangrenous. Jefferson, 30, died of bowel obstruction, which Williams treated with laxatives. Listau, 61, died from complications from delirium tremens after enduring multiple seizures during the course of her withdrawal at the jail.

Williams’ lawsuits and other problems would eventually contribute to the collapse of agreements between ACH and Madison County in 2015. But Williams is not the only ACH doctor with a lengthy rap sheet.

Shadowproof has reported multiple lawsuits against ACH doctors, Nadir Al-Shami and Ronald Davis.

Al-Shami was sued in the case of Timothy Strayer, a Dearborn County, Indiana, inmate who nearly died after his perforated ulcer was ignored for days. Al-Shami was sued in the case of Kenneth Collins, who nearly died from delirium tremens at a jail in Seymour, Indiana. He was sued in connection to the death of Danny Ray Burden, a diabetic inmate at the Grant County Detention Center.

Davis lost his license to practice medicine in California in 1994 after undercover officers caught his unlicensed office assistant “examining, diagnosing, prescribing a method of treatment, and treating patients” at his private practice.

He was also sued in Timothy Strayer’s case in Indiana, a state in which the doctor has faced disciplinary action against his license for failing to comply with the terms of the sanctions imposed on him in California. ACH has vouched for Davis repeatedly for over a decade as he fights the probationary status placed on his Indiana license.

The estate of deceased Indiana inmate Tammy Perez sued ACH alleging she was forced to withdraw from heroin in jail and died in her cell after days of severe illness.

In Missouri, ACH Dr. Catherine Van Voorn was sued after denying a pregnant pre-trial detainee basic access to healthcare for multiple days. By the time the inmate got to an emergency room, doctors discovered her unborn child had died days before and its body had begun to decay inside of her.

At the Buchanan County Jail, also in Missouri, officials made the decision to transport 25 year old Tyler Fee to the emergency room in a car and not in an ambulance. ACH doctors had withheld and altered his prescriptions, and an injury to his head was left untreated for days until he developed paralysis on the right side of his body. Fee spent over a week recuperating in the hospital and has been undergoing extensive therapy ever since.

In nearly every case, medical care was delayed or denied until the inmate was critically ill. They were then released on their own recognizance before receiving emergency medical care, shifting legal and financial liability from the county to the inmate.

Such horrendous lapses in medical care can be attributed to the “deliberately-indifferent customs and policies concerning inmate medical care,” which were put in place “to avoid liability for inmate medical bills.”