A settlement that includes the appointment of a monitor by a federal court was reached in a class action lawsuit over the unconstitutional lack of health care in Illinois prisons.

The draft consent decree between the Illinois Department of Corrections (IDOC) and attorneys representing Illinois prisoners marks the culmination of a legal struggle that has unfolded over the past eight years.

“We hope this is the beginning of the end of prisoners’ needless suffering and even death. It is a long road, and we are committed to ensuring the necessary changes are made,” declared Alan Mills, executive director of the Uptown People’s Law Center.

Two reports on Illinois prison healthcare requested by a district court in the Northern District of Illinois were compiled as part of litigation.

The second report released on November 14, 2018, concluded examples of preventable deaths were worse than initially uncovered, and that the state’s medical services vendor, Wexford, failed to hire “properly credentialed and privileged physicians.”

“This appears to be a major factor in preventable morbidity and mortality and significantly increases risk of harm to patients within the IDOC. This results from ineffective governance,” the report stated.

“Wexford and the IDOC fail to monitor physician care in a manner that protects patient safety,” the report added. “There is no meaningful monitoring of nurse quality of care. If care is provided, it is presumed to be adequate when, in fact, it may not be adequate.”

There were 33 death records reviewed, and within those records “73 episodes of grossly and flagrantly unacceptable care” were uncovered. In fact, the inappropriate care was “so egregious” that it would typically lead to a licensing board evaluating a physician for sanctioning of their license.

The draft consent decree filed in federal court on January 3 for court approval attempts to deal with this systemic problem. It would require all physicians have a doctorate in medicine or osteopathic medicine or that they be “certified in internal medicine, family medicine, or emergency medicine.”

A process would unfold where the monitor and IDOC medical director determine whether a physician is providing care in a “safe and clinically appropriate manner.” Further education may be recommended if that could fix the problem. If not, they may be terminated.

The monitor will notify Wexford of any questionable or “potentially problematic” doctors.

IDOC is expected to conduct a recruitment effort for professionally qualified physicians, but if they cannot find such individuals, the monitor will review candidates to determine whether they are acceptable for hiring.

The agreement calls for the creation of two deputy chiefs of health services positions in state government that would provide “additional monitoring and clinical oversight for IDOC health care.”

Clinicians and registered nurses will be required to review all intake data and compile a list of medical issues for prisoners, particularly after they are transferred to a facility.

This is critical. The second report highlighted two cases, where prisoners died because staff did not conduct this basic review.

“In one case, a provider failed to take an adequate history of a patient in the midst of getting valve replacement for a congenital anomaly. The provider made the wrong diagnosis, failed to contact the patient’s civilian doctor, and even failed to read a letter in the IDOC medical record from the patient’s civilian doctor,” according to the report.

The report concluded, “As a result of this failure, the patient’s planned surgery was never done, his condition was unrecognized in IDOC for six months, and the patient died from complications of his heart condition without having obtained surgery.”

“Another patient from [Logan Correctional Center] was at Cook County Jail and was sent to Stroger Hospital for a pancreatic mass,” the report recounted. “A biopsy was non-diagnostic but the mass was strongly suggestive of pancreatic cancer and follow up was recommended.”

“The doctor at LCC presumed that the patient had a benign pancreatic mass and no follow up was initiated for five months,” the report further indicated. “Pain medication history was also not taken, and the patient was placed on inadequate doses of pain medication and suffered in pain over the last five months of her life.”

According to the drafted agreement, nurses must only conduct sick calls in clinical areas that protect privacy and confidentiality. They are not supposed to restrict the number of complaints from prisoners that they address during a sick call appointment.

It additionally requires the facilities to provide cleaner rooms for sick call, as well as access to hand sanitizer and soap for hand washing.

At the Stateville Correctional Center, medical investigators found there was no “functional sick call system” that provided “timely access to care.” Inmates were not given approved health request forms to ask for care. They put their request on “small scraps of paper” or generic request forms.

“Staff reported that inmates could borrow a pen from another inmate, but an officer commented to a court expert: ‘Yes, but it will cost them a lunch tray,’” the second report noted. “Even if there were sick call boxes on each unit, inmates cannot submit their forms because throughout [Stateville] inmates are locked down 24 hours a day except for four hours per week.”

“Thus, the institutional practice to lock offenders down 24 hours per day is a serious obstacle to access to care,” the second report stated.

It is unclear what the drafted agreement may do to address the systemic barrier to health care in facilities that lock prisoners down in this manner.

IDOC is supposed to make employees and employees of Wexford available for “brief interviews,” particularly when the monitor and the monitor’s consultants request tours. They are also to permit the monitor’s team to speak with prisoners outside of their cell.

Despite several documented issues with Wexford, it would seem IDOC will not be seeking a new vendor for Illinois prisons.

Illinois is the second most overcrowded prison system in the United States. (Alabama is the worst.) However, in 2015, the state was in the top ten when it came to lowest expenditures on prisoner health care.

That was largely a result of staffing because Illinois had the second lowest number of full-time equivalent health care workers of all 50 state prison systems.

The first step toward ending the risk of death from extremely poor health care is to develop a system that properly staffs facilities so requests for treatment can be filled by nurses and physicians.