Legislators grill UConn Health, DOC about inmate health care

Dr. Joseph Breton, former DOC chief medical officer.

Concerns about the medical care provided to inmates in Connecticut’s prisons emerged during a six-hour hearing Monday as family members of inmates testified about substandard care and the correction department’s former chief medical officer told lawmakers that requests for specialized treatment were routinely denied.

The hearing, called by Republican Sens. Heather Somers of Groton and Michael McLachlan of Danbury, was an attempt by lawmakers to understand the problems that have vexed the prison’s health care system.

In particular, lawmakers seemed intent on questioning officials at UConn Health, which managed medical care for the Department of Correction for about two decades until this month when, amid growing concerns and complaints, DOC took back the job of managing health care for its approximately 13,400 inmates.

In recent months, legislators and civil rights groups have expressed their concerns about the quality of medical and mental health care being provided to inmates. This care was provided by UConn Health’s Correctional Managed Health Care (CMHC) through a contract with DOC.

Incidents — including an inmate at the state’s lone women’s prison giving birth in her prison cell — as well as large budget cuts, lack of outside oversight and a history of complaints have fueled these concerns.

In addition, over the last decade, hundreds of prisoners have filed complaints or suits against the department, including two last week. It is hard for anyone to draw conclusions about whether these indicate systemic problems, however, because the state does not track in any searchable way the resolutions of the complaints and lawsuits.

The testimony offered Monday by UConn Health officials clearly frustrated Somers.

“It’s very difficult … to have confidence that we are changing a system, or we are transitioning a system, if we don’t know what the issues were in the previous system,” said Somers, Senate Republican co-chair of the legislature’s Public Health Committee.  “You should be able to identify for us, and I don’t think it’s too much to ask, to where the issues were that you saw, not to ping you, but to give us insight so how we can fix them going forward. You were the experts.”

Legislators did get some insight from Dr. Joseph Breton, who became a prison physician in 2015 after being in private practice as a primary care doctor for more than a decade. In March, he was appointed DOC’s chief medical officer, but resigned three months later. He no longer works for DOC.

When asked what his biggest frustrations and hurdles were when working as a prison physician, Breton said the “biggest road block” was the utilization review committee (URC) — a team of CMHC physicians who decided if prisoners received care outside of the prison, like at a specialist.

Breton said the committee met weekly and doctors usually received a response within a week.

“In the beginning, I can tell you, that 95 percent of what I put in for the URC system was denied, so you begin to learn what they’re going to accept and what they’re not going to accept,” he said. “And so I got very keen on just not putting in things that I knew were not going to go through.”

Breton said, even if approved, it would then be weeks before prisoners would see specialists.

He said later that the committee was replaced with a new committee that has been charged with making quicker determinations and to prioritize the most urgent cases first.

Several family members also spoke at Monday’s hearing.

Cathy Camera said her partner, Patrick Camera, who has been in prison for seven years, was denied medical evaluation and treatment until he became “physically and medically compromised.” He was eventually diagnosed with stage four cancer, but he still hasn’t received the follow-up specialist appointments requested by outside doctors, she said.

Marian O’Shea, wife of former inmate Michael O’Shea, sobbed as she told legislators that her husband went to prison for a 120-day DUI sentence and died about eight weeks later in 2011. She said he received improper treatment for alcohol detoxification and didn’t receive some critical medications for other conditions. He eventually received a medical furlough, but died a few weeks after released.

Keshanna D. Staten, the mother of 19-year-old Karon Nealy Jr., who died while in prison, spoke about her son on Monday. The little girl in the photo is Nealy’s 4-year-old daughter.

Keshanna Staten, the mother of 19-year-old Karon Nealy Jr., who died while in prison, also wept as she spoke about her son. Nealy’s 4-year-old daughter was next to her as she spoke.

Staten filed a civil suit last week against DOC Commissioner Scott Semple, Dr. Gerald Valletta, the principal physician at Garner Correctional Institution in Newtown, and several correction officers.

Nealy, who was known as KJ, died on July 27, 2015 at UConn Health John Dempsey Hospital while serving a two-year sentence. He was slated for release in September 2015, according to the suit.

After suffering a slew of symptoms, including headaches, fatigue and body aches, Nealy frequently begged for medical attention, but was denied, the suit said.

Staten said Monday that she still hasn’t received her son’s medical records from DOC, without any explanations.

“No mother should have to bear the pain of losing their child with no explanation and Karon’s daughter deserves to know what happened to her father,” Staten said.

Sen. Doug McCrory, D-Hartford, said “this is not supposed to happen.”

“A 19-year-old kid shouldn’t lose their life while they are incarcerated in Connecticut,” McCrory said. “It’s not supposed to happen.”

Officials at UConn Health, DOC testify

Dr. Andrew Agwunobi, UConn Health’s CEO, said at Monday’s hearing that the health system was losing money from the CMHC contract — one of the reasons that UConn Health asked DOC to start managing inmate health care again.

Agwunobi said CMHC recently has spent about $5,000 per inmate each year.

In an attempt to get some clarity about how inmate complaints are handled, Somers asked Gail Johnson, former interim executive director of CMHC, for specifics about health care grievances filed by prisoners. Johnson explained that grievances were reviewed and answered by physicians, and recorded in a database, which was shared with DOC. Johnson was interim executive director for a year.

Johnson said she couldn’t answer how many grievances were filed over the year, adding that she doesn’t have access to her previous files because she no longer works for CMHC, or give a specific timeframe in which grievances were answered, saying it depended on the nature of the grievance.

Breton identified lack of staffing as the second biggest barrier to care — including doctors, nurse practitioners, physician assistants and nurses.

“We need to markedly, markedly increase providers in the facility and increase nursing staff so nurses aren’t working double shifts weeks on end,” he said.

When he started at Osborne Correctional Institute as a doctor, there were four providers, but that it went down to two. He and the other doctor worked 7 a.m. to 3 p.m. without electronic medical records, he said.

Johnson said electronic medical records were implemented in May.

Semple told legislators that more than 80 percent of the 650 CMHC staff have transitioned to his department in order to keep working in prison health care. Others, Agwunobi said, have retired or taken jobs elsewhere in the state.

Mark Pazniokas / CtMirror.org file photo

Correction Commissioner Scott Semple.

Semple said the Correction Department still needs to get its chief operating officer and medical director on board.

When asked when the DOC would have a fully staffed management team, Semple said, “We anticipate we will be on good ground by January.”

Semple said not many state correction systems have health care arrangements with university systems. Most states contract with private companies, or have their own systems.

“We will take a much leaner approach because we have to,” Semple said. “We obviously are operating on a very lean budget.”

“When you look at the investment per incarcerated person, we’re roughly in the middle of the road nationally, and in comparison to our neighboring states, we’re probably on the low side … the question is ‘why?’”

He said a private consultant who had worked in California’s correctional system was hired to help department officials going forward, but that a final report was not completed.

Semple also said he has concerns about the utilization review committee’s decision-making process.

The amount of time the committee took to make that decisions “sometimes was extremely problematic,” he said. “The discussions that we’re having internally is how can we create a mechanism where we can be much more responsive to the needs of the offender.”

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