The New York Attorney General found that Correctional Medical Care, Inc. (CMC) violated state law by engaging in the “corporate practice of medicine.” The finding resulted in a September 2014 settlement agreement that required the for-profit prison and jail medical care provider to restructure, hire an independent monitor and pay $200,000 in restitution and civil penalties.

CMC, which is headquartered in Blue Bell, Pennsylvania, has contracts worth $32 million annually to provide health care services at 13 New York county jails.

The New York State Commission of Correction’s Medical Review Board reported to the state Attorney General “that the increased involvement of general business corporations, such as CMC, in providing medical, dental, and mental health services” in prisons and jails “has led to unacceptable consequences at many of these facilities.”

Between 2009 and 2012, six deaths occurred at the Tioga County Jail, which contracted with CMC. The Medical Review Board found that in three of those deaths “there were egregious lapses in medical care.”

Additionally, Nicole Carmen, 39, died in April 2013 at the Schenectady County Jail, which also had a contract with CMC. She suffered serious health effects, including seizures and an aneurism, due to heroin withdrawal. The head nurse at the jail denied Carmen medical care for four days, incorrectly claiming that she was “faking it.” According to attorneys representing Carmen’s estate, “the walls and floors of Ms. Carmen’s cell were also covered with vomit, bile and feces. Ms. Carmen was also observed as incoherent, and exhibiting jerking motions on the left side of her body, indicative of seizure activity.”

And in August 2014, Mark Cannon, Jr., 24, died at the Albany County Jail while under CMC’s care. He had suffered a stroke but was essentially ignored and left untreated by medical staff for several hours; jail and CMC employees waited until he was unresponsive and immobile before transporting him to a hospital. Upon arrival at Albany Memorial Hospital, Cannon was judged to be “too critical” for treatment. He was eventually determined to be brain dead and removed from life support.

As neither CMC’s owner, Maria Carpaio, nor its president, Emre Umar, who is Carpaio’s husband, are licensed medical professionals, the company employed and contracted “with various medical and allied professionals” to deliver health services to jails in New York.

However, state law limits the practice of medicine to licensed professionals and prohibits the corporate practice of medicine. The lack of medical practice knowledge by its top corporate officers led CMC to hire staff who failed to include in prisoners’ medical records “(i) required admission histories and physical examinations; (ii) medical orders; or (iii) completed mental health assessments, nor did CMC staff make necessary referrals to a psychiatrist or physician for those inmates who exhibited symptoms of mental distress.”

The Medical Review Board further found “serious deficiencies and illegalities” that included “unlicensed and inexperienced staff; inadequate staffing; lack of adequate medical oversight; and failure to adhere to medical and administrative protocols and procedures.” It was determined from prisoners’ medical records that there was no “evidence of physician or psychiatrist oversight, and that staff dispensed medications in the absence of medical orders.”

The Attorney General’s investigation affirmed those findings. It also went deeper, and found that CMC and Monroe County had entered into agreements that “typically modified staffing matrices in a downward spiral, with no corresponding decrease in contract costs.” Despite the agreements, CMC still failed to meet medical staffing requirements.

Additionally, “[s]everal professional staff members were hired without appropriate licenses and experience, and one was hired despite a prior felony conviction” for altering “a duly authorized prescription by increasing the quantity of the drug.”

The Attorney General concluded that CMC not only engaged in the corporate practice of medicine, it had also engaged in deceptive business practices by: 1) failing to provide on-site physician coverage that was contractually required; 2) employing a “Director of Forensic Mental Health who was illegally engaged in the duties of a social worker without a social worker license”; and 3) substituting the services of a physician assistant to provide medical care without decreasing the cost of the company’s contract.

Under the September 22, 2014 Assurance Agreement between the Attorney General and CMC, the company must restructure its business operations and contracts so that “its functions are limited solely to administrative support of medical services” in New York jails and prisons for the next three years. Further, it must hire an independent monitor to assure compliance with all its contracts and with state laws.

Per the agreement, CMC was also required to pay Tioga County $100,000 in restitution plus a $100,000 civil penalty to the Attorney General’s office. See: In the Matter of Correctional Medical Care, Inc., New York State Attorney General, Assurance No. 13-495.

The Tioga County penalties were due to the deaths of six prisoners at the county’s jail, where CMC was contracted to provide medical services. One of the prisoners committed suicide despite the fact that he clearly presented a danger to his own safety; he was not referred to a psychiatrist or any other mental health staff for intervention.

The Attorney General’s investigation was initially spurred by those deaths after the New York State Commission of Correction brought the issue to the AG’s attention.

Nevertheless, seemingly without regard for this marred performance history, Tioga County renewed its contract with CMC in November 2015. The renewal extends the county’s relationship with the company for a two-year period, with an option to renew for three one-year extensions.

At the time of the contract renewal, Tioga County legislator William Standinger (the sole county legislator to vote against the contract renewal) said CMC had offered the least expensive response the county had received to a request for proposals for jail medical services.

Beyond the civil action brought by the New York Attorney General, lawsuits claiming inadequate medical care have been an issue for CMC. The company paid a $62,000 settlement in the death of Broome County, New York prisoner Alvin Rios, who the Medical Review Board found was left “in an emergent, life-threatening status without appropriate medical attention” before his July 20, 2011 death, which was caused by an arrhythmia-induced cardiomyopathy from illicit drug use.

In August 2015, a federal lawsuit was filed on behalf of the estate of 29-year-old Lucky Lee Wilkins, Jr., who committed suicide while incarcerated at the Schenectady County Jail on May 28, 2014. He had been held at the facility for over two months on a felony drug offense. The suit claimed that Wilkins sought treatment for depression from CMC and a local hospital but did not receive mental health care. “Prior to his death, Mr. Wilkins reported that he had unsuccessfully sought help from medical staff on multiple occasions, but was denied, as they thought he was ‘faking’ his condition,” the complaint stated. The case remains pending. See: Helijas v. Correctional Medical Care, U.S.D.C. (N.D. NY), Case No. 1:15-cv-01049-GTS-DJS.

CMC was named as a defendant in a civil rights action concerning the September 27, 2011 death of Patricia Pollock, who died from endocarditis, a critical but treatable cardiac condition, at the Montgomery County Corrections Facility in Eagleville, Pennsylvania. The case settled for $325,000 in July 2015. See: Kenney v. Montgomery County, U.S.D.C. (E.D. Penn.), Case No. 2:13-cv-02590-EGS.

In addition, the death of Mark Cannon, Jr. at the Albany County Jail, described above, resulted in litigation that remains pending in federal district court. See: Cannon v. Correctional Medical Care, U.S.D.C. (N.D. NY), Case No. 9:15-cv-01417-GLS-DJS.

And a lawsuit filed over Nicole Carmen’s death at the Schenectady County Jail, also described above, resulted in a $425,000 settlement with CMC in December 2015. The federal district court refused to seal the settlement agreement.

“The allegations of wrongdoing against the defendants are very significant and the settlement proposed is substantial,” the court wrote. “Additionally, as the complaint notes, there have been numerous prior allegations against Correctional Medical concerning similar wrongdoing. Further, in September 2014, Correctional Medical reached an agreement with the New York State Attorney General concerning allegations of understaffing public facilities and shifting work hours to less qualified staff. For all these reasons, there is a strong public interest in this settlement not being under seal.” See: Chase v. Correctional Medical Care, U.S.D.C. (N.D. NY), Case No. 1:14-cv-00474-DNH-TWD.

“[E]very dollar that CMC spends providing care to inmates directly affects their profit margin, providing a direct incentive to provide inadequate medical care to inmates,” noted the lawsuit filed over Carmen’s death.

The estates of Cannon, Carmen and Wilkins were represented by attorney Elmer Robert Keach III, who was quoted as saying CMC is “irresponsibly run and its actions have led to the death of detainees in upstate New York” – an apparent gross understatement.

Sources: www.pressconnects.com, www.times­union.com, www.ithica.com, www.uticaod.com, www.dailygazette.com

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