The family of a mentally ill Oregon prisoner who died due to complications from an untreated broken neck received $7.4 million to settle their claims.

In 2012, the Lane County Jail (LCJ) in Eugene, Oregon entered into a contract with Tennessee-based Corizon Health, Inc. to provide medical care. The move was justified as a cost-saving measure.

Kelly Conrad Green II suffered from paranoid schizophrenia. He was hospitalized in 2012 after expressing that he planned to kill himself by breaking his neck.

On February 11, 2013, Eugene police received reports that Green was acting strangely and talking about suicide. He was taken to LCJ and the booking form reported that Green might be suicidal and was a paranoid schizophrenic. He was barely able to make it through the booking process, according to the booking officer.

During Green’s arraignment at about 10:43 a.m. on February 13, 2013, the court informed him that he would be held for several days. Green then ran about eight to 15 feet, lowered his head and rammed into a cinder block wall. He sustained a significant head laceration that bled profusely.

Corizon medical staff, including physician’s assistant Kristin White, registered nurse Sharon Epperson and licensed practical nurse Jona Bougard, responded. Green said he could not move.

White later claimed that she conducted a full neurological examination, but court staff and deputies said she did not. Nor did she ask for a cervical collar or a backboard for Green. White did not call for an EMT because she believed there was very low risk that Green had a serious head injury; in fact, she and Epperson believed he was faking paralysis.

No attempt was made to immobilize Green’s neck as he was lifted into a wheelchair without a C-collar or backboard. His limp body slid out of the wheelchair, so deputies used his sweatshirt to tie him to the chair. He was wheeled to the jail clinic at about 10:55 a.m.

While White was suturing Green’s wound, Epperson held up his head. During the procedure Green lost control of his bowels, which is a symptom of a spinal injury. Medical chart notes did not reflect this loss of control or that a neurological exam was performed.

At 11:29 a.m., Green was wheeled 20 or 30 feet to a segregation cell. He was limp and his feet dragged. Deputies roughly removed his shirt, pulled him from the wheelchair, dropped him on the floor, put him on the bed and removed the rest of his clothes. No attempt was made to clean him, despite his loss of bowel control. The deputies left Green naked, soiled and motionless.

Medical staff told deputies that Green was fine so long as he was breathing. Mental health staff checked on him at 2:28 p.m., but believed he was faking paralysis. Again, nobody bothered to place a blanket over Green’s unclothed, immobile body.

Nurse Leah Smith, who had just started her shift, noted that Green’s vital signs were indicative of shock. She reported his vitals to White at 3:53 p.m. Although White was the medical professional with the most training on site at the time, she clocked out and went home just before 4:00 p.m.

At some point, Corizon administrator Vicki Thomas finally understood that the situation was an emergency. Before calling an ambulance, however, she and Epperson spent 15 minutes cleaning Green’s soiled body. It was unclear, but doubtful, that any precautions were taken to protect his neck as they did so.

An ambulance was finally called, with a code 1 (drive normal), at 4:33 p.m. The ambulance arrived 16 minutes later and EMTs immediately immobilized Green’s neck.

Green left LCJ by ambulance at 5:20 p.m. and arrived at the hospital within eleven minutes. He underwent emergency spinal surgery to treat a burst fracture of the C-4 vertebra that had compromised, but did not sever, his spinal cord. The injury left Green a ventilator-dependent quadriplegic.

Through a personal representative, Green filed a federal lawsuit against LCJ and Corizon defendants, seeking $30 million in damages. Ten months later he died as a result of ventilator dependence complications, and his family amended the suit to bring wrongful death claims.

In denying Corizon summary judgment, the district court noted “there is evidence in the case from which a jury could conclude that medical records were removed and added after the fact by one or more of the defendants.” White and other staff appeared to have fabricated records in an attempt to cover up their wrongdoing.

Corizon policy requires a review process in cases like Green’s, but that did not occur until after the plaintiffs gave notice of their lawsuit. “Although the review did find White to be ‘reckless,’ a Corizon official rescinded that assessment in depositions,” the district court observed. “Although Corizon claims it took corrective action via ‘counseling’ for White and now has a backboard and C-collar on site, there is no documentary evidence to support the counseling. Indeed, White received an excellent performance review in the Fall of 2013. She is still the primary caregiver at the Lane County Jail. She feels that everything done with respect to Green was within Corizon policies and procedures.”

Lane County terminated its contract with Corizon in mid-2015, and California Forensic Medical Group now provides medical care at LCJ.

The county filed a cross-claim against Corizon because its staff had misdiagnosed Green’s condition and the company “failed to defend and indemnify us,” said Commissioner Pete Sorenson.

In July 2015, Green’s family settled their claims against Corizon Health for $7 million. One week before trial, Lane County Commissioners agreed to pay $500,000 to settle the family’s remaining claims. The settlement was not finalized, however, because county attorneys “attached an unacceptable condition to their offer,” according to court filings.

That condition was the county’s desire to continue pursuing its cross-claim against Corizon. Ultimately, a settlement conference was held and the parties agreed that the county would dismiss its Corizon cross-claim in exchange for a $100,000 reduction in the amount of its payment, resulting in a total settlement of $7.4 million. See: Johnson v. Corizon Health, Inc., 2015 U.S. Dist. LEXIS 44638 (D. Or. 2015).

PLN has previously reported on problems, abuses and lawsuits involving inadequate medical care, or in some cases no medical care, provided by Corizon. [See, e.g.: PLN, March 2014, p.1].

Additional source: The Register-Guard

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