by Julie K. Brown, Miami Herald

Yvonne McBride was a physically healthy 26-year-old woman when she entered Lowell Correctional Institution for women June 20, 2013.

The Florida Department of Corrections noted in its exam of McBride that, other than a bout of constipation and a history of depression, she was in good health. She had no fever, no cough, no chest pain or breathing problems. Her lungs and chest were clear, her heart was normal, her FDC medical records show.

But a month and four days later, McBride was dead.

The Miami Herald found that McBride is among untold numbers of Lowell inmates who have suffered serious misdiagnoses, delays in treatment and medical neglect over the past decade. The institution — the largest women’s prison in the nation — also has a long history, documented in reports and medical audits, of alarming and even life-threatening deficiencies, ranging from failing to provide routine medications to delaying treatment for inmates with potentially fatal illnesses.

McBride’s prison medical records show that she was seen in the prison infirmary July 23 for a fall. The nurse noted that McBride told her she had been ill for six days, coughing up mucus and feeling weak and short of breath.

“The officers sent her multiple times to the infirmary. She was sick as a dog, but they kept sending her back to her dorm,” said her mother, Lydia McBride, a registered nurse for 25 years.

Later that day, McBride was admitted to the infirmary. The next morning, records show, she awoke about 1 a.m., stood up and fell on the floor. She was vomiting blood, her FDC records show.

By the time she arrived at Ocala Regional Medical Center about 1:30 a.m., McBride was in cardiac arrest and septic shock, emergency room records show. They revived her twice between multiple blood transfusions. But her body was shutting down — she had acute pneumonia and renal failure, according to the hospital record.

“Nothing helped to revive the patient back, and unfortunately with the septic shock by an unknown organism, we lost the patient,’’ wrote the emergency room doctor, Sujatharani Thiruman.

She was pronounced dead at 8:44 a.m. July 24. An autopsy concluded she died of bronchopneumonia, brought on by the swine flu virus. Twelve other inmates at Lowell later were suspected to have contracted the H1N1 virus, and two months later, 23 more inmates were sickened by suspected influenza, FDC records show.

“This is a woman that needed to be hospitalized and treated for this very severe pneumonia,” said Cyril Wecht, a forensic pathologist who reviewed McBride’s medical records as well as the autopsy.

The report of the FDC inspector general’s office, in which most of the words are blacked out, absolves the staff and institution of any blame. “There is no evidence to suggest that inmate McBride’s death could be attributed to anything but natural causes.”

Lowell, the nation’s largest women’s prison, has two doctors, two advanced nurse practitioners and about two dozen LPNs for nearly 2,700 inmates, according to the FDC.

Families who have lost loved ones say that while the deaths have been attributed to natural causes, many would not have died had they received adequate and timely medical care.

Prisoners and their relatives can exaggerate illnesses, incompetence or indifferent medical care. But the problems at Lowell and its sister facility, the Florida Women’s Reception Center (FWRC) — an intake point for women en route to Lowell and other prisons — are well-documented by the department and the state’s Correctional Medical Authority (CMA), which oversees inmate healthcare.

The Herald looked at nearly five years of medical complaints, audits, surveys and facility inspections at Lowell, which consists of a main compound, an annex and a work camp. Inmates interviewed for this story also supplied the Herald with medical records, emails and other documents to support their claims of medical neglect. The records reveal that, for years, the prison’s infirmaries have been dangerously understaffed and its medical facilities often have failed to provide timely, basic treatment for common ailments such as hypertension.

Until October 2013, prison medical facilities were staffed by Department of Corrections personnel. Corizon, a private company with contracts all over the country, was brought in by Gov. Rick Scott, a former healthcare tycoon, promising to slash medical costs and save money. Corizon handles healthcare at Lowell and 113 other Florida prison facilities.

Under Corizon, spending on healthcare at Lowell has dropped significantly, continuing a trend over the past decade. At the same time, inmates have been denied emergency care and timely treatment for chronic illnesses and routine cancer screenings, according to audits of Lowell and FWRC conducted in February and September 2015, respectively. Additionally, audits found colonoscopies for inmates with unresolved bleeding that weren’t ordered; vaccinations and immunizations for hepatitis that were never initiated; oncology follow-ups that never happened; tests that were denied and post-partum exams that occurred four weeks late.

The list goes on: no follow-up for an inmate with acute head trauma; ultrasounds that were ordered but not carried out; inmates with HIV never treated; inmates with histories of breast cancer deprived of their medication. The September audit found that an inmate at FWRC, located next-door to Lowell, complained of a golf-ball-size lump in her ear in June and was denied an MRI by Corizon.

“What our folks are told at Corizon is to do the right thing. To practice good medicine,” said Corizon spokeswoman Martha Harbin. “Preventive care is getting this stuff on the front end. That’s how you save costs. You don’t save costs when the conditions rise to the level of complications.”

Separately, state and county health inspections of Lowell have found problems there with sanitation, food safety and contagious diseases that have, at times, led to quarantines, which the department calls “movement restrictions.” Parasites have been found in the water, and meat served to the inmates was deemed rancid in 2012 by the U.S. Department of Agriculture, records show.

Lowell Warden Angela Gordon said that more than half of the complaints she receives are about medical care, and that “through the grievance process, from what I can see, very few of them are found to be legitimate.”

She said the healthcare workers “are doing their jobs,” adding: “It may not be exactly what the inmates think they should be getting, but the inmates are receiving care for the most part.”

However, inmates told the Herald they are not only getting sick, they also are finding themselves cursed at for complaining — and punished for pleading with nurses and doctors for help. Even those with serious, visible health problems are sometimes thrown in disciplinary confinement for “disrespect” if they question their medical diagnosis, inmates said.

Former inmate Tanya Yelvington, 55, said she was disciplined for asking a nurse to change her bloody gloves before examining her.

In 2008, Yelvington, then at Gadsden Correctional Institution in Quincy, discovered several lumps in her breasts. She was alarmed because her family had a history of breast cancer — both her sister and mother had had it.

Shortly thereafter, she was transferred to Lowell and, for the next year, Yelvington, her husband and her sister fought the Department of Corrections to get a biopsy. She underwent several mammograms, she said, but they were either inconclusive or turned up nothing.

That’s because the technician who performed them — on a mobile mammogram unit — failed to capture the portion of her breast where one of the masses had formed, Yelvington said. She said she argued with the technician to the point where she was threatened with confinement — a highly restrictive form of incarceration away from the general population.

“I have large breasts and I told her ‘the lump was in my nipple and unless you have the nipple inside the machine you are not going to see what I’m talking about,’” Yelvington said.

At one point, her sister, Teresa Tellez, offered to pay for a private biopsy, but FDC declined, Yelvington said.

In October 2008 — 10 months after his wife said she detected lumps — Yelvington’s husband, Larry Jones, wrote a letter to both the Ocala Star-Banner and the state, demanding to know why she had not been treated.

“Another week has passed and my wife has still not received any medical help but she did go to medical 10/16. My wife was found to have 3 masses 10 months ago at [Gadsden] and is now at LCI. When she got to medical she waited for an hour and a half and finally was told [after she asked] that they had no record of why she was there in medical. This is a sick woman who stayed there for nothing because a [corrections officer] sent her. This is the SECOND time this has happened,’’ Jones wrote on Oct. 17.

All in all, it took 14 months for Yelvington to get a biopsy, records show. By then, the malignant tumor in her right breast had more than doubled in size, her medical records show. The cancer had spread to her lymph nodes. She agreed to have a double mastectomy.

She had surgery in November 2009 at Memorial Hospital in Jacksonville. The hospital provides services to inmates, although the doctors who perform surgery are contracted by the Department of Corrections separately, a hospital spokeswoman explained.

When she returned to the prison, Yelvington said she contracted an infection that nearly killed her. Photographs show that after her surgery, her chest was so mutilated that portions of her breasts were still attached.

She said the doctor in charge of the surgery offered to repair the damage to her chest, but FDC would not approve the procedure, considering it cosmetic.

“They do as little as possible and will go to the lengths of letting you die or misdiagnose you to save money. The inmates are animals to them … if you have bone cancer, they will tell you you have arthritis and give you Tylenol,” Yelvington said last month, sitting on her sister’s couch in Hollywood, where she spent her first Thanksgiving with family in a decade and a half.

She says when she exited the prison, FDC made sure she left without a shred of dignity. The prosthetic breasts that her sister had bought for her to wear home were thrown out by a corrections sergeant. FDC said her possessions were tossed because she failed to make proper arrangements to collect them within the required time frame.

Yelvington, who served 16 years in prison, doesn’t minimize the debt she owed for her crime, a DUI manslaughter that killed a 51-year-old motorcyclist in 1998. But she said inmates are human beings.

“When these medical doctors and nurses take an oath, they don’t take an oath to say, ‘I’m going to help these people in the hospital because they are worthy. [But] because you made a mistake and you’re in prison, we’re going to treat you like a dog … you don’t deserve to live,’” she said.

State of emergency

There were seven deaths recorded at Lowell and its annex last year. But that number could be misleading because seriously or chronically ill inmates who are transferred to a prison hospital, such as the Reception and Medical Center in Lake Butler — and then die — don’t count against Lowell’s tally, even if they left Lowell only a few days earlier.

The most recent audit of Lowell’s healthcare highlighted alarming deficiencies, including inmates being denied antibiotics, blood-pressure medication and insulin.

Although inmates recount a range of horror stories, it is difficult for outsiders, including the news media, to verify them. When it fulfills public records requests, the FDC redacts anything related to medical care. For example, they might black out facts like the attending individual was a nurse or that an inmate was bleeding after a cell extraction. The prison system does this under the federal law known as the Health Insurance Portability and Accountability Act or HIPAA. Because of the same law, it also will not comment on the treatment given individual inmates.

While the law protects the privacy of prisoner health records, it also limits public oversight. Even family members can have difficulty getting a prisoner’s medical records.

Several inmates interviewed for this story said they found it difficult to obtain their own records. The CMA noted that one of the most problematic issues was sloppy medical-record keeping. “Notable disorganization,” the auditors found at Lowell’s sister prison, the FWRC. The disorganization often made it impossible to follow through with treatment for an inmate. Prisoners at Lowell reported the same issues to auditors a few months prior.

At the conclusion of a recent audit, the CMA declared a state of emergency at Florida Women’s Reception Center and said that immediate action was required by Julie Jones, secretary of the department.

Corizon, based in Tennessee, has been the source of so much trouble that Jones decided earlier this year to renegotiate. Then last month, the company said it had decided not to renew its $1.1 billion contract, and plans to pull out in six months, leaving care for 74,000 of the state’s 100,000 inmates in limbo.

Corizon also is facing a federal class-action lawsuit from inmates over the quality of care they received, and Florida has fined the company almost $70,000 for failing to meet standards set by the CMA.

FDC spokesman McKinley Lewis said the department has issued a corrective plan for FWRC. The major issues, he said, have been resolved there.

“We took that very seriously,” Harbin, of Corizon, said. She said 75 doctors and nurses were brought into the reception center and every single patient was seen and evaluated.

But officers who work at Lowell say the medical staff is stretched so thin that officers are being forced to pick up the slack.

An officer said the prison is now asking guards to distribute routine over-the-counter medication, such as ibuprofen, to inmates, something the officer isn’t comfortable doing.

“Now we have to hand out pills to inmates, which means we have to fill out the forms and make sure they aren’t taking too much. I can stand there for three hours handing out pills just because Corizon doesn’t want to give inmates their pain medication. I turn from a corrections officer to a pill line nurse,” said the officer, who didn’t want his name used for fear of reprisals from the agency.

Mom’s last glimpse

McBride’s mother, Lydia, said that she last saw her daughter when she was transferred from the Marion County Jail to the prison system in June 2013. The family later found out that shortly after arriving at Lowell, Yvonne had fallen ill, and that the medical staff — FDC medical staff — kept telling her there was nothing they could do and kept sending her back to her dorm.

“A healthy 26-year-old doesn’t die of pneumonia,” said Lydia McBride, who once worked as a nurse for the Marion County Jail but says she quit because she didn’t approve of the way the other nurses treated prisoners.

“They treat these inmates like, no matter what their complaint is, they are liars. All the nurses were like that and it probably was like that at Lowell,” she said.

Court records show that her daughter was arrested in January 2013, charged as an accomplice in an armed robbery. She and Charles Studer, then 23, were convicted of robbing an acquaintance of $900. The Ocala police report said that Studer likely brandished a BB gun, and that McBride went along for the ride.

Her FDC medical file said McBride suffered from panic disorder, anxiety and depression. She told doctors that she had been raped multiple times and battered by an ex-boyfriend. She tried to commit suicide and was once admitted at a hospital for mental health treatment, records show.

McBride said that she tried for years to find the right combination of medication to help control her daughter’s bipolar disorder. She said her daughter used alcohol to try to control her panic, and her erratic behavior led her to get into trouble. She would lose jobs and hang out with the wrong people.

“It was difficult to watch her pain,” her mother said.

“Prisoners are human beings and the people who are their guardians, no matter what their personal thoughts may be, they should treat these inmates. There is no excuse for this, this was a preventable death if she had been properly diagnosed and treated,” said Wecht, a former president of the American Academy of Forensic Sciences who has reviewed a number of high-profile autopsies, including those of John F. Kennedy and JonBenet Ramsey.

Records show that McBride was among seven women who died at Lowell in 2013. Three of those medical-related deaths — two from pneumonia and one from a failed shunt — occurred within two days of each other in April.

Former inmate Kat Jones recalls two women who died in her dorm that month. Jones also was ill, and claims that it seemed like women were getting sick all around her. The sickness was so widespread that the dorm was shut down and quarantined, she said.

FDC records show that there were 10 cases that required dorm isolation in April 2013, though a report didn’t say why.

“I remember telling my husband that I cannot breathe — I was throwing up and blood was coming out of my nose, my eyes were infected and they kept saying nothing was wrong with me,” said Jones, who served multiple prison terms for credit card fraud and grand theft.

Upon her release in May 2013, still a few months before Corizon took over the healthcare, Jones said she went straight to the hospital. Both her eyes were swollen shut, and she had a severe ear, nose and throat infection, she said. She underwent surgery, she said, when the doctors discovered part of her lung had collapsed.

“I can’t tell you how many times I was threatened with confinement for arguing with a nurse,” Jones said. “How are they upholding their oath when they deny you medical care?”

Liane Lastra, who just left Lowell a week ago, said she was told by prison staff that a pregnancy test she received when she arrived at Lowell earlier this year, in February, showed she was eight to 12 weeks along.

A month later, she started bleeding and went to the infirmary. Her medical records show that she was seen on March 7, with the nurse noting that Lastra was “at 12 weeks of pregnancy.” She reported abnormal vaginal bleeding and clotting. The nurse noted that Lastra was told to come back Monday — two days later — and see the doctor, records show.

“There’s nothing I can do for you, go back to your dorm,’’ Lastra recalled the nurse saying. She recalled that initially, she felt no discomfort, but was nevertheless alarmed by the bleeding. She asked for permission to stay on bed rest, but she said the nurse refused. The nurse’s log doesn’t list anything that the nurse advised her to do.

Two days later, on Monday, March 9, the doctor performed a pap test, records show. He noted that he removed several clots during the pap and noted that the patient “probably miscarried.”

“He put something inside me and I could feel him scraping. He told me there was nothing he could do, I was probably having a miscarriage,” she said. The doctor told her to return to her dorm and come back the next day for a sonogram. She spent the night in excruciating pain, she said.

When she arrived the next morning, she was told to wait in the hallway. She said the nurses had difficulty finding her medical file.

“I started feeling urges to push and leaned down and I was praying.” Something popped out of her and fell into her pants as she was standing there being ignored, she said. Once she got the staff’s attention, they had her drop her pants so they could remove what had dropped, Lastra added. She was not sent to a hospital.

Lastra was no longer pregnant.

Corizon said it could not comment on specific cases.

‘Clean and orderly’

In June 2014, the Department of Corrections received several reports that there were worms crawling out of the bathroom sinks and toilets in Lowell’s annex in two dorms, P and Q. According to FDC’s inspection report, black larvae were found in the sinks, and the drains were “filthy’’ and filled with bugs and other parasites. On June 16, the prison inspector took photographs of the bug-infested conditions and told prison authorities that the water should be tested in all the dorms.

A day later, Eric Lane, the regional director who oversees Lowell, wrote a note to a Jason Melnick, who had written the prison about alleged corruption and other issues, including unsanitary facilities at the prison. Contrary to what the department’s own inspector had found a day earlier, Lane said there was no record of any worms or insects in Lowell’s annex.

“I want to stress to you that the idea that any staff member associated with this agency would knowingly and willingly make continued, concerted efforts to ‘cover-up’ a clear cleanliness issue/health hazard … is alarming at the least,” Lane wrote, adding that he had the dorms inspected the day before and all areas were “clean and orderly.”

County health inspections show that over the past two years, the prison kitchens have at times been plagued by rats, roaches and flies. Mechanical dishwashers didn’t operate properly and dishes were washed in trash bins filled with water. More than once, the prison has been ordered to use “single serve” plastic utensils because of cleanliness issues. The food the prison serves inmates has been so inedible at times that the U.S. Department of Agriculture did a surprise inspection and found that the meat— which smelled like fish — was rancid. Kitchen workers reported they were told to use garlic or sauce to mask the smell.

Former inmate Crystal Pascual, who worked in the Lowell annex kitchen, said the inmates used to tie the bottom of their pants legs or tuck them secure in their boots to keep the mice from crawling up their legs. She said she fed them so they would stop jumping on her.

“The dishpit and oven had families living in there,” said Pascual, who was released in 2013.

Inmates also said that if they dare talk in the chow hall the officers take their trays and dump their food. FDC, when asked about the policy of prohibiting inmates from talking during their meals, said it is a security precaution to guard against inmates becoming loud and disorderly.

FDC records show that, in addition to flu problems in 2013, Lowell had an outbreak of chickenpox in February 2014, head lice in April of that same year and, between Sept. 23 and the first of October, 65 inmates were kept in dorm isolation because they complained of gastrointestinal problems.

Records show another 19 inmates fell ill this past August from a stomach ailment.

A ‘natural’ death

Jones spent a lot of time in the prison infirmary because of her diabetes and other health problems. She said she saw nurses — who were state employees at that time — dismiss inmates who complained of problems with their medication.

“I had to take insulin three to four times a day. I lived in medical and their medical is terrible. They are there to do a job and even the ones who care are told to patch it up and send them on their way,” she said.

Cynthia Goodman, who was serving a three-year prison term on drug charges, was among those who died in 2013. Her death predated Corizon getting the healthcare contract by a few months. Jones, who said she was with Goodman before she died, said Goodman bled to death in a prison bathroom.

Goodman was a kidney dialysis patient, Jones said.

“She kept complaining that she was bleeding from her port. She complained for more than a month. We gave her clothes because she would bleed all over them. She would tell them but they would just send her back to the dorm,” Jones said.

“One morning she got up early with me. We were both in wheelchairs. She got into the shower and started screaming for help. I got in there and blood was spurting from her port, all over the walls on the ceiling, on the floor, people were screaming. Everyone was frozen and didn’t know what to do,” she recalls.

“The sergeant came and kept calling medical, but no one answered. He took her out the door, but she died,” said Jones, who was later interviewed by prison inspectors about the death.

“They tried to say she was picking at her skin, that she was picking at the port. I know that isn’t true. She complained for over a month.”

Goodman’s autopsy, by the Marion County Medical Examiner, said Goodman died because of a “rupture of infected hemodialysis shunt.”

The manner of death was listed as “natural.”

Of the 57 deaths at Lowell over the past decade, only one — a disputed suicide in 2008 in which the inmate allegedly hanged herself while handcuffed — has been categorized as anything other than “natural.” Ten recent deaths remain under review.

Jones said that when she went to prison she thought it was the other inmates, especially the killers and other violent offenders, she was going to have to worry about.

“You don’t have to worry about the inmates; you have to be worried about the people who are supposed to be there to protect you and take care of you.’’

This article was originally published by the Miami Herald on December 20, 2015; reprinted with permission from the author.