On Feb. 18, 2005, Jermaine Lamar Wilson was found hanging from a bed sheet in his cell, eight days after a judge ordered his release. His clothes were stained with blood from a gash on the back of his head. Prison officials claimed his death was a suicide.
"They called me on the phone that night and told me my son had died," said his mother, Susie Wilson. "Just a phone call and that was it.
"When I wanted to meet them and have them answer my questions, no one would talk to me."
She did not receive the department's report until February of last year, Wilson said. Mixed in with her son's files were those of another inmate, Jermaine Lamont Wilson.
"Even after all that time, it's been upsetting to me that they couldn't differentiate who my son was," she said.
Correctional Medical Services, the private Missouri-based company which holds a no-bid contract with the state to provide medical care to inmates, has faced criticism from the judicial system and prisoner advocacy groups.
According to a report filed by an independent monitor, Delaware prisons will remain under the supervision of the U.S. Department of Justice while the state makes slow progress in addressing the inadequate inmate health care provided by the Department of Correction's medical vendor.
In the 229-page report, independent monitor Joshua W. Martin III wrote that the company suffers from a "lack of stable and effective leadership" and has not fully cooperated with monitors.
"The monitoring team has also faced difficulty in receiving consistent and accurate information from CMS," Martin wrote.
He said CMS staff frequently provided information about practices and procedures which later proved to be false.
Delaware prisons have made little or no progress in addressing the high rate of turnover of staff, lack of patient privacy, access to medical and mental health care, and providing adequate clinic space and equipment, Martin wrote in the report.
In the infirmary at the Delaware Correctional Center in Smyrna, he found two nurses and one medical assistant assigned to 44 inmates.
"Patients in this infirmary are either ones that would require a nursing home if they were in the community," Martin wrote, "or ones that have some acute problem that requires careful attention."
Martin wrote that the three staff members were overburdened with providing health care and cleaning duties. Consequently, there was a lack of documentation in patient charts.
At the same facility, the monitoring team found there were no patient referrals occurring for three months "because the person who was assigned to schedule appointments for inmates was on sick leave, and CMS had failed to find a temporary replacement."
Martin found that two facilities, Baylor Women's Correctional Institution in New Castle and DCC, were particularly lapse in providing access to medical care for inmates.
"Nurses do not consistently see patients within 72 hours of receiving their health service requests," he wrote. "In fact, sometimes patients are not seen at all."
Among the most improved areas of prison health care is screening and identification of inmates at risk of suicide or suffering from mental illness, the report concluded.
Martin wrote that 2,247 Department of Correction staff members have been trained on suicide prevention issues in the preceding six months.
Rev. Christopher Bullock, pastor of the Canaan Baptist Church in Wilmington, said he founded the Delaware Coalition for Prison Reform and Justice in order to address the inadequacies and injustices faced by prisoners.
"The Department of Justice launched a major investigation based on our findings," Bullock said. "They found 87 civil rights violations in the Delaware prison system."
He said Martin and the monitoring team had conducted a "superb and comprehensive review," which confirmed what the coalition had found in their own investigations.
"CMS is not doing their job, plain and simple," Bullock said.
Delaware inmates deserve better, he said, particularly when they are paying their debt to society.
"I don't advocate a reduction in sentences or early release," Bullock said. "I only advocate that they are treated in a humane, decent way."
The Department of Justice began investigating the conditions at four state prisons in July 2006 and determined the facilities "violated the constitutional rights of Delaware inmates."
Their findings were reported to Gov. Ruth Ann Minner in a letter dated Dec. 29, 2006. In the letter, assistant attorney general Wan J. Kim threatened to file a law suit against Delaware if the state and the department were unable to reach a resolution regarding the investigation's concerns. However, no law suit was ever filed.
Jodi Bobb, a spokeswoman for the DOJ, said the department negotiated a settlement with the state.
"We anticipate [the agreement] will resolve the deficiencies we identified during our investigation if the state implements the reforms," Bobb said.
In Martin's most recent report, he said that the prisons were in "substantial compliance" with 31 of the 217 total provisions required by the Justice department in the agreement. The prisons were not compliant with 17 and in "partial compliance" with 169.
"The assessment of partial compliance that the monitoring team has used is a very broad designation," Martin wrote in the report. "And in some instances reflects minimal progress that the State has made in eliminating constitutional deficiencies."
Ben Fleury-Steiner, criminal justice professor, said the judicial system has been ineffective in ensuring prison health care reform happens.
"The court orders prisons to a series of reforms," Fleury-Steiner said. "Prison officials agree and in some instances even implement a few superficial changes, but in a matter of months, as has been the case in Delaware, nothing actually happens."
He said the problem stems from mass incarceration. Jails are full of prisoners from marginalized communities who never received adequate health care outside of prison.
The solution is to cut the number of people in prison, Fleury-Steiner said, but politicians are terrified of looking soft on crime.
"Everyone wants to be safe in their communities," he said. "But politicians in Delaware and elsewhere have gone way overboard.
"The price being paid is a system that literally allows prisoners to needlessly suffer and sometimes die."
Bullock said CMS was not performing its duty to prisoners and Delaware could provide better health care.
"Until CMS is removed and a new vendor from Delaware, for Delaware, is given responsibility for health care, change will be gradual at best and non-existent at worst," he said.
There are world-class physicians right here in the state and we should use them, Bullock said.
"The issue's always cost," he said. "But you can't put a price tag on someone's physical, mental, or spiritual condition."
John Painter, the chief of media relations at the Delaware Department of Corrections, said the 2009 budget proposal includes $40 million for inmate health care, including a $38 million contract which goes directly to CMS.
He said the DOC and CMS were working hard to implement the changes suggested in the monitor's report.
"The commissioner is willing to consider any change that would lead to an improvement in inmate medical care," Painter said. "But he is not, at the moment, prepared to talk about changing medical vendors."
CMS did not respond to requests for comment.
Wilson said she filed a civil lawsuit in 2005 against the Department of Corrections, which is currently in mediation.
The prison health care system needs drastic changes and should be closely monitored, she said.
"It hasn't changed since my son died," Wilson said. "It hasn't gotten better and his story isn't the only one.
"I want it to change. I don't want anyone else's child to die, their family to have to go through what my family is still going through."
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