Medical Claims and Malpractice at West Texas Immigrant Prison

Part II  PNA's Medical Gulag
Tom Barry
February 15, 2009
(The second of a three-part series on prison medical care. First part is at: )
Complaints about medical care at the Reeves County Detention Center aren’t new. In 2007 an inmate went on a hunger strike protesting inadequate medical care. When inmates protested after the death of an inmate in solitary confinement on December 12, 2008, they alleged that medical deficiencies and malpractice were widespread.
Six weeks later the immigrant inmates rioted again with the same demands that they be provided with decent medical care.

Juan Angel Guerra, a South Texas attorney who was the former district attorney in Willacy County, says some 200 inmates at the immigrant prison have enlisted his services to address their concerns about medical and other abuses.

During the week of the Jan. 31 disturbance, the county kept the prison on “lockdown,” denying access to reporters and all others, including Guerra. Neither the county, which owns the prisons, nor GEO Group, which runs the immigrant prison, released any information about the concerns of the rioting prisoners, simply saying in brief releases that the “issues” were being resolved.

Similarly, the Bureau of Prisons, which contracts with Reeves County, to hold the immigrant prisoners, ignored public requests for information.

A full week after authorities said that they restored control over the prison, County Attorney Alva Alvarez sent a letter to Guerra denying his request to meet with his clients. "We are doing everything possible to meet your request," Reeves County Attorney Alva Alvarez wrote. "However, since the facility was destroyed, there is no secure place for you to meet with your clients at this time."

Reeves County Dentention Center is not a maximum-security prison. It has been variously described by prison officials as a minimum or low-security facility – hence the “detention center” designation. The immigrants detained at the Pecos prison are not violent criminal offenders but rather immigrants, often legal ones albeit noncitizens, who have been convicted generally of nonviolent felonies like drug possession and various immigration violations.

In the name of guaranteeing public saftety, Reeves County officials have kept the prison off limits to reporters and attorneys. And in an apparent effort to keep the story about inmate protests from gaining momentum in the media and to keep it away from the view of state and federal officials, county officials and the private prison contractors have refused to comment on prison conditions.

Among those who have declined to comment about the state of medical care at the detention center is the private contractor that is responsible for this care. 

Leader in Correctional Healthcare

Physicians Network Association (PNA), a Lubbock-based company that calls itself a leader in correctional healthcare,” has subcontracted with Reeves County since 2002. As the owner of the prison, Reeves County has a contract with the Bureau of Prisons to hold fedeal immigrant prisoners. But rather than run the facility itself, the county subcontracts its responsibilities to GEO Group to operate and manage the prison and to PNA to provide medical and dental care. (See Medical Claims Part One)

In its presentation as part of the negotiations over its current contract with the county, PNA assured the county that “as a subcontractor, PNA has fourteen years’  experience assisting operators exceed expectations.”  It emphasized the “cost-effective” character of its medical services, and promised that it would “work as your partner to ensure appropriate healthcare without compromisng opertions.”

“We are recognized for our responsiveness to the needs of our customers,” boasted PNA, referring as “customers” to the private prison firms like GEO (with which it has ten contracts) and counties like Reeves that own prisons not to the inmates it cares for.

PNA included GEO Group and Management and Training Corporation (MTC) among its references, and it told the county: “PNA has never had a contract canceled or been removed from a facility.”

It noted that it was “proud of its record of no substantiated grievances in any facility.”

The Dec. 12 prisoner protest at Reeves County Detention Center started when inmates saw the body of Jesus Manuel Galindo removed from solitary confinement. Inmates contend that Galindo did not receive medical attention for his epileptic seizures.

The Galindo family says it has filed a lawsuit against the Reeves County Detention Center. David Galindo, the dead inmate’s brother, told a reporter after the second riot that started Jan. 31, “The reason they’re having riots is because their personnel is doing the wrong thing just like they did to my brother.”

After the second disturbance started, an inmate called the media. The Pecos prisoner said that the protest began when prison officials placed Ramon Garcia, 25, in solitary confinement after he complained of dizziness and feeling ill. “All we wanted was for them to give him medical care and because they didn't, things got out of control and people started fires in several offices,” said the inmate, who declined to give his name for fear of reprisals by officials.


Lana Williams, a family friend of Garcia, told KFOX TV in El Paso that his medical neglect had been a problem since August 2008. "He's gotten to the point where he can't walk down the hall without holding on to the wall, and this has been going on and getting progressively worse," said Williams. Garcia told her was being been placed in solitary confinement whenever he complained about feeling ill.

PNA’s Medical Gulag

It shouldn’t be surprising that long-running complaints about medical cars abuses sparked the inmate protests at the Reeves County Detention Center. Six years ago the Justice Department found widespread medical abuses at another county-owned, privately run adult detention center, where the same subcontractor, Physicians Network Association, was also the the medical services provider.

Concerned about civil rights violations at the detention center, the Justice Department sent a study team from its Civil Rights division to investigate the jail in May 2002 to determine if there were violations that could be prosecuted under the Civil Rights of Instiutionalized Persons Act (1997).

On March 6, 2003 the Justice Department sent a letter and a long report of its findings to Santa Fe County, which owned the jail and contracted with Management and Training Corporation (MTC), a private prison firm, to operate the jail. The county had an intergovernmental services agreement (IGSA) with the Justice Department to hold detainees waiting trial who were under the custody of the U.S. Marshals Service and the Bureau of Indian Affairs.

MTC subcontracted the medical services part of the IGSA contract to PNA.

Summarizing its findings, the Justice Department stated:

“We find that persons confined suffer harm or the risk of serious harm from deficiencies in the facility’s provision of medical and mental health care, suicide prevention, protection of inmates from harm, fire safety, and sanitation.”


In its report, the Justice Department team specified 52 actions that were needed “to rectify the identified deficiencies and to protect the constitutional rights of the facility’s inmates to bring the jail into compliance with civil rights standards. Thirty-eight of the 52 identified deficiencies related to medical services.


The Justice Department report concluded: “The Detention Center, through PNA, provides inadequate medical services in the following areas: intake, screening, and referral; acute care; emergent care; chronic and prenatal care; and medication administration and management. As a result, inmates at the Detention Center with serious medical needs are at risk for harm.”

The Justice Department’s investigation was sparked by the suicide of Tyson Johnson in January 2002 at the Santa Fe County Detention Center. Johnson, who was awaiting a hearing on charges of stalking, was a longtime sufferer of severe claustrophobia.

In a New York Times (June 6, 2004) story on the Justice Department’s investigation and MTC, Suzan Garcia, Johnson’s mother, said that had tried to contact the jail because she was concerned about her son’s psychological condition. ''I called the jail and asked to speak to a doctor, but they said they didn't have a doctor,'' Ms. Garcia said. ''When I asked to speak to the warden, they just put me on hold and then the phone would disconnect.''

According to the Justice Department’s finding and associated reports, Johnson had asked to see a psychologist, but the 580-inmate jail didn’t have a doctor let alone a psychologist or a psychiatrist

So Mr. Johnson tried slitting his wrist and neck with a razor, and when that failed, as the New York Times reported, he told the jail's nurse, Sheila Turner, “Today I am going to take myself out.”

A guard, Crystal Quintana, told investigators that the nurse replied, ''Let him.'' Ms. Turner denies this, her lawyer said.

As the New York Times recounted: “Ten minutes later, Mr. Johnson, 27 and with no previous criminal record, was found hanging from a sprinkler head in a windowless isolation cell where he was supposedly being closely watched.”

Despite being placed on suicide watch, Johnson hung himself with a supposedly “suicide-proof” blanket inside the isolation cell. His family contends that instead of tending to his psychological problems, the medical staff neglected him and taunted him.

The NYT story by Fox Butterfield described the state of mental healthcare for which PNA was responsible:

“The nearest doctor on contract was in Lubbock, Tex., a two-hour plane flight away, and he visited the jail on average only every six weeks, seeing only a few patients each time, the report found. The nurse had an order in her file to spend no more than five minutes with any inmate patient, which the report said was not enough time.

“There was no psychologist or psychiatrist, and although the nurse had no mental health training care, she was distributing drugs for mentally ill inmates, the report said.

“The jail did have a mental health clinician, Thomas Welter, who was employed by Physicians Network Association, a subcontractor. But he never did any evaluations of mentally troubled inmates, the report said. Instead, he boasted to them about his own history of drug use, according to a recent deposition by Cody Graham, who was then warden of the Santa Fe jail. Not long after Mr. Johnson hanged himself, Mr. Graham escorted Mr. Welter to the gate and told him not to come back.”

Pattern of PNA Medical Malpractice

The Justice Department found a pattern of gross medical care deficiencies at the Santa Fe jail. Among its findings were the following:


·         PNA’s intake medical screening, assessment, and referral process is insufficient to ensure that inmates receive necessary medical care during their incarceration.”

·         “Even when PNA staff identify inmates with serious medical needs during the intake process, they fail to refer them for appropriate care.”

·         “Chart review revealed that of those inmates in our sample who did receive the initial health screening, none were referred to the Health Services Unit for the medical attention they needed.”

·         The grievance system does not provide an avenue for resolving problems of access to health services. The grievances we reviewed included a complaint from one inmate who was supposed to have an x-ray, but had received no response from the Health Services Unit despite having filed two grievances in three weeks.”


Seven Suicide Attempts, One Completed in Seven Months of MTC/PNA


·         “As of the time of our visit, during the seven months since MTC assumed management of the facility, there had been one completed suicide and seven attempted suicides. A review of these incidents reveals that the Detention Center staff fail to respond appropriately to inmates’ indications of mental health crises and possible suicidality.”

·         “For example, one inmate answered several of the initial mental health suicide screening questions in the affirmative, including that he had recently experienced a significant loss, that he felt that he had nothing to look forward to, and that he ‘just didn’t care.’ He reported that he had been diagnosed with Post Traumatic Stress Disorder and that he was taking an antidepressant for this condition. He also stated that he felt that he needed to see a psychologist. Despite these indicators, the screening nurse concluded that the inmate needed only a routine mental health referral, as opposed to an immediate mental health evaluation and determination whether mental health services were necessary.”

·         “Another incident involved an inmate who cut her wrists with a razor and was placed on a 15-minute suicide watch in the medical unit. According to the subsequent investigation of the incident, the inmate was upset because her medications were stopped. The inmate was treated for lacerations to her wrists and released from suicide watch without ever receiving a mental health evaluation or mental health clearance.” An inmate placed on watch status in a medical unit cell for his own safety due to mental illness and seizure disorder was able to cut both of his wrists with a razor blade within 5 minutes of his arrival in that cell. The only way that staff knew that the event had occurred was when blood began running down the floor from his cell."


Five Minutes Per Patient


·         “The nurse practitioner’s personnel file included a memo from the Vice President of Operations of PNA instructing her to see one patient for each five minutes of scheduled clinical time. Many inmates, particularly those with acute or chronic conditions, require significantly more clinical attention to ensure that their needs are adequately addressed.”

·          PNA does not test for sexually transmitted diseases (STDs). STDs are prevalent in jail populations. Left untreated, STDs can cause brain and organ damage and damage to fetuses. PNA’s failure to screen for STDs places the inmates and the community at risk.”

·         PNA fails to provide timely access to appropriate medical care for inmates when they develop acute medical needs. Medical care is unreasonably and unnecessarily delayed and, even when provided, often inadequate.”

·         Even once inmates succeed in getting to the Health Services Unit, they frequently receive substandard care. We reviewed the medical records of ten inmates seen for primary care by the nurse practitioner within a one-month period. Six of the ten inmates received substandard care.”


PNA’s Failure to Respond to Acute Medical Needs


·         “Additional chart reviews confirmed PNA’s failure to respond to inmates’ acute medical needs. For example, one inmate reported breast lumps and lumps in her armpit, chest pain, and swelling in her legs and feet. Although a mammogram was ordered in October 2001, it had not been done by the time of our visit to the Detention Center seven months later.”

·         “At the time of our visit, the only physician providing supervision or care at the Detention Center was the doctor who is the Chief Executive Officer (CEO) of PNA and is based in Lubbock, Texas. As the CEO of PNA, this doctor has numerous responsibilities, including supervising the medical care at each of the facilities at which PNA provides care throughout the south and southwestern United States. This physician was visiting the Detention Center an average of once every six weeks, and saw only a few patients during each visit. While he is available by telephone for consultation, he does not visit the Detention Center frequently enough to provide adequate supervision. Given the deficiencies in care and other problems identified in this letter, additional physician supervision at the Detention Center is necessary.”


No Pre-Natal Care, Improper Treatment for Seizures


·         “PNA fails to provide inmates with needed medications in a timely manner, and fails to monitor medication in inmates with serious medical needs.”

·         The Detention Center fails to provide for continuity of medications for inmates upon arrival at the facility. Several files we reviewed revealed that the nurse practitioner does not continue the same medications for inmates that were prescribed for them prior to their incarceration. Sometimes the nurse practitioner simply discontinues the medication, and sometimes she changes the inmate’s prescription to older, less expensive medications which are significantly less effective.”

·         PNA fails to provide adequate prenatal care for pregnant inmates. Of the four pregnant women at the Detention Center at the time of our visit, none had any prenatal visit with an OB/GYN during their incarceration documented, despite the fact that two of the women were in their third trimester of pregnancy and near term.”

·         “An inmate had been prescribed a medication for his seizure disorder, in addition to several other medications, and his blood levels of the seizure medication had been measured. Although the laboratory results showed that the amount of this drug in his system was not enough to achieve the intended therapeutic effect, there was no reference to this finding anywhere else in his medical record. Moreover, staff failed to respond appropriately, such as adjusting his medication. Seven days later, the inmate attempted suicide by cutting his wrists, then suffered a seizure.”


Keeping it Cost-Effective


·         “PNA’s formulary does not contain effective medication for inmates with serious medical needs such as hypertension, heart failure and diabetes. In addition, the formulary includes many less expensive, less effective medications than are currently available for the treatment of some diseases.”

·         “Some inmates at the Detention Center are currently provided with less effective medications with greater side effects than they had received prior to incarceration, which can lead to deterioration in inmates with mental illness and end-organ damage in inmates with diseases such as hypertension and diabetes.”

·         Even when staff did monitor medication levels, they failed to respond to indications that an inmate’s dosage was inappropriate. Although the laboratory results showed that the amount of this drug in his system was not enough to achieve the intended therapeutic effect, there was no reference to this finding anywhere else in his medical record. Moreover, staff failed to respond appropriately, such as adjusting his medication. Seven days later, the inmate attempted suicide by cutting his wrists, then suffered a seizure.”


PNA and MTC Leave Town


Neither MTC nor PNA stuck around Santa Fe to help the country resolve its problems with the Justice Department. Both MTC and PNA said they had to terminate their contracts because they were losing money.


Soon after the Justice Department issued its findings in March 2004 on medical care and other problems at the Santa Fe County Detention Center, PNA pulled out of its contract with MTC. A year later in April 2005, MTC announced that it had “chosen to end this contract because it has not been possible to operate profitably. Under two different contracts and with two different medical providers, MTC and both medical providers have lost money.”


Before the private prison companies terminated their unprofitable contracts, their personnel left town. MTC asked Warden Cody Graham to leave his job in Santa Fe, and he transferred to another MTC county jail in Gallup, New Mexico. According to a heart-rending investigative story in the Santa Fe Reporter (April 2, 2003)on the death of a jail inmate because of deficient medical care, PNA’s regional medical consultant left at the same time as the warden. That PNA supervisor was Katherine Graham, wife of the MTC warden.


A story in the Albuquerque Journal (June 28, 2004) on the “tough negotiations” following “state and federal audits slamming the facility for inadequate  medical services” reported, “PNA will not return if and when the county and MTC reach a new agreement, jail administrators have said.”


County Commissioner Paul Duran recommended that the county would do a better job running the jail. He noted that the Utah-based MTC – a for-profit company – was not providing enough medical staffing or case managers to deal with inmate needs. “I think it’s the profit element that is the root of all these problems.” The county did take over management of the jail after MTC left, and worked with the Justice Department to rectify its findings of deficiency.


Judith Greene, director of Justice Strategies, echoed Commissioner Duran’s observation. She told the New York Times, ''This goes to the heart of the problem in the private prison business,'' Ms. Greene said. ''You get what you pay for.''
Tom Barry directs the TransBorder Project of the Americas Program ( at the Center for International Policy in Washington, DC. He blogs at