One Dead in Ohio
In early July, Rodney "Rocky" Eickstadt checked into a Columbus, Ohio, jail for what he thought would be a 175-day stretch on a drunk-driving rap. The 35-year-old electrician, who had never committed any other crime, had no idea it would turn out to be a death sentence.
Eickstadt, unbeknownst to himself or his family, had developed a severe case of diabetes, a disease that can killif left untreated. And untreated it was.
"I believe they killed my son," said Eickstadt's 71-year-old mother, Dorothy.
The main target of her anger is Prison Health Systems, the huge for-profit corporation that runs the medical ward at Franklin County Correctional Center II. On January 1, Tennessee-based PHS, which takes care of 175,000 inmates in 27 states, is due to take over management of New York City's jail medical system. The new contract, worth an estimated $300 million over the next three years, is supposed to represent a new day in the long and troubled history of the city's correctional health system. But if Rocky Eickstadt's experience is any guide, the city should proceed with extreme caution.
For two and a half weeks, PHS medical staffers apparently failed to diagnose, treat, or even acknowledge Eickstadt's life-threatening diabetic symptoms. And he had a medical encyclopedia's worth: vomiting, constant urination, shortness of breath, fatigue, and bleeding gums, according to records obtained by the Voice.
The pattern of apparent neglect lasted right until the bitter end. Even after Eickstadt was found writhing on the floor of a holding cell with barely detectable blood pressure, the company's nurse waited 15 minutes to call a PHS physician. Finally, on the morning of September 11, Eickstadt was shipped to the county hospital, where he died two days later.
The county, which signed a $2.5 million a year contract with PHS in 1998, wasted no time in letting the company know who was liable for any lawsuits. "Despite clear indications . . . of a diabetic condition, [PHS] personnel did nothing to address or diagnose his diabetes," wrote Jeffrey Glasgow of the Franklin County attorney's office.
"We plan to sue them all," says Michael Rourke, who is representing Eickstadt's family in the case.
A PHS spokesperson says it is company policy to withhold comment on deaths at its facilities until staffers conduct a "mortality review" of prison and medical records. In a September 18 letter, Vincent Spagna, the company's medical director at the jail, admitted that he too had "concerns about the performance of the nursing staff," though he had not yet drawn any conclusions.
PHS, which is currently in final contract negotiations with New York's Health and Hospitals Corporation, was supposed to be a godsend. For the past three years, the city's 13,000 inmates, most of them housed on Rikers Island, have been under the care of St. Barnabas Medical Center. The St. Barnabas contract, inked in January 1998, was hailed as a money-saving innovation, imposing a managed-care model on a system with out of control costs. Yet, almost immediately, the scheme collapsed. Within the first six months, two city inmates died amid allegations that serious injuries and illnesses were improperly treated, and Manhattan DA Robert Morgenthau opened an investigation into the hospital's patient-care practices.
The PHS contract, which is due to be approved by HHC's board by early December, is basically a back-to-the-future plan, replacing the lump-sum payment system that caused so many problems under St. Barnabas. From now on, the city will pay its medical contractors for each service performed on-site. The idea is to create incentives for more aggressive treatment of inmate illnesses; St. Barnabas was often criticized for skimping on care in order to cut costs under the HMO model. Under the new plan, EMS will transport the most severely ill inmates for care in city hospitals, which will pick up the cost.
In Septemberat almost exactly the time Rocky Eickstadt was wasting away in Ohiothe city was selecting PHS over St. Vincent's Hospital and Capital Health Management of Queens for the contract. Sources close to the process say PHS was the lowest bidder.
Recently, corrections officials around the country have begun to raise serious questions about PHS's performance in their jails. The company has come under fire for failing to maintain adequate staffing levels or acceptable patient care in Maine, Georgia, Pennsylvania, Florida, and Washington.
In Philadelphia, PHS was forced to make improvements after an independent monitor released a scathing 1998 report that found serious deficiencies in the company's treatment of acute illnesses and in its propensity for hiring subpar doctors. In one case cited in The New York Times, PHS staffers were alleged to have waited five months to treat a man who was suffering from a life-threatening aneurysm.
There were other allegations. In 1994, officials in Pinellas County, Florida, accused the company of contributing to the death of a 46-year-old female inmate, who pleaded for, but never received, her prescribed heart medication. In addition, a small county jail in Maine recently fired the company for inadequate staffingthe same problem that led the Georgia state corrections department to fine the company $250,000 in 1995.
Ernesto Marrero Jr., the executive director of Correctional Health Services, which will oversee compliance with the New York contract, says that won't happen here. "We've identified certain positions, mandated posts, that they will have to fill," he told the Voice. "If they don't have a certain number of doctors and nurses and licensed practical nurses, they will get fined $1000 a shift. They seem to me to have an understanding that they will need to maintain a level of quality to keep the contract."
But some of the doctors at Rikers apparently have big problems with PHS. Several of them, along with a number of support workers, have already left the island rather than work for the company, insiders say. Others are considering a speedy exit. "The staff is scared because PHS has a bad reputation," one Rikers administrator told the Voice. "They are cheap and they don't pay well and they have bad press. People are very upset and they're searching for jobs.
"If someone called me up today and offered me something similar, even for a little less money, of course I'd jump at it."
Marrero says they have nothing to worry about. He says he will direct his 15-person quality-assurance unit to monitor the company's performance "day to day."
"I have no problems with PHS's supervisory culture," he added.
Rocky Eickstadt's family, which will soon file a multi-million-dollar lawsuit against PHS, would beg to differ. There was no supervisory culture, they say.
Within a few weeks of entering the Franklin County jail in July, Eickstadt began complaining of constant urination and bleeding gums, according to his mother, who visited him in jail every Thursday and Sunday. By August 23, his symptoms had worsened and his mother convinced him to submit a "call card" to PHSwhich contained details of his condition and a request for medical help.
If the company had heeded the warning signs then, it's possible Eickstadt would be alive today. But the card was apparently never read by anyoneand Eickstadt was given no tests and no treatment. "The call card information alone strongly suggests a serious diabetic condition," the county's attorney, Jeffrey Glasgow, claimed in his letter to PHS and its subsidiary.
Despite the severity of his symptoms, it was 18 days before Eickstadt was seen by the company nurse. By September 10, he was so ill he reported for emergency sick call. (Why didn't he fill out a second call card in the interim? It's not clear, but his mother says he was deeply depressed about being locked up and about his recent breakup with the mother of his two-year-old daughter. "I'd tell him to take care of himself and he'd tell me, 'They just laugh at you in here, Mom.' ")
By the time the nurse saw him on September 10, Eickstadt's condition had deteriorated to the point where he could hardly walk, talk, or catch his breath. These symptoms were all consistent with diabetes, yet the examining nurse left Eickstadt in his cell, and, inexplicably, ordered him to be placed on a diet of clear liquids for three days. "Alert medical if problem continues," she wrote in the log. She did collect a urine sample, but no urinalysis was ever performed, according to medical records.
That afternoon, his mother made her regular Sunday visit and was shocked to find what looked like a corpse slumped in the visiting room across from her. "He just laid his head on the table," she says. "Then he said, 'Mom, I can't breathe, why don't you leave.' That was the last time I saw him alive."
The next morning, at 3:20 a.m., Eickstadt apparently passed out, and deputies brought him to a holding cell adjacent to the nurses' station. His blood pressure had plummeted to an alarming 98/48. Still, no one called a doctor. Eickstadt was left alone, untreated and delirious, for the next four hours.
By 7:20 a.m., he was barely alive. When a nurse peered through the cell window, she saw Eickstadt curled up on the floor with his feet propped up on the toilet; his blood pressure was scarcely measurable. She then scrawled this in the patient's "progress notes": "Asked inmate where he hurts. Inmate makes moaning sound."
Amazingly, the nurse waited another 15 minutes to call a PHS doctor, according to her notes. Later that morning, Eickstadt was transported to Columbus Community Hospital, where a test showed he had a blood sugar level of 1397about 10 times normal.
Eickstadt died on September 13 of "acute diabetic ketoacidosis"a failure of all major organs brought on by diabetic shock.
Ernesto Marrero believes that none of this can happen in New Yorkand that the Eickstadt case won't influence the city's ongoing negotiations with PHS. "I don't see how this will affect the selection process," he said. "Even in the best hospitals in New York City, you'll find cases like this."
Dorothy Eickstadt doesn't think her son was treated like a hospital patient; she thinks he was left to die like a sick dog. She had no idea PHS was coming to New York and was surprised to hear that anyone outside Ohio would be interested in her son's death. She said she had hoped her son would get out of jail, win his battle with the bottle, and get back to his job.
"The last thing I told him was, 'Keep pushing, Rocky, keep pushing,' " she said.
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