Special Report: Dying to get out
Advocates face tough challenge

by MIKE FUHRMAN of the Tribune's staff
Published Monday, September 30, 2002

KANSAS CITY — Karen Russo wants to put Correctional Medical Services out of business.

As president of the Wrongful Death Institute, she has spent the last year working to ensure the state's inmate health-care contractor provides ailing Missouri inmates with the medical care they are entitled to under federal law.

She's talked with dozens of inmates and their families, reviewed thousands of pages of inmate grievances and medical records, and implored the company to do what she believes is morally and legally right. She's exchanged terse letters with CMS administrators and come to the conclusion that her pleas have had little impact - that the company cares more about protecting its profits than the health of Missouri inmates.

It will take a multimillion-dollar court judgment against CMS and the Missouri Department of Corrections to get their attention, Russo said. That has become her goal, her purpose.

"Cost containment are the two words that motivate CMS and DOC," she explains matter of factly.

Russo claims that CMS-contracted doctors and staff members in Missouri prisons consistently deny or delay treatment for scores of inmates suffering from chronic illnesses and debilitating injuries. "They're horrified, they're scared and they're sick," she said. "They've been run through the ringer."

CMS officials insist that their health-care workers and contracted physicians provide inmates with high-quality care and that Russo's complaints are flat-out wrong.

"Ms. Russo has no idea what she's talking about," said company spokesman Ken Fields. "My understanding is she has no medical or legal training, but she makes vague, baseless allegations that are without merit."

Working from her Kansas City home, Russo spends her days corresponding with prisoners and talking on the phone with relatives of sick inmates. She's amassed boxes of records she claims document the case for replacing CMS. Mildred Crider, Leora Taylor and LaMonte Ashley are among her clients.

When a woman calls Russo to seek assistance for her ailing son, Russo provides a shoulder to cry on and explains that CMS has a bad track record, an assertion the company disputes.

Russo takes down the inmate's personal information and asks the woman to forward her son's medical records and grievances to her. The Wrongful Death Institute, Russo tells her, doesn't charge for its services but accepts donations from inmates and relatives who can afford it. "Send whatever you can," she says.

She has a small band of volunteers and has an agreement with a Kansas City law firm to pursue a class-action civil rights lawsuit against CMS and DOC.

Inmates swear by Russo.

"She's godsent to us," said Raymond Young, a former Columbia resident serving time at Northeast Correctional Center for a drug charge.

"She could be doing whatever she wants to do out there. She's our voice," Young, 59, added. "She has an army out there, an army of comrades who will go to the end of the earth to follow her."

Young, who was hit in the back with a baseball bat in 1970, has a chronic back condition and diabetes. He's had five operations and is now mostly confined to a wheelchair. He's also watched several of his friends die in prison.

He claims CMS-contracted doctors are "for documentation only" and that his condition has steadily deteriorated since he was imprisoned in 1995 as a persistent offender.

Citing probable litigation over Young's health care, CMS officials declined to respond to his allegations.

DOC officials said after five surgeries very little can be done for Young's back.

They attribute complications related to his diabetes to Young's poor diet and unwillingness to quit smoking. A record of his prison canteen purchases documents his affection for Ding Dongs and Ho Hos.

Randee Kaiser, a DOC official who monitors CMS' work in Missouri prisons, said Young was seen by a doctor more than 20 times and nurses 161 times in the first 5 months of this year. Since 1996, DOC records show he has been examined by 91 outside specialists.

"Here is a man who is in the medical unit almost every day," Kaiser said. "He has unrealistic expectations. Discomfort is not proof of poor care."

Young said he is working with Russo to make a difference for himself and for the men and women who will follow him into the Missouri Department of Corrections.

"Until you have these 12s on and walk that mile, you don't have a clue," said Young, 59. "They are killing us. They are murdering us  legally," Young said.

Few lawyers and advocacy groups are working to ensure that Missouri inmates receive the health care they are guaranteed under federal case law.

The legal standard for winning inmate cases is difficult to meet. Lawyers for inmates must prove that health-care providers acted with "deliberate indifference" rather than negligence, the typical standard in medical malpractice lawsuits.

"The law in these cases make it difficult for a plaintiff to prevail," said Richard Sindel, a St. Louis attorney who unsuccessfully sued CMS on behalf of female inmates at Chillicothe Correctional Center. "It's almost as if you have to have a doctor who is aggressively maltreating you."

Sindel said he's constantly inundated with mail from inmates seeking his help. He doesn't have any current lawsuits pending against CMS and is hesitant to get involved because of the time and expense of prison litigation.

And even when you have a case that meets that standard, it's still difficult to convince a jury to award damages to inmates.

Even St. Louis attorney David Ferman, who successfully sought damages for 60 Missouri prisoners injured in the 1997 Texas prison riots, said he is reluctant to take on inmate clients.

"It's difficult to win with a jury," he said. "People don't feel sorry for them. They're usually uneducated, unattractive people" who have little credibility on the witness stand even if they're telling the truth.

Their cases "are not that sexy to a jury, and there's not that much money at the end of the rainbow," Ferman added.

CMS lawyers are proficient at defending the company from lawsuits related to medical care.

Fields, the company spokesman, said the companys performance in Missouri's prison infirmaries has insulated it from large court judgments.

"CMS' record in inmate health-related litigation is a strong one and reflects the quality of care provided to inmates in Missouri ," Fields said. "During the past 10 years, approximately, the courts have ruled in favor of CMS in every medical malpractice or wrongful death case brought before them for a verdict."

Nationally, 95 percent of the cases against CMS' many of which are filed by inmates without legal counsel - are dismissed, Fields said. The company has settled "a very small minority" of cases, he added. The terms of out-of-court settlements are typically confidential.

In the decade since CMS began staffing Missouri's prison infirmaries, health-related lawsuits filed by inmates have decreased dramatically. The state Department of Corrections settled five cases involving inmate health care out of court between 1992 and 1996 but has not settled a case since then, a spokesman for the attorney general's office said.

That hasn�t stopped Russo and St. Louis lawyer Sarah Cato, who has a private practice, from working to help ailing inmates.

"They need assistance quicker than we can get it to them," said Cato, who runs the Civil Rights Legal Defense Team and counts more than 200 inmates among her clients. "We're making an effort. I don't know if we're making a difference."

Cato concedes that it's not easy working on behalf of murderers, rapists, child molesters and other criminals that most of society finds repugnant.

"When you look at their crimes, some of them are quite heinous," Cato said. "But they are somebody's son or daughter, mother or father, sister or brother."

Her clients in Missouri prisons include an inmate who is going blind, a man suffering from morbid obesity and an amputee whom she claims lost a testicle and mass of flesh in his buttocks from an untreated or under-treated infection.

CMS officials would not comment on individual inmates - health care without a confidentiality release from the inmates.

Like Cato, Russo said her work is inspired by her Christian faith. Both plan to continue their work until they're satisfied Missouri inmates are getting the care they deserve.

"I don't think God's finished yet," Russo said. "I just think he's real upset."

Reprinted with Permission