Prison Health Services Inc., which provides medical care to Maryland's 24,000 inmates, has disciplined three nurses and a physician assistant at the Baltimore women's detention center in connection with the treatment of Deborah Epifanio, the 34-year-old woman whose death last month is being investigated by the state.
Epifanio died Sept. 14, four days after being taken by ambulance from the jail to University of Maryland Medical Center, where doctors diagnosed an advanced case of cryptococcal meningitis. Hospital records indicate she had been experiencing fainting spells for several days by the time jail caregivers sent her to the emergency room. Records also mention a head injury she apparently incurred in a jailhouse fight, although state correctional officials say no incident report was ever filed.
Members of Epifanio's family, who say they saw correctional employees covering her bruises with makeup when they arrived at the hospital to view her body, are seeking answers about her treatment at the jail. They wonder whether quicker or better care might have saved her life.
In a new disclosure, a July 13 letter from Epifanio stated that she also had been hospitalized for fainting spells for several days while in the custody of the Maryland Correctional Institution for Women in Jessup. She wrote the letter to a community outreach group from the prison infirmary, which is also run by Prison Health Services.
On Aug. 20, she was transferred to the city detention center, and records from her September hospitalization indicate that doctors were not made aware of the earlier fainting episodes or the earlier hospitalization.
"I'm not getting any answers yet" from the state, said Epifanio's sister, Mildred Revis, who learned of the letter from a supervisor at You Are Never Alone, a prostitution outreach project in West Baltimore that had been counseling Epifanio. "We're just finding out a little information on our own each day."
State officials won't comment on any aspect of the case, pointing to a pending internal investigation by the Department of Public Safety and Correctional Services.
Prison Health Services, a subsidiary of American Service Group Inc., based in Brentwood, Tenn., released a statement yesterday saying that the four employees -- a registered nurse, two licensed practical nurses and a physician assistant --had been "reprimanded and assigned to new duties" as of Oct. 6, "upon completion of interviews and investigations. ... The analysis revealed that these employees did not perform a function customarily done during the intake process."
The actions come as Prison Health Services faces harsh criticism for purported lapses in its institutional medical care. Palm Beach County, Fla., officials recently implicated the company's shortcomings in nine inmate deaths during the past two years. A report last June by the New York Commission on Correction blamed the company's cost-cutting measures for an inmate's death after his prescribed medication was withheld.
In Baltimore, a 2002 report by the U.S. Department of Justice found that at least six deaths at the city's detention center were due to chronic health neglect. Attorneys for the American Civil Liberties Union and the Public Justice Center alleged in a filing last March that medical care at the detention center is so poor that it is unconstitutional.
Prison Health Services has provided medical care for Maryland's inmates since 2000, under a contract due to expire June 30. By then the state will have paid the company about $261 million for its services, although a company press release last July said that the contract had become a money loser -- with $1.1 million in losses coming in last May alone -- because of rising hospitalization costs, a growing inmate population and a greater number of mental health patients and patients infected with the AIDS virus.
Epifanio fell into the latter category. Her family described her as mildly mentally retarded, and she was often in and out of jail on drug and prostitution charges. She had been seeking counseling from the YANA project to break the cycle when she was imprisoned at Jessup last May on another prostitution charge.
She then wrote Tracy Hood, a YANA supervisor, last July 13 from Jessup, saying in her letter, "I only have about two months left [in prison]. Then I would like to come back to your program. I'm tired of working the streets tricking always in and out of jail." A few lines later she added, "I'm in the infirmary. I been here because I fain(t)ed and they rush me to the hospital in Laurel Md. I was there 5 days."
When she left Jessup on Aug. 20, she was transferred to the city detention center to await trial on a pending charge from 2000.