A short jail stay becomes death sentence

Tyler Butler walked to the Hopkins County Detention Center in April, 2010 to serve a short sentence for a misdemeanor.

He vomited twice as a deputy helped him change into a prison uniform, was sweating heavily and could barely stand. Butler, 25, told the deputy he had a MRSA infection and was under medical care for several conditions, including high blood pressure and rheumatoid arthritis.

The deputies dealing with Butler were concerned about his medical condition and didn’t want to admit him. They called the only medical person on duty, a licensed practical nurse who worked for Southern Health Partners, the for-profit that Hopkins County had contracted with to provide health care in the jail.

“I have staph infection all over me ... it’s in my groin ... I don’t need to be here,” Butler told that nurse. Without consulting the physician on call, or anyone else with more training or experience, she told the deputies that Butler could be admitted.

That’s the horrific beginning to a story that only gets worse. Butler, never seen by a physician, died three days later in his jail cell. His story is recounted by R.G. Dunlop in the latest installment of the Kentucky Center for Investigative Reporting’s ongoing examination of the severe problems in Kentucky’s local jails, and in an opinion by the 6th Circuit U.S. Court of Appeals.

Butler was one of about 140 who died in Kentucky’s county jails in the last five-and-a-half years, according to KyCIR.

Despite this death toll, legal challenges that have resulted in large settlements to survivors and at least one federal investigation, the the Kentucky Department of Corrections has taken little interest in investigating or finding ways to improve the medical care afforded prisoners in jails. That’s a crime.

The Department of Corrections is within the Justice and Public Safety Cabinet, which just got new leadership when Gov. Matt Bevin appointed John Tilley, a Democrat, as secretary of the cabinet.

Tilley, an effective advocate for penal reform in the House, should use his skills and good working relationship with Senate Judiciary Committee Chairman Whitney Westerfield, a Republican, to ensure that being imprisoned in a county jail for a misdemeanor violation doesn’t amount to a death sentence.

Jails are often money-losing propositions for counties. Companies like SHP win contracts by promising to keep medical service costs low, even though Kentucky Department of Correction guidelines say that emergency health care on par with what’s available elsewhere in the community, “shall be available to all prisoners.”

Butler didn’t get that kind of care. “The undisputed facts establish that Butler’s urgent need for medical treatment was apparent the moment he walked through HCDC’s door,” the court wrote. “Yet, SHP staff did not provide it in spite of Butler’s requests for help and the urging of jail deputies.”

The day after Butler’s death SHP’s president and the vice president of operations visited the jail and, after a brief review, reported that “everything looks fine.”

It’s a new definition of “fine.”

Physicians who contract with SHP and other for-profit providers spend very little time in the jails. Nurses on site are often LPNs, who are not authorized to diagnose medical conditions. There is abundant testimony that the nurses signed forms saying they had read SHP’s written policies and procedures but there was no effort to assure they had actually read or understood them, no ongoing evaluation of their work, no training in the medical rights of prisoners, or regular review of the medical notes they were supposed to make.

KyCIR found no evidence that Corrections has taken any interest in improving this Dickensian world. Perhaps that’s not surprising since bringing the hammer down on cash-strapped, elected county judges and jailers could have a serious political downside.

But political expediency is no excuse in the face of unnecessary deaths, costly legal settlements and insults to our concept of basic human rights.