Care at NC jail was supposed to be ‘best in the nation.’ So why have inmates died?

When Tom Keith was Forsyth County’s district attorney in 2000, he filed and then dismissed a charge of involuntary manslaughter against a corporation providing medical care at the Forsyth County jail.

But that dismissal came with an agreement: the company, Correctional Medical Services, would give Forsyth County $200,000 to ensure that “the medical unit at the jail is the best in the nation,” according to a news release that Keith sent out in 2000.

So on July 8, when Keith’s successor Jim O’Neill announced that a nurse and five officers were charged with involuntary manslaughter in the death of inmate John Neville, Keith was upset.

“This really bothered me because this is absolutely a preventable death,” Keith said. “And why 25 years later haven’t we learned our lessons?”

Keith’s comments in an interview with The News & Observer came just days before Forsyth County renewed its contract with Wellpath, the current medical provider at the jail and one with its own history of trouble at the Forsyth jail and across the country.

Sheriff Bobby Kimbrough said he supports continuation of WellPath’s work at the jail and appreciates the changes the company has made to meet Forsyth County’s needs.

The new $4.3 million contract started Tuesday and adds another year to the current $13.2 million, 3-year agreement.

John Neville

Neville’s cellmate woke up to him thrashing on the floor.

Neville, 56, died two days later on Dec. 4, 2019, at Wake Forest Baptist Medical Center. An autopsy report blamed Neville’s death on jail employees’ response to Neville’s medical crisis.

A nurse told Neville that he was having a seizure. But instead of taking him to a medical facility, Neville was wheeled to a suicide-watch room where jailers laid him on his stomach, secured his arms behind his back and raised his legs to his wrists.

Neville’s autopsy report said that within four minutes he stopped moving. He repeatedly told staff that he couldn’t breathe. He asked for help. He was ignored.

The autopsy report said that Neville was in the same position for 12 minutes before employees realized that he was telling the truth. He stopped breathing and his heart also stopped.

Video released by a judge at the request of the N&O and other media outlets shows that a nurse walked into the cell, checked Neville and walked out with everyone else. But she continued watching him through the window before telling a detention officer something was wrong.

The autopsy said Neville died from both positional and compressional asphyxiation from the way he was positioned in the jail cell.

Clarence Cousins

Clarence Cousins, 37, found himself in the Forsyth County jail on Sept. 17, 1996, after the feds charged him with trying to sell 100 grams of marijuana, Keith wrote in the 2000 news release, which the N&O obtained.

Cousins told the nurse that he drank a fifth of liquor and a quart of beer on a daily basis, though his story about how much he drank that day varied, according to Keith.

Keith said Cousins’ admission led him to be housed in a portion of the jail reserved for people with medical problems so he could be monitored for delirium tremens symptoms.

Delerium tremens is a condition that can lead to cardiovascular collapse for a person who abruptly stops alcohol abuse. The condition is fatal 37% of the time, according to the National Center for Biotechnology Information.

Around 5:30 p.m. on Sept. 17, 1996, Cousins rang a cell alarm bell and was sweating and talking incoherently. At 12 a.m. he was examined by nurse Arthelia Moser, who worked for Correctional Medical Services. Keith’s news release said that Moser diagnosed Cousins with a mental disorder and not delerium tremens.

At 3:45 a.m., Cousins died.

Keith said the N.C. Office of the Chief Medical Examiner concluded he died of complications from delirium tremens.

At the time CMS was the nation’s largest correctional health care firm, based in St. Louis, and provided health care to inmates in jails and prisons in more than 30 states. It was reported to be three times larger than its closest competitor, according to Keith.

And in 1996, CMS had a contract with the Forsyth County jail valued at $1.5 million.

Moser was one of two CMS employees on duty the night Cousins died, according to the news release.

And CMS was at the center of controversy at the time for deaths of inmates at several prisons.

Keith had asked the State Bureau of Investigation to look into Cousins’ death. The SBI released a multi-volume report to Keith in early 1998. But Keith waited to press charges until a wrongful-death lawsuit concluded that same year. CMS settled the case by paying $175,000 to the Cousins’ estate.

On Aug. 16, 1999, a grand jury indicted Moser and CMS on charges of involuntary manslaughter. Keith became the first prosecutor in North Carolina to charge a corporation.

In his news release, Keith laid out his reasoning for charging the corporation.

“CMS engaged in conduct in such a reckless and careless manner as to show a thoughtless disregard or a needless indifference to the rights and safety of others…,” Keith wrote.

He cited insufficient staffing with only two people for 600 inmates. And he said CMS violated the law and the National Commission on Correctional Health Care standards for not having a care plan for Cousins and failing to adequately train Moser.

Though Moser faced jail time for her actions, CMS could only receive a fine.

Attorneys for CMS argued that a corporation could not be charged with involuntary manslaughter under North Carolina laws, but a Superior Court judge ruled in April 2000 in Keith’s favor, as did the Court of Appeals in May 2000.

But Keith ended up dropping charges against both Moser and CMS.

In his news release, Keith said that both prosecutors and the defense agreed the case would result in years of costly litigation and appeals.

At this point, four years had passed since Cousins’ death. Keith said he determined in 2000 that CMS had changed the working conditions at the jail and found a good working environment between CMS employees and jailers. He said in the news release that it was in the jail’s best interest to allow CMS to continue implementing its programs.

Keith said in his news release that CMS already made reforms at the jail that far exceeded what remedies the court could impose if the company was guilty.

The company had increased medical personnel and supervision during the evening and done specialized training for nurses and jailers in the recognition of life-threatening conditions that are prevalent in a detention setting, including alcohol withdrawal.

Where is the money?

When Keith read about Neville he said he questioned what happened with the $200,000 CMS paid the jail that played a part in his decision to drop the charges.

An answer to that is hard to come by.

Forsyth County Assistant County Attorney Lonnie Albright said he does not know. “I haven’t a clue,” Albright wrote in an email. “That was before my time.”

Albright said Keith would be in the best position to answer that, but Keith had no oversight of the money.

That money for inmate health care was part of $525,000 that CMS paid local agencies, which Keith outlined in his news release about why he agreed to drop the charges.

The company’s money also went to an independent review committee to monitor health care in the jail, implement health-related programs and benefit various health care programs that provide services to the jail population.

Additionally, Forsyth County had, in response to Cousins’ death, formed a three-member board to oversee improvements made at the jail.

State laws

In 2001, Keith asked the General Assembly to amend North Carolina’s homicide laws to allow companies to be charged with murder or manslaughter.

But Keith said that request got him nowhere.

“At that point, I had been down there several hundreds of times,” Keith said. “I knew how the system worked.”

Keith said he had bipartisan friends in the General Assembly who mutually called on one another when they needed help. Keith said he had access and knew how to get what he needed.

But this was different.

“In essence, no legislator wanted every corporation in North Carolina against him because suddenly someone criminalized something that had been civil,” Keith said.

Keith said even his closest friends told him to go away.

And when O’Neill considered who to charge in Neville’s death, Keith’s problem weighed into his decision.

“The law in North Carolina does not provide a way for corporations to be charged with murder or manslaughter,” O’Neill said in an interview with The News & Observer.

Health care

The Forsyth County jail no longer uses CMS.

In 2011, the company merged with Prison Health Services, Inc. and became Corizon Health. The company touts itself as one of the leading providers of correctional healthcare services in the United States.

In 2004, Forsyth County switched its correctional healthcare services provider to NaphCare. Albright said NaphCare was succeeded by WellPath, known then as Correct Care Solutions, in 2012.

Federal charges were filed last October against Correct Care’s founder, Gerard Boyle, and former Norfolk, Virginia, Sheriff Robert McCabe for an alleged bribery scheme that funded McCabe’s election campaign in exchange for the jail’s contract.

Correct Care Solutions was founded in August 2003. According to the company’s website, Wellpath provides medical and behavioral health care to correctional facilities, inpatient and residential treatment facilities, forensic facilities and civil commitment centers. The company employs nearly 16,000 people at more than 500 facilities in 33 states across the United States and Australia providing care to more than 300,000 people.

In North Carolina, Mecklenburg and Guilford are among the other counties that contract with WellPath.

“They are, I am told, the largest inmate healthcare provider in the country,” Albright wrote in an email.

Federal court records list WellPath as a defendant in at least 250 lawsuits and Correct Care Solutions as a defendant in at least 1,600 lawsuits.

Neither the company’s attorney or spokeswoman responded to the N&O’s voicemail message and three email attempts last week to contact the company for comment on this article. The spokeswoman replied to a voicemail left at the attorney’s Raleigh-based office with a message on LinkedIn asking for questions to be sent to her email but did not reply to the subsequent emails.

Deaths in jail

Since 2005, at least 19 people have died at the Forsyth County jail, according to a database of jail deaths maintained by The News & Observer. That number ties with Guilford County for number of deaths, but is less than in Wake and Mecklenburg’s jails which both have had more than 20 deaths, the database shows.

At least six inmates died at the Forsyth County jail between 2012 and 2017 during WellPath’s first contract with the county, the database states.

Four deaths at the Forsyth County jail have prompted lawsuits against WellPath, while the fifth was classified as a suicide and the sixth was from complications due to HIV.

▪ On Aug. 3, 2013, Dino Vann Nixon died after being denied in the jail a medication he had taken for years under his doctor’s instructions. A lawsuit filed by Nixon’s family said he died from withdrawal from benzodiazepines that caused coronary artery disease and an abnormal enlargement of the heart, Triad City Beat reported.

The lawsuit alleged that Correct Care Solutions failed to give Nixon his medication and assumed he was suffering from alcohol withdrawal despite having no history of alcohol abuse. Forsyth County officials settled with Nixon’s wife by paying her $180,000.

▪ On Sept. 18, 2014, Jennifer Eileen McCormack Schuler, 31, who was three months pregnant, died of hypoxic brain injury, acute kidney failure and dehydration, according to the Winston-Salem Journal. Schuler had been nauseous and had a history of throwing up throughout her pregnancy and had both in the jail, the newspaper reported. She also barely ate or drank and couldn’t keep down her medicine.

Schuler’s family filed a lawsuit that said that doctors had been treating her prior to her arrest and controlled her nausea with Zofran. But at the jail, they said she received only one dose of the antinausea medicine and doctors were not told of her worsening condition by jail staff.

By the time Schuler was transfered to Wake Forest Baptist Medical Center for treatment she was undernourished and severely dehydrated, the lawsuit said. She was in a vegetative state for five days before her family took her off life support.

The Schuler lawsuit was settled but the terms were sealed.

▪ On May 2, 2017, Deshawn Lamont Coley, 39, died from complications of asthma. He had begged jail staff for his inhaler but was ignored, the Winston-Salem Journal reported. Coley’s mother filed a medical malpractice lawsuit against Wellpath a day shy of the two-year anniversary of his death.

A wrongful death lawsuit in Coley’s case is still pending.

▪ That same year, Stephen Antwan Patterson, 40, died on May 26, 2017, from an irregular heartbeat. His family sued, saying the jail’s medical staff failed to treat his blood pressure that was 210/140, according to the Winston-Salem Journal. A normal blood pressure is under 120/80. The American Heart Association considers Patterson’s blood pressure to be a sign of a hypertensive crisis.

The Patterson lawsuit was settled in July but the terms were kept confidential, WFDD reported.

Neville’s attorney, Mike Grace, has said that the Neville family is considering a lawsuit because of his death but one has not so far been filed.

Renewal of contract

Keith said he wishes that Forsyth County would consider partnering with Wake Forest Baptist Medical Center to find a better solution to providing medical care at the jail instead of using one of the few available national corporations to do the work.

When the company’s first contract ended in 2017, no one else bid for the job and Forsyth kept Correct Care Solutions, Albright said.

Forsyth County Sheriff Bobby Kimbrough was elected in December 2018 and told the Atlantic, which wrote a lengthy article about correctional health care companies, that his to-do list included getting rid of WellPath.

But then he met with company officials.

Kimbrough told the Atlantic that since then he saw major improvements at the jail. He told the Atlantic that the decision to renew the contract with WellPath wasn’t a hard one.

Kimbrough answered questions about WellPath in a written statement he sent the N&O Thursday.

“Detention Center healthcare is like buying a suit off-the-rack as opposed to having a suit tailor-made for you,” Kimbrough said in a written statement. “Since I took office, WellPath has made alterations to ensure they are a better fit for Forsyth County.”

Kimbrough wrote that as the needs of the jail have changed, WellPath has adjusted to meet those needs. That includes adding a pandemic position that begins Oct. 1 and will respond to needs related to COVID-19 among the jail population.

“We are grateful WellPath has stepped up and continues to be responsive and make appropriate changes,” Kimbrough said.

The decision to renew WellPath’s contract came before news of Neville’s death at the Forsyth County jail had become public.

On Thursday evening, a protest in an unrelated death broke out in Winston-Salem. Signs demanded justice for Neville and for the county to drop its contract with WellPath.

But Kimbrough remains supportive of WellPath.

“While the choice of contracted medical services remain off-the-rack, so to speak,” Kimbrough said, “WellPath has ensured that they are tailoring their services for a better fit as we work together to meet the needs of the Detention Center residents.”