Case 4:03-cv-01114-UWC Document 1 Filed 05/13/2003 Page 1 of 22

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IN THE UNITED STATES DISTRICT COUR1 ~ ~ ,,,...,'

NORTHERN DISTRICT OF ALABAMJ\13 tl,~\~ \3 ~H \1: 30

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JERRY BAKER, BILLY RAY

DAVIS, JOHNNY DEFRIES,

TONY DEXTER, TED

MCGINNIS, DARRYL MULLINS,

JERRY YOUNGBLOOD,

Case No.

on behalf of themselves and other

persons similarly situated,

Plaintiffs,

vs.

DONAL CAMPBELL, Commissioner of the Alabama Department of Corrections;

RALPH HOOKS, Warden ofSt. Clair Correctional Facility; and

NAPHCARE, INC.,

Defendants.

COMPLAINT NATURE OF THE ACTION This is a civil action brought to vindicate the Plaintiffs' rights under the Eighth and Fourteenth Amendments to the United States Constitution pursuant to 42 U.S.C. § 1983. The Plaintiffs are seven Alabama inmates
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incarcerated at S1. Clair Correctional Facility ("S1. Clair") who suffer from serious medical conditions, including cancer, hemophilia, Hepatitis C, and deafness. Because of the grossly inadequate medical care provided to them by the Defendants, the Plaintiffs and the class they represent are suffering serious harm and are at great risk of further harm, including death. The failure to provide adequate medical care to the Plaintiffs violates the Eighth and Fourteenth Amendments to the United States Constitution. The Plaintiffs seek declaratory and injunctive relief to remedy the Defendants' unconstitutional practices.
JURISDICTION 1. This action arises under the Eighth and Fourteenth Amendments to the United States Constitution and 42 U.S.C. § 1983. Jurisdiction is invoked pursuant to 28 U.S.C. §§ 1331 and 1343. This Court has jurisdiction over the Plaintiffs' request for declaratory and injunctive relief pursuant to 28 U.S.C. §§ 2201-2202.
PARTIES 2. The named Plaintiffs are all prisoners incarcerated at S1. Clair Correctional Facility, an Alabama maximum-security prison. As explained in greater detail in the Factual Allegations Regarding the Plaintiffs, below,
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all of the named Plaintiffs have been and continue to be provided grossly inadequate care for their serious medical conditions.
3. Defendant Donal Campbell is the Commissioner of the Alabama Department of Corrections ("ADOC"). As Commissioner, he is responsible for the development and oversight of all ADOC policies and practices, including medical and nutritional care in all ADOC facilities and the monitoring and oversight of health care services that have been contracted out to private providers. Defendant Campbell is responsible for ensuring that Alabama prisons operate in a manner that is consistent with the United States Constitution. He is sued in his official capacity only.
4. Defendant Ralph Hooks is the Warden of St. Clair Correctional Facility. He is responsible for the day-to-day operations of the prison and supervises all conditions and practices therein. Defendant Hooks is sued in his official capacity only.
5. Defendant Naphcare, Inc. is a private for-profit company that is under a contractual obligation to the ADOC to provide the Plaintiffs' medical care. Under the terms of the contract, Naphcare is obligated to provide "all reasonable and necessary medical, dental, and mental healthcare to Inmates" in the ADOC. On or about May 2,2003, the ADOC notified Naphcare that it was terminating the contract within 90 days.
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During this 90-day period, however, Naphcare continues to be responsible for the health care provided to inmates at St. Clair. The acts by Naphcare about which the Plaintiffs complain are part ofNaphcare's formal and informal policies and practices.
CLASS ACTION ALLEGATIONS 6. The Plaintiffs bring this suit on their own behalf and on behalf of the class of all present and future inmates who are or will be incarcerated in the St. Clair Correctional Facility and who are in need of medical care. 7. The individual Plaintiffs sue on their own behalf and as class representatives pursuant to Rule 23 of the Federal Rules of Civil Procedure. The prerequisites of Rule 23(a) and Rule 23(b)(2) are satisfied. There are questions of law and fact common to the class and the claims of the named Plaintiffs are typical of the claims of the class: all class members suffer from a serious medical illness and are at great risk of harm as a result of the Defendants' provision of grossly inadequate medical care. FACTUAL ALLEGATIONS REGARDING THE CLASS 8. Alabama spends less per prisoner on medical care than any other state in the nation - only about $1300 per inmate per year. As a result, the health care system at St. Clair -- the Alabama prison designated to treat chronically ill inmates -- is completely inadequate to meet the serious
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medical and dental needs of inmates. There is a severe shortage of qualified medical personnel, a lack of access to all levels of medical and dental care, a deficient chronic care program, long delays in proper diagnosis and treatment, and dangerous lapses in the provision of necessary medication and medical supplies.
9. Decisions regarding treatment are made primarily on the basis of cost, rather than on the basis of the medical needs of patients. Serious medical problems are largely ignored until they present an emergency that the Defendants consider to be sufficiently life threatening to warrant treatment or transport to a hospital. Medical treatment has been deliberately delayed until it will no longer be effective in order to reduce costs. This financially calculated approach to medical treatment places inmates' lives in severe danger, causes unnecessary pain and suffering, and exacerbates serious medical conditions.
Insufficient Staffing 10. There is insufficient medical and dental staff to properly screen, diagnose and treat inmates with medical and/or dental problems. The inmates at St. Clair have no access to a primary care physician. Rather, the over 1500 inmates are served by one part-time urologist present at St. Clair only one day per week. The nursing staff is insufficient and
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underqualified, and the dentist is available only two days per week. As a result, inmates are denied prompt access to medical care and are forced to endure unnecessary delays in treatment.
Access to Care 11. Inmates are discouraged from seeking necessary medical care and treatment. Other than emergency situations, inmates' only access to a physician occurs through a process called "sick call," whereby inmates request to be examined for their condition or illness. Inmates wait in line to be screened by a nurse who then determines whether referral to a physician is necessary. The screenings are conducted by Licensed Practical Nurses ("LPN's") who are not qualified by education or training to properly assess patients, resulting in their failure to appropriately refer inmates to a physician for further diagnosis and treatment. Inmates who specifically request to see a doctor are often denied the opportunity to do so. Even inmates who are referred to a doctor face delays because of the lack of a full-time, on-site physician. 12. Inmates are charged a $3.00 co-pay every time they are screened by the L.P.N., even ifhe or she does not refer the inmate to the doctor and no medical treatment is provided. Moreover, inmates must pay this fee for each medical condition that is assessed; inmates are not allowed
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to combine medical conditions or illnesses in one sick call request. These practices deter inmates with legitimate medical problems from seeking medical attention. Inmates with chronic illnesses are often required to utilize the co-pay system for necessary care (as opposed to elective care) that is related to their chronic illness. For example, inmates with diabetes must pay the $3.00 co-pay if they seek treatment for hypoglycemia (low blood sugar) even though the inmates would not need to seek treatment if the medical staff provided adequate glucose monitoring and insulin adjustment.
13. Inmates are typically denied information about the results of medical tests, even when those results are abnormal. Even when inmates are informed, they are not educated about their disease or how to manage their illness. As a result, inmates do not always seek proper follow-up treatment that could improve their condition or even save their lives.
14. Inmates who must be seen by a specialist and even those who have been referred to a specialist by a physician often have their treatment delayed because of expense. Referrals have been denied altogether in an effort to save money.
15. Even inmates housed in the infirmary have difficulty receiving care. There is no operational call system so that inmates can get the
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attention of the medical staff when they are locked in their infinnary cell. Sick inmates must bang on the door and hope another inmate or one of the medical staff hears them. Dying inmates unable to control their bowel movements sometimes go for hours without being changed or cleaned. Because of the shortage of nursing staff, nurses depend on inmates to perform these tasks.
16. Nurses often fail to follow instructions from on-site or free world physicians. Nurses have discontinued treatment, changed medication, or failed to arrange referrals to specialists, placing inmates at risk of serious injury, complications from their illness, or even death.
17. The Defendants have failed to conduct required annual tuberculosis ("TB") testing for each inmate, an illness causing death if not treated. TB is contagious and has the potential to spread rapidly through a prison population. The Defendants' failure endangers the entire prison population at St. Clair.
18. Medical records are disorganized and lack critical documentation. During a recent audit, the ADOC consultant could not confirm off-site consults because the files were in such disarray. Medical records that should be transferred along with inmates from one facility to another are sometimes lost, missing important information, or not
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transferred at all. The poorly maintained medical records cause unnecessary delays and uninformed treatment decisions.
Chronic Medical Conditions 19. Inmates with chronic conditions such as diabetes, HCV (Hepatitis C), kidney disease, and cancer are not properly identified, appropriately treated, or consistently followed-up. The Defendants' treatment of these chronic conditions falls far below the standards of care that are well established and widely accepted by the medical community for the treatment of chronic illnesses. As a result, the Plaintiffs suffer pain, increased medical complications, and the risk of death.
Medication and Medical Supply Practices 20. Inmates on medication, including medication for chronic illnesses, frequently have their prescriptions disrupted or changed (often by nurses without physician approval) to a less expensive medication without proper follow-up to determine if the new medication is effective or to evaluate side effects. 21. The Defendants do not provide adequate pain management for inmates who are in chronic and acute pain. Cancer patients, for example, often receive pain medication sporadically or not at all.
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22. Inmates frequently experience dangerous lapses in receiving their prescribed medications. These gaps in medication may have lifethreatening consequences for inmates with serious medical conditions.
23. Inmates are at risk of receiving expired medications. During a recent audit, the ADOC consultant noted that many vials of medication were expired, including Ampicillin, Cogentin, Atropine, Epinephrine, and Lidocaine. Epinephine is used to treat cardiac arrest; the provision of expired Epinephrine in a cardiac emergency could lead to unnecessary death.
24. Distribution of necessary medical supplies is often delayed or denied altogether. Inmates with colostomies are denied the bags that attach to their abdomen for proper waste removal. Although these bags should be provided daily, the official practice is to provide these bags three times per week. Some inmates have gone over one month without a replacement bag, forcing them to clean feces from the bag in the sinks in their cells, without medical gloves or disinfectant.
Dental Care 25. Inmates for whom dentures are medically necessary must wait for months and sometimes years to receive them. Inmates who previously received dentures from the ADOC must wait at least five years before
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getting another pair - even if the old pair no longer fits or is broken. Inmates without appropriate dentures cannot eat properly, a problem that creates or exacerbates other medical problems, including malnourishment and acid reflux.
STATEMENT OF FACTS REGARDING NAMED PLAINTIFFS 26. Plaintiff Jerry Baker is 63 years old and has been housed at
St. Clair for fourteen years. He suffers from a serious breathing problem. Although Mr. Baker was prescribed several medications to treat his problem on March 13,2003, the nurses at St. Clair have been unable to locate his records and, thus, his prescriptions have gone unfilled. The failure to fill his prescribed prescriptions may have serious medical consequences.
27. Last year, Mr. Baker suffered a rapid weight loss of twenty-six percent of his body weight (he went from 155 to 115 pounds), for which he was not diagnosed or treated. Mr. Baker may be at risk for lung or colon cancer, yet his weight loss was not investigated. His weight loss was caused or compounded by the fact that he has only two teeth on the top of his mouth and ten teeth on the bottom. He was given a top denture plate approximately five years ago, but that plate has been broken for over a year. When he took it to the infirmary, they glued it back together with Crazy Glue; it still does not hold together. For the last year, Mr. Baker has had
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only half of a plate in the top of his mouth. Even though the doctor prescribed extra food (double trays), he is unable to consume enough food and therefore receive proper nourishment due to his difficultly in chewing food. The limited time given to inmates to eat - 4 to 6 minutes - only exacerbates this serious problem. Mr. Baker has not been prescribed vitamins or any nutritional supplements, such as a nutrient drink, that could assist him in gaining weight.
28. Plaintiff Billy Ray Davis is 47 years old and has been housed at St. Clair since 1987. In September 1999, Mr. Davis had trouble breathing and went to the prison doctor. He was treated for bronchitis, but continued to have difficultly breathing. Despite repeated requests for diagnosis and treatment, the prison doctor told Mr. Davis that his condition could not be diagnosed and refused to send him out of the prison for a specialty referral. When a "free world" doctor finally examined him in October 2000, the doctor explained that Mr. Davis's left lung had collapsed. Another physician later told him that the damage could have been corrected had his condition been diagnosed and treated promptly.
29. Mr. Davis is currently prescribed medication for his lung problems, including an inhaler. Despite his serious medical needs, he was not provided the inhaler for three to four months last year. His prescription
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ended on May 5,2003; he has to sign up for sick call and pay $3.00 to have it renewed. His other medications, including Albuterol and Theodur, have been delayed for as long as 10-12 days at a time.
30. Mr. Davis also suffers from a bone spur in his right elbow, causing sharp pain at times, and resulting in the inability to lift items weighing over 5-10 pounds. The physician told him that he needed to be sent to a specialist to treat his condition. Instead, the nurse practitioner gave him an ace bandage for ninety days.
31. Plaintiff Johnny Defries is 63 years old and has been housed at St. Clair for fifteen years. He suffers from numerous illnesses, including cirrhosis of the liver. Although liver damage from cirrhosis cannot be reversed, treatment can stop or delay further progression and reduce complications. A low protein diet is necessary for patients like Mr. Defries with end-stage cirrhosis, but Mr. Defries' diet consists of the very same food served to the general population, albeit without dessert.
32. Mr. Defries has been diagnosed with a number of other significant medical conditions, including shingles, an ulcer, and a hernia. In October or November 2002, Mr. Defries contracted shingles, an inflammation of the nerves that causes extremely painful skin lesions that persist for months. Shingles is so painful that a patient is often incapable of
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wearing clothing. Although immediate treatment with antiviral drugs can reduce the severity and duration of an attack, Mr. Defries lay in his bed for ten days begging for help before he was finally moved to the infirmary. After twelve days in the infirmary, he was finally given medication for the first time. Although his medication was supposed to be administered five times per day, he received it only sporadically. He continues to suffer from pain from the shingles, although he is not provided any pain medication or treatment.
33. Confined to a wheelchair for months due to a painful hernia, Mr. Defries finally had surgery on January 23,2003. Although he was in constant pain during the month following the surgery, the Lortab that was prescribed for him was only given to him sporadically.
34. Mr. Defries uses dentures that are twenty-two years old. He has no teeth on the bottom of his mouth; he has only had a top plate for the last six years. This top plate is virtually unusable because it is so worn and does not fit his mouth properly. During a recent visit to the prison dentist, the top plate was improperly re-lined, causing pain when the plate is worn. Without dentures, Mr. Defries has a total of three teeth in his mouth. Despite multiple requests, the Defendants refuse to replace Mr. Defries' dentures. Although Mr. Defries has multiple nutritional needs, he cannot
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chew any solid food, exacerbating the risks to his already poor health. He is supposed to receive the nutrient drink Resource, but the prison health care unit has been out of the drink for the past two weeks.
35. Plaintiff Tony Dexter is 54 years old and has been housed at St. Clair for four years. He suffers from a type of hemophilia called von Willebrand Type III disease, a bleeding disorder characterized by the inability of the blood to properly clot. Ifblood does not properly clot, blood can leak into the muscles, joints, and other parts of the body, causing scarring, cartilage erosion, and damage to the joints. Despite needing infusions of blood products on an average of two to three times per month to prevent internal bleeding and possible death, the infirmary at St. Clair has consistently failed to have adequate supplies on hand.
36. On February 25,2003, Mr. Dexter had a hip bleed, or spontaneous internal bleeding. A week later, he met with Dr. Lineberry, an oncologist who visits St. Clair on a part-time basis. Dr. Lineberry ordered ten units of blood product to be kept on-site, but told Mr. Dexter that he could not guarantee that it would be delivered, available, or actually administered to Mr. Dexter should he need it. During the first week of April, Mr. Dexter had a hip and nose bleed. The medical staff could not properly treat Mr. Dexter and, the next day, had to transport him to a
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hospital for an infusion. Since April 21, 2003, Mr. Dexter has not received the blood pressure medication that he has been taking on a daily basis for eleven years.
37. Mr. Dexter was recently told that he may also have Hepatitis-C (HCY), a blood-borne virus that attacks and kills liver cells. Over ninety percent of hemophiliacs have contracted HCY through infected blood products. Despite its official policy, the Defendants do not test or treat HCY, leaving Mr. Dexter vulnerable to progression of the disease and its complications and, ultimately, death.
38. Plaintiff Ted McGinnis is 48 years old and has been housed at St. Clair for over ten years. In 2001, he suffered from swelling in his legs and feet. Blood tests showed an enzyme count of 200 (60 is nonnal), which is indicative of HCY. The then-prison doctor asked Mr. McGinnis if anyone had ever told him that he had Hepatitis-C and advised him to reduce the protein in his diet while more blood tests were performed. Two more blood tests were conducted and all showed increased levels of enzymes. Mr. McGinness was given an ultrasound within three months of the initial blood test; it showed fatty tissue in his liver. On two occasions in late 2002, the physician at St. Clair told Mr. McGinnis that a liver biopsy, which is necessary to properly diagnose and treat HCY, was recommended. The
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physician also recommended treatment with interferon, a drug commonly used to treat HCV. Despite that physician's recommendation, Mr. McGinness has not been given biopsy or any follow-up treatment. Instead, he was placed on a chronic care list to be treated for a liver disorder. The only "treatment" he receives, however, is a monthly check of his weight, blood pressure, and pulse. Mr. McGinniss suffers severe joint pain, especially in his hips, that may be a result of HCV. The pain is so severe that he wakes up in the middle of the night three to four times per week. He also has headaches, swelling, and fatigue. With the exception of water pills, he has never been given any medication to treat any of these conditions. As a result, he takes ibruprofen that he purchases from the store. Because this medication is insufficient to deal with his pain, he often takes excessive amounts, causing stomach pain. Instead of treating his underlying pain and other conditions, the nurses gave him Zantac for his stomach. Mr. McGinnis often asks the medical personnel about receiving treatment for HCV, but has been told that Naphcare will treat inmates only "if they get sick enough."
39. Plaintiff Darryl Mullins is 45 years old and has been housed at 8t. Clair for nineteen years. In November 2002, he was diagnosed with testicular cancer, which has spread to his lymph nodes. Despite a CT scan
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on January 30, 2003, showing the metastasis of the cancer, chemotherapy was not initiated until April 29, 2003, -- a period of three months -- because there was not a nurse at St. Clair certified to provide it.
40. On January 22,2003, Mr. Mullins underwent surgery for the removal of his testicle. He was given pain medication following his surgery, but it was discontinued after one week, despite his continued severe, unrelenting pain. On February 24, 2003, he complained to a nurse that he was in severe pain and begged for pain medication, but the nurse refused to provide it. After counsel for the Plaintiffs sent a letter to the Defendants on March 10,2003, Mr. Mullins was finally given pain medication, several weeks after is had been abruptly discontinued.
41. Plaintiff Jerry Youngblood is 31 years old and has been housed at St. Clair since March 2002. He is extremely hearing-impaired and has to read lips to communicate. His multiple requests to be evaluated for a hearing aid have been ignored. Mr. Youngblood's inability to hear makes it difficult for him to adequately monitor his surroundings, placing him at risk of harm from other inmates and at danger of getting in trouble from correctional officers for not following orders.
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EXHAUSTION OF ADMINISTRATIVE REMEDIES 42. The current contract medical provider, Naphcare, Inc., uses a two-part complaint process for inmates to obtain redress of the grievances over inadequate medical care. Inmates must file a "Naphcare Medical Complaint Form," wait for a response, and then file a "Naphcare Medical Grievance Form." Inmates who request grievance forms are often denied them. One inmate was told that he would have to fill out three complaints before he could receive a copy of a grievance form. The inability to make legitimate complaints contributes to the inability of medical staff to properly diagnose and treat the inmate population. 43. The Plaintiffs have exhausted their administrative remedies by filing complaint and grievance forms with Naphcare, to the extent the grievance process has been available to them. All of the Plaintiffs received inadequate responses to their complaints and grievances or received no response at all.
a. Plaintiff Baker submitted complaints on February 20 and April 7, 2003. On March 23 and April 11,2003, Mr. Baker submitted grievances to the Health Care Unit.
b. Plaintiff Davis submitted a complaint on Apri124, 2003, and a grievance on May 6,2003.
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c. Plaintiff Defries submitted complaints on February 20, March 28, and April 7, 2003. On April II and April 20, 2003, Mr. Defries submitted grievances.
d. Plaintiff Dexter submitted complaints on July 16, 2002, February 20 and April 21, 2003. On February 20 and April 21, 2003, he submitted grievances.
e. Plaintiff McGinness submitted a complaint on March 17, 2003, and a grievance on April 23, 2003.
f. Plaintiff Mullins submitted complaints on February 27 and March 1,2003, and a grievance on March 6, 2003.
g. Plaintiff Youngblood submitted a complaint on April 7, 2003. Although the Defendants indicated that the situation would be addressed, Mr. Youngblood has received no follow-up treatment. Mr. Youngblood submitted a grievance in May 2003.
CLAIMS FOR RELIEF 44. The Defendants' deliberate indifference to the serious medical needs of the inmates housed at St. Clair violates the Plaintiffs' rights under the Eighth and Fourteenth Amendments to the United States Constitution, as enforced through 42 U.S.C. § 1983.
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PRAYER FOR RELIEF WHEREFORE, the Plaintiffs pray that this Honorable Court grant the following relief: 1. Certify the plaintiff class; 2. Declare that the acts and omissions of the Defendants with regard to the class members violate the Eighth and Fourteenth Amendments to the United States Constitution; 3. Enter a preliminary and permanent injunction requiring the Defendants, their agents, employees, and all persons acting in concert with them to cease their unconstitutional and unlawful practices; 4. Award to the Plaintiffs reasonable costs and attorneys' fees; and 5. Grant the Plaintiffs such other relief as the Court deems necessary and just.
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Case 4:03-cv-01114-UWC Document 1 Filed 05/13/2003 Page 22 of 22 Respectfully submitted,
<~098) Grace Graham (GRA 099) Kelley Bruner (BRU 028) Southern Poverty Law Center 400 Washington Avenue Post Office Box 2087 Montgomery, AL 36102-2087 (334) 956-8200 (334) 956-8481 (facsimile) Attorneys for Plaintiffs
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fiLED
IN THE UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF ALAB~J"I-A\Y 23 Pfl 5: 01

JERRY BAKER, ANTHONY

CABLE, BILLY RAY DAVIS,

JOHNNY DEFRIES, TONY

DEXTER, JAMES FREEMAN, .,.

TED MCGINNIS, DARRELL

MULLINS, BRUCE

Case No. CV-03-C-1114-M

STRICKLAND, JERRY

YOUNGBLOOD,ROOSEVELT

YOUNGBLOOD

on behalf of themselves and other persons similarly situated,

Plaintiffs,

vs.

DONAL CAMPBELL, Commissioner of the Alabama Department of Corrections;

RALPH HOOKS, Warden ofSt. Clair Correctional Facility; and

NAPHCARE, INC.,

Defendants.

AMENDED COMPLAINT

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NATURE OF THE ACTION This is a civil action brought to vindicate the Plaintiffs' rights under the Eighth and Fourteenth Amendments to the United States Constitution pursuant to 42 U.S.C. § 1983. The Plaintiffs are eleven Alabama inmates incarcerated at St. Clair Correctional Facility ("St. Clair") who suffer from serious medical conditions, including cancer, hemophilia, Hepatitis C, and deafness. Because of the grossly inadequate medical care provided to them by the Defendants, the Plaintiffs and the class they represent are suffering serious harm and are at great risk of further harm, including death. The failure to provide adequate medical care to the Plaintiffs violates the Eighth and Fourteenth Amendments to the United States Constitution. The Plaintiffs seek declaratory and injunctive relief to remedy the Defendants' unconstitutional practices.
JURISDICTION 1. This action arises under the Eighth and Fourteenth Amendments to the United States Constitution and 42 U.S.C. § 1983. Jurisdiction is invoked pursuant to 28 U.S.C. §§ 1331 and 1343. This Court has jurisdiction over the Plaintiffs' request for declaratory and injunctive relief pursuant to 28 U.S.C. §§ 2201-2202.
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PARTIES 2. The named Plaintiffs are all prisoners incarcerated at St. Clair Correctional Facility, an Alabama maximum-security prison. As explained in greater detail in the Factual Allegations Regarding the Plaintiffs, below, all of the named Plaintiffs have been and continue to be provided grossly inadequate care for their serious medical conditions. 3. Defendant Donal Campbell is the Commissioner of the Alabama Department of Corrections ("ADOC"). As Commissioner, he is responsible for the development and oversight of all ADOC policies and practices, including medical and nutritional care in all ADOC facilities and the monitoring and oversight of health care services that have been contracted out to private providers. Defendant Campbell is responsible for ensuring that Alabama prisons operate in a manner that is consistent with the United States Constitution. He is sued in his official capacity only. 4. Defendant Ralph Hooks is the Warden ofSt. Clair Correctional Facility. He is responsible for the day-to-day operations of the prison and supervises all conditions and practices therein. Defendant Hooks is sued in his official capacity only. 5. Defendant Naphcare, Inc. is a private for-profit company that is under a contractual obligation to the ADOC to provide the Plaintiffs'
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medical care. Under the terms of the contract, Naphcare is obligated to provide "all reasonable and necessary medical, dental, and mental healthcare to Inmates" in the ADOC. On or about May 2, 2003, the ADOC notified Naphcare that it was terminating the contract within 90 days. During this 90-day period, however, Naphcare continues to be responsible for the health care provided to inmates at St. Clair. The acts by Naphcare about which the Plaintiffs complain are part ofNaphcare's formal and informal policies and practices.
CLASS ACTION ALLEGATIONS 6. The Plaintiffs bring this suit on their own behalf and on behalf of the class of all present and future inmates who are or will be incarcerated in the St. Clair Correctional Facility and who are in need of medical care. 7. The individual Plaintiffs sue on their own behalf and as class representatives pursuant to Rule 23 of the Federal Rules of Civil Procedure. The prerequisites of Rule 23(a) and Rule 23(b)(2) are satisfied. There are questions of law and fact common to the class and the claims of the named Plaintiffs are typical of the claims of the class: all class members suffer from a serious medical illness and are at great risk of harm as a result of the Defendants' provision of grossly inadequate medical care.
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FACTUAL ALLEGATIONS REGARDING THE CLASS 8. Alabama spends less per prisoner on medical care than any other state in the nation - only about $1300 per inmate per year. As a result, the health care system at St. Clair -- the Alabama prison designated to treat chronically ill inmates -- is completely inadequate to meet the serious medical and dental needs of inmates. There is a severe shortage of qualified medical personnel, a lack of access to all levels of medical and dental care, a deficient chronic care program, long delays in proper diagnosis and treatment, and dangerous lapses in the provision of necessary medication and medical supplies. 9. Decisions regarding treatment are made primarily on the basis of cost, rather than on the basis of the medical needs of patients. Serious medical problems are largely ignored until they present an emergency that the Defendants consider to be sufficiently life threatening to warrant treatment or transport to a hospital. Medical treatment has been deliberately delayed until it will no longer be effective in order to reduce costs. This financially calculated approach to medical treatment places inmates' lives in severe danger, causes unnecessary pain and suffering, and exacerbates serious medical conditions.
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Insufficient Staffing 10. There is insufficient medical and dental staff to properly screen, diagnose and treat inmates with medical and/or dental problems. The inmates at St. Clair have no access to a primary care physician. For months, the over 1500 inmates were served by one part-time urologist present at St. Clair only one day per week. Although another physician has apparently been hired recently, it is unclear whether this physician specializes in primary care or whether he is at the prison a sufficient number of hours to adequately provide care. The nursing staff is also insufficient and under-qualified, and the dentist is available only two days per week. As a result, inmates are denied prompt access to medical care and are forced to endure unnecessary delays in treatment.
Access to Care 11. Inmates are discouraged from seeking necessary medical care and treatment. Other than emergency situations, inmates' only access to a physician occurs through a process called "sick call," whereby inmates request to be examined for their condition or illness. Inmates wait in line to be screened by a nurse who then determines whether referral to a physician is necessary. The screenings are conducted by Licensed Practical Nurses ("LPN's") who are not qualified by education or training to properly assess
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Case 4:03-cv-01114-UWC Document 5 Filed 05/23/2003 Page 7 of 27
patients, resulting in their failure to appropriately refer inmates to a physician for further diagnosis and treatment. Inmates who specifically request to see a doctor are often denied the opportunity to do so. Even inmates who are referred to a doctor face delays because of the lack of a full-time, on-site physician.
12. Inmates are charged a $3.00 co-pay every time they are screened by the L.P.N., even ifhe or she does not refer the inmate to the doctor and no medical treatment is provided. Moreover, inmates must pay this fee for each medical condition that is assessed; inmates are not allowed to combine medical conditions or illnesses in one sick call request. These practices deter inmates with legitimate medical problems from seeking medical attention. Inmates with chronic illnesses are often required to utilize the co-pay system for necessary care (as opposed to elective care) that is related to their chronic illness. For example, inmates with diabetes must pay the $3.00 co-pay if they seek treatment for hypoglycemia (low blood sugar) even though the inmates would not need to seek treatment if the medical staff provided adequate glucose monitoring and insulin adjustment.
13. Inmates are typically denied information about the results of medical tests, even when those results are abnormal. Even when inmates
7

Case 4:03-cv-01114-UWC Document 5 Filed 05/23/2003 Page 8 of 27
are infonned, they are not educated about their disease or how to manage their illness. As a result, inmates do not always seek proper follow-up treatment that could improve their condition or even save their lives.
14. Inmates who must be seen by a specialist and even those who have been referred to a specialist by a physician often have their treatment delayed because of expense. Referrals have been denied altogether in an effort to save money. An inmate with cataracts, for example, has been told that surgery will not be perfonned so long as he has "one good eye."
15. Even inmates housed in the infinnary have difficulty receiving care. There is no operational call system so that inmates can get the attention of the medical staff when they are locked in their infinnary cell. Sick inmates must bang on the door and hope another inmate or one of the medical staff hears them. Dying inmates unable to control their bowel movements sometimes go for hours without being changed or cleaned. Because of the shortage of nursing staff, nurses depend on inmates to perfonn these tasks.
16. Nurses often fail to follow instructions from on-site or free world physicians. Nurses have discontinued treatment, changed medication, or failed to arrange referrals to specialists, placing inmates at risk of serious injury, complications from their illness, or even death.
8

Case 4:03-cv-01114-UWC Document 5 Filed 05/23/2003 Page 9 of 27
17. The Defendants have failed to conduct required annual tuberculosis ("TB") testing for each inmate, an illness causing death if not treated. TB is contagious and has the potential to spread rapidly through a prison population. The Defendants' failure endangers the entire prison population at St. Clair.
18. Medical records are disorganized and lack critical documentation. During a recent audit, the ADOC consultant could not confirm off-site consults because the files were in such disarray. Medical records that should be transferred along with inmates from one facility to another are sometimes lost, missing important information, or not transferred at all. The poorly maintained medical records cause unnecessary delays and uninformed treatment decisions.
Chronic Medical Conditions 19. Inmates with chronic conditions such as diabetes, HCV (Hepatitis C), kidney disease, and cancer are not properly identified, appropriately treated, or consistently followed-up. The Defendants' treatment of these chronic conditions falls far below the standards of care that are well established and widely accepted by the medical community for the treatment of chronic illnesses. As a result, the Plaintiffs suffer pain, increased medical complications, and the risk of death.
9

Case 4:03-cv-01114-UWC Document 5 Filed 05/23/2003 Page 10 of 27
Medication and Medical Supply Practices 20. Inmates on medication, including medication for chronic illnesses, frequently have their prescriptions disrupted or changed (often by nurses without physician approval) to a less expensive medication without proper follow-up to determine if the new medication is effective or to evaluate side effects. 21. The Defendants do not provide adequate pain management for inmates who are in chronic and acute pain. Cancer patients, for example, often receive pain medication sporadically or not at all. 22. Inmates frequently experience dangerous lapses in receiving their prescribed medications. These gaps in medication may have lifethreatening consequences for inmates with serious medical conditions. 23. Inmates are at risk of receiving expired medications. During a recent audit, the ADOC consultant noted that many vials of medication were expired, including Ampicillin, Cogentin, Atropine, Epinephrine, and Lidocaine. Epinephine is used to treat cardiac arrest; the provision of expired Epinephrine in a cardiac emergency could lead to unnecessary death. 24. Distribution of necessary medical supplies is often delayed or denied altogether. Inmates with colostomies are denied the bags that attach
10

Case 4:03-cv-01114-UWC Document 5 Filed 05/23/2003 Page 11 of 27
to their abdomen for proper waste removal. Although these bags should be provided daily, the official practice is to provide these bags three times per week. Some inmates have gone over one month without a replacement bag, forcing them to clean feces from the bag in the sinks in their cells, without medical gloves or disinfectant. In addition to the obvious cruelty in subjecting these men to such an ordeal, the practice poses a risk of infection to themselves and other inmates from the exposure to feces.
Dental Care 25. Inmates for whom dentures are medically necessary must wait for months and sometimes years to receive them. Inmates who previously received dentures from the ADOC must wait at least five years before getting another pair - even if the old pair no longer fits or is broken. Inmates without appropriate dentures cannot eat properly, a problem that creates or exacerbates other medical problems, including malnourishment and acid reflux. STATEMENT OF FACTS REGARDING NAMED PLAINTIFFS 26. After the original complaint was filed, Plaintiff Jerry Baker died on Thursday, May 15,2003. He was 63 years old and had been housed at St. Clair for fourteen years. He suffered from a serious lung disease. Although Mr. Baker had been prescribed several medications to treat his
11

Case 4:03-cv-01114-UWC Document 5 Filed 05/23/2003 Page 12 of 27
problem on March 13, 2003, his prescriptions went unfilled for almost two months leading up to his death. The failure to fill his prescribed prescriptions may have contributed to his death.
27. Last year, Mr. Baker suffered a rapid weight loss of twenty-six percent of his body weight (from 155 to 115 pounds), for which he was not diagnosed or treated. Mr. Baker may have been at risk for lung or colon cancer, yet his weight loss was not investigated. His weight loss was caused or compounded by the fact that he had only two teeth on the top of his mouth and ten teeth on the bottom. He had been given a top denture plate approximately five years ago, but that plate had been broken for over a year. When he took it to the infirmary, they glued it back together with Crazy Glue; it did not hold together. For the last year, Mr. Baker had only half of a plate in the top of his mouth. Even though the doctor prescribed extra food (double trays), he was unable to consume enough food and therefore receive proper nourishment due to his difficultly in chewing food. The limited time given to inmates to eat - 4 to 6 minutes - only exacerbated this serious problem. Before his death, Mr. Baker had not been prescribed vitamins or any nutritional supplements, such as a nutrient drink, that could have assisted him in gaining weight.
12

Case 4:03-cv-01114-UWC Document 5 Filed 05/23/2003 Page 13 of 27
28. Plaintiff Anthony Cable is 38 years old and has been housed at St. Clair on and off since 1983. Last September, a spider bit Mr. Cable on his left hamstring. He aggressively sought treatment for his condition because, as he informed the medical staff, he knew that he was allergic to insect bites. Even so, the medical staff refused to allow him to see a doctor. Instead, they told him to "sign up for sick call" (which costs a $3.00 copay). Although he did so, he was not placed on the list for the next day. It was only after a correctional officer and Mr. Cable's trade school instructors intervened on his behalf that Mr. Cable was allowed to visit with a doctor. By that time (two days after he first sought medical treatment), he had to be sent to Carraway Hospital's emergency room. He remained hospitalized for three days and was treated for sepsis, a potentially life-threatening infection. Upon Mr. Cable's release from Carraway, the hospital's orders were that the prison medical staff pack his wound with gauze twice per day and provide antibiotics for two weeks. Instead, his antibiotics were stopped after only one week.
29. Mr. Cable then developed an abscess and was sent back to Carraway hospital for further treatment.
30. Earlier this year, Mr. Cable developed a staphylococcus infection, although the prison medical staff insisted that it was another
13

Case 4:03-cv-01114-UWC Document 5 Filed 05/23/2003 Page 14 of 27
spider bite. Three days later, he was sent to back to Carraway hospital, where he remained for eight days in isolation and received intravenous antibiotics. In April, a boil arose on Mr. Cable's left lower hip. It is the size of two quarters. When he went to sick call, the nurses gave him a shot of antibiotics and lanced the area. To this day, they have never told him what the cause of the boil.
31. Mr. Cable has experienced an unexplained weight loss of over thirty pounds in one month (from 177 to 146 pounds), yet he is apparently not being diagnosed or evaluated to determine the cause of this problem.
32. Plaintiff Billy Ray Davis is 47 years old and has been housed at St. Clair since 1987. In September 1999, Mr. Davis had trouble breathing and went to the prison doctor. He was treated for bronchitis, but continued to have difficultly breathing. Despite repeated requests for diagnosis and treatment, the prison doctor told Mr. Davis that his condition could not be diagnosed and refused to send him out of the prison for a specialty referral. When a "free world" doctor finally examined him in October 2000, the doctor explained that Mr. Davis's left lung had collapsed. Another physician later told him that the damage could have been corrected had his condition been diagnosed and treated promptly. Mr. Davis is now experiencing problems with his right lung.
14

Case 4:03-cv-01114-UWC Document 5 Filed 05/23/2003 Page 15 of 27
33. Mr. Davis is currently prescribed medication for his lung problems, including an inhaler. Despite his serious medical needs, he was not provided the inhaler for three to four months last year. His prescription ended on May 5,2003; he has to sign up for sick call and pay $3.00 to have it renewed. His other medications, including Albuterol and Theodur, have been delayed for as long as 10-12 days at a time.
34. Mr. Davis also suffers from a bone spur in his right elbow, causing sharp pain at times, and resulting in the inability to lift items weighing over 5-10 pounds. The physician told him that he needed to be sent to a specialist to treat his condition. Instead, the nurse practitioner gave him an ace bandage for ninety days.
35. Plaintiff Johnny Defries is 63 years old and has been housed at St. Clair for fifteen years. He suffers from numerous illnesses, including cirrhosis of the liver. Although liver damage from cirrhosis cannot be reversed, treatment can stop or delay further progression and reduce complications. A low protein diet is necessary for patients like Mr. Defries with end-stage cirrhosis, but Mr. Defries' diet consists of the very same food served to the general population, albeit without dessert.
36. Mr. Defries has been diagnosed with a number of other significant medical conditions, including shingles, an ulcer, and a hernia. In
15

Case 4:03-cv-01114-UWC Document 5 Filed 05/23/2003 Page 16 of 27
October or November 2002, Mr. Defries contracted shingles, an inflammation of the nerves that causes extremely painful skin lesions that persist for months. Shingles is so painful that a patient is often incapable of wearing clothing. Although immediate treatment with antiviral drugs can reduce the severity and duration of an attack, Mr. Defries lay in his bed for ten days begging for help before he was finally moved to the infirmary and provided medication. Although his medication was supposed to be administered five times per day, he received it only sporadically. He continues to suffer pain from the shingles, but is not provided any appropriate pain medication or treatment.
37. Confined to a wheelchair for months due to a painful hernia, Mr. Defries finally had surgery on January 23,2003. Although he was in constant pain during the month following the surgery, the Lortab that was prescribed for him was only given to him sporadically.
38. Mr. Defries uses dentures that are twenty-two years old. He has no teeth on the top of his mouth; he has only had a top plate for the last six years. This top plate is virtually unusable because it is so worn and does not fit his mouth properly. During a recent visit to the prison dentist, the top plate was improperly re-lined, causing pain when the plate is worn. Without dentures, Mr. Defries has a total of three teeth in his mouth. Despite
16

Case 4:03-cv-01114-UWC Document 5 Filed 05/23/2003 Page 17 of 27
multiple requests, the Defendants refuse to replace Mr. Defries' dentures. Although Mr. Defries has multiple nutritional needs, he cannot chew any solid food, exacerbating the risks to his already poor health. He is supposed to receive the nutrient drink Resource, but the prison health care unit has been out of the drink for the past month.
39. Plaintiff Tony Dexter is 54 years old and has been housed at St. Clair for four years. He suffers from a type of hemophilia called von Willebrand Type III disease, a bleeding disorder characterized by the inability of the blood to properly clot. Ifblood does not properly clot, blood can leak into the muscles, joints, and other parts of the body, causing scarring, cartilage erosion, and damage to the joints. Despite needing infusions of blood products on an average of two to three times per month to prevent internal bleeding and possible death, the infirmary at St. Clair has consistently failed to have adequate supplies on hand.
40. On February 25, 2003, Mr. Dexter had a hip bleed, or spontaneous internal bleeding. A week later, he met with Dr. Lineberry, an oncologist who visits St. Clair on a part-time basis. Dr. Lineberry ordered ten units of blood product to be kept on-site, but told Mr. Dexter that he could not guarantee that it would be delivered, available, or actually administered to Mr. Dexter should he need it. During the first week of
17

Case 4:03-cv-01114-UWC Document 5 Filed 05/23/2003 Page 18 of 27
April, Mr. Dexter had a hip and nose bleed. The medical staff could not properly treat Mr. Dexter and, the next day, had to transport him to a hospital for an infusion. Even so, Mr. Dexter still has pain in his hip. Since April 21, 2003, Mr. Dexter has not received the blood pressure medication that he has been taking on a daily basis for eleven years. He has been having headaches on and off since that time.
41. Mr. Dexter was recently told that he may also have Hepatitis C (HCY), a blood-borne virus that attacks and kills liver cells. Over ninety percent ofhemophiliacs have contracted HCY through infected blood products. Despite its official policy, the Defendants do not test or treat HCY, leaving Mr. Dexter vulnerable to progression of the disease and its complications and, ultimately, death.
42. Plaintiff James Freeman is 34 years old and has been housed at St. Clair for seven years. When he was 28 years old, a gunshot wound caused him to lose his spleen, colon, and seventy-five percent of his intestines, resulting in a temporary colostomy. As a result, his feces collects in a small bag attached to his lower abdomen. Although this bag should be replaced daily, the policy at St. Clair is to provide bags only three times per week. For over a month, however, Mr. Freeman did not receive a single replacement bag. He was forced to rinse the bag out daily in the sink in his
18

Case 4:03-cv-01114-UWC Document 5 Filed 05/23/2003 Page 19 of 27
cell -- the same sink that he and his cellmate use to obtain water and brush their teeth. Despite his repeated requests, the nursing staffhas never provided gloves or disinfectant. The failure to provide new, sterile bags on a daily basis increases the risk of infection where the bag is connected to Mr. Freeman's abdomen.
43. Mr. Freeman's colostomy should be temporary. Although he has requested surgery to reverse the colostomy on many occasions, his requests have been ignored.
44. Plaintiff Ted McGinnis is 48 years old and has been housed at St. Clair for over ten years. In 2001, he suffered from swelling in his legs and feet. Blood tests showed an enzyme count of200 (60 is normal), which is indicative ofHCV. The then-prison doctor asked Mr. McGinnis if anyone had ever told him that he had Hepatitis C and advised him to reduce the protein in his diet while more blood tests were performed. Two more blood tests were conducted and all showed increased levels of enzymes. Mr. McGinness was given an ultrasound within three months of the initial blood test; it showed fatty tissue in his liver. On two occasions in late 2002, the physician at St. Clair told Mr. McGinnis that a liver biopsy, which is necessary to properly diagnose and treat HCV, was recommended. The physician also recommended treatment with interferon, a drug commonly
19

Case 4:03-cv-01114-UWC Document 5 Filed 05/23/2003 Page 20 of 27
used to treat HCV. Despite that physician's recommendation, Mr. McGinness has not been given biopsy or any follow-up treatment. Instead, he was placed on a chronic care list to be treated for a liver disorder. The only "treatment" he receives, however, is a monthly check of his weight, blood pressure, and pulse. Mr. McGinniss suffers severe joint pain, especially in his hips, that may be a result of HCV. The pain is so severe that he wakes up in the middle of the night three to four times per week. He also has headaches, swelling, and fatigue. With the exception of water pills, he has never been given any medication to treat any of these conditions. As a result, he takes ibruprofen that he purchases from the store. Because this medication is insufficient to deal with his pain, he often takes excessive amounts, causing stomach pain. Instead of treating his underlying pain and other conditions, the nurses gave him Zantac for his stomach. Mr. McGinnis often asks the medical personnel about receiving treatment for HCV, but has been told that Naphcare will treat inmates only "if they get sick enough."
45. Plaintiff Darrell Mullins is 45 years old and has been housed at 8t. Clair for nineteen years. In November 2002, he was diagnosed with testicular cancer, which has spread to his lymph nodes. Despite a CT scan on January 30,2003, showing the metastasis of the cancer, chemotherapy
20

Case 4:03-cv-01114-UWC Document 5 Filed 05/23/2003 Page 21 of 27
was not initiated until April 29, 2003 -- a period of three months -- because there was not a nurse at St. Clair certified to provide it.
46. On January 22,2003, Mr. Mullins underwent surgery for the removal of his testicle. He was given pain medication following his surgery, but it was discontinued after one week, despite his continued severe, unrelenting pain. On February 24,2003, he complained to a nurse that he was in severe pain and begged for pain medication, but the nurse refused to provide it. After counsel for the Plaintiffs sent a letter to the Defendants on March 10, 2003, Mr. Mullins was finally given pain medication, several weeks after it had been abruptly discontinued.
47. Plaintiff Bruce Strickland is 46 years old and has been housed at S1. Clair for six years. Mr. Strickland has cataracts in his right eye, causing blurry vision from a few feet away. Although he has been to the eye doctor on at least four occasions, he was told that surgery would not be performed so long as he had "one good eye." His eyesight continues to deteriorate and, without treatment, he will eventually completely lose vision in his right eye.
48. Plaintiff Jerry Youngblood is 31 years old and has been housed at St. Clair since March 2002. He is extremely hearing-impaired and has to read lips to communicate. His multiple requests to be evaluated
21

Case 4:03-cv-01114-UWC Document 5 Filed 05/23/2003 Page 22 of 27
for a hearing aid have been ignored. Mr. Youngblood's inability to hear makes it difficult for him to adequately monitor his surroundings, placing him at risk of harm from other inmates and at danger of getting in trouble from correctional officers for not following orders.
49. Plaintiff Roosevelt Youngblood is 61 years old and has been housed at St. Clair since 1983. He suffers from several serious medical conditions, including cirrhosis, a yeast infection on his penis, chronic diarrhea, and a weak bladder for which he has to wear a catheter. He has never been treated appropriately for any of these conditions. He also has numbness in his legs. In November 2002, a scan was done on his leg. Although the technician performing the scan told him that he had a blockage in his leg and that he needed surgery, no surgery has been performed. Despite the apparently serious nature of his condition, no doctor has ever diagnosed the blockage in his leg. As a result of his condition, Mr. Youngblood cannot walk without the assistance of a wheelchair or walker, and he is at risk for an arterial blockage, which is life-threatening, or nerve impingement, which can be disabling.
EXHAUSTION OF ADMINISTRATIVE REMEDIES 50. The current contract medical provider, Naphcare, Inc., uses a two-part complaint process for inmates to obtain redress of the grievances
22

Case 4:03-cv-01114-UWC Document 5 Filed 05/23/2003 Page 23 of 27
over inadequate medical care. Inmates must file a "Naphcare Medical Complaint Form," wait for a response, and then file a ''Naphcare Medical Grievance Form." Inmates who request grievance forms are often denied them. One inmate was told that he would have to fill out three complaints before he could receive a copy of a grievance form. The inability to make legitimate complaints contributes to the inability of medical staff to properly diagnose and treat the inmate population.
51. The Plaintiffs have exhausted their administrative remedies by filing complaint and grievance forms with Naphcare, to the extent the grievance process has been available to them. All of the Plaintiffs received inadequate responses to their complaints and grievances or received no response at all.
a. Plaintiff Baker submitted complaints on February 20 and April 7, 2003. On March 23 and April 11, 2003, Mr. Baker submitted grievances to the Health Care Unit.
b. Plaintiff Anthony Cable submitted a complaint on May 7,2003, and a grievance on May 12,2003.
c. Plaintiff Davis submitted complaints on April 24 and May 7,2003 and grievances on May 6 and May 14,2003.
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Case 4:03-cv-01114-UWC Document 5 Filed 05/23/2003 Page 24 of 27
d. Plaintiff Defries submitted complaints on February 20, March 28, and April 7, 2003. On April 11 and Apri120, 2003, Mr. Defries submitted grievances.
e. Plaintiff Dexter submitted complaints on July 16,2002, February 20 and April 21, 2003. On February 20 and April 21, 2003, he submitted grievances.
f. Plaintiff Freeman submitted a complaint on May 6,2003, and has also submitted a grievance.
g. Plaintiff McGinness submitted a complaint on March 17, 2003, and a grievance on April 23, 2003.
h. Plaintiff Mullins submitted complaints on February 27 and March 1,2003, and a grievance on March 6,2003.
i. Plaintiff Bruce Strickland has submitted a complaint and grievance.
J. Plaintiff Jerry Youngblood submitted a complaint on April 7, 2003. Although the Defendants indicated that the situation would be addressed, Mr. Youngblood has received no follow-up treatment. Mr. Youngblood submitted a grievance in May 2003.
k. Plaintiff Roosevelt Youngblood submitted a complaint on May 6,2003, and has also submitted a grievance.
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Case 4:03-cv-01114-UWC Document 5 Filed 05/23/2003 Page 25 of 27
CLAIMS FOR RELIEF 52. The Defendants' deliberate indifference to the serious medical needs of the inmates housed at St. Clair violates the Plaintiffs' rights under the Eighth and Fourteenth Amendments to the United States Constitution, as enforced through 42 U.S.C. § 1983.
PRAYER FOR RELIEF WHEREFORE, the Plaintiffs pray that this Honorable Court grant the following relief: 1. Certify the plaintiff class; 2. Declare that the acts and omissions of the Defendants with regard to the class members violate the Eighth and Fourteenth Amendments to the United States Constitution; 3. Enter a preliminary and permanent injunction requiring the Defendants, their agents, employees, and all persons acting in concert with them to cease their unconstitutional and unlawful practices; 4. Award to the Plaintiffs reasonable costs and attorneys' fees; and 5. Grant the Plaintiffs such other relief as the Court deems necessary and just.
25

Case 4:03-cv-01114-UWC Document 5 Filed 05/23/2003 Page 26 of 27 Respectfully submitted,
1Jd~~ oms S. ees (DEE 001) Rhonda Brownstein (BRO 098) Grace Graham (GRA 099) Kelley Bruner (BRU 028) Southern Poverty Law Center 400 Washington Avenue Post Office Box 2087 Montgomery, AL 36102-2087 (334) 956-8200 (334) 956-8481 (facsimile) Attorneys for Plaintiffs
26

Case 4:03-cv-01114-UWC Document 5 Filed 05/23/2003 Page 27 of 27 " '

CERTIFICATE OF SERVICE

I hereby certify that I have served a true and correct copy of foregoing document

the~May, on

2003, by facsimile and first-class mail, postage prepaid, on the

following persons at the addresses listed below:

William Addison, Esq. Department ofCorrections 101 S. Union Street P.O. Box 301501 Montgomery, AL 36130 (f) 334-353-3891
Miles Huffstutler, Esq. Naphcare, Inc. 950 22nd Street North Suite 825 Binningham, AL 35203-5301 (f) 205-458-8596

Morris Dees

 </s> Case 4:03-cv-01114-UWC Document 15 Filed 06/27/2003 Page 1 of 3

FIL~ED

IN THE UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF ALABAMA 03 JUN 21 PH 12: 44

JERRY BAKER, et aI.,

UiPiJUbV~~llB~

Plaintiffs,

vs. DONAL CAMPBELL, et aI.,

Case No. CV 03-C-1114-M

Defendants.

PRELIMINARY INJUNCTION SETTLEMENT AGREEMENT WHEREAS on May 13,2003, plaintiffs filed suit challenging the constitutional adequacy of the medical care provided to persons with serious illnesses by the Alabama Department of Corrections (ADOC) and Naphcare, Inc.; and WHEREAS on May 23, 2003, the plaintiffs filed a motion for a preliminary injunction seeking immediate relief; and WHEREAS the plaintiffs and defendants agree that it is in their best interests to resolve the motion for preliminary injunction; NOW THEREFORE the parties, by and through their respective counsel, hereby stipulate and agree to the following provisions: 1. The defendants have hired a full-time, forty-hour per-week primary care physician who is assigned exclusively to St. Clair Correctional Facility. The defendants agree to maintain this full-time position at St. Clair pending the outcome of this litigation. This full-time position is separate and apart from the part-time oncologist, nephrologist, and dentist who also serve the inmates at St. Clair.

1

Case 4:03-cv-01114-UWC Document 15 Filed 06/27/2003 Page 2 of 3
2. The defendants agree to hire and/or maintain the following qualified and competent nursing staff:
a. (2) RN's on first shift on M-F - forty hours per week each b. (1) RN on second shift on M-F - forty hours per week c. (1) RN on first shift on weekends - sixteen hours per week d. (8) LPN's - staffing for all three shifts e. (1) Nurse Practitioner / Physician's Assistant - 20 hours per week f. (1) RN to administer chemotherapy - 8 hours per week g. (2) RN's assigned exclusively to dialysis patients - 40 hours per week each This staffing agreement does not include additional necessary non-nursing staff, such as dialysis technicians and medical clerks. To the extent that additional staffing is required to comply with the terms of this agreement, NaphCare, upon execution of this agreement, will immediately engage in a good faith effort to fill any additional staff positions in a timely manner. Within two weeks of the execution of this agreement, counsel for NaphCare will notify plaintiffs' counsel ofNaphCare's effort and the results of that effort. Until all required staff are hired, counsel for NaphCare will continue on a bi-weekly basis to keep plaintiffs' counsel apprised ofNaphCare's effort. 3. The defendants agree to provide all prescribed medication and necessary medical supplies within a medically appropriate period of time. 4. The defendants agree to provide all necessary off-site medical specialty consultations and treatment within a medically appropriate period of time. 5. The plaintiffs agree to waive all fees and costs associated with the preparation and litigation of the preliminary injunction motion. 6. The parties expressly acknowledge and agree that this agreement does not constitute an admission of liability by the defendants.
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Case 4:03-cv-01114-UWC Document 15 Filed 06/27/2003 Page 3 of 3

7. The parties agree that the relief agreed upon here is narrowly drawn, extends no further than necessary to correct the violation, if any, of a federal right, and is the least intrusive means necessary to correct the violation, if any, of a federal right.
8. The parties agree that this preliminary injunction settlement agreement is limited only to the plaintiffs preliminary injunction motion and does not resolve any other issues in this litigation. This agreement will terminate upon the final resolution of this litigation. The parties agree that this preliminary settlement agreement is enforceable by this federal court.
Agreed upon this ;}fo~y of June 2003.

BIlly Addison Department of Corrections P.O. Box 301501 Montgomery, AL 36130 (334) 353-3880
/::i~ MIller, HamIlton, Smder & Odom 2501 20th Place South Suite 450 Birmingham, AL 35223
ATTORNEYS FOR DEFENDANTS

~~~!Jv16--
Rhonda Brownstein Grace Graham Kelley Bruner Southern Poverty Law Center 400 Washington Avenue Montgomery, AL 36104 (334) 956-8200
ATTORNEYS FOR PLAINTIFFS

3

 </s> Case 4:03-cv-01114-UWC Document 35 Filed 03/19/2004 Page 1 of 1
./ "

IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF ALABAMA
MIDDLE DIVISION

JERRY BAKER, et al.,

)

)

Plaintiffs,

)

)

v.

)

Civil Action Number

)

CV-03-C-1114-M

DONAL CAMPBELL, et al.,

)

)

Defendants.

)

)

ORDER GRANTING MOTION TO DISMISS

ENTEREDrn~ J
MAR 19 2004~

Because Plaintiff only seeks injunctive relief against Defendant NAPHCARE, INC. 's (NAPHCARE) its Motion to Dismiss is hereby GRANTED without prejudice, since it no longer provides medical services to inmates ofthe Alabama correctional facilities.
The case should proceed against the remaining Defendants.

~, DONE this J!!day of

2004.

ChiefUnited States District Judge U. W. Clemon

 </s> CM/ECF - U.S. District Court Northern District of Alabama - Docket R... https://ecf.alnd.uscourts.gov/cgi-bin/DktRpt.pl?294622068080458-L_9...

U.S. District Court Northern District of Alabama (Middle) CIVIL DOCKET FOR CASE #: 4:03-cv-01114-UWC

CLOSED

Baker, et al v. Campbell, et al Assigned to: Judge U W Clemon Demand: $0 Cause: 42:1983 Prisoner Civil Rights
Plaintiff Jerry Baker

Date Filed: 05/13/2003 Jury Demand: None Nature of Suit: 555 Prisoner Petition (Prison Condition) Jurisdiction: Federal Question
represented by Grace Graham WHATLEY DRAKE LLC 2323 Second Avenue North Post Office Box 10647 Birmingham, AL 35202-0647 328-9576 Fax: 328-9669 Email: ecf@whatleydrake.com ATTORNEY TO BE NOTICED
Kelley Bruner SOUTHERN POVERTY LAW CENTER PO Box 2087 Montgomery, AL 36102-2087 1-334-956-8200 Fax: 1-334-956-8481 fax ATTORNEY TO BE NOTICED
Morris Dees, Jr SOUTHERN POVERTY LAW CENTER PO Box 2087 Montgomery, AL 36102-2087 1-334-956-8200 Fax: 1-334-956-8491 fax ATTORNEY TO BE NOTICED
Rhonda C. Brownstein SOUTHERN POVERTY LAW CENTER 403 Washington Avenue PO Box 2087 Montgomery, AL 36102-2087 334-956-8200 Fax: 334-956-8481 Email: rbrownstein@splcenter.org ATTORNEY TO BE NOTICED

1 of 10

6/28/2007 11:35 AM

CM/ECF - U.S. District Court Northern District of Alabama - Docket R... https://ecf.alnd.uscourts.gov/cgi-bin/DktRpt.pl?294622068080458-L_9...

Plaintiff Billy Ray Davis
Plaintiff Johnny . Defries
Plaintiff Tony Dexter

represented by Grace Graham (See above for address) ATTORNEY TO BE NOTICED
Kelley Bruner (See above for address) ATTORNEY TO BE NOTICED
Morris Dees, Jr (See above for address) ATTORNEY TO BE NOTICED
Rhonda C. Brownstein (See above for address) ATTORNEY TO BE NOTICED
represented by Grace Graham (See above for address) ATTORNEY TO BE NOTICED
Kelley Bruner (See above for address) ATTORNEY TO BE NOTICED
Morris Dees, Jr (See above for address) ATTORNEY TO BE NOTICED
Rhonda C. Brownstein (See above for address) ATTORNEY TO BE NOTICED
represented by Grace Graham (See above for address) ATTORNEY TO BE NOTICED
Kelley Bruner (See above for address) ATTORNEY TO BE NOTICED
Morris Dees, Jr (See above for address) ATTORNEY TO BE NOTICED
Rhonda C. Brownstein (See above for address)

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Plaintiff Ted . McGinnis
Plaintiff Darryl Mullins
Plaintiff Jerry Youngblood

ATTORNEY TO BE NOTICED
represented by Grace Graham (See above for address) ATTORNEY TO BE NOTICED
Kelley Bruner (See above for address) ATTORNEY TO BE NOTICED
Morris Dees, Jr (See above for address) ATTORNEY TO BE NOTICED
Rhonda C. Brownstein (See above for address) ATTORNEY TO BE NOTICED
represented by Grace Graham (See above for address) ATTORNEY TO BE NOTICED
Kelley Bruner (See above for address) ATTORNEY TO BE NOTICED
Morris Dees, Jr (See above for address) ATTORNEY TO BE NOTICED
Rhonda C. Brownstein (See above for address) ATTORNEY TO BE NOTICED
represented by Grace Graham (See above for address) ATTORNEY TO BE NOTICED
Kelley Bruner (See above for address) ATTORNEY TO BE NOTICED
Morris Dees, Jr (See above for address) ATTORNEY TO BE NOTICED
Rhonda C. Brownstein

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Plaintiff Roosevelt Youngblood on behalf of themselves and other persons similarly situated
V. Defendant Donal Campbell Commissioner of the Alabama Deptartment of Corrections
Defendant Ralph Hooks Warden of St Clair Correctional Facility Defendant NAPHCARE, Inc TERMINATED: 03/19/2004

(See above for address) ATTORNEY TO BE NOTICED
represented by Grace Graham (See above for address) ATTORNEY TO BE NOTICED
Morris Dees, Jr (See above for address) ATTORNEY TO BE NOTICED
Rhonda C. Brownstein (See above for address) ATTORNEY TO BE NOTICED
represented by Andrew W Redd ALABAMA DEPARTMENT OF TRANSPORTATION LEGAL BUREAU 1409 Coliseum Blvd. Montgomery, AL 36110 1-334-242-6965 Fax: 1-334-264-4359 Email: redda@dot.state.al.us ATTORNEY TO BE NOTICED
William F Addison ALABAMA STATE BOARD OF MEDICAL EXAMINERS 848 Washington Avenue Montgomery, AL 36104 334-242-4116 Fax: 334-242-4155 Email: ckruger@albme.org ATTORNEY TO BE NOTICED
represented by Andrew W Redd (See above for address) ATTORNEY TO BE NOTICED
represented by Giles G Perkins MILLER HAMILTON SNIDER & ODOM LLC 505 North 20th Street, Suite 1200

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Plaintiff Anthony . Cable
Plaintiff James Freeman

Birmingham, AL 35203 205-226-5200 Fax: 205-226-5226 Email: gilesperkins@mhsolaw.com TERMINATED: 03/19/2004 ATTORNEY TO BE NOTICED
J E Murrill, Jr MILLER HAMILTON SNIDER & ODOM LLC 1200 Financial Center 505 20th Street, North Birmingham, AL 35203 226-5200 Fax: 226-5226 fax Email: jaymurrill@mhsolaw.com TERMINATED: 03/19/2004 ATTORNEY TO BE NOTICED
James A Patton, Jr OGLETREE DEAKINS NASH SMOAK & STEWART One Federal Place 1819 Fifth Avenue North, Suite 1000 Birmingham, AL 35203 205-328-1900 Fax: 205-328-6000 Email: jay.patton@ogletreedeakins.com TERMINATED: 03/19/2004 ATTORNEY TO BE NOTICED
represented by Grace Graham (See above for address) ATTORNEY TO BE NOTICED
Morris Dees, Jr (See above for address) ATTORNEY TO BE NOTICED
Rhonda C. Brownstein (See above for address) ATTORNEY TO BE NOTICED
represented by Grace Graham (See above for address) ATTORNEY TO BE NOTICED
Morris Dees, Jr

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Plaintiff Bruce . Strickland

(See above for address) ATTORNEY TO BE NOTICED
Rhonda C. Brownstein (See above for address) ATTORNEY TO BE NOTICED
represented by Grace Graham (See above for address) ATTORNEY TO BE NOTICED
Morris Dees, Jr (See above for address) ATTORNEY TO BE NOTICED
Rhonda C. Brownstein (See above for address) ATTORNEY TO BE NOTICED

Date Filed 05/13/2003 05/13/2003 05/14/2003 05/23/2003 05/23/2003 05/23/2003
06/02/2003
06/06/2003 06/12/2003
06/19/2003

#

Docket Text

1 COMPLAINT filed (DWC) (Entered: 05/14/2003)
SUMMONS and complaint issued returned to pla (DWC) (Entered: 05/14/2003)
2 SUMMONS and complaint returned executed: upon dfts Donal Campbell, Ralph Hooks, NAPHCARE, Inc on 5/13/03 filed (DWC) (Entered: 05/14/2003)
3 MOTION by plas for preliminary injunction , for expedited discovery , for expedited hearing w/exhs atta filed cs (DWC) (Entered: 05/28/2003)
4 MOTION by plas for class certification w/exhs atta filed cs (DWC) (Entered: 05/28/2003)
5 AMENDED complaint filed by plas [1-1]; adding plas Anthony Cable, James Freeman, Bruce Strickland, Roosevelt Youngblood filed cs (DWC) Modified on 05/28/2003 (Entered: 05/28/2003)
6 OBJECTIONS by misc Ernest Hubbard to class certification on behalf of absent class member engaged in pending cases [4-1] filed cs (DWC) (Entered: 06/03/2003)
7 OBJECTIONS by misc Terry Little to motion for class certification [4-1] filed cs (DWC) (Entered: 06/09/2003)
8 MOTION by defendant NAPHCARE, Inc to dismiss claims against Naphcare , or to stay all proceedings with memo in support thereon filed cs (MAA) (Entered: 06/13/2003)
9 ORDER, ; In-court hearing set for 10:00 am 7/1/03 Courthouse, Bham, AL; parties to exchange witness lists by 6/25/03 filed ( by Chief Judge U W. Clemon )

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06/20/2003
06/20/2003 06/24/2003
06/25/2003 06/27/2003 06/27/2003 06/30/2003 06/30/2003 07/01/2003
07/01/2003 07/01/2003 07/01/2003 07/02/2003

cm (DWC) (Entered: 06/19/2003)
10 ORDER, granting pla's motion for expedited discovery [3-2], certain documents as listed are to be made available to the plas for inspection & copying not later than 6/25/03;when documents have been provided, the plas' expert pertmitted to tour the med facilities at St Clair Corr Fac, review documents as set out & meet w/ designated inmates including plas filed ( by Chief Judge U W. Clemon ) cm (DWC) (Entered: 06/20/2003)
11 MOTION by dft NAPHCARE, Inc to dismiss all claims against dft NAPHCARE , or in the alternative to stay all proceedings against dft NAPHCARE filed cs (DWC) (Entered: 06/23/2003)
12 ORDER (WritHCadT) that Tony Dexter, James Freeman, Ted McGinnis, Darrell Mullins, Roosevelt Youngblood, Johnny Defriese appear before the USDC ALN 7/1/03 10:00am, Bham, AL filed ( by Chief Judge U W. Clemon ) cm (DWC) (Entered: 06/24/2003)
13 MOTION by defendant NAPHCARE, Inc to continue hearing on class certification filed cs (KAM) (Entered: 06/25/2003)
14 OPPOSITION by plas to dft NAPHCARE's motion to dismiss all claims against dft NAPHCARE [11-1], motion to stay all proceedings against dft NAPHCARE [11-2] filed cs (DWC) (Entered: 06/27/2003)
15 STIPULATION of parties of Preliminary Injunction Settlement Agreement filed (DWC) (Entered: 06/27/2003)
16 MOTION by potential class member, Terry Little, for judicial notice and intent to appeal with exh att, filed cs (Former Employee) (Entered: 06/30/2003)
17 MOTION by movant Alvin H Daniels, potential class member, for continuance of class certification and preliminary injunction hearing, and opp to class counsel, filed cs (Former Employee) Modified on 06/30/2003 (Entered: 06/30/2003)
18 11 - ORDER dft NAPHCARE's motion to dismiss all claims against dft or in the alternative motion to stay all proceedings against dft NAPHCARE is OVERRULED w/o prej [11-1] [11-2] ( by Chief Judge U W. Clemon ) entered cm (DWC) (Entered: 07/02/2003)
DOCKET modification (utility event), terminating motion to dismiss claims against Naphcare [8-1], terminating motion to stay all proceedings [8-2] pursuant to 7/1/03 Order doc 18 (DWC) (Entered: 07/02/2003)
19 17 - ORDER finding the motion for continuance of class certification and preliminary injunction hearing, [17-1] moot ( by Chief Judge U W. Clemon ) entered cm (DWC) (Entered: 07/02/2003)
20 13 - ORDER granting motion to continue hearing on class certification [13-1] ( by Chief Judge U W. Clemon ) entered cm (DWC) (Entered: 07/02/2003)
21 ORDER the parties' Preliminary Injunction Settlement Agreement is APPROVED [15-1] filed ( by Chief Judge U W. Clemon ) cm (DWC) (Entered: 07/02/2003)

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08/07/2003 08/11/2003
08/12/2003 08/13/2003 10/23/2003 11/07/2003 11/17/2003 02/19/2004 02/24/2004 02/26/2004 03/03/2004 03/10/2004 03/10/2004
03/10/2004 03/19/2004 03/19/2004

22 Report of Parties (form 35) of compliance with FRCP 26 filed (DWC) (Entered: 08/07/2003)
23 ORDER (Scheduling) that the dates agreed to by the parties in their Planning Meeting are ADOPTED & binding on the parties; discovery cutoff 1/31/04 ; dispositive motions ddl 2/23/04 by Chief Judge U W. Clemon entered cm (DWC) (Entered: 08/11/2003)
24 ANSWER by dfts Donal Campbell, Ralph Hooks w/appear by atty(s) Andrew W Redd filed cs (DWC) (Entered: 08/12/2003)
25 ANSWER by defendant NAPHCARE, Inc filed cs (DRR) Modified on 08/13/2003 (Entered: 08/13/2003)
26 MOTION by defendant NAPHCARE, Inc to dismiss all claims against Naphcare filed cs (KWC) (Entered: 10/23/2003)
27 RESPONSE by plaintiffs to Naphcare's motion to dismiss all claims against Naphcare [26-1] filed cs (KWC) (Entered: 11/07/2003)
28 REPLY by defendant NAPHCARE, Inc to plas' response [27-1] to Naphcare's motion to dismiss filed cs (KWC) (Entered: 11/18/2003)
29 Joint MOTION by plaintiff, defendant to revise scheduling order to submit expert report on 02/28/04, to extend disc until 03/31/04, and move all other ddls accordingly filed cs (KWC) (Entered: 02/19/2004)
30 29 - ORDER granting motion to revise scheduling order [29-1] ; dfts to submit expert report on 02/28/04; Discovery cutoff 3/31/04 ( by Chief Judge U W. Clemon ) entered cm (KWC) (Entered: 02/24/2004)
31 STIPULATION of parties regarding release of health information filed cs (MAA) (Entered: 02/26/2004)
REMARK -order doc #30 returned by USPS as to Ernest Hubbard marked "unclaimed - deceased" (KWC) (Entered: 03/03/2004)
32 16 - ORDER overruling without prejudice motion for judicial notice and intent to appeal [16-1] ( by Chief Judge U W. Clemon ) entered cm (KWC) (Entered: 03/11/2004)
33 3 - ORDER finding the motion for preliminary injunction [3-1] moot, finding the motion for expedited discovery [3-2] moot, finding the motion for expedited hearing [3-3] moot ( by Chief Judge U W. Clemon ) entered cm (KWC) (Entered: 03/11/2004)
34 4 - ORDER overruling without prejudice plas' motion for class certification [4-1] ( by Chief Judge U W. Clemon ) entered cm (KWC) (Entered: 03/11/2004)
35 ORDER granting motion to dismiss all claims against Naphcare [26-1] without prejudice; case should proceed against remaining dfts filed ( by Chief Judge U W. Clemon ) cm (KWC) (Entered: 03/19/2004)
DOCKET modification (utility event) terminating party NAPHCARE, Inc per order doc #35 (KWC) (Entered: 03/19/2004)

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03/22/2004 06/02/2004 06/02/2004
06/04/2004
06/14/2004 06/15/2004 06/15/2004 06/17/2004
06/17/2004 06/22/2004 06/22/2004 06/22/2004 06/24/2004
06/29/2004 07/07/2004 07/07/2004 07/27/2004

REMARK- order doc #35 as to Ernest Hubbard, returned by USPS marked "deceased" (KWC) (Entered: 03/26/2004)
36 NOTICE of parties settlement & mediation not necessary filed by plaintiff cs (SRJ) (Entered: 06/02/2004)
37 MOTION (JOINT) by plaintiffs & defendents for order approving attached settlement agreement and to approve attached notice to the class filed cs (SRJ) Additional attachment(s) added on 9/15/2005 (SRJ, ). (Entered: 06/02/2004)
38 37 - ORDER granting parties' joint motion for order to approve attached settlement agreement and to approve attached notice to the class [37-1] ( by Chief Judge U W. Clemon ) entered cm (SRJ) (Entered: 06/07/2004)
39 OBJECTIONS to proposed medical care settlement by Montez McGowan filed (SRJ) (Entered: 06/15/2004)
40 OBJECTION to proposed medical care settlement by Samuel Williams at SCCF filed (SRJ) (Entered: 06/16/2004)
41 OBJECTION to proposed medical care settlement by James Edwards at St Clair Correctional Facility (SCCF) filed (SRJ) (Entered: 06/16/2004)
DOCKET modification (utility event) to dismiss movant party Ernest Hubbard pursuant to returned envelope recvd 06/15/04 from US Postmaster marked "Returned to Sender DECEASED" (SRJ) (Entered: 06/17/2004)
42 OBJECTIONS by James Van Noy of SCCF to proposed medical care settlement [37-1], [36-1] filed cs (SRJ) (Entered: 06/21/2004)
43 OBJECTIONS to Proposed Medical Care Settlement by inmate Michael Christianson deem filed 06/16/04 (SRJ) (Entered: 06/22/2004)
44 OBJECTIONS to Proposed Medical Care Settlement by inmate Anthony Crook deem filed 6/14/04 (SRJ) (Entered: 06/22/2004)
45 OBJECTIONS to Proposed Medical Care Settlement by Carl A Perry, Jr., filed cs (SRJ) (Entered: 06/22/2004)
46 OBJECTIONS to granting of joint motion for preliminary approval of proposed settlement agreement & court's approval of the motion for notice to the class by movant Alvin H Daniels to filed (SRJ) (Entered: 06/25/2004)
47 OBJECTIONS by Antonio Rudolph to Proposed Medical Care Settlement filed (SRJ) (Entered: 06/30/2004)
48 OBJECTION by George Brown, Jr., to Medical Care Settlement filed (SRJ) (Entered: 07/08/2004)
49 OBJECTION by Kevin McCarty to proposed Medical Care Settlement filed (SRJ) (Entered: 07/08/2004)
50 ORDER ; Fairness Hearing is hereby SET for Fri 8/27/04 2:00pm at Hugo Black Courthouse, Bham., AL filed (by Chief Judge U W. Clemon ) cm (SRJ) (Entered: 07/27/2004)

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08/04/2004 08/27/2004 08/31/2004 08/31/2004

51 OBJECTIONS by movant Alvin H Daniels to Fairness Hearing [50-2]; and Notice of change of address filed cs (SRJ) (Entered: 08/05/2004)
COURTROOM NOTES: FAIRNESS HEARING (UWC) - before the Honorable U. W. Clemo, CUSDJ - opening remarks of the court - testimony of plaintiffs plaintiffs rest - no testimony by defendants - written order to be entered by the court - (Penny Enoch, rptr.) (DGS) (Entered: 08/27/2004)
52 ORDER APPROVING CONSENT SETTLEMENT; the Court hereby finds that the Proposed Settlement Agreement is FAIR, REASONABLE, and ADEQUATE; filed ( by Chief Judge U W. Clemon ) cm (SRJ) (Entered: 08/31/2004)
53 ORDER of DISMISSAL based on Court Approving Settlement Agreement [52-1]; Case is hereby DISMISSED without prejudice w/costs taxed as paid and satisfied, filed ( by Chief Judge U W. Clemon ) cm (SRJ) (Entered: 08/31/2004)

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 </s> Exhibit A

BAKER v. CAMPBELL Agreement of Experts
January 21, 2004

DEFINITIONS:
• Serious medical need “Serious medical need” is defined as a valid health condition that, without timely medical intervention, will cause (1) unnecessary pain, or (2) measurable deterioration in function (including organ function), or (3) death, or (4) substantial risk to the public health.
• Formulary
The “formulary” is defined as a list of medications approved for use by practitioners. It is developed and monitored by a Pharmacy and Therapeutics committee, with physician representation from the ADOC’s medical care provider’s Alabama operation. The formulary process may require step-therapy to assure cost-effectiveness. The formulary process may require pre-authorization for selected therapeutics because of their safety profile, injudicious use by nonspecialists or high cost. There is a clear and efficient mechanism for practitioners to request a waiver for non-formulary medications, based on medical necessity. The formulary and waiver process for requests for waivers of the formulary are an integral part of the medical necessity decision-making process. Non-formulary requests will be considered similarly to requests for off-site care.

• Medical Necessity
The following principles are intended to assist in making medical necessity decisions that are soundly-based and consistent:
• The intervention must be intended to be used for a medical condition. A health intervention is an activity undertaken for the primary purpose of diagnosing, preventing, improving or stabilizing a disease, illness or injury. Activities that are primarily cosmetic, custodial, or part of normal existence (e.g., baldness or impotence), or undertaken primarily for the convenience of the patient, family, or practitioner are not considered serious medical needs.
• The published evidence should demonstrate that the intervention can be expected to produce its intended effects on health outcomes. The published evidence used to justify a determination must be peer-reviewed, reporting scientifically well-controlled studies. The evidence should directly relate the intervention to improvements in health.
• There is no other intervention that produces comparable or superior results in a more cost-effective manner.

Exhibit A

• The intervention’s expected beneficial effects on health outcomes should outweigh its expected harmful effects.

• Nothing in these principles should prohibit the ADOC or PHS, at their discretion, from covering health interventions that do not meet these criteria.

• Medical necessity will be determined by the RMD in conjunction with the site responsible physician.

• Clinical Guidelines

The ADOC and its medical care provider will develop and implement

chronic disease guidelines that are reasonably-based on the most current

nationally-accepted guidelines for the management of chronic and communicable

disease, customized for corrections. The targeted conditions will be prevalent

among inmates. They will be conditions for which there is a sound scientific

basis that interventions make a difference in morbidity and mortality. Further,

these will be conditions targeted as national priorities by the Surgeon General

(Healthy People 2010) or the National Committee for Quality Assurance (HEDIS

Quality Compass). These guidelines are published and periodically updated by:

Diabetes

American Diabetes Association

Hypertension

NIH-JNC

Asthma

NIH – NAEP

HIV

U.S. DHHS

MRSA

Bureau of Prisons and/or CDC

Tuberculosis, STDs CDC NCHSTP

Viral hepatitis

U.S. DHHS

Performance expectations (e.g., monitoring timelines) and performance measurements will be summarized and made available to practitioners. The clinical guidelines will be reviewed and updated annually, as necessary.

ELEMENTS OF ADEQUATE CARE AND TREATMENT FOR INMATES WITH SERIOUS MEDICAL NEEDS:

• Access to care is not unreasonably impeded.
• Access to effective and appropriate diagnostic testing, consultation, medication and therapeutic interventions.
• Adoption of nationally accepted clinical guidelines for chronic and communicable disease. This includes at least quarterly monitoring, with a physician visit and appropriate diagnostic evaluation, for primary prevention and early detection of complications of illness. Patients shall be evaluated for their degree of control, and plans should be documented to improve control, when necessary. For patients in good control, with conditions such as hypertension or epilepsy, who

2

Exhibit A
have been stable for more than six months, visits may be scheduled every six months so long as medication continuity is maintained. • Continuity of care including continuity of medication on transfer, at St. Clair, and on release. • Health assessment for any incoming inmate who has not had such an evaluation, or whose documentation is not available, within the past year. • Use of a continuously updated formulary. Requirements for step-therapy are acceptable when medically legitimate. • Timely access to formulary and non-formulary medication. The non-formulary process should not pose any barriers to time-urgent care. • Timely access to outside specialty care when medically necessary. The utilization management process should not pose any barriers to time-urgent care. No prospective approval is required in these circumstances.
All specialty referrals are to be made by a physician. The only exceptions to this policy for an individual mid-level practitioner can be made by the regional medical director, in writing. Nurses involved in the utilization management process may approve referrals for specialty care or may ask for additional demographic or clinical information. Only physicians may issue denials or recommendations for alternative medical care. Alternative recommendations or denials will only be made in consideration of the individual patient’s condition. When an alternative recommendation or denial is issued, the rationale will be clearly specified.
The medical director, or delegate, must give prior approval for all outside referrals not anticipated by guidelines. The medical director should consider medical information on the individual patient. The referring physician should have the opportunity for informal and formal review of any alternative recommendation.
The approval process should not exceed five business days for non-urgent care, measured from the date that requested information is supplied. The consideration process shall not be unreasonably delayed.
As part of the database, the ADOC’s medical care provider will track all requests for outside care by date, specialty or test, and medical reason. The tracking should include the disposition of the utilization management decision. This list will form the basis for external review.
As part of the database, the ADOC’s medical care provider will also track the date of the appointment, and whether the patient was seen. This information will form the basis for studying the time lag to outside care.
All non-urgent referrals will be accomplished within 60 days, or sooner according to medical necessity. The patient will be seen by the referring physician every
3

Exhibit A
thirty days until such time as the referral has been accomplished. The purpose of these visits is to assess whether there is any reason to intervene in the process.
The ADOC’s medical care provider will submit quarterly reports to the ADOC and to the ADOC’s monitor, we well as to the consultant of this agreement. These reports will include counts of visits by specialty or diagnostic test, lag time to appointments by specialty, and turnaround time on reports to primary physicians. Data will be tracked and trended with a twelve-month tail.
The ADOC’s medical care provider will also report quarterly on hospital discharges by diagnosis and length of stay. Data will be tracked and trended with a twelve-month tail and reported to the Department’s consultant.
The care recommendations of the specialist will be acknowledged in the medical record and considered. Any deviation from or override of the specialist’s recommendations must be affirmatively medically justified in the medical record.
Prostheses, including dental, and devices such as hearing aids, will be repaired and/or replaced in a timely manner, consistent with the medical condition of the patient. Turnaround time should not exceed 90 days, unless there are sound medical reasons.
• Access to medically trained personnel for emergency transportation to hospitals.
• Medical information is transmitted as medically appropriate to outside medical caregivers. Medical records are available to ADOC consultant, Plaintiffs’ counsel, and any other authorized monitor/consultant. Medical records are timely transferred when the inmate moves from one facility to another.
• Co-payments do not apply for care required by clinical guidelines or care requested by physicians, such as follow-up care. Co-payments shall be waived for control of serious communicable disease control, e.g., access to care for boils and tuberculosis.
• Inmates will not be charged co-payments for being informed of the results of laboratory or diagnostic tests.
• Sick call shall not be conducted between 11:00 PM and 6:00 AM. Any inmate presenting to the nurse more than two consecutive times for the same symptoms, with deterioration or no improvement, will be referred to a higher-level practitioner. Sick call will be available to inmates from every area of the facility at least five days per week. Nurses performing sick call will be trained in the use of nurse screening protocols, with emphasis on the timing of appropriate referral to a higher-level practitioner. Nurses will be trained in physical assessment to implement these protocols. The assessment and treatment plan will be appropriate to the complaint, including timely referral to a higher-level practitioner, if necessary.
4

Exhibit A
• Annual screening for tuberculosis will include a review of symptoms, PPD for non-positives, chest x-ray within 96 hours for TB skin test converters, respiratory isolation for converters with positive symptoms, and surveillance activities to determine whether there is intramural transmission of tuberculosis.
• Comprehensive medication management program to minimize lag time from prescription to first dose, to maintain continuity of medication, to eliminate gaps in prescription renewal, and to counsel and document legitimate refusals of medication. The prescribing practitioner should be notified of any patient who is not taking prescribed medication, as measured by missing doses on three consecutive days.
• Dental care shall focus on the timely treatment of emergencies, the restoration of restorable teeth in lieu of extraction, and on dental hygiene. Cleaning will be based on the following protocol: diabetics, seizure patients, HIV-positive inmates, cardiac patients, and inmates at risk for periodontal disease shall receive a cleaning on an annual basis. All other inmates shall have the opportunity for a cleaning at least once every 24 months.
• Clinical staff shall all undergo a rigorous credentialing process that includes primary verification of licensure and restrictions or sanctions, and inquiry with the National Practitioner Data Bank.
• Licensed staff shall not practice beyond the scope of their license.
• Consulting physicians shall be qualified in their specialty, as defined by their hospital privileges. Nurses must have graduated from an accredited RN or LPN program and hold applicable licenses. All other ancillary personnel must meet applicable state regulatory requirements and training standards. Personnel working under a license or certification who are subject to restrictions or conditions imposed by the licensing agency, or who have formal complaints filed against them, must immediately report such restrictions, conditions, or complaints to the Medical Director.
• Medical and nursing staff must be currently certified in cardio pulmonary resuscitation (“CPR”), according to the certification schedule defined by the Red Cross or American Heart Association. All health care staff who sees patients shall receive regular training to maintain competence in current methods for diagnosing and treating medical complications associated with acute and chronic illness, including the ability to recognize when referral to a physician or specialist is necessary.
• Implementation of a comprehensive quality management program with a program description and annual work plan. Activities will include communicable disease control, pharmacy and therapeutics, mortality review, clinical guidelines, and adherence to standards. In addition there is regular performance measurement on access to on-site and off-site care, availability of specialty care, continuity (during incarceration and on release), coordination between health care practitioners,
5

Exhibit A
complaints, medication management, acute care, chronic disease care and communicable disease. • Focus studies should be performed where problems exist. Barriers should be identified and interventions should be designed to reduce the barriers. Remeasurement should occur to document meaningful improvement. • Data on performance measurements should be tracked and trended. • Data shall be discussed at a quality management committee, with appropriate analysis and plans documented in the minutes. • Mortality reviews shall be timely and self-critical. • An annual program summary and evaluation shall be published within three months of the end the year, documenting an inventory of activities, trended performance data, self-critical analysis, and plans for the upcoming year based on findings of the past year. • Medically required special diets will be ordered when determined to be necessary by the responsible physician. POLICIES AND PROCEDURES TO BE DEVELOPED/REFINED BY ADOC: The following policies and procedures are subject to approval by the contract consultant, approval that will not be unreasonably withheld: • Nurse screening protocols • Clinical Guidelines for chronic disease and communicable disease, including viral hepatitis • Quality management plan, work plan, template for evaluation, performance measurement procedures, and mortality review • Medication management • Staff training • Bloodborne pathogen control plan • Airborne pathogen control plan • MRSA control plan including surveillance, diagnosis, treatment, hygiene, environmental sanitation, and exchange and laundering of linens and clothing
6

Exhibit A

STAFFING:

• Designated medical authority (MD) for facility
• Clear chain of command for quality oversight and utilization management
• One FTE physician equates to 40 hours of on-site, hands-on, medical care
• This facility must have at least 40 hours physician care on-site, and 40 hours of a mid-level practitioner such as a nurse practitioner.
• This facility must have sixteen hours of RN coverage in every 24-hour period; LPN’s must be supervised.
• Sufficient staff to perform performance measurement and other quality management functions
• For each additional 200 inmates over the census that existed on January 21, 2004, staffing shall be increased as follows: 0.2 FTE physician or 0.3 FTE mid-level practitioner.

PERFORMANCE MEASUREMENT:
Criteria for Performance Measurement1 Relevance: the measure should address features of the system or practitioner that are relevant to the stakeholder likely to make judgments about quality of care, and that are likely to motivate efforts toward improvement in quality. The measures should
• Represent priority clinical and financial issues • Identify areas of care with measurable opportunities for improvement • Represent activities for which a facility or practitioner is directly accountable and
might be modifiable • Define a scale with magnitude and direction that is unambiguous in its relation to
quality • Motivate improvements in quality, efficiency and cost-effectiveness
Validity: Validity of a measure is influenced by measurement errors and biases, which if unresolved, make the reliability and interpretation of the measure questionable. To be valid, a measure should:
• Have a high level of consensus regarding its meaning and importance • Produce comparable results when measured by different auditors (reliability) • Produce comparable results when measured in different settings, different time
periods, or with different data sources • Measure directly the process or outcome it is intended to measure

1 Criteria adapted from “Criteria for Measure Selection, National Committee for Quality Assurance
7

Exhibit A
• Be able to be adjusted for other population characteristics which might affect the measure but which are not necessarily under the control of the facility
Feasibility: The measure should be amenable to collection, computation, and implementation in a way that complements existing health system approaches to performance measurement. The measure should be:
• Clearly specified • Inexpensive to produce • Adhere to accepted conventions of confidentiality • Available in a timely manner • Amenable to audit • Resistant to gaming
Frequency of Measurement Each measure is to be performed every three months, unless otherwise indicated.
When performance on any individual measure equals or exceeds 90% in two successive quarters, that individual measure can be performed every six months. When performance falls below 90% on any individual measure, the measurement periods defaults to every three months.
Performance measures marked with asterisks necessitate clinical judgment during the audit. Appropriate disciplines are noted on the tool.
Nursing Sick Call 1. Seen within 36 hours of request, or 72 hours on weekends 2. Assessment appropriate to chief complaint* 3. Relevant vital signs charted* 4. Treatment plan appropriate* (e.g., refer to higher level practitioner on third visit for same symptoms)
Urgent Care 1. Care timely* 2. Appropriate vital signs documented* 3. Appropriate MD/PA/NP assessment and plan*
Clinical Guidelines – annual review 1. The clinical guidelines and related disease management program will be based on nationally-accepted guidelines for asthma, diabetes, HIV, epilepsy, hyperlipidemia, viral hepatitis and hypertension, as defined above 2. For communicable disease, the guidelines conform to CDC, ACET, ACIP, BOP etc. for STDs, TB, prevention of viral hepatitis and HIV, MRSA, etc.
Chronic Disease—PPD Positive 1. Clinical evaluation and treatment decision within 14 days*
8

Exhibit A
Chronic Disease—Viral Hepatitis 1. All screening, diagnostic procedures, and treatment will occur consistent with the medical care provider’s clinical guideline as referenced in ¶ 11 of the Settlement Agreement.
Chronic Disease—Asthma—(Applies only to Moderate and Severe Asthma) 1. Peak flow on intake or within past 3 months 2. On inhaled steroid, as medically necessary, if the patient is classified as moderate persistent or worse for more than four weeks. 3. Followed chronic disease guideline; assessment includes degree of control; strategy to improve outcome if control is fair or poor or status worsened*
Chronic Disease—Diabetes [to comport with Diabetes Settlement Agreement] 1. Blood sugar on intake 2. Hemoglobin A1C performed quarterly (unless stable <7.0, then every 6 months) 3. Level ≤ 7.0 or documented clinical strategy within 45 days of intake (or arrival at facility) or within past 3 months. Patients with high levels may have interim objectives of levels greater than 7.0. 4. Dilated retinal exam within the past 12 months 5. Lipid evaluation within the past 12 months 6. Foot exam within the past 3 months 7. Urine microalbumin within the past 12 months unless one prior positive has been documented then it is no longer needed to test. 8. Blood pressure controlled or documented attempt (threshold 130/80) 9. Low-dose enteric coated aspirin prescribed 10. Followed chronic disease guideline; assessment includes degree of control; strategy to improve outcome if control is fair or poor or status worsened *
Chronic Disease—HIV 1. CD4 count and viral load within 45 days of intake or arrival at facility, or within past 3 months 2. PCP prophylaxis offered within 2 weeks if CD4+ count ≤ 200 3. HAART therapy consideration with documentation in the medical record, within 2 weeks if CD4+ count ≤ 350 or the viral load is >55,000 (RT-PCR assay) or >30,000 (bDNA assay) 4. Followed chronic disease guideline; assessment includes degree of control; strategy to improve outcome if control is fair or poor or status worsened * 5. Pneumovax once 6. Influenza vaccine annually, October - February
Chronic Disease—Hypertension 1. Blood pressure reading noted at intake 2. Intake blood pressure > 140 systolic or > 90 diastolic: treatment or plan will be initiated within 14 days of identification. The diagnosis of hypertension cannot be made with a single blood pressure reading.
9

Exhibit A
3. Followed chronic disease guideline; assessment includes degree of control; strategy to improve outcome if control is fair or poor or status worsened *
Specialty Care Access (Cardiology, Dermatology, Eye, Gynecology, Neurology, Ophthalmology, Orthopedics, Podiatry, Pulmonary, etc.)
1. Progress note reflects need for consultation 2. Consultation ordered by a physician, physician assistant or nurse practitioner 3. Consultation accomplished within 60 days of order 4. Primary care visits every 30 days until visit is accomplished 5. Documentation of follow-up as medically appropriate.
X-Ray (chest) 1. Timely reporting of results, clinician acknowledgment and appropriate followup of abnormal chest x-rays within 72 hours after x-ray is performed*
X-Ray (non-chest) 1. Timely reporting of results, clinician acknowledgment and appropriate followup of abnormal x-ray within 96 hours after x-ray is performed*
Laboratory 1. Report back within 72 hours as appropriate 2. Clinical acknowledgment and appropriate clinical response*
Medication Administration Records 1. % of blank spaces in the five medication administration books 2. Assess % of refusals (3 consecutive days) in medication administration books 3. Assess % of refusals (3 consecutive days) with appropriate follow-up
Lag Time from Prescription to Delivery of First Dose of Medication 1. Median number of days from prescription to delivery of first dose 2. Examination of cases in longest tenth percentile for barriers
Dental Care 1. Emergency evaluations seen by a licensed, independent health care practitioner within 24 hours 2. “Priority” patients seen within seven days, timely treatment including restoration when appropriate 3. Ratio of restorations to extractions for the trailing three months 4. Dental hygiene visit, including cleaning, within 24 months for inmates in custody for > 24 months 5. Documentation of providing oral health information to patients seen 6. Clear and complete documentation of visits and procedures including medical history
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Exhibit A
Credentialing – Every 12 months 1. Assess 100% of MD/PA/NP files with validation of current license and DEA certificate 2. Assess 100% of nursing files with validation of current license 3. Assess 100% of dental files with validation of current license 4. Assess 100% of mental health files with validation of current license
Complaints and grievances (requires a system to track and trend complaints and grievances from inmates through all conduits)
1. Analyze trends in terms of numbers and category distribution 2. Assess % appropriately addressed within 14 days 3. Assess % answered responsive to specific complaint
Utilization Management and Alternative Treatment Plans 1. Timely 2. Medical information considered 3. Requesting practitioner informed with specified reason for the denial or alternative treatment plan 4. Specific alternative treatment plans proposed, where applicable
Pending Off-site Referrals 1. % waiting more than 30, 60, and 90 days 2. 30 day review by primary physician, where applicable
Comprehensive quality management program 1. Quality Management Program Description and Annual work plan 2. Activities include communicable disease control, pharmacy and therapeutics, mortality review, clinical guidelines, and adherence to standards. In addition there is regular performance measurement on access, availability, continuity, coordination, complaints, acute care, chronic disease care and communicable disease. Focus studies should be performed where problems exist. Barriers should be identified and interventions should be designed to reduce the barriers. Re-measurement should occur to document meaningful improvement. 3. Focused studies on all identified opportunities for improvement 4. Tracked and trended data on performance measurements 5. Minutes 6. Mortality reviews timely and self-critical 7. Annual program summary and evaluation
11

 </s> IN THE UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF ALABAMA

BAKER, et al., on behalf of themselves and other persons similarly situated,
Plaintiffs, vs. CAMPBELL, et al.,
Defendants.

Case No. CV-03-C-1114-M

SETTLEMENT AGREEMENT WHEREAS on May 13, 2003, the Plaintiffs filed suit challenging the constitutional adequacy of the medical care provided by the Alabama Department of Corrections (ADOC) to inmates housed at St. Clair Correctional Facility (St. Clair); and WHEREAS the Plaintiffs and the Defendants agree that it is in their best interests to resolve this litigation; NOW THEREFORE the parties, by and through their respective counsel, hereby stipulate and agree to the following provisions to resolve this litigation: I. CLASS CERTIFICATION 1. For the purpose of settlement only, the Defendants do not object to class certification. The settlement class is defined as “all present and future inmates who are or will be incarcerated at St. Clair Correctional Facility and who are in need of medical care.”

II. AGREEMENT OF EXPERTS 2. The Defendants agree to comply with the requirements for adequate
medical care for inmates housed at St. Clair as contained in the document entitled “Agreement of Experts.” The Agreement of Experts, which is attached to this Settlement Agreement as “Exhibit A,” is incorporated into this Settlement Agreement as though fully set forth herein.
3. The Agreement of Experts addresses such issues as (1) the medical treatment that will be provided to inmates who are ill; (2) timely access to appropriate care; (3) the levels and types of staffing necessary to provide adequate care; (4) the formulary; (5) the development and implementation of performance measures; and (6) the ADOC contract oversight and quality management program to ensure ongoing quality of care.
4. In the event that the inmate population at St. Clair increases over and above the inmate census that existed on January 21, 2004, the ADOC agrees to add additional medical staff in accordance with the staffing levels expressed in the Agreement of Experts. III. TREATMENT WITH RESPECT TO NAMED PLAINTIFFS
5. All required procedures, evaluations, and/or medications shall be recorded in the medical record of each inmate. The named medical consultant for this agreement will receive copies of all reports, studies and evaluations related to the medical assessments of these named plaintiffs and will be kept informed as to the details of their medical management as soon as they become available to the ADOC’s medical care
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provider.1 Completion of these evaluations and commencement of treatment as medically indicated shall be a component of the consultant’s evaluation of medical care and determination of compliance with this Agreement. Failure to follow these stipulations or to provide appropriate follow-up and documentation may lead to a finding of non-compliance by the consultant. The ADOC’s medical care provider’s Regional Vice-President or State Medical Director shall be designated the responsible authority to assure that these medical evaluations are scheduled and completed, follow-up recommendations acted upon and that inordinate delays do not occur in either evaluation or treatment. The ADOC will also name a responsible individual (either employee or contractor) to specifically assist the medical care provider and the medical consultant in assuring compliance with these stipulations for the named plaintiffs.
6. Tony Dexter, AIS No. 169283, will receive an evaluation by a hematologist for his von Willebrand’s disease (Type 3) within 30 days of the date of this Agreement. Within 90 days of the completion of this evaluation by a hematologist, Mr. Dexter shall be evaluated for possible treatment for hepatitis C consistent with the clinical guideline for treatment referred to in paragraph 11 of this Agreement. If in the opinion of a gastroenterologist treatment is indicated (based on the guideline) and can proceed without a liver biopsy, treatment shall commence within 30 days of that evaluation. If a liver biopsy is deemed necessary for treatment, a hematologist shall be consulted for specific recommendations concerning pre- and post-liver biopsy transfusion requirements to assure clinical stability. If indicated, hospitalization to accomplish this procedure shall be accomplished. If in the opinion of a hematologist a liver biopsy is not feasible (i.e., presents excessive risk) a copy of that opinion shall be provided to the
1 At the time of this agreement, the “medical care provider” is Prison Health Services, Inc.
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consultant as soon as it becomes available. Assuming compliance with the clinical guideline for treatment, Mr. Dexter will receive appropriate therapy commencing within 30 days of completion of evaluation for treatment of his hepatitis C infection. All nursing staff and all security shift commanders will be educated on at least an annual basis and all new employees oriented at time of hire, that all of Mr. Dexter’s bleeding episodes must be considered a medical urgency and potential emergency regardless of what may appear to be trivial on initial assessment. The site physician or on-call practitioner will be contacted for all bleeding episodes and appropriate treatment will be provided. All bleeding episodes, as well as the name of the practitioner contacted and the decision regarding disposition, shall be documented in the medical record.
7. James Freeman, AIS No. 160415, will receive an evaluation from a colorectal specialist within 30 days of the date of this Agreement. Within 30 days of the date of this Agreement, Mr. Freeman will also receive an appropriate evaluation and diagnosis by either a surgeon or gastroenterologist regarding the recent-onset abdominal pain that is currently requiring opiates for control. Subsequent to these evaluations, if it is the medical opinion of the specialist that a reanastomosis can be performed successfully, it must be scheduled and performed as soon as practical and no more than 90 days of the completed evaluation. Prior to surgery and as long as necessary (or if surgery is not deemed technically feasible, indefinitely), Mr. Freeman will receive adequate supplies of colostomy materials to appropriately care for his medical condition. He will be given regular and routine unrestricted access to a clean working environment (including hot and cold running water with soap or disinfectant available) in which to change and/or clean his colostomy bags. At least once every six weeks, he will be
4

scheduled for a routine examination of his stoma to assure that it is not infected. Evaluations that are more frequent shall occur on an “as needed” basis. All such evaluations will be recorded in the medical record. If there is an infection or skin breakdown, prompt and appropriate medical treatment shall be provided.
8. Ted McGinnis, AIS No. 121161, will receive an evaluation from a hematologist regarding his abnormal complete blood count (lymphocytosis) within 30 days of the date of this Agreement. Within 90 days of this evaluation by a hematologist, assuming no medical contraindications, Mr. McGinnis will be evaluated as a candidate for treatment for hepatitis C consistent with the clinical guideline for treatment referred to in paragraph 11 of this Agreement. Assuming no medical contraindications, this evaluation shall include the previously approved liver biopsy, which shall be performed within 90 days of the hematology evaluation. Assuming compliance with the clinical guideline for treatment, Mr. McGinnis will receive appropriate therapy commencing within 30 days of completion of evaluation for treatment of his hepatitis C infection.
9. Darrel Mullins, AIS No. 138916, will receive appropriate and prompt medical treatment under the direction of an oncologist or radiation therapist for metastatic seminoma of the testicle that has metastasized to his abdomen and lower back. Mr. Mullins will be kept fully informed of his medical condition at all times and apprised of his treatment options. He will receive regularly prescribed pain medications in dosages necessary to alleviate pain and suffering. Such treatment for pain will not be allowed to lapse once prescribed unless dictated by changes in his clinical condition.
5

IV. CONTRACT WITH MEDICAL CARE PROVIDER 10. The ADOC’s contract with its medical care provider is incorporated into
this Settlement Agreement as though fully set forth herein. If the Settlement Agreement conflicts with the ADOC contract with its medical care provider, the Settlement Agreement controls. V. HEPATITIS C
11. The ADOC’s medical care provider’s current clinical guideline for Hepatitis C is incorporated into this Settlement Agreement as though fully set forth herein. The clinical guideline for Hepatitis C may change from time to time as medically appropriate, so long as there is no decrease in the level of care or conflict with viral hepatitis guidelines issued by the Centers for Disease Control and Prevention or the National Institutes of Health. VI. TIMING
12. Aside from the provisions contained in ¶¶ 6-9 that may include different time requirements, absent any unforeseen delays that are outside the control of the ADOC, the Defendants agree to implement the terms of the Settlement Agreement by July 1, 2004. VII. MONITORING AND REPORTING
Appointment and Duties of the Consultant 13. The Plaintiffs and the Defendants stipulate to the appointment of a consultant, who shall be independent of the Plaintiffs and the ADOC, to facilitate the implementation of the Settlement Agreement and to oversee compliance. The parties agree that John Robertson, M.D., MPH, FACP, shall serve as the consultant.
6

14. The consultant shall contract for his services directly with the ADOC and shall in all relevant respects be governed by existing ADOC rules and regulations regarding such employment, including those related to compensation and expenses.
Inspection of Facilities 15. For a period beginning on July 1, 2004, and ending on July 1, 2006, the consultant will tour St. Clair at least four times per year for a total of eight visits over the time period. At least three of these visits shall be formal audits requiring a consultant’s report as detailed in ¶ 19. One visit may be utilized as a problem-solving, consultative visit during which the consultant may meet with employees of the ADOC, its medical care provider, or any other person as he deems necessary. The consultant shall notify the ADOC at least two weeks in advance of each visit. Each visit shall last no longer than five business days. 16. During each quarterly visit, the consultant may, as he deems necessary:
a. meet with the primary care physician, the Health Services Administrator (or Head Nurse), and any other medical care staff with whom the consultant wishes to meet;
b. meet with vendor corporate staff and ADOC central office staff; c. tour the prison, including the infirmary, mental health unit, segregation unit, and general population living areas, and speak with any inmates, on-site medical care staff, and ADOC correctional staff at the prison; d. review any records, including the medical records of any inmate.
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Quarterly Reporting by ADOC

17. On a quarterly basis beginning with the quarter ending September 30,

2004, the ADOC will provide the consultant with the written information listed below.

As necessary, the information will be in a reporting format (e.g., logs and/or report

forms) that will be initially developed by the consultant and agreed upon by the Plaintiffs

and the ADOC by July 1, 2004. The information provided by the ADOC to the

consultant is as follows:

a.

the inmate census at St. Clair;

b.

ADOC and medical care provider’s staffing, including the number

of staff and scheduled and actual hours currently provided;

c.

training efforts undertaken during the preceding quarterly period;

d. performance measurement reports of the ADOC or its medical care

provider that relate to items specific to the Agreement of Experts;

e. mortality reports, grievance analyses, and incident reports on

sentinel events;

f.

any new medical care policies and procedures or revisions to

medical care policies and procedures that were implemented during the preceding

quarterly period;

g.

data derived from the performance measurements identified in the

Agreement of Experts;

h.

monthly reports submitted by the medical care provider to the

ADOC and any reports resulting from the ADOC’s consulting process; and

8

i.

any other documents or reports requested by the consultant that

would assist him in performing his duties under the terms of the Settlement Agreement.

18. Information detailed in subsections (d), (e), and (g) of ¶ 17 shall be

provided to the consultant only and shall be reviewed on-site.

Reports by the Consultant

19. Within 30-40 days after the consultant’s formal audit, the consultant shall

submit a written report to the ADOC and to the Plaintiffs’ counsel. This report shall

include (a) the steps taken by the ADOC to implement the terms of the Settlement

Agreement since the consultant’s prior report; and (b) the ADOC’s status in achieving

substantial compliance with the terms of the Settlement Agreement.

20. “Substantial compliance” means that the ADOC has and is reasonably

expected to continue to substantially satisfy the terms of the Settlement Agreement.

Where there appears to be non-compliance with the terms of the Settlement Agreement,

the consultant shall provide a detailed explanation of the basis of his finding, and provide

a recommendation to the ADOC for how compliance might be achieved. A finding of

non-compliance shall not be based on isolated, non-continuing instances of failure to

substantially satisfy the terms of the Settlement Agreement, nor shall a finding of non-

compliance be based on omissions of a technical or unimportant nature.

21. By July 1, 2006, the consultant shall issue a final report detailing the

ADOC’s overall effort at achieving compliance with the terms of the Settlement

Agreement during the preceding two years and recommending any future action to be

taken by the ADOC to achieve or maintain substantial compliance.

9

22. The consultant’s reports and any documents reviewed or information obtained during the consulting period may be used by either party in an action to enforce the Settlement Agreement in state court or in any new action brought by the Plaintiffs pursuant to ¶¶ 25 - 27. Otherwise, any report by the consultant shall remain confidential. VIII. NEW CONTRACTORS
23. The ADOC shall incorporate the Agreement of Experts and any other relevant terms of the Settlement Agreement in any Request for Proposal for medical care submitted to potential vendors. IX. DISCLAIMER OF LIABILITY
24. The Plaintiffs and the Defendants expressly acknowledge and agree that this Settlement Agreement does not constitute an admission of liability by the Defendants. X. ENFORCEMENT OF SETTLEMENT AGREEMENT
25. This Settlement Agreement is not a consent decree, and is not enforceable in federal court. In the event of non-compliance with any of the terms in this Settlement Agreement, the Plaintiffs may enforce the Settlement Agreement in state court only, pursuant to 18 U.S.C. § 3626(c)(2)(B).
26. The Plaintiffs are not precluded from bringing a new action in federal court in the event of non-compliance with the terms of this Settlement Agreement. In the event that the Plaintiffs’ current counsel bring suit on any of the issues presented in this action before July 1, 2006 (the end of the consulting and reporting period), the newly filed action will be considered a related case. All discovery that has been exchanged to date will be deemed to be part of discovery in any such new action. All documents
10

provided to the consultant pursuant to ¶ 17, and all consultant’s reports that were written pursuant to ¶ 19 will be admissible in any such new action.
27. Should Plaintiffs decide that an enforcement action or new action is necessary, information derived from the reports listed in subsections (d), (e), and (g) of ¶ 17 shall be filed under seal, to the extent Plaintiffs can determine the source of the information. XI. DISMISSAL
28. If the Court approves this Settlement Agreement, the current case will be dismissed without prejudice from federal court.
29. Nothing in this settlement prohibits the named plaintiffs or any class member from bringing individual claims for damages against the ADOC, its employees, or its agents. XII. PLAINTIFFS’ ATTORNEY’S FEES AND COSTS
30. The Defendants shall pay the Plaintiffs’ attorney’s fees and costs in the total amount of $30,000.
Agreed upon this _____ day of May 2004.

____________________________ William Addison, Esquire Department of Corrections P.O. Box 301501 Montgomery, AL 36130 (334) 353-3880
ATTORNEYS FOR THE DEFENDANTS

_________________________ Rhonda Brownstein, Esquire (BRO 098) G. Grace Graham, Esquire (GRA 099) Southern Poverty Law Center 400 Washington Avenue Montgomery, AL 36104 (334) 956-8200
ATTORNEYS FOR THE PLAINTIFFS

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[CONTENT] May 13, 2003 | 42 | § | 1983 | the U.S. District Court | the Northern District | Alabama | the Alabama Department of Corrections (ADOC | Naphcare, Inc. | St. Clair Correctional Facility (St. Clair | St. Clair |||  ||| May 23, 2003 | Plaintiffs ||| June 26, 2003 | Preliminary Injunction Settlement Agreement |||  |||  ||| March 18, 2004 | the District Court | U.W. Clemon | Defendant Naphcare's | Naphcare | Alabama ||| Defendants ||| June 2, 2004 | a Settlement Agreement ||| St. Clair Correctional Facility ||| Agreement of Experts ||| The Settlement Agreement | Defendants | four |||  ||| between July 1, 2004 | July 1, 2006 | ADOC and Plaintiffs' | Defendant ADOC's | the Settlement Agreement ||| The Settlement Agreement ||| the Settlement Agreement, Plaintiffs | 18 | U.S.C. | § |||  |||  ||| August 31, 2004 | the District Court | Clemon |||  [SUMMARY] On May 13, 2003, a group of prisoners filed a 42 U.S.C. §1983 class action lawsuit in the U.S. District Court for the Northern District of Alabama in order to challenge the constitutional adequacy of medical care provided by the Alabama Department of Corrections (ADOC), Naphcare, Inc., and St. Clair Correctional Facility (St. Clair) to inmates housed at St. Clair.  Plaintiffs requested declaratory and injunctive relief as well as class certification.

On May 23, 2003, Plaintiffs filed a motion for a preliminary injunction.  On June 26, 2003, the parties entered into a court-enforceable "Preliminary Injunction Settlement Agreement" in order to resolve Plaintiffs' motion for preliminary injunction.  The agreement provided that Defendants would, without admitting liability, work to cure any existing violation of federal rights by: (a) hiring and maintaining additional staff, (b) timely providing all necessary medical treatment, and (c) keeping Plaintiffs' counsel apprised of efforts to engage in good faith compliance with the agreement.  The parties also provided that the agreement would terminate upon final resolution of the case.

On March 18, 2004, the District Court (Chief Judge U.W. Clemon) issued an order granting Defendant Naphcare's Motion to be dismissed from the suit on grounds that Naphcare no longer provided medical services to inmates of Alabama correctional facilities.  The court ordered that the case proceed against the remaining Defendants.  

On June 2, 2004, the parties entered into a Settlement Agreement in order to resolve the litigation.  The agreement provided for the certification of a plaintiff-class (consisting of "all present and future inmates who are or will be incarcerated at St. Clair Correctional Facility and who are in need of medical care") for purposes of settlement only.  Defendants agreed to undertake a number of reform efforts elaborated in a separate "Agreement of Experts", including: (a) providing adequate and timely medical treatment, (b) providing adequate levels and types of staffing, (c) developing and implementing performance measures, and (d) adopting an oversight and quality management program.

The Settlement Agreement also required Defendants to undertake specific courses of care and treatment for four of the named plaintiffs.

To ensure Defendants' compliance, the agreement further provided for the appointment of an independent consultant charged with overseeing the implementation of the agreement.  The consultant was required to periodically visit and audit St. Clair during the period between July 1, 2004 and July 1, 2006, and to submit written reports to ADOC and Plaintiffs' counsel for the purpose of tracking Defendant ADOC's progress toward achieving "substantial compliance" with the terms of the Settlement Agreement. 

The Settlement Agreement specified, however, that it was not a consent decree and was not enforceable in federal court.  It provided that, in the event of non-compliance with the terms of the Settlement Agreement, Plaintiffs would be entitled to enforce the agreement in state court only, pursuant to 18 U.S.C. §3626(c)(2)(B).  Alternatively, Plaintiffs would be entitled to bring a new action in federal court.

After notice of the proposed settlement was issued to the class, several individual class-members submitted their objections.  Nevertheless, on August 31, 2004, after holding a fairness hearing, the District Court (Judge Clemon) approved the consent settlement and finally dismissed the case.    

We have no further information on this case.

