Silvis had just started his shift at the facility in Indiantown, Florida, and the nurses looked stunned.
They explained, as well as they could, what had occurred the night before.
A man was dead.
Silvis called a prison captain and pulled the surveillance tape.
At 7:28 p.m., Conrad entered the cell.
She left seven minutes later.
Silvis was taken aback.
Anyone with that license certainly lacks the training or authority to declare a person dead.
Instead, witnesses later told a state investigator, she left Cox while his skin was still warm.
Silvis called Conrad to demand an explanation.
He recalls her telling him she hadn’t started CPR on Cox because she believed he was already dead.
Outside the prison walls, someone witnessing a murder can call for an ambulance.
But incarcerated people cannot visit a medical clinic on their own, or choose their own doctor.
They cannot dial 911.
Injury and illness are commonplace in prisons.
With fixed per-patient revenue, these privately owned companies have an incentive to avoid expensive procedures and otherwisecut costs.
A prisoner also has to overcome a Supreme Court standard known as “deliberate indifference.”
And any prisoners seeking injunctive relief such as a transfer to a hospital must file a federal constitutional claim.
Nearly two-thirds of those cases involved allegations of constitutionally inadequate medical care.
Still more said they were denied basic medical accommodations such as dentures and walkers.
Together, the claims describe a US prison medical culture defined by a gross disregard for human life.
But such sweeping accountability measures are rare.
In BI’s sample, nearly nine out of 10 cases alleging substandard care were unsuccessful.
Plaintiffs in only five of these cases won theirEighth Amendment claims.
Here’s what it takes.
Such readings of the Constitution have largely insulated prison healthcare providers from legal accountability.
Gomez’s lawsuit was dismissed.
The officer did not respond; he later told investigators he didn’t hear Cedri cry out.
“Man down!”
Soon men across the unit were battering their steel cell doors into a steady thunder.
Nearly 30 minutes passed before prison medical staff and corrections officers appeared.
Four minutes after that, Conrad, the licensed practical nurse, arrived and left without performing CPR.
Conrad did not respond to inquiries by phone, email, or mail.
Her decision not to provide care may not have been an anomaly.
Because she was incarcerated, Mason had only one way to seek medical care: placing a sick call.
The next day, another officer discovered Mason in her cell, collapsed in her own vomit.
Hours later, she suffered a grand mal seizure.
Mason spent nine days in the hospital.
She lost the case.
The South Carolina Department of Corrections did not respond to requests for comment.
Over successive decades, such judicial caution has become pervasive.
A month later, Kirk collapsed and was transferred to a local hospital.
There, doctors discovered a total obstruction of one of his coronary arteries.
Kirk received treatment and survived.
He lost the case.
Yet such testimony rarely persuaded judges that claims had met the deliberate-indifference bar.
One particular case stood out.
His medical appointments were rescheduled and canceled.
His repeated petitions for care were dismissed or ignored.
Arteries in his esophagus had burst a complication of advanced liver failure, hospital doctors later said.
Rhinehart underwent emergency surgery to repair the tears in his throat.
An MRI scan during his hospitalization showed that a mass on his liver had grown to 11 centimeters.
Walden wrote again to prison administrators.
Rhinehart needed to be seen by an oncologist immediately.
The prison’s medical contractors never scheduled the appointment.
Not long after, the arteries burst again.
He woke in his cell doubled over in pain.
Blood poured from his mouth and nose, nearly filling a small trash can in his cell.
He had a second emergency surgery.
Corizon doctors refused to authorize the stent procedure, and Rhinehart was sent back to prison instead.
Stieve and the Michigan Department of Corrections did not respond to requests for comment.
By February 2013, Rhinehart’s disease was consuming him.
He died after a Corizon provider gave him a high dose of morphine.
An autopsy commissioned by Rhinehart’s family listed the cause of death as an overdose.
Mark Mann’s experience in the Florida prison system echoed Kenneth Rhinehart’s.
Mann first complained of stomach cramping and blood in his stool in May 2014.
Prison doctors ordered an abdominal X-ray and stool screenings, which returned normal results.
The prison doctor gave diagnoses first of hemorrhoids, then of acid reflux.
He prescribed Imodium and Maalox.
Mann had Stage 4 colon cancer.
(Mann has since died.)
Eleventh Circuit judgesfoundthat this scope of care, including the X-rays and lab work, was enough.
“The law was exceedingly tough on prisoners back in 2019,” she told BI.
“And I think it has gotten tougher since then.”
They asked the court to order the release of medically vulnerable prisoners and mandate additional COVID-19 safety precautions.
By the time theyfiled suitin April 2020, three men at the facility were already dead.
Hundreds of other prisoners were believed to be infected.
The prisoners won a preliminary injunction requiring the prison to evaluate medically vulnerable prisoners for temporary release.
But the Bureau of Prisons got the injunction reversed on appeal.
The case eventually settled, with the bureau agreeing in May 2021 to track COVID-19 infections at the facility.
One of these cases was filed by a woman incarcerated at Coffee Creek Correctional Facility in Oregon.
For over a week, while locked in solitary, she begged for medical treatment without response.
In 2023, she reached a settlement for $251 in damages.
In BI’s sample, private medical contractors almost never lost.
Such court outcomes are extremely rare.
Almost all of the remaining cases settled.
They provided medical attention without providing medical treatment, he concluded.
And the courts signed off.
As with the other private companies, Wexford typically prevailed.
Wexford did not respond to requests for comment.
His claim had failed against all of the defendants at the district court.
They had done so for eight years, Norwood said, years marked by intense pain.
“Norwood has been the victim of serious institutional neglect,” the judgesfound.
Neither Ghosh nor his attorneys responded to requests for comment.
Ghosh was a defendant in multiple cases in BI’s sample, though he always prevailed.
And he was not alone.
Dozens of prison healthcare workers were repeat defendants.
The two doctors with the most complaints were, like Ghosh, employed by Wexford.
Vipin Shah, another Illinois doctor employed by Wexford, appeared as a defendant in eight cases.
Shah was accused of providing inadequate care for severe infections and, like Obaisi, delaying necessary surgeries.
Shah also denied each time that he’d been indifferent; he prevailed every time.
Shah, Obaisi’s estate, and their attorneys did not respond to requests for comment.
Wexford was the company in charge of Cox’s care at Martin Correctional Institution that spring of 2015.
He thought her failure to provide CPR constituted a violation of her medical license.
Less than three months later, Wexford did fire someone and it was Silvis.
In a deposition, Conrad said she retired.
In addition to Silvis, BI spoke with three other former Wexford healthcare providers.
All four described the company’s cost cutting as extremely dangerous.
They said the company drove revenue by chronically understaffing facilities and retaliating against staff who reported lapses in care.
She said she knew almost immediately that she’d made a mistake.
On her first day, she expected training.
Instead, she told BI, she got a pile of outdated policy manuals and a chilly welcome.
Within a few days, multiple nurses quit.
Sixteen nurses short of a full staff, she was drowning.
Routine care was falling through the cracks, she said in court filings.
Men sometimes went weeks without their pills and longer without nurse’s visits.
She asked Ronald Martinez, then the prison warden, for more staff, training, and resources.
Then she appealed to Wexford’s regional managers.
Her daily requests turned into desperate pleas.
Martinez did not respond to requests for comment.
“Most people would have walked away by now but somehow you have stuck it out.”
Reinhart did not respond to requests for comment.
She felt proud and even hopeful.
Egan was fired shortly after.
Wexford said any harm that Egan suffered was resulting from Egan’s conduct alone.
Egan’s retaliation suit against Wexford remains ongoing.
The report describes a litany of preventable deaths and critical lapses in treatment.
The Illinois Department of Corrections did not respond to requests for comment.
In December 2023, Illinois state officials awarded Wexford another five-year contract worth more than $4 billion.
She noted his stilled chest and blood trickling from his nose and mouth.
Two corrections officers told a Florida state investigator they saw Conrad search for a pulse at Cox’s wrist.
“He’s dead,” she told them, and exited the cell.
Cox’s mother, Monica Stone, commissioned an independent review of the autopsy report by a forensic pathologist.
Whatever chance Cox had of survival was lost when no one gave him CPR.
Five minutes after Conrad left, two other licensed practical nurses arrived sprinting into his cell.
They started chest compressions and ordered officers to call 911.
She argued that they’d violated her son’s constitutional rights by withholding critical medical care.
“I believed there was nothing more I could do,” she said.
Shaniek Mills Maynard, a magistrate judge, did not find a constitutional violation.
A district judge, Robin L. Rosenberg, concurred.
In the eyes of the courts, Conrad’s failure to give CPR was not constitutionally inadequate care.
The District Court for the Southern District of Florida granted summary judgment to every defendant.
