Illinois' new prison health care provider has record of poor care

Kenneth Johnson was slowly suffocating to death.

Johnson, 60, was in a Vermont prison awaiting trial in December 2019. Despite repeatedly complaining that he was struggling to breathe, he was misdiagnosed and largely ignored by the prison's correctional and medical staff, according to a lawsuit his family filed in 2021.

His condition worsened. When he finally was admitted to the prison's infirmary, staff members never checked his airway — despite his plummeting oxygen levels, according to the lawsuit.

Instead, it says, a nurse accused him of faking it and told him he was “acting like a . . . 2-year-old."

He eventually stopped breathing, was found without a pulse and pronounced dead. Medical examiners later identified a previously undiagnosed cancerous tumor pressing on his airway as the cause of his death, according to the wrongful death lawsuit.

Johnson's case is an example of how substandard medical care has caused preventable harm and even death to people locked up in prisons and jails. Often, in Illinois and elsewhere, that care is provided by private, for-profit companies, a Chicago Sun-Times investigation has found.

One of them is Centurion Health, the provider responsible for Johnson's medical care. It recently was given a contract by the state of Illinois to provide medical care to people housed in every state prison.

Centurion, one of the nation's largest correctional medicine companies, was hired by Illinois officials despite having a record of providing inadequate health care, according to a Sun-Times examination of more than 100 lawsuits, a Justice Department investigation and state audits.

Lawsuits from other states describe cases in which people in prison say they were repeatedly ignored, denied care and misdiagnosed. They accuse Centurion of being deliberately indifferent to routine and emergency health needs.

The suits say the inmates' treatment violates the U.S. Constitution's Eighth Amendment, prohibiting cruel and unusual punishment, and the 14th Amendment, guaranteeing people equal protection under the law and due process.

Over the summer, the company was brought in by Illinois officials to replace the state's previous private health care provider, Wexford Health Sources, which also has faced accusations of providing poor care, neglect and preventable deaths.

In 2023, the Illinois Department of Corrections was set to give Wexford a 10-year, $4 billion contract. But negotiations to finalize a contract later stalled. And, in July, the corrections department instead signed a short-term emergency contract with Centurion Health.

It's unclear whether Centurion will be the long-term choice to run the department’s troubled health care system. In October, the state extended its emergency contract with the company to Jan. 20.

Centurion did not respond to requests for comment.

An IDOC spokesperson did not respond to questions about whether the state plans to sign a longer-term contract with Centurion.

A recurring pattern

The volume of suits doesn't capture how bad the health care is for people in prison, according to Paul Wright, director of the Florida-based Human Rights Defense Center, which advocates for better prison conditions. But he said the lawsuits offer a glimpse into a larger issue.

"There are a whole slew of people who are sick and die in prison, and no one is ever going to file a lawsuit for them," Wright said.

The suits have a recurring pattern: Inmates repeatedly complain about a health issue, they're ignored by correctional and medical staff members, and their condition worsens to the point of dangerous complications or death.

Those conditions included: a spinal cord infection festering in a man's back until he could no longer walk; chronic hepatitis ignored until it permanently damaged a man's liver; prostate cancer ignored until it became terminal; and high blood pressure, cholesterol and diabetes left unmanaged until patients had heart attacks and strokes.

Several suits also detailed failures in mental health care, including the case of a combat veteran suffering from post-traumatic stress disorder and suicidal ideation who was left untreated and unsupervised and hanged himself.

Lawsuits against Centurion came from prisons and jails around the country: Indiana, Missouri, New Mexico, Mississippi, Arizona, Florida, Maryland, Vermont, Kansas and Georgia. Some came with legal representation. Others were handwritten by people in prison representing themselves.

They speak to the challenges of delivering and monitoring correctional health care, said Wright.

Centurion and other private health care companies that serve prisons are more motivated by their profit margins than the health and well-being of the incarcerated populations they're responsible for, he said.

Wright, who is also the editor of Prison Legal News, has sued Centurion for access to records, and Centurion has filed retaliatory suits against his organization.

The companies "are all pretty bad," he said. "They have the same business model predicated on getting as much taxpayer money as possible and then providing as little medical care as possible."

In the years leading up to the 2023 contract talks between Wexford and Illinois, a federal judge had determined the health care that the company provided was so poor that it violated the U.S. Constitution. A court-appointed independent monitor published reports documenting deaths from substandard medical care.

The accusations against Wexford over the years have included a man who lost vision in his left eye that medical staffers refused to treat because of Wexford’s “one good eye policy." In another case, Wexford staff stopped maintenance chemotherapy for a survivor of brain cancer, and, after the cancer returned, staff members took months to schedule a surgery. By then, he was dead.

Issues with Wexford have come up outside of prison walls, too. Former IDOC Director Donald Snyder took $30,000 in kickbacks from a Wexford lobbyist from 1999 to 2002 to help secure one of the company's contracts with the state.

He was sentenced to two years in prison in 2008. Wexford kept its contract.

‘Well-documented failings’

Virginia-based Centurion Health serves 11 state correctional systems — "more than any other company," according to the company. Nearly 275,000 incarcerated people are under Centurion's care.

Centurion Health was created as a joint venture between the health care companies Mental Health Management Services and Centene Corp. in 2011 to "transform correctional medicine to modern medicine," according to the company's website. Centurion Health became its own corporation in 2023.

Before that change, Centene was often named as a defendant in lawsuits against Centurion. Beside suits filed by people in prison and their loved ones, a Centene shareholder filed a complaint in Delaware in 2020 against Centurion and Centene, saying it had a "long history of failing to provide proper health care to the prison populations."

That history "has forced Centurion to defend numerous lawsuits — many of which appear to have been resolved through financial settlements," the complaint says. "Despite Centurion’s well-documented failings, Centene has taken no steps to develop any oversight over its wholly owned subsidiaries, even as this apparent and public misconduct continues."

The shareholder suit also cites other lawsuits against Centurion and Centene as evidence, including two Mississippi class-action lawsuits filed in 2020.

Those suits represented more than 200 inmates at the Mississippi State Penitentiary in Parchman, Mississippi. Known as Parchman, it's that state's only maximum-security men's prison.

The inmates were represented by lawyers from Team Roc, the philanthropy founded by Shawn “Jay-Z” Carter. Their suits said Parchman's facilities were in a "perpetual state of systemic failure," with unlivable conditions and chronic staff shortages. Inmates were frequently deprived of medical care, according to the complaints.

“Broken bones, abscesses, diabetes and a host of other injuries and maladies routinely go without examination, much less medically effective treatment,” according to one complaint. “For example, plaintiffs in this action insert their own catheters, treat their own stab wounds, vomit up blood, teeter on the verge of diabetic coma, and suffer through seizures without medical care.”

The suit led to a Justice Department investigation. Its report, issued in 2022, said Parchman's conditions violated the Eighth and 14th Amendments to the U.S. Constitution.

Before the investigation's results came out, Centurion pulled out of its multimillion-dollar contract with the Mississippi Department of Corrections in July 2020. At the time, Team Roc said it was a "significant victory," according to the Mississippi Clarion Ledger, which reported that Centurion's contracts with Mississippi totaled nearly $289 million over five years.

In the years since, the state's corrections department appeared to improve conditions at Parchman so much that Team Roc dropped its federal lawsuits in 2023, NBC News reported.

VitalCore Health Strategies is the current health care provider for the state's prisons. The corrections department did not respond to a request for comment.

‘An expendable population’

Neglected health issues and medical emergencies often become preventable deaths, according to several lawsuits and reports.

As was the case with Othel Moore Jr., a healthy 38-year-old man incarcerated in a Missouri prison.

In the early hours of Dec. 8, 2023, correctional officers at the Jefferson City Correctional Center conducted a prisonwide sweep and pulled Moore from his cell, put him in a full-body restraint and sprayed him in the face with pepper spray. According to a lawsuit filed by his family, Moore did nothing to provoke the guards.

After he was pepper-sprayed, guards put a spit mask on his face and a large cotton cloth over his nose and mouth. Unable to move and breathe properly, Moore pleaded for help but instead was put in a cell, fully restrained and alone for 30 minutes, according to the suit.

When guards and Centurion medical staff members came into the cell, Moore was unresponsive. Yet the nurses did not immediately attempt lifesaving measures, according to the lawsuit. He eventually was taken from the cell and brought to the prison's emergency room, where he was pronounced dead.

The full incident and his death were captured on the prison's surveillance footage, according to the suit.

"Defendants knew or should have known that Moore was in severe medical distress and knew they were required to provide immediate medical assistance," the complaint says. "Despite their duty, they deliberately chose to do nothing, directly violating Moore’s Eighth Amendment rights.

"Their inaction amounted to a clear denial of medical care, which exacerbated the harm inflicted upon Moore."

The suit is ongoing. A separate criminal investigation by the Cole County sheriff’s department into Moore's death led to 10 people being fired from the prison, and four former correctional staff members were charged with second-degree murder, according to the Missouri Department of Corrections.

A spokesperson for the corrections department declined to comment on the Moore family's case but confirmed Centurion is still the department's contracted health care provider.

Andrew M. Stroth, a Chicago civil rights lawyer representing Moore's family, called for stronger accountability for Centurion.

"You've got a private sector company making hundreds of millions of dollars, not providing ethical and real care to the inmates," Stroth said. "These individuals may be in custody, they may be in prison, but that doesn't take away their right to proper and necessary health care."

It's tough, though, to generate outrage over how people are treated in prison, Wright said. And despite the performance standards built into the companies' contracts with state governments, there is little or no oversight into their practices, he said.

"Prisoners are viewed as an expendable population in this country," Wright said.

Johnson, who died in a Vermont prison in December 2019, was misdiagnosed with chronic obstructive pulmonary disease when he first complained that he couldn't breathe, according to the wrongful death lawsuit his family filed against Centurion and the Vermont Department of Corrections.

Centurion medical staff at the Northern State Correctional Facility never examined him to see whether something was blocking his airway or throat, according to the complaint. It says he was given a nebulizer, which didn't relieve his symptoms.

He eventually was admitted to the prison's infirmary and died about three days later.

His death triggered investigations by the Vermont Defender General’s Prisoners’ Rights Office, Disability Rights Vermont and other groups, according to the news outlet VTDigger. Centurion is no longer the medical provider for Vermont's correctional system, according to a Vermont Department of Corrections spokesperson, who wouldn't comment on Johnson's case.

In July, a judge ordered Centurion to pay Johnson's family $1.5 million.

Despite that payout and other settlements Centurion has paid, these lawsuits aren't holding companies like Centurion accountable, in Wright's view.

In settling these cases, he said, Centurion doesn't have to answer the accusations it faces. And the payments won't set it back financially.

It's just the cost of doing business.

This story was produced as part of a fellowship with the USC Annenberg Center for Health Journalism.