CoreCivic Manages Our Prison, and Tries Not to Manage Our Medical Care

May 1, 2024

Five years ago, abdominal pain drove James to the infirmary at South Central Correctional Facility, the Tennessee private prison where he and I are currently incarcerated. He was prescribed acetaminophen, the infirmary’s preferred treatment for everything from migraine to terminal illness. He came back a few more times, complaining of the same pain, so an X-ray was taken of his stomach. They told him it looked fine. This went on for four years.

In 2023 officers finally escorted James to an outside clinic, where biopsies revealed late-stage lung and liver cancer. He needed radiation and chemotherapy. Soon.

He was transported out to his first appointment, but South Central had never sent over his chart so he was transported back. On the second try there was some sort of scheduling issue. He was transported back. It’s been six months since his diagnosis, and he has yet to receive any treatment.

“They are just waiting me out,” James told Filter, “hoping I’ll die before they have to spend any more money on me.” James is 70, and has been incarcerated for the past 17 years.

Tennessee has 14 adult prisons, 10 of which are operated by the Tennessee Department of Correction. As the operator, TDOC manages whatever happens on the physical premises, but can outsource things like scheduling or food service to various for-profit corporations that offer to do it for less money. At South Central and the remaining three prisons, management itself has been outsourced to a for-profit corporation, CoreCivic. But as the operator CoreCivic can still contract out our kitchen service, for example, to a different private company. CoreCivic is responsible for our medical care, but it isn’t always clear whether CoreCivic is the company providing it.

Currently the registered nurses here—the ones who examine us, perform emergency procedures and make referrals to outside hospitals—are hired through CoreCivic. Anyone who performs mid-level procedures or prescribes medications is hired through Corrections Professional Corporation—a private prisons health care company that is not CoreCivic, but works for no one else but CoreCivic and is headquartered at the same address. This is the same sort of strategy through which CoreCivic holds four private prison contracts even though the state of Tennessee is only allowed to have one.

But nothing in the infirmary or related to our medical care ever has CoreCivic’s name on it, let alone Corrections Professional Corp. The nurses’ ID badges don’t say who they work for. The medical forms come from TDOC. Even South Central staff reached by Filter said they didn’t know who was handling the medical services, or declined to answer. CoreCivic did not respond to Filter‘s inquiries.

 

A “sick call” form to request a visit to the infirmary, and the accompanying form to withdraw the copay

 

One night in 2022, Andrew found himself in agony, unable to pee. Requesting an emergency visit to the infirmary costs $3; after hours, $5. But around 1 am, the pain was bad enough that he pounded on his cell door until an officer came.

Medical staff told him he may have a kidney stone. His bladder was swollen with urine, so they tried putting in a catheter to relieve it. They tried over and over and over.

“I’ve never experienced such pain,” Andrew, 59, told Filter. “I’ve had broken bones and open fractures, and those seemed mild compared to what I was going through.”

Eventually he was transported to an outside emergency department. A series of tests showed he had a bladder infection, and a urethra so mangled from the botched catheterization attempts that the urine had to be drained from a 12-inch tube through a hole cut into his abdomen. Andrew pees out of his stomach now.

For the past two years South Central has changed his drainage tube about once a month. This gives him frequent bladder infections, and the frequent antibiotics to treat the bladder infections give him gastrointestinal problems. Only once has he been transported back out to a hospital, where he was told that he needed two procedures on his urethra—one to remove scar tissue, and another to reconstruct it using tissue from the inside of his cheek—but that he’d then be able to pee as he had before. Neither procedure has been performed.

“I feel like they want me to die so they don’t have to pay for the surgery,” Andrew said. “The doc said it would have to be done at Vanderbilt Hospital in Nashville.”

CoreCivic is responsible for hospital-trips costs up to $4,000, but past that the bill is supposed to go to the private medical contractor for the state-run facilities. Currently that’s Centurion Health. CoreCivic can play hot potato with the bills, but the state gets the final say. So we’re told a lot of our necessary treatments are actually elective.

Until Centurion won a messy bidding war in 2020, TDOC’s medical contractor was the company formerly known as Corizon Health.

In 2023, amid hundreds of malpractice lawsuits across the country, Corizon filed for bankruptcy, shunted its contracts into one shell corporation and its legal liabilities into another, and essentially disappeared.

Some time back I remember a notice with “Corizon Health” posted to the wall before an audit inspection, to be taken back down once the audit was over. That was the only time I recall ever seeing a name.

The doctors asked James why he hadn’t started chemo by now; he told them he didn’t know.

Lonnie, 54, has high blood pressure and is supposed to take his medication at the same time every day. His blood pressure pills, cholesterol pills and blood thinner pills are all designated “keep-on-person,” which means he’s allowed to pick them up a month at a time. But each month the pharmacy is out of one of them, or can only fill part of his prescription for another, so he’s always stopping and starting. After five years of dizziness and headaches, it was simpler to just stop all of them.

“I can control not taking them,” Lonnie told Filter. “I can’t control ordering or receiving them.”

The purpose of the faceless shell corporations and the contracts behind other contracts is to limit liability for the people at the top. But somewhere along the way down to us, the endless bureaucracy becomes something that exists on purpose, so that sick prisoners give up on accessing care.

In mid-April, James was transported out for a third attempt at starting chemo. Though he only got a referral to a specialist, he was able to talk to the doctors this time. They asked him why he hadn’t started by now; he told them he didn’t know.

On the ride back to South Central, the driver kept slamming on the brakes. The transport buses don’t have regular rows of seats facing forward; you sit shackled to a bench that runs down the side facing the middle, with just empty space in front of you. If you come to a sudden stop, the effect is the opposite of what a seatbelt is supposed to do, especially for older prisoners when no one else is back there to break their fall. James returned from the hospital with a fractured arm and bruises from head to toe. Like CoreCivic, he’s decided he doesn’t need treatment after all.

 


 

Top image (edited) via Tennessee Comptroller of the Treasury. Inset photographs via Filter; materials were received by mail.

Tony Vick

Tony has served almost three decades of a life with parole sentence in Tennessee. Before prison he lived as a closeted gay man; his Southern Baptist parents and an older brother have since died. While incarcerated he has worked as a tutor, clerk and newspaper editor. He's also begun book clubs and writing workshops, and prisoner-led elder care programs. He writes about captivity in the hope of contributing to the prison reform movement.  

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