Accountability for deadly prisons: Critics say Delaware has little oversight. Is the solution national accreditation?

There were two Jermaine Wilsons doing time at Gander Hill prison in Wilmington. They were young black men who were unrelated.

One, in prison for a robbery charge, had served about three years and was due to be released in February of this year. His mother was picking him up.

The other, doing time for violating parole stemming from drug charges, was facing new charges associated with a cocaine bust. He was scheduled in February to be transferred to the maximum security wing of the Delaware Correctional Center near Smyrna -- the state's roughest prison, built for the most incorrigible offenders.

But corrections officials sent the wrong Jermaine Wilson to Smyrna.

And days later -- when he should have been free, guards found 20-year-old Jermaine Lamar Wilson dead, hanging from a bedsheet in his cell.

Because he had a cut on the back of his head, his family suspects he was murdered.

"There was blood all over his clothes," said Laretta Wilson, Jermaine Lamar Wilson's aunt. "There was blood in his underwear and all over his pants. Maybe someone hit him on the back of his head?"

The Delaware Medical Examiner's Office called the wound "superficial" and ruled the death a suicide.

Wilson's family received little information from the Delaware Department of Correction. No apology. No excuse. Just Wilson's blood-soaked clothes. Correction Commissioner Stan Taylor declined to comment on specific inmate deaths, including Wilson's.

During a six-month News Journal investigation, a former doctor and two nurses who worked in Delaware prisons and dozens of inmates and their families claimed prison health care in Delaware is dangerously substandard -- leading to needless deaths, prolonged suffering and the spread of infectious diseases inside and outside prison walls.

Wilson's death raises a larger question: Are standards throughout Delaware's prison system too low?

There are few safeguards in Delaware prisons:

•Dr. Janet Kramer, of Wilmington, an expert in prison health care, said inmates should be screened for hepatitis C and HIV -- but pretrial and convicted inmates are not routinely screened when they are sent to prison or when they leave. Delaware prisons have become incubators for new strains of the AIDS virus, creating a public health crisis, experts say.

•Former prison doctor Ramesh Vemulapalli says a private medical company ordered him to treat inmates for HIV or hepatitis C, but not both. Delaware led the country in two of the past four years in the rate of inmates dying of AIDS.

•Inmates in Delaware kill themselves at twice the national rate. Dr. Carol A. Tavani, a neuropsychiatrist and executive director of Christiana Psychiatric Services, said new inmates should be counseled in person about suicidal tendencies, not simply given a "contract" to sign promising not to kill themselves.

•Unlike Pennsylvania and other states, Delaware does not have a medically trained state employee overseeing contract health providers. Maryland has its own statewide correctional accrediting agency, Delaware does not.

•The prison's grievance system is overseen by the medical vendor, not prison officials or an independent medical professional.

•Commissioner Taylor awarded the current $25.9 million medical contract -- signed this year with Correctional Medical Systems (CMS) of St. Louis -- without putting the contract out for bid. Gov. Ruth Ann Minner approved the decision, but insisted it was a contract extension even though CMS replaced First Correctional Medical of Tucson, Ariz., a different company.

•The state occasionally discharges convicted inmates early so neither the state nor its prison health care contractor has to pay medical costs, leaving the payments to families or the federal Medicaid program. Neither federal prison regulators nor the public is told about inmates who die after such discharges.

•The state does not routinely conduct autopsies on inmates who die in prison or those hospitalized at the time of their death, a policy the president of the National Association of Medical Examiners believes prevents evaluation of the quality of prison medical treatment. And if it does conduct autopsies, the results are sent to the medical vendor -- not the prison.

•Dr. Robert Cohen, an expert in prison health care whom state and federal courts have appointed to monitor prisons in five states, said the state should investigate medical malpractice claims. Instead, the state's medical board occasionally takes complaints from inmates and their families about prison health care professionals, but it is only an advisory panel. The board's findings are confidential and given to the private medical vendor.

Jermaine Wilson's transfer

The American Correctional Association mandates thorough psychological screening upon entry into prison. If any abnormality -- such as thoughts of self-harm -- is discovered, an inmate is immediately sent for a comprehensive mental health exam, said Joey R. Weedon, the ACA's director of government affairs. And the ACA requires inmate movement and release dates to be closely monitored, a process that broke down in Delaware when Wilson was shipped to hard time in Smyrna, rather than freedom at home.

"That's an assumption written into numerous standards," Weedon said. "A patient's medical records and their files should be updated, and good time credited, so they're released properly."

In an effort to conform to these best practices -- and expose problems in prison medicine and management -- many U.S. prisons have sought accreditation through the ACA, which conducts a series of inspections and audits.

Delaware has not.

"We have not gone down the ACA road," Taylor said. "We just have not done it."

Pennsylvania prison standards

Other prison systems have found accreditation to be useful.

In a performance and accountability report in 2003, the Department of Justice said that "it strives to maintain facilities that meet the accreditation standards of several professional organizations, including the American Correctional Association."

According to the report, 90 percent of federal prisons were accredited in 2003. State prisons, like those in Pennsylvania, also have found success in accreditation.

"Accreditation shows you're running a safe, humane institution that meets all the standards," said Martin Dragovich, superintendent of the Pennsylvania State Correctional Institution in Chester. The prison, built on part of the old Pennsylvania Shipbuilding Company site along Chester's crime-ridden waterfront, has a capacity of 1,175 inmates and was just 15 inmates short of that in August.

"It shows you're doing something right," Dragovich said of accreditation. "It's clear you're following nationally recognized procedures. I have a sense of pride in being accredited."

For the Pennsylvania Department of Corrections, accreditation is mandatory. Every state corrections facility in Pennsylvania, except two recently constructed, is ACA-accredited -- including all 15 community corrections centers and the department's central office.

The ACA began offering accreditation in 1978 and has accredited more than 1,500 correctional facilities, including more than 80 percent of all state departments of corrections and youth services, and facilities operated by the Federal Bureau of Prisons and the U.S. Parole Commission. In addition to national recognition, accreditation benefits include improved management as well as increased accountability and more credibility with the public.

Thomas A. Rosazza is a corrections consultant based in Colorado Springs. His corrections career has included work with federal and state agencies, including the National Institute of Corrections and the American Medical Association Jail Standards Project.

"There are a lot of benefits to accreditation," Rosazza said. "Specifically, what it helps people do is impose a management construct on the system. The standards reflect the best practices, establish a safe environment from things like fire and environmental conditions to staff and inmate safety."

The ACA standards cover administration, disease prevention, AIDS care, training and a host of other areas.

"There are 531 standards," Dragovich said. "They're not site-specific. The same standards apply to every facility seeking ACA accreditation."

No oversight

Every institution in the Pennsylvania Department of Corrections has a correctional health care administrator whose role is to oversee the medical vendors and investigate grievances and other complaints made against the state's medical vendor -- Prison Health Services.

Shirley Laws-Smith -- a registered nurse -- is the correctional health care administrator at SCI Chester. She has counterparts at every facility in the state. If she questions a vendor's procedure, she can take immediate action.

"If they make a decision and I don't agree with it, I will contact the central office at the Bureau of Health Care Services," she said.

Delaware's inmate grievance process is quite different. In Delaware, no one with any medical training oversees the actions of the medical vendor, and the vendor controls any complaints. When an inmate files a grievance about poor care, it goes straight to the vendor. When an inmate appeals the decision, the grievance eventually goes back to the vendor.

Pennsylvania officials say it is vital to have someone medically trained in the oversight role.

"You have to have someone watch the hen house," said Dragovich, the Chester superintendent.

At the Chester prison there's an infection control nurse, two dentists and two psychologists who work for the state -- not the medical vendor.

All mental health workers in Delaware prisons are contract workers employed by medical vendors.

The Chester infirmary has 23 rooms and 30 beds with call buttons for the patients -- something not seen in Delaware.

While guiding a tour of the infirmary last month, Louisa Perez noticed a Latino inmate in a cell holding an ice pack to a bloody nose.

She took the time to calm him down, speaking Spanish through the cell door.

"They're not going to hurt you. They're going to take care of you," she said. "You just have to learn to behave."

In Delaware, only the juvenile facilities operated by the Department of Services for Children, Youth and Their Families have achieved ACA accreditation -- and the best practices and rigorous oversight that accompanies it. The Delaware American Civil Liberties Union strongly supports accrediting the state's prisons.

"Absolutely! Please. Please," said ACLU Delaware Executive Director Drewry Fennell. "We need it. The biggest issue here is a systemic failure, a failure of oversight and a failure of transparency."

Tough process

But the accreditation process, according to the ACA, would involve a tough look at "services, programs and operations essential to good correctional management, including administrative and fiscal controls, staff training and development, physical plant, safety and emergency procedures, sanitation, food service, and rules and discipline."

Serious issues about prison management -- a key component of the accreditation process -- most recently were raised in Delaware after a July 2004 hostage situation in which prison counselor Cassandra Arnold was raped by Scott A. Miller, an inmate serving a 699-year sentence for rape, assault and kidnapping.

Miller was shot to death following a nearly seven-hour standoff.

In an e-mail she sent to prison officials days before her abduction and rape, Arnold warned of security lapses.

"I was down in MHU 23 today, and due to your request a few weeks ago I thought you might want to know this. ... I AM NOT A SNITCH, but you asked for this stuff," her e-mail said.

The e-mail identified a security problem at "MHU 23," which is Building 23 of the Delaware Correctional Center's medium-high security unit.

"When I exited 24 both sliders [doors] to 23 were all the way open. It was 0800, so I understand that there was no movement. The control room door was propped. I closed it, but after I did, people continued to go in and out of the pod, leaving it propped."

Three months after her abduction, Arnold wrote a two-page letter to a gubernatorial task force reviewing problems in the corrections department. "Any person who tries to tell the truth about unsafe practices is immediately labeled a snitch," she wrote.

The letter also said many of Arnold's colleagues continue to work in unsafe conditions. Arnold, who is suing the department, has not returned to work.

"And even as I try to move forward with my life despite that awful seven hours," the letter said, "it is hard to do so knowing that the Delaware Correctional Center continues to work in such a dysfunctional and dangerous way."

Prison guards used the incident to urge Gov. Ruth Ann Minner for a raise and better conditions by saying that poor working conditions led to the standoff. The Minner administration granted improvements, including quicker eligibility for pensions and pay increases linked to the number of years on the job. Since getting raises, prison guards have been quiet and have accepted the forced overtime they complained so much about before the raise.

Leaders for the Correctional Officers Association of Delaware, which represents prison guards with the rank of corrections officer up to sergeant, would not comment. Neither would representatives with the American Federation of State, County and Municipal Employees Local 247, which represents corrections officers from lieutenants through captains.

Commissioner Taylor, who started his career with the agency in 1976 as a prison guard, said he was "not aware" of accountability issues within his department.

Still waiting for an answer

At 17, Jermaine Lamar Wilson pleaded guilty to robbery. He had been in custody since December 2002 and was moved to Gander Hill when he turned 18. His mother said her son showed absolutely no sign he was contemplating suicide.

"He was happy," Suzie Wilson said. "He called three times a day. He was never depressed. He was happy he was getting out. Who wouldn't be?"

He sent a letter home eight days before his death.

"Halleulah!! I'm finally coming home mom, and to stay," Jermaine Wilson wrote. "God is good. I was praying last night and I know you was praying for me too, and it all worked out."

When Suzie Wilson was told her son was sent to Delaware's maximum security prison instead of being released from Gander Hill, she and her sister drove to Smyrna to find out why. Guards there told them there was no release paperwork for Jermaine. She was told to go to dinner and return. Maybe they'd have something for her then.

"Something very strange was going on," said Jermaine's aunt Laretta. "When we questioned the staff, they were all nervous."

On Feb. 17 of this year, she and Jermaine's mother waited at the prison until 9 p.m., when they returned home angry and frustrated.

Early the next morning, at around 2 a.m., Suzie Wilson got a call from Smyrna's deputy warden.

"Ma'am, Jermaine is no longer with us. Jermaine appears to have hung himself. We found him dead a little after 12," she recalls being told by the deputy warden.

Wilson's attorney, public defender Brian Bartley, didn't know what happened to his client until he received a frantic call from Wilson's mother.

Bartley researched the case and discovered there were two Jermaine Wilsons with different dates of birth. According to court documents, the other Jermaine Wilson has been arrested 27 times, most recently for cocaine trafficking. He pleaded guilty to the charges and is serving a three-year prison sentence.

"This was a tragedy of errors," Bartley said.

Wilson's mom insists the cause of her son's death is being covered up.

"We have not heard anything from the DOC," Suzie Wilson said. "Not a letter. Not a boo."