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Jury sides with Ill. inmate whose under-treated diabetes ended in leg amputation

Prisoners stand in a crowded lunch line during a prison tour at Elmore Correctional Facility in Elmore, Ala. A Department of Justice report finds violence in Alabama's overcrowded prisons is 'cruel' and 'pervasive.'
Brynn Anderson/AP
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Prisoners stand in a crowded lunch line during a prison tour at Elmore Correctional Facility in Elmore, Ala. A Department of Justice report finds violence in Alabama's overcrowded prisons is 'cruel' and 'pervasive.'

A decade after Illinois Department of Corrections inmate Anthony Rodesky began developing the blisters that would eventually lead to a below-the-knee leg amputation, a federal jury in Peoria last week awarded him $400,000, finding the state violated the Americans with Disabilities Act in its treatment of Rodesky’s type 1 diabetes.

The jury did not, however, side with Rodesky in his Eighth Amendment claims of “deliberate indifference to serious medical need” — a long-held interpretation of constitutionally prohibited “cruel and unusual punishment — against the warden of Pontiac Correctional Center, where Rodesky’s condition deteriorated, culminating in his 2015 leg amputation.

Alan Mills of the Uptown People’s Law Center, which represented Rodeksy in the case, called the jury award “extraordinarily satisfying…quite the vindication of what he’s been through for really a decade.”

But Mills said Rodesky’s path to a $400,000 jury award is emblematic of longstanding issues in the Department of Corrections, which is under a three-year-old consent decree for inadequate medical treatment for prisoners — a consent decree for which a federal monitor has repeatedly said isn’t being followed — along with a handful of settlements in other massive suits requiring institutional change within the department.

“The outcome [in Rodesky’s case] was particularly egregious but…unfortunately, the care is also typical,” Mills said. “People shouldn’t lose their legs because of a blister. And that’s what happened here. And it shows not only, I think, the poverty of medical care that’s being provided, but also it shows just how little the Department of Corrections does to deal with people who have a disability.”

A Department of Corrections spokeswoman declined to comment, citing pending litigation.

From blisters to amputation and a long-running contract

Rodesky, who is serving a 30-year sentence for murder, had for years managed the poor circulation in his feet caused by type 1 diabetes by wearing gym shoes he purchased from the prison commissary. But in Aug. 2011 while Rodesky was still an inmate at Tamms “supermax” Correctional Center, a guard confiscated his shoes. According to court records, the guard alleged Rodesky had a paperclip hidden in one of the shoes.

Sign held by an opponent of conditions at Tamms Correctional Center at a rally in Chicago.
WUIS/Illinois Issues

He was provided with canvas shoes that were allegedly four sizes too large, and within days Rodesky’s right foot had formed several blisters. But even after getting ointment and antibiotics from Tamms’ medical director, Rodesky’s infection grew significantly worse over the following months, to the point where “his socks stuck to the discharge leaking from his open sores,” according to his federal complaint. But Rodesky was only provided with band-aids, and his request for special diabetic shoes via an emergency grievance with the prison was denied.

After a year involving two surgeries and more infections, Rodesky spent the rest of 2012 in Tamms’ infirmary, where his wound eventually got better despite the prison’s medical director allegedly ignoring some of the post-surgery directives. But when Tamms closed down at the end of that year, Rodesky was transferred to Pontiac Correctional Center, where he was put in a cell on the prison’s third floor. It was the constant climbing up and down the stairs to get his twice-daily insulin shots that reopened Rodesky’s newly healed wounds, re-infected his foot and led to the eventual amputation of his leg.

Rodesky was eventually assigned a cell in a lower gallery at Pontiac, but not until his ulcers got worse. He alleged the prison’s medical director’s care exacerbated his condition and denied him pain medication. Rodesky underwent multiple more surgeries after being transferred to Pontiac, and was officially diagnosed with a bone infection and later gangrene. Finally in July 2015, his entire right leg below the knee was amputated.

Despite the $400,000 victory, Mills said Rodesky’s win is frustrating since it would have been preferable for Rodesky to have gotten appropriate medical treatment back in 2011, rather than have his infection escalate to an amputation, lawsuit and finally a jury trial in 2021.

Just before Rodesky’s trial began last week, he settled with the former medical directors for Tamms and voluntarily dismiss the claims against Pontiac's medical director. Both of those doctors were employees of Wexford Health Sources, the Pittsburgh-based healthcare company that solely services government-run facilities including state and federal prisons, county jails, juvenile detention centers and psychiatric hospitals.

Illinois has contracted with Wexford since 1992. It’s one of a handful of large healthcare companies in the nation that offer healthcare services almost exclusively in correctional settings. According to the most recent comprehensive survey of states’ prison healthcare systems, Illinois was one of 20 states whose department of corrections contracted with a private medical care provider at the time of a 2015 report by the Pew Charitable Trusts.

Wexford has been a co-defendant with the Department of Corrections in hundreds of lawsuits filed by inmates Illinois, and though the vast majority are eventually thrown out, the pair have been subject to well over 100 settlements and jury awards in the past decade alone.

In 2013, a jury awarded $12 million to the family of a former Stateville inmate who was allegedly wasn’t provided his anti-seizure medicine for days, despite calling out for it, ending in a brain aneurysm that permanently debilitated him. Wexford separately agreed to enter a consent judgment for $14 million with the former inmate’s family, with both parties knowing the family wouldn’t likely see that much, as the company reached the limit on its insurance. Finally in 2016, the family settled with Wexford’s insurer for an undisclosed amount, according to court records.

But aside from that $12 million award, the Department of Corrections typically settles for much lower dollar amounts. According to Illinois Times reporting from 2015, the state had paid less than $704,000 in more than 100 cases ended in the previous decade, averaging a little more than $6,000 per case. It’s unclear how much Wexford has paid out in settlements.

Wexford’s most expensive day in an Illinois federal court came in 2019, when a jury awarded $11 million to an inmate at Taylorville Correctional Center who finally received a diagnosis of kidney cancer four months after complaining of blood in his urine. But he wouldn’t undergo surgery for another 15 months, by which time the cancer had spread to three other organs, rendering him terminal. The jury in that case returned verdicts against Wexford itself — a rarity — in addition to two Wexford doctors. A former Department of Corrections employee was dismissed from the case.

That case is reminiscent of an earlier $800,000 settlement between Wexford and the family of another Taylorville inmate who died of colon cancer in 2012. In the three years since the inmate entered prison with elevated liver enzymes — a possible sign of cancer — his symptoms became increasingly severe, including losing more than 40 pounds and eventually needing diapers. But a Wexford doctor would only diagnose him with hemorrhoids and told him he needed mental health treatment instead. When the inmate finally went to the hospital, a CT scan revealed late-stage colon cancer that had already metastasized.

Wexford gained national attention after a 2019 investigation from WBEZ revealed the company’s so-called “one good eye” policy, in which Wexford allegedly denied eye surgery to Department of Corrections inmates because their other eye was functioning. Wexford takes issue with the “one good eye” characterization, but calls its policy a “trade secret.”

The Department of Corrections’ continued reliance on Wexford has raised the ire of both activists and lawmakers and raised eyebrows after former agency director was sentenced to two years in prison in 2008 for accepting $50,000 in bribes while serving under former Gov. George Ryan. $30,000 of that sum came from a lobbyist for Wexford.

Wexford’s 10-year, $1.4 billion contract was set to run out in 2021. Prior to that sunset, the Department of Corrections announced early last year that it would pilot a program partnering with Southern Illinois University’s School of Medicine to provide health care at a few prisons. As of the 2015 Pew report, four other states also contracted with medical schools at state universities to provide prison health care.

But SIU’s prison health care pilot hasn’t yet begun, and Wexford still provides medical care to all Department of Corrections facilities. Agency spokeswoman Lindsey Hess confirmed to NPR Illinois that Wexford’s contract has been extended through July 29, 2022.

“During this extension, the Department is committed to posting a comprehensive RFP that meets the medical and mental health needs of the individuals in custody,” Hess said in an email. “We are continuing to explore the use of SIU physicians in the IDOC system.”

The judge in Rodesky’s case dismissed Wexford from the suit more than a year ago, and the jury couldn’t decide on whether its employees — the two prison medical directors — showed deliberate indifference to Rodesky’s medical needs.

Road to consent decree

Rodesky won at trial not on his claims of inadequate medical care, but his assertion that having to climb stairs in order to get insulin shots to manage his Type 1 diabetes violated the Americans with Disabilities Act, especially after Pontiac’s medical director ordered his cell be moved to a lower block.

But the year before Rodesky developed his blisters and in the opposite corner of the state, Stateville Correctional Center inmate Don Lippert was allegedly denied his insulin shots twice in one day, sending him into diabetic shock each time. Lippert filed a handwritten complaint in federal court, claiming the Department of Corrections provided inadequate medical care tantamount to cruel and unusual punishment.

The court decided Lippert’s case had merit, assigned him a pro bono attorney and in 2011, Lippert’s handwritten complaint became a full-blown class action lawsuit — one that would eventually force change on the Department of Corrections.

A prison gate slightly open.

After a years-long court battle, the state in 2019 agreed to a consent decree ordering a sweeping overhaul of how the state provides medical and dental care to Illinois' prison population.

In the lead-up to the state agreeing to the consent decree, medical experts commissioned to complete an audit on the quality of the medical care within the Department of Corrections found “significant lapses in care” in 60% of inmate deaths from nonviolent causes in the 17-month period examined. But that doesn’t mean Illinois’ prison system is the deadliest; in fact, Illinois had the eighth-lowest inmate death rate among all states between 2001 and 2019, according to the U.S. Department of Justice.

The 2015 Pew report also found that at the time, Illinois was spending the eighth-lowest amount among states for healthcare costs per inmate (though that was long before agreeing to the medical care consent decree, plus two other settlements that demand the Department of Corrections improve mental health care and accommodations for deaf and hard of hearing inmates — including providing hearing aids — both of which drive up overall health care costs for the agency).

Illinois also had the second-lowest per-inmate healthcare staffing ratio in the nation, a metric targeted for improvement under the Lippert consent decree. The report also pointed out that Illinois was one of 15 states whose prison healthcare system didn’t use electronic health records, another aim of the consent decree.

The consent decree that bears Lippert’s name was agreed to nearly three years ago — days before a trial in the case was schedule to begin — required the Department of Corrections to submit plans for how it would implement a host of system-wide reforms to how it delivers medical care to prisoners, along with plans to increase medical and dental care staffing within prison facilities.

But in the fourth of his biannual reports filed in October, the federal court monitor in charge of overseeing the consent decree’s implementation wrote that the agency still had not made comprehensive staffing and reform plans, and blasted the agency for allegedly being non-responsive to its requests for additional information and input. The monitor also claimed that since its last report in April, the agency had only addressed 11 of the 235 recommendations from six months prior, characterizing that 4% of items as only the most pressing and dire.

“This is in line with the Monitor’s opinion that IDOC does not yet have a comprehensive plan to address this Consent Decree; instead, it seems to primarily respond to crises and threats of legal action,” the monitor said.

In a written response filed the same day, however, the Department of Corrections strongly disagreed with the monitor’s characterization that it wasn’t cooperating, but acknowledged the pandemic and the agency’s “vaccination efforts took time away from specific Decree requirements.”

Three weeks later, the Department of Corrections submitted a 16-page document establishing deadlines for 88 separate aims in the consent decree. A few of those steps are already complete, while the majority are planned for 2022. The latest deadline in the plan is set for June of 2023.

An aging, more unhealthy prison population

As the prison population in the U.S. ages, state and federal prison systems must contend with treating a greater number of inmates for chronic conditions, including diabetes. Though Rodesky and Lippert were born with their type 1 diabetes, type 2 diabetes more common in Black and Latino populations in the U.S., due to factors like lack of access to healthcare and affordable healthy food. America’s prison population is disproportionately Black and brown, and in the past two decades, the rate of prisoners reporting ever having diabetes or high blood sugar has increased to 8%, according to the most recent available data from the U.S. Department of Justice.

Mills said most of the time Rodesky was living with the foot infection his body couldn’t fight off due to his diabetes, “his blood sugar was through the roof.”

“He never really had it under control and part of the reason is because [IDOC] never could get it together to coordinate the time that you get your insulin and the time they provide you with food,” Mills said.

The consent decree goes far beyond Lippert’s original claims of being denied insulin, but the monitor’s most recent report circles back to diabetes management. Inmates with diabetes should be given insulin before their meals, but the monitor said coordination of insulin with meals is “uncertain” at some Illinois prisons, particularly ones with earlier breakfast times.

Breakfast times within the Department of Corrections range from 6 a.m. at the latest to 2:30 a.m. at the earliest — a distinction taken by Stateville. Facilities with earlier breakfast times result in “very low” rates of inmates with diabetes receiving their morning insulin “because they don’t want to get up at that hour to eat,” according to the monitor. Skipping morning insulin and skipping breakfast can mess with diabetics’ blood sugar levels.

“If a 3 a.m. breakfast is an impediment to large segments of inmates eating that meal, why isn’t the meal time changed?” the monitor wrote.

Diabetes is far from the only ailment the Department of Corrections has to contend with in its population. A 2015 report from the Justice Department found state and federal prisoners were about 1.5 times more likely than the general population to report ever having chronic conditions like high blood pressure, asthma or diabetes.

The prevalence of infectious diseases in incarcerated populations also presents a challenge in congregate settings like prisons. The report estimated 21% of prisoners in the U.S. have ever had tuberculosis, hepatitis or a sexually transmitted disease, compared with 5% of the general population.

And a majority of prisoners were either overweight, obese or morbidly obese at the time of the report, according to the DOJ.

A generally unhealthy prison population meant thousands of vulnerable inmates when COVID-19 hit Illinois in March 2020. Advocates grew panicked over how the virus would spread in a congregate setting like a prison. A massive outbreak at Stateville early in the pandemic left 12 inmates dead in the span of a month. Outbreaks in other prisons followed. To date, 88 inmates have died of COVID.

According to the Department of Corrections’ latest available data, 11,502 incarcerated people housed within the agency have tested positive for COVID since the pandemic began. That’s nearly 42% of Illinois’ current prison population, though the total population when the pandemic began was closer to 38,000, making it difficult to compare cumulative cases over the last 21 months.

As of November 2021, the Department of Corrections’ population has fallen to approximately 27,500 incarcerated people across nearly four dozen facilities, including transition centers, life skills re-entry centers and treatment centers. That new low is a continuation of falling headcount over the last nine years; overcrowding had been a perennial issue for the state’s prison system for years, reaching a peak population of more than 49,000 inmates in 2013.

But a few COVID-era policies helped accelerate that population reduction.

At the beginning of the pandemic, Gov. JB Pritzker halted transfers from county jails to state prisons. Transfers resumed several months later, but only at the discretion of corrections officials. Since then, state prisons have refused to take hundreds of inmates from county jails all over Illinois, but the biggest single backlog is waiting at the Cook County Jail.

Additionally, Pritzker last year OK’d a medical furlough program via emergency executive order to relieve crowding and slow the spread of the virus in prisons. And in March, the state agreed to release up to 1,200 inmates to settle a class action lawsuit brought on behalf of elderly and medically vulnerable prisoners.

Listed last among the 10 named inmate plaintiffs who brought the suit? A diabetic inmate at Pontiac Correctional Center named Anthony Rodesky.

This story has been clarified to reflect the timing of how Rodesky settled with and voluntarily dismissed claims against the former medical directors at Tamms and Pontiac,, respectively, and a detail about Rodesky's shoes.

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