Death on the Installment Plan

Medical neglect, chronic disease, a hepatitis epidemic. Some Colorado prisoners pay for their crimes with their lives.

Roderic Gottula, a former DOC medical director and now a consultant on correctional health-care issues, notes that most medical staffers who work in corrections "fell into it" rather than set out to find a job behind bars. Even so, he believes that Colorado's prisons usually deliver appropriate care in an environment hamstrung by security concerns and other challenges.

When Gottula left the system in 1995, he says, inmates were actually averaging twelve medical visits a year, far more than most people on the outside. "Obviously, they have an issue with illnesses that the average person doesn't have," Gottula explains. "But a lot of the visits aren't strictly medically related. If you want an extra mattress or different shoes, you go to medical. Sometimes they do it because they want to get out of work, check out the new nurse or try to get drugs. There's a whole variety of reasons."

But Gottula admits to being puzzled by the number of DOC deaths among younger inmates, particularly those deaths resulting from conditions that are usually non-fatal. "You don't see forty-year-olds dropping dead on the streets that often," he says. "Now, some of these guys have diabetes or other problems, but you don't see them dropping on the streets, either. You almost never see someone in the twenty-to-thirty age range die of these types of causes. This is really unusual."

Mark Andresen
Roderic Gottula devised the DOC's first hepatitis treatment policies a decade ago.
Brett Amole
Roderic Gottula devised the DOC's first hepatitis treatment policies a decade ago.

Gottula wonders if the prison system is doing sufficient diagnosis and follow-up care of manageable illnesses. Even suicide, he suggests, reflects on the quality of health care, since suicidal prisoners typically see a health-care provider shortly before they try to take their lives. Last summer the DOC had a string of three suicides in four weeks. One was at San Carlos, the system's special prison for the mentally ill; the other two involved inmates who'd recently been moved from the state mental hospital in Pueblo back to regular prisons and killed themselves within days of the transfer.

"In that kind of situation, you'd expect they would be monitoring the inmate carefully to see how the transition was going," Gottula says.

Mental-health issues can play a part in other kinds of deaths, too. The DOC estimates that it has close to 2,500 prisoners with diagnosed mental illnesses, but only the most impaired end up at San Carlos. Others are supposed to be cared for in "special-needs" units at various prisons. But the care may not provide adequate protection for the mentally ill, who are often seen as easy prey by other prisoners. And it doesn't always protect staff from inmates who could be seriously deranged.

Consider the case of Edward Montour, a Limon inmate accused of killing corrections officer Eric Autobee with an oversized soup ladle in the prison kitchen in October.

The official version of the slaying, the DOC's first staff murder in more than seventy years, is that it came out of nowhere, a random assault by a "model" inmate who later admitted to investigators that he was seeking a transfer in order to avoid being labeled as a snitch. But Montour, who's serving a life sentence for the 1997 murder of his three-month-old daughter, also had a reputation within Limon as an unstable, often heavily medicated prisoner. Both inmate and staff sources say that kitchen workers had accessed inmate records and used the information found there to taunt Montour, who'd become increasingly agitated in the days leading up to the attack.

"If you taunt a convicted murderer and continuously call him 'Baby Killer,' among other things, most times the response is negative," says one Limon prisoner. "To involve other inmates in this game is dangerous."

"Montour should have been sent to a mental facility," says another. "When he first got here, they had him so pilled up he'd walk like Frankenstein to and from the pill line. There are lots of guys here with psycho jackets who should be in the state hospital, and he was one of them."

Your name is David Jenner. You are forty years old and serving what amounts to a life sentence -- 96 years -- for sexual assault. One day in 1997, a physician's assistant informs you that you've tested positive for the hepatitis C virus.

This is not, you are told, a big deal. The virus, which is spread primarily through dirty needles -- intravenous drug use, amateur tattooing -- can lurk in your system for years, even decades, with no visible symptoms. Most hep C infections become chronic, but only a small percentage of cases become deadly, progressing to cirrhosis or liver cancer. The DOC will monitor your blood, you learn, and if certain liver enzyme levels reach dangerously high levels, you could be eligible for treatment with a drug called interferon.

Over the next three years, you request and receive numerous blood tests that measure how your liver is doing. Each time you are told that you are faring just fine. But in 2000, you are transferred to the Limon Correctional Facility, and no one there seems particularly interested in your case. You ask for a blood test again and again, at least twenty times -- an average of twice a month for ten months. Your requests are ignored.

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