Margie Ryder, 39, died three months after asking a judge to intervene in her healthcare at Fluvanna Correctional Center for Women. His ruling was still pending. (Illustration by Frank Pichel)

Inmates at Fluvanna Correctional Center for Women weren’t particularly surprised when Margie Ryder died last month.

Sad, yes. But sick inmates at Fluvanna die with frequency.

In 2016, a judge approved a settlement of a lawsuit brought by inmates alleging medical care at the facility was so poor it violated inmates’ constitutional rights. The Department of Corrections promised to make improvements while denying any wrongdoing.

Twelve deaths later, a federal judge ruled the prison wasn’t keeping up its end of the bargain and ordered the state to hire more staff and take inmate health complaints more seriously.

“Some women have died along the way,” Judge Norman K. Moon acknowledged in a January decision.

This year: at least three more deaths that raise concerns about medical care, according to the Legal Aid Justice Center, which is representing the women.

Among them, Ryder, a 39-year-old who was serving a two-year sentence for embezzlement and was due to be released in October.

Her friends at the prison say she was terrified her chronic medical condition was being managed so poorly that she’d die. After she was hospitalized three times following lapses in the delivery of her medication, she asked Judge Moon to intervene in her care.

His ruling was still pending when she passed.

“When she did die, it didn’t surprise anybody here,” said inmate Shebri Dillon, who says prisoners at the facility resort to performing medical procedures on themselves when they can’t get prison staff to take them seriously.

Dillon has her own horror stories, including cleaning out an infection in her gums with Q-tips before packing the socket with table salt smuggled from the mess hall. “So many people have died. It’s like, at this point, we almost practice Civil War medicine ourselves.”

State says nothing’s wrong

Officially, the state concedes no deficiencies in the quality of the care it provides to inmates at Fluvanna or any other state prison.

Department of Corrections Director Herald Clark told lawmakers earlier this year that the legal setbacks were a result of court-room technicalities rather than a reflection of the care inmates receive.

As for all those deaths, they argue that prison inmates are typically less healthy than the general population as a result of poor life decisions leading up to their incarceration. And prisons are difficult environments in which to provide health care.

The state is in the process of appealing Moon’s January ruling, which, among other things, required the facility to provide “meaningful responses” to medical grievance requests and boost its medical staff to a minimum of 78 employees.

After Ryder’s death the department put out a brief statement: “As is public knowledge following her lawsuit, she had a terminal illness.”

(Illustration by Frank Pichel)

Unsaid is that outside medical staff at the University of Virginia Medical Center expressed repeated concerns about the care she was receiving at Fluvanna. Pulmonary arterial hypertension is indeed terminal if untreated, they testified in court, but if properly cared for, a patient could expect to survive indefinitely.

“My conscience says I have to speak out on Ms. Ryder’s behalf,” a nurse, Lauren Bedard, wrote in a court filing. “Every time I see this patient at UVA, I wonder whether it will be the last time I see her alive.”

Lawyers for the inmates say not only is it clear that Fluvanna is providing woefully deficient care, but that the problems likely extend throughout the state’s correctional system.

Shannon Ellis, an attorney with Legal Aid Justice Center who has led litigation on the case, says her organization receives correspondence from inmates all over the state. The allegations mirror complaints at Fluvanna.

“The only difference is that those facilities are not under the microscope,” she said.

The strictest compassionate release policies in the country

State lawmakers have primarily approached prison health care as an unwelcome financial quandary.

The General Assembly ordered an audit of rising inmate health costs, which had increased 40 percent over 10 years. The report, delivered last year by the Joint Legislative Audit Review Commission, pointed to two key challenges: An aging prison population and difficulty recruiting and maintaining medical staff.

The percentage of inmates who are 55 or older more than doubled over the past 10 years, according to the report.

Part of that comes down to larger demographic trends associated with the aging Boomer generation, but auditors said policy decisions in Virginia exacerbated the situation, pointing to a 1995 decision to abolish parole and an accompanying “Truth-in-Sentencing” mandate that inmates serve at least 85 percent of their sentences.

Another factor keeping sick and dying inmates in prison: Virginia has the second most restrictive compassionate release policy in the country, allowing inmates to be released early only if they are given a prognosis of three months or less to live. Only Kansas sets a stricter time requirement, requiring a prognosis of 30 days to live.

And the auditors note that unlike some other states, Virginia’s release policy doesn’t consider serious illnesses that are not terminal or permanently incapacitating.

“It’s deeply disturbing that there are 80-year-old women at Fluvanna who have dementia and don’t know why they’re there and are being cared for in such an appalling manner,” said Ellis. “Those women should not be incarcerated.”

Sen. Dick Saslaw, D-Fairfax, filed legislation this year based on the report’s recommendations. It would have extended early release consideration to inmates expected to die within 12 months. It passed the Senate but was voted down on a party-line vote in a House subcommittee, with Republicans opposing.

“We’ll try to respond through executive action,” says Secretary of Public Safety Brian Moran. “But I think it’s important for the legislature to say, this should be the policy of the commonwealth to provide compassionate release. It’s humane, it’s more cost effective. And it does not threaten public safety.”

Out-sourced medical care and high turnover

The audit also observed that instability in staffing can lead to inadequate care, pointing to high turnover in key roles at prisons where the state has outsourced health care. The report found that nine of 12 prisons where health services are provided by a contractor lost their top administrator during the prior fiscal year and that front-line staff like nurses left at twice the rate as those at non-contract facilities.

The auditors didn’t necessarily fault the contractor, Armor Correctional Health Services, noting that it was specifically brought into difficult-to-staff facilities like Fluvanna. The report says the approach was not intended to save money. Instead it was meant to make it easier to recruit talent by avoiding pay restrictions in the state salary schedules.

In either case, it hasn’t appeared to work. The initial lawsuit against Fluvanna alleged healthcare decisions were being made based on price. Turnover remained high.

State lawmakers appropriated $6.5 million this year to cover the cost of bringing health care at Fluvanna back in house after prison officials told them they couldn’t comply with court orders as long as outsourcing continued.

A spokeswoman for the Department of Corrections, Lisa Kinney, said the state is not considering taking similar steps at other facilities.

Auditors made a variety of suggestions to improve staffing issues at contract facilities. For now, Kinney says the state is focusing on one: A partnership in which a public teaching hospital like UVA or VCU would take over one prison’s health services as part of a pilot program – an approach that independent experts say has worked well elsewhere.

Lawmakers put language in this year’s budget directing the state to establish a workgroup to begin talks, which Kinney says are ongoing.

‘You can’t not pay for their medical care’

While the legislature has focused on finding ways to save money, advocates say one of the big problems is that the state isn’t spending enough.

“If the state has decided that they’re going to incarcerate this number of people, then it has to come to terms with the cost of that decision – including their medical care,” Ellis said.

The Department of Corrections requested but was denied $1.3 million this year to convert three of its male dormitory units into infirmary and assisted care facilities that could provide skilled nursing.

Without the funds, they said they’d have to transfer inmates either to expensive hospital beds or place “offenders in less appropriate housing settings.”

Lack of money is not, however, an issue identified by state auditors. And Moran, the state secretary of public safety, said that while the legislature resisted loosening compassionate release policies, they’ve been open to the funding requests Gov. Ralph Northam’s administration made.

In either case, advocates say the problems at Fluvanna do not appear to be getting better.

Ellis said that on a recent visit she witnessed a 70-year-old woman in a broken wheelchair that presented a clear fall risk. Last month, another volunteer observed an elderly woman in the infirmary lying in a bed full of her own feces. She said a client has been kept on antibiotics for months while waiting months for a specialist appointment.

Dillon, the inmate, shared similar accounts.

“When I go back toward the infirmary, it’s the only place in the entire prison where my hair stands on end,” she said. “I don’t know what it is, but something goes through you. It’s not a place you ever want to be.”

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Ned Oliver
Ned, a Lexington native, has a decade’s worth of experience in journalism, beginning at The News-Gazette in Lexington, and including stints at the Berkshire Eagle, in Berkshire County, Mass., and the Times-Dispatch and Style Weekly in Richmond. He also has the awards to show for it, including taking a pair of first-place honors at the Virginia Press Association awards earlier this year for investigative reporting and feature writing. He is a graduate of Bard College at Simon’s Rock, in Great Barrington, Mass.