Limestone HIV unit's facilities, delays in pill distribution cited

Alabama prison officials have agreed to provide dozens of improvements to the medical care and treatment of Alabama's HIV-positive prisoners to settle a federal lawsuit.

The Alabama Department of Corrections also must submit its HIV unit at Limestone prison to two years of monitoring by a medical consultant, who will visit quarterly to make sure prisoners are treated in accordance with national standards.

The 19-page settlement agreement was released Wednesday after a hearing before U.S. Magistrate John Ott. Ott said he would recommend that U.S. District Judge Karon Bowdre approve the agreement.

"In over six years, I've never had a mediation process that has been as long, as arduous," Ott said.

Investigations stemming from the 2002 lawsuit revealed dismal conditions and bug-infested, warehouse-like housing for hundreds of Alabama's sickest prisoners. Poor medical care led to numerous premature deaths, according to a series of reports.

They were filed by a medical expert, hired by the prisoners' attorneys, who reviewed 44 inmate deaths.

Since the lawsuit was filed, DOC switched medical providers. Before the settlement, housing conditions and medical care had improved. The settlement puts in writing some things that the department already was doing, said DOC spokesman Brian Corbett.

"We do still deny any constitutional violation with regards to care at Limestone. Based on the costs and risks of litigation we feel like it's in the best interest of the state to reach this compromise agreement," Corbett said.

State cost unclear:

It's unclear how much the settlement will cost the state, as attorney's fees have yet to be finalized.

Among the costs known Wednesday - $16,000 a year for the medical consultant to monitor the agreement and up to $1,500 per autopsy after the death of an HIV- positive prisoner. Previously, the state did not require full autopsies on infected prisoners.

The plaintiffs in the case must pick up a little more than half of the consultant fees, expected to run $35,000 to $40,000 a year, Corbett said.

Dr. Joseph Bick, chief medical officer at the California Medical Facility, a prison for sick inmates, has been selected as the consultant.

Miami attorney David Lipman, along with attorneys from the Atlanta-based Southern Center for Human Rights, represented the prisoners.

"These people have lived ... in an egregious situation for a very long time at Limestone Correctional Facility," SCHR attorney Joshua Lipman said at Wednesday's hearing.

He said the prisoners were satisfied, for the most part. Some of the men remain upset that HIV-positive prisoners do not get access to the same classes, jobs and living conditions as other prisoners, Lipman said.

Alabama remains one of the few states, possibly the only one, that continues to segregate HIV-positive prisoners. A few have been allowed to take classes or work, but most cannot.

Desegregation of programs took a back seat to decent housing and medical care in this case. The prisoners still hope for progress in this area, Lipman told the judge.

DOC General Counsel Charles Crook said he believed the settlement provided "more than constitutional provisions," for the prisoners.

"I'm the first to admit, that there was a time in recent years when there were inadequacies that needed to be addressed," Crook said.

Limestone insight:

Some of the settlement points offer insight into unusual medical practices of the past at Limestone.

For example, HIV-positive prisoners used to provide emergency medical care to fellow infected prisoners. They also placed the bodies of dead prisoners into body bags. Both are banned by the settlement.

It requires fresh water to be available at all times to HIV prisoners, and calls for their meals to be served after 5 a.m.

The settlement also fixes problems in the pre-dawn pill line. Previously, HIV- weakened patients, some of whom could barely stand, had to wake up at 3 a.m. and wait in an outside line to receive life-saving medications. With no food available at that time, the men took their pills on empty stomachs - against FDA guidelines - leading to nausea, vomiting and further deterioration.

The settlement allows prisoners to keep their pills with them, and requires prison personnel to deliver pills to acutely ill men.

The settlement requires a nurse be added to Limestone's medical staff as an HIV coordinator.

It also requires an HIV specialist to treat patients in the unit, as well as a medical doctor for Limestone's other prisoners, positions currently filled, Corbett said.

When the suit was first filed one doctor oversaw care for more than 2,000 prisoners, including the HIV unit.

Further provisions call for improved dental care, better pest control and a ban on triple-bunking or dorm-style housing for HIV-positive prisoners.