Thursday, April 24, 2014
The state medical examiner did an autopsy Thursday on an inmate who died at the Maine Correctional Center in Windham, but will have to do blood tests before declaring how the man died.
Garrett Brewer, 35, of Presque Isle died Wednesday afternoon in his cell. His father said Brewer had suffered from diabetes since he was a teenager and had complained recently about the prison staff changing his medications and about a lack of exercise, which is important to controlling a diabetic's blood sugar level.
The prison provides needed medicine to inmates three times a day and makes special dosing arrangements as necessary, Associate Corrections Commissioner Jody Breton said Thursday. She said the prison in Windham also has round-the-clock nursing care in case of emergencies.
The prison changed medical providers last summer because of complaints about the previous provider. Correct Care Solutions, based in Nashville, Tenn., has had the contract since July.
Deputy Attorney General William Stokes said Thursday that law enforcement's investigation of Brewer's death will focus strictly on whether a crime was committed.
"We don't look for malpractice or good or bad medical care," he said. "At this point, there is no evidence that's been reported to me of anything suspicious."
Brewer had served 66 days of a nine-month sentence for trafficking in methamphetamine.
His father, Thomas Brewer of Presque Isle, said in an interview Wednesday that his son's death raises questions in his mind about the quality of medical care his son received.
Breton would not comment on Garrett Brewer's medical regimen, or any other aspects of his health and health care or his living situation.
Dr. Christine Twining, medical director for Maine Medical Partners Endocrinology & Diabetes Center, said diabetes is very dangerous if it's not treated correctly.
"People can have diabetic ketoacidosis, and if they don't get proper hydration and insulin ... they can die from that," she said, although it is rare in this country.
The condition is a result of the body's inability to convert blood sugar into energy because it lacks insulin.
People also can die when their blood sugar gets too low, Twining said.
Of the two major types of diabetes, the rarer Type 1 typically occurs in young people. The condition leads to very few or no insulin-producing cells in the pancreas, and generally requires doses of the hormone multiple times each day.
Patients need varying amounts of insulin depending on how much they exercise or whether their diet is heavy in carbohydrates, Twining said.
Insulin costs, on average, $200 per month, but that varies greatly depending on how much a person needs and what type of insulin they use.
Twining said she has no direct knowledge of Brewer's death or his medical care.
The state Department of Corrections will review the inmate's death, as it does any critical incident, to determine whether any change in policy or procedure is needed, Breton said.
Medical care in Maine's prisons has been a perennial concern. The state has used several vendors in recent years. Some of the changes have followed allegations of poor care.
A government report in 2011 found multiple problems with the vendor that preceded Correct Care Solutions.
An analysis by the state Office of Program Evaluation and Government Accountability showed that Correctional Medical Services failed to provide certain required services and had poor record-keeping so it was difficult to assess the company's performance.
In half of the 24 cases studied in 2010, the analysis found no records to show that the inmates had received their medication.
The state now pays Correct Care Solutions a management fee. The costs for medicine, staffing and other care are billed to the state. If costs exceed the budgeted amount, the two parties each pay half of the excess up to $700,000 a year. The state is responsible for increases beyond that.
The arrangement is intended to help contain costs and reduce the financial incentive that might exist for the vendor to cut back on care to increase profits.
Breton said the state has been meeting regularly with its new vendor to monitor performance.
The state has seen a spike in inmates filing grievances about health care, but attributes that to the Department of Corrections' decision to eliminate narcotics from the medicines made available in the prisons.
Health care costs systemwide were about $1.4 million, 2.2 percent under budget, through February, according to documents provided by the Department of Corrections.
Judy Garvey, a spokeswoman for the Maine Prisoner Advocacy Coalition, said Thursday that the state has an important responsibility in overseeing inmates' medical care and should do a comprehensive review after a year.
"Advocates are not certain about the new medical provider because they haven't been there long enough," Garvey said. "What we expect the state would want to do after a year, after the terrible problems in the past, they would do a re-review."
David Hench can be contacted at 791-6327 or at: