It's a place where sick men beg for food, then die from starvation, according to a doctor's report. Where pneumonia goes untreated and men drown in their own respiratory fluids. Where HIV-weakened patients stand in long lines in the middle of the night for pills they take on empty stomachs; then they vomit.
These are the conditions at Limestone prison's HIV-unit, a converted warehouse that houses about 300 Alabama prisoners with AIDS or HIV, according to a report filed Tuesday in a federal lawsuit against the Alabama Department of Corrections and Birmingham-based Naphcare Inc., the prison system's medical contractor.
"The most egregious medical failure at Limestone is the number of preventable deaths," wrote Dr. Stephen Tabet, an infectious disease specialist at the University of Washington and attending physician at a Seattle hospital that treats HIV patients. Tabet visited Limestone in February and reviewed 38 deaths since 1999 in the HIV unit.
"The conditions at Limestone Prison are unsafe for both the incarcerated and for the staff," Tabet wrote in his 125-page report. He called the medical system "broken, severely distressed and often non-existent."
Naphcare spokesman David Davis blamed DOC operations and facilities for many of the findings. He also said the company disagrees with many of Tabet's findings.
Prisons' spokesman Brian Corbett pointed out that Tabet is paid by people suing the department. He said it would be inappropriate for him to comment further on a lawsuit.
Among Tabet's findings:
Alabama is the only state in the country that segregates prisoners with HIV. They live in a sheet-metal warehouse. Cold air pours in. Insects and spiders are rampant.
In 2002, a staph infection spread, creating infections and pus-filled boils on numerous men. "It is clearly evident that this happened due to overcrowding and the probable influx of stinging and biting insects in the unit," the reports states.
Tabet found cases where inexpensive, preventative care is not done. Pennies-a-day Bactrim, which could halt pneumonia deaths, is not readily given.
Prisoner Dewayne Wilder, 37, pleaded with nurses to help him breathe: "I'm afraid to go to sleep. Please stay and talk to me and watch me." He was initially given Tylenol. Respiratory distress continued for weeks. He died in April, 1999, after being given medication too late.
Prisoners also died from AIDS wasting syndrome. Though not unusual, it's treatable with medications to increase muscle mass. Not one prisoner was given the medicine, Tabet found.
A prison doctor who treated prisoner Earnest Wynn, 39, in December 2001 wrote: "begging for sandwiches because he can't eat solid food. Burst into tears during evaluation. Emaciated looking."
She gave him intravenous fluids and diarrhea medication, but nothing for the weight loss. He died within two months.
"This patients was literally starving to death," Tabet wrote.
Inmate John Bolton weighed 74 pounds. He pleaded for help, saying his appetite was good but he couldn't keep food down. "No discomfort or distress level observed and no plan at this time," a nurse wrote in April.
"He died from starvation on 5/22/2000," Tabet wrote.
The report cited nurses illegally prescribing medications. It found cases in which fellow inmates prepared bodies after death and placed them in body bags. "This practice is inappropriate," Tabet wrote.
In order to receive medications, HIV-weakened patients, some who could barely stand, had to wake up at 3 a.m. and wait in an outside line up to 45 minutes. 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.
"Patients at Limestone are treated like they are nuisances," Tabot wrote.
Dr. Colette Simon, who has overseen medical care for Limestone prisoners since 2000, pointed out that many of the deaths in the report occurred before her arrival. Also, since Naphcare has had the contract only 14 people have died.
"People used to just drop dead," Simon said. Changes since her arrival have been lauded, she said. "I've been treating them differently."
Simon also said that certain issues such as food and pill times are out of her control. However, she disagreed with Tabet's findings of preventable deaths.
"People will die no matter what, no matter who they are," Simon said.
This is the second time a medical expert has found inadequate care at Limestone. A 2002 audit by Jacqueline Moore and Associates said the death rate from AIDS is more than twice the national average in prisons. Naphcare has sued, claiming the audit contains inaccuracies.
Attorneys with the Southern Center for Human Rights in Atlanta filed the lawsuit last year, one of three pending cases over inmate medical care.
Alabama's prison spending ranks 50th in the nation. The state is also last in funding medical care for prisoners.