This firm promised to enhance well being care in jails. Dozens of its sufferers have died.

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NORMAN, Oklahoma — Two days after Thanksgiving in 2022, Shannon Hanchett walked into an AT&T retailer for a brand new telephone, and ended up in handcuffs.

Hanchett ran the Cookie Cottage, a well-liked bakery on this school city, the place she made treats named for locations throughout the state, from Stilwell Strawberry to Lawton Lemon. However currently, her psychological well being gave the impression to be fraying. She was falling behind on orders. Her marriage was crumbling. And the 38-year-old mom of two had picked fights with household and buddies.

All of it detonated that day within the AT&T retailer. Staff phoned police after Hanchett started pacing, ranting and calling 911. Physique digicam footage reveals an officer from the Norman Police Division speaking to her for a number of minutes, then tackling, handcuffing and arresting her for misusing the emergency line.

Like so many individuals experiencing psychological well being crises within the U.S., Hanchett landed not in a psychiatric hospital, however in a county jail. In her case, it was Norman’s Cleveland County Detention Heart, which contracts with a for-profit firm to supply medical care: Flip Key Well being Clinics.

And for Hanchett, that’s the place issues received even worse.

As native jails have morphed into a number of the largest psychological well being therapy services within the U.S., many counties have outsourced medical care to non-public firms that promise to include rising prices. Flip Key is likely one of the quickest rising in the course of the nation.

No less than 50 individuals who have been beneath Flip Key’s care died in the course of the previous decade, an investigation by The Marshall Venture and The Frontier discovered. Our reporting unearthed firm insurance policies and practices which have endangered individuals in jail — particularly these with psychological sickness.

In dozens of circumstances, Flip Key staff didn’t ship individuals to the hospital after they have been in disaster, catatonic or refusing to eat or drink. The corporate staffed psychological well being and different medical positions with low-level nursing assistants educated to carry out fundamental duties like taking very important indicators, however to not diagnose or assess medical circumstances.

Medical docs and extra advanced-level nurses working for Flip Key steadily consulted over the telephone for a restricted variety of hours per week as a substitute of constructing in-person visits, based on authorities information and paperwork obtained by way of lawsuits.

Till final 12 months, the corporate typically restricted the sorts of medicines it will present individuals in jail, not giving them long-acting psychiatric medication and prescriptions they’d acquired earlier than their arrests.

We obtained information from sheriffs who raised considerations concerning the firm not offering the right medicines for individuals in jail with psychological sickness. “I have been told that Turn Key does not prescribe those types of medications,” one Texas sheriff wrote in a 2022 e mail. “This is causing a cascade of problems not only for their safety and well-being, but for the staff and facility as well.”

Flip Key officers declined interview requests for this story. In response to written questions, the corporate issued a press release from its medical director, Dr. William Cooper: “Turn Key’s goal is to provide the highest level of care pursuant to the client’s budget. … The company continues to expand because of the quality of the care provided.” He added that Flip Key’s “constantly working to build on the quality of care it provides.”

To look at the corporate’s practices, we obtained information, together with inside paperwork and emails between firm leaders and public officers, in almost 70 counties throughout Oklahoma, Texas, Arkansas, Louisiana, Colorado, Kansas and Montana. We additionally reviewed greater than 100 lawsuits involving jail deaths and accidents. Many have been dismissed for not assembly authorized hurdles required for civil rights lawsuits: Plaintiffs should show that the corporate wasn’t simply negligent, however confirmed “deliberate indifference” to sufferers’ medical wants, amongst different necessities. Some fits resulted in settlements, lots of which have been confidential, and almost two dozen fits stay pending.

A girl in Colorado died after a bag of medicine she’d hidden in her physique burst, whereas a Flip Key nurse allegedly dismissed her signs and refused to name an ambulance. A person in Arkansas died after medical workers didn’t give him remedy to forestall lethal signs of alcohol withdrawal and didn’t name an ambulance till he grew to become unresponsive. One other man in Arkansas died after medical information present he wasn’t given the seizure remedy he wanted, and he was strapped to a restraint chair and coated with a spit hood.

Flip Key declined to answer questions regarding these incidents.

Medical care in jails might be difficult and dear, mentioned Dr. Anne Spaulding, founding father of the Heart for the Well being of Incarcerated Individuals at Emory College in Atlanta. Most individuals in jails are there awaiting trial, and lots of arrive with complicated wants — some are in drug withdrawal or experiencing psychological well being crises; others want costly therapies corresponding to HIV medication, insulin or dialysis.

Jail operators have a constitutional obligation to provide essential medical care, regardless of the sickness, she mentioned. “When you lock the door of a jail or prison cell, you are preventing the person from going out and seeking health care elsewhere,” she mentioned. “So you have to provide it.”

However there aren’t any nationwide requirements for what constitutes essential medical therapy in jail, and federal courts are cut up over what stage of care is sufficient, particularly for individuals awaiting trial. Near half of individuals in jail have acquired a analysis of a serious psychological sickness, based on authorities knowledge final compiled in 2017, and two-thirds endure from substance abuse. Ladies, the fastest-growing group of individuals in jails, have even greater charges of psychological well being and habit issues.

Some, like Hanchett, have undiagnosed psychiatric points and have been arrested after public episodes. It took 10 days after she was put in jail earlier than a health care provider consulted on Hanchett’s care. Flip Key’s major psychiatrist prescribed antipsychotic capsules and famous Hanchett didn’t reply to questions. Medical workers recorded her signs as “severe — having a marked impact on the inmate’s ability to function satisfactorily in the current outpatient setting.”

By then she had been mendacity on the ground of an empty cell for days, largely bare, dehydrated and in deep psychosis, information present. The licensed sensible nurse on the jail consulted with an off-site Flip Key nurse practitioner, who mentioned to provide Hanchett some Gatorade, based on jail information. Her pulse was weakening, her blood strain dropping — she couldn’t arise or costume herself.

A nurse reported listening to Hanchett saying: “They are going to kill me.”

Brief-staffed

Because the inhabitants of individuals it handled in jails doubled over a span of six years to greater than 20,000, information present Flip Key had 4 docs, three psychiatrists and 10 nurse practitioners on workers. Some oversaw care at a number of jails in several states.

Flip Key has staffed its jails with largely licensed sensible nurses or licensed medical assistants, based on depositions and inside paperwork. These staff can get licensed with a 12 months or much less of education and are educated to carry out fundamental duties like checking pulse charges, to not assess medical circumstances. In 2020, a contract monitor for the Tulsa County Sheriff’s Workplace complained in an e mail that the corporate was utilizing low-level personnel to fill the function of psychological well being technicians, which raised “questions if inmates are truly being serviced accordingly.” The sheriff’s workplace declined to remark for this story.

In its assertion, Flip Key mentioned it “maintains an on-call team that has doctors, nurses, and mental healthcare providers who are available 24 hours a day, every day of the year.”

However in lots of the circumstances we examined, the on-the-ground staff failed to acknowledge extreme well being issues, and didn’t search counsel from docs and extra senior nurses who consulted remotely.

The outcomes have been typically deadly, as within the case of Marconia Kessee. He lived out and in of lodge rooms and struggled with extreme psychological sickness, mentioned his uncle, Michael Washington. In 2018, Kessee went to a hospital for assist and ended up in jail in Norman. Police physique digicam video reveals Kessee stumbling and falling after officers ordered him to stroll throughout the road to a homeless shelter — so the officers arrested him for trespassing.

On the county jail, a licensed sensible nurse working for Flip Key didn’t acknowledge that Kessee was overdosing on methamphetamine and prescribed drugs, as a substitute accusing him of faking signs that included seizures, based on a lawsuit filed by his household. The nurse and jailers left Kessee alone in a cell.

Inside two hours, he was useless of an overdose. He was 35.

In response to the lawsuit, the nurse mentioned he hadn’t been educated on overdoses and wasn’t certified to find out if somebody was experiencing one. Flip Key’s medical director agreed — and conceded that with out such information, the nurse was unlikely to ask a higher-up for assist.

In a confidential settlement, Flip Key settled the case for an undisclosed quantity final 12 months. The corporate didn’t reply to questions on Kessee’s demise.

Constructing an empire

From the start, Flip Key has asserted that it may well present high quality care to individuals in jails at a decrease price.

The week after Cleveland County Sheriff Joe Lester took workplace in 2009, a bookkeeper introduced him a stack of unpaid payments from the native hospital and well being clinics. It added as much as about $1 million in medical debt for treating jail detainees, Lester mentioned later in a courtroom deposition. The division’s whole price range for the 12 months was half-spent, and the sheriff’s workplace was getting assortment calls.

“When somebody goes to the hospital, whether it’s a headache or what, it’s a big expense,” Lester mentioned.

Hospitalizations additionally pressure jail staffing as a result of a deputy typically stays with the detainee till they return to jail.

Lester reached out to Jon Echols, who ran an organization that supplied well being care personnel to native nursing houses. The county awarded his firm a contract to supply 24-hour nursing personnel on the jail.

The corporate completed the primary three months of the contract beneath price range and despatched only one individual to the hospital by ambulance, Echols advised county officers in 2009, based on a neighborhood newspaper report. He and his enterprise companions fashioned the corporate that might grow to be Flip Key Well being Clinics.

Echols gained a seat within the Oklahoma Home of Representatives in 2012. A Republican, he now serves as Home majority ground chief. In March, we requested Flip Key company leaders for an interview, together with Echols, who was nonetheless listed as the corporate’s president and founder. He didn’t reply, however his title and photograph have since been faraway from the corporate’s web site. His most up-to-date monetary disclosure, filed in Might with the Oklahoma Ethics Fee, reveals he retained a “non-controlling minority ownership interest” within the firm, and acquired a wage by way of 2023.

Flip Key has since expanded right into a multimillion-dollar firm with contracts to supply medical look after greater than 75 jails — and 23,000 individuals — in 10 states.

At first, a lot of the jails the place Flip Key operated have been lockups in small counties. However in 2016, the corporate gained its largest contract, in Tulsa, after the native sheriff modified the bidding necessities, permitting the corporate to qualify. On the time, Echols advised The Frontier: “I wanted a fair opportunity. … There’s no doubt that I asked that we be able to bid.” Flip Key promised to cowl as much as $500,000 a 12 months in outdoors medical prices, together with hospitalizations; the county would pay for something over that quantity.

Flip Key later boasted to potential purchasers that it decreased emergency transfers in Tulsa by 77% and the variety of days prisoners spent within the hospital by 35% inside a couple of months.

The corporate went on to get the contract for the troubled county jail in Oklahoma Metropolis, the state’s largest, on comparable phrases.

In its assertion, Flip Key’s medical director mentioned the corporate tries to scale back medical prices by offering therapy earlier than emergency care is required. The corporate added that it “rarely, if ever,” reduces staffing when it wins a brand new contract.

Lethal selections

Christa Sullivan was jailed in Oklahoma Metropolis in 2020 after she suffered delusions, heard voices and attacked her husband with a knife. It was the primary time the 64-year-old grandmother and navy spouse had ever been incarcerated.

She advised the jail workers she had been identified with nervousness, schizophrenia, insomnia, a coronary heart situation, excessive ldl cholesterol, hypertension and fatty liver illness, information present. She reported a historical past of suicide makes an attempt and hallucinations. She had been prescribed medicines, together with the anti-anxiety drug Ativan.

Sullivan was put on the prolonged state waitlist for individuals who want therapy as a result of they aren’t competent to face trial. Flip Key was accountable for her care whereas she waited.

Inside a couple of days of her arrest, Sullivan tried to kill herself by slicing her wrists, information present. She went on to aim suicide quite a few occasions, making an attempt to drown herself in a bathroom and to strangle herself with an grownup diaper.

Sullivan repeatedly requested for Ativan, the drug she’d been taking earlier than jail. She was advised it wasn’t on Flip Key’s accredited checklist, generally known as a formulary, based on her medical information.

In its assertion, the corporate mentioned it screens Ativan and different “controlled substances that are addictive and prone to abuse and use as illicit currency in a correctional setting,” and added that entry to these medicines is “closely moderated.”

Sullivan had been in jail for greater than six months when she confronted a health care provider about her entry to Ativan in January 2021. He wrote in his notes: “As I approach her cell, I see she is walking around naked. Not currently screaming. I greet her and she tells me ‘You lied to me. You have Ativan here. A nurse told me.’ I advise her again that Ativan is not on the psychiatric formulary.”

As a substitute, information present, docs on the jail injected her a number of occasions with the antipsychotic Haldol, which was on the corporate’s checklist of accredited medication.

Sullivan was typically in deep psychosis, information present. She developed strain sores from mendacity bare on the ground. Medical exams famous she was “at extremely high risk for complications including sudden death.”

However she wasn’t taken to a hospital for almost a 12 months. Then, twice in a single week, she was despatched to the emergency room to be handled for dehydration, kidney points and accidents to her head and again — after which promptly returned to jail. After Sullivan’s return, a health care provider famous that she was exhibiting extreme indicators of “failure to thrive, at high risk for poor outcome.” Medical information word she’d misplaced virtually 30 kilos since her preliminary reserving, and that she was allergic to Haldol — the drug Flip Key had been injecting her with. A psychiatrist lastly prescribed her Ativan on March 25, 2021, information present.

On April 13, 2021, she was discovered useless in her cell. The medical expert labeled her explanation for demise “undetermined.” An investigation by the Oklahoma State Division of Well being discovered the jail didn’t present Sullivan sufficient care, in violation of state requirements. A spokeswoman for the Well being Division mentioned it referred the case to the native district lawyer’s workplace for prison investigation. Nobody was charged.

A spokesperson for the Oklahoma County district lawyer’s workplace mentioned that Sullivan’s demise occurred beneath a earlier administration, and the workplace didn’t have information concerning the choice to not file fees.

A lawsuit filed by Sullivan’s household alleges Flip Key repeatedly confirmed “deliberate indifference” to her situation and refused to switch her to a hospital as a result of the corporate didn’t need to bear the associated fee for therapy. Flip Key has denied the allegations and contended in its response to the lawsuit that Sullivan’s therapy was “reasonable and within the applicable standards of care.” The case is scheduled for trial subsequent 12 months.

After a suicide contained in the Oklahoma County Detention Heart in December 2021, the identical psychiatrist who’d handled Sullivan, Dr. Gabriel Cuka, emailed an entreaty to native public defenders, giving them a listing of 18 “inmates who need inpatient psychiatric stabilization that exceeds the capacity” of the jail, information present.

“Basically, these individuals need forced long acting injectable antipsychotic agents,” he wrote in an e mail. “I am not saying that these inmates are incompetent in the Oklahoma legal sense of the term. These inmates are very ill and in some cases dying.”

Cuka now not works for Flip Key and is a defendant within the Sullivan household’s lawsuit. He declined to remark. In courtroom filings, Cuka has denied allegations that he under-prescribed any remedy or that Sullivan’s psychological well being worsened beneath his care.

Comparable issues cropped up at different jails served by Flip Key. An analysis accomplished by psychological well being consultants for the jails in Smith County, Texas, famous that detainees couldn’t get long-acting injectable antipsychotic medication and the formulary restricted entry to medication they’d been prescribed earlier than being jailed.

A sheriff’s division e mail we obtained reveals Smith County waited weeks in early 2023 to get orders for pressured remedy for individuals with extreme psychological sickness as a result of the corporate’s major psychiatrist was out of the workplace. No less than one individual died by suicide within the jail throughout that point interval, information present.

Jason Weger, the sheriff of Eastland County, Texas, who wrote a 2022 e mail elevating considerations about entry to medicines, advised a neighborhood psychological well being authority: “I am growing more and more concerned about the inmates not receiving the proper medical attention they need. Especially when it comes to the mental health people we are housing.”

Weger declined to remark.

Flip Key didn’t reply to questions concerning the emails from Smith and Eastland counties, however the firm mentioned it all the time has workers out there.

In mid-2023, The Marshall Venture and The Frontier obtained a replica of Flip Key’s formulary checklist after being denied copies quite a few occasions by way of open information requests. Round that very same time, the corporate stopped utilizing it, information present. Dr. Jason Beaman, a forensic psychiatrist at Oklahoma State College who reviewed the formulary, advised us it was lacking a key drug for individuals with schizophrenia in addition to many more moderen, costlier long-acting injectable antipsychotic medication.

When Eusebio Castillo Rodriguez was locked up within the Union County, Arkansas, jail on a DWI cost in June 2022, his documented signs of alcohol withdrawal — a typical drawback in jails — went untreated for greater than 5 days, based on a lawsuit filed by his household. Most therapy protocols embrace a prescription for a medicine to forestall lethal seizures or alcohol withdrawal delirium. As a substitute, a Flip Key physician consulting over the telephone prescribed a blood strain drug, information present.

The household’s lawyer employed Dr. Thomas Fowlkes, a correctional medication specialist who steadily testifies on behalf of jail well being care contractors, to assessment Rodriguez’s therapy. In his report, he wrote that Flip Key’s protocols and therapy have been “far below the standard of care.”

When Rodriguez’s situation grew to become dire, jail medical workers first tried to move him to a neighborhood hospital in a deputy’s automobile, information present — an ambulance was referred to as after he grew to become unresponsive. The hospital life-flighted him to a bigger hospital in Little Rock, the place he died days later, information present.

Fowlkes wrote: The jail workers “intended for Mr. Rodriguez to be merely dumped off at the hospital with no apparent concern for his wellbeing and without taking any responsibility for the serious medical condition which developed directly as a result of their lack of medical care.”

Price and penalties

In a number of the bigger counties the place Flip Key had contracts, our evaluation of monetary knowledge confirmed jails paid for added fees for issues corresponding to COVID-19 assessments and sensors designed to enhance well being monitoring.

Counties additionally paid for lab assessments and prescribed drugs when these prices have been excluded from the contracts or exceeded a threshold. In Smith County, Texas, over the three-year interval we examined, the jail paid an extra $1 million to Flip Key past the quantity for base medical companies — largely resulting from funds for sure medicines. The corporate mentioned in its assertion that counties by no means paid greater than the contract required.

The corporate cultivated shut relationships with legislation enforcement. At conferences in Arkansas, Texas, Kansas and Colorado, Flip Key raffled off looking gear together with crossbows and knives to sheriffs and deputies, based on social media posts. It handled purchasers to steak dinners and delivered packages of smoked bacon for Christmas, based on emails we obtained.

Non-public fairness companies have taken an curiosity in Flip Key’s development: Gladstone Capital Company invested $11 million within the firm in 2021 by way of secured loans, information present. The Dallas-based non-public fairness group Trive Capital acquired a majority stake in Flip Key by 2019, based on courtroom filings and interviews. Neither agency responded to requests for remark.

The corporate mentioned in bid paperwork that its income grew a mean of 87% a 12 months between 2014 and 2019. However as Flip Key has grown, so has the variety of lawsuits alleging its care led to deaths and accidents.

In July 2023, a federal choose in Colorado denied the corporate’s request to dismiss a lawsuit that accused a Flip Key nurse at a jail north of Denver of refusing to name an ambulance for a girl she believed was “acting a fool.” In actual fact, Amy Lynn Cross was foaming on the mouth earlier than she died of drug toxicity.

Flip Key canceled its contract with Weld County final December.

In bids submitted to officers in Larimer County in northern Colorado in 2022, Flip Key officers mentioned the corporate had settled solely 13 lawsuits, most of them “for nuisance value and for strategic benefit to our clients … a record we are willing to put up against any of our competitors.”

The corporate didn’t reply questions on ongoing lawsuits or settlements. In its assertion, the medical director mentioned the corporate “trusts in its front-line healthcare providers, it values input from its correctional partners, and Turn Key investigates sentinel events and incorporates lessons learned to improve outcomes.”

However a number of jails have ended their contracts with Flip Key over its stage of care. Garfield County, Colorado, did so in June 2023 after Sheriff Lou Vallario mentioned he decided the corporate wasn’t offering sufficient nurses and psychological well being staffing.

Ouachita County, in southern Arkansas, ended its contract with Flip Key after simply six months, partly as a result of the corporate wasn’t offering many in-person visits from medical suppliers, mentioned Robert McAdoo, the county government.

In September 2023, officers in Smith County, Texas, additionally opted to not renew Flip Key’s contract. As a substitute, the jail will use a neighborhood hospital system for medical and psychiatric care.

It’ll price extra money, however having in-person visits from a psychiatrist to deal with individuals with extreme psychological sickness is price it, mentioned Neal Franklin, the county’s chief government.

“I know they’ve actually treated this individual and seen them with their own eyes and talked directly to them,” he mentioned.

The cookie queen

Shannon Hanchett’s buddies referred to as her The Cookie Queen. Her small store in Norman bought out of cookies almost each day.

Bethney Grove grew to become shut with Hanchett by way of Fb posts about baking. The primary time they met in individual, Hanchett stunned Grove with a classic beehive cookie jar adorned with bumblebees — Grove’s favourite image.

“She did everything 1,000% — whether it was laugh, tell a joke, get mad, advocate for something,” Grove mentioned.

She mentioned she had assumed that after the post-Thanksgiving encounter with police, Hanchett had been taken to a hospital or psychiatric facility — not locked in jail.

Hanchett’s household mentioned they didn’t need to publish her $1,000 bond as a result of they feared that if she have been launched with out therapy, she would possibly damage herself or another person.

4 days after her arrest, her uncle, a lawyer, wrote a letter asking a county choose to problem an emergency order to switch her to a neighborhood hospital.

“As a family we are extremely concerned about Shannon staying in jail with her current mental health issues that will continue to worsen without treatment,” Michael Schade wrote. A listening to on her case was nonetheless two weeks away.

Shortly after midnight on Dec. 8, Hanchett was discovered useless in her cell. The psychological well being analysis Hanchett’s household had pleaded for was scheduled to happen eight hours after her lifeless physique was found.

In keeping with an post-mortem, Hanchett’s demise was brought on by problems from a coronary heart defect, with contributing elements together with psychosis “with auditory and visual hallucinations” and dehydration.

In January, her widower, Daniel Hanchett, sued Flip Key and Cleveland County on behalf of his sons.

“She was a very loving mother and the boys were her biggest priority in life,” he mentioned.

Flip Key has requested a choose to dismiss the case. In its filings, attorneys for Flip Key and its staff wrote that the case didn’t meet an evidentiary hurdle exhibiting “an unnecessary and wanton infliction of pain” or that it was “repugnant to the conscience of mankind.”

As within the case of Marconia Kessee, Shannon Hanchett’s jail cell was video monitored. The footage stays beneath a protecting order in federal courtroom, so it isn’t public. However her household’s lawyer, Daniel Smolen, mentioned she was locked in a cell with no sink, mattress or bathroom for greater than every week.

“When they finally removed her from her cell, they found her naked and so dehydrated that she couldn’t even stand. Instead of calling an ambulance, they dragged her limp, naked body by the arms down a long, concrete floor,” he mentioned. Hours earlier than Hanchett died, Smolen mentioned, nurses didn’t present her sufficient care. “Instead, they mocked and laughed at her.”

Information present three months after Hanchett’s demise, Cleveland County renewed Flip Key’s contract.

This text was printed in partnership with The Marshall Venture, a nonprofit information group protecting the U.S. prison justice system, and The Frontier. Join The Marshall Venture’s newsletters, and observe them on Instagram, TikTok, Reddit and Fb.

Disclosure: AT&T and Fb have been monetary supporters of The Texas Tribune, a nonprofit, nonpartisan information group that’s funded partly by donations from members, foundations and company sponsors. Monetary supporters play no function within the Tribune’s journalism. Discover a full checklist of them right here.

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