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An examination of a health care system that runs counter to national standards, and often falls far short of meeting medical needs. While Kentucky counties look to cut costs, for-profit companies have stepped in. But inmates are suffering and state officials aren't doing anything about it.

Judge Finds Evidence Of Indifference In Montgomery County Jail Death

Ronald Gaunce with family members
Ronald Gaunce with family members

A federal judge has ruled there is evidence that a doctor, a nurse and the Montgomery County jailer all demonstrated “deliberate indifference” to the medical needs of an inmate who died in the jail in March 2013.

The inmate, Ronald Gaunce, was featured in a Kentucky Center for Investigative Reporting series last year on jail health care woes. (Read "Dying For Dollars: For-Profit Health Care in Kentucky’s Jails")

Late last week, U.S. District Judge Karen Caldwell refused to dismiss some claims in a lawsuit filed by Gaunce’s mother, Diana Rice, against Dr. Ronald Waldridge, registered nurse Patrina Tipton and jailer Eric Jones. The ruling made way for a trial now set for June 20.

KyCIR reported in December that Gaunce was lying in his own feces at the jail, wracked with pain from severe drug withdrawal, before dying of a seizure on March 25, 2013.

Waldridge, the jail’s contract physician, was 80 miles away, in Shelbyville, and he neither spoke to nor examined Gaunce before he died, even though there is evidence the doctor knew that Gaunce “had a serious medical need,” Caldwell noted in her 37-page opinion.

Waldridge not only had a busy private practice, he also was medical director at 21 Kentucky jails for Southern Health Partners, a private, for-profit healthcare company based in Chattanooga, Tennessee.

Through an employee, Waldridge declined to comment Monday. In all, he oversaw the medical care of about 3,500 inmates -- nearly one-fifth of the state’s entire jail population.

Although the doctor’s contract with SHP called for him to spend one to three hours each week at the Montgomery County jail, east of Lexington, he actually went there only every two to three months, and then only briefly, according to testimony in the case.

In his stead, Waldridge hired advance-practice registered nurses, or APRNs, who made periodic visits to the Montgomery County jail and the 20 others for which Waldridge had assumed responsibility.

Lower-level nurses employed by Southern Health Partners were responsible for providing regular medical care at the jails.

This for-profit jail health care model is entrenched in Kentucky and beyond. Caldwell found the way it was implemented in Montgomery County to be arguably deficient in several ways.

Although jailer Jones disputed nurse Tipton’s testimony that she told him to call her or 911 immediately should Gaunce’s condition worsen, Jones’ alleged failure to pass these instructions on to his deputies could constitute deliberate indifference to Gaunce’s medical needs, the judge wrote in her ruling.

Caldwell, who is chief federal judge in the Eastern District of Kentucky, also found that Waldridge never requested discharge instructions after Gaunce was hospitalized briefly three days before his death. There was no medical professional at the jail on March 24, the day after Gaunce returned from the hospital, and Waldridge neither evaluated Gaunce that day nor ensured that another medical professional did so, Caldwell wrote.

“There is evidence in this case that Dr. Waldridge rendered no medical attention to Gaunce at all after receiving information that he had a serious medical need,” Caldwell said in the ruling.

Moreover, the nurse did not call Waldridge for at least three days after Gaunce had been jailed, Caldwell wrote, or properly monitor Gaunce’s vital signs and food and fluid intake, as required by SHP’s treatment guidelines for drug and alcohol withdrawal.

Caldwell also found that SHP “had no training program” for its nurses, and she found no evidence that the company investigated Gaunce’s death, disciplined Waldridge or Tipton in connection with it “or even interviewed them or visited the jail.”

Attorneys for Waldridge, Tipton, jailer Jones and SHP did not respond Monday to requests for comment.

Reporter R.G. Dunlop can be reached at rdunlop@kycir.org or (502) 814.6533.

R.G. Dunlop is an award-winning investigative reporter whose work has exposed government corruption and resulted in numerous reforms. Email R.G. at rdunlop@lpm.org.

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