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SOURCE:    William Allen

Of The Post-Dispatch

Andrew A. Skolnick Contributed Information For This Story.
PUBLICATION: St. Louis Post-Dispatch

DATE: September 27, 1998

"Is there a God?"

Those words, spoken during a phone call from prison, were the last ones Calvin Moore's family ever heard from him.

To Joyce Davis, an aunt who took the call, her nephew's voice conveyed a deep sense of fatigue and dread. It was in stark contrast to the energy, playfulness and dedication to the Bible that had once marked Moore's personality.

Two weeks later he was dead.

Moore died Feb. 21, 1996, at the age of 18 after serving only a few weeks of a two-year sentence in the Kilby Correctional Facility, a few miles east of Montgomery.

He died in the care of St. Louis-based Correctional Medical Services.

He died after suffering severe mental illness, dehydration and starvation. He became too weak to walk and lost 56 pounds -- more than one-third his body weight -- in less than a month, according to records.

Although he virtually melted before their eyes, CMS doctors and nurses failed to treat him, repeatedly violating company policies. The company said it provided "appropriate and compassionate care."

An official state report said Moore died of natural causes.

An internationally renowned expert on forensic medicine and pathology from the University of Chicago called that report a "whitewash" and said Moore's death was "a homicide resulting from criminal negligence."

Moore's father, with the help of the Southern Poverty Law Center, in Montgomery, filed a lawsuit against the company, four of its doctors, a psychologist and three nurses. The suit alleged that they were negligent, committed malpractice and inflicted cruel and unusual punishment on Moore.

The suit was settled confidentially in August. CMS called it a "compromise of a doubtful and disputed claim."

Calvin Moore did not come from an ideal family. His mother was a drug addict and his father had been shot and blinded in an argument over money.

Nor was Moore an ideal citizen. He had been convicted on seven counts of burglary.

But he didn't have to die.

Moore's case illustrates the state of privatized health care in many jails and prisons around the United States.

"Calvin Moore may not have been God's favorite creature, but he was one of them," said Richard Cohen, legal director of the Southern Poverty Law Center. "He had not been put in prison for a particularly serious crime, but he was basically given a death sentence."

"Full of life"

Moore's family remembers him as a healthy, likable kid. He had lots of friends, a love of music and a great sense of humor.

"He was just a fun boy," said his father, Calvin Olison, smiling. Olison sat one recent day on his porch on the northern edge of Mobile.

Olison, his blinded eyes covered by sunglasses, propped a walking cane between his legs, flipping it back and forth like the pendulum of a clock.

"He knew how to make you laugh," Olison said of his son.

A few blocks north, in the town of Pritchard, Moore's mother, Gale Moore, sat on the front steps of the worn brick-and-frame house where she lives with her mother and other family members. A sapping heat hung in the yard despite the shade of a tall water oak, the same kind of tree that Helen Keller cherished in her childhood home in Tuscumbia, in northern Alabama.

The smell of cooking fires wafted down the street.

Two sisters -- Joyce Davis and Lisa Gwinn -- stood in the tattered screen door above Gale Moore, like sentries.

Moore described the love her son felt for the Bible. He attended church and Sunday school. He was an obedient child, and he liked the attention he got at family reunions.

She displayed a photograph of her son taken at the 1992 Adams Middle S chool spring dance. He stood arm-in-arm with his girlfriend proudly, his average frame decked out in a tuxedo.

Except for having his appendix taken out around age 8, Calvin Moore was a healthy, active youngster. He played football, baseball and basketball. He would run from school with glee to report scoring a touchdown or winning one of the sprinting events in track.

"He was full of life, full of energy," said an uncle, Frederick Olison.

But Calvin Moore's early life was not without its troubles.

His mother and father lived apart.

When blinded by the shotgun blast, his father left his job as a foreman at a prefab housing company in town. After a long convalescence, he moved to Mississippi to work in an institution for the blind.

While his mother struggled with drug addiction, Calvin Moore lived with different relatives.

Moore dropped out of high school and got involved with a group of teens whom family members simply described as "the wrong kind."

Police caught him burglarizing. Just over 18, he was bound for prison.

Gale Moore recalled seeing her son around Christmas 1995 in the Mobile jail just before he was sentenced. She was held there on drug charges.

"Mom, you'll pray for me?" he asked.

"I will," she said."You stay in your Bible and pray for me, too."

"I have to go back to my cell. I love you, Mom."

It was the last time Gale Moore saw her son alive. Two months later, he was lying in a casket.

"Nothing medically wrong"

Calvin Moore entered Kilby Correctional Center on Jan. 3, 1996. The prison is a cluster of one-story buildings that looks more like a community college campus, save for the guard towers and chain-link fences topped by concertina wire.

A CMS health screening form dated Jan. 26 shows that Moore was 5-foot-7, weighed 166 1/2 pounds and had normal blood pressure of 120 over 80.

Officers suspected Moore had joined the Muslims, was trying to leave them and was being threatened. He told guards that he feared he would be murdered, or at least raped. Guards believed he may already have been raped.

On Feb. 7 Moore asked for and was granted protective custody. About this time, his aunt got the call asking about God.

The state report noted that Moore was "frightened, anxious, confused and trembling." He was moved to an isolation cell in D block.

By all accounts, Moore had never exhibited symptoms of mental illness. But now he appeared to have a psychotic break. Nurses and guards reported him becoming increasingly depressed and "unresponsive." He was put on a suicide watch.

He didn't eat the food brought to him, and he rarely drank fluids. He was sometimes heard mumbling.

When guards called to him, he simply stared at them from his cell. Concerned, the guards reported it to nurses and doctors.

Moore was unable to walk, so two guards helped him to the medical area in West Ward, where a nurse determined "nothing was medically wrong with him," according to a report. Another nurse and a doctor described him as "uncooperative," "disillusioned" and "catatonic."

For the next several days Moore was taken back and forth between the mental health unit and a stark isolation cell in the P-1 unit, a block of cells where officials place seriously disruptive prisoners or those they wish to punish. Critics say the P-1 unit and others like it around the state also serve as warehouses for an overflow of mentally ill inmates.

Moore's P-1 cell, one of six isolation cells in the unit, has blank walls and no chairs, desks or other furniture. No personal belongings are permitted.

A stainless steel combination toilet and sink is the only object breaking the monotony of masonry. A narrow concrete platform a few inches higher than the floor serves as a bed. Bedding was a rubber mat and a blanket.

Moore spent the last days and nights of his life lying on the concrete floor in his own urine. Medical workers bathed him frequently, mainly because his weakened body seemed to constantly reek. Once he put shaving cream into his mouth and tried to eat it. Another time he drank his own urine.

After Moore exhibited what CMS employees described as "inappropriate sexual behavior" in the mental health unit, a doctor ordered a shot of the anti-psychotic agent haldol for him. He was sent back to an isolation cell.

A nurse reported seeing Moore up and walking around his cell the next day, but he still wasn't talking. Within a few days he was back to lying on the floor, unable to pick himself up out of the pool of urine.

The health care staff apparently made only cursory checks on Moore. In a report written days later, Dr. George Lyrene, the CMS medical director at Kilby, could not explain why workers ignored signs that Moore was shutting down.

"As the patient's illness progressed, it is not clear why the staff failed to recognize the seriousness of his condition," Lyrene wrote in a report. "The failure to obtain vital signs on several encounters is clearly in contrast (with) the standard CMS procedure."

Lyrene has since left CMS, as have some of the nurses involved.

Records show on Feb. 20 Moore was examined by psychologist Charles Woodley and psychiatrist Dr. William Sanders, both CMS employees. When they walked into his cell he was lying face down on the floor.

They noted that he was still not eating or drinking, and that he was unable to care for himself. Moore was bathed and returned to the mental health unit, but no medical assessment was conducted, the state report said.

Guards had repeatedly noted that Moore wasn't eating and that his complexion had changed, featuring an unnatural paleness. But, according to state records, no one on the CMS staff weighed him again.

That evening, Moore appeared frail. Mucus was caked around his nose; he was slobbering and urinating on himself. A nurse cited in the report said that "it didn't cross her mind that he might need medical treatment" and that Moore "did not appear medically ill."

Moore's ordeal ended the next day, Feb. 21, a Wednesday.

Health care workers described him as dehydrated, speechless and staring blankly as they shaved and bathed him beginning about 7 a.m.

A nurse examined Moore and found his pulse racing at 120 beats per minute. His eyes were "rolled back in his head" and she could "barely get a blood pressure," the report said.

Dr. Walter Mauney was notified, and he and a nurse tried to insert an intravenous line into Moore to give him fluids. They could not find his veins.

At 11:06 a.m., the medical staff notified prison authorities of Moore's "emergency condition." Lyrene joined in the attempts to insert an IV. But these efforts failed. A nurse said she thought Moore stopped breathing, then started again.

Workers carried Moore outside to an ambulance. It was a pleasant winter's day in Alabama. The sunshine had burned off a morning fog, bringing the temperature into the 60s. The ambulance left Kilby at 11:30 a.m, speeding along the mix of country and suburban roads a few miles to East Montgomery Medical Center.

Paramedics found fluid in Moore's lungs and inserted a tube into his trachea to aid breathing. But his heart began to fail. Despite attempts to bring him back, he "flatlined," their report said.

The ambulance arrived at the hospital around noon, and its cargo was officially declared dead.

Calvin Moore had returned to the free world.

"Medical neglect"

An autopsy by the state medical examiner, Dr. Allan Stilwell, showed Moore weighed 110 pounds, meaning he had lost 56 1/2 pounds in less than four weeks. The sodium and urea nitrogen levels in Moore's body had risen dangerously high, indicating severe dehydration.

The autopsy found "no anatomic cause of death," Stilwell's report said. Noting that Moore had fluid in the lungs and elevated sodium and nitrogen, Stilwell concluded that the death was "possibly related to an unidentifia ble heart lesion such (as) an irregular heart conduction system (sic)."

On the bottom line of his autopsy report, Stilwell gave the cause of death as "natural."

Dr. Robert Kirschner, a University of Chicago pathologist and former board member of the National Association of Medical Examiners, called Stilwell's report "a whitewash."

"The conclusions of the medical examiner's report on the death of Calvin Moore are not consistent with the medical findings or the events leading up to the death of the inmate as recorded in prison records," Kirschner said.

"In my professional opinion, Moore's death was a homicide resulting from criminal negligence. The conclusion of the medical examiner's report -- that Moore's death was a natural death caused by some undetectable heart lesion -- is nonsense."

Prison records and lab findings show that Moore died of "pathologically high sodium levels in the blood caused by severe dehydration," he said. Moore's death was clearly due to "gross custodial and medical neglect."

Stilwell, who has since retired, stood by his report.

"It was the best finding I could come up" based on the facts at the time, he said. "If I was presented with it now, and had all these facts as they now are coming up, it may be different."

Carlos Rabren, who retired last month as director of the Alabama Depar tment of Forensic Sciences, declined to comment on the autopsy. He was Stilwell's boss.

But Rabren did ask about Moore's criminal record. When Rabren was told of the burglaries, he said: "He should have stayed out of people's houses. He would have done a lot of good prevention right there, wouldn't he?"

Dr. Jacqueline Feldman, a member of the Alabama Department of Corrections medical advisory committee, concluded that the incident raised several questions about Moore's care, including why he wasn't given a medical assessment as he deteriorated.

By Feldman's count, at least seven prison guards and 10 health-care staffers interacted with Moore.

"Who was in charge?" she asked in a report. "Why didn't people `get' the whole picture?"

An internal report by Department of Corrections investigators concluded that many procedures for inmate care were ignored and that documentation of Moore's mental and medical health "appeared questionable."

"It appears that even though many opportunities existed to do so, the physical health of Inmate Moore was never properly assessed," the investigators wrote.

Nor was his mental health.

Dr. Seymour Halleck, an eminent psychiatrist from the University of North Carolina, concluded that CMS showed "inexcusable indifference" to Moore. Halleck is a specialist in forensic psychiatry and former member of the President's Commission on Mental Health.

CMS psychiatrists failed to diagnose and treat Moore despite "powerful evidence that his psychotic condition required immediate evaluation," Halleck said in a deposition given in July on behalf of Moore's family. This "grossly deviated from -- and was contrary to -- accepted medical practices and standards of care."

The company has not hired enough qualified psychiatrists to handle hundreds of mentally ill inmates in Alabama, he said. CMS "seems to rely heavily upon nurses, psychologists and social workers to take on much of the medical functions traditionally entrusted to psychiatrists."

He expressed disbelief that nurses failed to monitor Moore's food intake, dehydration and weight loss.

"A hands-off attitude?"

Gayle Gear is the lawyer who handled the Moore case for the Southern Poverty Law Center. Based in Birmingham, Gear champions the rights of mentally ill inmates, whom she calls "my kids."

She's also been a persistent critic of CMS, which took over prison health care in the state in 1994.

"Calvin was the sickest of the sick, and they let him die," Gear said.

Among other charges, the lawsuit claimed that Moore's vital signs were never taken in the nine days before he died and that CMS staffers failed to act when they saw Moore lying face down in his urine. It also charged that CMS and its chief psychiatrist in Alabama, Dr. Gail Williams, acted with "deliberate indifference" toward Moore when they earlier implemented policies meant "to curtail the amount and quality of psychiatric and psychological care, including medication, available to mentally ill inmates at Kilby."

Larry Linton, regional manager for CMS in Alabama, disputed these charges, saying it was "an extremely complex case," with "very conflicting reports coming out of our staff" as to whether Moore was eating and drinking.

"We were very, very surprised -- shocked would be accurate to say -- when he died," Linton said. He said CMS "followed this guy closely."

But, he added, "We're not going to tell you we did everything the way it ought to have been done. We found things we could change to improve."

Gear said the Moore case is only one example of poor correctional health care in Alabama. It illustrates what happens when a state government fails to monitor and evaluate the performance of a health care company.

"Alabama has a hands-off attitude," she said. "They are not evaluating the quality of care. The state sends $23 million to St. Louis. How do we k now what we got for $23 million?"

Tom Gilkeson, spokesman for the Alabama Department of Corrections, said the medical advisory committee keeps tabs on problems.

"We've been satisfied with the service we've gotten from CMS," he said.

Anger and grief

Kids scurried along the side of the house trapping lizards with paper cups as Gale Moore sat in the shade on her front steps and spoke of her son's fate.

"I'm angry about it," she said. "I believe somebody killed him. They can't make me believe he died of natural causes."

A few blocks away, Calvin Olison talked wistfully about a call he'd gotten in Mississippi the day his son landed in jail.

"I had a long talk with him," Olison recalled. "He said he was going to straighten up."

That was the last time Olison heard his son's voice.

"I want to make sure this doesn't happen again," Olison said.

And he flipped the walking cane between his legs, back and forth like the pendulum of a clock.

Caption: (1) Photo By J.B. Forbes/POST-DISPATCH - Gale More of Pritchard, Ala., talks about her son, Calvin, who was 18 when he died in prison. In front of her are photographs of her son before he was sentenced for burglary.

(2) Photo By J.B. Forbes/POST-DISPATCH - Calvin Olison on the porch of his home in Mobile, Ala. He remembers his son, Calvin Moore, as a fun boy who was "full of life." Olison settled a lawsuit over his son's death in August.

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