A federal jury awarded a former Michigan inmate $307 million after it found a state prison health contractor and a doctor violated his civil rights by refusing to pay for surgery to reverse a colostomy procedure, forcing him to live behind bars for two years with a leaking, stinky colostomy bag.
In his lawsuit filed in 2019 against CHS, TX, Inc., formerly known as Corizon Health, and Dr. Keith Papendick, a medical administrator, Kohchise Jackson alleged the defendants were “deliberately indifferent” to his serious medical needs when they denied his repeated requests to reverse the colostomy.
The denial was not for a legitimate medical reason, he argued, but because it cost the prison and its contractor less to force him to live with a colostomy bag attached to his side in prison, where he was subjected to physical abuse and ridicule by other inmates who were repulsed by its foul smell.
“It was a horrible experience for me,” Jackson, 44, told Local 4 in Detroit. “Shame on you,” he added. “I’m still a human being at the end of the day.”
Jackson was paroled in May 2019 after serving two years and two months in Michigan prisons near Jackson and St. Louis, according to the Detroit Free Press. He developed a hole in his colon in 2016, while he was in St. Clair County Jail in Port Huron, awaiting trial on charges that included assault with a dangerous weapon.
While complaining of severe pain, fever, vomiting, that he was “farting out my penis” and that feces was coming out in his urine, he was initially misdiagnosed and treated with antibiotics for a urinary tract infection, the complaint said.
After several months of worsening symptoms, Jackson was taken to a hospital outside the prison, where an ER doctor correctly diagnosed he had a colovesical fistula, a hole in the tissue separating the large intestine from the bladder.
In December 2016 that doctor performed an emergency surgery that cut and diverted his large intestine out through the skin, forming a temporary stoma that was connected to a colostomy bag. The infected area of his large intestine below that point was cut out and the rest was left to heal until a second operation could be performed to reconnect the two sections of colon and close the stoma.
That reversal operation was scheduled for February 2017, the lawsuit said. But it didn’t happen while he was in jail because his condition was not deemed “emergent or life-threatening.”
In March 2017 Jackson was transferred to Michigan Department of Corrections (MDOC) custody, where Corizon Health was responsible for prison inmate health care.
The following month, a prison medical provider sent a request for a surgical consult for the colostomy reversal for Jackson. Papendick, then Corizon’s director of utilization management for Michigan prisons, denied the request because he determined it was “not medically necessary.”
Papendick also later testified he was required to follow an MDOC policy directive that categorized the colostomy reversal as “reconstructive” and “cosmetic.”
Jackson’s complaint argued that MDOC policy does not prohibit surgical procedures to restore continence or improve a prisoner’s quality of life, and even permits surgical procedures for sex-reassignment for transgender inmates.
While Jackson continued reaching out to the prison ombudsman, medical staff and lawyers, demanding to get his colostomy reversed, over the next two years he suffered from pain, incontinence, ostracization and humiliation, the complaint alleged.
Corizon Health frequently failed to provide him with a sufficient supply of colostomy bags and patches or supplies that fit with each other or were the correct size for his stoma. This caused watery excrement and digestive juices to leak out of the stoma and onto his body, bedding, and clothes. Sometimes he had to clean and reuse bags when supplies ran out. Because a stoma does not contain a sphincter, Jackson had no ability to control the timing of his bowel movements in order to avoid defecating on himself.
The foul smell and leaks led to estrangement and ridicule from other inmates, he testified.
“No one wanted me around when I had that bag. Once they got to smelling the bag, everybody had a problem with it,” Jackson said in a deposition. It didn’t just smell like feces, he said. “It smelled like the inside of me.”
During his first two weeks in prison, an ill-fitting patch caused the stoma to back up with feces and then come off in the prison yard.
“I had feces all over me. The guys were looking at me crazy.”
He and his frustrated bunk mate, who had been denied a transfer to another cell, eventually got into a physical fight over the smell, sending Jackson to the ER with a bleeding stoma.
When asked by attorneys for Corizon Health if his main problem with living with the colostomy was the appearance of it, Jackson replied, “It wasn’t about appearance. It was about me having to have this bag and feel like an animal. Every time I cleaned it, it would be like cleaning a dog kennel,” adding he was “uncomfortable with this bag the whole time and wondering if they ever was going to take it off.”
The lawsuit alleged that since Corizon is a for-profit corporation that was paid the same amount per month for each prisoner regardless of the care it provided, it had “a strong financial incentive to deny medical care to Michigan prisoners whenever possible.”
Jackson’s lawyers further asserted that Corizon, through its “final decisionmaker” Papendick, refused to reverse Jackson’s colostomy in order to avoid paying for the procedure, “so that it could retain a larger portion of the prisoner healthcare payments it received from the State of Michigan as corporate profit.”
MDOC’s five-year, $716 million contract with Corizon ended in 2021.
The lawsuit accused Corizon and Papendick of depriving Jackson’s Eighth Amendment rights by demonstrating “deliberate indifference to his serious medical needs.”
Jackson’s need to undergo the second step of the colostomy procedure “in order to restore normal rectal function, close his stoma, and allow Mr. Jackson to control his bowel movements constituted an objectively serious medical need,” his attorneys argued.
Two doctors who treated Jackson testified that colostomies for diverticulitis should be reversed about eight weeks after placement, and that living with a stoma generally results in significant suffering for a patient.
“Corizon’s decision to leave Plaintiff to defecate uncontrollably into a bag taped to his stomach for over two years, in order to shift the cost of his reversal surgery onto Michigan taxpayers, caused the Plaintiff needless pain, suffering, humiliation, and loss of personal dignity,” the complaint said.
After Jackson was released from prison, in June 2019, he enrolled in Michigan’s Medicaid program and underwent a successful colostomy reversal operation. He now is self-employed, doing landscaping and construction work.
During closing arguments of the eight-day trial in a federal court in Detroit that began on March 24, Jackson’s attorney Jonathan Marko told jurors, “You have the power to stop them,” referring to prison health care providers he said have harmed Jackson and other prisoners, and urged them to return a large verdict. “Claw back that taxpayer money,” he said.
Adam Masin, a New York attorney representing defendants CHX TX and Papendick, told jurors during his closing argument that at least 1 million Americans live with colostomy bags and there is no medical consensus on how quickly a colostomy should be reversed, the Free Press reported.
What is clear, he said, is that there was no pressing medical need for the reversal surgery.
The defendants argued in a pretrial brief that “experienced medical providers can have a difference of medical judgment about the medical necessity and timing of a risky colostomy reversal surgery when the colostomy is functional and there is no medical complication that puts the patient’s health at risk. That difference of opinion is not an Eighth Amendment violation.”
Masin further contended that Corizon would not have saved money by denying Jackson the surgery, as it would have been paid for by Medicaid if it was approved while Jackson was in prison.
In their pleadings, the plaintiffs’ attorneys noted that Michigan’s Medicaid program specifically prohibits reimbursement for “all supplies and services that are not medically-necessary.” So, the defendants would not have been able to file a Medicaid claim while still insisting the colostomy reversal was “cosmetic” and not medically necessary.
After deliberating for two hours, on April 2 jurors returned a verdict that found Jackson had proved by a preponderance of evidence that Papendick was deliberately indifferent to Jackson’s serious medical needs, that Corizon Health/CHS TX was liable to Jackson under a theory of municipal liability, and that Jackson was entitled to punitive damages.
They awarded Jackson $7.5 million in compensatory damages and $300 million in punitive damages against Corizon, and $100,000 in punitive damages against Papendick.
In his order issued April 13, U.S. District Judge Gershwin A. Drain approved the verdict and damages awarded by the jury, leaving attorney’s fees to be determined later.
“I think that this jury recognized the basic human rights and the constitutional rights of everybody,” Marko told the Free Press after the verdict.
“This is a warning shot across the bow to for-profit health care companies” that get their money from taxpayers through the prison and jail system, Marko said.
