A Miami-Based Jail Health-Care Company Profits While Patients Die

The families of those who have suffered under Armor Correctional's care say the company has shown blatant disregard for the well-being of those it receives taxpayer dollars to help.
The families of those who have suffered under Armor Correctional's care say the company has shown blatant disregard for the well-being of those it receives taxpayer dollars to help. Photo illustration by Michael Campina

The voice on the other end of the line sounded so thin, so frail, that at first Erika Williams didn't recognize it as her son's. It was only by the ten digits glowing on her iPhone — the number for the Flagler County jail — that she realized who was calling her February 4, 2019, a balmy Monday in North Florida.

A doting father to the 2-year-old daughter he'd nicknamed Precious, Anthony Fennick had a wicked sense of humor and a generous spirit. But the 23-year-old struggled with drug addiction and, just after Christmas 2018, landed in what Sheriff Rick Staly had dubbed the "Green Roof Inn" on a 300-day sentence for violating the terms of drug court.

Every morning, afternoon, and evening, Fennick dialed home to ask about his little girl, Avangelee, and to tell his parents not to worry about him. In the days leading up to that Monday call, though, he'd described feeling worse and worse, beginning when medical staff prescribed him the antibiotic Bactrim for a bump on the back of his neck. Fennick said his head was pounding and he was sure he had a fever, but nurses told him he couldn't see the doctor until Tuesday.

That Monday, he told his mother over the phone, he felt so exhausted he couldn't button his jumpsuit. His head throbbed so violently it hurt to open his eyes. A rash covered his chest. "I can't talk for long," Williams recalled him saying. "I want to lie down." Williams repeatedly phoned medical staff at the jail, but nurses there insisted that privacy laws prohibited them from even talking to her.

The next call to Williams came not from her son, but the hospital: Fennick was on life support. Williams and her husband rushed to AdventHealth Palm Coast, where they found Fennick unconscious and breathing through a respirator. He was handcuffed to his bed.

"That saying that people say, you know, such-and-such thing is the first thing that I see when I open my eyes and the last thing that I see before I go to sleep?" Williams says. "I totally understand it now, because the one image I'll never get out of my head is how I found him when I walked in that room."

She kept a nearly constant vigil by his side until he died February 9, exactly three months before he was due to be released from jail. His family's countdown of the days had dropped into double digits, and he was already making plans to take his daughter to see Toy Story 4.

Amid the public uproar about the death of an inmate who spent his final days pleading for help, Staly terminated the county's contract with the for-profit company that provided the jail's medical services, Armor Correctional Health Services. "In response to this tragedy, Armor has shown little interest in anything other than denying responsibility and trying to bill us for even more money," the sheriff said in a February news conference.

Fennick's death is one of the latest incidents to rock the Miami-based company, which over 15 years in business has positioned itself as a major player in the private correctional health-care industry. As of last year, according to one of its bids, Armor was handling health care for 41,000 inmates under contracts with 32 clients in eight states. Though it has a contract with one Immigration and Customs Enforcement facility and several state prisons, it operates mostly inside county jails, the majority of which are in Florida.

Armor officials have defended Fennick's treatment, telling New Times in a written response to questions that he received "appropriate and timely care." They say they are proud of the company's standard of care and committed to the patients it serves.

"We operate in a challenging industry, and we do it because we believe high-quality health services should be available to all people, including those in correctional environments," reads the response to New Times' inquiries, which was attributed only to senior members of Armor's medical and management teams.

But in recent years, the company, founded by politically connected physician Jose "Pepe" Armas, has been haunted by deaths on its watch — deaths, in most cases, of people who haven't been convicted of anything. Armor has been criminally charged for allegedly falsifying records in the death of a man in Wisconsin and dropped by at least seven counties in Florida, New York, Colorado, and Oklahoma. After allegations of failing to meet contractual obligations and placing inmates at risk in New York, the company also agreed to pay $350,000 and not bid on any contracts in the state for three years in a 2016 settlement with the New York Attorney General.

Settlements against the company and the counties where it operates have reached into the millions. The family of a 32-year-old New York inmate named Bartholomew Ryan, a former Marine who hanged himself, was awarded $7.8 million. In the Wisconsin case, the family of 38-year-old Terrill Thomas, a Milwaukee father of six who died of dehydration after the water was switched off in his cell and medical staff ignored him, was awarded $6.75 million. The death of Thomas, whose mental illness prevented him from communicating about his lack of water, made national headlines and outraged local leaders.

"The idea of dying in that manner was so unconscionable, you can't even — inconceivable, I guess, is the right word," Milwaukee County Board of Supervisors Chairman Theodore Lipscomb says. "It just seemed so inconceivable that you are in custody, with medical professionals around you, that you're under monitoring, people are charged with your care, you do not have your normal ability to advocate for yourself, and that that could be the outcome in America."

A New Times review of court records, news reports, and government documents found at least 34 lawsuits accusing Armor of contributing to a death. In other cases, the inmate survived, but with serious or debilitating injuries. Among them are troubling allegations: In Milwaukee County, a woman gave birth while Armor staff ignored her; the baby died in the same cell where she'd born hours earlier. In Oklahoma County, an Armor nurse allegedly tried to perform an exorcism on a woman who was in the throes of drug withdrawal; she died the next day. And in Hillsborough County, Armor staff chose not to send a woman to the hospital after discovering irregularities in an electrocardiogram even though she'd gone into cardiac arrest weeks earlier. The woman, who had been arrested for failing to appear in court while she was in the hospital recovering, died hours after her release from jail.

Caring for the incarcerated is inherently costly and challenging. It entails a patient population that disproportionately struggles with mental health and substance abuse issues. Many inmates do not regularly see a doctor. And in a jail setting, where people wind up either right after arrest, while awaiting trial, or to serve sentences of less than a year, turnover is high. Litigation is common, and many lawsuits are ultimately dismissed, including some of those reviewed by New Times.

"We provide consistent, quality medical care to our population, which most often includes extremely complex medical profiles," the Armor officials say. "Sometimes in healthcare, outcomes are unpredictable. Despite physicians following evidence-based protocols and pathways, the fact is that patients don't always respond to therapy. This is the case for every medical provider."

But the families of those who have suffered under Armor's care say the company has shown blatant disregard for the well-being of those it receives taxpayer dollars to help. Government officials who have contracted Armor accuse the company of the same problems: chronically high staff turnover, poor record-keeping, and preventable deaths on its watch. In court filings, attorneys argue that Armor has a pattern of delaying sending inmates to the hospital and outside specialists, sometimes with fatal consequences. While company officials vehemently deny those claims, insisting they do what's best for their "inmate patients," the allegation has found backing in several audits and in the depositions of at least two nurses once employed by Armor.

"There was a strong corporate push for the doctor not to send patients out due to money," said Carolyn Rubin, who was fired from her job as a registered nurse after the death of a woman at the Sarasota County jail. She added, "It was our duty to keep them there as long as possible, to prevent costs of the hospital, plus pulling deputies out of the jail that have to go sit with the patient at the hospital. The jail also frowned upon it too."

"There was a strong corporate push for the doctor not to send patients out, due to money."

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Williams believes that's what happened in her son's case: In an effort to maximize profits, medical and jail workers waited until it was too late to get him the care he needed. Since her son's death, her life has stalled. Months after Fennick was supposed to have been released, after the new Toy Story movie came out and the countdown ran out, his black leather shoes still sit beside the door at his mother's house. Williams moves the pair when she vacuums and mops the tile, but she always puts them back. She had hoped that once he got out of jail, he would get clean and go back to college. If he had been taken to the hospital even just a few hours earlier that Monday, she believes he might still be alive.

"They took even his fighting chance away," she says. "They took every last minute that he could have had — every last minute, every last second that he could have had to fight, they took that away."

click to enlarge Erika Williams never turns off the light in the room where she keeps her son’s remains. “I just want my baby home,” she says. - PHOTO BY BRITTANY SHAMMAS
Erika Williams never turns off the light in the room where she keeps her son’s remains. “I just want my baby home,” she says.
Photo by Brittany Shammas

When Armor Correctional scored its first contract in October 2004, it had been in existence for a mere three months. Under the guidelines initially sent out by the agency, the Broward Sheriff's Office, the brand-new company didn't even qualify. To have a shot at the job of caring for the county's 4,000 inmates, bidding vendors were supposed to have a track record of providing medical services in a correctional setting. Armor had none.

But the 14th-largest sheriff's office in the United States relaxed its standards by allowing applicants with any kind of medical experience, the Miami Herald reported at the time. Armor's founder, Armas, six years earlier had launched a chain of medical facilities called Medical Care Consortium, Inc. (MCCI). Just like that, the company was allowed to bid.

Armor's proposal to do the job for five years for $127 million wasn't the cheapest offer Broward received. But the company might have had something else working in its favor. In the months before winning the contract, Armas, his businesses, and his employees had donated heavily to the reelection campaign of then-Sheriff Ken Jenne, who would be sent to prison in 2007 on unrelated corruption charges.

"Between June 29 and Aug. 5, they gave at least $9,500 — including $1,500 returned by the campaign as illegal, excessive contributions," the Broward Daily Business Review reported in 2005.

Armor, for its part, says it was created for the purpose of handling health care for the Broward jail system. "After learning of the issues and challenges confronting the Broward County Sheriff's Office (BSO), Dr. Armas created Armor, based upon proven managed care principles and reflecting his commitment to patient-centered, cost-effective, quality healthcare," the company's website says. Armor officials told New Times: "There was a need. There was little to no concept of the intricacies of correctional healthcare, but we understood that need, so we continue to provide the required services."

The day Armor took over medical care in the Broward jail system, state officials hadn't even issued the company's pharmacy license; the Miami Herald called the first few days "rocky." Yet the nascent company, at the time based in Coconut Creek, was able to use that first contract to pick up new business at a remarkable clip, scoring multiyear contracts with Brevard, Hillsborough, and Martin Counties within about a year, their value topping $220 million. Soon Armor would have a stranglehold on Florida jails.

The company's success, at least in part, was thanks to some political string-pulling. A former Hillsborough sheriff, Cal Henderson, in 2005 agreed to become a consultant for Armor after leaving office. His role included helping the company in "developing and maintaining relationships with government agencies and organizations," according to an agreement signed in 2005 and included in court records. Henderson, who contacted at least six Florida sheriffs to recommend Armor, was paid $3,000 a month, plus an additional fee of $2,000 per month for 24 months if the company secured a new contract. Jenne, Palm Beach County Sheriff Ric Bradshaw, and then-Brevard Sheriff J.R. "Jack" Parker also pressed other sheriffs to hire Armor, according to the Herald.

The company's deal-making with one Florida sheriff resulted in a lengthy legal battle. Prison Health Services in 2007 sued then-Sarasota County Sheriff Bill Balkwill for allegedly giving Armor an unfair advantage in awarding it a $9 million contract. Company officials had showered the sheriff with perks including a dinner at a swanky restaurant and a charter fishing trip on Lake Okeechobee.

"Had a great time!" Balkwill wrote to Armor exec Doyle Moore after the fishing jaunt, records show. "Give a call when you're ready to talk about the contract and what you can do. I'll be sending you pictures of who caught the lunker... hahaha."

Balkwill and Moore deleted thousands of files before they could be collected as evidence, prompting a criminal probe of the former sheriff. Attorneys for Prison Health Services, which provided jail health care in Sarasota before being snubbed in favor of Armor, suggested Armor had promised Balkwill that a job would be waiting for him after his retirement. But a jury in 2010 absolved Balkwill and Armor, and the criminal investigation ended without any charges against the former sheriff.

Armor continued expanding rapidly. By 2013, the company said on its website it was the health-care provider at 13 county jails and four state prison facilities in Florida. It was also making a push to go nationwide, racking up contracts in four states. Between 2010 and 2013, the company had revenues exceeding $540 million and yearly profits of $88 million, according to tax returns provided to the Colorado Springs Gazette by Fort Lauderdale attorney Greg Lauer, who has sued Armor on behalf of inmates' families.

To date, Armor has had contracts in at least 11 states outside Florida: Colorado, Georgia, Illinois, Maine, New York, Nevada, Oklahoma, South Dakota, Utah, Virginia, and Wisconsin. Financial statements included in a 2018 Armor bid indicate the company had contract revenues exceeding $242 million in 2017.

The company's success has benefited its founder, who is listed in Florida corporate records as its president and director. From 2012 to 2013, Armor paid Armas $9.6 million in dividends, according to the Florida Bulldog. He owns a $7 million waterfront home in Gables Estates (purchased before Armor was formed), along with properties in the Keys and a Colorado ski town. A Cuban-American internist educated at the Pontificia Universidad Católica Madre y Maestra in the Dominican Republic, Armas appears to have never given an interview about Armor. But as the company's footprint has grown, his profile has risen.

Dr. Jose “Pepe” Armas, who founded Armor Correctional, has been appointed as a Florida International University trustee and a member of the Constitution Revision Commission. - PHOTO VIA FLORIDA INTERNATIONAL UNIVERSITY
Dr. Jose “Pepe” Armas, who founded Armor Correctional, has been appointed as a Florida International University trustee and a member of the Constitution Revision Commission.
Photo via Florida International University

In 2010, then-Gov.-Elect Rick Scott named Armas and his wife, Dr. Ada Gonzalez Armas, to his inaugural committee. During the years Scott was running for the governor's mansion, Armas donated at least $36,750 to his campaigns and to organizations that supported him. Armor chipped in another $91,000, an amount matched by Armas' other company, Medical Care Consortium, Inc., according to state records. Scott seemed to respond kindly to the donations. While governor, he named Armas to Florida International University's board of trustees in 2011 and reappointed him in 2016. Scott also appointed Armas' wife to the state Board of Education, on which she served from 2013 to 2015.

In 2017, Scott gave Armas perhaps his most influential appointment yet: a spot on the Constitutional Revision Commission. In that role, Armas was one of 37 commissioners given the power to recommend changes to Florida's constitution.

"Dr. Jose 'Pepe' Armas is a distinguished physician and healthcare executive whose focus on patient-centered care has defined his career," an announcement from the governor's office read. It mentioned MCCI rather than Armor, though the correctional company had by then spread from coast to coast in the Sunshine State — far beyond the reach of MCCI.

In its pitch to sheriffs, Armor makes a compelling case: It says it can offer better medical services for the inmates in its custody, and at a better price. All over its website are claims of multimillion-dollar savings for clients, but also a promise: "As a matter of policy and as a function of practice, we do not compromise patient care in an effort to save money."

It's that guarantee that has turned the Supreme Court-enshrined duty of caring for inmates into business with an estimated $13 billion in spending each year, according to the Prison Policy Initiative. Forty years ago, it fell solely to sheriffs and other county officials to provide medical services to the people they locked up. But with a lack of resources and expertise, coupled with swelling jail populations, many government officials found the task burdensome. On their watch, too, came stunning allegations of mistreatment.

Unheard-of before an enterprising nurse started Prison Health Services in 1978, outsourced health care is now in place in around 40 percent of jails and prisons. Armor is among only a handful of companies that make up the industry, all of them — from Corizon to Wexford — with horror stories and a litany of lawsuits to their names.

"It's an oligopoly," says David Fathi, director of the ACLU's National Prisons Project. "There are very few market participants."

The rival companies ingratiate themselves with decision-makers by making political contributions — Armor, for its part, has contributed $300,000 in Florida races since 2004 — and maintaining a presence with groups such as the National Sheriffs' Association. Armor is a platinum corporate partner with the law enforcement organization, an honor that costs $7,500 and comes with perks such as a profile in the "Buyers' Guide" issue of the magazine Sheriff and Deputy, a free print copy of the annual sheriff's directory, and a discount on booth space at the association's annual conference. In 2014 at the event, Armor sponsored a "relaxation station" offering free massages, according to a report from In the Public Interest.

At stake are lucrative government contracts, which typically are structured with the contract worth a fixed dollar amount and the company pocketing whatever it doesn't spend. Though some municipalities are satisfied with the setup, critics say there's an inherent conflict — it incentivizes companies to slash spending as much as they can.

"The whole business model is problematic, because the way they make money is by spending as little as possible," says Lauer, the Broward attorney who has sued Armor in five deaths. "This is kind of like the principles of economics — if you set it up that way, they've got to squeeze every dollar they possibly can out of every single contract."

Fathi says that often translates to companies trying to get by with too few employees, or with employees being asked to act outside their scope — licensed practical nurses doing work that should be done by registered nurses, for instance, or registered nurses doing work that should be done by doctors.

"What it all comes down to is money and the desire to save money by cutting corners on staff — that's the biggest single problem," he says.

Lipscomb, the Milwaukee County board chairman, worried about the for-profit aspect when then-Sheriff David Clarke — famous for his cowboy hats, Fox News appearances, and support for President Donald Trump — proposed outsourcing jail health care to Armor in 2013.

"The whole business model is problematic, because the way they make money is by spending as little as possible."

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"Something that you are obligated constitutionally and morally to provide good service, I just don't think is appropriately outsourced," Lipscomb says. The board rejected the idea, but Clarke sued and a judge ordered them to go through with it, pointing to the county's failure to meet staffing levels required under a consent decree regulating inmate care.

Five years later, after deaths including those of Thomas and the baby born behind bars, a county audit found that understaffing continued under Armor. In the 22-month span auditors reviewed, staff levels never hit the required 95 percent, instead hovering around 89 percent on average. There were gaps in the roles of registered nurse, psychologist, and psychiatrist. (Understaffing is a problem that has also been found by auditors in Osceola County, Florida; and El Paso, Colorado, in recent months, and contributed to El Paso and Armor parting ways.)

Perhaps more troubling, Armor was criminally charged for doctoring records in the Thomas case in February 2018. While medical records made it appear as if he were routinely checked, an investigator watched surveillance footage and found that nurses and other employees had walked past his cell and only occasionally glanced inside. "Had Armor Correctional medical staff actually performed the assessments that they falsely recorded in Mr. Thomas' patient health care records," the criminal complaint says, "medical staff may have identified Mr. Thomas' fatal medical distress."

Armor's leadership tells New Times the charge is "without basis in fact or law."

"Following a jail death investigation that revealed reckless indifference on the part of numerous Milwaukee County employees and supervisors, a local District Attorney filed unprecedented charges against Armor," the company says. "In so doing, the District Attorney granted immunity to actors who committed intentional crimes while simultaneously excusing many other Milwaukee County employees who recklessly neglected the safety of inmates. Armor is confident these charges will be dismissed pre-trial."

Yet county commissioners had had enough. In December 2018, Lipscomb led an initiative to move inmate care back under county control. The measure passed, and the county is expected to take over in 2021.

"It's one of those cases where you regret that time proved you correct, one of those instances where I wish I had been wrong," Lipscomb says. "I wish they'd have lived up to all of the promises, but it just wasn't so. It didn't even meet the minimum."

click to enlarge Armor’s offices are located just east of the Palmetto Expressway near Tropical Park. - PHOTO BY MICHAEL CAMPINA
Armor’s offices are located just east of the Palmetto Expressway near Tropical Park.
Photo by Michael Campina

One accusation prevalent in lawsuits against Armor is that it drags its feet on sending inmates to the emergency room, specialists, or outside providers.

In Tampa in 2009, Linda Stevenson was in the hospital recovering from cardiac arrest when she missed a court date on a DUI charge. With that, the Hillsborough County Sheriff's Office put out a warrant seeking the arrest of the 52-year-old woman — a pharmacist and mother of two who had never before been arrested.

At the Hillsborough County jail, where Armor had a contract, Stevenson told medical employees about her recent hospital stay and heart problems. Records from South Seminole Hospital, which had released her only three weeks earlier, backed up her claims. Yet according to a now-settled lawsuit over the January 2010 incident, a doctor's order for an EKG wasn't fulfilled for nine days. When one was finally done, on January 15, it revealed "critical significant abnormalities."

Dr. Willy Noel, whose employment violated Armor's policies because he held only a limited medical license, according to the lawsuit, looked over the results but didn't send Stevenson to a cardiologist or hospital. Instead, she was released January 20, the same day she was found guilty of the misdemeanor crime.

In a cab on her way home from the jail, Stevenson went into cardiac arrest again. Paramedics arrived and rushed her to the same hospital where she'd been treated weeks earlier. But by then it was too late: She'd already suffered brain damage. Stevenson — a licensed pilot, ballroom-dancing pro, and the kind of person who, as her son put it, "always had something to say" — died January 29, 2010.

"Armor Correctional should have provided the appropriate care by knowing she had this cardiac condition, knowing that she was supposed to see a cardiologist within two or three weeks of discharge from the hospital," Alan Landerman, the attorney who represented Stevenson's family against Armor, said in an August 2016 hearing. "They didn't do so."

Armor maintains it acted appropriately. In September 2016, the company settled a lawsuit brought by Stevenson's son and daughter, who were teenagers when she died. By then, Hillsborough County had already dropped the company after almost a decade of working together. Sheriff's office officials wouldn't say if the 2014 decision was motivated by dissatisfaction with Armor, but it came after at least three deaths in the county's jail system. One 2012 case, in which a beloved former high-school coach, Allen Hicks, had a stroke that went untreated for 36 hours at the jail, drew widespread headlines and indignation.

From ambulance trips to hospital stays to patient care, outside medical treatment is costly — and many of Armor's contracts require the company to pick up the bill. Typically, deputies must escort inmates, which adds to the expense. And sometimes, government officials are the ones fretting about costs: In Manatee County, on the west coast of Florida, commissioners in late 2017 discussed the rising costs of healthcare under Armor, paying specific attention to emergency room visits within the inmate population. "At all times possible, we try to make sure that doesn't reach that problem," a county administrator said.

That comment suggests "overt efforts are being made to stop people in the Manatee County Jail from going to the emergency room," reads a complaint filed in the pending case of Darryl Vaughn Hanna, a 29-year-old suspected killer who was left in a vegetative state after he passed out and hit his head on three occasions. He was sent to the hospital only after the third time, the lawsuit says; by then, it was too late. He was returned to the jail in a vegetative state. 

Christopher Datta, a 22-year-old who was arrested for a probation violation on a drug charge, told medical staff about his history of lower back problems when he arrived at the Sarasota County jail April 11, 2014. Beginning April 19, he complained to nurses and doctors that he couldn't feel anything below his waist, according to a now-settled lawsuit against Armor. Doctors and nurses treated him with ice, Aleve, a knee brace, and, eventually, pain medication but refused his requests to go to the hospital. At one point, he collapsed in a jail hallway, where he urinated and defecated on himself. The lawsuit says nurses and correctional officers walked by and accused him of being uncooperative.

April 23 of that year, an officer wheeled Datta to a courtroom for a hearing. The judge placed him on house arrest but gave him permission to go to a hospital first. Datta wheeled himself to a pay phone and called 911. Only then did he make it to an ER, where he received emergency surgery.

"No matter how bad he got — to the point where he was lying on the floor in his own feces — they wouldn't send him to the hospital."

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The delay cost Datta. He now suffers from chronic pain, bowel and bladder dysfunction, erectile dysfunction, and decreased sensation from his hips to his toes — problems that are expected to be lifelong. At 22 years old, he learned he'd probably always need a catheter and would never have a normal sex life. Armor stands by its handling of the case, but Datta's lawyer says it was woefully inadequate.

"He wasn't treated like a patient," attorney Daniel McBreen says. "He was treated like a prisoner. And no matter how bad he got — to the point where he was lying on the floor in his own feces — they wouldn't send him to the hospital."

Beyond simply avoiding trips to the emergency room, Armor employees have time and again been accused of denying inmates the proper medication.

Before he wound up in jail, James Herr was a Vietnam War veteran, a psychologist, and a teacher who spent his career working with special-needs students. He coached cross-country running, participated in marathons and triathlons, and once biked 167 miles across the state of Florida. In retirement, he and his wife Joyce traveled widely and golfed every Sunday.

But in the spring of 2015, the 71-year-old became, as his wife put it, confused. One March day, people walking past his home in New Smyrna Beach, Florida, called the cops to say he'd pointed a gun at them. He holed up in a bathroom inside his house and refused to answer to police. A SWAT team deployed tear gas and flash bangs, and Herr was arrested for aggravated assault with a deadly weapon. Officers later learned the supposed deadly weapon was a BB gun.

At the Volusia County branch jail, Armor staff noted Herr was "not providing logical answers" and "continue[d] repeating random thoughts." He was incoherent and delusional, and though he reported taking medication, he didn't say what kind. Staff decided a full medical assessment couldn't be completed and placed Herr on suicide watch for his refusal to cooperate. No one called his wife or the VA hospital that treated him to figure out his prescriptions, according to a lawsuit filed earlier this year. So Herr didn't get the blood pressure medication he'd taken for years — not even when his wife called to insist he needed it.

Around 11:30 p.m. March 19, Herr's sixth day in jail, a corrections officer found him breathing abnormally in his cell. CPR didn't work. He was taken to Ormond Memorial Hospital, where he was soon pronounced dead. An autopsy determined the cause was hypertensive heart disease, a condition that could have been controlled if he had received his medication, his wife argues in a complaint against Armor and the county.

"That he died without my being with him has presented the greatest challenge," she wrote in one court filing. "I was there for our pets when they passed, not so for my husband."

Armor says the claims listed in the lawsuit are untrue and medication was "dispensed appropriately and in a timely manner." Yet allegations of Armor failing to provide lifesaving medicine are not new. In the company's early days in Broward County, two HIV-positive inmates filed lawsuits claiming the company showed "callous indifference" by refusing for months to provide antiretroviral drugs. In one of the cases, a judge ordered one of the inmates to be released early so he could seek treatment from his own doctor. Armor argued in court that the two men weren't good candidates for the medication due to mental health and drug abuse issues; the two sides agreed to a settlement in 2008.

In his 2016 lawsuit against Armor, then-New York Attorney General Eric T. Schneiderman cited a "failure to provide access to medications" as one way the company betrayed its contractual obligations and put inmates at risk in Nassau County. The lawsuit pointed to the case of John Gleeson, a 40-year-old electrician and father who struggled with heroin addiction and arrived in jail May 29, 2014, after being accused of stealing scrap metal from a garage. Gleeson, who suffered from a hereditary swelling condition called angioedema, filed a sick-call request June 5 seeking the medication he took at home. That request went unanswered, so he filed another the next day. He wasn't examined until June 11 and, according to a lawsuit, was provided the wrong medications by staff. Gleeson died July 14, 2014, after his neck swelled to double its size, preventing him from breathing. A state regulatory body, the New York Commission on Corrections, found the death was preventable and Armor bore responsibility.

"Had John Gleeson been provided with competent medical care by Armor Inc. in a timely manner, been properly referred to a specialist, received a correct diagnosis, and received proper medical treatment, his death may have been prevented," read the report, which directed officials to investigate the company.

The attorney general's lawsuit cited other instances where inmates were denied medication despite a contractual requirement for it to be provided within 24 hours of receiving a written prescription. In one, a judge ordered the company to explain why it had withheld antipsychotic medication from a 21-year-old inmate who had been taking it since she was 8.

More recently, a Colorado judge was upset to learn that a suspected killer, James Edward Papol, had endured several multiday stretches without his antipsychotic medication at the El Paso County jail. After a defense attorney argued in April that Papol's mental state was faltering and hurting his ability to stand trial, Judge Robin Chittum ordered Armor to regularly provide his prescription drugs, the Colorado Springs Gazette reported.

"Holy cow. I have a first-degree murder case," the judge said, according to the newspaper. "This defendant needs his medications."

click to enlarge A still image of Karen Ibarra being dragged through the Sarasota County jail. - STILL VIA SARASOTA COUNTY SHERIFF'S OFFICE
A still image of Karen Ibarra being dragged through the Sarasota County jail.
Still via Sarasota County Sheriff's Office

Armor vigorously denies suggestions it puts profits over patients or provides anything other than high-quality medical care. In court cases, media stories, and government disputes, company leaders always insist that "frequent and unfounded allegations and legal actions" are simply an unfortunate part of working in correctional health care. The company has policies calling for inmates to receive compassionate care and to be transported to the hospital when necessary.

And in a report included in one of its bids, the company claims plaintiffs' attorneys are using "incomplete, inaccurate and biased media reporting" as leverage for higher settlement amounts. The media is perpetuating a false, but increasingly accepted narrative that private companies prioritize profits over care, the report says.

"Armor has been an outspoken advocate for accessible, quality correctional healthcare and accountability of medical providers," it says. "Further, the company embraces the coordination of patient healthcare with community providers to an underserved population. However, we take exception to the exploitation of tragic cases for purposes of financial gain."

But in previously unreported depositions from cases in two states, former employees — both registered nurses — lend credence to claims of delayed care and denied medication.

In the first, a nurse, Carolyn Rubin, was deposed in 2015 for a now-settled lawsuit over the August 2012 death of Karen Ibarra, a 47-year-old woman jailed in Sarasota County, Florida, on a probation violation. Ibarra, who told her husband during phone calls she wasn't getting her prescription medication, had complained she couldn't move her legs, but Armor staff thought she was faking.

She spent the last ten days of her life begging for water — nurses mostly refused her requests and told her she could get it herself. On August 21, a nurse tried to place an IV and failed. A doctor told the nurses to force fluids and try an IV again in the morning. But by that time, Ibarra had been found unconscious on the floor. Her lips were blue. The cause of death, according to the lawsuit, was cardiac arrhythmia caused in part by dehydration.

Rubin, who was fired by Armor for her handling of the incident, told Ibarra's attorneys that in retrospect, refusing water amounted to intentional indifference. But, she said, she was warned against being manipulated and told to do only the minimum for Ibarra.

"There's a culture in the jail where if you actually care for a patient, you are then blackballed as a pushover and just — you know, it's — you're then gossiped about," she said.

After Ibarra's death, Rubin said she thought she might have misinterpreted the situation and acknowledged that stopping Ibarra's medications could have affected her behavior. Armor had an unwritten policy at the Sarasota jail of cutting off all psychiatric medication so that a psychiatrist could determine "what was behavioral and what was medication-induced," Rubin said. She called it "very cruel."

"We'd have inmates try to hang themselves, cut themselves," she said. "Some would actually have the wherewithal to come up to the infirmary on an emergency basis and tell us: 'Please help me — I'm going to lose it. I'm telling you right now, I am going to lose my mind.'" (Rubin did not return calls from New Times seeking further comment.)

As for the claim that Armor delays sending inmates to the hospital, she said she couldn't cite any specific examples. Yet, she said, "there was a mentality to try to treat in-house and not send out. It was never specified out loud, just in passing comments." The jail doctor, Frantz Simeon, was "very frustrated at times that he was not allowed to send somebody out."

In his deposition, Simeon denied needing permission to send inmates to the hospital or worrying about financial considerations. "It doesn't come to my mind," he said. "Provide care if we have to do that, if we have to send someone out."

"There's a culture in the jail where if you actually care for a patient, you are then blackballed as a pushover."

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But the other nurse's deposition included claims similar to Rubin's. In a New York case, 53-year-old Antonio Marinaccio flagged down a corrections officer at the Nassau County jail April 26, 2015, and told him: "I feel like I am having a heart attack." A nurse evaluated him and, deciding he was able to walk and had no shortness of breath, told him to follow up with medical staff later in the morning. Less than an hour later, a guard on a security round found him face-down on the floor. Marinaccio, who was in jail on a one-year sentence for driving while intoxicated, had gone into cardiac arrest. He was taken off life support days later. The New York Commission on Corrections (NYCC) found Marinaccio's death could have been prevented, and directed officials to "conduct an inquiry into the fitness of Armor Correctional Health Services, Inc., as a medical care provider in the Nassau County Correctional Center."

Katherine McCormack Grange was the nurse who performed Marinaccio's intake screening. She told state investigators and Marinaccio's attorneys she thought he needed an EKG, which the NYCC later concluded might have saved his life. The jail doctor refused, and McCormack Grange said she discovered after Marinaccio's death that a note she had placed in his medical record explaining the doctor rejected further testing had disappeared.

Management was concerned about the costs of various tests and medication, McCormack Grange said, adding the assistant director of nursing once "told [her] that they had just received a $20,000 bill last month, and to use the medication [they] had." In Marinaccio's case, the doctor prescribed medication — an albuterol pump — the jail wasn't ordering at the time. McCormack Grange said that was "because it was too expensive."

She too said that "employees knew that Armor did not want nurses to send patients to the hospital." They had to call the doctor for permission, and most of the time it wasn't allowed.

A higherup at Armor insisted nurses could perform EKGs and send inmates to the hospital. "It's a case-by-case basis on how the patient presents, and is made by a physician, a provider, and sometimes even nursing staff," Karen Davies, a senior vice president at the company, said in a deposition. She suggested McCormack Grange might have had ulterior motives for speaking out. "I don't believe that Ms. McCormack was a very happy employee... I think that perhaps she may have had a personal agenda."

By the time she was deposed over the death last year, McCormack Grange had already quit her job at the jail. She told Marinaccio's attorney she thought Armor was "negligent at times and that [her] license was in jeopardy." So bothered was she by Armor's practices, in fact, she went as far as reporting the company to the state board overseeing nursing. The New York Board of Education is barred by law from confirming or denying the existence of an investigation; information is released only if there is a finding of guilt. McCormack Grange did not respond to a phone message from New Times.

Armor officials tell New Times the nurses' claims are untrue. They say despite Rubin's statements, there's "no policy or practice of withholding psychotropic medication to any patient in need." They take aim at McCormack Grange by saying she provided conflicting testimony and even lied on the record when asked about whether she'd contacted the attorney representing the Marinaccio family. They point out she waited until after leaving the company to report it, and they claim her "vindictive statements" were motivated by a dispute over back pay.

"As a result of this dispute," the Armor leaders say, "we have a disgruntled former employee who will say anything to disparage the company. This is quite unfortunate, since Armor presented Ms. McCormack with her first opportunity to practice as a nurse after she obtained her license."

In the front room of her home in Palm Coast, Williams keeps a poster-size photo of Fennick above the urn filled with his remains. On the ledge around it are pictures from when he was an infant so small she called him "Ant," a nickname that stuck for the rest of his life. There's also a plaque the guys from drug court gave her; inscribed is a poem called "The Broken Chain": "In life we loved you dearly/In death we do the same."

"At night when it gets dark and the sun starts going down, I make sure I leave this room light on and he's never in the dark," Williams says. "I just want my baby home."

As Williams speaks, her granddaughter flits around the room. She's dressed in a unicorn romper she loves so much she refuses to take it off for bed. Avangelee paints pictures of "Daddy in my heart." After he died, Williams told her that thunder is her dad making a ruckus in heaven and rain is him watering her flowers. When Williams cries, Avangelee reaches for her face and asks, "OK, Mimi?"

Williams wants justice for her family — especially her granddaughter. In August, the medical examiner's report revealed Fennick died of a stroke possibly caused by an allergic reaction to the medicine he was given for the bump on his neck. The medical examiner said the stroke could have been caused by an underlying genetic condition — a detail Armor views as vindication. In a letter to the sheriff, CEO Otto Campo said the agency had unfairly assigned blame before all the facts were known and insisted the report shows Armor staff acted appropriately.

"In the case of Mr. Fennick, for example, it would have been better if all parties had withheld judgment until all of the medical facts were revealed through laboratory testing and an autopsy, which now clearly show that Armor Correctional Health acted responsibly, professionally, and appropriately while Mr. Fennick was in our care," he wrote.

But Williams says the autopsy findings prove medical staff at the jail neglected his serious medical concerns. She believes that Armor and the sheriff's office share the blame and says that if there was even a fly on the wall of the cell, "I'm taking that fly down." Sometimes she wants to be arrested just so she can get a look inside the walls of the jail.

"They stole everything, stole everything from him. They even stole his duty to the community to learn a valuable lesson and to serve the sentence he was given. They even stole that. They even stole that!" she says, her voice growing louder. "They gave him their own sentence."

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Brittany Shammas is a former staff writer at Miami New Times. She covered education in Naples before taking a job at the South Florida Sun Sentinel. She joined New Times in 2016.
Contact: Brittany Shammas