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The family of Nestor Garay, a federal prisoner, filed a wrongful death lawsuit March 4, alleging that private prison operators negligently left him in the care of underqualified medical workers who failed to respond properly to a medical emergency.

Garay was 41 when he died June 28, 2014, shackled to his bed at Midland Memorial Hospital in Texas. The cause, according to the neurologist who examined him there, was a stroke he’d suffered two days earlier and 40 miles away, at Big Spring Correctional Center. The facility is operated by the Geo Group and its medical subcontractor, Correct Care Solutions.

Garay’s story was the subject of a Nation investigation on medical neglect in federal contract prisons, reported in partnership with the Investigative Fund and Reveal from The Center for Investigative Reporting.

Garay suffered the stroke in a 10-man cell in the 3,500-bed prison, one of 11 federal facilities that house only noncitizens. His cellmates were startled awake around 1:30 a.m. June 26 by the sounds of his pained moans. When they found Garay unresponsive, nearly falling off his top bunk and covered in sweat and urine, they called for help. The only medical staff member on duty that night was a licensed vocational nurse, or LVN, whose licensure required only one year of training. In most settings, LVNs serve as support staff for more highly trained registered nurses or medical doctors.

The LVN phoned a physician assistant who was on call for a consult; rather than order that Garay delivered to an emergency room, the physician assistant ordered a dose of antiseizure medications and had Garay returned to his cell until morning.

When the morning nurse found Garay on a mattress on the floor of a cell at 6:15 a.m., his face was drooping and his right arm was contracted. It was only then, roughly five hours after Garay’s cellmates first reported the stroke, that he was ordered to an emergency room. It took another hour before Garay finally was on the way to the hospital. The Midland neurologist said that for ischemic strokes, the window for intervention typically is three hours. After the long delay, he said, treatment “was pretty futile.”

In the family’s lawsuit, Garay’s parents, Indalecio and Alvara Garay, who have lived for decades in California’s Napa Valley, allege that their son’s “life threatening conditions were left untreated.”

“The nurses on staff were severely undertrained and were not equipped to recognize, diagnose, or treat patients with serious illnesses or conditions,” the complaint reads.

Geo Group and Correct Care Solutions said they would not comment on pending litigation. But Big Spring’s own mortality review faulted both the LVN and physician assistant for failing to alert the clinical director when Garay’s condition did not improve. The review found that the physician assistant “did not respond correctly to the initial report from nursing describing new onset of presumed seizure of a previously healthy 41 year old male.” It also found that neither diagnosis nor treatment was “appropriate and timely.”

Big Spring, like the other 10 contract prisons that the Bureau of Prisons uses to hold noncitizens, is not an immigration detention center, but a federal prison for low-security inmates. The segregated, private prisons operate under less strenuous rules than the rest of the bureau’s facilities.

Garay is one of at least 137 men who have died while incarcerated in privately run Bureau of Prisons facilities. Medical records obtained through a federal open records lawsuit revealed systemic shortcomings in their medical care. Doctors who reviewed 103 of the medical files agreed that in 25 cases, including Garay’s, substandard medical care likely contributed to prisoners’ premature deaths.

The reviewers repeatedly found evidence that the private contractors who operate these facilities – Geo Group, Corrections Corporation of America and Management and Training Corp. – and medical subcontractors have used low-trained medical workers such as LVNs to fill positions that in Bureau of Prisons-operated facilities would be staffed by more highly trained registered nurses. The prison contractors are not bound by Bureau of Prisons staffing plans.

Nestor Garay had been sentenced to a five-year term for selling drugs near his parents’ home in Napa. Like nearly every other prisoner held in Big Spring, he likely would have faced deportation to Mexico after completing his sentence. But he died one year into his sentence.

“We don’t want prisoners who are still in the prison to be mistreated anymore,” Indalecio Garay said after filing the lawsuit. “We don’t want others to suffer. We want them to pay for the damage they’ve done.”

Seth Freed Wessler

Seth Freed Wessler is an independent journalist and senior fellow at the Schuster Institute for Investigative Journalism. He is the recipient of a 2014-15 Soros Justice Media Fellowship.