He Almost Died From A Burst Appendix. A For-Profit Jail Medical Provider Dismissed It As Heartburn.

In December 2023, Willie Cunningham began to experience excruciating abdominal pain. Detained at Pennsylvania’s York County Prison after he was unable to pay bail, Cunningham went to the jail’s medical staff for assistance. 

One nurse told Cunningham he had heartburn. Another said he had a stomach virus. Neither examined him, according to a lawsuit filed last year by the nonprofit legal clinic, Pennsylvania Institutional Law Project, against York County, PrimeCare Medical, the jail’s for-profit healthcare provider at the time, and others. 

But Cunningham didn’t have heartburn or a stomach virus. He had appendicitis. By the time he was finally taken to the hospital, his appendix had burst, and he had developed sepsis. 

PrimeCare did not respond to emails seeking comment. The York County Solicitor told The Appeal in an email that “neither the Commissioners nor anyone else from York County will comment on pending litigation.” York County and PrimeCare have denied all wrongdoing in their legal filings. 

“I was just hurting so bad and I wanted help,” Cunningham told The Appeal. “Why are these people in positions to take care of us and they don’t care? You get paid to do a job, you incarcerate us, and then you just say, ‘Okay, he’s a criminal, he doesn’t matter, he can die.’”

On December 16, 2023, Cunningham began to feel ill.

“I thought it was a bug that was going to go away,” he said. But two days later, “it really started hurting me bad.”

That evening, Cunningham vomited three times, according to the complaint filed in his lawsuit. At 11:00 pm, an officer brought Cunningham to the medical unit. 

According to Cunningham’s complaint, the provider on duty, the jail’s assistant director of nursing, did not take his vitals, examine him, or palpate his abdomen, but falsely reported that she did. 

Cunningham says she told him he had heartburn.

The pain kept Cunningham up all night. By the morning, his sheets and clothes were soaked in sweat, according to the complaint. At about 6 a.m., an officer brought him back to the medical unit. 

This time, he saw Registered Nurse Diana Knight. The suit alleges that Knight, like the previous provider, did not conduct a physical exam, palpate his abdomen, or take his vitals. Knight allegedly falsely recorded in his medical records that she took his vitals.  

Knight told Cunningham he had a stomach virus that would go away in a few days. (Knight has been sued by the surviving family members of at least two people who died while detained at York County Prison; in both of those cases, she was accused of reporting inaccurate information in medical records. When reached by phone, Knight said she was no longer working at YCP. In a text following the conversation, she told The Appeal that she has no comment on the allegations. In filings responding to the family members’ lawsuits, attorneys for PrimeCare denied that Knight had engaged in any wrongdoing.)

Cunningham was in bed for the rest of the day. The next two mornings, officers brought Cunningham back to the medical unit. Both times, the providers allegedly did not examine him and sent him back to his cell.

“The pain was so severe, I’ve never felt anything like it before,” Cunningham said. “I couldn’t eat, I couldn’t sleep.”

He says fellow detainees took care of him.

“They was trying to fix me soup,” he said. “They were just trying to make me better by doing things for me. The guards, every time they look at me, they want to take me to medical because they knew something’s wrong.”

By December 22, Cunningham was barely able to walk. An officer took him back to the medical unit—his fifth visit in as many days.

“I was in so much pain. I went in there and they said, ‘Well, take a seat on the bench,’” Cunningham told The Appeal. “I was laying on the bench. [The officer] said, ‘You can’t lay on the bench.’”

“Lady came out, looked at me and said, ‘Take him to the hospital,’” he continued. “At that particular time I couldn’t stand up or sit up, my stomach was hurting so bad.”

Despite Cunningham’s condition, an ambulance wasn’t called. He says officers made him walk to a vehicle, with his hands handcuffed and his legs shackled.

“I didn’t know how severe it was. I was just happy to be getting out of there,” he said. “I went to the hospital. They said I should have been dead. They didn’t know how I was still living.”

Cunningham was diagnosed with a burst appendix with abscesses, gangrene, peritonitis, and sepsis with acute kidney failure. He underwent two surgeries to clean out the infection in his abdomen, according to the suit. 

“I was thinking it was over,” Cunningham said. “I didn’t think I was going to make it. The tapes in my mind [were] just rewinding my life.”

For the first two to three weeks of his month-long hospitalization, he was still in YCP’s custody.

“The whole time you’re handcuffed and shackled,” he said. “You have one leg shackled to the bed at the bottom, and one hand shackled up to the bed.”

He says that during this time, officers forbade him from having any contact with his mother, even by phone. After about two or three weeks, he was released on bail. The handcuffs came off, and he could finally see his mother. 

On January 21, 2024, the hospital discharged him. Unable to pay for the visiting nurse service his medical team had recommended, his 75-year-old mother became his caretaker. She helped him with basic daily tasks, took him to doctors’ appointments, and tended his wounds. 

His mom, Cunningham says, was a “lifesaver.”

“She dedicated her life to being there for me,” he said. “I was a baby all over again.”

A Pattern of Alleged Medical Neglect and Dehumanizing Treatment

Multiple lawsuits and grand jury investigations echo Cunningham’s claims of medical neglect and dehumanizing treatment. 

In 2018, Everett Palmer, Jr. was booked into YCP on an old DUI charge. Over the course of the next two days, his mental health rapidly deteriorated, but “no corrections officer or PrimeCare employee ever attempted to get Mr. Palmer the help he so obviously needed,” according to a suit filed by Palmer’s family. 

After correctional officers tased him and forced him into a restraint chair, Palmer lost consciousness. In 2023, York County settled the suit with Palmer’s family for $1 million dollars, and PrimeCare paid the family $500,000. The District Attorney chose not to file any criminal charges. The county’s investigating grand jury recommended many reforms to help prevent a similar tragedy from occurring again. According to a subsequent lawsuit filed by Haywood Dixon’s family, none of the reforms were implemented. 

In July 2023,  medical staff ignored Haywood Dixon’s pleas for help, according to a recently released report by the York County Investigating Grand Jury. As with Palmer, corrections officers tased Dixon and put him in a restraint chair. Shortly before Dixon’s death, a sergeant told the nurse on duty that Dixon did not look well and asked her to check on him, according to the grand jury report. She refused, saying that Dixon was an “asshole” and the nurse on the next shift could take care of him.

When District Attorney Tim Barker released the redacted report, he also announced that no criminal charges would be filed against staff members, saying that their actions may meet the criteria for criminally negligent homicide, but that charge is not part of the state’s penal code. In his remarks, Barker said “right now there is no accountability for that kind of conduct.” 

“If medical treatment had been provided earlier at the point in time of the taser and the ERC [Emergency Restraint Chair] usage, that would have increased the opportunity for survival,” Barker said. “With prompt care, Mr. Dixon’s condition was survivable.”

Profits Over People

Cunningham’s suit asserts that PrimeCare’s contract incentivized the company to deny medical care to patients, ultimately leading to countless preventable tragedies. 

Under the terms of the contract, PrimeCare was financially responsible for off-site medical care, including hospitalizations, up to $1,000,000 per contract year.

Last year, after years of controversy, York County dropped its contract with PrimeCare. Dauphin County did the same after PennLive’s Joshua Vaughn uncovered widespread medical neglect and corruption at the local jail. Both York and Dauphin counties switched to MEDIKO, another for-profit healthcare company. 

Approximately 75 percent of PrimeCare staff stayed on at YCP when MEDIKO took over, and a “handful departed after the transition,” according to a company spokesperson. 

MEDIKO CEO and founder Kaveh Ofogh told The Appeal in a statement that “training is a major priority” for the company and that nurses are given “clear, step-by-step guidelines for assessing and responding to patient concerns.” The company also prioritizes “hiring more registered nurses and licensed practical nurses rather than relying primarily on certified personnel,” he said.

While PrimeCare is out of York and Dauphin counties, the scandal-plagued company still operates in Pennsylvania, New Hampshire, New York, Maryland, and Florida. 

Cunningham says he trusted the providers at YCP to provide him with the care he needed.

“I believed in these people,” he said. “When they told me I had heartburn, I believed that. I didn’t know I was dying.”

He says the ordeal has changed him. He constantly worries that “something’s gonna go wrong with me and I’m going to end up dying,” he said. 

“I don’t trust medical now,” said Cunningham, who is incarcerated at a state prison and is in treatment for anxiety. “I don’t trust nobody now.”

Cunningham hopes his lawsuit will help ensure that what happened to him never happens again.    

“Something needs to be done with the medical department,” he said. “People should be able to get the treatment they need, not somebody playing guessing games with their life.”