Incarcerated in a Western Maryland prison, Nathaniel Appleby-El knew he was going blind in his right eye.

It had started a couple of days earlier, in late May 2016, with itchiness, redness and irritation. Then came a sudden loss of vision.

Appleby-El told a nurse at the North Branch Correctional Institution in Cumberland that his retina was detached, and he needed to be seen by an ophthalmologist. It was, he said, a medical emergency. But prison medical staff did not immediately treat it like one.

It would be nearly a year until Appleby-El was finally seen by an ophthalmologist, in March 2017. That doctor diagnosed him with a complete retinal detachment in his right eye and a retinal tear in his left eye. He was then sent for a second opinion — but the diagnosis was unchanged.

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Fifteen months after first complaining of a loss of eyesight, Appleby-El finally underwent laser surgery at Johns Hopkins Hospital in August 2017. The surgery was successful — he regained 50% to 60% of his vision — but it required extensive follow-up care to guard against infections and complications.

Appleby-El languished in prison without any post-surgery care. His medication was withheld. The pressure in his right eye became critically high. Eventually, the optic nerve was destroyed. Appleby-El is now completely and permanently blind in his right eye.

Appleby-El will receive a $200,000 settlement payment, most of which will be paid by Wexford Health Sources, a former medical contractor for state prisons, said State Treasurer Dereck Davis.

“You can say a million and it won’t be enough,” Davis said, given that Appleby-El lost his eyesight in one eye. Davis voted to approve the state’s $15,000 portion along with fellow board members Gov. Wes Moore and Comptroller Brooke Lierman.

Davis said the former vendor failed to meet a standard of care and professionalism in this case.

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“We pay those guys well to perform, and they didn’t,” he said.

Appleby-El’s attorneys did not respond to a request for comment on the settlement.

The payment comes as the state continues to weigh alternatives to its current prison healthcare provider, YesCare.

Maryland has given itself some runway to make that long-delayed decision, even as YesCare continues to face medical neglect and malpractice lawsuits, and even as the company is called out as an example of questionable business practices by a bankruptcy judge in Texas.

Wexford, the defendant in Appleby-El’s lawsuit, is considered a likely bidder for the next contract. As of Monday, the Maryland Department of Public Safety and Correctional Services said there are “no updates” on who might be selected as a new vendor.

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A culture of neglect

In a handwritten, pro-se lawsuit filed in 2019, Appleby-El lamented the loss of vision in his eye and scrawled out his impressions on the state of health care in Maryland prisons.

“There is a culture within the Maryland Department of Corrections that compels all staff, from the tier officers who first hear an inmate’s medical complaint, to the chief physician, and to the warden, to treat such complaints as being altogether false, or grossly exaggerated, unless they see blood, or some noticeable physical injury,” he wrote.

Appleby-El continued: “The really frightening part of this culture, is that 99% of the time they are right. The prison administration is willing to risk that 1%, rather than bear the cost of responding to 99% of what turns out to be ‘false alarms.’”

An excerpt from a handwritten lawsuit filed by Nathaniel Appleby-El. (Court records/Court records)

Since Appleby-El’s experience with Wexford, the state has cycled through two more medical providers. It awarded a contract to Corizon Health, which later split into two entities: a rebranded company called YesCare that retained the deal with Maryland, and another company called Tehum Care Services, which declared a controversial bankruptcy that has drawn the scrutiny of progressive U.S. senators and the Department of Justice.

Correction: This story has been updated to correct the name of Wexford Health Sources, and to correct the payment amount Maryland approved in a headline and photo caption.

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