United for No Injustice, Oppression or Neglect
Medical Neglect Articles
Article Last Updated: 8/08/2005 02:37 PM
If you attempt to detach yourself emotionally so as to be objective, several interesting features can be seen. In most all of horrific stories regarding medical care or its absence, there is an element of some unconscionable delay in care, whether it be the failure on the part of personnel to respond to an emergent situation or the failure for an interminable and indefensible period of time to provide services or medical appliances. This is in contradistinction to the situation that exists outside the prison system, in which some self-evident mishap in treatment ends with a lawsuit.
A parallel feature is that in most all cases it is difficult to isolate who precisely is responsible. If an inmate dies in a cell, is it the result of neglect on the part of custody or is it purely the result of medical bungling? You see very little of those situations in which an inmate is given the inappropriate medicine or in which he dies as a direct result of treatment. Remarkably, you see few cases in which a specific condition was missed or misdiagnosed. In these cases it is fairly easy to ascribe responsibility to one or several people.
This is not the usual case in the prison system, because this is basically a closed system and the care involves the participation of a number of people, from the doctor's accuracy of diagnosis, to the pharmacy providing the medication, to the specialists' contribution, to the custodial responsibility in being alert to medical crises and to the prompt transport of patients, to the timely posting on the patients' charts of the results of tests or of specialists' reports and recommendations. If there is a weak link in this chain and if something untoward happens, it is much easier to hold the physician responsible simply because of a conventional and convenient notion that the doctor is "in control."
In fact, nothing can be further from the truth. We as physicians have nothing to say about those very services upon which we logically depend. In the outside world - "on the street," as is the term in prison parlance - if a doctor is dissatisfied with the competence or responsiveness of a pharmacy, a medical diagnostic laboratory, a home health-care provider, and so on, he or she can simply turn to another provider. These various agencies, in turn, aware that they are in a competitive market place, strive to do a good job for their potential and actual customers. In fact, I can only think of two instances in the past five years where an inmate died due directly to a physician's incompetence or neglect. Granted, that is two too many, too be sure, but the point remains valid.
There are other factors that contribute to the perception of the inadequacy of medical care. One of these is the unwillingness of the Health Care Services Division to be responsive to our request for help. The doctors at Corcoran State Prison sent no less than three letters, certified and return receipt, to the deputy director in Sacramento, Dr. Rene Kanan, outlining our concerns and - literally - begging for help. Each and every doctor signed them unanimously. The result? Nothing.
Worse, she has not provided for substitute physicians to take the place of those who have left, aggravating an already critical situation.
Another factor is the adolescent antipathy of one service for another. The head nurse and the chief medical assistant are at loggerheads and discourage their respective employees from attending meetings of the other department. Nothing good can come of this as it relates to patient care.
Another factor is the basic antipathy of custody towards the inmate population. Regardless of which story of mistreatment of inmates you choose to believe, you can count on the fact that this state of affairs is antipathetic to the mission of the medical department. Think of it this way: Would you leave your child with a baby sitter that had a similar relationship to your child as custody does to the inmate population? Another factor is found in the epidemiology of the inmate population:
In a fashion more than parallel to that in the outside world, the prison population is getting both older and younger. The youth are mostly gang affiliated and, therefore, productive of injuries, often life-threatening. The older population is growing in numbers; and the usual diseases are more than compounded in their effect by the generally unhealthy environment physically and socially in prison.
I would like to see relatives of the inmate population as well as interested laypeople have an ongoing dialogue with the physicians. When I was the acting chief medical officer at Substance Abuse Treatment Facility, I spent hours conversing with family members and attorneys by phone. This practice in and of itself avoided countless lawsuits and accusations.
It's very easy to find criticism of prison doctors. Situations so emotionally charged bring to the surface many people and agencies, each with a political agenda of its own. I am convinced - with the exception of family members - the specific agendas of these various parties are more important to them than are the individual inmates.
In the years I have spent in Department of Corrections, absolutely no one has asked me: "What do you need to do your job?" And, "How can I help you." It's the sound of silence, and it says it all.
The author, a staff physician with the state Department of Corrections
at California State Prison, Corcoran, lives in Fresno and writes on subjects
related to the practice of medicine and related issues in the prison system.
Judge seeks oversight of prison health system
Reform bill signed
FOLSOM – A federal judge on Tuesday moved to place the state prison system's troubled health care operations into receivership, complicating a massive prison overhaul bill signed into law hours earlier by Gov. Arnold Schwarzenegger.
U.S. District Judge Thelton Henderson, ruling in a class-action lawsuit brought against the California Department of Corrections, said the state's 162,000 prisoners "are being subjected to an unconstitutional system fraught with medical neglect and malfeasance."
Poor care has been blamed for the deaths of more than two dozen inmates.
"Defendants themselves have conceded that a significant number of prisoners have died as a direct result of this lack of care, and it is clear to the court that more are sure to suffer and die if the system is not immediately overhauled," he said.
Henderson's ruling, in San Francisco, came after Schwarzenegger appeared at Folsom State Prison to sign into law the most sweeping overhaul in three decades of the nation's largest prison system.
Schwarzenegger's signature was expected. The Republican governor has been calling for major reforms to the $7 billion-a-year system since shortly after he took office in November 2003. He helped craft a bipartisan solution through months of negotiations with the Democrat-controlled Legislature.
"When I came into office, we faced some very serious problems with our correctional system, including out-of-control budgets, a failed internal discipline system and a disturbing lack of accountability," Schwarzenegger said. "And the more we looked at the problems, the more we realized that the first step that we must take is to reorganize the whole agency."
The law restructures the bureaucracy of the 32-prison system and concentrates power with his hand-picked corrections czar, Youth and Adult Corrections Secretary Roderick Hickman.
Schwarzenegger said attention must now turn to several reforms: improving the health care system targeted by the judge Tuesday; overhauling a youth corrections system experts described as draconian; and fixing a rehabilitation system so flawed that the majority of ex-convicts are soon back behind prison walls.
It's unclear what affect Henderson's ruling will have on the governor's overall reform plan, since it could take control of the health care system out of the state's hands.
Top prison officials have acknowledged they can't manage the inmate medical system. They said they are counting on consultants and the legislation the governor signed Tuesday to make improvements that should have begun more than a year ago.
Prison department spokesman Todd Slosek said it is "unknown at this time" whether the state would oppose a receiver.
"The department's interest all along was for ... constitutionally adequate health care to our inmates," he said.
The judge said he will appoint a receiver to force improvements unless the Department of Corrections convinces him otherwise. He will make his final decision following a July 11 hearing.
In a review of 193 prison deaths, Henderson said many of the medical records were lost and that 34 of them were "highly problematic, with multiple instances of incompetence, indifference, neglect and even cruelty by medical staff."
One inmate, Henderson said, was given medication for high blood pressure in 2002 and was not seen again by physicians until he was found dead.
In a separate ruling Tuesday, Henderson said he also might hold the corrections department in contempt of court for not abiding by a June 2002 agreement to improve health care.
He said the department has failed to achieve "any substantial progress in bringing the medical care system even close to minimal constitutional standards."
Tuesday's federal court decision is the latest instance in which the courts have sought to exert control over California's problem-plagued prison system.
Federal judges already are assuming oversight of pieces of what on July 1 will become the new Department of Corrections and Rehabilitation. The combined department will replace what now are the California Department of Corrections and the California Youth Authority.
Another judge has appointed a special master to help reform the youth authority, while a separate special master is being considered to oversee stalled parole reforms.
Schwarzenegger, driven by near-constant prison scandals, made reorganizing the system the vanguard of his larger plan to restructure state government.
"This is just the first step," said Hickman, who will have responsibility for the entire system.
On the Net:
Read the reorganization bill, SB737, and the parole bill, SB619: www.sen.ca.gov
California Youth and Adult Correctional Agency: www.yaca.ca.gov
Associated Press writers Don Thompson in Folsom and David Kravets in
San Francisco contributed to this report.
Prison doctors' union sues to block higher standards
By Don Thompson
SACRAMENTO – The union representing prison doctors sued the Department of Corrections to block higher standards for physicians, blaming appalling health care problems on an inferior prison system.
The Oakland-based Union of American Physicians and Dentists said Monday its doctors are not responsible for the problems. The Department of Corrections wants doctors to be board certified in internal medicine or family practice, or pass a competency test.
The plan follows a series of scathing reports on health care at state prisons. National experts reported last month that conditions are so poor that inmates are dying of neglect and maltreatment.
The suit filed Friday in Sacramento County Superior Court said imposing new minimum qualification standards violates state law, which requires that any new qualifications must be approved by the State Personnel Board. The board now requires only that doctors and dentists be licensed in California.
The department has twice tried to impose such standards under what the union alleged were flawed evaluation programs. The union said no correctional agency in the nation requires its doctors to prove their competency.
The Department of Corrections is "arbitrarily, capriciously, and unilaterally imposing new minimum qualifications for prison doctors to divert attention from its own execrable management spanning two decades," the union said in a statement. "In a desperate last ditch effort to divert attention from its own colossal mismanagement, CDC is doing its best to blame prison doctors for its own failures."
National experts last month reported cases of doctors who acted incompetently, prescribing the wrong treatment or ignoring complaints until it was too late. They and other experts have said doctors are sometimes unqualified to see the patients they treat, conditions are abysmal, and the medical system is severely understaffed.
Youth and Adult Correctional Agency Undersecretary Kevin Carruth acknowledged last week that prison officials are unable to manage the medical system, and want to hire University of California consultants to design a plan to improve care in 18 months.
The union criticized the plan to pay UC San Diego and UC San Francisco $14.7 million, when it says the state could be better served by implementing 28 reforms that the union has suggested.
A Senate committee cut out the consultants' money last week, in anticipation that a federal judge will hold hearings and may appoint an overseer for the health care system.
On the Net:
California Youth and Adult Correctional Agency: www.yaca.ca.gov
California Department of Corrections: www.corr.ca.gov
Prison Law Office: www.prisonlaw.com/
Posted on Thu, Apr. 14, 2005
San Quentin 'decrepit'
SACRAMENTO - California's landmark San Quentin Prison is a decrepit facility that poses a major public-health-care risk to thousands of inmates who are living in refugee-camp-like surroundings, a court-appointed panel of medical experts has found.
In a scathing report, obtained by the Mercury News, the experts said the prison is overseen by an indifferent staff that ignores a major federal court agreement to improve health care.
The inspectors examined 10 inmate deaths over the past three years and found that most were preventable. Before their deaths, three of the inmate-patients were treated by a single unidentified prison doctor, identified only as Dr. X, who at one point was placed on administrative leave.
The 53-page report is based on inspections earlier this year by two doctors and a nurse. In it, they told U.S. Judge Thelton Henderson that San Quentin is ``so old, antiquated, dirty, poorly staffed, poorly maintained with inadequate medical space and equipment and overcrowded'' that its entire mission needs to be re-evaluated.
In some of the strongest language ever used to describe a state-run facility, they also said that reviews of medical records at the Marin County lockup on the shore of San Francisco Bay ``demonstrate multiple instances of incompetence, indifference, cruelty and neglect.''
Corrections Director Jeanne Woodford, who was the longtime warden at San Quentin, was not available for comment. But Todd Slosek, a spokesman, acknowledged that concerns over health care are longstanding.
He said, ``The department has developed a remedial plan and is working with the court to ensure that the experts' concerns are addressed.'' And he noted the prison system is developing standards for physicians.
The reports on San Quentin and two other state prisons came to light on the eve of a Senate hearing set for today into the skyrocketing cost of prison health care. Costs have doubled to more than $1 billion annually over the past six years.
Sen. Gloria Romero, D-Los Angeles, chair of today's hearing, called the report ``damning.'' ``This has truly been a correctional agency that's neglected the most basic of inmate rights protected by the U.S. Constitution. It's shameful to realize that taxpayers are pouring $1 billion into a system'' that should pay for the most basic of health care needs.
Not only are inmates constitutionally guaranteed adequate health care, but most inmates also wind up getting released and if they are sick they can pose a health risk to the general population. In addition, the state has been forced to pay out millions of dollars in settlements to inmates who have alleged they were mistreated in state institutions.
The inspections and report were ordered by Henderson who oversees compliance under a sweeping legal agreement known as the Plata settlement -- after Marciano Plata, one of nine plaintiffs in an April 2001 class-action lawsuit filed by inmates' rights activists. While the medical experts said there had been initial progress, they now found conditions ``disturbing'' in a cover letter dated April 9 and signed by Dr. Michael Puisis, an Illinois-based expert on correctional health care.
The legal settlement reached several years ago requires California's 32 prisons to provide adequate health care by 2008. The lawsuit charged that the prisons' poor medical care violated the Constitution's ban on cruel and unusual punishment.
But the experts found that overall compliance with the agreement was ``non-existent'' and that there was indifference to turning things around. In fact, they recommended that the mission of San Quentin, which receives new inmates, be re-evaluated.
The Schwarzenegger administration has been seeking to overhaul the way prisons are administered, centralizing control in Sacramento under Youth and Adult Corrections Secretary Roderick Hickman.
However, for the second time in the past month, an independent investigation has painted a grim picture of the way a state prison is managed. Last month, the Office of the Inspector General reported that the California Institution for Men in Chino was on the verge of chaos in the wake of the first slaying of a guard in 20 years.
Now, the medical panel is describing an equally disturbing situation at San Quentin.
``Some of the physical structures or arrangements for housing at San Quentin are so decrepit that it is degrading and dangerous to house human beings in them for extended periods of time,'' the report states.
``Yet, these arrangements have existed for so long that staff have become inured to the conditions and have become so accustomed to the degrading conditions that they are considered normal. Leadership has become so accepting of inability to change that an overwhelming attitude of resignation exists.''
Review of 10 deaths
Perhaps most important, the report reviewed 10 deaths. ``Each of these should have resulted in discipline; while these were referred to investigations, nothing had yet been done. Lack of timely discipline after the first death may have resulted in the continued mistakes and deaths.''
The experts also inspected California State Prison, Sacramento, and Salinas Valley State Prison. At Sacramento, they cited a lack of nursing supervision, and similarly they found a lack of nursing leadership at Salinas Valley. As a result of poor leadership there, the inspectors said, there is ``staff confusion and dissension.''
Besides Puisis, others involved with the report include Dr. Joe Goldenson
of Berkeley and Madie Lamarre, a nurse from Atlanta, Ga.
Contact Mark Gladstone at firstname.lastname@example.org or (916) 325-4314.
Posted on Fri, Apr. 15, 2005
Prison's medical system assailed
SACRAMENTO -- The inmate could neither eat nor drink and was dehydrated when he showed up at the San Quentin clinic shortly after 8 p.m. on Jan. 28. With a fever over 103 and a racing pulse, his vital signs indicated possible shock and a life-threatening emergency.
With prison medical records in disarray, the doctor on duty did not have a chart to check the inmate's history. The doctor failed to evaluate the inmate for dehydration and diagnosed bronchitis and the flu. He prescribed Tylenol, Benadryl, cough syrup, antibiotics and two other medications and told the inmate to come back in a week.
Heading back to his cell, the inmate collapsed, according to a report from three court-appointed medical experts obtained by the Mercury News. The physician, known only as ``Dr. X,'' gave him some fluids and sent him back to his housing unit. By the next afternoon, the felon was in shock and died about 30 hours after he was first seen by Dr. X.
In their report to U.S. District Court Judge Thelton Henderson, the medical experts cited 10 deaths at San Quentin. Most were preventable, they said, including three cases overseen by Dr. X.
These and other cases reflect a broken medical system that might require a partial takeover by the federal court, suggested Sen. Gloria Romero, D-Los Angeles, at a legislative oversight hearing on prison health care Thursday.
Department of Corrections officials acknowledged that the reports were ``damning.'' But in an apparent effort to stave off federal intervention, state authorities revealed for the first time that next year they expect to start contracting out for health care.
``This would be a different way of delivering health care,'' said Kevin Carruth, undersecretary of the Youth and Adult Correctional Agency, which oversees prisons. Asked his timeline, Carruth said, ``If we're lucky and things go well, a year plus.''
The plan is designed to help the state meet the terms of a settlement of a lawsuit by nine inmates in which the prison system has agreed to upgrade health care to its 165,000 inmates. The plan is still being shaped.
Carruth said he believes that in the long run the new scheme -- which would entail contractors in Sacramento overseeing subcontractors at different prisons -- would save money for the state, which now spends $1.1 billion a year on inmate health care.
``We've had a structure that has not historically placed health care priorities as high as other priorities,'' Carruth said. He noted that revamping the department -- set to take place in the next few months -- will help elevate health care priorities.
The notion of contracting out health services ran into immediate criticism from Sen. Mike Machado, D-Stockton. ``You guys are just hiding from the responsibility. You are putting the state at risk,'' he scolded Carruth. ``You are not being accountable to the taxpayers and yet you have the nerve to come to us and ask for money and say, `Trust us, we're going to come up with the performance standards.' ''
``You haven't given me the confidence to sit here and endorse the budget for your department,'' Machado declared to applause from the audience in a state Capitol hearing room.
Earlier, Machado tangled with Dr. Renee Kanan, corrections acting medical director, over whether she has the power to order washbasins in examination rooms. In their report, the experts determined that in some clinics at San Quentin doctors don't have access to hand-washing facilities.
``Do you have the authority to demand that wash sinks be placed in every examination room?'' Machado asked.
Kanan responded that she has required an alcohol-based material be made available for medical personnel to wash their hands with.
Machado interpreted this to mean that she doesn't have the clout to require the sinks. Later, a corrections spokesman said Kanan can order the washbasins but ``she can't do it alone.''
Kanan said the department is moving to address one of the broader criticisms raised by the investigators. In their report dated April 9, they said San Quentin does not conduct a review of each prisoner death. Kanan said she has now implemented death reviews, begun to look to hire physicians from overseas and retained a headhunter to find medical personnel for the prison system, which has many vacancies.
The report to Henderson said Dr. X ``exhibited extremely poor clinical
judgment'' in three cases of extremely ill prisoners who needed to be seen
in an acute hospital. ``His actions fall well below the accepted standard
of care,'' the experts said. The physician was put on administrative leave
after the inmate's death.
Contact Mark Gladstone at email@example.com or (916) 325-4314.
Prison Clinics Called Dirty, Deadly
A report by court- appointed monitors says healthcare at San Quentin
is so bad it is dangerous, sometimes fatal, to inmates.
April 14, 2005
SACRAMENTO — Despite a court order to improve medical care for inmates, San Quentin State Prison's health facilities and treatment practices are so harrowingly bad that many sick prisoners should not be taken there at all, independent examiners have concluded.
The court-appointed experts inspected the medical records of 10 inmates who died over the last few years in California's oldest and best known prison and concluded that in each case, the treatment "showed serious problems" and "most deaths were preventable."
Doctors and nurses misdiagnosed illnesses, gave patients the wrong medications, neglected them for months and even years or delayed sending them to emergency rooms until they were fatally ill, the experts discovered.
The examiners watched a dentist examine inmate after inmate while wearing the same pair of gloves. Records were in such disarray that doctors reported that they could not find medical files for at least 30% of the inmates they examined.
Based on visits to the prison earlier this year, the experts' April 8 report documented filthy clinics and patient housing. Dental examinations are done in a place without light or water; inmates are initially evaluated in a room without a sink for washing hands; nurses until recently used a broom closet as an examination room; and wheelchair-bound patients cannot roll into the hospital cells on their own because the doors are too narrow.
"We found a facility so old, antiquated, dirty, poorly staffed, poorly maintained, with inadequate medical space and equipment and overcrowded that it is our opinion that it is dangerous to house people there with certain medical conditions and also dangerous to use this facility as an intake facility," the experts wrote.
The examiners found less dreadful but nonetheless extensive shortcomings with the medical care at Salinas Valley State Prison and the California State Prison at Sacramento, in Folsom. Although they found improvements, the visits uncovered some of the same management problems that plague San Quentin, including a lack of basic medical equipment, dirty facilities and a culture of indifference among some senior medical staff.
Taken together, the site reports raise major questions about California's compliance with the settlement of a lawsuit charging that inmate medical care was so poor it amounted to cruel and unusual punishment.
The case was settled in 2002 and is being overseen by U.S. District Judge Thelton Henderson in San Francisco, who appointed the monitors.
Under the terms of the settlement, the state's prisons should already be making improvements, and must complete them by 2008.
Henderson, who last year threatened to appoint a receiver to take over the entire state Department of Corrections, discussed the reports Wednesday in Sacramento with the medical experts, state prisons commissioner Roderick Hickman and, separately, state Sen. Gloria Romero (D-Los Angeles), chairwoman of a Senate panel investigating state prisons.
Todd Slosek, a corrections spokesman, said department officials will be prepared to discuss the problems at a hearing Romero has set for today on the broader topic of prison healthcare costs.
"We're currently working with the courts to address the issues raised by the experts," he said, adding that the department has developed a remedial plan for the deficiencies found at San Quentin.
Romero said the reports make her question whether the prison system is capable of reforming itself. She noted that while $1 billion of the $7-billion annual prison budget is spent on healthcare, the reports suggest that much of this money is squandered.
"What these reports reflect is there has been a culture of negligence by the bureaucracies across the various administrations in terms of addressing the most basic healthcare needs of inmates," Romero said.
The monitors — who include doctors and nurses with experience in prison healthcare — raised the same concerns about the overcrowded San Quentin prison, which is supposed to house no more than 3,317 inmates but has a population hovering around 6,000. They noted the incredibly low expectations of the staff, who would refer to "the San Quentin way" and say that they were "making do with the hand we've been dealt" when discussing the prison's inferior clinics and equipment.
The experts also noted that the prison only emerged within the last decade from a previous federal order to improve medical care.
"The system of organizational structure within the [California Department of Corrections] that permitted this facility to deteriorate over the past 10 years to the state described in this report must be addressed as well," they wrote. "These problems have not occurred overnight."
Among the problems at San Quentin identified by the examiners:
• Three patients who later died had been seen by the same doctor, who the experts said failed to properly treat patients with clear signs of extreme illness and did not refer them for emergency care "until their conditions had deteriorated to the point where their deaths were inevitable." The doctor, who was not named in the report, was placed on administrative leave after the third death.
• One patient identified as having "extremely high blood pressure" was "basically neglected for over a year and a half" until he died.
• Another patient who died from renal failure was not correctly diagnosed for "an extended period" and then was not given dialysis. He was, however, given medicines that were not safe for him.
• A diabetic inmate with a foot problem was housed in the mental health unit because there were no empty beds in the medical unit. There, his shoes were taken away, as is customarily done with psychotic and suicidal patients, even though his bare foot was then made more vulnerable to damage.
The experts found less serious but still inadequate conditions at Salinas. Their report said the Corrections Department had increased doctors' hours to reduce the backlog of untreated inmates.
Still, the experts concluded that high nurse and medical assistant turnover and vacancies undermined prompt examinations, with appointments often rescheduled and new patients not being referred to physicians.
"The fact that healthcare staff has difficulty obtaining basic medical
supplies for clinic operations is completely unacceptable, and helps explain
staff exasperation and frequent turnover," the experts wrote.
Overseer may be needed for prison health care, experts say
By Don Thompson
SACRAMENTO – Health care conditions at California prisons are so bad a federal judge should consider appointing an overseer to manage the system before more inmates die of neglect or ill-treatment, experts and angry state lawmakers said Thursday.
Top prison administrators acknowledged they can't manage the prison medical system, but said outside consultants signed contracts this week to help. But even basic improvements are 18 months away, Youth and Adult Correctional Agency Undersecretary Kevin Carruth told a Senate hearing.
"Does it bother you in the next 18 months we're probably going to have even more deaths? Does it bother you?" asked Senate Majority Leader Gloria Romero, D-Los Angeles, who chaired the joint hearing of two prison oversight committees.
U.S. District Judge Thelton Henderson should hold the state in contempt or appoint a receiver to force the state to comply after court-appointed experts reported that inmates are dying for lack of basic care, said Don Spector of the Prison Law Office, an inmate rights law firm that was party to the settlement.
Romero said Henderson told her Wednesday he has a "dire concern over the ability and commitment of this prison bureaucracy to fix it." Henderson last year threatened to appoint a receiver to take over the entire state Department of Corrections, but has not done so.
"The reports are abominable, they are damning ... (portraying) a system so broken that is an actual threat to inmates, to the staff that work there, to the public," Romero said, noting experts' conclusion that "at least 30 inmates have died from preventable causes."
The deputy director who manages Corrections' Health Care Services Division, Dr. Renee Kanan, agreed a federal overseer should be considered, after acknowledging she can now only recommend improving even basic sanitary conditions that the experts found appalling and dangerous.
Sen. Mike Machado, D-Linden, was furious at the lack of progress in complying with a federal court order more than a year old.
"You guys are just hiding from the responsibility; you're putting the state at risk; you're not being responsible to the taxpayer," Machado told the officials.
Sen. John Campbell, R-Irvine, said, "The system needs to be changed, blown up, whatever it is, so we get a standard of care that is acceptable."
The experts said administrators at Marin County's antiquated San Quentin State Prison have had a year to comply with a court order to improve medical care, yet compliance was "nonexistent." Conditions there are so poor they said the number of inmates should be limited, an outpatient unit should be closed or used for nonmedical purposes, and new inmates should be processed at some other prison.
Things are better, and improving, at Salinas Valley State Prison and the California State Prison at Sacramento, in Folsom, yet still don't meet the progress expected after a year, the experts reported. The settlement requires that all 32 prisons provide adequate health care by 2008.
California's $1.1 billion inmate health care system is among the nation's worst, yet the state spends two or three times more per inmate as do other states, Romero said the experts told her Wednesday. The experts did not testify about their inspections, the first in their series of reports on the state's compliance.
Carruth said the reports are both "scathing" and "accurate."
"We are not appreciably better than we were 14 years ago," when the first in a series of suits challenged the state's inmate medical care, Carruth acknowledged. "It is not our area of expertise, frankly," which is why the state is seeking advice from the University of California medical system and the state Department of Managed Care.
"We are going to move as expeditiously as we possibly can, given the constraints we have to live under," Carruth said.
Kanan, who has directed the prison health care system for six months, said she had believed providing more and better doctors and nurses was the biggest problem.
But the experts' reports show even more basic reform is needed, she said. The experts found examining rooms with no sinks, employees who had to walk through sewage puddles or shower rooms to examine inmates, doctors who wore the same gloves and used the same tongue depressors to treat multiple inmates. Medical records were missing for at least 30 percent of inmates.
Inmates literally died of neglect or, worse, harmful medical treatment, said Spector, of the Prison Law Office.
"The medical care is so bad that more inmates are dying from medical neglect than are dying from violence," he said. "Being sent to prison is literally killing people."
On the Net:
California Youth and Adult Correctional Agency: www.yaca.ca.gov
California Department of Corrections: www.corr.ca.gov
Prison Law Office: www.prisonlaw.com/
October 06, 2004 06:23 PM US Eastern Timezone
Medical Board of California Obtains Suspension of Soledad Physician's License
SACRAMENTO, Calif.--(BUSINESS WIRE)--Oct. 6, 2004--On October 4, 2004,
Administrative Law Judge Jonathan Lew signed an order which prohibits Soledad
physician Isaac A. Grillo, M.D. from practicing medicine; possessing, prescribing,
dispensing, furnishing, administering, or otherwise distributing any controlled
substance or any dangerous drug; and possessing or holding his physician
wall and wallet certificates, any triplicates and regular prescription
blanks, DEA order forms, and any DEA permits. Grillo has been ordered to
appear at the Office of Administrative Hearings in Oakland on October 22,
2004 to show cause why the suspension of his license to practice medicine
should not be extended.
The Medical Board had filed an accusation against Grillo alleging unprofessional conduct through gross negligence and incompetence in that he failed to diagnose a cervical spinal injury of a prisoner at Soledad prison who had suffered a subluxation of C4-C5, resulting in quadriplegia. The board later adopted a stipulated settlement and disciplinary order, which imposed a public letter of reprimand with a condition precedent: successful completion of Phases I and II of the Physician Assessment and Clinical Education (PACE) program at the University of California at San Diego.
In a September 8, 2004 communication to the board from the Director and Associate Director of the UCSD Pace Program, the board was informed that serious deficiencies were noted during Grillo's assessment by the PACE faculty/staff. The assessment report noted that at a multi-disciplinary staff meeting on September 1, 2004, the director and other participants "expressed grave reservations about whether Dr. Grillo should be practicing medicine" and that the "deficiencies documented during his two-day Phase-1 PACE Assessment, if applied in the real world of medical practice, would almost certainly have resulted in patient harm, and perhaps even death." The report also stated that Grillo's serious deficiencies of clinical knowledge and judgment extended beyond the limited scope of the PACE Program's five-day clinical education and that as a result, "may require additional training or monitoring either in residency, fellowship, or some other proctored environment."
The mission of the Medical Board is to protect healthcare consumers through the proper licensing and regulation of physicians and surgeons and certain allied healthcare professions and through the vigorous, objective enforcement of the Medical Practice Act.
If you have a question or complaint about the healthcare you are receiving, the board encourages you to visit its Web site at www.caldocinfo.ca.gov , or for questions call the Consumer Information Line at 916-263-2382, or with complaints call 800-633-2322.
'Scrubs flu' hits nurses at prisons
By Andy Furillo -- Bee Staff Writer - (Published September 8, 2004)
Dozens of prison nurses across the state called in sick Tuesday in an
apparent protest over their deadlocked contract negotiations.
More than half of the day-shift nurses at maximum-security Pelican Bay
State Prison - 21 out of 40 - participated in what state officials believe
was a sickout organized by the California State Employees Association,
the Department of Corrections said.
Seventeen out of 19 nurses came down with "scrubs flu" at the Central
California Women's Facility in Chowchilla. An additional 14 called in sick
at the California Correctional Institution in Teha chapi and seven out
of 10 nurses didn't make it to work at California State Prison, Solano.
Altogether, nurses called in sick at inordinately high rates at 13 prisons
across the state. Corrections officials said they experienced no disruption
in their routine operations Tuesday, shuffling supervisors into line jobs
and calling in contract registry nurses to fill in on some of the shifts.
"Everybody's operating normally," Corrections spokeswoman Terry Thornton
Nurses' bargaining unit representative Christina Rodriguez said Tuesday's
job action was not sanctioned by the union, but that state nurses in the
departments of mental health and developmental services, as well as corrections,
are reaching a boiling point.
"State nurses have had enough," she said. "We've been bargaining with
the state but nobody's listening to us. We want quality patient care, safe
staffing and fair wages."
The sickout came almost a month after contract talks stalled on Aug.
11 between the nurses' union and the state Department of Personnel Administration.
The contract that covers the 3,700 state nurses, including 900 who work
in corrections, expired July 1.
Even though the contract expired, the administration gave the nurses
5 percent raises. According to state negotiators, the prison nurses countered
by demanding an immediate 26 percent pay raise, elimination of forced overtime,
seniority rights on job assignments and an elimination of management authority
to change shift assignments, days off and vacation schedules.
Since the 5 percent pay hike, state nurses earn an average $4,782 a
month, according to the Department of Personnel Administration. Union officials
say the pay scale is far below community nursing jobs in private and public
sectors and has resulted in a 25 percent vacancy rate in the prisons alone.
In an Aug. 13 letter to the union, state labor relations chief David
Gilb said he had no choice but to reject the CSEA's Aug. 11 proposal.
"We would like to reach an agreement with you," Gilb wrote. "But reaching such an agreement does not require us to abandon our interests as management, nor as stewards of the taxpayers' money."
The Bee's Andy Furillo can be reached at (916) 321-1141 or firstname.lastname@example.org .
A public health crisis
Sunday, September 05, 2004 - The recent death of Anthony Shumake, a California State Prison at Solano County inmate, is but another incidence of death which may have been the result of medical neglect.
I have reports of possible negligence that resulted in at least two more deaths at the California Medical Facility and CSP-Solano, both in Vacaville, bringing the total to three since April.
As someone who has been taking complaints from inmates and their families from 33 prisons and most of the jails since 1998, I believe that death due to neglect is not unusual. I believe the media is essentially banned from state prisons as part of a coverup of medical neglect and abuses to inmates that routinely make them much sicker than before they were incarcerated. It is unacceptable that the media is banned from taxpayer-financed institutions, including prisons, jails and juvenile halls when the lawsuit payouts are so high.
Since I wrote an article decrying medical neglect ("Building better prisons: State institutions could use some major changes," Forum, The Reporter, Oct. 22, 2000), we as taxpayers have paid out hundreds of millions more of our tax dollars due to mismanagement. Conditions in prisons have worsened. Advocates, inmates and their families have no place to go for help even in potentially fatal emergencies. We're spending billions on a failed prison and jail system that is breaking the bodies and spirits of men, women and children. We call it "corrections," but nobody is being corrected. People are simply being destroyed for the rest of their lives.
There are no statistics anywhere showing the inhumane treatment is doing one thing to prevent or deter crime. In fact, it appears that what we are doing is destroying addicts and the mentally ill simply for being sick. Caging people instead of healing them is barbaric and ineffective. Yet legislators put into office by law enforcement unions refuse to put an end to the conveyor belt laws responsible for the overcrowding and resulting inhumane conditions.
Any sentence to prison or jail is a potential death sentence with the rampant abuses and disease epidemics raging out of control there.
And since we are all connected - at least 3 million people are in some way related to a prison inmate - this devastation is affecting everyone. During a Jan. 29 federal congressional hearing, it was reported by the Center for Disease Control that life-threatening diseases were leaking out to the public. The public safety is not being served when inmates are denied basic custodial care such as food, clean water, fresh air, medical, mental health and dental care. Yet this is what has been happening.
Anthony Shumake's death was preventable. The law states that an inmate's medical care should be at the same level as regular community care. But for the sake of making a profit on this slave-labor industry, human services are being denied to inmates on a daily basis. The standards are far below that of regular community care.
The death toll in prisons is high and taxpayers have a right to know the details. Politicians elected by law enforcement labor unions are so callous that you could drop a dead body on almost any desk in the Legislature and they would just work around it. Shocking conditions are considered business as usual and the lawsuit payouts are hidden from journalists, spread across several budgets.
Hospital and ambulance bills aren't getting paid. It is not uncommon for an ambulance to take two or three hours to arrive to the more remote prisons. Even prison visitors have died because the correctional officers usually aren't trained in even the most basic first-aid procedures and there are no doctors on the grounds at night or on the weekends.
Now with West Nile virus in full swing and no insect repellents or screens available for inmates roasting in sweltering cells, the risks of more medical deaths are even greater.
There are too many people in prison. The fiscal and human toll of this callous grinding machine are immeasurable.
The dead bodies have been stacking up now for six years, all of it flying beneath the radar of a banned media. We need to demand the immediate release of all nonviolent inmates for humanity's sake. Prisons might be just a photo-op for Gov. Arnold Schwarzenegger, but he needs to sign Senate Bill 1164 by Gloria Romero, D-Los Angeles to allow media access to inmates in our prisons.
The author is director of United for No Injustice, Oppression or Neglect, or UNION, an advocacy group for inmates and their families.
• The author is a columnist for the Oakland Tribune.
Scathing Report on Prison Doctors
August 11, 2004
SAN FRANCISCO — Incompetent doctors, including some with a history of substance abuse or mental health problems, have been hired by California's prison system and have contributed to serious deficiencies in healthcare for inmates, according to a federal court report released Tuesday.
At one facility, half of the eight doctors had prior criminal charges, loss of privileges at community hospitals or mental health problems, the panel said. At another, seven of 20 doctors had similar problems.
"There appears to be an emerging pattern of inadequate and seriously deficient physician quality" in prisons, a panel of experts said in a letter to U.S. District Judge Thelton Henderson, who ordered the report as part of a civil rights suit alleging substandard medical care for inmates.
A panel of two doctors and a nurse practitioner conducted reviews of medical treatment at about half a dozen of the state's 32 prisons. They concluded in a July 16 letter to the judge that the department had hired many incompetent doctors with a history of problems, then failed to monitor them, putting inmates at serious risk of injury or death.
"The only requirement for hiring is a medical license," said the letter.
California Department of Corrections officials said they were formulating a plan that would improve prison medical services, the fastest-growing part of the $5.7-billion state prison budget.
"There will be remedial training and greater clinical supervision … and a stricter adherence to department policies," said spokeswoman Margot Bach. "The department … takes the healthcare of inmates very seriously."
The panel concluded that many doctors were not trained to administer the treatments they were providing inmates, some with serious illnesses. The report did not name the prisons or the doctors.
"An incompetent retired cardio-thoracic surgeon manages complex internal medicine patients and makes serious life-threatening mistakes on a continual basis," the report said.
The panel also cited the case of an obstetrician who was managing HIV patients and a neurosurgeon who was seeing patients with internal medicine problems, although he was not trained to read electrocardiograms used in internal medicine.
"It could be named the Keystone Docs," said state Sen. Jackie Speier (D-Hillsborough), who has scheduled hearings on the corrections healthcare system for next month. "If it was a want ad, it would say something like, 'Bad doctors apply here. No one turned away.' "
The prison healthcare budget for this fiscal year is $879 million. Officials say rising costs are a result of the growing and aging inmate population, as well as increased spending for prescription drugs, medical treatment and court-mandated services.
The Corrections Department agreed 2 1/2 years ago to settle a lawsuit brought by the Prison Law Office, a Marin County civil rights group, on behalf of the state's 163,000 inmates. That plan is projected to cost tens of millions of dollars a year, and, among other things, calls for putting nurses in prison clinics around the clock.
The findings by Henderson's medical panel surprised even Don Spector, executive director of the Prison Law Office. "It was worse than we thought," he said. "We always knew there were physicians who had no business practicing medicine, but we did not know it was this pervasive."
Henderson is expected to hold a conference on the panel's report and the state's remedial plans this month.
The report described a system in which individual prisons operated with great autonomy and little oversight. The corrections official in Sacramento with final word on hiring was not a doctor. Only one of the prisons reviewed had its chief physician and surgeon's position filled — and that doctor was an ophthalmologist who was training doctors in internal medicine.
At individual prisons, the report found, doctors with training deficiencies were hiring and overseeing the work of other prison physicians. "At one of the facilities reviewed, the vice chairman of the committee that oversees credentialing is an obstetrician who had lost his license for seven years for incompetence and alcoholism," said the report, adding that he oversees doctors practicing internal medicine although he has no experience in that area.
The union that represents about 600 prison doctors, dentists and psychologists blamed quality problems on cost cutting by the state, which has led to the hiring of contract physicians rather than civil service doctors.
"Contract doctors are most of the problem," said Dr. Robert Weinmann, president of the Union of American Physicians and Dentists. "We have a recalcitrant state system. They want to hire and fire locally at will with no benefits."
The panel and Spector of the Prison Law Office gave high marks to the new acting head of the state's prison healthcare services, Dr. Renee Kanan.
But, Spector added, "she is one person in a gigantic system with more bureaucratic hurdles than you can imagine."
Sacramento -- Half of the doctors working at one California prison have a criminal record or mental health problems or have lost the right to practice in a hospital.
At another lockup, a neurosurgeon with no expertise in internal medicine misdiagnosed an inmate suffering from pneumonia in both lungs, prescribing anti-depression medicine that nearly killed him.
And an obstetrician who lost his medical license for seven years helps determine whether problem physicians at one prison should remain on the job.
Adding more bad news for a scandal-plagued state prison system, two reports released Tuesday depict a corrections system rife with unqualified doctors working in poor conditions. The reports were made public by a Marin County law office that sued the state over prison health care. They add to mounting evidence that California's troubled prisons run a medical operation with out-of-control costs that often fails to provide basic health care for 162,000 inmates.
The reports come on the heels of the mysterious death of an inmate at a Vacaville prison who apparently died after having a tooth pulled. The death has the inmate's Richmond family and some lawmakers questioning whether health care providers at the prison made mistakes with deadly consequences.
On Tuesday, state Sen. Jackie Speier, D-Hillsborough, called the reports' findings "shameful.''
"It's Keystone Docs,'' said Speier, who has become a frequent corrections critic and who is looking into the June 28 death of Solano State Prison inmate Anthony Shumake.
The reports were commissioned by the Marin-based Prison Law Office, which represents inmates and in 2001 sued the state Department of Corrections over shoddy medical practices. The lawsuit was settled in 2002 after the department agreed to dramatically reshape its health care program.
As part of the oversight of the settlement, three independent prison health experts -- Dr. Michael Puisis of Illinois, Dr. Joe Goldenson of San Francisco and Madie LaMarre, a nurse from Georgia -- this year reviewed medical procedures at several prisons and at department headquarters. Among the findings compiled in two reports:
-- At one prison, an obstetrician sees HIV patients. At another, "an incompetent retired cardiothoracic surgeon manages complex internal medicine patients and makes serious life-threatening mistakes on a continual basis,'' according to the report.
-- Doctors in one unit at Salinas Valley State Prison in Soledad (Monterey County) must conduct exams while inmates remain in their cells, meaning the only way to touch an inmate is through a 4-inch by 12-inch food port. Health clinics at Salinas Valley and Sacramento State Prison have no examination tables.
-- At Sacramento State Prison, forms inmates file to request a visit with a doctor were found piled up on a desk and had not been reviewed in months. At some facilities, according to the report, there is no chief physician, and therefore "physicians monitor themselves.''
The reports' authors were unavailable for comment Tuesday, and many of the allegations in the reports did not include names of doctors, prison locations or other details.
But corrections officials did not dispute the reports' findings, instead saying they are working on a response plan that will be presented later this month to U.S. District Court Judge Thelton Henderson, who is overseeing the implementation of the settlement.
Margot Bach, a spokeswoman for the Department of Corrections, said plans are already being developed to improve supervision of doctors from department headquarters and ensure that doctors are only working with inmate maladies that they are qualified to diagnose.
This is not the first indictment of the prison system's medical system.
Composing about 20 percent of the Corrections Department's $6 billion annual budget, health care services have been blasted for being too expensive and, at times, deadly. Prisons typically employ several primary care doctors and contract with specialists for services.
The state auditor reported in April that three-fourths of medical contracts doled out by the department were not competitively bid, and many prisons fail to review whether providers aren't over-billing the state.
A lengthy review of the entire prison system commissioned by Gov. Arnold Schwarzenegger called for dismantling and rebuilding corrections' health care administration.
And a largely confidential report conducted by a state prison watchdog agency reviewed by The Chronicle earlier this year suggested that three deaths at a Corcoran (Kings County) prison during the last two years could be attributed in part to medical negligence.
Both prison officials and a representative of a union that represents about 600 state corrections doctors say the state faces some of its health care problems because of its inability to hire enough good doctors, leading to many vacancies and forcing some spots to go to physicians with checkered pasts.
Corrections physicians typically earn about $134,000 a year -- a salary that isn't enough to lure many doctors to work inside prison walls, said Gary Robinson, executive director of the Union of American Physicians and Dentists.
"Who wants to work inside a prison, most if which are located in the middle of the desert?'' Richardson said.
Speier, who heads a Senate government oversight committee, said she has begun communicating with some of the state's largest health maintenance organizations in hopes of persuading them to loan executives to help provide advice to change the system without having to raise costs dramatically.
"There is plenty of expertise in this state,'' she said. "Right now, we have a system with extraordinary costs, extraordinary liability and very poor care.''
E-mail Mark Martin at email@example.com.
Posted on Sat, Jul. 03, 2004
Legislator to investigate prison inmate's death
By Karl Fischer and Rebecca Rosen Lum
An aide for Assemblywoman Loni Hancock, D-Berkeley, said Friday her office intends to investigate the death of a prison inmate from Richmond who had a dental infection so severe that he could not swallow for days before officials sent him to an outside hospital.
A report from the ambulance that took 41-year-old Anthony Shumake from California State Prison Solano in Vacaville to a Manteca hospital on Monday stated that his neck "was swollen and red in color down to his clavicle ... patient was also spitting up gray sputum." Shumake died hours later at the hospital.
"The way it was handled raises some serious questions," said Hans Hemann, Hancock's chief of staff. "We'll be looking into it very thoroughly. It raises questions about the entire system as well as for this one family, who must be going through unbelievable anguish."
Prison officials said Friday state law forbade them from commenting about a prisoner's medical issues, adding that the facility's medical staff followed procedure after finding they could not properly care for Shumake.
But the death prompted mistrust and criticism from parts of Richmond's political establishment, led by the Rev. Andre Shumake, a prominent Iron Triangle activist and the prisoner's uncle.
Family members said prison officials have told them next to nothing since sending a telegram Tuesday morning informing them that Anthony Shumake had died and that the body would be cremated if they did not retrieve it.
"There has been tremendous negligence. Now it seems like they're trying to cover everything up," the Rev. Shumake said. "They didn't even have the decency to knock on the door."
Prison officials and the San Joaquin Coroner's Office said Friday they would not release the cause of death for several weeks. Several inmates who knew Shumake told the family he died of heart failure.
Prison doctors did not find that Anthony Shumake needed emergency medical care, but did need care the facility could not provide, Department of Corrections Lt. Mary Neade said. So they called for a basic life-support ambulance to take Shumake on a two-hour ride to Doctors Hospital in Manteca, a facility with which the prison contracts.
"When an inmate is sick we try to treat him here. If the ... medical department feels he can't be treated here, we send them out to the hospital," Neade said. "If staff determines he needs immediate attention, they call 911 and he's treated at the nearest hospital."
The ambulance company did not return calls Friday. A hospital spokesman said the cause of death remained officially "undetermined" pending results of the coroner's autopsy and toxicology tests.
Shumake told the ambulance crew that he'd had a tooth pulled six days earlier and that his wound had become infected, according to the report. The swelling in his neck made it impossible for him to eat and difficult for him to breathe.
The private ambulance crew checked Shumake's vital signs three times during the trip and found no significant changes, the ambulance report shows.
It was the second prisoner death of the year at Solano, a medium-security prison housing about 6,000 prisoners, Neade said. In January a terminally ill prisoner died of natural causes at an area hospital.
Records show Shumake was serving a 12-year, eight-month sentence for
convictions in 2000 of corporal injury to a spouse, stalking and drug possession,
as well as a parole violation from a 1994 attempted robbery conviction.
Inmates' Medical Tab Nears $1 Billion
June 2, 2004
SACRAMENTO — As medical bills for the state prison system approach $1 billion a year, lawmakers Tuesday called into question the use of tax dollars for procedures such as a male inmate's breast reduction surgery and skin treatments at a Beverly Hills dermatologist.
Paying millions to shuttle prisoners to hospitals hundreds of miles from where they are locked up also faced criticism.
With inmate healthcare spending nearly double what it was in 1999, lawmakers are demanding immediate changes to bring costs into line.
"Even if it weren't a tight budget year, this would be something that is absolutely unacceptable," said Assemblywoman Wilma Chan (D-Alameda).
The attacks on prison spending came at a joint legislative hearing and followed a state audit released in April. The audit revealed that prison officials seek competitive bids for less than a quarter of the contracts they enter into with hospitals, and may be routinely paying claims for services never provided.
The state prison system runs 32 facilities with 160,000 inmates, and healthcare accounts for a significant chunk of its $6-billion annual budget.
Prison officials challenged some of the accusations made by lawmakers, but acknowledged that reforms were needed. "We are using the recommendations contained in the Bureau of State Audit report as a blueprint for change," said Jeanne Woodford, director of the Department of Corrections.
Those recommendations include imposing rules to ensure that contracts are negotiated competitively and imposing uniform treatment standards spelling out what is appropriate and when.
But Woodford warned that the department must abide by a number of court judgments requiring it to provide medical care that may seem excessive.
"We are under court mandates affecting our services," she said.
In many cases, officials say, they are unable to attract trained doctors and nurses to work in the prisons and are left no choice but to enter into costly contracts with distant hospitals.
Prison officials also pointed out that the system must tend to thousands of patients requiring special care, including those with AIDS and other diseases, elderly inmates, prisoners in need of transplants, and paraplegics and quadriplegics.
Lawmakers, however, say the department can do better.
"We need to protect the constitutional rights of the prisoners, but excuse me, as a taxpayer I have constitutional rights too, and these guys are getting care that I don't even get," said Assemblywoman Rebecca Cohn (D-Saratoga).
Some legislators pointed out that at the same time prisons are entering into contracts with private healthcare providers with no discernible cost controls, many prisoners are unable to get the most basic treatment.
Sen. Jackie Speier (D-Hillsborough) said she was frustrated to learn — through a tip to the Legislature's government oversight hotline — that just last Thursday a prison inmate had received breast reduction surgery at the same time the department has had to eliminate efforts to curb tuberculosis.
"I understand lots of inmates at this particular prison have undergone this procedure," Speier said. Prison officials say they do not authorize any surgery unless it is absolutely necessary; any treatment that is out of the ordinary must be approved by a team of physicians and headquarters.
"Certainly our policy is not to perform cosmetic surgery," said Renee Kanan, who oversees healthcare services for the department. "But there may be some mitigating factors in this particular case."
Speier shot back: "I can't imagine the necessity for breast reduction surgery in a male inmate."
Cohn demanded that the department tally up the cost for acne and other treatments provided to inmates by a Beverly Hills dermatologist.
The department did not have the figures at the hearing, but Kanan said there are instances where such treatments are medically necessary.
"There are severe cases of acne that are disfiguring," Kanan said. "There would be some circumstances where it would be appropriate medical treatment."
Lawmakers also called on the department to find ways to provide care for inmates closer to the prisons. Sen. Gloria Romero (D-Los Angeles) estimates that the state is wasting millions of dollars by contracting with hospitals hundreds of miles away instead of taking advantage of facilities nearby or providing adequate care in their own clinics.
In fiscal 2002-03, for example, the state spent more than $8.7 million transporting inmates to and from hospitals.
Prison officials said they are working on ways to contain those and other costs — but cautioned lawmakers to be patient.
Woodford said the administration is talking to University of California officials about a plan "to partner with them to create a healthcare system that is more accountable and cost effective."
Assemblyman Todd Spitzer (R-Orange), however, said the auditor's report came out two months ago, and the state Corrections Department should have a clear plan for moving forward by now.
"This is what people hate about government."
Diseases Can't Be Locked In
June 1, 2004
Over recent months, legislators in Sacramento have taken Californians to some pretty grim places in hearings on the state's 32 prisons. No corridor of the $6-billion correctional system is likely to be darker than the one lawmakers plan to explore today.
A joint Senate-Assembly committee will examine profound problems in the prisons' healthcare delivery system, including the tuberculosis and hepatitis C that inmates may carry back to their communities.
Although taxpayers pay nearly $1 billion a year to provide medical care to the state's 162,533 inmates, up from $600 million just three years ago, the extra money hasn't always bought better health.
Consider the arrival of an inmate with infectious tuberculosis in December at Solano State Prison in Vacaville, west of Sacramento. Although Shasta County jail officials had accurately diagnosed and medicated him after he was arrested, he arrived at Vacaville with no TB medications, no TB culture results and no medical records, and infected up to 10 people, according to the California Conference of Local Health Officers, which monitors public health threats.
That does not mean TB runs rampant in the prisons, but it underscores the need to revive the prisons' own Public Health Service, a 40-person unit that had been tracking and treating infectious diseases until it was disbanded in October because of budget cuts.
The prisons also need to grapple better with an epidemic of hepatitis C, which is spread mostly through dirty drug needles and sexual contact. As of two years ago, top prison officials say, the disease had infected an incredible 1 in 3 state prison inmates.
Currently, there is too little testing for and treatment of hepatitis C, and county health officials accuse prisons of fobbing off sick parolees on county health systems.
Poor management goes beyond tracking and treating disease. State prison auditors have described a pattern of overpayment for medical services inside and outside prisons. In the last two years, only a quarter of prison contracts with medical providers were competitively bid, according to a report in April.
A related failure is the lack of a bulk purchasing system to drive down inmate prescription drug costs. California taxpayers pay 66% more to buy medications for inmates than the federal Department of Veterans Affairs does for drugs for former military personnel.
The Schwarzenegger administration has produced some good longer-term ideas. These include possibly turning over prison healthcare to the University of California or a managed-care provider.
First, however, legislators, prison officials and the administration should rein in uncontrolled costs, as well as find money to shore up detection and treatment in prisons. Diseases brought into prison or contracted there should be dealt with there.
Scathing report on prison health care still not out
Sacramento -- The death last week of an 80-pound inmate at a prison in Corcoran who hadn't eaten in 40 days might not have surprised California corrections administrators.
More than a year ago, a state prison watchdog agency issued a blistering confidential report on health services at the facility, suggesting three inmate deaths in the previous two years could be attributed in part to negligent medical treatment.
Detailing conditions at the Substance Abuse Treatment Facility in Corcoran, the report chronicled a health department in disarray. The report, a copy of which was reviewed by The Chronicle, has not been publicly released by Gov. Arnold Schwarzenegger's administration.
Problems ranged from lax oversight that has led to the wasting of millions of taxpayer dollars to full-time doctors who see only a handful of patients and continually sleep on the job, according to investigators with the Office of the Inspector General.
Now an inmate is dead after apparently slowly starving himself to death, and prisoner advocates are wondering just what it will take to improve medical treatment at the Substance Abuse Treatment Facility in Corcoran.
A Bay Area lawmaker who is leading the charge to reform California's troubled corrections system is demanding that Schwarzenegger publicly release the inspector general's report.
"I'm becoming concerned that the administration is either dragging its feet or covering something up,'' said state Sen. Jackie Speier, D-Hillsborough, who has been asking for several inspector general reports for more than a month. "What are they hiding?''
A spokeswoman for Schwarzenegger said administration lawyers would likely release the reports to Speier -- and the public -- but were redacting names and other information that might be relevant to ongoing prison investigations.
Meanwhile, corrections officials say they're still trying to determine exactly what happened to Khem Singh last week. Singh, 72, had been on and off hunger strikes since he was sent to prison in 2001. A Sikh priest who lived near Modesto, Singh was serving a lengthy sentence for lewd and lascivious conduct with a child under 14.
Before dying, he had not eaten in 40 days, according to Patrick Hart, chief deputy district attorney for Kings County. Prison documents indicate he was removed from his cell Feb. 14 and taken to a local hospital, where he died two days later of heart and lung failure attributed to starvation.
Corrections officials say Singh had been in and out of a medical clinic at the prison but was not there this month.
"After 40 days, you would think he would have been in the hospital,'' said Kelly Santoro, public information director for the prison.
Hart said his office has determined there was no criminal negligence by prison staff, but sources said Wednesday the inspector general's office had begun a probe this week. The office reports to the governor and conducts financial audits and investigations of prison issues.
Prisoner advocates say death by starvation is something that shouldn't happen in modern prisons.
"You don't just starve to death overnight,'' said Don Specter, executive director of the Prison Law Office. "This amount of inattention is inexcusable. ''
State prisons do have policies to handle inmates on hunger strikes -- the policies were created after Specter's office won a 2002 class-action lawsuit alleging inhumane medical conditions in all state lock-ups. An internal review is determining whether prison medical staff correctly followed procedures, said Rosanne Campbell, deputy director of health care services for the Department of Corrections.
It's not the first time health care at the facility has been investigated.
Lesser known than its neighbor, Corcoran State Prison, the Substance Abuse Treatment Facility houses more than 6,200 inmates.
Last January, investigators with the inspector general issued a report that concluded medical services there were inexcusably bad. A probe that lasted more than a year found full-time doctors paid more than $90,000 annually were only available to inmates 12 hours a week and full-time dentists spent most of their days outside the prison at private practices. Among the other findings:
-- Three inmate deaths may have been caused in part by lax medical care. One inmate with a blood disorder was found lying prone in his cell in May 2001 and told a nurse "he couldn't go on,'' according to the report. The nurse told him to see a doctor the next day. He was later found vomiting blood and was pronounced dead soon after in the prison emergency room.
-- One inmate in 2000 was diagnosed with tuberculosis, a highly contagious disease, but not isolated from the prison population for more than a year. Two guards and an inmate later tested positive for TB.
-- Investigators witnessed pharmacy workers throwing away 30-pound garbage bags full of medication. They determined costly drugs were shipped to the prison for inmates who had been transferred or released in the same fiscal year that pharmacy spending at the prison exceeded the allotted budget by 211 percent, or more than $3 million.
Corrections officials say they have a comprehensive plan to address each issue raised by the inspector general's report and review progress monthly. Included in the plan are establishing working hours for medical personnel and better tracking systems for medications.
"A lot of it was oversight, and we're monitoring all of that,'' Campbell said.
She said it would be "premature'' to say that the recent death at the facility shows that progress in improving medical care had been slow.
"We're looking into it, and if we still see gaps (in care) we will address that,'' she said.
But Speier said Singh's case may show yet another example of problems within corrections that never seem to be fixed.
She and Sen. Gloria Romero, D-Los Angeles, held hearings in January highlighting a code of silence within prisons that prevents the system from policing rogue guards, a subject that came up in legislative hearings nearly a decade ago. And the state is in legal trouble for failing to change some procedures at Pelican Bay State Prison that were first described in a 1995 federal court decision.
Speier and Romero are authoring legislation that would add funding to the inspector general's office and require that most of the office's reports be made public. She believes the public disclosure of reports would add pressure on corrections officials to make changes that benefit guards, inmates and taxpayers, who keep footing the bill for expensive litigation.
Schwarzenegger, who first proposed eliminating the inspector general's office but has since changed his mind, has not offered an opinion yet on the legislation.
Spokeswoman Terri Carbaugh said the governor generally does support beefing up the office and more public disclosure. The governor recently made public 20 previous inspector general reports, and Carbaugh said he planned to release more as soon as lawyers completed their review.
Speier said she would place another call Wednesday to the governor's office to seek the other reports, including the study of medical care in Corcoran.
"There are numerous examples of complete mismanagement in corrections, and this is precisely why we need more oversight, '' she said.
E-mail Mark Martin at firstname.lastname@example.org .
Dying inmates seek release
11:38 PM PST on Sunday, January 25, 2004
By STEFANIE FRITH
Lonnie Creech is dying. So is Helen Loheac.
Both sit behind razor wire and iron bars at California prisons. Both are waiting for a compassionate release.
Creech, 52, has lung cancer and has been given less than three months to live. Loheac, 81, has a chronic kidney ailment and goes to dialysis three times a week.
Their chances of going home to die, though, are slim.
Legislation passed in 1991 allows some sick inmates with fewer than six months to live and who are not threats to society to die at home.
Last year, only 17 inmates out of 48 who applied won a compassionate release from the California Department of Corrections.
Seven more applied to the Board of Prison Terms. One was denied and three more are being considered by the board.
Last year, Vidilla Spragin of San Bernardino was granted her request and was released from the California Institution for Women in Chino.
Spragin, who had killed her husband by setting him on fire, died last month from liver cancer.
Creech was sentenced six years ago to 14 years for assaulting a Riverside police officer and making terrorist threats. He spends his days in the infirmary at the California Rehabilitation Center in Norco, said Lt. Tim Shirlock.
"He qualifies for a compassionate release," said his sister, Vangel Creech, who lives in Murrieta. "He's in a very weakened condition."
Creech's brother Dub, a retired Riverside police officer, said he never thought Lonnie would receive more than two years in prison for his crime.
He was convicted of pushing a gun at a police officer after his in-laws reported he was suicidal and had a gun in the same Riverside apartment as his wife and child.
Vangel Creech said her brother pushed the gun away after an officer shoved it in his eye.
"He's been dealt a bad deck of cards," said Dub Creech. "He's a great guy. We just want him to spend his last days outside of that rat hole and just spend his last days with his family."
Creech is a former auto mechanic with three children. His health has suffered all his life, said Vangel Creech.
His right foot was severed in a car accident and in 1992 he had a heart attack, she said.
In July he was diagnosed with small cell lung cancer and a tumor in his stomach, according to Sarv M. Grover, California Rehabilitation Center Chief Medical Officer.
A compassionate release request with the California Department of Corrections was denied in September by then-director Edward Alameida. Two weeks ago, a second request was denied by acting director Richard Rimmer. Spokeswoman Terry Thornton said the decision was based on Creech's criminal history and current medical condition.
"He is still ambulatory," Thornton said.
Creech's family plans to appeal the decision to the Youth and Adult Correctional Agency and legislators.
Recently, the Riverside County District Attorney's Office, which prosecuted Creech, wrote a letter to the corrections department stating it would not be opposed to his release, as long as he wears an electronic monitoring device and is not allowed access to drugs and alcohol, said Deputy District Attorney Robert Spira. Former Youth and Adult Corrections Agency secretary Robert Presley also wrote a letter on Creech's behalf.
Even if the CDC had recommended that he be released, the sentencing judge would have had the final say, said Thornton.
Being terminally ill is unfortunate, but not necessarily a reason to be released from prison, said Jim Benson, vice chairman of the Santa Ana-based Citizens Against Violent Crimes. Each case should be reviewed individually and one must make sure a sick inmate wouldn't be able to commit another crime, he said.
Benson said he is, however, open to making provisions so that family members can visit with terminally ill inmates more often. "I would favor some flexibility," he said. "What we are concerned about is protecting citizens."
Helen Loheac, an 81-year-old woman who is serving a 25-years-to-life sentence at the California Institution for Women for conspiracy to commit murder, is also waiting to hear if she will receive a compassionate release.
Loheac has a chronic kidney ailment and is shackled by correctional officers every other day to go to dialysis. The Board of Prison Terms is reviewing her case, said spokesman Bill Sessa.
"Her time is very short," said Daisy Benson, an inmate at CIW. "(It) just makes me crazy, this old doll sitting here waiting for handouts."
At the time of her conviction, Loheac was 69 years old and living in Shasta County in Northern California.
Her son, who was in jail, said he was sending a friend to her house to pick up some items. Meanwhile, an informant had reported to police that the son had accepted his offer to kill the only witness to the son's crime.
When an undercover officer, posing as the friend, came to the house Loheac gave him some money, a photograph and the pink slip to the son's car. Loheac was then convicted of conspiracy for a murder that never happened.
Inmates like Loheac and Creech who are terminally ill are no longer a threat to society and should be released, said Cynthia Chandler, co-director of the Oakland-based Justice NOW, which assists women in prison.
Often, ill inmates don't even realize they are behind bars and up to $80,000 per year can be spent treating them, she said.
"The only people you are punishing are family and friends," Chandler said.
Reach Stefanie Frith at (909) 893-2114 or s email@example.com
Rotting in Jail
L.A. County jails have become incubators for an ugly drug-resistant skin disease, venting it into state prisons and out into the community as inmates with still-active sores bring the infection home to family and friends. Though down somewhat from its July-September peak caseload, incidence of drug-resistant “staph” (Methicillin-resistant staphylococcus aureus or MRSA) is still running at twice last year’s level. Eradication in the jails is nowhere on the horizon and counter-measures recommended over a year ago have not all yet been implemented.
One strain of MRSA has been a chronic problem in hospitals, where it usually attacks the elderly or immune-compromised; the so-called “community-based” strain thrives in crowded quarters where people of any age share clothing or equipment (sports teams) or are simply in frequent physical contact (day care centers). Jails, where these factors are often coupled with limited access to showers, provide an ideal hothouse for its spread.
At the onset, MRSA infection might be mistaken for an intense insect bite reaction, but the inflammation expands in size, continues to ooze, and can spread from one part of the body to another. On the scalp – less visible and less well-washed – infection often proliferates. If not properly treated, serious complications can follow, including blood infection (bacteremia) and inflammation of the heart membrane or bone marrow. There have even been a few fatalities at Texas prisons, according to a report in Morbidity and Mortality, published by the Center for Disease Control.
Though some inmates say the problem goes back to 2000 or earlier, growing complaints at the Wayside (North L.A. County) facility in late 2001 took officials of the L.A. County Sheriff’s Department (which administers all county correctional facilities) on a sidetrack: an assault on spiders suspected to be coming in with clothes and bedding. Despite fumigations of the laundry facility, no spiders were captured dead or alive. By April 2002, bacterial cultures from skin complaints were showing a high MRSA incidence, and in June, Sheriff’s medical personnel notified the County Health Department of mushrooming infection rates. A joint task force of the two agencies started meeting regularly in summer 2002 and – after consulting California’s Department of Health Services, the U.S. Center for Disease Control, and veterans of an outbreak in Georgia’s prison system – developed an action plan to roll the bug back.
Strategies included heightened skin infection screening on intake, better monitoring (with more culturing of suspicious lesions), and improved inmate education and videos on spotting symptoms and preventive measures (frequent hand-washing and showers, not sharing clothing or soap). More frequent and disinfecting laundering was urged and, of course, prompt medical attention to suspicious wounds, which would be treated by a better-trained health staff. Finally, based on input from the Center for Disease Control, anti-bacterial liquid soap was to be provided periodically.
By the end of last year, 921 cases had been confirmed, with 57 inmates hospitalized, 10 of them with invasive complications. So this February, L.A. County chief medical officer Thomas Garthwaite began reporting monthly (or more) to a perturbed Board of Supervisors. While the caseload climbed, averaging almost 130 per month during the first half of the year, Garthwaite’s reports chronicled task force countermeasures implemented at a leisurely pace. In March, jail medics were being encouraged to do more wound cultures; in April, a cost estimate of the liquid soap was expected and “logistical barriers” to increasing linen changes were noted. A lack of trained jail personnel meant inmates must go to County-USC to get wounds drained. July cases spiked to 216; August’s and September’s hovered around 200.
November’s number, 155 cases, was an encouraging turn downward. But it’s too early to call it a trend. Random interviews of inmates released from Twin Towers don’t show that there’s much familiarity with the term “staph” or recollection of seeing any videos. The anti-bacterial soap is slated to start in January, says Capt. Rod Penner, who oversees medical services for LASD. Why so late? “We couldn’t introduce it until other parts of the program were functioning well, because we wouldn’t know if reductions were due to that or other improvements,” explains Dr. Elizabeth Bancroft of the Health Department.
Control measures may be working, but the jails are still exporting cases
which may come back to haunt them. Sergio Frutis of Pomona, fresh out after
three weeks behind county bars, isn’t sure he’s heard of staph and says
he saw no video when he came in. “Does this look like it?” Frutis asks,
displaying a bump on his breastbone about as big and bright as a glowing
cigar end. It keeps oozing into his T-shirt; he says. He put some lotion
on, saw a nurse, received no pills, and requested a medical appointment.
The next day, he was in court and got released, never having seen a doctor.
Now he has no idea what he has or where to go for treatment.
© 2003 Southland Publishing, All Rights Reserved
Chowchilla inmates sue over medical service
Seven inmates at Central California Women's Facility in Chowchilla have
sued prison medical staff members, alleging malpractice, negligence and
"We need some kind of watchdog board to oversee these doctors so that there doesn't have to be all this litigation," said Michelle Kinser, one of the plaintiffs, in a statement issued by Justice Now, an Oakland-based human rights organization that works with women in prison.
Kinser, a San Jose native, began suffering extreme weight loss, tremors and pain in and around her pelvis and bladder nearly two years ago. Though she was diagnosed with a possible bladder mass, Kinser said, Mekkam canceled two referrals to a surgeon and an oncologist.
She said Mekkam told her she was suffering from a mental disorder and was imagining symptoms despite a history of multiple carcinomas, or cancerous growths, including bladder cancer that required chemotherapy in 1995.
Mekkam did not return The Bee's phone calls.
Other defendants named in the lawsuits, which were written by the inmates, include physicians Loraine Goodwin, Ernest Reeves, Jagdev Singh, Sampeth Suryadevara, Kuldip Behniwal, a urologist in private practice, and several nurses.
Some of the plaintiffs allege they were denied referrals to specialists and were removed from the prison's chronic care program, though they were clearly ill. "These cases make a powerful statement, exposing medical neglect that is tantamount to torture," said Cynthia Chandler, co-director of Justice Now. "Taxpayers need to know how their money is being misused."
The Chowchilla prison, which opened in October 1990, houses more than 3,000 female inmates and employs more than 900 workers. Russ Heimerich, spokesman for California Department of Corrections, said the agency is frequently sued for medical neglect by inmates, but almost always prevails in court.
He said all the state's inmates receive the medical care they need. "We are both morally and legally obligated to provide necessary medical care to inmates, and we do so."
Alice do Valle, spokeswoman for Justice Now, said the lawsuits are not the first legal remedy the women sought.
Several of the plaintiffs had filed earlier complaints with the California Medical Board, but were told that prison doctors do not fall within the board's jurisdiction, she said.
"What I want to know is whose jurisdiction these doctors fall under and who is supposed to be overseeing their practice," said Loraine Stallings, another plaintiff, in the Justice Now statement.
Stallings, who was diagnosed with a tumor in her left ear, is suing prison doctors for attributing her symptoms of constant ear pain, infections, headaches and hearing loss to excessive wax buildup. She said she now faces surgery that doctors say will cause facial drooping, complete loss of hearing in her left ear and damage to the taste buds on the left side of her mouth.
The five remaining lawsuits alleging similar complaints were filed by inmates Eleanor Guiterrez, Michelle Joe, Wilma Kilpatrick, Cynthia Escobar and Bonnie Stum.
The reporter can be reached at firstname.lastname@example.org
For the reporters reading this: My good friend who is in prison sends me many details about the almost unbelievable conditions inside our prisons and jails. These are things he does not make up but witnesses personally with his own eyes. I have never known him to lie.
He was recently taken to the old men's central jail in downtown L.A. to await a resentencing. He was there for a period of one month and while there he told me about something that was happening to a cellmate.
The young man had been there for several months awaiting trial. While there he had picked up a foot disease. My friend described it as quite nasty with lots of peeling skin. I asked him, "Is it athlete's foot?" He said, "If it is I've never seen anything like it before." He said besides the flaking and peeling of the skin, which was quite deep, the area surrounding the skin was blackened. This should have been healthy tissue but was not. This was a white kid and the dark skin was not part of his natural color. It was clearly connected to some kind of infection or fungus or something.
I got the address of Merrick Bobb from the Internet and asked the boy to write directly to him as we felt that at least this person knew enough about the failures of the present system to keep an open mind and listen to his plight. I have not followed up on it further.
The inmate was very concerned as the condition was only getting worse and jail staff appeared not to want to be bothered. When he went to the clinic for help he was given Vasoline. Of course, that was ineffective. The prisoner then bought a tube of cream at canteen (at an inflated price) which only had about 10% of the type of medicine he believed he needed to cure the problem. He needed something stronger but was denied anything else from the clinic. In spite of the worsening condition, the clinic continued to recommend Vasoline.
Adding to the situation was the fact that the men's showers were not draining well. When the men showered, the water backed up two to three inches around the men's ankles. My friend thought this alone could be helping in he spread of the disesase and he was afraid to take a shower even though he had some shower sandals.
Inmates there were afraid to file a grievance. You know the old story. Nearly every complaint is ignored. For inmates who persist and continue to file complaints there is guard retaliation. Retaliation is as certain as night follows day. How do you get a handle on something where the truth is throttled?
For people who think this is no big deal, consider the fact that these
diseases are easily spread. Some men are not held long at the old jail
and are soon released back to the communities they came from. They carry
with them whatever illnesses or conditions they picked up in jail. It is
a case ALWAYS of being sicker than before you went in and I continue to
believe that this sort of
Prison medical care suit settled
Prison advocates yesterday announced a tentative settlement of a class- action lawsuit that they say will improve medical care for the 160,000 inmates in California's 33-prison system.
For Mary Kelly, whose 32-year-old son, James Anthony Kelly, died of tongue cancer that had gone untreated at Corcoran State Prison, it is too late.
The Simi Valley mother said one prison doctor had told her Tony's pain came from his biting down on his tongue. Her son was in prison on a two-year sentence for possession of psychedelic mushrooms.
"Even if they are in there for life, they don't deserve to die for not being treated for an illness," she said. "They shouldn't die of a disease that is curable. We miss him every day."
The Department of Corrections, whose inmates have a constitutional right to medical attention, must submit its new medical protocols -- addressing training of staff, timeliness of care and other issues -- to the U.S. District Court by Feb. 15.
The Prison Law Office in San Rafael filed the lawsuit on behalf of nine plaintiffs, including a paraplegic inmate whose catheter went unchanged for months and a prisoner with AIDS whose pain medications were cut off eight times.
The lawsuit alleged that prison officials relied on inadequately trained and poorly supervised medical technical assistants; failed to provide adequate nursing coverage on evenings and weekends; and failed to treat prisoners with chronic conditions such as AIDS and kidney disease.
Donald Specter, director of the Prison Law Office, said the agreement had been reached Monday afternoon after working more than two years to settle the case.
"This would never have happened without a lawsuit," Specter said. "We're overjoyed that it is going to make the prisons' conditions more tolerable without having to go through a giant war to prove that the current conditions are shoddy."
Department spokesman Russ Heimerich said budget allocations for medical care of prisoners had increased from $316 million in 1998-99 to $663 million in the current fiscal year.
"There has always been a dispute over whether our medical care meets the constitutionally mandated minimal standards," he said. "By the dollar figures alone, we've dedicated ourselves to improving health care in the prison system. "
Among other provisions, the settlement requires that registered nurses be available in prison emergency rooms on a 24-hour basis, establishes time limits for prisoners to receive medical care and creates a panel of clinicians to audit the Department of Corrections' progress.
Heimerich says prison officials are pleased that the settlement, which is for injunctive relief and does not cover any damages sought by the nine plaintiffs, allows them to put the program together without the outside intervention of a federal master.
The settlement is subject to a fairness hearing and final approval by U.S. District Judge Thelton Henderson.
Chronicle staff writer Bob Egelko contributed to this report. / E-mail
Pamela J. Podger at email@example.com