Prisons' Keystone Docs

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Prisons' Keystone Docs

 

Health care is another mess to be cleaned up.

 

When some California doctors aren't competent enough for a private practice,

they end up in prison. And get paid for it. According to a report by a panel

of experts, the prison system is a haven for staff physicians with professional

shortcomings, substance abuse and mental health problems. The result for

inmates has been medical care that sometimes does more harm than good. For a

system as mismanaged as the state prisons, the findings shouldn't have been a

surprise. But the problems were worse than expected, even by Prison Law Office,

the

civil rights activists responsible for the study. Don Spector, head of that

group, told the L.A. Times he'd always known there were prison doctors who

shouldn't be practicing medicine, but he didn't know it was this bad. In their

survey, the panel of experts found four doctors at one prison with criminal

backgrounds, loss of privileges at private hospitals or mental health problems.

One

retired surgeon manages patients with complex internal-medicine problems and

makes life- threatening mistakes on a regular basis. An obstetrician is

overseeing HIV patients; a neurosurgeon is treating patients with internal

medicine

problems, and one doctor who had lost his license for seven years for

incompetence and alcoholism is vice chairman of a credentialing committee as

well as

overseeing a group of internists, although he has never practiced internal

medicine. What a crew. Keystone Docs is what state Sen. Jackie Speier

(D-Hillsborough) calls them. The prison want ads, she told the Times, must say

something

like " Bad doctors apply here. " The California system is known for its overpaid,

politician-buying prison guards, and an almost total lack of accountability

for management failures. Among the latest of strange occurrences is the recent

promotion to chief deputy warden of an employee at the Tehachapi prison who in

1995 was almost fired for misconduct. (He led a raid of masked prison guards

on prisoners suspected of harboring drugs and weapons, and several prisoners

got injured.) Strange way to run a prison. Gov. Arnold Schwarzenegger has a

major challenge in cleaning up this system. But there are signs of progress. The

Department of Corrections, after losing a lawsuit brought by Prison Law, now

has set out to improve its medical care. The report on medical care, ordered by

a federal judge, is one of the first steps. Next will come remedial training

for physicians and, according to officials of the department, a stricter

adherence to policies. While they're at it, they'd better improve the wording of

their help-wanted ads.

 

 

Copyright 2004 Long Beach Press Telegram

Los Angeles Newspaper Group

 

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http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2004/08/11/BAG0G85QLF1.DTL

 

 

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 markmartin.

 

 

 

 

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