‘Ticking Time Bomb': Prisons Unprepared For Flu Pandemic

[Guest guest]

Wonderful post! What goes along with this is that prison medicine is

terrible, so inmates are released sick and infectious. 2 items:

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.

By Jordan Rau, Times Staff Writer

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 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.

, 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.

http://www.latimes.com/news//la-me-

prisons14apr14,1,6067346.story?coll=la-newsaol-headlines

Health-Care Contractor at Va. Prisons Under Fire

Other States Question Company's Services

By Gelineau, Associated Press

Thursday, May 18, 2006; VA04

A prison health-care company that has come under fire nationally for

what some call shoddy medical care is under contract with the

Virginia Department of Corrections and is stirring similar complaints

here.

Prison Health Services, the largest U.S. provider of health care to

inmates, has been the target of lawsuits and allegations of poor

medical care and neglect in other states. The company provides care

to about one-third of Virginia's 31,270 inmates.

In 2004, 330 medical grievances were filed by inmates at Virginia

prisons using the Brentwood, Tenn., company, Department of

Corrections spokesman Larry Traylor said. The department does not

track how many of those grievances were deemed justified, he said.

Inmates, however, in dozens of complaints shared with the Associated

Press, say the care is so bad, some fear for their lives.

" I know we're in prison, and I know things won't operate how they do

out there -- but we are not sent here to die, " said Aimee Mootz, a

former inmate medical aide in the infirmary at Fluvanna Correctional

Center for Women.

Prisoners regularly received substandard care at the infirmary --

including one seriously ill inmate who, Mootz said, was often left

alone by medical staff to sleep in a pool of her own vomit.

Prison Health Services and the Department of Corrections said they

are unable to defend themselves against complaints because of patient

confidentiality laws. A spokeswoman for the contractor would not

disclose how many lawsuits have been brought against the company but

said 96 percent of such cases are dismissed before trial.

" It's worth noting that the practice of medicine is fraught with

exposure to lawsuits, and a disproportionately high number of

lawsuits originate in prisons and jails, " company spokeswoman

Morgenstern wrote in an e-mailed response to questions. " We have an

excellent team of medical professionals in Virginia, and they work

hard every day to provide quality medical care. "

Prison Health Services provides medical care at more than 310 jails

and prisons in 37 states. It has been under contract with the

Virginia Department of Corrections since 2001 and is used by eight of

Virginia's 42 prisons, Traylor said. Between Feb. 1, 2004, and Jan.

31, 2005, the company was paid nearly $44 million, he said.

The Department of Corrections' Office of Health Services is charged

with monitoring health care for Virginia's inmates. Traylor provided

AP with a copy of a 2004 internal audit report that analyzed how well

the agency was monitoring two PHS-run infirmaries and a third run by

the Department of Corrections. For the most part, the audit

concluded, there were adequate controls over health service

operations at all three medical units.

The audit noted, however, that there were areas that needed

improvement. They included oversight of drug distribution,

documentation of medical procedures and inmate medical records and

compliance with inmates' special dietary needs. The audit did not

include a review of the quality of the inmates' health care.

Traylor pointed out that while there were 330 medical grievances

filed against the contractor in 2004, hundreds of grievances were

also filed that same year at Virginia prisons that do not use the

company, indicating it is not a company-specific issue.

Many inmates, he said, arrive at prison with multiple medical

conditions they have long neglected and often expect immediate cures.

Still, other states have encountered problems with Prison Health

Services:

· In Alabama, a court-ordered monitor of health care at the state's

women's prison found that Prison Health Services made mistakes in

prescribing drugs and gave substandard care to 19 of 22 prisoners

whose charts he reviewed. Women suffering from HIV, staph infections

and other medical problems were consistently denied treatment, the

monitor wrote in a report.

· In South Carolina, a mentally ill inmate who committed suicide last

year left a letter for his wife complaining that he hadn't received

his medication for seven days. A special jury assembled by the county

coroner later concluded the inmate died because of poor medical care

from Prison Health Services. The Richland County Council terminated

its contract with the company, with one member calling its

service " unacceptable and inhumane. "

· In New York state, the Commission of Correction began investigating

Prison Health Services in 2000, soon after it entered into a contract

with many New York prisons. The commission found the company cut

corners in staffing by hiring physicians with questionable

credentials and asking lower-paid medical providers to deliver care

beyond their levels of expertise to save money, said Lawrence,

the commission's director of operations. New York continues to use

the company in some of its prisons.

" The fundamental problem with PHS and the companies that are like it

is that they're business corporations holding themselves out as

medical care providers, " Lawrence said. " Physicians are not in

charge, [and] profit imperatives and other business practices tend to

trump medical autonomy. "

Morgenstern, the Prison Health Services spokeswoman, said the

company's physicians and medical staff have exclusive control over

decisions requiring professional medical judgment. She noted that

under Virginia laws, the company does not need to be owned by

physicians.

Security concerns often overshadow the medical needs of inmates, said

Cohen, former director of medical services at New York City's

Rikers Island jail and now a national expert on correctional medical

care.

" It is my experience that for-profit health-care providers fail to

respond to the routine conflicts between health care and security to

the detriment of prisoners' health, " he said.

Fluvanna inmate Marguerite Brown, 51, said the prison's nurses

repeatedly ignored her pleas for help after she told them she'd been

bleeding heavily from fibroid tumors. Brown said the nurses sent her

away with vitamins for anemia. She said she eventually had to be

rushed to the emergency room for a blood transfusion.

" It's been rough -- real rough, " said Brown, serving a 13-year

sentence on a variety of fraud and credit card theft charges. " If it

weren't for God, I probably wouldn't know which way to go. "

Inmates from every prison in Virginia that uses Prison Health

Services have lodged medical complaints with the American Civil

Liberties Union of Virginia, executive director Kent Willis said. The

ACLU received 167 inmate health-care complaints in 2005, he said.

In letters to the ACLU that were shared with AP, inmates from PHS-run

facilities complained about a variety of problems, including chronic

medication shortages and constant neglect of serious medical issues.

" This place is killing me, " wrote Greensville Correctional Center

inmate Larry AsBury, who said more than half the inmates he knows at

Greensville are covered in rashes that go untreated. AsBury, who said

he also has tuberculosis, wrote that he once waited months for a

doctor to remove a cast from his wrist, finally becoming so

frustrated he used a pair of fingernail clippers to cut it off.

Willis acknowledged that garnering public sympathy for inmates is

tough.

" You combine that with the fact that the whole process is so

isolated, [and] it's difficult for information critical of the

services to surface, " Willis said.

http://www.washingtonpost.com/wp-

dyn/content/article/2006/05/17/AR2006051700714.html