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Old 08-27-2003, 12:17 PM
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Default Prison Medicine Costly Decisions Cost lives

I just read the series of Articles in the Columbus Dispatch below:

Cost of inadequate care is measured in human terms and millions of dollars

Monday, August 25, 2003

By Randy Ludlow
Illustration: Photo, Graphic

William Reynolds Sr. died after his pneumonia was diagnosed but treated only with Pepto-Bismol.

David Thiessen died after a nurse waited 40 minutes to call an ambulance as he suffered epileptic seizures.

And Terri Lynn Luckel underwent emergency surgery for internal bleeding and fell into a coma for more than two weeks after her blood-thinning medication was doubled.

Atop the cost of lives lost and damaged, Ohio taxpayers have parted with $1.1 million during the past three years to settle claims of medical negligence and wrongful deaths within state prisons.

The payments, mostly to prisoners or their estates, were spawned by a problematic prison health-care system that critics denounce as long on mistreatment of inmates and short on cash and accountability.

The Dispatch and WBNS-TV (Channel 10) conducted a three-month investigation, including a review of thousands of pages of state records, and found:

* Per-inmate spending on health care has edged up 9 percent since 2000, while medical costs outside prison have increased twice as much. The state credits efficient practices; critics call it a prescription for poor care.

* Prison administrators and doctors are pressured to contain medical costs, with central-office approval required for certain surgeries, tests and drugs. Doctors have been scolded for ''liberal'' referrals of inmates to specialists.

* Spending limits on medical contracts progressively have ratcheted down costs, with caps set at the amount paid to low bidders the prior year. One contractor says the practice yields lower-paid, less-trained prison physicians.

* State assessments of the quality of care provided to inmates by physicians and other medical providers are secret amid what critics portray as a near-total lack of accountability and outside review.

In response to the findings of the investigation, the state senator in charge of a prison-oversight committee plans an examination of health care behind bars, and the prisons director wants to identify and correct problems.

''It's gotten to the point where I think they (prison officials) feel they can do whatever they want. I think that's been a real problem for the past couple of years,'' said Sen. Mark Mallory, a Cincinnati Democrat and chairman of the committee.

''The reality is, we are talking about human beings, and we're talking about the expenditure of public money and the accountability of public money, and those things should really be of concern to everybody in the state,'' he said.

Mallory said he will assign the staff of the joint House-Senate committee to examine the quality of health care in Ohio prisons and report back to lawmakers.

''We need to get into the issues of medical care inside the institutions and again make sure it is provided in a timely manner and as efficiently as possible.''

Prisons director Reginald Wilkinson said he would welcome any legislative review, and will talk with prison officials to determine where problems exist and seek solutions.

''Where situations can be remedied, that's what I want.''

Hidden costs

Pending lawsuits against the Ohio Department of Rehabilitation and Correction alleging that inmates died because of inadequate or negligent care could yet boost one of the hidden costs of health care behind bars.

''Certainly, there are unfortunate incidents. But even when you look at the grim side of what happens when people die in prison, our mortality is a lot less than the average population in Ohio,'' Wilkinson said.

Lawyer Alphonse Gerhardstein, president of the Prison Reform Advocacy Center of Cincinnati, said of inmate claims for damages: ''The state's getting off cheap. The number is tiny compared to the problem.''

The state paid Barbara Slade-Lanier $20,000 in May to settle the wrongful-death suit she filed over her son's lack of care in prison, but she still feels cheated. ''As far as I'm concerned, they got away with murder.''

Slade-Lanier, called ''Love'' by her first-born, David, still wells with tears and anger while reading letters he sent home to Cleveland from the now-closed Orient Correctional Institution, southwest of Columbus.

Hi, Love. ... Every night, I just pray I'll make it out of here alive. I'm very sorry for what I've done, but I'm not ready to die. I really need these shots and I'm not getting them down here.

The 27-year-old robber died Sept. 22, 2001, of a toxic overload of iron that was not adequately flushed from his body after receiving blood transfusions required by his anemia disorder.

''They knew what he needed to survive, and they said they gave it to him. But if they did, then he'd be here,'' she said. ''He didn't take a life, and he shouldn't have had to pay with his life.''

Shrinking budgets

The amount taxpayers pay for prison medical care will top $122 million this fiscal year. The 2000-01 medical budget allocation of $125.7 million suffered a $14 million (11 percent) cut and has yet to return to the same level.

From paying $6.79 per inmate per day in 2000, the department now spends $7.40, a hike of 9 percent during the same time the medical-costs component of the Consumer Price Index rose 19 percent.

Dr. Robert Greifinger, former medical director of New York Department of Corrections, warns of the price for inadequate funding.

''The budgets for health care for inmates have to keep pace with medical-care inflation. If they do not, not only will the inmates suffer, but the public health will suffer with greater ultimate costs to the taxpayers,'' he said.

For the current fiscal year, the medical budget grew by $4.2 million, or 3.4 percent, but the health-care budgets of 25 prisons -- many housing more inmates than a year ago -- were cut an average of 11 percent.

Prison officials say the institutional reductions are largely attributable to retaining $10.8 million to directly distribute to prisons as needed instead of moving funds between accounts.

Ohio Department of Rehabilitation and Correction records show ongoing pressure to contain costs, with the medical director's approval required to prescribe certain medicines or authorize certain procedures for inmates, including hernia operations.

Prison physicians have grumbled about what they apparently view as limits on the care they prescribe.

In a memo to prison health-care administrators on March 29, 2002, Kay Northrup, director of the correctional health-care office, asked that medical providers be instructed to alter the message some were giving inmates.

''Please discuss this issue with your physician, dentist, etc., to be sure they are citing clinical reasons, not budgetary reasons, for treatment decisions. If you have a problem with any of your clinicians on this issue, please let us know,'' she wrote.

In a 2001 e-mail, Northrup instructed prison officials to tell podiatrists they were ''no longer in the boot business'' and to stop ordering special footwear for inmates with feet hobbled by stiff state shoes.

''There has been some discussion about the need to improve the state shoes . . . (as) these may contribute to foot problems. . . . Such recommendations for alternative footwear should be strictly limited to true medical need -- diabetics who develop foot ulcers due to the stiffness of state shoes.''

Dr. Bruce Martin, medical director of Ohio's prison system, says the quality of health services has not been compromised -- and, in fact, has improved -- even as administrators admittedly work to restrict spending.

The system's nationally recognized telemedicine program, which allows inmates at far-flung prisons to be ''seen'' by specialists in Columbus, has helped hold a line on costs along with increased use of generic drugs and effective, but less costly, alternative medical practices, Martin said.

Wilkinson observed: ''Even Ohio State and Grant hospitals are doing things to save costs. The costs we are saving are not indicative of a lack of medical care. The mission here is to not spend more taxpayer dollars than we absolutely have to.''

Gerhardstein, who won a legal bid to improve prison psychiatric care, replied: ''It's a short-sighted reduction in today's dollars for a larger expenditure over time. Certainly, the need for medical care has not been cut.

''If you're going to try to provide 44,000 prisoners with adequate medical care, plus make a decent profit for a private company, and then cut the budget that's necessary for that medical care, it's not going to happen. The inmates are going to lose.''

Compromising quality

The prison system has reduced medical costs by using contract caps to gradually pay less to the companies providing the doctors, dentists and others who work in prison clinics.

For example, the contract cap for physicians at the Lebanon and Warren prisons northeast of Cincinnati was $260,000 last year, with the winning low bid coming in at $198,000 -- the amount at which the cap was set for this year.

One provider cautions that the spending limits placed on prison medical-care contracts -- while demanding more work from physicians who are paid less -- are a classic example of getting what you pay for.

''The financial constraints the state is experiencing . . . has inhibited the ability of our system to provide better health care for inmates,'' said Christopher Pasiadis, chief operating officer of Annashae Corp. of Cleveland.

''One thing that suffocated us in our ability to recruit and retain better medical professionals'' for prisons is the contract caps, he said. Annashae-provided physicians have been a constant source of complaints from prison officials.

''If you're offering less than a doctor could make at a private clinic or emergency room, how are going to sell that physician on working with maximum-security or medium-security inmates in a remote area of Ohio?''

The result is ''a lesser-caliber physician, maybe a lesser-trained physician'' working in prisons, Pasiadis said.

Before paying lump-sum amounts for physician services starting in 2001, the state paid hourly rates that equaled $166,400 annually for full-time medical directors and $145,600 for full-time physicians, a total of $312,000 for the typical prison.

The Department of Rehabilitation and Correction this year is paying $175,000 -- $137,000 less -- for both a medical director and physician to work at Southern Ohio Correctional Facility near Lucasville.

The department must offer competitive salaries to improve the quality of physicians, as it did to attract better psychiatrists, Gerhardstein said.

''They're getting the dregs, and there's no reason for it,'' he said.

Martin disputes that there are inferior prison physicians because of the falling contract caps, which he calls a ''good practice.''

''I do not believe it impacts quality at all. It has forced us to use available resources in a much more proficient manner. I know the quality of the doctors I've got working,'' he said.

At the same time, when asked if decreased spending improves the quality of health care, Martin replied: ''The answer to that is obvious. . . . It does not help your mission.''

Hidden records

Without the option of turning to other medical providers, inmates who feel they receive inadequate care can only file grievances with prison administrators seeking reviews of their health-care complaints.

A 2001 report by a consultant hired by prison officials suggested revamping medical-grievance procedures to provide independent review by medical professionals. Prison officials discussed creating a task force to examine the issue but never followed through.

Gerhardstein said the medical-grievance system lacks accountability.

''The medical grievance goes to a bureaucrat, the bureaucrat then sends it to the medical staff, who then say, 'We're giving fine care. What's the inmate griping about?' Then they send the grievance back and deny it.

''If they aren't going to provide grievance systems that actually look at medical problems, then they're going to be stuck with lawsuits, and that's what we do,'' the lawyer said.

Beyond accreditation from the American Correctional Association every three years, when out-of-state corrections officials review Ohio prisons in scheduled visits, there are no outside checks on the quality of medical care.

In fact, prison officials' assessments of the quality of care behind bars are secret -- with fines possible for disclosure -- under a law enacted in 1998.

The department maintains a long checklist to evaluate physicians and others monthly to ensure they are meeting patient-care needs and contract requirements, but the documents are confidential.

''The notion here was not to prevent any public-records inspection, but more so to protect the medical records of inmates,'' Wilkinson said.

The Correctional Institution Inspection Committee, consisting of Mallory and seven other lawmakers appointed to oversee prison operations, largely has been toothless the past two years.

While records show that the committee's staff periodically persuaded prison officials to address inmates' health concerns, lawmakers killed funding for staff for two years amid the state-budget crunch.

However, beginning July 1, legislators provided $200,000 -- less than half the committee's prior budget -- to hire a staff to assist members in fielding inmate complaints and keeping check on prisons.

At this point, Ohio should gather ''an independent, outside team of correctional medical experts'' to review prison medicine, said Dr. Ronald Shansky, former medical director of Illinois prisons and a correctional health-care consultant.

''If the concerns are serious, the state should want to know. Is it getting a bang for its buck, or is it creating liability?'' he asked.

''Health care has been an afterthought in corrections,'' Shansky said. ''People don't care unless they have relatives locked up. There's a lot of prejudice against inmates in this society.

''A society is judged by how it deals with prisoners. If you deal brutally with your most alienated population, that says something about you as a society.''

WBNS-10TV reporter Eve Mueller, researcher Joel Chow and intern Kristen Orlando contributed to this story.
Barbara Slade-Lanier, left, visits the grave of her son, David Slade, at Cleveland Memorial Gardens with her sister, Laverne Crim. David Slade died of a toxic overload of iron that was not adequately flushed from his blood.
Jennifer Burkhart, a third-year medical student at Ohio State University, listens to an inmate's heart during an examination at the Corrections Medical Center on the South Side.
(3) Reginald Wilkinson
(4) Graphic

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Old 08-27-2003, 12:19 PM
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Critics: Charging for medical care discourages early treatment

Proponents: Fee cuts down on prisoners faking ailments

Monday, August 25, 2003

By Randy Ludlow
Illustration: Photo

Three times, Dan Cahill paid $3 a visit in futile hopes he could get past the screening nurse to see a prison doctor about his severe bronchitis.

Cahill abandoned his quest for care, concluding that he no longer could part with the $3 co-pay charged inmates for self-initiated clinic visits.

''It cost me $9. That was half my state pay. I just couldn't afford it anymore,'' said Cahill, who earned $18 a month as a kitchen worker and porter at the now-closed Orient Correctional Institution.

''Out of that money, you had to buy your toothpaste, toiletries, writing paper, stamped envelopes, whatever,'' said the convicted burglar and drug trafficker who was paroled in 1999.

Enacted in March 1998, the co-pay is credited by prison officials with weeding out malingerers who signed up for clinic visits in hopes of landing a ''lay-in'' -- an excused absence from work assignments due to illness.

The $3 per-visit co-pay approved by Ohio lawmakers almost immediately cut ''sick-call'' clinic visits by nearly half, from 626 to 345 a day.

Some suggest the co-pay discourages inmates from seeking early care for seemingly minor ailments that could infect inmates and staff, or later develop into serious illnesses.

''A fee-for-service program ignores the significance of full and unimpeded access to sick call and the importance of preventive care,'' says the National Commission on Correctional Health Care in its position statement on prison co-pays.

More than 35 state prison systems now charge inmates a co-pay for medical and dental visits they initiate.

In Ohio's 33 prisons, physician visits, follow-up care, mental-health treatment, intake and periodic physical exams, chronic-care clinics, hospitalization and infectious-disease testing are free. Indigent inmates, those who have earned or received less than $9 during the 30 days before a sick-call visit, also are exempt from the $3 co-pay.

Officials at Pickaway and Belmont correctional institutions recently suspended the co-pay and offered ''free clinics'' to prisoners to help deal with outbreaks of staph infections.

''I don't think it has been a deterrent to good health care,'' Reginald Wilkinson, director of the Ohio Department of Rehabilitation and Correction, said of the co-pay.

''Now inmates are thinking twice about manufacturing different kinds of ailments for the sake of getting out of work or any other reason,'' he said. ''It sends the message: We're not going to waste the time of our doctors and nurses.''

Alphonse Gerhardstein, a lawyer and president of the Prison Reform Advocacy Center of Cincinnati, countered: ''The $3 co-pay is a great example of nickeling-and-diming inmates in order to intimidate them from seeking medical care.''

Three dollars does not sound like much to most Ohioans, but critics contend that it is a burden to inmates who do not receive money from family or friends and only earn $18 to $24 a month from their prison jobs.

Taxpayers, of course, pay for inmates' housing, food, clothing and other needs, but in percentage terms, the $3 co-pay would be the equivalent of $594 to an average-income Ohio household earning $47,521 a year.

The inmate co-pay has brought in $1.7 million since 1998, with annual collections dropping 28 percent from $408,554 in the first full year to $295,978 in the fiscal year ending June 30.

Of the $1.7 million collected, the prison system still has $1 million in an account dedicated to improving inmate health care, and it has used the fund to purchase big-ticket items such as kidney dialysis machines.

Dr. Bruce Martin, medical director of the state prison system, was surprised when told the amount of the balance. ''I'd like to get my hands on that money,'' he said.

The National Commission on Correctional Health Care says charging inmates a co-pay ''should be contingent on evidence it does not impede access to care. Such evidence might consist of increased infection rates, delayed diagnosis and treatment of medical problems, or other adverse outcomes.''

The Department of Rehabilitation and Correction never has formally studied the impact of the co-pay on access but has no evidence it has compromised the health of inmates, said Kay Northrup, director of the Office of Correctional Health Care.


Former prisoner Dan Cahill says the $3 co-pay for self-initiated medical visits forces impoverished inmates to choose between care and commissary items. The photo was taken in 1999 outside the Corrections Medical Center on the South Side.
Nurse Denise Crowder examines an inmate while Dr. C.B. Sai-Sudhakar ''watches'' via a telemedicine link between the Corrections Medical Center and Ohio State University Medical Center
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Old 08-27-2003, 12:20 PM
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Monday, August 25, 2003
Illustration: Photo

Taxpayers paid $1.15 million in court judgments and settlements during the past three years stemming from medical-negligence and wrongful-death claims against the Ohio Department of Rehabilitation and Correction. Prison officials say the incidents are aberrations. The total includes $310,119 for medical monitors and other expenses to settle a federal class-action lawsuit alleging poor inmate health care and other problems at the ''super-max'' Ohio State Penitentiary at Youngstown. The state agreed in 2002 to improve the prison's medical services. Here are the stories behind the cases:


Award: $475,000

Sentence: 14 to 50 years for aggravated robbery (Cuyahoga County)

After repeatedly going to the infirmary at the Southeastern Ohio Correctional Facility near Lancaster and complaining of a sinus infection and other illness during a 10-day period, Oliver fell critically ill on July 29, 1997. He was flown to the Ohio State University Medical Center, where he underwent neurosurgery for an infection-related facial-and-brain abscess. Oliver was left with disabilities and permanent brain damage requiring long-term care. A Court of Claims lawsuit claimed his condition went untreated and worsened because of inappropriate care. Oliver and his wife, Sonia, who now live in Utah, were awarded a settlement on March 26, 2001.


Died: June 16, 2000

Cause of death: suicide by hanging

Award: $120,000

Sentence: 16 to 50 years for aggravated murder, other offenses (Greene County)

After repeated suicide and escape attempts, Bell hanged herself in a cell at the Ohio Reformatory for Women in Marysville on June 16, 2000. Prison officials were accused of deliberate indifference in failing to properly treat her bipolar disorder. Contrary to prison regulations, Bell covered her cell door window and hung herself while passing corrections officers ignored the covering for 2 1/2 hours. Bell entered the prison at age 16. A wrongful-death lawsuit filed by her mother, Jane Zertuche, was settled on July 18, 2002 in U.S. District Court.


Award: $50,000

Sentence: three years for complicity to aggravated robbery (Stark County)

Suffering from a disorder that made her susceptible to blood clots and requiring blood-thinning medication, Luckel protested for four months as a physician at the Ohio Reformatory for Women more than doubled her dosage. She underwent emergency surgery for internal bleeding and other problems after being flown to Ohio State University Medical Center in critical condition. She recovered after 2 1/2 weeks in a coma and a second surgery. A lawsuit claimed her blood was not regularly tested to appropriately adjust her medication. The state settled the case on June 29, 2000.


Died: July 6, 1997

Cause of death: epilepsy, grand mal seizure

Award: $50,000

Sentence: 11/2 years for breaking and entering and theft (Cuyahoga County)

After suffering a seizure at 6:55 p.m. on July 1, 1997 at Belmont Correctional Institution in St. Clairsville, Thiessen was ordered transferred to a hospital by a prison physician. However, despite the doctor's order, a nurse did not call for an ambulance until 8 p.m., and Thiessen did not arrive at the hospital until after 8:15 p.m. He died five days later at Ohio State University Medical Center. The state settled with his mother, Lynne Giessler, of Rocky River, on Nov. 4, 2002.


Award: $45,000

Sentence: two to 10 years for attempted felonious assault (Cuyahoga County)

The still-imprisoned inmate suffered permanent hearing loss after a nurse punctured an eardrum with a syringe during an irrigation procedure to remove wax buildup on May 27, 1997, in the infirmary at Grafton Correctional Institution. Two subsequent surgeries failed to repair the ruptured eardrum. A Court of Claims magistrate awarded Valles damages on April 9, 2002, after finding the nurse should have halted the procedure after he complained of pain.


Died: April 15, 1997

Cause of death: hepatitis

Award: $40,000

Sentence: five to 25 years for drug trafficking and possession of criminal tools (Cuyahoga County)

The inmate at Belmont Correctional Institution had been found to have a skin rash two weeks before his death, according to a lawsuit filed by his mother alleging negligent diagnosis and treatment, and delay in transporting him to a hospital. The state settled the case on Dec. 21, 2000, with his mother, Arlene Fulton of Cleveland.


Died: Sept. 22, 2001

Cause of death: liver failure, heart attack

Award: $20,000

Sentence: five years for aggravated robbery and possessing a weapon under disability (Cuyahoga County)

Slade was suffering from Diamond Blackfan Anemia when he was imprisoned at the former Orient Correctional Institution, southwest of Columbus. The disorder required blood transfusions and close monitoring of his blood chemistry. He died at Ohio State University Medical Center of iron overload, which led to liver failure and a heart attack. Prison officials said Slade periodically refused intra-muscular injections since he had received near-nightly intravenous treatment outside prison. Treatments he received in prison to flush toxic excess iron from his system were inappropriately low in dosage and frequency, a hematologist wrote. A lawsuit filed by his mother, Barbara Slade-Lanier of Cleveland, was settled on May 5, 2003.


Died: Sept. 14, 2001

Cause of death: hepatitis C, cirrhosis

Award: $17,921 (legal fees)

Sentence: 20 years to life for aggravated murder (Columbiana County)

While incarcerated in the former Orient Correctional Institution, Davis sued in U.S. District Court on Jan. 2, 2001, to win an evaluation for a liver transplant. Judge Algenon Marbley ruled the evaluation was improperly denied by Dr. Bruce Martin, prison system medical director. The judge ordered Davis evaluated for a transplant, but he died less than a month later. The state was ordered to pay attorney fees.


Died: March 23, 1999

Cause of death: pneumonia

Award: $12,250

Sentence: one year for criminal damaging and possession of harmful intoxicants (Greene County)

After he complained for more than a week of illness at the Correctional Reception Center at Orient, a March 17, 1999, X-ray established that Reynolds was suffering from pneumonia, and a physician recommended follow-up care. Reynolds returned to the infirmary on March 18 and 19 with nausea and was given Pepto-Bismol and returned to his cell. On March 20, a weakened Reynolds was taken to the Ohio State University Medical Center, where he died. A Court of Claims judge found the inmate should have been immediately treated for pneumonia on March 17 and that the prison treatment ''fell below the standard of care.'' He awarded damages to Reynolds' sister, Betty Spencer of Fairborn.

Sources: Ohio Department of Rehabilitation and Correction, Ohio attorney general, Ohio Court of Claims, U.S. District Court

Caption: (1) Terry Oliver
(2) Carol Ann Bell
(3) Terri Lynn Luckel
(4) David Thiessen
(5) Paris Valles
(6) Donzel Fulton
(7) David Slade
(8) Keith Davis II
(9) William Reynolds Sr.
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Old 08-27-2003, 12:24 PM
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Monday, August 25, 2003

After the death of 19-year-old inmate Sean Schwamberger in April, The Dispatch and WBNS-TV (Channel 10) assigned members of their staffs to determine the quality of health care behind bars. Working together, reporters from the two organizations reviewed thousands of pages of state documents, examined every inmate death from the past three years and conducted dozens of interviews as part of a three-month investigation of prison medicine.

RANDY LUDLOW is a state desk reporter for The Dispatch . He joined the newspaper one year ago after 19 years with The Cincinnati Post . Ludlow covered state prisons and corrections issues during a decade as The Post's statehouse bureau chief in Columbus.

TIM REVELL joined The Dispatch as a photographer in 1979. He was named Best Photographer in Ohio by the Associated Press for a collection of work shot in 2001.

EVE MUELLER covers state government for WBNS-TV (Channel 10). She joined the station in 1993. She won an Emmy for her work on the public-affairs program Capitol Agenda and a national Edward R. Murrow award for her reporting on black mold in school buildings.

JOEL CHOW has been a researcher for WBNS-TV (Channel 10) since 2001. He works with the station's investigative unit and the ''Consumer 10 Hotline,'' which receives as many as 600 calls a month. Chow is president of the Ohio Associated Press Broadcasters.

SCOTT DOELLING is a photojournalist for WBNS-TV (Channel 10). Since joining the station's staff in 1996, he has handled a variety of photographic assignments, including breaking news, investigative reports, sports and features.
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Old 08-27-2003, 12:26 PM
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Wrongful deaths. Inadequate care. Questionable doctors. . . . Health care in Ohio's 33 prisons is plagued with serious, deadly problems.

Sunday, August 24, 2003

By Randy Ludlow
Illustration: Photo

Death behind bars

A total of 120 inmates died in 2001 and 118 died in 2002. Through the end of July, 56 inmates have died this year. Prison officials point out that patients die at the best hospitals and note that many inmates enter prison in poor health. Here are some examples of how inmates died while under the care of the prison medical staffs:


Died: April 11, 2000

Cause of death: heart attack

Sentence: four to 15 years for attempted rape (Morrow County)

After complaining of chest pains at Madison Correctional Institution near London, he collapsed while walking to a van to be taken to the hospital. An ambulance was summoned, and he died at the hospital.


Died: May 23, 2000

Cause of death: cardiac arrest

Sentence: 11 months for drug trafficking (Shelby County)

He developed chest pains after running 300 yards at his own pace during an exercise program at Montgomery Education and Pre-Release Center in Dayton. He was treated at the infirmary and died at a hospital. The exercise, which records say was required but officials later said was voluntary, was eliminated after his death.


Died: June 6, 2000

Cause of death: heart attack

Sentence: nine to 25 years for felonious sexual penetration (Cuyahoga County)

While working, he complained of dizziness and was taken to the infirmary at Allen Correctional Institution near Lima. He was waiting to be seen when he slumped over and lost consciousness.


Died: Nov. 17, 2000

Cause of death: pulmonary arrest, bronchial cancer

Sentence: 14 to 65 years for rape, theft and aggravated robbery (Cuyahoga County)

He collapsed in a cell at Madison Correctional Institution near London and later was pronounced dead at Madison County Hospital. A CAT scan on Nov. 14 determined he had a mass on his lung. He was waiting to be scheduled for surgery when he died.


Died: July 9, 2001

Cause of death: heart attack

Sentence: 15 years to life for murder (Wood County)

He complained of chest pains after recreation and was examined for 25 minutes in the infirmary at Southern Ohio Correctional Facility in Lucasville. Ten minutes after returning to his cell, he was found unresponsive.


Died: March 1, 2003

Cause of death: irregular heart beat

Sentence: two years for forgery, identity theft and possession of criminal tools (Greene County)

He went to the infirmary at Southeastern Correctional Institution in Lancaster, complaining of chest pains at 12:10 p.m. Vital signs and heart rate appeared normal. Diagnosed with heartburn, Humphrey said he was feeling better and left the infirmary. He collapsed at 12:35 p.m., and the staff began CPR. Forty-seven minutes later, he was taken by ambulance to a hospital, where he was pronounced dead.


Died: April 29, 2003

Cause of death: staph sepsis (massive infection)

Sentence: 11 months for forgery (Lucas County)

He contracted a drug-resistant staph infection at Pickaway Correctional Institution near Orient. His wound was not cultured to determine whether his infection was the potentially lethal strain. The penicillin he was given was ineffective.

Source: Ohio Department of Rehabilitation and Correction

An investigation by The Dispatch and WBNS-10TV resulted in a series of stories appearing today and Monday:


Inadequate care costs lives and money.

* Low standards for prison doctors | A8

* Inmates who died behind bars | A8


* At 11 p.m., Eve Mueller examines the cost of medical negligence.


View WBNS-10TV reports at www.dispatch.com


Budget cuts slice medical care

At age 19, Sean Schwamberger was tired of being a punk.

Cashing two forged checks for $777.32 cost him 11 months, and the small-time con just wanted to return to Toledo for the go-straight lifestyle of a house painter.

But rather than the celebration of redemption envisioned in his prison journal, Schwamberger's homecoming was one of second-chances lost.

He died as inmate A 436969 on April 29 amid a prison staph outbreak -- perhaps for want of a $10 diagnostic test and a different antibiotic.

The drug-resistant staph infection that overwhelmed Schwamberger and his prescribed penicillin was not detected until he fell mortally ill in the yard of Pickaway Correctional Institution.

His death is a symptom of serious flaws -- sometimes fatal -- that regularly beset the health-care system in Ohio prisons.

A three-month investigation by The Dispatch and WBNS-TV (Channel 10) found that the medical care provided to 45,402 inmates in 33 prisons is riddled with hidden problems and costs.

Reginald Wilkinson, director of the state prison system since 1991, said the investigation's findings are aberrations that do not present an accurate portrayal of prison medicine.

''I think the department has an excellent medical system, and I think we are actually a model for the rest of the nation from a number of points of view,'' he said. ''We know what we are doing, and we do it well.''

A review of thousands of pages of records from the Ohio Department of Rehabilitation and Correction from the past three years and dozens of interviews reveal:

* Taxpayers, who underwrite annual spending of more than $122 million on correctional health care, also footed more than $1 million in bills to pay wrongful-death and medical-negligence claims filed by inmates and their families.

* Critically ill inmates died at hospitals after waiting nearly an hour for ambulances, and prisoners with chest pains died of heart attacks within minutes of being seen and released from clinics.

* Some prisoners waited up to 16 months for surgery while their ailments worsened, with the waiting list once backlogged with 100 inmates.

* Inmates, including the mentally ill, went days without receiving their prescribed medicine and without seeing doctors, while officials fretted about fielding enough nurses to staff prison clinics.

* Medical professionals working in state prisons included a doctor under a 35-count felony indictment, a physician who lied about his criminal background and others with a history of disciplinary action.

* In a flood of e-mails between prisons and the Office of Correctional Health Care in Columbus, administrators regularly complain about the poor performance of contractor-provided physicians and dentists.

Some prisons have gone months without medical directors while revolving-door rosters of doctors work too few hours to fulfill contracts requiring that ill inmates be seen within two days.

Amid long-lingering state budget woes, a medical system has evolved in which contractors are paid less to care for more inmates, with one contractor lamenting a corresponding drop in the caliber of physicians.

Meanwhile, the state continues to rehire contractors with checkered histories while some physicians ousted because of concern about the quality of their care later resurface to work in other institutions.

''We don't profess that we're perfect. We profess to operate a constitutional health-care operation, and we do. But we're also very cognizant of the fact that if there are quirks . . . we want to fix them,'' Wilkinson said.

'Systemic problem'

Alphonse Gerhardstein, president of the Prison Reform Advocacy Center and a Cincinnati lawyer who won a 1995 settlement to improve psychiatric care for mentally ill inmates, disputes Wilkinson's description of ''quirks.''

After reviewing the findings of The Dispatch and Channel 10, Gerhardstein diagnosed Ohio's prison medical system as ''in crisis.''

''This is a pathetic situation in Ohio, and it needs to be addressed promptly. . . . It's reflective of a systemic problem,'' Gerhardstein said.

Medical care tops the list of inmate complaints to the Prison Reform Advocacy Center. In 2002, prison officials found merit to 85 of 562 inmate grievances claiming improper care or delays in care or medication.

''Back in the late 1700s, when we passed the Constitution, we knew that we were supposed to treat inmates in a way that wasn't cruel and unusual, and here we're doing it. And that's terrible in the year 2003,'' Gerhardstein said.

Within the past three years, the state has paid five wrongful-death claims filed by relatives of deceased inmates -- and more lawsuits are pending.

''They didn't die because they weren't receiving treatment; they didn't die because they were being ignored,'' said prisons spokeswoman Andrea Dean. ''Just like unfortunate deaths occur in hospitals . . . there are unfortunate deaths that occur in the Department of Rehabilitation and Correction.''

Dr. Bruce Martin, the prison system's medical director, defends the system and its handling of unhealthy inmates.

''You will find no perfect system, but I think we do an excellent job meeting the challenges -- meeting the increasing demands -- with the limited resources,'' Martin said.

Increased costs

Prison clinics form the front line of the health-care system. Inmates who need skilled-nursing care are housed at the Frazier Health Center at Pickaway Correctional or in Columbus at the Corrections Medical Center, which includes a hospice.

Those who need hospitalization or surgery are treated in a prison wing at Ohio State University Medical Center, which is paid $26 million annually by the state.

Wilkinson describes Ohio's specialized in-house medical facilities, and the relationship with Ohio State, as rare among state prison systems. ''We actually save lives.'' Many prisoners have left the state system with ''prolonged lives'' because of the care received while serving their time, he said.

Aside from the millions in taxes Ohioans provide, they have a significant stake in the quality of the prison medical system.

''Tens of thousands of inmates are being released into the community every year with undiagnosed or untreated communicable disease, chronic disease and mental illness,'' said a report by the National Institute of Justice in conjunction with the National Commission on Correctional Health Care.

With an average sentence of 33 months in Ohio, the state released 25,635 inmates last year from a system that is at 123 percent of capacity.

Ineffective care also escalates public spending as the health of freed ex-convicts with no insurance worsens and they seek treatment at taxpayer expense for conditions not diagnosed or treated appropriately behind bars.

''The quality of (prison) care is not as high as it might be, resulting in unnecessary morbidity, premature mortality and increased costs,'' the institute report found.

Mourning the premature death of her son, Schwamberger's mother thinks he was ''not given the medical attention he deserved as a human being."

''He wanted to come home and do things right,'' Karen Bollett Neal said. ''Sean was not a bad person. He did some bad things.''

Bob Schwamberger remains in near-denial over his son's death. ''It's unbelievable. I thought he would be safer there.

''They didn't take care of my son. He was there under state custody. He should have been protected by the state instead of allowed to lay there and get sicker and sicker and sicker.''

Burned out

While in Pickaway Correctional at Orient, 15 miles southwest of Columbus, Schwamberger was under the care of Dr. Adil Yamour, a 66-year-old Washington Court House resident who has worked in prisons for more than nine years.

After eight years at London Correctional Institution, Yamour was described in mid-2002 as experiencing ''burnout'' by Vicki Ware, the prison's health-care administrator, who requested he be replaced.

''He orders ibuprofen for everything, regardless of the diagnosis,'' Ware wrote to the Rehabilitation and Correction Department's central office. ''He takes off without notifying me. . . . 95-98 percent of my daily . . . complaints are regarding the doctor.''

Yamour, a native of Iraq, said he lost his job at London because of discrimination and that he gave good care to inmates despite being asked to see ''an unheard of'' number of inmates -- 70 to 93 in an eight-hour shift.

The physician, criticized by Ware for telling inmates he was not allowed to order certain procedures or medicines because of a lack of funding, said that what he told prisoners was true.

After he was removed as medical director at London, Yamour was reassigned as a physician at Pickaway, which receives its physicians under a state contract with Columbus-based Clinicare.

Despite an outbreak of at least 26 staph cases among inmates in two months at Pickaway, no culture tests were taken to learn whether the infections were the easily treated common strain or the potentially deadly, drug-resistant form.

State health officials were alarmed by the lack of culture tests -- which now are standard procedure in the wake of Schwamberger's death -- when prison administrators summoned them for help the day before he died.

Within the next month, the recommended tests detected 15 other inmates with methicillin-resistant Staphylococcus aureus infections. No other prisoners died during the staph outbreak, which officials attributed to shared tattoo needles after first suspecting spider bites.

Eight more Pickaway inmates have been infected with drug-resistant staph since, with the latest case reported to public-health officials on Tuesday.

In a Feb. 28 e-mail, medical director Martin wrote that it was his ''best guess'' the wounds were being cultured, but added: ''I would recommend only doing cultures if there is a nonresponsive wound.''

Martin also later expressed concerns that Yamour was lancing and draining lesions to create open sores that could worsen infections. Yamour defended his practice, calling it a ''medical must'' to drain infections.

Complaining of back and shoulder pain, Schwamberger refused to go to OSU Medical Center on April 23. But he relented the next day and was checked at the Columbus hospital and ''sent back, nothing wrong with him,'' Yamour said.

Both Yamour and Martin defended Schwamberger's care, saying he appeared to be responding to treatment until he collapsed from toxic shock and was hospitalized at OSU on April 26, three days before he died.

Ohio State officials said they could not comment on Schwamberger's treatment because of medical-privacy laws.

''If we could turn the clock back and do something different to save his life, we would be happy to do it,'' Wilkinson said. ''I have not seen anything definitive at this point that he died because of negligence.''

Higher standard

Although federal court precedents require states to provide ''reasonably adequate'' health care, Ohio's system bills itself as demanding a higher ''community standard of care'' for its prisoners.

The care inmates receive within prison walls is expected to be the same quality Ohioans receive on the outside from their personal doctors, dentists, pharmacists and optometrists.

But without the option of choosing another provider, a few examples -- among dozens -- illustrate the substandard treatment some inmates have received:

* An inmate at the Ohio Reformatory for Women at Marysville bled profusely and was in ''excruciating pain'' because of improper anesthesia after a physician's assistant performed a surgical incision on her vaginal lip on Jan. 21. Robert Kessack, who officials say performed the procedure outside the scope of his duties and without supervision, was fired by his employer, West Edge Medical Care Inc.

* Incidents at the ''super-max'' Ohio State Penitentiary included an inmate in cardiac distress who waited five days for heart surgery and a prisoner with a lump on his shoulder that grew to larger than a billiard ball. He spent 16 months on a surgery waiting list before its removal. State officials agreed in court in mid-2002 to improve the quality of care and other conditions at the Youngstown prison.

* Inmates at Lima Correctional Institution went as many as five days without prescribed medications after the prison pharmacy was unstaffed for six days during a two-week period in late 2001. Prime Care, the pharmacy contractor, sent a pharmacist to replace one who resigned, but his license once had been revoked and he was rejected by prison officials. Failure to give medications to inmates in a timely manner is an ongoing problem.

* Despite the 1995 settlement of a class-action lawsuit to secure improved care for mentally ill inmates, prisons continue to encounter problems. The prison system has a separate, $67 million annual budget for mental-health services.

In June, officials at Lorain Correctional Institution warned that prisoners were running out of medication, and psychiatrists were not evaluating enough inmates. Records show delays of up to a week in obtaining psychotropic medicine for the mentally ill at prisons and backlogs of inmate assessments.

Dr. Shura Hegde, a contract psychiatrist at Lorain, was ousted in 2001 after prison officials found he gave ''full mental-health evaluations'' in 10 minutes and gave the same assessment scores to 30 of 31 inmates, ''some of whom were psychotic.'' Lorain officials complained Hegde played ping-pong on duty and billed for half-hour lunches for four years and was overpaid $36,864. He denied the charges.
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Old 08-27-2003, 12:27 PM
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Ongoing complaints

In a quest to improve care, the Department of Rehabilitation and Correction abandoned the direct employment of doctors and dentists more than 15 years ago in favor of hiring contractors, at first paying per-hour rates and then later soliciting lump-sum bids.

The partnership between the public agency and private-sector companies has not always been effective, with ongoing complaints from the department about some contractors failing to provide contractually required care to inmates.

Prison officials have insisted on the removal and replacement of numerous problem physicians, but no company providing doctors has ever lost a contract because of substandard performance.

''I will readily admit" problems with contractors, Wilkinson said. ''Typically, we'll find something wrong and fix it. Unfortunately, sometimes issues and problems slip through the crack. We are very intent on trying to fix problems that occur.''

Records show ongoing prison complaints about staff provided -- or not provided, in some instances -- by Annashae Corp., a staffing management company in Cleveland.

For years, health-care administrators have complained about Annashae's failure to consistently provide medical directors and about physicians who fail to see enough inmates or otherwise prove troublesome.

The prison department's concerns spiked late last year when some Annashae physicians threatened to quit because the company had not paid them for months because of cash-flow problems. The company said all physicians were paid.

Annashae has continued to receive state contracts because it has met state guidelines and standards and addressed prison concerns, said Dean, the prison spokeswoman.

Christopher Pasiadis, Annashae's chief operating officer, said there is turnover among the firm's physicians, but the company always has honored its contracts and its physicians have provided quality clinical care.

Bidding on medical contracts has become a losing proposal because of the state's unwillingness to pay enough money to attract first-rate physicians to work in prisons, he said.

Some Ohio prison officials have been displeased with the physicians assigned to treat inmates at their institutions and periodically have begged for replacements.

Angered by an Annashae-provided physician at Madison Correctional Institution near London in February, the prison's health-care administrator penned a plea to higher-ups in Columbus.

''We need to do something immediately or we're gonna get sued. One inmate was told he needed to pray to God. That may be, but a doctor usually takes a more proactive approach to medicine.''

WBNS-10TV reporter Eve Mueller, researcher Joel Chow and intern Kristen Orlando contributed to this story.

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Old 08-27-2003, 12:29 PM
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Sunday, August 24, 2003

By Randy Ludlow
Illustration: Photo

The prison doctor was a candidate to bunk with the felons he treated.

Unknown to prison officials -- because they never bothered to check -- a prescription-peddling physician strolled into the razor-wire enclosures of two of Ohio's most-secure institutions for more than a year.

Dr. Ayman Kader was under a 35-count felony indictment while working in the close-security Lorain Correctional Institution and the ''super-max'' Ohio State Penitentiary at Youngstown.

His history did not catch up to him until Jan. 6, when officials at the Mansfield Correctional Institution finally followed state policy and conducted a criminal-background check of their newly arrived medical director.

Banished from Mansfield, Kader was convicted a month later of five counts each of drug trafficking and illegal processing of drug documents for writing bogus prescriptions for amphetamines in Tuscarawas County.

The 49-year-old Kader received a suspended three-year prison sentence and a $40,000 fine when he pleaded no contest Feb. 6. His Ohio medical license was permanently revoked.

Kader is not the only contractor-provided medical professional with a spotty past to work in Ohio prisons, according to state records:

* Dr. Brett Toward was approved to work in Grafton Correctional Institution despite falsifying state forms on which he did not disclose that he was a two-time drunken-driving offender and had been convicted of a firearms offense.

* Dr. Frederick Ho-A-Lim, assigned to the Toledo Correctional Institution, improperly practiced without a license at a Toledo hospital in 2001 during a 23-day suspension of his license for failure to pay child support.

* Dr. Naba Goswami, who worked in Belmont Correctional Institution in 2001, had trouble gaining an Ohio medical license in 1995 because he had been denied a South Dakota license in 1984 for copying another's answers during an exam.

* Dr. Steven Friday, a podiatrist in Chillicothe, Ross and Southeastern correctional institutions, lost his license in 1995, before working in prisons, because of alcohol dependency and three DUI convictions. He was granted a probationary license in 1998 and remained on probation until April.

* Dr. Lenzy Southall, medical director at North Central Correctional Institution in Marion, twice had his license suspended and has faced hundreds of thousands of dollars in liens for failure to pay state and federal taxes.

* Dr. Judson Wynkoop, a Hocking Correctional Institution dentist, was cited last year for violating standards of care.

* Dr. Thomas Fellner, a dentist at Mansfield and Richland prisons, spent one year on probation through mid-1999 for infection-control and X-ray violations.

* Richard Sweet, a pharmacist at Lorain and Grafton prisons, lost his license for one year for drug abuse and stealing drugs before receiving a five-year probationary license in 1996. He faces an Oct. 14 unprofessional-conduct hearing before the State Board of Pharmacy on allegations of verbal abuse of a nonprison customer.

''We do have to tolerate a different standard sometimes because it's hard to get people to come and work in the prisons to provide medical care,'' said Andrea Dean, spokeswoman for the Ohio Department of Rehabilitation and Correction.

''You're not going to get the valedictorians of the class from Ohio State University knocking on the door to work at the Pickaway institution as medical director. . . . You're not going to find doctors who can go get jobs at Riverside (Hospital) knocking down the doors to come and work at Chillicothe Correctional Institution.''

Still, Dean conceded, the Egyptian-born and educated Kader never should have been allowed to set foot inside a state prison while under felony indictment.

''They didn't do the job,'' she said of the failure of officials at the Ohio State Penitentiary and Lorain Correctional to run department-required criminal-background and security-clearance checks on Kader.

The institutional inspectors and two deputy wardens at both prisons were reprimanded and underwent ''corrective counseling'' for their failure to check on the physician.

On March 21, 2001, seven months before he began working in prison, Kader was indicted for repeatedly writing medically unnecessary weight-loss prescriptions for undercover agents between mid-1999 and early 2001.

He transferred from the ''super-max'' prison to Lorain Correctional in December 2001 after officials threatened to revoke Annashae Corp.'s $435,000-a-year contract unless it assigned a permanent physician to oversee inmate care. Annashae had touted Kader as ''one of our most valued, cooperative physicians.''

Christopher Pasiadis, Annashae's chief operating officer, said the company checked Kader's medical credentials, but was unaware he was under indictment because the prison system is supposed to do criminal background checks.

''People do not go to medical school dreaming of some day working in a maximum-security prison,'' he said.

Kader could not be located for comment. He is being investigated in New York for obtaining a medical license in March 2002 and failing to disclose his indictment. He briefly worked in Bath, N.Y., before his license was suspended. Pennsylvania authorities also are moving to revoke his license in that state.

In Toward's case, officials were unaware he did not disclose his criminal convictions on state forms. But they learned through a background check that he had two convictions for driving under the influence and a misdemeanor conviction for improper use of a firearm in a motor vehicle. Prison officials debated whether he should work in prison, but cleared him.

Prison officials were unaware Toward had failed to disclose his convictions until the falsified forms were discovered by The Dispatch and WBNS-TV (Channel 10). Toward declined to comment.

''Did we know that going in? No. Had we known he falsified his application, we would have not have allowed him to continue to provide a service for us,'' Dean said.

Toward worked in Grafton as a probationary contractual employee from Clinicare for about three months during the summer of 2002 before he left amid complaints that he was not working enough hours seeing patients, records show.

Misdemeanor and traffic convictions do not forbid employment in state prisons, but felons are disallowed, Dean said.

Officials realize some prison physicians are not top-drawer.

''We just have some poor-quality physicians that either have left our other institutions voluntarily or have gotten the boot, and I can help to make sure you don't unknowingly get (one) of those,'' Beth Ferguson, a prisons contract administrator, wrote to a deputy warden last year.

But not all prisons succeed in side-stepping departed doctors.

Ho-A-Lim, who now works in the Toledo Correctional Institution, is one of at least three physicians who lost their behind-bars jobs, only to later surface in another prison.

The doctor said he stopped working at the Northeast Pre-Release Center in Cleveland because he had tired of the commute from his Toledo-area home. ''I told them to replace me. They begged me to stay. They said I was one of the best doctors they had,'' Ho-A-Lim said.

Asked about continuing to practice medicine during the suspension of his license, Ho-A-Lim ended the conversation.

Last summer, officials at the Northeast Pre-Release Center appeared frantic to rid themselves of Ho-A-Lim, who attracted complaints of working only two hours during a scheduled 10-hour day and not showing up another day.

''I cannot tolerate such inadequate coverage,'' wrote the prison's health-care administrator. ''We had a female that was injured this morning (and) in a wheelchair since 8:45 a.m. waiting to see him. Nearly four hours!!! What are we to do with this man?''

WBNS-10TV reporter Eve Mueller and researcher Joel Chow contributed to this story.


Caption: (1) Doctors in question
Dr. Ayman Kader worked in two state prisons while under a 35-count felony indictment.
(2) Dr. Brett Toward failed to disclose his criminal background before working in a state prison.
(3) Dr. Frederick Ho-A-Lim was removed from one prison for poor performance but now works in another.
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