In the Land of the Blind—Even One Eye Won’t Suffice: California prisons and medical care
Moss David Posner M.D.
August 07, 2006
Yesterday, the wire services reported the comments of James Tilton, the current transient Director of the Department of Health Care Services for the California Department of Corrections. Echoing—apparently—the opinion of the Federal Receiver, Robert Sillen, he said,
Clearly, I have seen cases where inmates are dying due to lack of health care in the system…The facts are there: We have seen people not getting appropriate care.”
No problem there. Well, not completely true. Let’s examine some facts:
First fact is—Mr. Tilton agreed to take the position because the last two substitutes for the previous long-term director quit, each in approximately two months, resigning in disgust, stating that they could not get the support for the changes that were necessary. So let’s give him an attaboy for stepping up to the plate. Furthermore, these men can hardly be faulted for the mess they have inherited.
If the past two directors had to resign in frustration, why do we conclude anything different other than they were telling the truth, that they couldn’t get the support they needed? For some reason, Mr. Tilton doesn’t have that problem--yet.
He’s found out that the problem is the lack of care, and he has a solution: Farm out the medical care either to the University or to a private agency. Let’s start with first things first:
Where are there any definitive studies done that show that the morbidity and mortality figures for the inmates in the California Department of Corrections is statistically significantly higher than for other state Departments of Corrections? Have you seen any? I haven’t.
Don’t misunderstand me. I’m not condoning bad medical care in any way shape or form. Let’s get that straight from the git-go.
The significant problem was brought to the attention of the public by the success of an initial case of Madrid, and later followed by the Plata and other similar cases. Significantly, it was not just the facts of these cases, but also the notorious and disgraceful failure of the Directors of the Department to remediate the system problems, as they had promised the court they would do, things which really lay at the heart of the problem. In fact, the court even threatened to arrest individuals if they did not come under compliance with criteria that were established.
Nowhere during this process were doctors fired or charged with offenses in large numbers. Could it be that that wasn’t the problem? Ask the Prison Law Office. The problem was that what the Department said it would do, it didn’t do. These are overwhelmingly administrative functions.
One physician for whom I have great respect pointed out, in substance and effect,
The Madrid case occurred about 1999. The Plata case occurred in another prison five years later, and in the interim, the Department did absolutely nothing. That Madrid case was a shot across their bow, and they did absolutely nothing.”
What did the Department do as a consequence of this court order? Nothing. Well, at least nothing that pleased the court. The Prison Law Office gave very negative reports to the Judge, the Hon. Thelton Henderson, of the 9th Circuit. What were these reports?
The reports had to do with specific standards that were established, regarding the time frames obligatory for follow-up appointments, consultations, and in particular in the Mental Health area, for various procedures to be followed, criteria for performance for doctors, nurses pharmacies, para-medical employees, etc. (See my articles, "The Sound of Silence", and "Why I Speak Out".)
The primary focus was not on numerous doctors or scores of instances of gross malpractice, but rather on select instances, which were really symptoms of a non-system. If the problem was just some doctors, it would have been the easiest thing for the administrators to act. There are California Code and other regulations, which govern such acts. There is the California Medical Board, which is tasked, among other duties, with specifically this responsibility. And--get this—the Director of Health Care Services was removed from her post as director. You would think that would be telling everybody something.
Even so, this did stop the medical administrators. There was one other thing to which they agreed—to reevaluate the competence of the physicians. The specific means to accomplish this was unspecified.
So what did this Director do? Signed a contract with a newly named entity for the purposing of “testing” the doctors. There is good reason to believe that this particular choice of evaluation was grossly unfair and simply deflected the attention from those who were really responsible, and that is being fought right now in the courts as we speak.
Well, guess what? Of the doctors who agreed to take this “test,” I have yet to hear of one single case of a physician not passing. I wonder how the doctors in the community at large would do on that test.
One of the unintended consequences of this pressure on the doctors was for them to leave in droves for jobs in the private sector. Guess they weren't so incompetent after all.
Worse yet, the dreadfully understaffed department was now even more severely understaffed--in fact, in violation of mandatory minimums. At one time there were about 15 doctors at the SATF facility in Corcoran. At that time I was the acting Chief Medical Officer.
SATF is the largest prison in the free world, harboring 7500 inmates. After this harassment of the physicians, their staff was at one time reduced to two physicians, according to one report I received after I left. So why didn’t the department use the companies that provide physicians for just such purposes, companies they had used in the past?
Well, you ask, so who is responsible and why are we not hearing about it? I’m glad you asked that question. You’ll love this answer:
For months I kept detailed notes of incidents where medications were not give, where our orders were ignored, where inmates never were taken to the appointments by custody officers who were too busy to care. I copied the proof and kept it in a safe place. What do you think happened?
The very first weekend I left the folder on my desk, rather than in a drawer, behind a locked door, in a locked clinic that is also either locked or monitored 24/7, my proof, my files were taken, and I was given a disciplinary letter, based upon a “violation” of HIPPA regulations, an accusation which in no possible way will hold up. Regardless of this, you would think the information would be critical. The Chief Physician gave me his word that the papers would be returned, “When it’s time.”
I guess it isn’t “time” yet. I have send certified letters to the Warden demanding access to this critical information, not just to protect myself against attempts me to remove me from my job with the Department, but to help my patients, who are my primary responsibility. If nothing else, you would thing that concern would be valid.
You would think it, but you would be wrong. I am fighting for my life and for my professional reputation. In 43 years, I have never been sued for malpractice, never suffered comparable disciplinary actions—until I had the misfortune to choose to work for the Department of Corrections of California.
So getting back to the new appointees:
If this medical care is farmed out to the University or worse yet to a private corporation, (such as Geocorp, which the governator mentioned about a year ago (more about them later) you and the relatives of the inmates will have even less access and less to say about what happens to those men and women. If you think it was or is bad now, you ain’t seen nothing yet, folks.
More incredible documented details about the key players to come. In the words of the great and recently-departed investigative reporter Sherman Skolnick,
Stay tuned.”
Clearly, I have seen cases where inmates are dying due to lack of health care in the system…The facts are there: We have seen people not getting appropriate care.”
No problem there. Well, not completely true. Let’s examine some facts:
First fact is—Mr. Tilton agreed to take the position because the last two substitutes for the previous long-term director quit, each in approximately two months, resigning in disgust, stating that they could not get the support for the changes that were necessary. So let’s give him an attaboy for stepping up to the plate. Furthermore, these men can hardly be faulted for the mess they have inherited.
If the past two directors had to resign in frustration, why do we conclude anything different other than they were telling the truth, that they couldn’t get the support they needed? For some reason, Mr. Tilton doesn’t have that problem--yet.
He’s found out that the problem is the lack of care, and he has a solution: Farm out the medical care either to the University or to a private agency. Let’s start with first things first:
Where are there any definitive studies done that show that the morbidity and mortality figures for the inmates in the California Department of Corrections is statistically significantly higher than for other state Departments of Corrections? Have you seen any? I haven’t.
Don’t misunderstand me. I’m not condoning bad medical care in any way shape or form. Let’s get that straight from the git-go.
The significant problem was brought to the attention of the public by the success of an initial case of Madrid, and later followed by the Plata and other similar cases. Significantly, it was not just the facts of these cases, but also the notorious and disgraceful failure of the Directors of the Department to remediate the system problems, as they had promised the court they would do, things which really lay at the heart of the problem. In fact, the court even threatened to arrest individuals if they did not come under compliance with criteria that were established.
Nowhere during this process were doctors fired or charged with offenses in large numbers. Could it be that that wasn’t the problem? Ask the Prison Law Office. The problem was that what the Department said it would do, it didn’t do. These are overwhelmingly administrative functions.
One physician for whom I have great respect pointed out, in substance and effect,
The Madrid case occurred about 1999. The Plata case occurred in another prison five years later, and in the interim, the Department did absolutely nothing. That Madrid case was a shot across their bow, and they did absolutely nothing.”
What did the Department do as a consequence of this court order? Nothing. Well, at least nothing that pleased the court. The Prison Law Office gave very negative reports to the Judge, the Hon. Thelton Henderson, of the 9th Circuit. What were these reports?
The reports had to do with specific standards that were established, regarding the time frames obligatory for follow-up appointments, consultations, and in particular in the Mental Health area, for various procedures to be followed, criteria for performance for doctors, nurses pharmacies, para-medical employees, etc. (See my articles, "The Sound of Silence", and "Why I Speak Out".)
The primary focus was not on numerous doctors or scores of instances of gross malpractice, but rather on select instances, which were really symptoms of a non-system. If the problem was just some doctors, it would have been the easiest thing for the administrators to act. There are California Code and other regulations, which govern such acts. There is the California Medical Board, which is tasked, among other duties, with specifically this responsibility. And--get this—the Director of Health Care Services was removed from her post as director. You would think that would be telling everybody something.
Even so, this did stop the medical administrators. There was one other thing to which they agreed—to reevaluate the competence of the physicians. The specific means to accomplish this was unspecified.
So what did this Director do? Signed a contract with a newly named entity for the purposing of “testing” the doctors. There is good reason to believe that this particular choice of evaluation was grossly unfair and simply deflected the attention from those who were really responsible, and that is being fought right now in the courts as we speak.
Well, guess what? Of the doctors who agreed to take this “test,” I have yet to hear of one single case of a physician not passing. I wonder how the doctors in the community at large would do on that test.
One of the unintended consequences of this pressure on the doctors was for them to leave in droves for jobs in the private sector. Guess they weren't so incompetent after all.
Worse yet, the dreadfully understaffed department was now even more severely understaffed--in fact, in violation of mandatory minimums. At one time there were about 15 doctors at the SATF facility in Corcoran. At that time I was the acting Chief Medical Officer.
SATF is the largest prison in the free world, harboring 7500 inmates. After this harassment of the physicians, their staff was at one time reduced to two physicians, according to one report I received after I left. So why didn’t the department use the companies that provide physicians for just such purposes, companies they had used in the past?
Well, you ask, so who is responsible and why are we not hearing about it? I’m glad you asked that question. You’ll love this answer:
For months I kept detailed notes of incidents where medications were not give, where our orders were ignored, where inmates never were taken to the appointments by custody officers who were too busy to care. I copied the proof and kept it in a safe place. What do you think happened?
The very first weekend I left the folder on my desk, rather than in a drawer, behind a locked door, in a locked clinic that is also either locked or monitored 24/7, my proof, my files were taken, and I was given a disciplinary letter, based upon a “violation” of HIPPA regulations, an accusation which in no possible way will hold up. Regardless of this, you would think the information would be critical. The Chief Physician gave me his word that the papers would be returned, “When it’s time.”
I guess it isn’t “time” yet. I have send certified letters to the Warden demanding access to this critical information, not just to protect myself against attempts me to remove me from my job with the Department, but to help my patients, who are my primary responsibility. If nothing else, you would thing that concern would be valid.
You would think it, but you would be wrong. I am fighting for my life and for my professional reputation. In 43 years, I have never been sued for malpractice, never suffered comparable disciplinary actions—until I had the misfortune to choose to work for the Department of Corrections of California.
So getting back to the new appointees:
If this medical care is farmed out to the University or worse yet to a private corporation, (such as Geocorp, which the governator mentioned about a year ago (more about them later) you and the relatives of the inmates will have even less access and less to say about what happens to those men and women. If you think it was or is bad now, you ain’t seen nothing yet, folks.
More incredible documented details about the key players to come. In the words of the great and recently-departed investigative reporter Sherman Skolnick,
Stay tuned.”
Print
Email
