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FDOC Hazardous to Prisoners' Health

by Mark Sherwood and Bob Posey

Thirty percent of the 129 doctors who provide medical care to prisoners incarcerated in the Florida Department of Corrections (FDOC) have marks on their records ranging from malpractice to fraud. The FDOC rarely fires or disciplines doctors it hires, even in cases where negligence causes prisoners to die.
Dozens of Florida prisoners have died since 1994 after receiving inadequate health care.
Recent state and federal legislation have made it almost impossible for prisoners to successfully sue the Department of Corrections when subjected to medical malpractice, even when it results in disfigurement or life-threatening complications. Even if legal action was successful, prison doctors are shielded from personal liability and taxpayers are required to cover any legal judgments against the doctors.
At least one in every nine Florida prisoners suffers from severe mental illness which prison guards are not trained or equipped to deal with.
The above are just a few of the findings of a special investigative report conducted by the St. Petersburg Times recently. In a three part series that made headlines 'in that Central Florida newspaper during the month of September, facts and statistics were revealed about the Florida prison system that had been concealed from the public.

While prisoners in Florida, and their families, have been very aware that the quality of medical care has been going downhill for several years, and while taxpayers have been paying more and more, the Department of Corrections has been able to keep the true state of affairs from public scrutiny.

The special report by the Times, -judgments against the doctors which ran from September 26th through the 28th, shows that the DOC has been a dumping ground for troubled physicians. Doctors who have repeatedly lost malpractice claims, been found guilty of sexually abusing their patients, been found guilty of fraud, and who only have temporary or restricted licenses, or who have been disciplined by the State Board of Medicine, are a bargain for the DOC. And that appears to be the real incentive for the DOC, which is constitutionally required to provide at least some health care for the 68,000 prisoners in its custody.

Life and Death Cost-Cutting
The average doctor straight out of medical school averages $120,000 a year. The DOC pays far less, with salaries for the doctors it hires to treat prisoners running from $72,000 to $86,000 a year. With prison doctors being fully indemnified by the state, the prison system offers a safe haven for troubled doctors by allowing them to avoid malpractice insurance that increases when a doctor has problems.

David Thomas, the DOC's chief doctor, admits that economics is a factor in the quality of doctors hired by the department. But that does not trouble him. "Clearly, you would prefer people that don't have any problems," Thomas said. "But I do think there is a place for well trained people who have made a mistake, and we may be well placed to do that because we have a degree of control over our doctors that the outside world does not ."

The Times reported in the first of its investigative series that dozens of prisoners had unnecessarily died after receiving inadequate medical treatment since 1994. Some critics question the reasons why the DOC is so willing to hire doctors with questionable histories and put them in charge of a $225-million health care system, and the lives of prisoners.

"Those numbers are pretty atrocious", said Randall Berg, a lawyer with the Florida Justice Institute in Miami. "it shows they really don't care what level of care is provided - they're operating on the cheap."

Shady Physicians
The Times investigation discovered that of the 129 doctors employed by the DOC sixteen have had to pay off previous medical malpractice claims in Florida, some more than once.

Fourteen prison doctors or 11 percent - have disciplinary records with the state medical boards, a relatively rare distinction where last year less than half of 1 percent of the nation's doctors were disciplined by a medical board.

Seven of the DOC doctors have been disciplined more than once by medical boards and nine are listed in a book entitled Questionable Doctors that is put out by a national consumer group.

Three of the DOC's doctors have a history of sexual misconduct with patients.

Fifteen of the DOC's doctors are practicing on temporary or restricted licenses. Because of an exception in Florida's law, doctors who have restricted licenses or have not passed either the Florida or national medical exam, but are licensed in another state, may work in Florida's prisons.

Overall, only one-third of all the DOC's doctors are certified in a specialty, a requirement generally necessary to work at a hospital or for an HMO.

Between 1996 and 1998 the DOC admits it only reported three doctors to the state medical board. Two of those doctors, Abigail Rosario-Rivera and Frederick Vontz, are still employed by the DOC even after being reported to the medical board for negligently allowing prisoners in their care to die.

The department is even willing to hire and place in positions of authority doctors who commit crimes. Dr. Robert Briggs, the chief medical executive at Charlotte Correctional Institution, plead guilty in federal court in 1981 to filing fraudulent Medicare payment invoices.

Other examples of questionable doctors noted in the Times report include Dr. Effong Andem. He was disciplined in 1994 by the army on charges that included "lack of attention to detail, failure to assume responsibility for patients, failure to admit or recognize errors, and failure to learn from mistakes." The next year, he was hired by the DOC.

Dr. Mireya Francis was disciplined by the Florida Board of Medicine in 1993 for dispensing drugs to mentally ill patients without first performing psychiatric evaluations. In 1995 she was again disciplined for lying in her application about being denied from practicing medicine in Ohio. The DOC hired her despite those marks on her record.

Dr. Arnold Azcuy is a medical executive at North Florida Reception Center. He is in charge of reviewing prisoners' medical cases statewide and makes cost-control decisions about when to deny care. Dr. Azcuy paid out on three medical malpractice suits before coming to work for the DOC. Two of his claims, both in 1993, involved the deaths of his patients.

Another DOC doctor, Stanley Dratler, lost his medical license for three years in 1986 for fondling female patients. Before coming to the DOC, Dr. Jose Gonzalez was disciplined by the medical board after giving the wrong medicine to a pregnant woman causing her uterus to rupture and the fetus to die.

Dying by the Dozens
The DOC maintains that the, medical care being provided to prisoners is as good as one can get on the outside. But then they never thought anyone would care enough to look closer, or that DOC Secretary Moore would unintentionally open up Pandora's box.

Earlier this year Moore proposed to Gov. Jeb Bush that money could be saved if three oversight committees, the Florida Corrections Commission (FCC), the Correctional Medical Authority (CMA), and the Correctional Privatization Commission (CPC), were done away with. Moore told Bush that those entities (that provide a measure of oversight of the DOC's operations) are unnecessary, that the department can supervise itself.

That proposal ruffled a few feathers and focused attention on just what those committees do, ironically they are very seldom ever heard from or mentioned in the news.

The members of the CMA, a group set up by the legislature to audit prison medical care in 1993, apparently did not appreciate Moore's proposal to do away with them and in September they struck back with a news release that prompted widespread media coverage.

According to the CMA, since January 1994 at least 56 Florida prisoners have died from inadequate medical treatment. That's almost one in eight of the 463 death records that the CMA reviewed for that period.

"These deaths could have been prevented," said Linda Keen, executive director of the CMA. Instead, for years, CMA records indicate, Florida prisoners have been dying by the dozens as a result of substandard or simply negligent medical care.

The CMA has been doing the job it was authorized to do. It pays consulting fees to private doctors with no ties to the DOC to review a sampling of deaths at the state's prison hospitals.

Every few weeks the CMA sends a report on the findings of those doctors to the governor, the legislature, and the DOC. But the CMA cannot tell the DOC to do anything, their power being strictly limited by law.

Kay Harris, who is in charge of preparing the CMA reports, said she feels that despite the obvious problems exampled in the reports that nothing ever changes. "The average John Q. Citizen doesn't care about inmate health care," Harris said.

The chief administrator of the DOC's health care system, John Burke, disputes that the department is at fault. Despite the CMA's assertions, the department's record is a good one, he claims. "A percentage of people are going to die no matter what you do, and I don't think our percentage is inordinately high considering the population we take care of," Thomas said.

Thomas also noted that there are an additional 820 prisoner deaths since 1994 that the CMA hasn't reviewed, and knowing that they don't have the funds, he disingenuously asked why they didn't review them - too. "We're not perfect," Thomas defensively said, "People make mistakes, and other people suffer for it."

Bedlam in the Sun
The St. Petersburg Times report did not stop by just looking at the medical hell that Florida prisoners are increasingly being subjected to. The third part of the Times' series explored the care that the increasing number of mentally ill prisoners receive while in Florida's prisons.

According to a recent study by the U.S. Justice Department, an estimated 284,000 prisoners - 16 percent of the U.S. prison and jail population - suffer from severe mental illness. (See: FPLP, Vol. 5, Iss. 5, "Mentally Ill Prisoners") Many experts say that the Justice Department's study confirms the belief that prisons have become the nation's new mental hospitals.

With the wholesale closings of public mental hospitals in the 1960's and the prison-building boom of the past two decades, prison often becomes the only option available to mentally ill persons unable to cope with the pressures of society. From a high of 559,000 in 1955, the number of patients in state hospitals nationwide dropped to just 69,000 in 1995. At the same time, the number of jail and prison beds has quadrupled in the last 25 years, with over 1.8 million Americans now behind bars.

Florida is not an exception. As noted in the Times report, with the state prison population over 68,000, at least one of every nine prisoners in Florida suffers from severe mental illness.

For some of the incarcerated mentally ill, prison offers access to psychotropic drugs and treatment that they might not receive on the outside. But for others, prison often exacerbates their illnesses as they struggle to deal with officers unable or unwilling to distinguish between mental symptoms and willful unruliness. Punishment and discipline against mentally ill prisoners is common and on average results in considerably longer time behind bars, the Justice Department study found.

"A prison is absolutely the worst place for somebody with severe mental illness, and absolutely certain to exacerbate their symptoms," said Ron Honberg, legal director for the National Alliance for the Mentally Ill.

John Burk, deputy director for the Florida DOC's health care system, said, "Once these guys are put in prison they've got to function in a structured environment, a very structured environment, and some of them can't. But that's not a correctional officer's fault."

Many experts feel that without it being necessary to assign just who is at "fault," it is obvious that the Florida DOC is doing a poor job of dealing with a growing crisis within the prison system as concerns the mentally ill. Mental health staff in the prisons are often overwhelmed by their case loads and operate in an atmosphere where guards and administrators view mental health staff as coddlers who are easily manipulated by prisoners.

"Often its security who wants to make the call that inmates [fake mental health problems], so that it's okay not to provide treatment for them. There's an attitude that all inmates are [faking]," said Helen Cunningham, who quit the DOC in August as Baker Correctional Institution's senior psychologist. Cunningham said she often had to wait days before guards would bring prisoners requesting mental health care to her. She said she was treated worse by prison guards if she wrote up reports on allegations that prisoners had been abused, as she was often required to do.

The DOC spends over $46 million a year on mental health, but still is falling behind. In the last two years at least 65 mental health staff positions have been cut. The increasing numbers of mentally ill entering the system and the rising costs of psychotropic drugs is growing faster than the DOC budget.

"It's being tightened down as tight as we can get it," said DOC's John Burke. "[But] we think we're still providing care that meets the constitutional standard." Not so, says others, even former DOC employees.

Destructive Solution
"As they cut mental health services, which is what they're doing, you are going to have more and more inmates who are unmanageable because of mental illness," said Connie Schenk, a former DOC psychologist who quit in frustration during August. (See: This issue [of FPLP], "Beatings, Corruption, Cover-ups Detailed to Senate by Prison Psychologist.") "The way [the DOC] deals with mentally ill inmates who can be problematic is just to put them into close management [sensory depriving confinement], where they don't get near the access to help that they used to," said Schenk.

According to Terry Kupers, a forensic psychologist who wrote a book about the devastating impact that confinement can have, prisoners left with little contact with others often become psychotic and filled with rage.

Social science and clinical literature have consistently reported that when even mentally normal human beings are subjected to social isolation and reduced environmental stimulation, they may deteriorate mentally and in cases actually develop psychiatric disorders. The effects of such isolated confinement almost certainly creates more problems for those already suffering from mental illness.

"It becomes a vicious circle especially if the mentally ill inmate hurts an officer," commented Kupers. "Rather than providing any therapeutic treatment, the guards can get more and more brutal, and then the inmates become even more violent and disruptive. It just escalates."

Kay Jamison, a professor of psychiatry at the John Hopkins School of Medicine, notes that, "The incarceration of the mentally ill is a disastrous, horrible social issue." Subjecting the mentally ill to isolated confinement situations "can exacerbate their hallucinations or delusions," Jamison said.

Yet, despite the wealth of evidence showing the destructive and damaging effects of isolated confinement on the mentally ill, the Florida DOC has actually increased its use, and plans to increase it even further without consideration of the long term effects or the eventual cost to society or taxpayers. (See: FPLP, last issue, "The Return to Draconian Days in FDOC").

Decades of Neglect
Allegations and evidence that the medical care available to Florida prisoners is far below recognized standards, and that unnecessary deaths result from same, are nothing new. For 20 years, between 1973 and 1993, Florida's prison system was under the control of federal courts in a case that started out challenging the poor quality of medical care provided to state prisoners.

Throughout that case court appointed medical teams found that prison officials were providing below-standard medical care time after time. After costly improvements, and pressure from the federal court, that case was finally settled in 1993, with the state promising to provide medical and mental health treatment equivalent to the community's standard of care.

Bill Sheppard, the lawyer who represented prisoners in that federal case, said that the problem today is the same as it was two decades ago: Lack of money.

"Every damn death I've seen is a sad story," Sheppard said. "And the legislature is the .. .damn cause of it.

Another lawyer, Randall Berg of the Florida Justice Institute, said medical care did improve in the prisons up through the lawsuit in 1993.

"Things got measurably better. But it didn't take long for it to get back where it was .... And it's getting progressively worse." Berg commented.

It has become so bad and problems are so rampant that even Florida's normally prison-myopic legislators have had to take notice. According to Sen. Skip Campbell, vice chairman of the Senate Criminal Justice Committee, "I can assure you I get a letter a month from inmates saying, 'I'm not getting proper care.' I'm starting to believe now that maybe they aren't getting the treatment [they need]."

[Sources: St Petersburg Times, Orlando Sentinel. Reprinted with permission from Florida Prison Legal Perspectives.]

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