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Nevada Prisoner Health Care So Atrocious, Prisoners Volunteer for Execution to Avoid Suffering

by David M. Reutter

“It is my opinion that the medical care provided at Ely State Prison amounts to the grossest possible medical malpractice, and the most shocking and callous disregard for human life and human suffering, that I have ever encountered in the medical profession in my thirty-five years of practice.” – Dr. William Noel

The above quote comprises the conclusion of Dr. Noel in a report for the National Prison Project of the ACLU. In preparing that report, Dr. Noel examined 35 prisoner medical files from Nevada’s Ely State Prison (ESP), which is more than 250 miles outside Reno, Las Vegas. ESP houses Nevada’s death row. That fact, critics charge, may be the reason behind the atrocious healthcare at the facility.

Dr. Noel’s report details the death of one prisoner that resulted from a failure to render any meaningful treatment. In several cases, Dr. Noel found it simply astonishing the prisoners were still alive in light of a “system that is so broken and dysfunctional that … every one of the prisoners at [ESP] who has serious medical needs, or may develop serious medical needs, is at enormous risk.”

Anti-death penalty advocates point to the number of “volunteers” for execution at ESP. Ten of the last twelve prisoners who were executed in Nevada volunteered to be put to death by dropping their appeals. By far, that is the highest rate of death row volunteerism in the nation. Critics contend that the prisoners preferred to be executed rather than endure untreated, severe chronic pain and illness.

One can only wonder whether death row resident Patrick Cavanaugh wished he could have volunteered for an early death instead of having to endure two years in ESP’s infirmary without medical treatment before his agonizing end on April 10, 2006. Dr. Noel called the pain, suffering and indifference from medical staff that Cavanaugh experienced “almost too horrible to believe.”

Cavanaugh, a former manager for the rock group the Coasters, was on death row for shooting and killing one of the group’s singers, mutilating his body and dumping it in a canyon. While many of ESP’s 1,097 prisoners have committed horrible crimes, Dr. Noel noted that physicians are sworn to “make no judgments as to the character or morality, but … [to] treat the disease.”

Apparently ESP’s medical staff felt that Cavanaugh himself was the disease, which had to be killed with indifference. Cavanaugh, afflicted with diabetes, was insulin-dependant. Nonetheless, without any indication for the reasoning, an unsigned order dated August 28, 2003 stopped all of Cavanaugh’s medications, including his insulin.

Over the next three years Cavanaugh’s blood sugar levels ran dangerously high. While insulin was sporadically ordered it was never dispensed. As early as 2001 he developed leg ulcers due to diabetes, indicating that his disease was quite severe and had been negligently managed.

The cause of Cavanaugh’s lingering death “was complications of Diabetes Mellitus, peripheral gangrene of both lower extremities, hypertension, and congestive heart failure – all untreated,” wrote Dr. Noel. Everyone entering the area where Cavanaugh was confined could smell his putrefying flesh.

Former ESP nurse Lorraine M. Wilkin wrote that Cavanaugh’s “toes and feet turned black and this gradually progressed up the legs until it had turned into a stinking, rotting, oozing mess of dead flesh which had reached clear up to the level of his knees.” Dr. Noel said the medical record included “no indication … that a single consideration was ever given to surgically removing the gangrenous limbs,” which could have saved Cavanaugh’s life. “Instead, ESP medical staff literally left him to rot to death.”

Such behavior amounted to “the grossest possible medical malpractice” Dr. Noel had ever encountered, which constituted “deliberate acts of unconscionable cruelty.” ESP’s medical providers labeled Cavanaugh’s gangrene as “cellulitus,” which Dr. Noel said was akin to calling “9/11” a “high rise fire.”

Cavanaugh’s body was cremated immediately following his death without an autopsy or notification of his family. In April 2008 his family filed a federal lawsuit against the state, alleging grossly inadequate care that resulted in a “most miserable death.” See: Dougherty v. McDaniel, U.S.D.C. (D.Nev.), Case No. 3:08-cv-00192-LRH-RAM.

The body of another former ESP prisoner, Robert Estabrook, who reportedly died of cancer in July 2006, was likewise cremated without an autopsy.
The ACLU, in a December 20, 2007 letter to Nevada DOC Director Howard Skolnik, noted “There [was] no clear diagnosis of the cancer and no explanation for the sudden need for powerful narcotics” prior to Estabrook’s death.

Dr. Noel also found that ESP medical staff had little regard for prisoners with chronic pain.

Just the act of moving is extremely painful for prisoner John Snow, who has severe degenerative hip disease. He was recommended for hip surgery but the prison deemed his condition “not life-threatening.” Because he has no cartilage in his hips, walking causes Snow’s bones “to scrape and grate back and forth on each other.” Yet not only do medical staff refuse to provide Snow with any pain medication, prison officials do not let him use a wheelchair. Eventually, says Dr. Noel, he will be unable to move at all without surgery.

Snow was given Indocin for inflammation, plus steroids, to treat his hip condition. The fact that Indocin was prescribed demonstrates that ESP prisoners are seen as less than human, since that medication “is mostly used to treat animals, such as race horses” due to its harsh side effects, noted Dr. Noel.

Prisoner David Riker suffers from rheumatoid arthritis, fibromyalgia and chronic fatigue syndrome. He was told by staff “that treating chronic pain is against the policy of the prison.” Dr. Noel, however, noted that Riker’s “protopathic nerve pain is a living hell and must be treated.”

The medical staff at ESP makes no attempt to hide their deliberate indifference to prisoners’ serious healthcare needs. In fact, they brazenly flaunt it. Throughout Dr. Noel’s report, physician’s assistant Max Carter’s name surfaces repeatedly. Physician’s assistants have provided most medical treatment to prisoners at ESP, since the facility went without a full-time doctor for almost two years, from 2006 to 2008.

Carter took Riker off all his medications because he felt Riker did not have rheumatoid arthritis, contrary to previous diagnoses by doctors in California. Carter’s brazen attitude was further evidenced in the medical file of prisoner Charles Randolph. Carter responded to a medical kite submitted by Randolph on June 14, 2007. In that kite, Randolph asked why he was being switched to the medication lisinopril from atenolol, which he had been taking for years and worked for him. Carter responded that a medical study showed atenolol “increased cardiac chances.”

Nevertheless, Carter said he would put Randolph back on atenolol “so that your chances of expiring sooner are increased.” Dr. Noel learned that Carter then placed Randolph on the original medication “out of spite” for challenging his decision to switch prescriptions. This was cited as “an excellent example of the overriding ethos of medical care at ESP.”

Dr. Noel found the entire medical system at ESP was “broken and dysfunctional.” Most of the medical records he received were illegible, incomplete, failed to contain progress notes, had large gaps in treatment, and were missing such things as lab reports and X-rays. He did not believe the 35 cases he reviewed were an aberration.

The ACLU also began an investigation into medical care at the Southern Nevada Women’s Correctional Center. The women prisoners there complained of receiving improper prescriptions for psychotic conditions and little preventative dental care. “These are not isolated incidents, but the refrain we have heard from dozens of women,” said Lee Rowland, an ACLU attorney in Las Vegas.

Still, Nevada prison officials remained in denial. “We don’t have deplorable conditions at these prisons,” stated DOC Director Howard Skolnik. “I do know that I have recently been informed through some other auditing that the access to medical care and the quality of care provided by the department meets or exceeds community standards.” Dr. Noel, however, found the medical care at ESP “contradicts medical ethics and all community standards of care I know of in this country. It is certainly contrary to practice in the State of Nevada.”

The ACLU provided Dr. Noel’s report to Skolnik and Nevada Gov. Jim Gibbons, and in January 2008 asked the state to voluntarily enter into a consent decree to improve medical care for prisoners. The request was rejected. “Ely is a prison. It is not a hospital,” said Skolnik. “The operations of an infirmary in a prison are different than working in a hospital.”

Consequently, on March 4, 2008, the ACLU of Nevada and the ACLU’s National Prison Project filed a class action lawsuit against the Nevada DOC due to “a pervasive pattern of grossly inadequate medical care” at ESP.

“The state just hasn’t shown a sense of urgency in addressing the crisis at Ely,” stated Amy Fettig, a National Prison Project attorney. “They assured us that they were going to carry out far-reaching reforms to address the problems we brought to their attention, but that was months ago and they’ve made only half-hearted gestures to fix their broken system. We had hoped to avoid litigation but we can’t in good conscience wait any longer, with the men at Ely still at such risk.”

The lawsuit, filed in U.S. District Court in Reno, is pending class certification. See: Riker v. Gibbons, U.S.D.C. (D.Nev.), Case No. 3:08-cv-00115-LRH-VPC.

Apparently prisoners are not the only ones who have suffered as a result of inadequate care at ESP. Former ESP nurse Lorraine Wilkin, quoted earlier describing the deteriorating medical condition of Patrick Cavanaugh, was fired in February 2007. She filed suit in federal court on April 8, 2008, alleging retaliation by DOC staff and ESP’s former physician, Dr. Stephen MacArthur, for her disclosure of “drastic malpractice intentionally inflicted upon prisoners held at Ely State Prison.” She has also raised claims of racial discrimination, sexual harassment and medical malpractice. See: Wilkin v. State of Nevada, U.S.D.C. (D.Nev.), Case No. 3:08-cv-00187-LRH-RAM.

Space limitations preclude giving justice to the gross suffering and deliberate indifference to serious medical needs detailed in Dr. Noel’s 21-page report. In many years of writing for PLN, this author has read horrendous accounts of medical care in various state prisons. After examining the report discussed here, even as a layman I must concur with Dr. Noel’s conclusion quoted at the beginning of this article.

Dr. Noel’s report, titled “Report prepared for the National Prison Project of the ACLU: Review of Medical Records from Ely State Prison,” released on December 6, 2007, is available on PLN’s website.

Additional Sources: ACLU press releases, Los Angeles Times, Ely Times, Las Vegas Sun

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Related legal cases

Dougherty v. McDaniel

Riker v. Gibbons

Wilkin v. State of Nevada