by David M. Reutter

Whenever prisoners complain about inept healthcare, prison officials accuse them of being manipulating whiners, or assert they are being administered the ?community standard of care? by competent medical professionals. A review by The Capital Times has revealed that the community standard of care rendered to Wisconsin prisoners is often provided by doctors who have been disciplined by the Wisconsin Medical Examining Board (MEB).

Of the current 23 doctors employed by the Wisconsin Department of Corrections (WDOC), four physicians, or 17 percent, have been disciplined by the MEB for incidents that occurred prior to their employment with the state prison system.

Since 2002, WDOC has had 37 different doctors in its employ. Of those, eight (22 percent) have been disciplined for incidents that occurred prior to or during their tenure with the department. In comparison, of the 23,000 licensed physicians in Wisconsin, only 1.5 to 2 percent have been disciplined by the MEB.

In its report, The Capital Times identified one WDOC doctor with a standard of care so disturbing that it unsettled his professional colleagues. Dr. Thomas Williams joined the WDOC in July 2004; the following year he was in charge of the infirmary at Dodge Correctional Institution (DCI). ?It?s very frustrating working for this doctor,? said one prison nurse. ?I do a lot of things to cover my tail.?

Before his employment with the WDOC, Williams was in private practice. He was disciplined twice by the MEB for inadequate care to two patients in 1979 and 1980. One of those patients died. Both cases had a similar pattern of care: an insufficient exam, inadequate testing and prescribing medication without a diagnosis.

To address Williams? treatment deficiencies, the MEB sent him back to school for instruction on patient care, conducting exams, obtaining patients? medical histories and maintaining records. In other words, an entire curriculum on how to be a doctor. An examination of Williams? subsequent treatment of WDOC prisoners raises questions as to whether he took that instruction to heart.

DCI prisoner Ronnie Russell underwent a failed attempt by a surgeon at Waupan Memorial Hospital to create a fistula ? a connection between a vein and artery in his arm ? to facilitate his dialysis treatments. Four days later, after Russell was returned to DCI, Williams discontinued his antibiotic prescription and cancelled an ordered appointment with the surgeon to assess the wound ?ASAP.?

?It was going on for weeks,? said Russell. ?My arm was turning black. There was a real lot of black stuff there and a real lot of nasty smells.?

The infirmary nurses at DCI suspected an infection. Following their normal routine in the face of Williams? failure to render care, they continued to document the appearance and size of the oozing hole in Russell?s arm. Russell, who is a diabetic with AIDS, finally received treatment when he had an appointment at University Hospital in Madison for ailments unrelated to his arm.

There, doctors became alarmed when they saw his condition. They ordered tests, surgically cleaned the wound and gave him antibiotics. Apparently, the community standard of care is viewed differently by Williams and the doctors at University Hospital.

Nurses said they viewed it as a control issue with Williams. ?We get medications and start treating them,? stated veteran nurse Kathy Bradley. ?And on Monday morning the doctor stops them without even seeing the patient, just stops them because somebody messed with his orders.?

?I find the same issues keep coming up, being raised by the inmates who are under [Williams?] care, being reported to us through other channels, and I?ve gone through records, appearing time and time again in those records,? noted Todd Winstrom, an attorney with Disability Rights Wisconsin, who specializes in prison issues.

?Those concerns are not seeing inmates very often, not responding to what appear to be significant medical problems that require a medical response, and an ongoing pattern of just plain discourtesy to the patients.?

WDOC prisoner Scott Schuetze developed an infection of unknown origin in his leg. It was surgically cleaned at Waupun Memorial Hospital, leaving a half-dollar sized hole that didn?t heal. He continued to seek medical attention for the infection. ?I said, well, maybe I should be on some more antibiotics,? he stated. ?Nobody would listen.?

Eventually, an on-call doctor at DCI listened to him and ordered Cipro, an antibiotic. When Williams returned to his office, he discontinued the Cipro. When asked why Schuetze?s wound didn?t heal, Williams blamed the patient.

?It would have healed if he had stopped abusing it,? said Williams. ?He was witnessed by several of my nursing staff who reported to me he was digging at it in the shower. Every day he?d come out of the shower with bright red blood draining from the wound, which would only occur in a setting if he was manipulating the wound.?

Schuetze denied the accusation, saying Williams failed to treat the wound, cut back on his pain medications, took away his cane and denied him use of a wheelchair. Regardless of who was correct, a doctor?s obligation is to provide a community standard of care whether in a correctional setting or not.

According to retired family physician Linda Farley, Williams did not render that standard of care. After reviewing Schuetze?s medical records, Dr. Farley issued a report that found ?The standard of care should have dictated a return visit to the orthopedic physicians ? many weeks earlier, thus ensuring a much faster healing of the wound and saving the patient much pain and misery.?

Williams? care, or lack thereof, resulted in Schuetze being denied necessary treatment for five months from the time of his original surgery. He only returned to the hospital because he was sent by an on-call doctor on Williams? day off. Dr. Farley also faulted Williams? care rendered to Ronnie Russell, finding Williams ?did not exercise good medical judgment in neglecting to treat the fistula site, which showed clear evidence of infection.?

Despite such damning statements from nurses who work with Williams and from outside medical experts, prison officials still defended him. ?He?s one of our board certified physicians,? said WDOC Medical Director David Burnett. ?His medical care is sound and good, and I?ll stand behind him.?

Dr. Farley disagreed. She observed that the medical care provided to Russell ?was grossly inadequate and did not meet any acceptable standard of care.? DCI nurse Bradley said WDOC officials were ?well aware of the problems with Dr. Williams and they do nothing. They just keep covering up.?

But then consider that Williams? direct supervisor, Dr. Scott Hoftiezer, has had his own run-ins with the MEB. The Board has disciplined him on three occasions. Dr. Hoftiezer?s problems stem from a drug and alcohol addiction: He was ?writing false prescriptions, forging signatures,? and ?stealing drugs from friends and family? to obtain Vicodin and other narcotics, according to the MEB. ?It?s no secret that I?m a recovering alcoholic and drug addict,? Hoftiezer acknowledged.

Among the doctors with disciplinary records formerly employed with the WDOC is Dr. Vijaya Dasgupta. She was restricted from practicing anesthesiology in 1982 after she failed to keep a 16-month-old boy breathing for several minutes during a tonsillectomy. The resulting brain damage placed the boy under institutional care for the rest of his life.

The WDOC hired her in 1987. Ten years later, Dr. Dasgupta was disciplined for failing to diagnose a prisoner with lung cancer. He later died. Then, in 2005, as the MEB was about to launch an investigation into Dasgupta?s failure to biopsy a growth on a prisoner?s groin, she retired. That patient also died, due to a spreading cancer which had caused the groin growth.

Then there is Dr. Perry Coalman. The MEB disciplined him in 2001 for dispensing narcotics to numerous patients without trying to find the cause of their pain. He was also found to have practiced medicine even though his license had lapsed, and had practiced without malpractice insurance. The WDOC hired him in 2006.

Dr. Paulino Belgado was hired by the state prison system in 1995 and left in 2003. The MEB had disciplined him in 1992 because his patient care ?fell below the minimum standards of competence established in the profession.? Like Dr. Williams, Belgado had failed to order appropriate tests and provide adequate treatment.

At least three other Wisconsin prison doctors have been disciplined. Dr. Enrique Luy was sanctioned in 1993 for accidentally sewing a gauze pad into a patient?s shoulder during surgery. He has been with the WDOC since 2000. Dr. Burton Cox, like Dr. Hoftiezer, is a recovering addict; he was disciplined for drug use in Kansas and Maine before being hired by the WDOC in 2003.

Finally there is Dr. Mohammed Samara, whose Michigan medical license was suspended for six months because he failed to ?properly and adequately? assess the mental status of two elderly patients in 2003. He was hired by the WDOC that same year, and left in 2004.

Wisconsin is not alone in hiring doctors with disciplinary records imposed by state medical boards. The problem, however, is one that remains largely hidden. Corrections agencies are often desperate to hire doctors and will accept compromises in their credentials to maintain the façade that they provide adequate care.

Nor can prison officials claim this is a new, recently-diagnosed problem. The issue of doctors with disciplinary histories providing questionable care to prisoners was raised almost a decade ago in the Journal of the American Medical Association (?Prison Deaths Spotlight How Boards Handle Impaired, Disciplined Physicians,? by Andrew A. Skolnick, JAMA, Oct. 26, 1998. Vol. 260, No. 16, pp.1387-1392).

In that article, Dale L. Austin, deputy executive vice president for the Federation of State Medical Boards, stated, ?If physicians who have been disciplined for past misconduct are congregating in correctional settings, it should be a concern to the medical regulatory community.?

PLN has reported extensively on this topic, including cover stories in the Feb. 2001 and Nov. 2001 issues, as well as articles in July 1995, p.14; Nov. 1995, p.6; June 1996, p.17; May 1997, p.15; Sept. 2000, p.7; Aug. 2003, p.16; and May 2004, p.6.

Even high-ranking prison medical personnel are not immune. The Medical Director for the Arizona Department of Corrections, Dr. James Baird, has been sanctioned by the Arizona Medical Board. He was placed on five years probation in October 2002. During that disciplinary proceeding, Dr. Baird admitted to self-prescribing Propoxyphene for 20 years and taking 12 to 16 tablets a day. He was placed on street observation that included urine tests and substance abuse treatment.

Further, the former head of mental health services for the Oklahoma Dept. of Corrections, Dr. Gail Williams, was hired by Correctional Medical Services (CMS) in 1994 to oversee mental health care for the Alabama DOC, despite the fact that his medical license had been twice revoked for sexual misconduct. Another CMS doctor, Dr. Walter Mauney, hired by the company in 1995 to direct medical care at an Alabama facility, had previously been convicted of a sex crime involving a mentally-ill 16-year-old boy. He also had alcohol and drug addictions.

The above examples are most likely representative of a much larger problem. It should come as no surprise that incompetent, addicted and predatory doctors are unable to provide adequate medical care, which is why they have lost their licenses in the first place. When it comes to administering the community standard of medical care to prisoners, it is all a matter of perspective. If your perspective is that of a prisoner, pray you don?t get sick. If you do, your treatment provider may well be someone the relevant medical board has determined is only fit for prisoners.


Sources: The Capital Times; In the Matter of James Baird, M.D., Arizona Medical Board, Case No. MD-01-0813; The Post-Dispatch

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