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Deficient Medical Care Leads to Preventable Death of Seattle, Washington Jail Prisoner

The State of Washington’s Medical Quality Assurance Commission (MQAC) has charged a former King County jail doctor with providing substandard care.

According to a statement of charges filed on December 29, 2010, Dr. Anthony Rains engaged in “unprofessional conduct” while treating prisoner Lynn Dale Iszley at the King County jail.

Iszley arrived at the jail on July 15, 2007, and during the intake process nurses discovered “multiple abscesses” on his buttocks and legs. Concerned that Iszley had deep vein thrombosis or cellulitis, he was sent to a hospital.

Doctors at the hospital examined Iszley and prescribed Bactrim for his abscesses. He was returned to the jail the following day, on July 16, 2007. Not long afterwards, Iszley began experiencing symptoms of heroin withdrawal, vomiting almost the entire day. He had reported to nurses that he used three grams of heroin and drank 32-42 ounces of vodka per day.

A nurse practitioner prescribed nausea medication and instructed Iszley to drink fluids. During the early hours of July 17, 2007, he reported that he was vomiting with dry heaves. Nurses gave him more nausea medicine and told him to drink water, but Iszley couldn’t keep the water down.

Dr. Rains saw Iszley at approximately 11:00 a.m. that day. Iszley complained about the abscesses, nausea, vomiting and diarrhea. Rains noted that Iszley had “a soft but uncomfortable abdomen,” and attributed his symptoms to heroin withdrawal. Dr. Rains prescribed Pepto-Bismol and started the Bactrim prescription the hospital had ordered a day-and-a-half earlier.

Iszley reported to medical the next morning complaining of severe abdominal pain “like never before.” According to one report, Iszley told guards at the jail, “I think my liver just exploded.”

Dr. Rains saw Iszley around 9:45 a.m. on July 18, 2007. He had abnormal vital signs, could not keep water down, and reported that the medicines he had been prescribed did not control his “severe cramping, aching, dizziness and weakness, and continued nausea, vomiting, and diarrhea.”

Rains concluded that Iszley was experiencing symptoms of heroin withdrawal, and ordered that he be placed in a “detox tank” and that he drink more water. Four hours later, Iszley reported that he was suffering abdominal pain that was a ten on a scale of one to ten. Dr. Rains, who had since left the jail, phoned in an order for Motrin. Iszley was found dead the next day; it was later discovered he had a perforated ulcer.

Rains resigned after an investigation by the U.S. Department of Justice found that Iszley’s death was “likely preventable” and an “egregious example of [the jail’s] systemic failure” in providing proper medical care to prisoners.

According to the MQAC complaint filed against Dr. Rains, “the severity of [Iszley’s] pain, and the fact that he localized his abdominal pain, should have raised concerns ... that the pain was caused by something other than withdrawal.”

The MQAC further concluded that Iszley’s “signs of dehydration ... should have prompted, at a minimum, intravenous hydration and closer monitoring,” and that Iszley “should have been transferred to the emergency room of a hospital.”

Dr. Rains was employed by Jail Health Services when he worked at the King County jail; the MQAC complaint against him remains pending. See: In re Rains, Washington Medical Quality Assurance Commission, Master Case No. M2009-678 (Statement of Charges).

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Related legal case

In re Rains, Washington Medical Quality Assurance Commission