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Doctor of Death: Former Jail Physician Leaves Trail of Prisoner Deaths, Injuries

Doctor of Death: Former Jail Physician Leaves Trail of Prisoner Deaths, Injuries

by Matt Clarke

An Illinois doctor whose medical care – or lack thereof – was linked to the deaths of prisoners in multiple states has lost his license to practice medicine, has been fined at least $50,000 by state oversight agencies and has been named in more than three dozen lawsuits.

Dr. Stephen Austin Cullinan, 68, agreed on June 6, 2014 to the indefinite suspension of his medical license in Indiana – the last of a dozen states where he had been licensed to practice. In accepting the settlement, Cullinan agreed that the suspension carried no right of appeal.

The action by the Medical Licensing Board of Indiana followed a May 16, 2014 order by the Missouri Board of Registration for the Healing Arts to revoke Cullinan’s license in that state due to “alleged negligence in the treatment and care of one patient,” and for failing “to properly treat” two other patients. All three were prisoners in county jails. Two died.

Cullinan previously had been disciplined or agreed to surrender his license in Michigan on August 14, 2012; in Illinois on March 27, 2013; in Iowa on August 30, 2013; and in Ohio on December 11, 2013.

However, the state medical boards’ actions were essentially moot, as Cullinan had retired from practicing medicine in February 2012.

A federal lawsuit followed the December 12, 2007 death of a Sangamon County, Illinois prisoner who was treated by Cullinan. Maurice L. Burris, 50, was in jail for allegedly stalking a former girlfriend when he began experiencing severe stomach pain and vomiting. The suit, filed by Burris’ son, Jacob, alleged that Dr. Cullinan and Health Professionals, Ltd., a company co-founded by Cullinan and hired by Sangamon County to provide medical care at the jail, failed to adequately treat Burris’ condition beyond prescribing over-the-counter drugs such as Mylanta.

Burris died at a local hospital after suffering a heart attack at the jail. Doctors diagnosed him with “acute abdomen” and septic shock; he also suffered from a perforated ulcer and an unrecoverable brain injury, according to court documents.

Cullinan’s insurance company settled the wrongful death suit for $737,500 in November 2011, while Sangamon County officials agreed to pay Burris’ family $60,000. See: Burris v. Cullinan, U.S.D.C. (C.D. Ill.), Case No. 3:09-cv-03116-SEM-BGC.

The attorney representing Burris’ family, Alexandra de Saint Phalle, said the Illinois medical board’s disciplinary action against Cullinan, which included a 60-day license suspension and $30,000 fine, was inadequate. “I would have liked to have seen a higher fine,” she stated.

Further, de Saint Phalle said, suspending Cullinan’s license to practice medicine was “totally academic” due to his retirement. In a January 2012 letter to state health officials, de Saint Phalle wrote that Cullinan “has a history of providing grossly inadequate care to inmates.”

“The case before him was so simple and the errors so egregious, that Dr. Cullinan’s acts and omissions go beyond mere malpractice,” noted Dr. Marc Stern, the former medical director for the Washington State Department of Corrections, who served as an expert in the case.

Sangamon County canceled its contract with Cullinan and Health Professionals, Ltd. nine months after Burris died. Health Professionals had made campaign contributions to at least four Illinois sheriffs who contracted with the company to provide jail medical services. Health Professionals was purchased in 2007 by Correctional Healthcare Companies, which later merged with Nashville, Tennessee-based Correct Care Solutions. [See: PLN, Sept. 2013, p.24].

Prior to Burris’ death, Cullinan’s inadequate medical care led to the loss of a prisoner’s leg, resulting in an August 2012 reprimand and $10,000 fine by the Illinois Department of Financial and Professional Regulation. In 2007, Macoupoin County, Illinois jail prisoner Jason E. Waggener had a seizure and suffered a broken ankle and head injury. He was taken to an emergency room where the attending physician recommended that he be seen by an orthopedist. Instead, Dr. Cullinan ordered him returned to the jail.

During the next several days, Waggener became delusional and started to hallucinate. He removed his splint and walked around until he incurred a compound fracture that eventually led to the partial amputation of his leg. Macoupin County’s insurance carrier paid $339,880 to settle Waggener’s subsequent lawsuit and Health Professionals, Ltd. reportedly settled for $255,000. See: Waggener v. Macoupin County, U.S.D.C. (C.D. Ill.), Case No. 3:08-cv-03166.

In 2009, Michigan authorities fined Cullinan $10,000 for withholding psychotropic drugs from two mentally ill prisoners without consulting the prescribing psychiatrist or examining the prisoners. Also in 2009, Cullinan reportedly paid $17,500 to settle a malpractice suit filed on behalf of a prisoner who had not been properly treated or prescribed the correct medication after being attacked by another prisoner, according to the Illinois Times.

Further, Cullinan was implicated – but not named – in a 2010 lawsuit stemming from the death of a La Crosse County, Wisconsin jail prisoner who had a history of heart disease. In court pleadings, the widow of John P. King claimed that Cullinan, without consulting the prescribing physician, cut off the medication that King was taking in large doses – Xanax – which was known to potentially cause death when the dosage is reduced. [See: PLN, July 2013, p.24].

“What Cullinan did does seem like pretty serious malpractice,” stated a federal Court of Appeals judge. “You have a drug where reducing the dosage can have serious side effects. You have a doctor that knows this fellow has a prescription from the veterans’ hospital and he cuts it down drastically. And he does this without calling the veterans’ hospital to ask why this fellow has this large prescription. That sounds really bad.”

The attorney for King’s widow, Michael Devanie, said he tried to include Cullinan as a defendant after learning the doctor had an “unwritten policy” of routinely denying Xanax and similar drugs to prisoners, but the district court judge refused to allow it. The lawsuit ended in a defense verdict at trial, but on August 14, 2014 the Seventh Circuit Court of Appeals remanded the case for a new trial against one of the defendants – jail nurse Sue Kramer. See: King v. Kramer, 763 F.3d 635 (7th Cir. 2014).

Another prisoner who was denied his prescribed Xanax, Roy Wireman, Jr., experienced seizures and died at an Indiana jail in 2009. A federal lawsuit filed against Cullinan and Health Professionals, Ltd. over Wireman’s death settled under confidential terms in September 2011. See: Wireman v. Pulaski County Board of Commissioners, U.S.D.C. (N.D. Ind.), Case No. 3:10-cv-00077-RLM-CAN.

The litany of medical malpractice and deliberate indifference claims against Dr. Cullinan seems never-ending. A search of the PACER federal court docket system indicates that he has been named in at least 38 lawsuits in Illinois, Indiana, Michigan, Oklahoma, Wisconsin and Missouri.

The family of Grundy County, Illinois prisoner Robert Awalt filed suit after Awalt, an epileptic, was denied anti-seizure medication and died following multiple seizures. The federal district court granted in part, denied in part and continued in part the defendants’ motion for summary judgment on November 24, 2014, and the case remains pending. Cullinan and Healthcare Professionals are named as defendants. See: Awalt v. Marketti, U.S.D.C. (N.D. Ill.), Case No. 1:11-cv-06142.

U.S. Army veteran Justin Ray Sparlin sued Cullinan for failing to adequately treat his mental condition while Sparlin was held at the LaSalle County jail in Illinois. Two psychiatrists had diagnosed Sparlin with mental illness, yet Cullinan allegedly prescribed a medication for heart disease, high blood pressure and migraines. See: Sparlin v. Templeton, U.S.D.C. (N.D. Ill.), Case No. 1:11-cv-03875.

The mother of Patrick J. McCann, who died at a jail in Ogle County, Illinois, filed a lawsuit in 2011 after Cullinan substituted methadone for the opiate painkiller McCann had been prescribed for burns that covered 40% of his body. McCann, 34, who had tried to burn down his mother’s home, was being treated for a bipolar disorder with psychotropic medication that was fatal when combined with methadone. The wrongful death case is ongoing. See: Greene-McCann v. Ogle County, U.S.D.C. (N.D. Ill.), Case No. 3:11-cv-50125.

Robin Pedersen Craft filed suit against Cullinan in July 2012, alleging that while she was incarcerated at a jail in Lee County, Illinois he denied her the lithium she had been taking. As a result, after six days in custody, she was taken to a hospital when she began vomiting, urinating on herself and eating her feces. She was reportedly suffering from renal failure and lithium toxicity. Court documents claim that Cullinan failed to examine or monitor Craft at any time prior to her hospitalization; her lawsuit remains pending. See: Craft v. Varga, U.S.D.C. (N.D. Ill.), Case No. 3:12-cv-50270.

The family of Dale J. Dakota also filed suit against Cullinan in July 2012, alleging that Dakota’s death at a Michigan jail stemmed from a lack of proper medical care. Dakota, who had a history of heart problems, had a rash on his neck and a swollen eye, and was lethargic. Cullinan told guards to keep an eye on him and repeated that advice three hours later when the jail called to report that Dakota had fallen, hit his head and could neither stand nor hold objects.

Cullinan repeated the same advice a third time when guards called again two hours later to report that blood of unknown origin was smeared on the walls of Dakota’s cell. Dakota died in 2011 of an intracranial hematoma, sepsis and inflammation of the lining of his heart.

“Dr. Cullinan did not believe that Mr. Dakota’s medication would cause such a reaction and he stated that Mr. Dakota was acting up,” according to court documents. A $250,000 settlement in the case was approved by a federal district court in May 2013. See: Dakota v. Cullinan, U.S.D.C. (W.D. Mich.), Case No. 2:12-cv-00275-RAED.

One of the earlier known allegations of malpractice against Cullinan involved the 2004 death of Anthony Snyder, 36, incarcerated at a jail in Franklin County, Illinois. The coroner called Snyder’s death “100% preventable.” A subsequent lawsuit alleged that Cullinan had accused Snyder of faking his symptoms on the same day that Snyder was taken to a hospital emergency room. The suit settled under confidential terms.

The good news is that Dr. Cullinan is no longer practicing medicine. The bad news is the large number of prisoners who died or suffered injuries due to his abysmal medical care. Worse, he has never been held accountable for his harmful actions; he was never criminally prosecuted and eventually simply retired. Although a physician, Cullinan apparently failed to understand or embrace the Hippocratic Oath, which is summarized as “First, do no harm.”




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Related legal cases

Awalt v. Marketti

Greene-McCann v. Ogle County

King v. Kramer

Dakota v. Cullinan

Craft v. Varga

Sparlin v. Templeton

Burris v. Cullinan

Wireman v. Pulaski County Board of Commissioners

Waggener v. Macoupin County