Of the fifteen physicians employed by the Louisiana prison system, nine have received medical board disciplinary sanctions. Of those nine, two have served time in federal prison, five are on probation, two have their practice limited to "institutional settings," two can't treat patients under 18 years old and one has to have a chaperone when treating females younger than 60. The fact that 60% of Louisiana prison physicians have a troubled past has caused controversy and led to charges of possible substandard care.
"I don't think it would be desirable to take the state's lowest-quality physicians and have them deal with the most vulnerable population, whether it's corrections or the developmentally disabled," said Society of Correctional Physicians president Dr. Don Kern. "As a whole, it would seem like there may be a concern here because that's striking me as an unusually high proportion of people who have some kind of license problem."
The nine prison physicians with tarnished records make between $119,000 and $185,000 a year. The range for the six doctors without infractions is $160,000 to $228,800. This raises the question of whether saving money by being able to pay less to doctors with troubled pasts is a motive for hiring them.
Dr. Raman Singh, medical director for the Louisiana Department of Corrections, would probably deny that motivation. He said that some doctors choose prison medicine for its regular hours and out of a desire to help prisoners, but most physicians do not want to treat rapists and murderers in a setting that could erupt into violence at any time. Furthermore, the pay is lower than they would make in private practice and the prisons are located in rural areas where physicians are scarce inside and outside of the prisons.
That's why Singh will give a physician who has made a mistake a second, third or even fourth chance--so long as they weren't disciplined for medical incompetence. He is willing to give drug abusers and sex offenders a try.
"In the right setting, with the right level of supervision, they have the skills, and their medical judgment may be quite good, even if they're not doing so well in other aspects of their life, and they're providing a needed service," said Dr. Robert Marier, executive director of the Louisiana medical board.
But the use of physicians who have abused drugs, sold drugs, sexually abused patients or possessed child pornography is not such a simple issue. If we would not allow those physicians to practice outside prisons due to safety concerns, how can we justify allowing them to practice on prisoners?
"Why do we think their poor judgment is sequestered to this little narrow corner, and they're not going to cause trouble in other areas?" asked Dr. Sidney Wolfe, a physician and the director of health research at consumer advocacy group Public Citizen. "Aside from being unethical, it is dangerous. You're winding up having people, who don't have any choice being where they are, getting taken care of by people with demonstrable previous records and problems with the way they practice medicine."
"The problem is that it gives the impression that somehow a physician is good enough to work on inmates for their health care, needs but not good enough to work on other patients, as if inmates are less worthy of adequate care," according to Edward Harrison, president of the National Commission on Correctional Health Care, which has issued a statement condemning restrictions on medical licenses limiting practice to an "institutional setting."
Although advocates of the "institutional setting" restriction claim that these physicians can perform well given a setting that allows for supervision of their practice, they also make it clear the "institutional setting" means only prisons, mental health facilities or homes for developmentally disabled children. According to Marier, it would not include, for instance, a teaching hospital, which could also provide supervision. Marier also noted that the six-member state medical board not only places the "institutional setting" restriction on the physicians, but also helps the physicians on probation find jobs--in prisons or another "institutional setting." Again, this supports the conclusion that prisons have become dumping grounds for problem physicians.
"Prison shouldn't be a waste dump for physicians who have gotten into trouble and can't work anywhere else," said DeWight LeBlanc, a New Orleans resident who was a prisoner at Dixon Correctional Institute for five years.
But, reviewing the past record of the nine problem physicians, it appears to be exactly what prisons are – the hospital of last resort for doctors in trouble.
Dr. Casey McVea, 42, is the only full-time physician at Rayburn Correctional Center, where he is medical director. He earns $122,000 a year. In 2006, he pled guilty to possession of hardcore child pornography--41 still images and one film involving prepubescents. He remains on parole after having served four years in a federal prison. The medical board restricted his license to adult patients.
Dr. Randy Lavespere earns $175,000 a year for being the assistant medical director at the Louisiana State Penitentiary (LSP) at Angola. He spent two years in prison after he was convicted of purchasing crystal methamphetamine with the intent to distribute it in 2006. The $8,000 buy was made from an informant at a Home Depot parking lot. He sat out his 30 month sentence in a federal prison before his license was reinstated in 2009. The license is restricted to "institutional, prison or other structured setting."
Dr. Paul Toce receives a $162,500 annual salary for working as a physician at the LSP. In February 2012, He admitted to "professional sexual misconduct" and was placed on indefinite medical probation with his license limited to board-approved practices and a chaperone required. He is one of the prison system's newest hires.
Another new hire is Dr. Robert Cleveland, who makes $119,000 as medical department director at Avoyelles Correctional Center despite his 2009 health care fraud conviction and the fact that, while on federal probation, he issued numerous prescriptions in violation of a board order restricting his practice to "institutional settings." Cleveland admitted to giving patients free wheelchair certificates in exchange for referrals. His sentence was three months under house arrest.
Dr. John Crawford's annual salary is $157,000 for being the medical director at Phelps Correctional Center. In 2006, he was arrested for "several instances of bizarre behavior." The behavior included spray painting graffiti and illegally discharging a firearm. He was convicted for criminal trespassing and criminal mischief, which Singh said occurred in a prescription steroid induced psychosis. He was also addicted to sedatives and opiates. Nonetheless, Singh refers to him as "a heck of a doctor" citing Crawford's emergency room experience as extremely helpful in the prison setting.
Dr. Hal MacMurdo is a physician at LSP for which he is paid $122,000 a year. He has been on probation since September 2010 and is not allowed to prescribe controlled substances. He entered a long-term treatment facility after he was allegedly drinking alcohol on the job.
Dr. John Prejean, the medical department director at Hunt Correctional Center, makes $170,000. His license is unrestricted despite his having been charged with distribution of methamphetamine in 2003 along with other drug-related offenses. He was diagnosed with amphetamine dependence, sexual addiction, depressive disorder and having a history of cannabis dependence.
Dr. Jonathan Roundtree earns an annual salary of $185,000 for being a physician at LSP. His license is unrestricted, but he has a prior history of disciplinary actions stemming from the early 1990s when he dispensed controlled substances as a weight-loss clinic.
Dr. Angelo Tarver is the medical department director at Dixon Correctional Institute for which he earns $173,056 each year. His license is currently unrestricted, but he has a prior disciplinary history from his having self-medicated with Demerol and other drugs to control pain. He entered treatment, but relapsed in 1993.
The misconduct is not limited to physicians. Dr. Billy Cannon, a legend for his football career at Louisiana State University, is a dentist at LSP. He served time in a federal prison for counterfeiting.
Singh insists that these men make good prison doctors. He said that there have been only two second-chance doctors who were unsuitable for prison work. One of them, Dr. Guy Williams, was arrested in June 2005 for sexually assaulting a patient by sticking his finger into her vagina during a medical examination. That was not the first transgression for Williams. The medical board had already found that be may have engaged in "unprofessional conduct" with a different female patient years earlier.
The medical board placed Williams on probation. That didn't slow him down. While still on probation, he touched a female patient inappropriately and had sex with her. After he admitted those transgressions, the board finally suspended his license.
Prosecutors, in the aftermath of Hurricane Katrina, declined criminal prosecution. So, in July 2008, the board reinstated Williams' license restricted to the treatment of male patients. A year later, he arrived at Angola and was pulling down $138,000 a year. Not bad for a thrice-disgraced doctor.
But Angola was not good to Williams. He left in 2011 to join a pain clinic practice in Metairie. Singh says little other than the 67-year old physician was unsuited to prison practice.
Singh's point is that most of the troubled healers make good use of their second, or third, or fourth chance and become productive and competent prison doctors.
"Casey McVea--his supervisors can't brag enough about him and his quality of work. ... He's really a fine physician," said Singh who said that McVea is the rule, rather than the exception among second-chance prison doctors.
Singh also points out that having no doctor is a much worse alternative to having a doctor who needs another chance.
"I can't find a doctor at all for six months, that creates a huge liability for the unit and for the institution," said Singh. "To me, it's like running Angola without security. The point is, it's easier to find security officers. It's really impossible to find physicians. When I was new, I was told that 'we just need a body in that job.' Sometimes, it's so desperate a situation, you just need a body in the job."
And therein lays the rub. If you just fill the slot with a body, are you doing the prisoners any favors? A lawsuit for medical malpractice might be harder to win than one for denying any medical care at all, and that may provide the state and prison system some comfort, but the results for the prisoners who are denied competent medical attention may well be the same--illness, discomfort, disfigurement and even death.
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