Louisiana Bars Problem Doctors from Practicing Medicine in Most Hospitals. So They Treat Incarcerated People Instead.
Ten of Louisiana’s 12 prison physicians have had their medical licenses restricted or suspended at some point. The state’s incarcerated people have nowhere else to turn during a pandemic.
by Addy Baird, BuzzFeed News
In 2006, Randy Lavespere, a Louisiana doctor, was convicted of buying $8,000 of methamphetamine in a Home Depot parking lot with intent to distribute. He served two years in prison, and his medical license was revoked. But even though he had been convicted of a felony and barred from practicing medicine in most circumstances, he was allowed to treat patients in at least one setting: Louisiana state prisons.
In November 2009, just one month after the Louisiana State Medical Board reinstated his medical license and put him on indefinite probation, Lavespere was hired as a physician at the largest maximum security prison in the country, Louisiana State Penitentiary—better known as Angola, after the plantation on which it was built. Lavespere rose through the ranks at the prison, becoming the institution’s medical director in November 2014, less than three weeks after his license was fully reinstated. Earlier this year, he was promoted again, and now serves as the top doctor at the Louisiana Department of Corrections.
Ten of the Louisiana Department of Corrections’ 12 physicians—including six medical directors and two assistant medical directors—have had their medical licenses restricted or suspended. Several were disciplined for illegally distributing drugs, two committed fraud, one engaged in sexual misconduct, and another former medical director pled guilty to possession of child pornography, according consent orders issued by the Louisiana State Board of Medical Examiners.
Helming the state’s prison hospital wards are medical professionals tasked with taking care of people who cannot choose their doctors and live in conditions that often lead to health problems. But at least three Louisiana doctors began working in the state’s prisons before their licenses were fully restored, and one, the medical director at Rayburn Correctional Center, is currently still working with a restricted license, even though the National Commission on Correctional Health Care and the American College of Correctional Physicians (formerly the Society of Correctional Physicians) oppose the practice of hiring physicians with license restrictions.
“The doctors they hired there are there serving a sentence of their own,” said a man recently released from Angola, who requested anonymity to protect his privacy as he transitions back into the outside world.
Doctors with disciplinary records have often clustered at prisons in the state because of a loophole: The Louisiana State Board of Medical Examiners allows physicians barred from practicing medicine in most hospitals to work in certain “institutional” settings, such as prisons.
In response to questions from BuzzFeed News, the Louisiana Department of Corrections leaned on that exception. In order for doctors to be considered for jobs in prisons, a department spokesperson said in an email, “their licensing status must meet the Louisiana Medical Boards’ standards for working in a correctional setting.” He said that the doctors employed by the state provide “professional and responsive care” to people incarcerated in the prisons.
But under their care, a culture of medical neglect has flourished, according to interviews with two men who were previously incarcerated at Angola, a Tulane University doctor who frequently sees patients from Louisiana prisons, a lawyer who has represented many clients in prisons in the state, and the three correctional medicine experts who conducted a comprehensive review of Angola’s medical practices in 2016 as part of a lawsuit against the prison.
“The LSP health care delivery system fails to provide adequate care to the population and places inmates at significant risk of serious harm,” the review stated. “In our collective experience of over 60 years in correctional medicine, the Louisiana State Penitentiary’s delivery of medical care is one of the worst we have ever reviewed.”
Last month, a federal judge ruled that the Louisiana Department of Corrections had violated the U.S. Constitution’s Eighth Amendment, which forbids “cruel and unusual punishment,” and was failing to provide constitutionally adequate medical care. The Department of Corrections has appealed the ruling.
One man who was incarcerated at Angola told BuzzFeed News he developed an infection so severe that it spread from his lower back through his buttocks and into his scrotum. Two formerly incarcerated individuals alleged in interviews that they and the other patients they were with had been denied necessary surgeries, held in unsanitary conditions on the hospital ward, ignored by medical professionals, and consistently treated by the doctors as if they were lying about their needs.
The State Board of Medical Examiners “is willing to protect the health, safety and welfare of its citizens, unless they are in prison,” the three medical inspectors wrote. “By hiring these physicians, the Louisiana Department of Corrections and Public Safety has essentially ensured inmates receive substandard care.”
The Department of Corrections declined to comment on the experts’ assessment, pointing to ongoing litigation.
As the pandemic continues, many of the approximately 30,000 people incarcerated in the state’s prisons remain in the hands of doctors whose professional records have restricted them from working in community settings, like hospitals or private practices. Angola’s medical director, Dan LaFleur, pleaded guilty to possession of illegal narcotics and was sentenced to six months in federal prison in 2016. Prior to his sentencing, in 2013, his license had been suspended for six months, followed by seven years of probation on his license. The restrictions were lifted just over a year ago, in December 2019.
When the coronavirus began spreading through Angola in March 2020, men at the facility who tested positive for COVID were transferred to Camp J, a shuttered solitary confinement wing that was reopened last spring to serve as a quarantine center. Soon, the facility was at the center of a temporary restraining order filed by a group of people incarcerated at the prison.
“There are reports in DOC facilities of quarantine being broken, no social distancing options in quarantine, and no masks for people in quarantine,” the motion filed in April 2020 reads. “Numerous locations report a lack of soap, and/or insufficient soap, and a lack of hygienic practices to keep people safe.”
According to the filing, the camp was moldy, lacked ventilation, had inadequate temperature control, flooding issues, and faulty door locks.
The recently released man who spoke to BuzzFeed News described his own experience at Camp J. There, after contracting a severe case of COVID and pneumonia simultaneously, he said he was unable to take a deep breath without shooting pain in his ribs, incapable of walking short distances, and forced to yell for help, often waiting as long as 30 minutes before anyone came to check on him.
The emergency motion to close the building was denied by the court, and the Department of Corrections spokesperson said that people who are sick are no longer housed at the camp.
Across the state, prisons have often failed to provide protective equipment, delayed medical treatments, and prevented incarcerated people from social distancing, according to a lawyer, Mercedes Montagnes, who works with incarcerated individuals in the state. More than 3,200 of the people incarcerated in the state’s prisons have been diagnosed with COVID and 36 have died, the 12th-highest coronavirus fatality rate in the country, according to the Marshall Project. A BuzzFeed News review of COVID-19 vaccine shipments to correctional facilities found that of the 35 states that have distributed vaccines to incarcerated people, Louisiana had provided the fewest through March, with just a single shipment of 200 doses.
Louisiana, which has the highest incarceration rate in the country, has long faced scrutiny for the conditions inside its prisons. From 2001 to 2013, Louisiana had the highest prison mortality rate in the country, with an average of about 481 deaths per 100,000 prisoners, according to the Bureau of Justice Statistics, which include both federal and state facilities and do not include executions.
“Given our record reviews of deaths, it is our opinion that there are many preventable deaths at LSP that explain this extraordinary prisoner mortality rate,” the medical inspectors, Michael Puisis, Madeleine LaMarre, and Susi Vassallo, wrote in their report, concluding that the preventable deaths were a consequence of the systemic inadequacies in care at the prison. At the time of the 2016 review, every physician working at Angola had at some point had their license revoked or suspended.
The Department of Corrections provided BuzzFeed News with a list of current physicians working in state prisons, and BuzzFeed News compared them against the Louisiana State Board of Medical Examiners record of license restrictions. BuzzFeed News reached out to all doctors named in this story, but none responded to requests for comment.
BuzzFeed News reached out to all doctors named in this story, but none responded to requests for comment.
Five doctors, in addition to Lavespere, were restricted by the board from prescribing controlled substances. Hal David MacMurdo, a physician at Elayn Hunt Correctional Center, was required to maintain complete abstinence from drugs and alcohol based on reports that he had been drinking on duty. John Prejean, the medical director at Louisiana Correctional Institute for Women, had his medical license suspended until he completed a drug treatment program after he was charged with possession and distribution of methamphetamine and cannabis. Kasimu Moody, a part-time physician at Angola, issued controlled substances without legitimate medical justification. Robert Cleveland, the medical director at Rayburn Prison, was indicted on one count of healthcare fraud for a kickback scheme involving a medical equipment supplier and was later found to be prescribing narcotics from his home and vehicle; his license was suspended, and he is still on probation. Linda Bunch, the medical director at David Wade Correctional Center, was found to be part of a conspiracy to import and distribute human growth hormone and began working at Angola after Medicare declined to cover her services.
Daniel Crook, the assistant medical director at David Wade, was convicted of mortgage fraud. (He was later granted clemency by Louisiana Gov. John Bel Edwards.)
Paul Toce, the medical director at Dixon Prison and a former physician at Angola, engaged in “professional sexual misconduct,” according to his consent order, and prescribed medications to himself and family members without proper medical records. Casey McVea, who was previously the medical director at Raymond Laborde Correctional Center, pleaded guilty to possession of child sexual abuse images in 2004. He served four years in federal prison and worked at Raymond Laborde until he died of COVID-19 last summer.
Another former Angola doctor, Jonathan Roundtree, who is now the medical director at Elayn Hunt, had his medical license put on probation for three years in 1993 due to the “unlawful and imprudent dispensation of controlled substances.”
Roundtree and MacMurdo oversaw the care of Francis Brauner, now 55, who was transferred to Angola in 2005 after breaking his back while working in the fields at the Dixon Correctional Institute.
Brauner was paralyzed from the waist down, but still deemed a safety risk when he arrived at Angola, so he was locked in a room alone. Brauner said during a recent interview that he was not told that he needed to turn himself in the bed, and he developed a sore on his tailbone. It grew into an infection that spread through his buttocks and into his scrotum.
“The infection was so bad, it had opened up my bottom, and they put drainage tubes in there, and, I mean, it was—it was bad,” Brauner said. “They didn’t think I was actually going to live.”
After a few weeks at Earl K. Long hospital, he was sent back to Angola. It took more than a year for the infection to clear up, he said.
Following the incident, Brauner filed a lawsuit against Roundtree and MacMurdo, as well as former Angola medical director Jason Collins and two assistant wardens, alleging that the doctors had been deliberately indifferent in caring for his needs.
Brauner alleged in the suit that his pain and wounds were managed inadequately, the showers were unsanitary, he was denied a slide board and special cushions, and that the staff failed to provide proper turning and range of motion therapy.
In an interview with BuzzFeed News, Brauner described feces piled in the showers of the hospital wing, blood and bandages lying on the floor, fly traps hanging above the men while they tried to eat, no privacy during conversations with doctors, and deep mistrust between patients and the medical staff.
In 2015, a judge dismissed the suit, determining that Brauner’s claims did not rise to the high standards of “deliberate indifference.” The Department of Corrections cited that ruling in response to a request for comment on Brauner’s allegation.
While most of Louisiana’s prison doctors have had their licenses fully restored, the state’s pattern of relying almost exclusively on physicians with disciplinary records has put the doctors in positions somewhat familiar to formerly incarcerated people returning to the outside world: left to their own devices, without institutionalized support, guidance, or structure at the time when it’s likely needed most.
“If the prison wanted to have one person in the facility who was in that posture, they had a vibrant and wholesome plan to support that person and make sure that they were doing the monitoring and training that they needed in order to fulfill the mission of them being reintegrated into the medical team, I think that that could be fine,” Montagnes, the lawyer who has worked with Brauner and others in the state, told BuzzFeed News. “But that’s not what we see here.”
Instead, Montagnes said, while the state has repeatedly hired doctors with license restrictions, there has been “no evidence of monitoring, no evidence of support, no desire to see any sort of services be provided to these physicians in order for them to improve their standard of care.”
The Department of Corrections declined to comment on Montagnes’ assessment, citing ongoing litigation.
It was as part of a 2015 lawsuit that Puisis, LaMarre, and Vassallo visited Angola, reviewed the prison’s records, and interviewed patients and medical staff. As they wrote in their report, prison medical directors are supposed to oversee and organize all medical care in their facilities and supervise staff, but when Lavespere was medical director at Angola, he “apparently [did] not perform many of these typical functions.”
Though he, like the other doctors, handled some clinical care in the hospital wing, the experts found that Lavespere did not handle any formal review of his subordinates, supervise EMT staff, participate in “quality improvement efforts,” or oversee reviews of patient deaths. In his 2016 deposition for the case, he was unable to provide any specifics of how he spent his time managing the medical program and could not provide any information about the prison’s medical budget, the review stated.
Lavespere expressed doubt about the symptoms his patients reported, claiming that incarcerated people lie frequently about injuries or illnesses to get out of work.
“That’s the biggest challenge, you know,” he said in the deposition. “In Angola, they don’t necessarily want to get well because if they get well, then they have to do things.”
The Department of Corrections spokesperson declined to comment on whether the department endorses Lavespere’s opinion, pointing to the ongoing litigation.
For the people the prison doctors treat, the consequences of the substandard medical care have been grave.
In February 2010, according to the report, a healthy man at Angola was playing football when he suffered a neck injury that left him paralyzed. As of 2016, he was living in the hospital ward at the prison, where, he told the inspectors, he was held in a locked isolation room with no call system and no way to notify the nurses if the tube in his trachea became clogged and he was struggling to breathe.
“The solid door is locked and the nurses cannot hear him even if he screams,” the report stated. The man also told the inspectors that inmate orderlies, rather than the medical staff, did “everything for him,” including bathing and turning him, and that if he was asleep when breakfast was served, no one woke him up. He was offered no occupational or recreational therapy, and at the time he was interviewed said it had been two weeks since his hair was last washed.
In another instance documented in the review, medical records showed that a patient with AIDS was said to have been administered medication for four days after he had died, evidence that the prison’s medication records were unreliable, the medical experts wrote.
Despite the 2016 findings at Angola, Lavespere was promoted to interim department medical director last year. He took the job permanently in January 2021.
Some of the most severely ill or injured patients at the state prisons end up at Tulane University hospital. One doctor there, Anjali Niyogi, told BuzzFeed News that many of the incarcerated people she treats at the hospital for conditions like heart failure and lung disease should’ve been brought in much sooner. In the majority of cancer cases, she said, by the time she sees the patient, it’s too late, and the cancer has already metastasized, despite patients telling her that they had complained for years to prison doctors that they needed care.
“By the time that they have lost function of their legs, for instance, and they finally come to the hospital and we do an MRI and we see that there’s just metastatic disease throughout the spine, and at that point there is nothing we can do to regain function of the legs, nor is there anything we can do to really cure the cancer,” she said.
The Department of Corrections said they could neither confirm nor deny Niyogi’s allegations, saying that no specific issue had been brought by her to the state.
“The DOC makes every effort to transport offenders to tertiary hospitals in a timely manner when a higher level of care is indicated,” the department spokesperson said. “It is our goal to deliver the standard of care in each case.”
Health risks at the state’s prisons were already high long before anyone had heard of the coronavirus—and when the pandemic began its spread, there were few places in the country worse to be than a Louisiana state prison.
Because of COVID, many of the patients Niyogi said she was seeing with chronic diseases or conditions that required specialists were not provided transportation to outside appointments or even to telemedicine centers for virtual visits, leaving their needs untreated—and their care solely in the hands of prison physicians.
Addy Baird is a political reporter for BuzzFeed News based in Washington, DC. This article was originally published on May 10, 2021 at buzzfeednews.com and is reprinted with permission.
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