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<h1><b>Prisons Fail to Heal
Healthcare</b></h1><font size=3><a href="http://www.latimes.com/news/local/la-me-prison29sep29,1,231375,print.story?coll=la-home-headlines" eudora="autourl">http://www.latimes.com/news/local/la-me-prison29sep29,1,231375,print.story?coll=la-home-headlines<br><br>
</a></font><h2><b>Disclosures of doctors' spotty backgrounds point to a
state system still in crisis, a lawmaker declares. A hearing is scheduled
for today.</b></h2><font size=3>By Jenifer Warren<br>
Times Staff Writer<br><br>
September 29, 2004<br><br>
SACRAMENTO Nearly three years after California prison officials vowed
to make major improvements in inmates' medical care, the state is facing
new criticism that many of its doctors are incompetent, leading to costly
lawsuits and, at times, deaths. <br><br>
Documents obtained by The Times show that one in five prison doctors has
been disciplined by the California Medical Board or sued for malpractice
a rate almost five times that found statewide.<br><br>
Some physicians working behind bars have histories of criminal
convictions, cocaine or alcohol addiction and a loss of privileges at
hospitals, records show.<br><br>
One doctor, now working at the state prison in Susanville, was treated
for a psychotic disorder that prompted him to lead police on a chase
through the streets of Fresno. He was ordered by the medical board to
complete five years' probation after a psychiatrist declared: "He
cannot practice medicine safely."<br><br>
The disclosures are to be discussed by two state senators at a Capitol
hearing today. Questions are also likely to surface about the June death
of a Bay Area inmate whose family believes he was a victim of inept
care.<br><br>
Anthony Shumake, 41, died six days after a dentist under contract with a
Vacaville prison extracted a wisdom tooth. An infection created an
abscess and swelling in the neck, making it difficult for Shumake to
breathe. A San Joaquin County coroner's report said he died because the
abscess constricted his airway.<br><br>
Shumake's family wants to know why he was driven to a hospital in Manteca
a 75-mile ambulance ride rather than to a facility in Vacaville,
where he was serving a 12-year term for spousal abuse and stalking.
Corrections officials will not comment until an internal investigation is
completed.<br><br>
State Sen. Jackie Speier (D-Hillsborough) said Shumake's death and
statistics about doctors' spotty records illustrate a system in
crisis.<br><br>
"It's appalling," said Speier, who has joined Sen. Gloria
Romero (D-Los Angeles) in investigating the troubled prison system.
"In addition to causing tragedies for inmates, this incompetence
leads to lawsuits that cost taxpayers even more."<br><br>
Today's hearing on medical care adds another dimension to what has been a
difficult year for the youth and adult prison system. Despite new
leadership and a governor who says he is committed to reforming
corrections, the state has weathered allegations of inmate abuse,
corruption and other scandals that have prompted a federal judge to
threaten a takeover of California's 32 adult prisons.<br><br>
The disclosures about doctors come as healthcare costs are soaring. This
year, the Department of Corrections will spend more than $900 million
treating 164,000 convicts, accounting for 20% of the prison budget. Care
is provided by 302 staff doctors, whose annual salaries average $177,000,
as well as scores of physicians who work under contract with the
state.<br><br>
Corrections officials acknowledged that previous hiring practices failed
to screen out some problem doctors, and that managers at each prison had
their own, often inadequate standards.<br><br>
"We really had various fiefdoms in the 32 institutions," said
Dr. Renee Kanan, acting chief of healthcare. Instead of seeking versatile
physicians with a background in primary care medicine, managers hired
doctors who simply met the state's minimum qualifications, she said. But
recently, "we've raised the bar," she said. Now the state
requires applicants to undergo thorough screening and a test of their
abilities.<br><br>
In addition, the department agreed last week to a court order that will
subject every prison doctor to a rigorous evaluation by outside experts
to determine whether they are competent. Physicians with minor
shortcomings would be given remedial training, while those who fail could
be fired. Kanan said she expects some doctors will flunk, but could not
predict how many.<br><br>
She would not provide a cost estimate, because negotiations are still
underway with UC San Diego, the likely testing site. An aide to Speier,
however, said the first phase of screening would cost at least $1.5
million, not counting any supplemental training.<br><br>
The order for testing doctors was issued by U.S. District Judge Thelton
Henderson. It was prompted by a July report from a team of medical
experts who told Henderson that visits to half a dozen prisons revealed
"an emerging pattern of inadequate and seriously deficient physician
quality."<br><br>
Among other problems, the experts said, doctors were placed in positions
for which they were not qualified. "Thus, an incompetent
anesthesiologist or a retired neurosurgeon can be hired to see patients
for diabetes or coronary heart disease, conditions that they have never
been trained to treat," the report said.<br><br>
Henderson is overseeing the settlement of a 2001 lawsuit alleging that
medical care in prisons was so poor that it amounted to cruel and unusual
punishment. Under the settlement, the state agreed to phase in a new
healthcare delivery system by 2008.<br><br>
"We spend $1 billion each year on healthcare, and we still have
people losing their lives," Romero said. "We've been sued over
and over again, but our remedies for this problem never seem to go far
enough."<br><br>
Romero said figures showing that 20% of prison doctors had blemished
records were unacceptable.<br><br>
Among the most dramatic examples is Dr. Michael Reynolds, an obstetrician
who has worked at Corcoran State Prison near Fresno a men's institution
since 2003.<br><br>
Reynolds, a former alcoholic who once practiced in Irvine, was convicted
in 1981 of possession of cocaine. He was placed on probation for three
years and entered a substance abuse program, records show. Sued for
malpractice at least seven times, he won one case and settled six,
documents show.<br><br>
In two of the cases, Reynolds left a surgical sponge in a woman's
abdomen, an oversight he said might have been influenced by a hangover,
according to a 2001 deposition. In a third case, he paid more than
$900,000 to a woman whose baby was born brain-damaged and a quadriplegic,
allegedly because he waited too long to perform a caesarian section, the
deposition said.<br><br>
After Reynolds lost hospital privileges because of such episodes, the
state medical board launched an investigation. <br><br>
In 1996, the board concluded that Reynolds had committed gross negligence
in two cases and placed him on seven years' probation. The action banned
him from practicing obstetrics and required him to be monitored by
another physician. He also was ordered to undergo psychotherapy, drug
screening and competency testing.<br><br>
The state hired Reynolds in 2002, about 1 1/2 years before he completed
probation. A department spokeswoman said he could not be reached for
comment Tuesday.<br><br>
Kanan said Reynolds joined the department when its hiring process was
less selective, and that he would not "rank very high on the
screening process now." But she stressed that his record would not
necessarily disqualify him, though it would prompt a vigorous discussion
among prison physicians who evaluate applicants.<br><br>
A second doctor whose past has raised red flags with legislators is Dr.
Jeffrey Rohlfing, an orthopedic surgeon hired at High Desert State Prison
in Susanville in mid-2003.<br><br>
Rohlfing was placed on five years' probation by the board, ending in
2002, after an investigation found him guilty of impairment due to mental
illness and unprofessional conduct.<br><br>
In 1996, board documents show, Rohlfing began engaging in "bizarre,
irrational and delusional communications" with fellow staff members
at a Fresno hospital. After one confrontation, police were summoned,
prompting Rohlfing to flee in his car, running a red light before he was
finally apprehended at his home. Police placed him on a 72-hour
psychiatric hold.<br><br>
After a second incident led police to again place him in custody for 72
hours, Rohlfing was examined by a psychiatrist, who found he was a danger
to himself and others and could not practice medicine safely.<br><br>
In an agreement with the board, Rohlfing kept his license but was subject
to numerous conditions while on probation, including drug testing,
psychiatric evaluation and monitoring by another physician.<br><br>
Rohlfing was on vacation Tuesday and could not be reached for
comment.<br><br>
The president of a union for government doctors acknowledged that some
who practice in prison "are deficient and probably would not have
been hired if the state had proper credentialing
committees."<br><br>
Dr. Robert Weinmann of the Union of American Physicians and Dentists
added that a testing and retraining program was a fine idea for those
who needed it.<br><br>
"But," he said, "what they are planning to do sending
all the doctors, hundreds of them for testing is incredibly wasteful,
insulting and reflective of the poor management that got the department
into this mess in the first place."<br><br>
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