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August 11, 2004 - The Los Angeles Times (CA)

Scathing Report on Prison Doctors

A Panel Of Experts Ordered By Court To Review State System Calls Physician Quality 'Seriously Deficient'

By Tim Reiterman, Times Staff Writer

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SAN FRANCISCO - Incompetent doctors, including some with a history of substance abuse or mental health problems, have been hired by California's prison system and have contributed to serious deficiencies in healthcare for inmates, according to a federal court report released Tuesday.

At one facility, half of the eight doctors had prior criminal charges, loss of privileges at community hospitals or mental health problems, the panel said. At another, seven of 20 doctors had similar problems.

"There appears to be an emerging pattern of inadequate and seriously deficient physician quality" in prisons, a panel of experts said in a letter to U.S. District Judge Thelton Henderson, who ordered the report as part of a civil rights suit alleging substandard medical care for inmates.

A panel of two doctors and a nurse practitioner conducted reviews of medical treatment at about half a dozen of the state's 32 prisons. They concluded in a July 16 letter to the judge that the department had hired many incompetent doctors with a history of problems, then failed to monitor them, putting inmates at serious risk of injury or death.

"The only requirement for hiring is a medical license," said the letter.

California Department of Corrections officials said they were formulating a plan that would improve prison medical services, the fastest-growing part of the $5.7-billion state prison budget.

"There will be remedial training and greater clinical supervision and a stricter adherence to department policies," said spokeswoman Margot Bach. "The department takes the healthcare of inmates very seriously."

The panel concluded that many doctors were not trained to administer the treatments they were providing inmates, some with serious illnesses. The report did not name the prisons or the doctors.

"An incompetent retired cardio-thoracic surgeon manages complex internal medicine patients and makes serious life-threatening mistakes on a continual basis," the report said.

The panel also cited the case of an obstetrician who was managing HIV patients and a neurosurgeon who was seeing patients with internal medicine problems, although he was not trained to read electrocardiograms used in internal medicine.

"It could be named the Keystone Docs," said state Sen. Jackie Speier (D-Hillsborough), who has scheduled hearings on the corrections healthcare system for next month. "If it was a want ad, it would say something like, 'Bad doctors apply here. No one turned away.' "

The prison healthcare budget for this fiscal year is $879 million. Officials say rising costs are a result of the growing and aging inmate population, as well as increased spending for prescription drugs, medical treatment and court-mandated services.

The Corrections Department agreed 2 1/2 years ago to settle a lawsuit brought by the Prison Law Office, a Marin County civil rights group, on behalf of the state's 163,000 inmates. That plan is projected to cost tens of millions of dollars a year, and, among other things, calls for putting nurses in prison clinics around the clock.

The findings by Henderson's medical panel surprised even Don Spector, executive director of the Prison Law Office. "It was worse than we thought," he said. "We always knew there were physicians who had no business practicing medicine, but we did not know it was this pervasive."

Henderson is expected to hold a conference on the panel's report and the state's remedial plans this month.

The report described a system in which individual prisons operated with great autonomy and little oversight. The corrections official in Sacramento with final word on hiring was not a doctor. Only one of the prisons reviewed had its chief physician and surgeon's position filled - and that doctor was an ophthalmologist who was training doctors in internal medicine.

At individual prisons, the report found, doctors with training deficiencies were hiring and overseeing the work of other prison physicians. "At one of the facilities reviewed, the vice chairman of the committee that oversees credentialing is an obstetrician who had lost his license for seven years for incompetence and alcoholism," said the report, adding that he oversees doctors practicing internal medicine although he has no experience in that area.

The union that represents about 600 prison doctors, dentists and psychologists blamed quality problems on cost cutting by the state, which has led to the hiring of contract physicians rather than civil service doctors.

"Contract doctors are most of the problem," said Dr. Robert Weinmann, president of the Union of American Physicians and Dentists. "We have a recalcitrant state system. They want to hire and fire locally at will with no benefits."

The panel and Spector of the Prison Law Office gave high marks to the new acting head of the state's prison healthcare services, Dr. Renee Kanan.

But, Spector added, "she is one person in a gigantic system with more bureaucratic hurdles than you can imagine."

Copyright 2004 Los Angeles Times

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