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Battered in a fight with other inmates, the convict complained to the prison medical staff that he couldn't move. The doctors looked the prisoner over and quickly reached a diagnosis: He was faking it. When the inmate claimed he still couldn't get out of his bunk the next day, the staff poked and prodded him again. This time, according to state Medical Board records, the responding physician in charge "was observed to chastise and berate the patient, and to tell him there was nothing wrong with him." Nothing, that is, except a traumatic dislocation of his spine, a subsequent medical examination revealed, probably from a fall during the fight. It was an injury that required a cervical fusion, and it left the inmate a quadriplegic, the Medical Board records showed. The chastising doctor later was suspended by the Medical Board, but according to a blistering court order recently issued by a federal judge and legislative reports that have castigated prison health care throughout California, the incident at Salinas Valley State Prison is far from isolated. Health care in the Department of Corrections has become so unconstitutionally shoddy, U.S. District Judge Thelton E. Henderson found, that he is seriously considering the appointment of a receiver under his control to manage a system that he said is in "a blatant state of crisis." "We're not talking here solely about inmates not getting to see the doctor for weeks at a time, although that is serious," said Steve Fama, an attorney with the San Rafael-based Prison Law Office, the inmates' rights advocacy group that filed the class-action lawsuit over which Henderson is presiding. "We're not talking solely here about specialty service providers or ambulance companies threatening to stop providing services because their contracts are all bollixed up, although those things are very serious. "We're talking about people being killed because of bad care or unavailable care." Henderson cited a backlog of 34 deaths that he found to be "highly problematic, with multiple instances of incompetence, indifference, neglect and even cruelty by medical staff" when he ordered the state to show cause why he shouldn't place the $1 billion prison health care system into receivership. His order came more than three years after the state signed a consent decree to conduct a systematic upgrade in the quality of medical care it provides to its 162,000 inmates. The decree came as part of the lawsuit Fama's office filed in 2001. But full compliance on the state's part, the judge said, is still "years away," adding that "it is clear to the court that more (inmates) are sure to suffer and die if the system is not immediately overhauled." The judge will preside over a series of hearings that will run from May 31 to June 9. He has scheduled a July 11 hearing date on the appointment of the receiver. According to Henderson's 18-page order, state correctional officials "have publicly conceded their inability" to fix prison health care. Even the new team appointed by Gov. Arnold Schwarzenegger, who has promised "fantastic" prison reform, has "failed to demonstrate that they have the will and capacity to make the necessary changes," Henderson wrote. A glum Youth and Adult Correctional Agency Secretary Rod Hickman told reporters after the May budget revise that the state will do whatever it has to do to comply with the court's wishes, even if it means turning over a huge chunk of his authority to a federal judge. Hickman sidestepped questions when asked if he would welcome the receiver's appointment. But he acknowledged that the state has been incapable of resolving the prison health crisis on its own. "I think we've been trying for a long time, and we haven't met the court's satisfaction as of this time," Hickman said. "But I think there are some things that are obstacles to achieving compliance. I think we have to figure out exactly what those obstacles are and fashion a remedy that gets those obstacles out of the way." Dr. Isaac A. Grillo is the physician who had his license suspended for his treatment of the inmate, identified by the Medical Board only as "KH," on June 27, 2000, at Salinas Valley State Prison. Besides accusing the inmate of faking his injuries, the doctor also shot him up with a placebo solution while telling the prisoner the injection would "make him stronger," according to the accusation filed against Grillo by the Medical Board. Grillo also examined the paralyzed inmate-patient without securing his head and left him lying on a gurney "for hours," even though he did not flinch when the staff pin-pricked him to determine his response to physical sensations, the accusation said. Grillo could not be reached for comment for this story, and his Saratoga attorney, Bradford J. Hinshaw, declined to say anything other than "I think there are better examples out there," to showcase the problems of prison health care in California. The Department of Corrections might agree. In a report it released last August, the agency said that 58 of the 302 physicians it then had on staff - or 19 percent - had unspecified actions taken against their licenses by the Medical Board or had been forced to make some sort of malpractice payment. Fourteen of the doctors had been placed on probation at one time or another. A plethora of physician-related embarrassments have plagued the system, according to legislative studies and reports submitted to Henderson as part of the prison health care litigation. In some cases, obstetricians and pediatricians have been assigned to work in men's prisons. A doctor at one prison prescribed anti-psychotic medication to an inmate who struggled for breath due to pneumonia. Another physician whose license had been suspended for seven years due to alcoholism and incompetence was appointed vice chairman of a prison's medical care review committee. Prison doctors do not try to sugarcoat the shortcomings of the system in which they work. "It is a disaster," said Gary Robinson, executive director of the Union of American Physicians and Dentists, which is affiliated with the American Federation of State, County and Municipal Employees. But doctors and their union representatives say they shouldn't be used as scapegoats for the system's problems. What can they do, the doctors say, about a records tracking system that is not only totally lacking in automation, but is so bad that at one prison, the stack of unsorted medical reports waiting to be filed stands 3 1/2 feet high? How is it their fault, they ask, when more than a thousand nursing positions lie vacant and the state doesn't offer bonus pay to attract medical professionals of all stripes to the state's least-desirable prison locations, such as the Southern California desert? And who can pull a tooth or get a read on a sick inmate, they say, when the decaying physical plant and lack of equipment - including the absence of sinks in some prisons - make their jobs all but impossible? At Folsom State Prison last week, Dr. Joe M. Torruella spent a good part of his Wednesday morning searching the housing tiers - locked down due to a recent spate of inmate violence - for a convict whose chart indicated he had congestive heart failure and hepatitis C. It turned out the inmate still hadn't been transported to Folsom. "I went on a wild goose chase," Torruella said. "There are a lot of intrinsic problems here, but they're not centered around the medical staff." Corrections officials want to require all prison doctors who are not board-certified in internal medicine or family practice to pass a test showing that they are competent to practice correctional medicine. The doctors, however, have blocked the move in court. "The doctors already get evaluated every year," said the union's Robinson. Whether the issue is bad doctors run amok or lousy record-keeping, one officer at Folsom last week complained that inmates may be getting better health care than some people on the outside. The officer cited as an example a highly publicized instance of an inmate who received a heart transplant at a cost to taxpayers of more than $1.25 million. "All an inmate has to do is complain loud enough, and they send them out to outside doctors," said Chuck Alexander, a vice president of the California Correctional Peace Officers Association. "An inmate doesn't get told 'no.' " But Michael Pickett, a 34-year corrections employee who served for 18 months as deputy director in charge of health services until he retired in 2003, said such concerns are seriously misplaced. Health care in the Department of Corrections, he said, is "a wreck." "I wouldn't go to a CDC doc for nothing," Pickett said of the health system he once oversaw. State Sen. Jackie Speier, D-Hillsborough, said it is in the public's interest, as well as the prisoners', to fix the prison health program. For one thing, 95 percent of inmates are going to get out of prison, and nobody wants them spreading tuberculosis or hepatitis C or some other communicable disease, she said. For another, she pointed out that prison health costs have more than doubled in six years. She said that perhaps the only way to make the repairs is for the judge to step in and take over - and for the state to welcome the intrusion, not fight it. "The system is so broken," she said, "it can't be fixed." What's NextU.S. District Judge Thelton E. Henderson will preside over a series of hearings from May 31 to June 9. He has scheduled a July 11 hearing to consider the appointment of a receiver to manage health care for the Department of Corrections. About the writer: The Bee's Andy Furillo can be reached at (916) 321-1141 or afurillo@sacbee.com. |
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