Experts blast prison health care
Dying inmates neglected. Undiagnosed cancer. Haphazard recordkeeping. Unsanitary exam rooms, staff shortages and physicians who aren’t qualified.
It adds up to cruel and unusual punishment in the opinion of a court-appointed panel of medical experts assigned to assess the quality of medical care in Illinois prisons as part of a class-action lawsuit against the state.
Inmates were largely ignored as they languished and died, according to the panel’s report aimed at helping resolve the lawsuit brought by inmates. Problems ranged from small to massive. Linens weren’t washed in a manner appropriate to stem the spread of infections, experts found, and staff didn’t bother changing paper atop exam tables between patients.
The state, once amenable to settling the lawsuit filed by inmates, agreed to commission the report and the experts who compiled it, according to Alan Mills, executive director of the Uptown People’s Law Center in Chicago, which is representing inmates. Now that the report is complete, however, the state is balking at the conclusions and resisting settlement, Mills says. Experts, the state Department of Corrections noted in a written statement, reviewed procedures at just eight of the state’s 25 prisons, and so the conclusion that the medical care doesn’t pass constitutional muster is “incomplete.”
“While the IDOC agrees with certain recommendations contained in the report and has already taken steps to improve its delivery of services, we believe many of the conclusions in the report are flawed and disagree with a number of the criticisms presented,” IDOC says in its written statement. “The IDOC has always been and continues to be open to suggestions for improvements and willing to take the necessary actions when appropriate.”
The expert panel, led by Dr. Ron Shansky, former IDOC medical director, found plenty of room for improvement. Among other things, the panel reviewed 63 deaths and found “significant lapses in care” in 38, or 60 percent, of the cases, with more than one lapse in 34 of the 38 cases where problems were found.
Some of the cases are stomach-churning, with the panel finding that once inmates signed do-not-resuscitate orders, they were not treated for the simplest of maladies.
A 64-year-old incontinent inmate with advanced dementia who required a feeding tube and a catheter was seen just four times by a doctor in the eight months before he died from pneumonia on July 31, 2013, at Stateville Correctional Center. Two months before the inmate died, a physician prescribed an antibiotic after being told that the man was coughing and had low oxygen levels, but the doctor did not immediately examine the man. Tests showed that man’s infection was resistant to the prescribed antibiotic, but the prescription wasn’t changed. The man’s condition didn’t improve, and no one notified a doctor when he began coughing up thick mucus.
When a physician was finally told that the patient’s coughing had worsened, the doctor prescribed an antibiotic but did not see the inmate for eight days. The physician’s note documenting the visit was sparse: “Not responsive. No change. Alzheimer’s dementia. Continue same care.” The inmate’s vital signs were rarely recorded, but six days before he died, he had a temperature of 101 degrees and a respiratory rate of 22, considerably below normal. A doctor ordered a blood test and again prescribed an antibiotic but did not see the patient.
Two days before his death, the inmate was finally sent to an emergency room. By then, he had a temperature of nearly 103 degrees. Large amounts of mucus covered his face and chest, and he was having breathing trouble. The patient was returned to the prison the next day “in an obviously unstable condition,” the team wrote in its report. He needed supplemental oxygen, had a low blood pressure reading of 95/60 and a heart rate of 109, considerably higher than normal.
“The doctor was called twice for orders but did not respond,” the team of experts reported. “Five hours later, the patient was found dead in his cell.”
At Hill Correctional Center, an inmate and former smoker with a family history of lung cancer wasn’t diagnosed with the disease until more than three months after he began coughing up blood. At that point, he had lost 30 pounds during the previous year. Although a chest x-ray revealed a lung abnormality, doctors didn’t diagnose cancer until the man, who continued losing weight and coughing up blood, began submitting grievances stating that he thought that he had cancer and wanted to see a specialist. By the time a CT scan revealed a tumor that had wrapped itself around the man’s heart, major arteries and airways, the man was in such pain that he couldn’t walk upright and required a wheelchair.
Other problems included a shortage of nurses, physicians who weren’t board certified or otherwise qualified to practice in assigned areas, deficient peer review to address instances of substandard care, a lack of leadership in medical staff, no opportunities for inmates to speak in private with physicians and disorganized record keeping that made it difficult for health care providers to keep track of medical histories.
Mills said that he wasn’t surprised by the report.
“It confirmed everything we’ve heard anecdotally,” Mills said. “I guess the only surprise is how powerful it is, having read it all at once, rather than hearing a story here and a story there. … A lot of the problems are obvious to anybody.”
Many of the problems involved inmates who were at least 50 years old, and Mills said the issues will only grow more acute as the prison population ages. The state, he says, shouldn’t be keeping geriatric inmates behind bars.
“Do we spend too much on medical care?” Mills asks. “Of course we do. These people don’t belong in prison. Why is someone with a feeding tube in prison? It makes no sense whatsoever.”
Mills said that the state under former Gov. Pat Quinn indicated that it was willing to settle the lawsuit using the experts’ report as a guidepost for improvement, but Gov. Bruce Rauner has reversed course. The report, Mills said, will be the plaintiffs’ chief exhibit if litigation continues.
“As far as we’re concerned, this proves our case,” said Mills, who discounted the state’s defense of the status quo.
“Why should we trust you over independent experts that you have agreed are qualified?” he asks.
Contact Bruce Rushton at firstname.lastname@example.org.