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Thursday, Dec. 22, 2011 11:48 am

Get out of jail dead

Sangamon County jail death highlights grisly record of Dr. Stephen Cullinan

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Maurice Burris, 50, died on Dec. 12, 2007 after a perforated ulcer went untreated in the Sangamon County jail.
PHOTO COURTESY SANGAMON COUNTY SHERIFF OFFICE

Sangamon County taxpayers will pay the family of a deceased inmate $60,000 to settle a lawsuit filed by the family of Maurice Burris, who died a horrific death in 2007 due to a perforated ulcer that went untreated in the county jail.

But Dr. Stephen A. Cullinan, the Peoria physician whose alleged indifference to Burris’ suffering prompted a separate settlement this month between himself and Burris’ relatives, remains free to practice medicine, despite a history of malpractice lawsuits and a $10,000 fine levied in Michigan in 2009 by authorities who say that the doctor skimped on medication.

In addition, Cullinan, who could not be reached for comment, settled a malpractice case in Sangamon County last year for $130,000, according to the website of the Illinois Department of Professional Regulation. Just what case that might be is difficult to determine amid the thicket of lawsuits filed against Cullinan and his Peoria-based company, Health Professionals, Ltd., which provides medical services in more than 100 correctional facilities in several states.

Included in the cases is a lawsuit filed by Jason Waggener, who had a history of seizures when he was arrested in 2007 and taken to the Macoupin County jail in Carlinville, where he had a seizure that resulted in a broken ankle and lacerations to his head.  An emergency room physician told Cullinan that Waggener needed to see an orthopedic surgeon and offered to make a referral so that he could be immediately evaluated, according to court documents. Instead, Cullinan ordered Waggener back to jail.

Cullinan didn’t call in an orthopedist or a psychiatrist, according to court documents, and Waggener, delusional, took off his splint, walked around and sat Indian-style in his cell. Two days after he was returned to the jail, a nurse called Cullinan to report that Waggener was hallucinating, paranoid and walking without his splint. But Cullinan didn’t examine Waggener, nor did he call an ambulance, according to the lawsuit. The next morning, jailers found Waggener psychotic and sitting in a pool of blood in his cell, suffering from a compound fracture to his lower leg, which appeared gangrenous. Doctors ultimately amputated below the knee.

Court records show that both Cullinan and Macoupin County settled the case last year, but Sheriff John Albrecht didn’t sound concerned during a brief telephone interview.

Albrecht, a defendant in the case, said that he didn’t know how much the county paid to settle the case and that Cullinan’s company is still providing medical care in the Macoupin County jail, albeit under a different name. He said that he has no concerns about Cullinan’s abilities and believes that the doctor is still treating inmates.

“As far as I know, he does,” Albrecht said. “We’ve had good experience with him.”

By contrast, the Sangamon County sheriff’s office terminated its contract with Cullinan and HPL in 2008, nine months after Burris died from an ulcer that went untreated until it was too late.

Burris began feeling stomach pains on Dec. 2, 2007, one week after he was booked into the jail, according to court documents. He had a pulse of 142, twice the normal rate, and a respiration rate of 48 breaths per minute; the normal rate is fewer than 20 breaths per minute. He was vomiting and sweating, with a stomach hard to the touch, according to a July opinion in the lawsuit written by U.S. District Court Judge Sue E. Myerscough. Cullinan told a nurse at the jail that Burris would be fine, according to the judge’s opinion.

Dr. Stephen Cullinan
Cullinan examined Burris the next day and ordered a urine test. Surveillance video showed that he didn’t eat and made several trips to a sink, where he either vomited or had dry heaves, Myerscough wrote. On the next day, the third since pain began, Burris told a guard that he had a bleeding ulcer. His pulse rate was 138, with a respiration rate of 44 and a temperature of 95 degrees. Cullinan ordered a blood test, but a nurse told the doctor she couldn’t draw blood because she didn’t have supplies, according to court documents.

“Dr. Cullinan informed (the nurse) that Decedent would be fine and not to worry about it,” the judge wrote in her opinion.

Three hours later, video showed that Burris collapsed on the floor of his cell, but no one noticed, the judge wrote. For the next hour, he repeatedly fell onto his bed or collapsed on the floor before jailers responded and a nurse summoned an ambulance. By then, Burris had suffered a fatal brain injury caused by lack of oxygen, the judge wrote. He died eight days later.

“The case before him was so simple and the errors so egregious, that Dr. Cullinan’s acts and omissions go beyond mere malpractice,” wrote Dr. Marc Stern, former medical director for the state Department of Corrections in Washington State and now on the faculty of the University of Washington Public School of Health, in a memo written for the plaintiff’s lawyers. “In my opinion, the behavior Dr. Cullinan exhibited went beyond an error of knowledge – it was an error of attitude; it demonstrates the attitude of someone who did not care.”

In an interview, Stern said doctors are generally successful at saving lives if perforated ulcers are promptly treated. Burris, he said, was likely in “significant discomfort” while his condition deteriorated in the jail, and the care provided by Cullinan was below standard.

“I would say this is at the bottom level of what I would expect, and what I would hope, looking around the country,” Stern said.

Problems with Cullinan’s care date to at least 2004, when Anthony Snyder was rushed from the Franklin County jail in southern Illinois to an emergency room. He died three days later from pneumonia, a death the coroner said “was 100 percent preventable,” according to media accounts. In addition to pneumonia, Snyder, who was 36 and died after six months in the jail, had extensive bedsores, according to a 2004 story by the Associated Press.

“I’d venture to say this person had lain around for months,” Cape Girardeau County (Mo.) coroner Mike Hurst told a reporter.

In the subsequent lawsuit against Cullinan and the Franklin County sheriff, attorneys for Snyder’s family say that the doctor told the doomed man, who was incoherent and drooling, that he was faking symptoms on the day he was rushed to a hospital.

R. Courtney Hughes, attorney for Snyder’s family, said that the case was settled, but declined further comment, saying that settlement terms are confidential. Sheriff Donald Jones, who has been Franklin County’s top cop for about a year, says he recalls the case. HPL still holds the contract for medical care in the Franklin County jail, Jones said.

Neither HPL nor Correctional Health Care Companies, the firm’s parent company, could be reached for comment.

Concerns have been raised outside Illinois. In 2009, the state board of medicine in Michigan fined Cullinan $10,000 for denying psychotropic drugs to two inmates who suffered from schizophrenia and other mental disorders. According to Michigan investigators, Cullinan cut back on dosages prescribed by a psychiatrist without speaking with the psychiatrist, reviewing charts or examining the inmates.

Although the Illinois Department of Professional Regulation is supposed to post on its website disciplinary actions against doctors taken by other states, the state website contains no mention of the Michigan fine levied against Cullinan, who admitted no guilt but did not contest the charges.

Sue Hofer, spokeswoman for the Illinois Department of Professional Regulation, confirmed that the Michigan disciplinary case should have been on the department’s website, and she thanked a reporter for bringing it to the department’s attention. She attributed the error to a software problem.

While she said that she could not discuss specific cases, Hofer said that any discipline taken in another state is supposed to trigger an investigation in Illinois, as is any settlement or judgment in a malpractice lawsuit. And so Cullinan should have faced an investigation pursuant to the $130,000 malpractice settlement reached last year and recorded on the department’s website.

The department looks for gross negligence, Hofer said, and the standard of proof is “beyond a shadow of a doubt” when it comes to disciplining a doctor, which is akin to “proof beyond reasonable doubt” in a criminal case.

More than 30 lawsuits have been filed against Cullinan in federal courts in Illinois during the past decade alleging substandard care, and several more have been filed in other states, including Indiana, Wisconsin and Missouri. Most in Illinois were filed by inmates and have been dismissed. But several were not, and at least four cases involving Cullinan have been settled since 2004.

In Indiana, the family of Roy Wireman, Jr. sued Cullinan and a county sheriff last year after Wireman suffered seizures and died after being refused Xanax, which he had been prescribed for more than a decade. Citing confidentiality agreements, Thomas Manges, attorney for Wireman’s family, declined to discuss the case or settlement details.

There is no mention of a settlement in Indiana on the Department of Professional Regulation website, nor does the website include any information on any cases settled this year. Settlement amounts are supposed to be posted within 60 days of settlement; the court docket shows that the Burris case from Sangamon County settled within the past month.

Several Illinois cases are pending.

The family of Robert Awalt, who died last year in the Grundy County jail, sued Cullinan in September, saying that Awalt, an epileptic, died four days after his arrest after he suffered seizures. His family says that he was denied his epilepsy medication, even though his wife called the jail the night of his arrest and told officials that he needed prescribed anti-seizure drugs. When Awalt was booked, a jail nurse wrote on his chart that he needed the drugs, according to the lawsuit, and Cullinan reviewed the chart. In the hours before he died, both Awalt and inmates near him cried out for medical attention, according to court documents.

In Ogle County, Cullinan and the county sheriff are accused of causing the death of Patrick McCann, who died in jail last year after suffering second and third degree burns on 40 percent of his body.

McCann, who was mentally ill and taking psychotropic drugs, suffered injuries while trying to burn down his mother’s house. After 20 days in a hospital burn unit, he was sent to jail, according to a federal lawsuit filed in May by his mother. He died 10 days later.

James Macchitelli, attorney for McCann’s family, says in court documents that he believes McCann was never examined by a doctor while in jail. McCann’s injuries required EKG monitoring and daily blood tests that were not done, Macchitelli claims.

The coroner determined that McCann suffered a heart arrhythmia, but couldn’t say whether it was due to natural causes, an accident or something else. In an interview, Macchitelli said that McCann’s pain medication was switched from an opiate to methadone while he was in jail because methadone is cheaper. Methadone, which can be dangerous when combined with psychotropic drugs, killed McCann, Macchitelli says.

“My (medical experts) are sure: if he wasn’t taking methadone, he’d survive,” Macchitelli says. “What I’m looking at in this case is a medical doctor who’s all about money. Someone’s got to go forward with this guy and get a negligent homicide case. Would he be found guilty? I don’t know. But somebody’s got to wake someone’s ass up.”

Valerie McCann, Patrick McCann’s mother, sobs when she talks about what happened to her son, who was 34 when he died.

“When I think of the pain and suffering he went through, my mind blanks,” Valerie McCann says. “These are people that we knew, who we count on. And they let my son down. He would still be alive if he had been hospitalized.”

A core problem, according to the Burris lawsuit and a lawyer who represented Waggener in the Macoupin County case, is HPL’s business model in which the company is typically responsible for the first $50,000 spent on medical care outside jails.

That creates an incentive to keep desperately sick prisoners in lockups, says Grady Holley, a Springfield lawyer who represented Waggener.

“If you stop and think about it, it’s an incentive not to treat,” Holley says. “The way that you keep the money is that no one is ever sick enough to go to the hospital. It’s not only revolting, it’s also, from a doctor’s standpoint, unethical.”

Such contract provisions aren’t necessarily unethical, Stern said, but doctors have professional obligations.

“If they’re careless about sending people to the hospital, they’re going to incur costs somewhere along the line,” Stern said.

Contact Bruce Rushton at brushton@illinoistimes.com.

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