Wednesday, February 09, 2011

Texas' "Secret Death Penalty": Inadequate prison healthcare

A new report (pdf) from the Texas Civil Rights Project (TCRP) argues that "Texas has created a 'secret death penalty': poor medical care can turn temporary imprisonment for relatively minor offenses into a death sentence." Timothy Cole's family might agree. He died of an asthma attack in TDCJ in 1999, years before DNA would prove another man committed the rape for which he was falsely convicted.

The report's title, "A Thin Line," comes from a quote from Dr. Ben Raimer, a UTMB vice president and former head of the Correctional Managed Care Committee, and yes, he who recently received a $125K bonus. I was in the room back in 2006 when he told the Senate Criminal Justice Committee, “Right now the [health care] system is constitutional… but we’re on a thin line.” Indeed, he'd been saying the same thing for quite some time, warning that further cuts would render TDCJ healthcare unconstitutional. Now, of course the Legislature wants to slash prison heathcare even further, UTMB wants to bail, and TCRP fears that thin line is about to be breached.

They've got a point: According to the Legislative Budget Board's estimates (House report, large pdf, p. 554), per-prisoner healthcare spending under both the House and Senate budgets would decline from $7.67 per prisoner-day to $5.82. That's not fat they're trimming, nor even muscle, but all the way to the bone, going from $2,799.55 per prisoner year to $2,124.30. This at a time, notes TCRP, when TDCJ's prisoner population is aging, with older inmates' healthcare costs far outpacing those of younger prisoners.

Citing various case law (some of it not applicable in the US 5th Circuit), TCRP argues that "Texas has adopted a managed health care plan, which can potentially violate the Eighth Amendment if financial considerations are placed above the medical needs of the prisoner." One issue raised that I don't see frequently discussed was:
the thick veil of secrecy kept over inmate deaths, denying public oversight, and increasing medical negligence. According to state law, nearly every report or inspection that could tell legislators or the public the truth about the state of prison healthcare is kept secret – including everything from inmate grievances “to publicly-funded medical experiments to state inspections of blood-splattered kidney dialysis offices.” It is impossible, for instance, for a patient to find out whether the dialysis machine he uses regularly is cleaned of biohazardous materials, like blood, whether he is in prison or in the free world – even though the state obtains that information for itself.
Here's another notable excerpt on the remarkable lack of meaningful oversight or accountability for UTMB regarding the quality (or for that matter basic delivery) of prison health services:
Lack of accountability is one of the biggest problems in these contracts. UTMB and Tech are contractually rewarded for removing one of the most important sources of health care oversight and accountability: grievances filed by the inmates themselves. One performance measure included in these most recent contracts with UTMB and TTUHSC is the percentage of unsustained grievances: that is, grievances that are resolved against the inmate. The two providers are contractually obligated to sustain 10% or less of Step One medical grievances and 6% or less of Step Two medical grievances. This encourages providers to resolve even the most valid and pressing inmate grievances in favor of TDCJ rather than in favor of the inmate. If TDCJ employees feel they will be penalized for resolving valid grievances in favor of the inmate, then they will be encouraged to discard valid complaints, crippling the grievance system. The positive intent of this clause – to increase the quality of medical services so that fewer complaints are lodged – could be much more effectively reached by measuring the providers' reactions to and improvements following valid inmate grievances, which would reward improvement rather than unaccountability.

The contract also allows a relatively high percentage of vacancies in medical provider positions. The 2010-2011 fiscal year contracts permit up to a 12% vacancy rate for unit-level provider positions: that is, physicians, nurses, and other allied medical health providers who work in the prison units. A 12% vacancy rate is not success; it should be considered unacceptable. More healthcare providers in prisons means fewer necessary high-cost hospital and specialist visits, and thus fewer transportation costs. It also means faster healthcare, better healthcare, and fewer expensive complications from simple, easily-treatable ailments. TDCJ should prioritize recruitment rather than accept by contract an insufficient number of providers.

Finally, the contract gives performance measures for what constitutes adequate and timely access to care that are ultimately too weak to improve the system. Prisoners who submit sick call requests must be “physically triaged,” or examined to evaluate the urgency of their complaints, within 48 hours (72 hours on weekends), and, if referred to a physician or other medical professional, must be seen by that professional within seven days of triage. Though these standards seem acceptable, the mandatory compliance rate is low enough to make these standards less meaningful: UTMB and Tech must comply with these standards only 80% of the time without penalty or additional monitoring. This means that for every five prisoners who submit sick call requests, one prisoner can go entirely without investigation of his or her complaint with no penalty to the medical providers. Since inmate self-monitoring is the primary TDCJ mechanism for identifying prisoner health problems, it is crucial that complaints are taken more seriously than this.

In addition, there are no standards for prompt treatment, only prompt evaluation of whether treatment is necessary. Even when a serious health complaint is observed, treatment of that complaint could be delayed indefinitely without the medical providers violating their contractual obligations. Monitoring of performance outcomes is a necessary addition to the contract and the only way to identify and address problems of the most important part of medical care: the success of medical treatment.

Moreover, the contract specifies no performance measures for access to care in emergency treatment for prisoners, only for cases in which a sick call request is submitted. A prisoner like David West, who collapses in the shower, obviously cannot submit a sick call request, but under current guidelines nobody is strictly accountable for failing to treat him.
In addition, the report raises an issue I've thought for years deserved more play than it usually gets - jail and prisons' role in the development of drug-resistant disease and infections: "Prisons have become incubators of infections. Uneven treatment produces drug-resistant strains of diseases, which can be introduced to the public when prisoners are released. Hepatitis, tuberculosis, HIV/AIDS, and staph infections are among the most dangerous infectious diseases in prison. Each of these poses a serious risk to both prisoners and the public, and Texas prison health care must include proactive and preventative measures to prevent their spread." Well said; the harm from developing drug-resistant bugs spreads far beyond the prison walls.

In the end, aside from a rehearsal for possible future briefs in a federal civil rights suit, TCRP's report boils down to a plea to adequately fund prison healtlhcare during the budget crunch, reducing expenses if necessary not by by lowering quality of care but the number of inmates in the system, particularly those with high medical costs. It concludes with a sentiment I'd heartily endorse:
This legislative session, our leaders will face tough decisions. In a time when cuts to education and health care programs are likely, it will be extremely difficult politically to resist slashing prison health care budgets.

Fortunately, Texas can alleviate this serious problem by taking other, low cost, solutions. Parole non-violent offenders. Release the extremely ill on medically recommended intensive supervision. Closing a handful of prisons would both be politically easier than closing schools or hospitals, and help solve the prison health care crisis, without creating additional crime.

Times are tough now. But, if Texas is not careful, our prison system could end up in the same place as California’s: paying additional billions of dollars, under federal supervision, and being forced to release tens of thousands of prisoners. It’s time our legislators got “smart on crime,” not just “tough on crime.”
I wasn't able to attend their press event, but Brandi Grissom at the Texas Trbune has initial coverage.


DeathBreath said...

In my opinion, the budget cuts are related to self-serving politicians who possess no moral compass. They are free to legislate morality when it fits their myopic agenda.

I also believe that there is a hidden design in these budget cuts. Repotedly, some GOPigs are attempting to change the laws about states being able to declare bankruptcy. However, I don't know how this world play into possible Federal oversight.

What I do know is that Governor Perry is a pig, coward, and whore for the religious right and corporate America.

Unknown said...

This is a great article!

Prisoners generally have a lot of complaints about the, erm, conditions under which they’re imprisoned.

I’ve always tried to keep it in mind.

But in recent years, I’ve had occasion to look at the TDCJ medical records of a number of people living with HIV/AIDS, and it appears to me that the complaints they’ve had about their care are warranted.

The thing is: The prison population is going to have a higher rate of HIV/AIDS than the general population. They’re going to have a higher rate of mental illness than the general population. Statistically speaking, they are going to require a higher degree of medical attention and medication than the average person in Texas. That’s just the way it works.

Texas has gotta allow for that if they’re going to keep locking people up at such high rates!

It’s one thing to be letting moms and kiddies on the outside go without medical care. But when the government is housing them for extended periods in one of our prison facilities, the standard of care is a little higher, constitutionally speaking.

Thank you so much for talking about this. Interesting stuff, and it needs to be talked about MORE.

Anonymous said...

There are budget cuts, but all the inmates work in the prison, building and making furniture, farming, renting tractors to Harris County. Who is pocketing this money is it the Wardens and State Officials. Now the State charges the federal government at least $34.00 to $38.00 per day for each inmate. I would like this to be investigated. I believe that somebody is making alot of money and getting away with free prison slave labor market.

Anonymous said...

Let it be known that "Prisons" are horrible places period. It is bad for TDCJ and UTMB employees and worse for Inmates. It is smelly, dirty, hot, loud, abusive, deviant, corruptive, cruel, immoral, etc, etc, etc (add all the horrible things that you can possibly imagine)! I was there for 12 years, and I think I may have seen it all. I could go on forever, but for lack of time.
The "Sick Call" process relies on the Inmate to say he has a medical problem. Can you imagine how an "Inmate" could possibly and repeatedly state "a problem"; which I have seen at least 75% of the time amounted to much of nothing. And the amount of time and effort that UTMB and TDCJ spend "tracking sick calls" (look at Eastham alone). And TDCJ Health Services, lead by the infamous Lannette "Lanemous" Lithicum and her band of nurses, I have found point out more often that someone used "unauthorized abbreviations" and "wrong work codes". Grievances are tracked as they are about 50% of what Practice Managers are involved with daily. Alot of the grievances I have seen are about "why did I not get my medical boots", "the Provider was not nice enough" or "I was not given my medicine". I am sure there is quite abit more serious stuff out there (especially at Gatesville) but I never really witnessed anything very serious (but I also tried to do my job as I was taught from school with a moral code). The idea of "Constitutional Healthcare" with a band of Inmates leads to "additional costs" just because a "criminal" takes advantage of "the System" and a simple philosophical concept manifests itself. I challenge anyone to consider "dialectical materialism" in trying to understand this misnomer of "Constitutional Healthcare". Does any other Population Group have a distinct, specific right for Constitutional Healthcare? Thats right the Republicans believe that the Right of Healthcare for everyone else is "unconstitutional". So there you go; if Healthcare for everyone in America is unconstitutional, then there should be no such thing as "Constitutional Healthcare". I believe, as our President does, that "Healthcare is a right not a privilage". I do not really expect all Texans to understand this, but I am sure there are some (we are just buried in the "red republican" atmospere). I would like so much for Our Politicians to talk about "Prison Healthcare" as "Constitutional Healthcare" when they talk about our new "National Healthcare Reform". Let me be clear; Prisoners deserve their healthcare just as much as anyone else, just not "Constitutional Healthcare" because it will be abused and it will cost the State more in frivolous ways and means.

Prison Doc said...

I always look askance at reports promulgated by advocacy groups such as the cited TCRP report. As a full time correctional physician--by choice--for over 10 years, this report concerns a parallel universe from the one in which I work daily. Most left of center folks seem to prefer to cite horrific anecdotal cases and then generally extend that aura to an entire system. I read this linked report in its entirety, and see little correlation between it and the reality of medicine in the TDCJ system. In my experience TDCJ inmates receive health care in a manner that is equal to and often superior to that available in Texas to the working poor and even middle-class citizens, to wit:

1. Medical complaints are indeed physically evaluated by a health care professional within 24-72 hours as required. When does this not happen? When the patient changes his mind or refuses to be seen or when the complaint has spontaneously resolved which is common, since most complaints are of a nature that citizens in the free world would never think of seeking care for like minor allergies, skin rashes, constipation.

2. Chronic diseases are monitored and treated regularly and consistently in a manner prescribed by current national standards of health care.

3. Catastrophic conditions such as cancer, HIV, Hepatitis C,tuberculosis are all treated aggressively an in a manner equal to the highest standard of care available in the United States.

4. Missed doses of medication are rare except when the patient does not bother to take the dose. It is uncommon for a systemic failure or security concern to result in missed medication. Almost all medications are in the possession of the inmate except for potentially dangerous or frequenly abused drugs.

5. When medical grievances are not sustained it is usually for one of several reasons: the complaint may be false; the grievance writer may be seeking a treatment or work restriction that is not medically justified; the patient may be unhappy with a medical result such as an arthritic knee that still hurts despite maximum treatment--such results commonly occur in the free world as well.

6. Infectious problems are always more common in institutional housing; however, staph infections, viral infections, etc. are all treated aggressively and appropriately and are not encountered in epidemic proportions.

7. Prisoners commonly refuse or do not cooperate with prescribed treatments for reasons of their own. For example, in the past two years I have referred broken hands and fingers for emergency private sector treatment. In 100% of cases, the prisoner has removed his own cast within 24 hours to two weeks of the incident, negating the value of his treatment--but providing a ready excuse to claim that "my broken hand wasn't treated right".

8. Prisoners often magnify their symptoms and describe their care inaccurately to obtain sympathy from family members and other outsiders. Some prisoner complaints are undoubtedly true, but very often they are falsehoods.

9. COSTS should be considered in ALL medical care along with risk, likelihood of success, severity of the problem, etc. I don't personally know of any cases in which treatment was refused because of the COST of the treatment.

10. Undoubtedly bad results,deaths,negligence, and denial of care may occur in a large correctional system and are indeed despicable and intolerable, but to describe Texas prison health care as a "Silent Death Penalty" is patently false. Having worked in another state and in the Federal corrections system, I can say that UTMB Correctional Health Care compares very favorably with the others. Those who feel to the contrary should present data rather than the sad recitation of a few spectacularly bad results. To do otherwise as is done in the TCRP report is a flagrant attempt to cast more heat than light into the situation.

Anonymous said...

UTMB should be dismissed from any future state funds. They have proven to be shady and abusive and short on morals. The public deserves much more than what UTMB has offered.

Anonymous said...

Wasn’t the cause of death for David Ruiz inadequate TDC health care?

Prison Doc said...

8:40, it makes for a cute story but no, Ruiz did not die of inadequate health care; he died after a hard life made worse by longstanding illness.

Nobody lives forever.

gravyrug said...

Prison Doc, your comments may be true at your location, but there a great deal of difference in the healthcare at different facilities. A friend of mine, who has several different chronic health issues, was in for a year. During that time, she was transferred several times, and the level of care she received was different at every location, ranging from excellent, rapid, ongoing treatment to a couple of ibuprofen after a long wait for an infection.

Gritsforbreakfast said...

Prison Doc, a couple of questions:

Is what's said about an information blackout regarding prisoner deaths accurate?

Will all you say about UTMB health still be true if funding is cut 24%?

Finally, do you agree there are unit to unit differences in care? (I hear that a lot.)

Anonymous said...

PrisonDoc, I believe, writes very correctly describing what I have also seen. And yes, the healthcare delivery substantially differs from Unit to Unit. But who is responsible for that. The Management at the outlying UTMB/CMC outpatient clinics is less than desirable. I suspect UTMB (Galveston) knows this and this maybe one reason they want to unload UTMB/CMC and the TDCJ contract (also the greater cost is associated there also). No doubt they would keep the TDCJ Galveston Hospital because that is where many Students, Interns and Residents get training benefits (not in the outlying outpatient clinics that are most troublesome and expensive). But truely, low-level management is not good at best, mid-level management covers it up mostly and upper-level management seems to be more involved in political "shmooze" and blaming or demanding mid-level management fix the problems at the Unit level (of which they are incompetent to do). But remember this also though. The management at all levels is the throw-over from pre-UTMB (ie, the original TDCJ personnel) thus the "shotgun wedding" or what I refer to as the "nepotism" of UTMB/CMC. And the Head of TDCJ Health Services, yes, Lanette "Lannemous" Lithicum was, as I have heard, a second-rate Doctor at Estelle (so go figure). I believe a different contract for the outlying outpatient clinics is a good idea for UTMB (Galveston), but nothing is good for the Texas Tax Payers until "Constitutional Healtcare" gets redefined. Politicians do not have the courage for that though. Back to the original premise also, Prisons are Horrible!

Prison Doc said...

Grits I'll answer you as best I can.

1. I have no knowledge of "blackouts" on death reports. Most things are eventually public record...I suspect this complaint stems from the sentiment that there is something "sinister" about prison deaths, and when nothing evil can be found in the report, it's assumed that a coverup is in progress when in reality there probably isn't much to find out.

2. Regarding budget cuts, IMHO as a physician there is a LOT that UTMB could do to cut costs, mostly in eliminating most of its administrative bureaucracy in the Correctional Managed Care division. Other unnecessary expenses include testing done because of "defensive medicine", and contractual obligations (vide supra) that require us to treat all medical complaints as of equal importance, so that meaningful "triage" is not really allowed--this gums up the system.

3. Unit differences. There probably are some, but I have not seen them personally. I know that some of the huge maximum security units have a hard time getting things done because of inmate violence, security concerns, and the aforementioned contract obligations which require equal attention to be given to the most minor and nonsensical of complaints.

Horror stories such as those told on the "Gatesville Gulag" are frankly hard to believe and I don't really believe them. Most providers are interested in doing a good job, there is no up-side to doing a bad job and there is a really big downside.

I don't expect some readers of this blog to believe it, but we providers are actually under a lot of scrutiny on a regular basis.

Anonymous said...

"Horror stories such as those told on the "Gatesville Gulag" are frankly hard to believe and I don't really believe them."

I agree Doc but they are hard to dismiss especially when I consider back when the news stories started breaking on the Montague County jail, even though the issues were not prisoner health care related. More about things that should not go on do go on.

Anonymous said...

Why should the state be responsible to "fix" inmates choices? If an inmate is banging another mans cornhole, why should taxpayers be responsible for a choice an inmate made? These losers don't take care of themselves in the freeworld, (abusing drugs, unprotected sex, eating fast food everyday)then when they get to prison, they expect to be "fixed" for free? 2-9-11 5:52--- If you're uneducated enough to return to prison, then you deserve no mercy, you're too fucking stupid to begin with.

Anonymous said...

The doctors and nurses are the real criminals.

Unknown said...

Anonymous above me: The problem is that when you’re in prison, it’s the GOVERNMENT doing all of these to you, and it brings in constitutional protections.

Private citizens can do all sorts of things to one another that the government cannot do to them.

Because of the constitution.

In other words, we as a society can let human beings starve out on the street without food or water or medical care. There’s nothing legally preventing us from doing that. But when the government is housing them – and not letting them leave – there are constitutional standards that have to be met. Even if the person is stupid...

Your position is understandable. Lots of people are like you and don’t support the constitution.

But some folks do…

Anonymous said...

To 2/10/2011 07:14:00AM: You "heard" wrong. Dr. Lanette Linthicum was NOT a second rate Doctor at the Ellis II, later changed to the Estelle, Unit. Dr. Linthicum was one of the best physicians TDC/TDCJ hired in the laat 20 years. She was the greatest when she was at the Huntsville unit, and the Regional Medical Facility (Ellis II/Estelle Unit).

I worked with Dr. Linthicum from the day she came to work for TDC until I retired in 2004. She worked miracles on the admin side and more so on the medical side. TDCJ and Managed Care should be thankful she turned down those lucrative private medical practice offers and stayed on to try and help move the agency forward.

Retired 2004

Anonymous said...

Prison Doc.....PLEASE!! As someone who has seen a family member go through hell at the hands of the so-called "medical staff" at Gatesville, I find your comments unbelievable at best. Not only are inmates' medical complaints totally ignored, the inmates are told outright that they are "faking it" and then are denied lay-ins. If they are seen by anyone in medical at all, they are dismissed within a few minutes. My family member was actually told that the nurse didn't have time to see her because she had to do pill line. At the time she was suffering from extreme dizziness due to uncontrolled blood pressure. There were inmates who had severe problems like seizures and were not treated for it. One woman was so very definitely schizophrenic that the other women were trying to tell anyone who would listen that she needed psychiatric meds, but to no avail. She was just left to talk to herself all day. This is an abomination - how can this happen in a country that's supposedly the richest and most advanced in the world?

Hook Em Horns said...

Prison Doc said...

I don't expect some readers of this blog to believe it, but we providers are actually under a lot of scrutiny on a regular basis.

2/10/2011 07:44:00 AM

~~Don't paint with such broad strokes, only I can do that :-)~~

Then you say:

Horror stories such as those told on the "Gatesville Gulag" are frankly hard to believe and I don't really believe them.

Followed by:

Unit differences. There probably are some, but I have not seen them personally.

~~You can rest assured that there are differences in individual units. I have heard the same. I had not, personally, heard of the pedophiles running TYC but the facts are facts.~~

My problem with TDCJ is not the folks who do their job day and and day out to the best of their ability. I know MANY. My problem is with the bureaucracy and malfeasance that comes from a massive prison system, poorly run and financed.

~~There, I painted that with a BIG brush!~~

austex1151 said...

9:47- First off, I always am amazed at throw backs like you. Tx prisons are considered the worst in the nation for inmate sexual assault, with as much a 50% of perpetrators being staff! And they are rarely prosecuted. So crawl back in whatever slime you came from. You have nothing to offer this discussion.

For Prison Doc- I appreciate that you mean well and are probably one of the few "good guys" in this system. But I have spent a year keeping a Type 1 diabetic alive at Jester III. The doctor speaks poor English. Most of the nursing staff comes from various poor countries in Africa and Asia, are badly trained, and speak almost no English, and barely do a credible job. Dr. Ahm*d refused to treat the guy as a Type 1 for weeks. Within 6 weeks of arrival, this STATE JAIL inmate was being rushed to a freeworld hospital in ketoacidosis, barely alive. Ahm*d had spent the prior 3 weeks ignoring blood glucoses over what the glucometer could read- so 600mg/dl+!! They claimed he was "somehow manipulating his disease" for some undefined secondary gain- so he was housed in solitary confinement, fed every single meal under guard, forced to eat every bite even when it was wildly inappropriate (as in pancakes soaked in syrup, when his premeal glucose was 550!) Ahm*d constantly claimed he was "somehow" manipulating his disease, "because otherwise his treatment would work". Then he started claiming he was "eating his toothpaste" to drive up his sugars. And he claimed that Diet Coke would drive up his sugars. I actually got official statements from Coke and Colgate-Palmolive for this idiot. 4 months to force TDCJ to provide a diabetic diet! HbA1c went from under 7 to over 10 within 7 weeks. After months of battling all the way up to Dr Murray, the guy was moved to Young. No more crises so far. Trust me, I have chapter and verse in med records over a 10 month period of his "better than community care" to back me up. UTMB runs a 3rd world health care system, period. And the grievance system is a bad joke. I'd challenge TDCJ to disclose how often an inmate actually wins one of these. So I am glad you are trying to provide good care, because I know from experience that that makes old-line TDCJ staff hate your guts, but the care within TDCJ is NOT constitutional nor even close. It is a disgrace to this state. Unfortunately there are too many slime dwellers like 9:47 in the general population of this state. They just do not give a damn and think it is simply "justice". I used to be proud of being from Texas, but after all this no more.

austex1151 said...

And while I'm ranting....This same guy, who had many convulsions from sugars as low as 15(!!!), had the crap kicked out of him by guards during such a convulsion. He was "failing to follow an order". And being locked inside a solitary room, the vaunted nurse call device was worthless- in convulsions he could not use it. Not once were signs of impending convulsion noted by staff. 100% of the time, he was "found" in his cell unconscious.

Prison Doc said...

As I said in my original post, I don't deny that bad incidents occur, they surely do, even in private sector hospitals: we've all seen it, it's not the sole province of corrections.

This has been an enlightening dialog, but I'll stand by my original comments. As Pontius Pilate said, "What I have written I have written".

Kerry said...

Prison Doc, I have to say my personal experience with TDCJ sounds very little like what you stated.

I was in the Gatesville SAFP unit for ten months. We had one inmate, a female in her 30's with Hep C but not acutely ill, who died of pneumonia that was ignored and ignored until she was unable to walk. The inmates had to literally pick her up and drag her to pill line to be seen, and even then, the nurse refused to see her. The next day she and one other inmate were left in the dorm with an officer on lay in and during that time, she cried and begged for help that she could not breathe. The officer laughingly yelled that she should shut up and go to sleep. A few minutes later she died. It was not noticed until the rest of us returned to the dorm. She had been treated with nothing but decongestants and tylenol.

I saw another inmate in the regular unit whose belly was bloated enormously and who was extremely jaundiced and could barely move. She was obviously in mortal agony, and near death, but was made to sit upright in a hard metal chair all day long to be seen, and was treated with nothing but Darvocet. In fact, the prison bragged that they stocked nothing but tylenol 3 and darvocet for pain.

DUring the unit "shutdown", I overheard the nurses cackling and laughing about how people would be turning in sick calls now, trying to get out of the mass punishments dished out during these weeks, such as making everyone sit bolt upright in a plastic chair from 4 am til 8 pm without speaking or moving. They proudly noted that they were going to "refuse" each and every sick call, no matter how serious, to "teach them cons a lesson!". One of the inmates had gigantic boils laden with staph all over her face. The P.A. who was treating her accused her of not taking her meds and put her on DOT--still, the boils continued. They were left to burst and fester and she was in agonizing pain, sitting in those chairs with pus dripping from her face, and the P.A. continued to insist that she "must be doing it to herself somehow".

Then we have the poor girl who had an abscessed tooth, and who, after weeks of agony, finally gets in to see the dentist, who numbs her up and pulls--the wrong tooth.

ANd we had the folks who came in with psych symptoms well controlled on meds from the jail, only to find that the only antidepressant they could get at TDCJ was Zoloft.

And as for people not complying with therapy--you have no idea how difficult it can be to go and stand in an hour plus pill line every day when you could get a few more minutes of precious sleep, or actually get to eat your lunch, or how hard it is to take heavy duty psych meds or sleeping pills at 4 pm (the last pill call of the day) and then be forced to sit through four more hours of programming in a semiconscious state, where you will be written up for refusal to comply with treatment if you fall asleep, and for the same thing if you refuse your meds.

Hook Em Horns said...

Prison Doc, I don't want you to take on an unfair amount of criticism so please keep in mind that the comments, at least that I am reading, are not directed at you personally.

Having said that, your defense of healthcare throughout TDCJ is indefensible. You simply cannot be everywhere so your blanket denials or attempts to justify some of these allegations is weak.

YOU SAID: As I said in my original post, I don't deny that bad incidents occur, they surely do, even in private sector hospitals: we've all seen it, it's not the sole province of corrections.

You are correct sir. Incidents do happen in private sector hospitals but the comparisons stop there. Patients in the TDCJ are not there by choice, they are there under sentence of a court, therefore, their choices are limited and their complaints and concerns frequently fall on deaf ears.

I am also not foolish enough to believe that every single complaint is warranted or valid. There are plenty of criminals who are working the system...without question.

Comparing apples to apples though, the concerns over Texas prisons and healthcare are not isolated or necessarily random and TDCJ is administered by some folks who may have questionable motives when it comes to inmate care.

I don't know you but I suspect you are one of the good guys based on your obvious passion but please don't let your desire for the good to cause you to need see the bad.

I have a feeling we need more docs like you and fewer of some others. Thanks for being here!

Anonymous said...

The Gatesville Gulag
The medical services are inept, inhumane and a travesty to the good tax payers of Texas. How can they charge some a $5.00 co-payment when we the family is told 80K a year is being spent on prisoners? If for god’s sake you have to be shipped to hospital Galveston I will pray for you. No woman should be hogged tied and put on a bus for this travel and returned the next day after surgery shackled. This is inhumane to say the least. There have been instances where pregnant women have died down the in Gatesville with medical problems that easily could have been treated if there was any human compassion at all there. I was told a woman was written up for make too much noise one night right before she died in the dorms. The Tele medicine that UTMB charges the taxpayers is fraud. Tele medicine is supposed to provide onsite physician medical care without moving a prisoner across the state. That was the services that UTMB sold the state legislators as a money saving initiative to gain this lucrative contract. Most women will refuse medical treatment depending on who is giving this treatment. Some will forego OB/GYN services because the initial Pap smear is conducted by a Physician Assistance and not a doctor. I would urged anyone to avoid this examination completely now. One woman told me she did not believe her experience was unique. I have talked to several women, who have complained about the way their exams were done, who did them, just that issue in general. Women have talked about leaving the table bleeding because they have been treated so roughly: women who had abnormal results from Pap smears and other examinations aren’t treated properly. Women in prisons have a high risk for cervical cancer because they are exposed to multiple risk factors such as a diet low in fresh fruits and vegetables so my question is again where this so-called 80K a year being spent is. Also some women have said tests are provided in small, unclean rooms, without privacy, and that staff often inflicts pain while administering the tests. One woman stated “[physician] was cramming the speculum in like a Roto Rooter”. Some reported feeling sexually abused or violated during their Pap-smear examination. Many connect this feeling to previous histories of sexual or physical abuse. I have been told they would rather have a female care provider, who they believe would be more compassionate and understanding than male personal. Very few of the medical personal offer any explanations of the examinations, the results, or follow up care, including prescription drugs. When asked questions often times the medical personal are not receptive. As a result of these barriers, many people locked up avoid or refuse subsequent treatment by prison medical providers. One woman said terrified by her experience with a physician, said, “I would refuse another Pap smear by him. I just couldn’t do it, couldn’t go through it again. Many people in women’s prisons are aware of the potential health risks of refusing medical appointments but believe that this risk is outweighed by the value of avoiding violation by medical personal and maintaining their integrity, rights to privacy, and personal autonomy. In maintaining this system, TDCJ and UTMB blatantly violates the patients’ rights to family. Behind the prison walls, women are not allowed to show emotions, to simply put their arm around someone crying by lost of a family member. Their anger, pain and other feelings must be kept under tight control. To speak out or show their true feelings will lead to a guard writing up a case and then a kangaroo court where the house rarely loses. So exempt for tears they have nothing else or no one to turn to.

Anonymous said...

I had a love one almost die in Gatesville because everyone is faking so say's the nurse's and the PA down there. They do think it is fun to medically abuse those women down there. This are true stories. The Gatesville Gulag writer is a person I know with a love one down there being denied medical care. Prison Doc you are not on that unit and do not have a clue to what happens down there. The warden should be tried for crimes against humanity for one then the medical personal put in a prison also. How can a medical provider stand around and laugh at a sick person unable to walk. Why are the women put in a gym in the freezing cold weather of late with no heat. Why? Because it is too cold for them to be put outside but some pint size dictator says they are going to a building with no heat. And we wonder why they are always sick. How about 2 oranges and 2 apples being the only fresh fruit for an entire year. We do prisoners of war better than this. There is no humane treatment in Gatesville period and the medical is cruel and unusual punishment to say the least. You can not even begin to compare the TDCJ medical with out side care I see poor people on Medicaid getting free treatment at clinics that is far better than this crap we see as family members in Gatesville. The grievance system is broken rather it be officer abuses complaints or medical complaints. They go no where and no inmate ever wins.

Anonymous said...

I have never heard of a prisoner winning a grievance in Gatesville. I do not even believed they are read at all.

Anonymous said...

I had a love one in Gatesville suffering during a lockdown and for a week when the nurse would come onto the unit she was told "I FORGOT YOUR MEDICATION" Now she should have been fired. When I called the unit I was told my love one was lying. Inhumane medical along with a lot of incompentence. These people can not practice in the free world.

Anonymous said...

I would say 100% of the sexual assaults in Gatesville are all done by the staff everyday through their strip searches. These are criminal offences if I did them to some one. But it is not criminal if the prsion staff does this.

Anonymous said...

Hey Prison Doc
Pontius Pilate also washed his hands and sealed his fate into history. You sound just like him in real life also. I would assume by that statement you may just be responsible for some deaths also.

Anonymous said...

I am thinking that PrisonDoc needs to make a visit to Gatesvile and check out the situation there.

Anonymous said...

If he did go to Gatesville they would just put up their smoking mirrors. They will say they are lying (your love one is lying to you) They are not sick they are trying to get out of sitting in a freezing gym for 6 hours with no heat. They are not too old and sick to cut grass with a hoe while lawn mowers sit and rust. NOW IF SOME ONE WENT AND TALKED TO THE PEOPLE BEING ABUSED INSTEAD OF THE WARDEN AND STAFF AND ACTUALLY WOULD LISTEN THAN THEY WOULD SEE CRIMES AGAINST HUMANITY!!!! People have always been afraid of what they will find down there. When some one important goes down there they put on a big show and hide the abused inmates and hand pick thoses with threats of what will happen after the group leaves. Even now those people know something is going on down there that is not right but close their eyes. I believe women are buried down there now and in 50 or 100 years when their souls cry from the graves people will stil be writing about them if anyone is still free to do it.

Anonymous said...

I am advocating against the abuse of not only yesterday against the kids but today against the women in Gatesville today. Those guards and people running Gatesville today are just as big of perverts, rapist and sexual deviants as they have been down there for 140 plus years now. Staff sexual assaults occur down there as I write this. As soon as the sun goes down it gets worst but they use those showers and closets down there today just like they did so many years ago. Day time or night time those women are in danger!!!

Anonymous said...

“This is an abomination - how can this happen in a country that's supposedly the richest and most advanced in the world?”
Some things never change, Gatesville and Mountain View are prime example. Move the boys out bring the ladies in, business as usual.

Please remember Gatesville is the birth place of state sponsored child abuse. The wealth of that whole aria was built on the blood of children. The generational curse of abusing orphans and widows placed on that community will make the Gatesville gulag more inhuman than any other unit in TDCJ. It’s just natural. Stuff goes on there that would make the likes of Stephen King cringe.

"Horror stories such as those told on the "Gatesville Gulag" are frankly hard to believe and I don't really believe them." That’s the best part of TDC/TYC defense. The atrocities committed by these so called corrections people are way too hard for polite society to believe. That’s how these people get away with committing the most heinous acts against humanity. Corrections are going to deny it while polite society can’t fathom it, nothing new under the sun here. One will say she is a great doctor while another will say she is not. If she is or isn’t who can say because of safely practicing behind the cover of TDC. The reality is she may have been inadequate to practice medicine in the free world. With no accountability who would know?

About David Ruiz cause of death.
Ruiz had chosen a hard life, a life in the care of TYC and TDC/TDCJ. If Ruiz received the same type of health care in the free world his doctors would lose their license and possibly be doing time. His choice to bring attention to Texas’ kkk death camps caused his keepers to allow him to die of medical neglect. It would be retarded for an educated person to think otherwise, lest they be thought to be hiding something.
So what are the ladies learning in Gatesville, if you show kindness to a fellow inmate the kangaroos with hurt you. Interesting lesson.


Anonymous said...

What does Whitmire and Jerry Madden have to say about Gatesville? Who represents that district in the State House and Senate?

If there is something to this talk about Gatesville, then organize your facts and present them to the people who can have an impact.

Anonymous said...

People have gathered their facts and went to Austin before and as they were presenting their facts Senator Whitmire covered his microphone and carried on another Conversation with some laughing. If the elected leaders sent a real investigation team down there with some bite and a mandate the truth might come out. But the Office fg the Inspector General are a bunch of TDCJ cronies and doing the right thing is not in their dictionary. No one wants the truth to come out of that god forsaken place. Those guards are cruel plain and simple. They hide behind smiles and get nice with a little extra food and recreation when annouced inspections come down. If an inmate upsets one officer they will send two or three other officers to deal with them. The grievance sysytem is full of retaliation and no one beats the house. Most of those cases are an inmates word against an guards word and the inmate is lying because they are there. Often times the retaliating officer is a family member related by blood or marriage or the investigators family member works on the unit. Wake up people this is a 140 year old cover up and no one wants the truth to come out. There are non-violent offenders down there passed their eligable parole date but it is a number game TDCJ can not afford to have empty beds. The parole board answers to no one and is very corrupt. If you can not see these realities than you need your head exaime. We society do not want to see this. We society encourages rapes and sexual assaults in prisons because we want revenge and more punishment. Often times these are the weak non-violent offenders. Staff assaults which happens everyday can not or will not be stoped by the people in charge.

Anonymous said...

The elected officials like Madden and Whitmire only cares about themselves and the bottom line lining their pockets. They are cowards that will not step up and stop these abuses in Gatesville or any other prison.

Anonymous said...

As the People of Egypt have recently overthrown there Tyrant; why not the People bring to light the abuses at Gatesville. Take it to the streets, make someone listen, get an investigation, let the heads roll as they should. That is what I say.
And also by the way, I heard from several Doctors that Lannette "Lanemous" Lithicum was a second-rate doctor. Some of them still work for UTMB/CMC (also prevoius TDCJ MDs and one that did several years ago. I am sure she appreciates your loyalty but facts speak for themselves.

Anonymous said...

TDCJ is not a deeds-based organization. It does not care about public preception because it has free reign to abuse people. If an enternal investigation or that big joke that the tax payers pay for ACA goes into a unit they have to produce reports that smooths everything over. Remember they are all lying because they are there.

Anonymous said...

I find it hard to believe that Whitmire and Madden are not on top of this. Who represents this district?

Anonymous said...

Regarding the Gatesville mess, I would try Whitmire and Madden again before writing them off. For this story to get any traction, the media will have to throw some light on it. Has anyone talked to John Young (ed.) of Waco? Is he still there?

Is anyone in the media working on this? If so, please cite any published articles. Former employees of Gatesville who didn't go along with the bad stuff--contact the press or the reps in Austin. Let's put a fire under this.

Anonymous said...

Use your head here. The person who represents Gatesville needs these prisons and will do nothing. They need the jobs to stay in office. That is why those women are living in 100 year old buildings. A few years ago a roof fell in one some at Hill Top Unit over 100 years old. OSHA would not let you or I work or live in that building but the state does. The representatives of Gatesville have plenty of motivation to hide and cover up what is happening down there. No one will believe those women but their family members and we can do nothing. Gatesvilles was built on this horrible abuses and the state representative of Gatesville owes those women nothing because they are not from Gatesville and can not vote either. Common sense here people common sense.

Anonymous said...

Why not some liberal politicians out of Austin attack this thing at Gatesville, just bust in and bring it to the Public eye. There are truely many red-neck republicans that will never believe anything they do not want to, but greater things have been done by the will of the People. I say bring Gatesville down. I am appalled that any Healthcrae Provider would behave in such a manner, but I have seen it myself. There is an Iranian MD in the Huntsville area that CMC management has let run rampant for the ten years that I have seen (he called an HPV growth that lead to rectal cancer, hemorrhoids, until I saw the guy and I got him proper treatment). And he has been brought forward to management more than once to no avail by me and others. I have already commented on UTMB/CMC management. And PrisonDoc, although there are bad outcomes in the FreeWorld, the same abuses in the Prison are not seen in the FreeWorld, so get real. Why do you not go to Gatesville. New Leadership might likely be needed in the Correctional Care setting soon. Just a thought. There are good Units out there, but there are alot (sounds like Gatesville maybe one, maybe Coffield) that are not. So get your head out of the hole and look around. I wonder what Units you have been at anyway. I agree that you maybe a good Provider (of the many) but that does not say that all are, and the lamantations reference Gatesville are pretty consistent and strong. So check it out!

Anonymous said...

So what are the ladies learning in Gatesville, if you show kindness to a fellow inmate the kangaroos with hurt you. Interesting lesson.

Thank you!!! That is just what happens a major case of sexual misconduct. It is not view as human compassion or kindness but as some major homosexual laison. Then the kangaroo court follows where the house never loses and then some one's daughter does not make parole or a mother can not go home to her kids. The prison officials then sit back and laugh and tells the family they are lying to you. It is also called unhealthy relationships. Only a person who works in a prison can call an act of human compassion an unhealthy relationship. Try to help a sick person to the pill line and your written up or try telling an officer some one is sick or may committ suicide and they will do nothing until they cut themselves up. But the officers will have the time to post it up on their Face Book pages while mocking the poor person the whole time.

Anonymous said...

What are your "facts" concerning Dr. Linthicum's "second rate doctor" classification 2/11/2011 07:17 PM?

Please present your facts (not what you "heard"). My comments, in regards to your comments concerning Dr. Linthicum's medical expertise, was not out of loyalty; it was fact based!

Retired 2004

Anonymous said...

First off having retired from Allred last year, I would like to add my two cents in. My wife is a LVN employed by Texas Tech at Allred. In the 13 yr I was at Allred I saw excellent care for the most part given to the offenders. The staff at the unit do the best they can.
As for sick calls, some times offenders abuse the system.
One thing that would save the state money is to parole the older hospice inmates. Another would be to stop the nightly runs to Montford the psych hospital in Lubbock! You talk about abusing the system, when you have offenders who come repeatedly to the psych cells. cause they just can't cut prision life!
For the most part the medical staff do their job!
As for the $ 3.00 copay,I would love to pay that to my Dr!

Anonymous said...
The Gatesville community has been getting fat from the state sponsored abuse of orphans and widows forever. When the allegations of abuse was happing in 69 against tyc the local representative was acting governor at the time and issues a proclamation that the staff at Gatesville were the greatest thing in the world. Shortly after the world found out Texas politicians lie to cover up there prison atrocities.
This blog has former inmate telling their stories.

Anonymous said...

The tyc stopped sending boys to the Gatesville school in 1975 unless they were an escape risk or as in the summer of 1975 the other schools were full, or you wouldn’t have sex with the goat roper caseworker chick in Brownwood who ran was the nazi in charge of who went where. I may have been locked up but she did nothing for me. The school was fully closed down to boys in 1981 and the facilities were transferred back to the department of corrections. Anyone who has ever set foot on that place knew it was never, culturally, transferred to what was called the juvenile training school in 1913. So now the good citizens of Coryell county and the surrounding area have moved on from the economy of abusing children to an economy of abusing women.
See what the state has done to the old Gatesville State School for Boys today.

Anonymous said...

Heard an interesting story from a guy who grew up in the town of West. They played sports against the Gatesville Hornets. The Gatesville public school kids have a reputation of demonstrating unsportsman like conduct and being very sore losers. The kind of kids who like to pull the wings off of flies. Apparently this is a well known, and accepted fact about this little backwoods community whose wealth is so heavily tied to corrections. So here we have the inbreed parents of the city of Gatesville raising another generation of abusive ignorant future corrections officers. What is this like the 6th or 7th generation. Perpetuating that spiritual generational curse of abusing orphans and widow.