Ford Brewer, M.D., Ph.D.
Senior Medical Consultant
Division of Correction
Suite 309
6776 Reisterstown Road
Baltimore, Maryland 21215
Dear Dr. Brewer:
I've been volunteering in the prisons for longer than five years now and in no category are there more complaints and grievances than with medical matters. Recently, I have heard about denial of Fiorinal, HCTZ that runs out and simply discontinued, consults that take five months to schedul,e, and sick call running in the same line as feed up. Oddly enough, MCIH and MHC outdo the Penitentiary. But what prompted my Sunpaper letter of January 12 {Brewer has used it and the MCEA version as a "teaching device" for student nurses}, was not only bad medical care, but the blatant inaccuracies in disinformation in the MCEA letter of December 6.
The reason I am writing is that I have heard through one of your students that you used my January 12 Sun letter, along with the MCEA letter, for discussion in one of your classes at Johns Hopkins yesterday. I thought you might like to see the paragraphs which were omitted for the sake of space from the final, published version.
. . . Statistics on per inmate medical costs between 1981 and 1986 are not accurate indicators to demonstrate medical cost escalation resulting from the entry of private contractors into Maryland prisons. During the same period all medical costs in the United States experienced comparable increases, and the effects of this growth can be seen by the acceleration of HMO memberships and the pressure to develop payment restrictions and service accountability in the medicare and medicaid programs. Analogously, there have been parallel increases in health insurance charges in all sectors of the insured population.
. . . The kinds of questions the State should be asking when examining privatization of medical care are: What were the roles, if any, of relevant boards and commissions during the contract period? Can future contracts with private firms be structured to incorporate effective monitoring and sanction mechanisms? Can DOC provide the level of auditing required to enforce technical contracts and/or coordinate with existing State agencies?
I am hearing from sources external to the prisons that DOC is doing a lot to better its sad situation and, if true, I am glad about it and compliment you on your input. However, DOC obviously has a long way to go.
If I may ask a favor, I would like to obtain a copy of the consultant report released in November, 1986 discussing health care in DOC under the private contractors. Perhaps you have an extra copy of know where to get one. I would certainly appreciate having one.
Although I am accustomed to working directly with inmates, if there is any other way you know that I can help out, please let me know.
Sincerely,
Nancy Moran
nm
FROM:
Bernadette Crowford
Health Services Administrator
Division of Correction
In a letter to this office, you requested a copy of the consultant report released in November, 1986 discussing health care in the Division of Correction under the private contractors.
According to the Division of Correction Director of Health and Mental Hygiene Services, copies of the report are available through this office at .50 cents per sheet. The entire report is approximately 800 pages long.
Thank you for your interest in the Health Services program.
[NOTE: The current FOIA rate for the Department of Public Safety per COMAR is
15 cents per page.]
FR: Bro. Anthony B, 181-###
Dear Ms. Moran:
It is very imperative that the existing medical problem be brought to the attention of your office.
The P.H.P. Medical Corporation has created a major conflict in purposing that certain medications, such as Tylenol #3 and Fiorinal commonly prescribed by doctors and psychiatrists be discontinued. The efficiency of Fiorinal in the treatment of the target symptoms of tension headaches (headache pain, psychic tension, and muscle contraction in the head, neck and shoulder region) is shown to have significantly superior cinical (sic) effects to either component alone. Also, Fiorinal is indicated for the relief of the symptoms of tension (or muscle contraction) headache.
I have taken the liberty to investigate the situation and an underlying plot to deprive the inmates within the institution of adequate medical treatment, by denying us the right to medications normally prescribed for the relief of migraine headaches, certainly do exist.
The abovementioned situation is derived from the numerous complaints lodged against the nurses and correctional officers assigned to the hospital here. It is evident that these people do not wish to adequastely fulfill their assigned duties. I, for example, have had a prescription for Fiorinal placed at the bottom of my file for about 5 days before anyone found it there. This said prescription was written by Ms. Day, L.PN., and signed by Ms. V. Hill, L.PN., who would not honor the prescription once it was found.
Here at the Maryland House of Correction, there is no E.N.T. Doctor, nor is there a neurologist on the staff of the hospital. We have to wait sometimes as long as 3 to 4 months for the administration to send us out to University Hospital for treatment. Many men have suffered drastically, even died, because of not being transported to University in adequate time.
Since my arrival here, I have constantly complained of having headaches and a lump in my throat and chest. The physicians diagnosis are tension, headaches, and blister and/or tumor in my throat and/or chest. I have been persistent in following the correct procedures by going on sick call every 3 days. Some days I would receive medication and on others I would not be given any, depending upon the mood of the correctional officer and nurse on duty. The physicians here continuously recommended that I be taken out to University Hospital for treatment; but, nothing has come of it. I pray that your office would take action in the above matter right away. Whatever can be done will be greatly appreciated.
Respectfully,
Bro. Anthony B, #181-###
Memorandum
TO: Mohamed S. Al-Ibrahim, M.D. (U.Md.- General Internal Medicine)
FROM: nm
DATE: October 31, 1986
I received the attachment over the weekend and believe you may have some curiosity about it. By the man's commitment number, he has been in the system for about a year or less. The grievances are fairly typical, but this letter happens to [be] unusual because it is well written, to the point, contains no major spelling or grammatical errors, and is typed out in quasi-professional fashion. Note:
-- Medications involved are pain killers.
-- Delayed or non-dispensing of drugs despite existence of prescription; no transfer to UMH despite physician recommendation.
-- Guards interfering with medical care.
-- No specialists available at institution; lengthy wait for transfer to UMH.
I have not investigated this particular man's claims, but certainly none of the above is new. I helped an inmate file a civil rights action for basically the same issues more than two years ago. The suffering and dying part can be substantiated by former MHC nurses. The Penitentiary is worse.
I would forward this to the Audit Committee you told me about, but I don't know who or where they are or even whether they are still active. Headquarters is more or less useless because the way things work in DOC, the warden or chief of security is responsible for the guards and pain-killer drugs are considered a "security" issue and therefore subject to the terms and conditions of each prison (more likely, the "B"-shift captain). Specialists or consults at UMH are at the discretion of the contractor, who must pay extra for them and who is virtually unregulated or audited.
The Administrative Remedy Procedure takes two weeks with the warden, six months with the Commissioner, and another year with the Secretary. The Inmate Grievance Procedure takes at least six months before a hearing is scheduled and perhaps a year after that for a decision to come down, much less implemented (if ever). The Federal courts no longer have jurisdiction on medical complaints unless the situation is immediately life-threatening plus the provider is grossly and/or intentionally negligent.
As before, any assistance or advice would be most appreciated.
Mr. Nicholas J
#171-###
954 Forrest Street
Baltimore, Maryland 21202
Dear Mr. J:
I guess you by now got my follow up letter on IGC about the same time I received the letter on the viral study. I hope your 1983-type situation is moving along at a steady pace and you will not get estopped, etc.
I am very happy that you sent me that paper in your last letter. Knowing about things like that is very important to me and I appreciate your letting me in on current events like that. Also, I asked around at MHC yesterday and the same study is going on there.
I am enclosing a xerox from the newspaper (?!) which is right up the alley from that study they are doing at the Pen and Cut. They aren't exactly coming out and saying that is what they are doing, but AIDS and money for research on AIDS is where it is at right now. Prisons are marvelous populations to do this in for many reasons, and to be upfront and face the facts, the AIDS virus (for one) is a major threat to everyone's health right now.
Parenthetically, the "young, recent, black usually illiterate" etc. are exactly the population who they believe is most likely to acquire and transmit AIDS because they also are the most likely to have shot up drugs using second- or third-hand needles. I even say a thing on TV yesterday about the spread of AIDS in prison and believe it, the Penitentiary is not going to be immune.
If they are doing what they claim to be doing in this DCIB, I personally have no objections whatsoever with the one reservation that those who donate the little tubes of blood by having the crook of their elbows stuck with a needle for a few seconds every once in a while get some kind of compensation over persons who do not do the same. It is the least some people can do in exchange for how they got in there or staying someplace rent-free.
I also have to tell you that in the course of working at Hopkins, I've seen studies sent to that committee and most of them are far more complicated and potentially risky than the one you sent me. [Committee on Human Volunteers (have written some of their "contracts")] This is not pharmaceutical or cosmetic in the least. Also, although the blood is bing used in an experiment, the procedure for getting it is absolutely approved and safe and I just did it myself earlier today and have done it lots of times for years and will be doing it a lot in the future because there's nothing wrong with it. As long as they are not putting in a drug or serum or substance, just taking out a tiny bit of what's already there and plentiful. (It's something like two ounces out of a total of 8 pints or more for larger people - and your body restores it 100% in volume in minutes and 100% in content in a couple of days.)
If there is a major upswing of AIDS in the prisons, or in the populations outside, OR if those simple studies show them that similar viruses are transmitted fast or in certain ways, those DCRs are going to get changed as far as testing and screening faster than they can xerox the revision and I for one would go along with it. DOC would have the obligation and responsibility to rehouse different people the same as they would have to take away knives and shanks or transfer sombody once in a while to Clifton T.
Rather than go into a lot of detail and speculation and scaring anyone, in summary, all the Hopkins study is doing is tracking viruses - a lot of kinds of viruses - seeing where they are coming from and seeing how fast they go from one person to another. Viruses are just tiny bits of genetic material with a starch coating. They are found all over nature and everybody on earth is carrying around a lot of different kinds of them. The way you track viruses is by taking a little bit of blood from an artery close to the surface like inside an elbow and do scientific tests on what you get.
The scientists just happen to be using younger people because they need to start the tracking process before the person enters the prison. Since they only started this recently, they have to use people who have entered only very recently. They are not discriminating on the basis of race or poverty or education. As a matter of fact, they would like to have a good mixture of race or poverty or education, but they have to take what they can get and the people you described is what they can get.
I hope I have sheed some kind of light at least and I hope the xerox provides insight and food for thought. I majored in science when I went to college and do know at least a little bit about this stuff. I am hoping you will share the contents of this letter and the xerox with other people in case people get the idea to panic, etc.
(photocopy also posted at MHC)
P.S. COs haven't demonstrated wherewithal in regard to scratched fingers, headaches, epileptic seizures, CPR . . . .
At certain point in disease cycle, inmate should be released to conventional health care facilities. No danger of escape, not likely to be able to commit crimes over again.
Sincerely,
Nancy Moran
nm