Photo: Michael Lyle/Nevada Current)
Inmates in Nevada prisons are being denied necessary medical care and medications, according to providers and a memo provided to the Current.
“It has come to our attention that there have been instances of medical care being neglected for inmates in our care,” Warden Jeremy Bean of High Desert State Prison wrote in an August memo to all prison medical providers. “This is a serious violation of their rights under the 8th Amendment, which prohibits cruel and unusual punishment, including the denial of necessary medical care.”
Bean went on to say failing to provide “necessary medications or services not only violates the 8th Amendment but also goes against your obligations as licensed healthcare professionals.” The failure to provide care not only puts the health of offenders at risk, the memo reads, “but also jeopardizes your professional integrity and may result in disciplinary action.”
Gov. Joe Lombardo declined to comment on the memo or say whether he has taken any action as a result. His spokeswoman referred the Current to an emailed statement from NDOC, which says the department “is committed to providing the best care to our population and will continue to strive to meet the needs of our population.”
The failure to provide care is worsening, providers contend, under the leadership of Dr. Kenneth Williams, the Nevada Department of Corrections’ medical director. In February, the Current reported Williams was hired and permitted to work without a medical license, a minimum requirement for the job.
In March, the state Board of Medical Examiners said it had no jurisdiction over Williams, given his unlicensed status, and asked Attorney General Aaron Ford to investigate.
However, without explanation, in July the Board licensed Williams, who worked almost an entire year without a license, a class D felony. It’s the first time the medical board has approved a doctor who practiced without a license.
Williams did not respond to calls to his office and personal phone.
Doctors allege retaliation
Williams has terminated two practitioners in the last several weeks — a dentist who says he declined to abide by Williams’ directive to practice on patients without a dental assistant, and a doctor who questioned why Williams was not following his own policy of having an outside provider serve on the Utilization Review Board, a panel that evaluates appropriate care for inmates.
Both practitioners assisted Ford’s investigation of Williams’ hiring, given his lack of credentials, and suggest their terminations may have been retaliatory.
Ford’s office will not say whether the investigation of Williams has been completed.
In a complaint to the state’s Human Resources department alleging a whistleblower violation under state law, which prohibits an official from retaliating against an employee who reports wrongdoing, the dentist alleges Williams “abused his official authority and influence by intimidating, threatening me, coercing others to join him to take retaliatory action by terminating my employment…”
“There’s already a shortage of providers and now Williams is making it more difficult for the inmates to have any quality of care,” said a nurse from Northern Nevada Correctional Center who asked not to be identified out of concern for retaliation.
NDOC and Lombardo declined to address the termination of the two practitioners.
The state is seeking applicants for 35 medical positions with NDOC.
Williams is refusing to treat inmates for a variety of ailments and provide basic care, according to medical professionals – some who work for the state and others who were recently fired.
“He will invariably say no to treatment, and he cites money as the reason for saying no,” says a doctor who was fired last week after questioning Williams’ practices. “These patients are doing without simple things, like Tylenol for pain. He’s making medical decisions that are not in the best interest of patients, who can’t speak for themselves.”
The physician, who asked not to be identified in order to protect her professional reputation, says patients who require blood thinners are prescribed Coumadin, which costs less than the alternative brand, Eliquis. Coumadin, unlike Eliquis, requires continuous blood monitoring, which inmates do not receive.
The doctor, who has also filed a complaint with the state, says she doesn’t want money.
“I just want my job back. It’s so sad. I swear those prisoners really need help and no one seems to care,” she said. “I can’t get them in to see the dentist for months. I can’t get them to see the specialist for in some cases, greater than a year.”
Another provider noted inmates suffering from cancer are prohibited by Williams from receiving protein drinks such as Boost, unless they have a body mass index of 17% or less, which is considered seriously underweight.
Williams, who previously served in the same capacity for the Tennessee Department of Corrections, was sued there for refusing hepatitis treatment to all but the most infirm inmates because of cost. The U.S. Supreme Court ruled in his favor.
Lifelong implications from temporary sentence
Nevada houses some 10,000 inmates, the vast majority of whom will ultimately be released. But medical professionals say the lack of care they receive while incarcerated can result in a life sentence of navigating health complications.
“Lacking quality standards, robust monitoring, and funding from public medical insurance programs, correctional administrators must provide health care for incarcerated people with limited guidance and often scarce resources,” says a paper published last year in the New England Journal of Medicine. “Incarcerated people have little recourse for woefully inadequate medical care except litigation, but they face multiple barriers to accessing the legal system and counsel, and rare wins yield only incremental relief.”
A brief review of federal court filings indicates a variety of lawsuits alleging failure to provide medical care have been filed against NDOC and the state this year.
In one case, an NNCC wheelchair-bound inmate alleges he’s been waiting five years for cataract surgery and suggests his increasing blindness impedes his ability to navigate.
Another inmate confined to a wheelchair alleges he’s been denied accessible exercise opportunities.
A number of inmates allege NDOC has failed to provide mental health medication, and one contends guards ignored his emergency calls for asthma medicine.
Another inmate alleges “deliberate indifference and negligence” by the state, which he says is charging him for specialist treatment for aplastic anemia, and has denied the proper dose of hormones prescribed by a specialist.
“The State has a moral and legal obligation to provide health care for those people whom it incarcerates. The Federal Courts have mandated that offenders, though incarcerated, remain entitled to basic medical care,” reads a state website.
Deliberate indifference to an inmate’s serious medical needs constitutes cruel and unusual punishment under the Eighth Amendment. However, standards for “deliberate indifference” and “serious medical need” are subject to a court’s interpretation.
Williams is also ignoring a medical directive that requires the state to include an outside doctor on its Utilization Review Committee (URC), a panel of practitioners who meet to decide what treatment is appropriate for inmates. The panel “shall be composed of a minimum of four members,” and “at least one (1) outside medical provider,” the policy reads.
“The committee has been functioning for well over a year without an outside provider,” says a doctor who says she was terminated days after asking Williams why the committee was not in compliance with the policy Williams approved.
“It puts doctors in silos,” the physician said in an interview. “I had no communication with the other doctors as to their patient care.”
The doctor says Williams routinely ignores the recommendations of outside medical specialists.
“I’ve had specialists contact me and say, ‘Look, I don’t want to see your patients, because I’m now liable. I’ve given you guys recommendations and you’re not following them.’”
Quenga of NDOC said the policy governing the review committee has been updated, replacing the outside provider with an internal practitioner.
“These changes should improve the efficiency and function of the URC,” he wrote via email. “The current process more closely resembles a utilization review committee as they exist in the community. Lastly, this restructuring unencumbers the time of the providers and allows them to return to clinic to attend to the needs of the offender population.”