The McNeil Island Correction Center (MICC), located on McNeil Island near Steilacoom, Washington, has a long history of hiring misfits in its medical and psychological departments. In order to secure such a position it almost seems as though one must have drug or alcohol problems, a long history of incompetence in his or her profession, or a documented history of sexual misconduct with patients.

The Washington Department of Corrections (DOC) at first refused to provide documentation substantiating these claims. However, after a oneyear battle over public disclosure requests, followed by a successful lawsuit to compel disclosure of the documents, PLN finally obtained the documentation. (See: sidebar, page 3.)

This article highlights the poor quality of medical and psychological care that is provided to prisoners on McNeil Island. Such abysmal quality of care, as detailed below, results from the hiring of grossly inappropriate personnel.

Bruce H. Barrett was a Physician's Assistant (PA) for an unspecified duration at MICC, until he was found dead in his pickup truck on March 10, 1999. King County police found him slumped over the steering wheel alongside Interstate 5 near Seattle, Washington. Barrett had injected himself with a lethal dose of Demerol. Found on his person was a syringe, 1 full vial of Demerol, and 1 partially used vial of that drug. The lot number on the Demerol vials showed they came from the MICC pharmacy, signed out to Barrett earlier that day.

At the time Barrett died, at age 48, he was administratively appealing a 1week suspension from work without pay. Contrary to DOC policy, in 1997, Barrett escorted a prisoner with possibly active tuberculosis without properly wearing a facemask. After MICC was fined $2,000 by the Department of Labor and Industries (L&I) for that incident, Super- intendent Belinda Stewart imposed the suspension. Stewart characterized Barrett as arrogant and setting a "do as I say, not as I do" example for fellow staff.

On the day Barrett died, Health Care Manager Florence Reeves met with Stewart to discuss her belief that Barrett had been stealing narcotics and syringes from the MICC pharmacy. Pierce County Police launched a full-blown investigation.

Reeves suspected Barrett of the narcotics theft after RN Nancy Armstrong and Pharmacist Mark Olsen met with her on March 8, 1999. The two informants estimated that Demerol use in February 1999 exceeded that for the entire preceding 5 months. They reported that Barrett signed out most of the Demerol, and that he routinely signed out 2 syringes when only one was necessary. They also stated that Barrett refused to allow nurses to be present when he administered Demerol injections to prisoners.

Investigators questioned Barrett's girlfriend, Debbie Reed, who admitted she gave a pint-sized bottle of liquid morphine to Barrett. The unopened morphine had been prescribed to Reed's husband, who later died. Reed had given the morphine to Barrett after he offered to "dispose" of it for her.

Barrett's residence, vehicle, and MICC office were searched by police and prison investigators. Each contained empty Carpuject pre-filled syringes and syringe packages, as well as bloodstained tissues apparently used to blot blood from puncture wounds after Barrett injected himself. MICC medical staff reported that only Demerol and morphine come in Carpuject-type packaging. Not surprisingly, the Carpuject lot numbers matched lot numbers at MICC.

Barrett also worked at the Mark Reed Hospital in McCleary, Washington. Margaret Hutchinson, a nurse on Barrett's shift there, reported having seen Barrett in the medication room without any reason to be there. She also reported signing out a Demerol Carpuject to Barrett, and that he administered part of the dose to the patient and put the rest in his pocket. Hutchinson refused to work with Barrett ever again.

A record review revealed that Barrett had repeatedly logged doses of Demerol to prisoners for all manner of minor complaints, for which Demerol would not normally be given. Records showed Barrett's similar use of Stadol, a postsurgery pain medication, during the summer of 1998.

Nurses reported that, being suspicious about Barrett's unorthodox use of narcotics, on March 5, 1999, they began asking prisoners leaving Barrett's office if their injections had helped them. Those prisoners replied that they had not been given injections.

On March 10, 1999, MICC officials performed a urinalysis test on an unnamed prisoner at the Special Commitment Center (SCC), which houses civilly committed sex-offenders, one of whom was purportedly given a Demerol injection by Barrett earlier that day. The test was negative for Demerol, proving that the prisoner had not received the injection.

Barrett's struggle with drug and alcohol addiction began in high school and was constant throughout his career as a physician's assistant. In 1992 Washington gave him a conditional license with restrictions that included periodic drug tests. Five days later, the State Board of Medical Examiners cited him for abusing alcohol. Barrett was given additional license restrictions as a result. The Board licensed Barrett to practice medicine only at MICC under the supervision of Dr. Harper Buck.

DOC officials knew about Barrett's drug and alcohol addiction when they hired him in 1993. In 1998 the Medical Quality Assurance Commission lifted all prior restrictions on Barrett and granted him an unrestricted license. Thirteen months later, Barrett was dead of a drug overdose.

In the end, numerous DOC and Pierce County Sheriff investigators concluded that the evidence strongly suggested that Barrett pilfered narcotics from MICC to support his addiction.

Oddly, after Barrett's death, many of those who voiced their disgust at Barrett's narcotics theft changed their tune. Suddenly, according to them, Barrett was a fine clinician _ a leader and a fine example for others.

Barrett's unethical medical practices were not limited to stealing drugs from MICC. In fact, many complaints were filed against him, some by coworkers and others by prisoners, condemning his treatment of prisoner patients.

For example, in June 1994, an unnamed prisoner filed a complaint with the Washington Medical Disciplinary Board against Barrett and Dr. Harper Buck. Buck was Barrett's supervisor at MICC.

That prisoner had been recommended for herniarepair surgery. He complained that he was housed in a unit requiring him to traverse several flights of stairs, which aggravated his hernia. He complained that he was not being given medication for hernia pain. He was finally given Tylenol. When he complained that the Tylenol was ineffective, Barrett laughed at him and said, "That's all you're going to get."

The prisoner also complained that his hernia surgery was cancelled after he was placed in administrative segregation (adseg) for providing a THC positive urinalysis test.

Barrett and Buck essentially denied those allegations except that the surgery had been postponed. This was done, they claimed, for security reasons associated with the prisoner's being in adseg.

The Disciplinary Board dismissed the complaint, holding that the prisoner had received adequate medical care.

Another example is a complaint filed by an unnamed MICC nurse with the Washington Medical Quality Assurance Commission (Quality Assurance) in February 1997. Although reports are vague, it appears that the nurse complained of Barrett's substandard treatment of prisoner patients at MICC.

The nurse requested that her identity remain confidential under Washington's "whistleblower law," RCW § 43.70.075.

However, after Quality Assurance informed the nurse that her complaint could not be pursued without her identity being revealed, she recanted. She then said that she did not wish to incriminate Barrett, a fine clinician, but instead wanted MICC's general medical practices investigated. She cited "management's negligence," contending that "no one seems to care how bad it gets."

The complaint was dismissed when the nurse refused to have her identity revealed.

In 1999, Quality Assurance investigated several complaints against Barrett by civilly committed sex offenders at SCC. Those complaints alleged Barrett refused to treat various ailments, discontinued medication prescribed to SCC prisoners by outside physicians, and withheld medication.

Those prisoners also complained that Barrett said they were "faking their symptoms" and "feeling sorry for themselves." They also asserted that Barrett had referred to them as "rapos," a derogatory prison term for sexoffenders.

The most serious of the SCC complaints was that of Scott Brooks, who has a documented serious heart condition. He complained that Barrett discontinued his heart medication and refused to treat him. Barrett's position was that Brooks' condition would ultimately be fatal; thus it was not costeffective to treat him.

Shortly thereafter, Brooks had to be airlifted to an outside hospital for heart surgery. Brooks was again denied medication after returning to SCC following his surgery.

Barrett's defense was that SCC prisoners are sexoffenders, who are by nature chronic complainers. He denied all allegations, contending that the complaints were fabrications designed to inconvenience him because he was "part of the system."

Even in the face of the Brooks episode, Quality Assurance categorically accepted Barrett's position and dismissed the complaints without corrective action.

The most disturbing of all MICC's incompetents was Barrett's supervisor, Dr. Harper J. Buck, the MICC medical director from 1991 until March 1995 when he was finally fired after his substandard treatment of an MICC counselor, suffering a heart attack, exposed the level of Buck's inadequacy as a physician.

Among Buck's past professional indiscretions were allegations of his alcohol abuse, his abuse of medical support staff, and his inappropriate breast and pelvic exams of female patients. As a result of those allegations, in 1984, the State Medical Disciplinary Board ordered Buck to abstain from alcohol and to have a nurse present whenever he examined female patients. However, a couple of months later Buck was again before the Disciplinary Board on charges of fondling a female patient's clitoris during a pelvic exam. No nurse was present during the examination.

On those charges, in 1985, the Disciplinary Board found Buck in violation of the 1984 order, insofar as he had examined a female patient without a nurse present. The Board also found Buck guilty of inappropriate contact with a female patient.

For those violations Buck's license to practice medicine in Washington was revoked for 5 years, with 4 of those years suspended. He was forbidden from ever again diagnosing or treating female patients. Eventually Buck was hired by MICC.

In August 1992, a prisoner complained of heartburn to nursing staff at the MICC infirmary. A nurse called Buck at home, who recommended Milk of Magnesia for the prisoner. When Buck arrived at MICC about an hour later, the prisoner had stopped breathing. Buck and nursing staff tried to resuscitate the prisoner, to no avail. No heart stimulation drugs or electric shock were administered to restart the prisoner's heart. He was pronounced dead shortly thereafter.

The State filed charges against Buck for this incident. In 1993, Quality Assurance again revoked Buck's medical license for incompetence. The revocation was stayed, however, so long as Buck paid a $1,000 fine and received additional training.

In 1994, nursing staff filed various reports indicating Buck refused to examine prisoners in adseg. Buck's position was that those prisoners were "probably lying to get attention."

In August 1994, Buck evaluated a prisoner for his claimed hepatitisB. Buck ordered iron therapy without further investigation, even though lab reports read by Buck indicated problems other than hepatitis. The prisoner was later diagnosed with a duadenal ulcer.

In February 1995, Buck saw a prisoner previously diagnosed with arterial fibrilation (irregular heartbeat). He was pale and sweaty. Buck treated this prisoner by suggesting that he go out and walk around and get some exercise.

Because of his treatment of the ulcer and arterial fibrilation patients, Buck was once again in hot water with Quality Assurance. Dr. Roger Rosenblatt, an outside physician, filed a report informing Quality Assurance that Buck's treatment of these patients amounted to egregious negligence.

Then, in March 1995, MICC counselor Jim Swindler suffered a heart attack on the boat that ferries prison staff to and from MICC. According to Jan White, an MICC Pharmacy Assistant who witnessed the incident, Buck panicked and did not properly perform CPR on Swindler, who subsequently died. In her report on this incident, White wrote: "I personally would not want this man [Dr. Buck] to ever touch me or try to make any medical decisions for me whatsoever,"

In April 1995, Buck examined prisoner Dwaine Mosley, who had fallen and ruptured a quadricept muscle. Buck did not refer Mosley to an orthopedic specialist for nearly a month. Surgery was eventually performed on Mosley, but by waiting a month to refer him to the orthopedic specialist the surgery was less effective than it should have been. Mosley still has difficulty standing for long periods of time and cannot climb stairs.

Seattle attorney Richard Hilfer filed a medical malpractice lawsuit against Buck on Mosley's behalf, however, a Tacoma jury found Buck innocent of any wrongdoing.

Buck was ultimately fired in 1995, but only after his botched treatment of Swindler, the counselor who died of a heart attack.

MICC officials named a corridor at the prison after Swindler to commemorate his death from Buck's incompetence. Buck's atrocities against prisoner patients, however, drew no such reaction.

In 1998, Quality Assurance, at long last, revoked Buck's license to practice medicine in Washington. However, he may reapply in 10 years. Buck was reportedly practicing medicine in Russia in 1998, presumably to the great dismay of that country's citizens.

In retrospect, said Senator Shirley Winsley, a Fircrest Republican, "under no circumstances should he [Buck] have been hired."

Former MICC Superintendent Belinda Stewart attributes the Buck fiasco to the fact that "it's very hard for us to hire physicians because they can make a lot more as private doctors." "We're not competitive," said Stewart.

William Dalton, an MICC nurse, was fired by former Superintendent Stewart on March 6, 1997, (citing neglect of duty, gross misconduct, and willful violation of department policies, administrative code regulations, and state statutes) after Dalton injected a guard with the wrong serum.

On June 4, 1996, Karen Heyer, an MICC guard, received what was supposed to have been a tuberculosis screening test. However, Dalton injected Heyer with Tetnus/Diptheria Toxoids, rather than the appropriate Tuberculin Purified Protein Derivative. Dalton then logged the wrong serum lot number for Heyer's injection.

Heyer experienced pain and itching from the injection and developed a white lump on her arm where it was administered. Reddening around the injection area caused a false positive for tuberculosis, which worried Heyer greatly.

Aside from these allegations, Dalton had previously been reprimanded for sleeping on the job. Even so, in August 1998, the State Personnel Appeals Board overruled his termination after finding that the most serious charges against him were unfounded. However, the Board imposed a 15day suspension on Dalton for logging the wrong serum lot number.

On January 23, 1996, Donna L. Evans, a nurse at MICC, was fired for inappropriately dispensing medication.

On June 28, 1995, Evans opened a container and removed 10 Furosemide 40 mg. tablets, purportedly for a prisoner patient, without being directed by a supervisor to do so. Evans was not authorized to independently administer the drug, and she did not complete the appropriate documentation before or after obtaining the tablets. On April 5, 1996, the State Personnel Appeals Board denied Evans' motion to set aside the disciplinary action.

In February 2001, former Superintendent Dan Snyder, Lieutenant James Demotta, and Dr. Thomas Lucky, all of MICC, came under fire by way of a wrongful death lawsuit.

Thirty-two yearold Philip Montgomery, sentenced to prison for burglary, died of hepatitisC on September 7, 1999. His survivng family members then initiated a lawsuit.

MICC medical staff had diagnosed Montgomery with hepatitisC, however, despite his weight loss, continually deteriorating health, and noticeable swelling in his legs, Montgomery was denied appropriate hepatitisC treatment.

Despite Montgomery's repeated complaints, he was denied proper medication, was denied regular checkups, and was denied a diet appropriate for one with hepatitisC. Instead, Montgomery was placed in solitary confinement for complaining.

On September 5, 1999, while in solitary confinement, Montgomery had a 102-degree temperature. He was vomiting and in hellish abdominal pain. His requests for medical attention were ignored until September 7, 1999.

When he finally was seen by medical staff on the 7th, Montgomery was sent back to his cell, rather than to a medical care facility.

Later on that day, after his condition became even worse, Montgomery was taken to St. Joseph's Hospital in Tacoma, where he died that evening. His family was not notified of his condition or his transfer to the hospital.

Despite repeated calls from Montgomery's mother, requesting information about her son's condition, the prison shift lieutenant, James Demotta, concealed from her all information about Montgomery's worsening condition and his transfer to the hospital. As a result, Montgomery died alone and in excruciating pain.

Attorneys John R. Connelly, Jr. and Darrell L. Cochran of Gordon, Thomas, Honeywell, Malanca, Peterson & Daheim, P.L.L.C., filed the suit on behalf of Montgomery's mother, spouse, and daughters. [See: Estate Of Philip Montgomery, et al v. McNeil Island Correction Center, et al , Pierce County Superior Court, No. 012063877 (2001).]

Amid the above pandemonium, during which countless more violations surely went unnoticed, the MICC infirmary was closed by the Washington Department of Health. The closure followed a surprise inspection by the Health Department, which revealed many serious health care inadequacies. They are loosely categorized as follows:

Ø Lack of sufficient qualified health care staff to handle sick and emergency calls, chronic care, and routine tasks. The medical director position had just been filled, and medical staff was short 1 PA and several nursing staff.

Ø Some staff were not trained in first aid and cardiopulmonary resuscitation.

Ø Improperly filed health care records.

Ø Equipment was not properly cleaned and sanitized after use to ensure proper infection control.

Ø Lack of equipment to prevent crosscontamination of bodily fluids and of pharmaceutical substances.

Ø Scrub sinks did not have enough running water.

Ø Lack of a clear, consistent system for administering medication.

Ø Refused medication was not properly disposed.

Ø Medication was not stored in locked cabinets and was accessible to people not licensed to dispense drugs.

The infirmary was tentatively scheduled to reopen in August 1999. However, subsequent Department of Health reports revealed that MICC was either unwilling or unable to correct the infirmary's deficiencies. To date, Department of Health officials are unwilling to permit the MICC infirmary to reopen.

In 1996, L&I fined MICC over $13,000 for its inadequate training of medical staff, use of faulty medical equipment, and retaliation against staff who complained about MICC's medical practices. That fine was later reduced to $9,550 in 1998. [See: PLN September 1999, p. 4.]

There is no question that the medical atrocities at MICC are perpetuated by: (1) MICC administration's refusal to admit that its health care problems are systemic, rather than isolated instances; and (2) the Washington legislature's lack of concern for the quality of medical care given to Washington prisoners.

MICC administration steadfastly maintains that its health care services are adequate. When atrocities such as those above come to light, to avoid bad publicity, they are characterized by prison officials as isolated incidents. One can only wonder how many isolated incidents are required to constitute a pattern.

MICC administration may avoid some bad publicity by employing such ostrichvision. However, in doing so, it also perpetuates the medical incompetence at MICC by denying that it exists.

The legislature has thus far refused to appropriate more funds for prison health care staff. As aptly pointed out by former MICC Superintendent Stewart, no competent health care professional will work in prisons because wages are too low. Hence, only those not competent to work outside the prison will accept prison employment.

Unfortunately, although the Washington State government is perfectly willing to lock up increasing numbers of its citizens, it refuses to ensure that those citizens receive even minimally adequate medical care during their incarceration.

SCC hired Dr. Leslie Sziebert in 2000. His duties include treating the sexoffenders incarcerated there. The problem is that Sziebert is himself a sex offender.

Sziebert was offered his position at SCC just three weeks after Quality Assurance suspended his psychiatric license. His license was pulled after he was found to have had sexual contact with emotionally troubled female patients in his private practice in Yakima, Washington.

Sziebert reportedly nurtured romantic relationships with two of his female patients simultaneously. In 1999, after his relationship with one patient became more intense, he broke off with the other, who promptly attempted suicide.

Assistant Attorney General Jim McLaughlin said, "It was like he was looking for the best deal he could find." McLaughlin represented the State during Sziebert's license revocation hearings before the Quality Assurance Commission.

The father of the patient with whom Sziebert chose to continue his relationship turned Sziebert in, which resulted in his license revocation by Quality Assurance.

The patient who attempted suicide was found on her bed, along with an audiotape containing numerous telephone messages from Sziebert to her. Fortunately she survived, which is more than can be said for Sziebert's professional reputation.

After considering the evidence against Sziebert, which included testimony from colleagues who said that Sziebert participated in a running joke suggesting that he liked his patients "blonde, buxom, and borderline," Sziebert's license was suspended. Quality Assurance, however, approved Sziebert to treat sexoffenders at SCC.

SCC Director Mark Seleng said it is not uncommon for SCC to hire sexoffenders. He admits having previously hired an unnamed convicted rapist as a social worker.

Sziebert will earn $52.52 per hour at SCC, much less than a private psychologist would earn. Seleng said, "The loss to Yakima (where Sziebert formerly practiced) was our gain."

Caitlin Moughon, an attorney who represents SCC prisoners, expressed concern that SCC has "hired a doctor (Sziebert) who has some of the same issues as the residents he's been hired to treat."

Even though there is obvious reason for skepticism as to the quality of treatment Sziebert's SCC patients will receive, they may at least be physically safe. Some may be "blonde" and "borderline," but, as men, few are likely to be "buxom." Absent the "buxom" element, SCC prisoners may at least be spared Sziebert's sexual advances.

In 1995, MICC hired Dr. James McGuire even though MICC officials knew his Alaska psychiatry license had been revoked because McGuire had a sexual relationship with a patient suffering from multiple personality disorder. Prison officials said they hired McGuire because he was the only person who applied for the job.

McGuire is on Prozac and in sexoffender treatment, addressing his own psychological problems.

Quality Assurance considered McGuire's fitness to practice psychiatry in Washington in 1995. He was found fit only to treat male prisoners at MICC. According to Quality Assurance: "treating only the male inmates at the Corrections Center does contribute to the public welfare and does not represent a danger to the public." [See: PLN , November 1995, p. 6; In Re McGuire , OPS No. 941019442 MD.]

One can only marvel at the reasoning that substandard psychiatric treatment of mentally ill prisoners "does not represent a danger to the public." Quality Assurance must have overlooked the fact that these disturbed prisoners, likely worse off than before they were "treated" by McGuire, will eventually return to live among the unsuspecting public. [For a discussion of the problems caused by mentally ill parolees, see: PLN , May 2001, p. 4.]

McGuire recently attempted to convince Quality Assurance to lift the restrictions on his practice, but Quality Assurance refused.

Thomas Smith (no relation to the author) was hired as a therapist for the sexoffenders at SCC in June 1999. After an investigation in October and November 1999 substantiated several female coworkers' complaints of Smith's inappropriate sexual remarks to them, Smith was promoted.

Paula McCalmon, one of the complaining women, reported that Smith had tried to convince her to use drugs with him in addition to making crude sexual remarks. She said that while giving her a ride home on one occasion, Smith offered to "stop and get some dope," referring to marijuana. Smith, an African American, also repeatedly commented to her that, "you know you want this big black dick." McCalmon reports that Smith constantly bragged to her about his sexual prowess, despite her requests that he not speak to her in that fashion.

Teri Rodman, another complainant, reported that Smith suggested that she leave her boyfriend and take up with him. She said Smith repeatedly made comments such as: "I know you want to suck my big black dick" and "I know you like to fuck."

Rodman complained that while at a professional conference in Ocean Shores, Washington, when she commented that she would order salmon at dinner, Smith made a comment about the "salmon between her legs."

Rodman reported that Smith regularly made inappropriate sexual remarks in her presence, despite her requests that he stop.

Elizabeth Lake, another SCC employee, also complained about Smith's inappropriate sexual comments in the work place. She reported that Smith stated that he would like to "swim in your lake," and that Smith made many references to oral sex in her presence. She reported other inappropriate sexual remarks by Smith, as well as his attempts to get her to use drugs with him, despite her requests that he not speak to her in this fashion.

Lake also reported that Smith touched her breasts inappropriately and without invitation during a training exercise, commenting how nice it felt. Lake then sought another partner for the training exercise.

Male SCC staff reported seeing Smith engage in such behavior with the complaining women.

Smith denied any wrongdoing, claiming that sexual banter among SCC staff wasconsensual and commonplace. Therefore, he claims, his actions were appropriate under the circumstances.

Dr. Allen W. Traywick, Ph.D., disagreed with Smith in his report on the investigation. Traywick suggested immediate managerial intervention in order to abate Smith's behavior. This he believed was necessary for the emotional wellbeing of the complaining women.

In the end, Smith was formally reprimanded, after which he was promptly promoted to the next highest level of therapist.

SCC prisoners have filed numerous lawsuits complaining about the quality of the therapists who are "treating" them. Based on the foregoing, perhaps those complaints merit a closer look.

This article focuses solely on health care at MICC, however, readers should not assume such substandard care is limited to MICC. Low wages and poor attitudes result in similar incidents in prisons across the country. One need only consider the rising number of prison medical neglect lawsuits to substantiate this point.

As for the medical incompetence which has now come to light, MICC officials seem more concerned with concealing the existence of its substandard staff, rather than in addressing the problems and improving health care services. And, at present, the legislature appears unconcerned with the situation. Given the DOC's efforts to conceal medical misconduct by its employees, this article is probably the tip of the medical neglect iceberg at MICC.

Sources: Seattle Times ,Seattle Post-Intelligencer ,Tacoma News Tribune , government documents, and litigation materials.

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