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Court Monitor Criticized Care to Michigan Dialysis Treatment Afforded Prisoners
by David M. Reutter
Before the Michigan Department of Corrections closed the Southern Michigan Correctional Facility (SMCF) in late 2007 to avoid further litigation in the long-running class action known as Hadix, the federal judge overseeing the case and lawyers representing prisoners argued that closing SMCF would not only transfer the problem to another prison, it would worsen the situation of inadequate medical care for chronically ill prisoners.
In our May 2007 cover story and two other articles that followed that article, PLN reported on the horrid care provided to Michigan prisoners by the private medical vendor, Correctional Medical Services (CMS). Those articles detailed the circumstances surrounding the needless deaths of several prisoners. Now, the callous attitude of prison officials has resulted in the needless death of another prisoner.
After U.S. District Court Judge Richard A. Enslen entered an order preventing the closure of SMCF, Michigan prison officials appealed that and several other orders. While the matter was on appeal, Judge Enslen suddenly requested the matter to be transferred to another judge. Based upon that and other unresolved factual matters, the Sixth Circuit Court of Appeals remanded for reconsideration of the orders.
The new judge allowed SMCF to close, but retained jurisdiction over the chronically ill prisoners being transferred to the Ryan Correctional Facility (RCF). The Court found in that order “that there are serious deprivations of medical care affecting dialysis patients,” which included the failure to provide timely chronic care, timely medication renewal of chronic medications, and timely access to specialty care.
The Court monitor, Dr. Robert Cohen, entered his Corrected Sixth Report on September 5, 2008. He wrote that the “serious, ongoing problems in the medical care” in the prison dialysis unit “have harmed or have the potential to harm the prisoners receiving dialysis there.” He warned that it “is not a trivial matter,” for “[i]nadequate dialysis results in substantial, but preventable increases in morbidity and mortality.”
CMS failed to implement standing orders to develop plans for prisoner’s dialysis treatment. This is an unsafe practice that can result in an indefinite error in treatment. In addition, a low percentage of patients receive dialysis three times a week, which was found to be “extremely disturbing and unexpected.”
Moreover, there is no advanced care planning for these prisoners. They face 12 – 15 hours a week attached to a dialysis machine, the multiple medications they take cause multiple side effects that are often painful, they must eat bland food and forego things they enjoy, their fluid intake is restricted, they undergo frequent and often painful surgical procedures to maintain a viable venous access site, and they have shortened life spans. Thus, many suffer depression. Their fragile medical conditions require advance care planning discussions to make decisions regarding the kind of end-of-life care they wish to receive.
There also exist systematic problems with overall specialty care services. The report detailed numerous specific cases of deprivation of prisoner care for known chronic ailments. By far, the dialysis care is the worst, having caused a prisoner’s death on April 30, 2008.
A 17-station permanent dialysis unit was opened on July 7, 2008, but only 13 are in use. Dr. Cohen visited the on-site dialysis water filtration room and RCF on August 15, 2008.
“The room was filthy. The floor had just been mopped prior to our arrival but still had standing muddy water,” wrote Dr. Cohen. “The floor under the bicarbonate tank had many broken tiles and was covered with rust. The floor under the filtration tanks was so dirty that the tiles were not visible. The bicarbonate tank was open to the air with no cover to prevent contaminants from getting into the solution.”
Those conditions were found to be “a substantial failure of infection control” that require immediate correction. In addition, efforts to investigate the prisoner’s death were impeded. After detailing the medical and care history of that prisoner, Dr. Cohen concluded that his “death was premature and his emergency care was unacceptable.” He noted the prisoner “survived dialysis for less than four months.”
Dr. Cohen then criticized Michigan prison officials for refusing to allow prisoners from receiving organ transplants, which is the “universally accepted medical opinion” for treatment of persons with end stage renal disease.
Michigan Corrections Director Patricia Caruso believes it “is not good law or social policy, and [we] decline to spend limited public resources on solid organ transplants for prisoners when there are neither sufficient organs or money available to meet the demand by civilian patients.”
Organs normally come from family members and transplantation is a cheaper course of care, noted Dr. Cohen. He also wrote, “Transplantation of solid organs is available to prisoners in the Federal Bureau of Prisons, in New York State, Virginia, California, and in Washington State.” The report is available on PLN’s website.
See: Hadix v. Caruso, USDC, W.D. Michigan, Case No.: 4-92-cv-110. Corrected Sixth Report of the Independent Monitor Dialysis Services for Prisoners at Ryan Correctional Facility.
Before the Michigan Department of Corrections closed the Southern Michigan Correctional Facility (SMCF) in late 2007 to avoid further litigation in the long-running class action known as Hadix, the federal judge overseeing the case and lawyers representing prisoners argued that closing SMCF would not only transfer the problem to another prison, it would worsen the situation of inadequate medical care for chronically ill prisoners.
In our May 2007 cover story and two other articles that followed that article, PLN reported on the horrid care provided to Michigan prisoners by the private medical vendor, Correctional Medical Services (CMS). Those articles detailed the circumstances surrounding the needless deaths of several prisoners. Now, the callous attitude of prison officials has resulted in the needless death of another prisoner.
After U.S. District Court Judge Richard A. Enslen entered an order preventing the closure of SMCF, Michigan prison officials appealed that and several other orders. While the matter was on appeal, Judge Enslen suddenly requested the matter to be transferred to another judge. Based upon that and other unresolved factual matters, the Sixth Circuit Court of Appeals remanded for reconsideration of the orders.
The new judge allowed SMCF to close, but retained jurisdiction over the chronically ill prisoners being transferred to the Ryan Correctional Facility (RCF). The Court found in that order “that there are serious deprivations of medical care affecting dialysis patients,” which included the failure to provide timely chronic care, timely medication renewal of chronic medications, and timely access to specialty care.
The Court monitor, Dr. Robert Cohen, entered his Corrected Sixth Report on September 5, 2008. He wrote that the “serious, ongoing problems in the medical care” in the prison dialysis unit “have harmed or have the potential to harm the prisoners receiving dialysis there.” He warned that it “is not a trivial matter,” for “[i]nadequate dialysis results in substantial, but preventable increases in morbidity and mortality.”
CMS failed to implement standing orders to develop plans for prisoner’s dialysis treatment. This is an unsafe practice that can result in an indefinite error in treatment. In addition, a low percentage of patients receive dialysis three times a week, which was found to be “extremely disturbing and unexpected.”
Moreover, there is no advanced care planning for these prisoners. They face 12 – 15 hours a week attached to a dialysis machine, the multiple medications they take cause multiple side effects that are often painful, they must eat bland food and forego things they enjoy, their fluid intake is restricted, they undergo frequent and often painful surgical procedures to maintain a viable venous access site, and they have shortened life spans. Thus, many suffer depression. Their fragile medical conditions require advance care planning discussions to make decisions regarding the kind of end-of-life care they wish to receive.
There also exist systematic problems with overall specialty care services. The report detailed numerous specific cases of deprivation of prisoner care for known chronic ailments. By far, the dialysis care is the worst, having caused a prisoner’s death on April 30, 2008.
A 17-station permanent dialysis unit was opened on July 7, 2008, but only 13 are in use. Dr. Cohen visited the on-site dialysis water filtration room and RCF on August 15, 2008.
“The room was filthy. The floor had just been mopped prior to our arrival but still had standing muddy water,” wrote Dr. Cohen. “The floor under the bicarbonate tank had many broken tiles and was covered with rust. The floor under the filtration tanks was so dirty that the tiles were not visible. The bicarbonate tank was open to the air with no cover to prevent contaminants from getting into the solution.”
Those conditions were found to be “a substantial failure of infection control” that require immediate correction. In addition, efforts to investigate the prisoner’s death were impeded. After detailing the medical and care history of that prisoner, Dr. Cohen concluded that his “death was premature and his emergency care was unacceptable.” He noted the prisoner “survived dialysis for less than four months.”
Dr. Cohen then criticized Michigan prison officials for refusing to allow prisoners from receiving organ transplants, which is the “universally accepted medical opinion” for treatment of persons with end stage renal disease.
Michigan Corrections Director Patricia Caruso believes it “is not good law or social policy, and [we] decline to spend limited public resources on solid organ transplants for prisoners when there are neither sufficient organs or money available to meet the demand by civilian patients.”
Organs normally come from family members and transplantation is a cheaper course of care, noted Dr. Cohen. He also wrote, “Transplantation of solid organs is available to prisoners in the Federal Bureau of Prisons, in New York State, Virginia, California, and in Washington State.” The report is available on PLN’s website.
See: Hadix v. Caruso, USDC, W.D. Michigan, Case No.: 4-92-cv-110. Corrected Sixth Report of the Independent Monitor Dialysis Services for Prisoners at Ryan Correctional Facility.
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Related legal case
Hadix v. Caruso
| Year | 2008 |
|---|---|
| Cite | USDC, W.D. Michigan, Case No.: 4-92-cv-110 |
| Level | District Court |
| Injunction Status | N/A |