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Idaho: Prison Doctor’s Treatment Fell Below Standard of Care
by David M. Reutter
The Idaho State Board of Medicine’s Prelitigation Screening Panel found that a prisoner at the CCA-operated Idaho Correctional Center had “borne his burden of proving by a preponderance of the evidence that Dr. [Stephen] Garrett did not comply with the standard of care in failing to document his treatment of the patient and in failing to leave orders for follow up care of the patient.”
After prisoner Marlin Riggs was violently assaulted he was seen by Dr. Garrett on May 11, 2008. During the assault, Riggs was choked until unconscious and then kicked in the upper body and face.
While Dr. Garrett admitted he prescribed Ibuprofen for Riggs for “arthritis and headaches,” he contended that he never “saw/examined the patient myself and there is nothing that even indicates that a nurse or mid-level even discussed the case with me.” However, the panel found persuasive evidence that Dr. Garrett did in fact treat Riggs after the assault.
In addition to Riggs giving testimony and a description of Garrett, Riggs saw the doctor’s ID badge plus a note signed by two nurses stated, “Dr. Garrett placed nose back into position.” The note also contained Garrett’s verbal order for Ibuprofen.
Next, the panel considered whether Dr. Garrett’s standard of care was adequate. “The panel physician found that a civilian outside the prison would have been taken to an emergency room and been seen by a maxillofacial specialist, if appropriate imaging studies indicated such was needed,” the panel report stated.
The failure by Dr. Garrett to follow the SOAP model (starting with the patient’s Subjective complaints, following up with Objective test results, then stating the physician’s Assessment and Plan) was below the standard of care that requires a doctor to document his examination and treatment of a patient.
Without writing orders to alert the medical staff of the patient’s condition, possible complications or appropriate follow-up treatment, Dr. Garrett allowed Riggs to be placed in administrative segregation.
It was not until a full month after the assault that Riggs was finally examined by a doctor, who found that he had a “dramatic deformity and total collapse of 1. nare. No air possible.” Although that doctor ordered a review by an ENT specialist, it was another 48 days before the examination occurred.
Dr. Darrell Krammer documented a “nasal and sepal fracture secondary to trauma, with total left airway obstruction.” He also noted “a fairly marked deformity” and recommended “an open reduction of a nasal and septal fracture.” That surgery did not occur for another 49 days.
The panel physician found a “process failure” in Riggs’ care that began with Dr. Garrett’s failure to document his treatment and alert staff to complications and necessary follow-up. He said the “most disturbing aspect” of Garrett’s inadequate documentation was that his failure to assure timely care by a knowledgeable physician “could have resulted in the death of the patient.”
The Prelitigation Screening Panel therefore issued a report and recommendation finding the complaint against Dr. Garrett was meritorious. Garrett’s license to practice medicine is presently inactive. See: Riggs v. Garrett, Idaho State Board of Medicine, Case No. 89-10 (December 21, 2010).
The Idaho State Board of Medicine’s Prelitigation Screening Panel found that a prisoner at the CCA-operated Idaho Correctional Center had “borne his burden of proving by a preponderance of the evidence that Dr. [Stephen] Garrett did not comply with the standard of care in failing to document his treatment of the patient and in failing to leave orders for follow up care of the patient.”
After prisoner Marlin Riggs was violently assaulted he was seen by Dr. Garrett on May 11, 2008. During the assault, Riggs was choked until unconscious and then kicked in the upper body and face.
While Dr. Garrett admitted he prescribed Ibuprofen for Riggs for “arthritis and headaches,” he contended that he never “saw/examined the patient myself and there is nothing that even indicates that a nurse or mid-level even discussed the case with me.” However, the panel found persuasive evidence that Dr. Garrett did in fact treat Riggs after the assault.
In addition to Riggs giving testimony and a description of Garrett, Riggs saw the doctor’s ID badge plus a note signed by two nurses stated, “Dr. Garrett placed nose back into position.” The note also contained Garrett’s verbal order for Ibuprofen.
Next, the panel considered whether Dr. Garrett’s standard of care was adequate. “The panel physician found that a civilian outside the prison would have been taken to an emergency room and been seen by a maxillofacial specialist, if appropriate imaging studies indicated such was needed,” the panel report stated.
The failure by Dr. Garrett to follow the SOAP model (starting with the patient’s Subjective complaints, following up with Objective test results, then stating the physician’s Assessment and Plan) was below the standard of care that requires a doctor to document his examination and treatment of a patient.
Without writing orders to alert the medical staff of the patient’s condition, possible complications or appropriate follow-up treatment, Dr. Garrett allowed Riggs to be placed in administrative segregation.
It was not until a full month after the assault that Riggs was finally examined by a doctor, who found that he had a “dramatic deformity and total collapse of 1. nare. No air possible.” Although that doctor ordered a review by an ENT specialist, it was another 48 days before the examination occurred.
Dr. Darrell Krammer documented a “nasal and sepal fracture secondary to trauma, with total left airway obstruction.” He also noted “a fairly marked deformity” and recommended “an open reduction of a nasal and septal fracture.” That surgery did not occur for another 49 days.
The panel physician found a “process failure” in Riggs’ care that began with Dr. Garrett’s failure to document his treatment and alert staff to complications and necessary follow-up. He said the “most disturbing aspect” of Garrett’s inadequate documentation was that his failure to assure timely care by a knowledgeable physician “could have resulted in the death of the patient.”
The Prelitigation Screening Panel therefore issued a report and recommendation finding the complaint against Dr. Garrett was meritorious. Garrett’s license to practice medicine is presently inactive. See: Riggs v. Garrett, Idaho State Board of Medicine, Case No. 89-10 (December 21, 2010).
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Related legal case
Riggs v. Garrett, Idaho State Board of Medicine
| Year | 2010 |
|---|---|
| Cite | Case No. 89-10 (December 21, 2010) |
| Level | Administrative Agency |
| Injunction Status | N/A |