The former chief psychiatrist at the jail in Fresno County, California was placed on probation for five years and ordered to take additional training courses in the wake of numerous complaints that he provided substandard mental health care to prisoners, many of whom experienced worsening symptoms while incarcerated.

In a settlement agreement that took effect on September 19, 2014, the Medical Board of California first suspended the license of Dr. Pratap L. Narayan, 54, then stayed the suspension and placed him on probation. Narayan was also ordered to undergo a clinical training program, a course in prescribing practices and training in medical record keeping as a result of the Board’s ruling. In addition, he was banned from solo practice and required to submit to monitoring by an unspecified, impartial colleague with whom he was required to share office space.

Narayan was cited for 17 causes for discipline stemming from his treatment of mentally ill prisoners at the Fresno County Jail. The Board’s order listed six prisoners who were under Narayan’s care from August 2007 through September 2011, and cited a pattern of unprofessional conduct that included changing prisoners’ medication and dosages, and sometimes even withholding medication, usually without ever seeing the prisoner or conducting any interviews or examinations.

Narayan had been accused of a “troubling pattern that evidences a lack of knowledge and/or ability in the practice of psychiatry that constitutes incompetence,” according to one complaint. He allegedly failed to prescribe necessary psychiatric medicine to prisoners under his care, resulting in many being deemed incompetent to stand trial and numerous transfers to state hospitals for mental health treatment. [See: PLN, Aug. 2014, p.56].

The final order cited six counts of repeated negligence, six counts of inadequate record keeping, two counts of prescribing without prior examination, and one count each of unprofessional conduct, repeated negligent acts and improper prescribing.

“This probation was by agreement with Dr. Narayan after the medical board withdrew many of the serious accusations against him and proceeded based on just record-keeping and documentation charges,” said Narayan’s attorney, Mitchell Green.

The Board’s discipline order described in exacting detail Narayan’s failures to adequately care for mentally ill prisoners, though the Board did not cite any motive for the substandard treatment of his incarcerated patients. According to background documents, Narayan graduated in 1984 from the Andhra Medical College in India and completed both a psychiatric residency and a fellowship in forensic psychiatry at the University of Florida.

The discipline order used only initials to identify his prisoner patients to protect their confidentiality, and cited repeated examples of how Narayan changed medications, altered dosages, changed medication administration times and, in some cases, halted prescriptions altogether without examining the prisoners or, in cases when he did, without scheduling a follow-up exam. In each case, the discipline order stated, Narayan failed to explain his reasoning or “the thought process behind his clinical decision.”

In many cases, the Board found, Narayan’s decisions led to worse conditions for his patients. For example, a 40-year-old female prisoner identified as C.V., who was jailed for allegedly assaulting her husband with a knife on August 9, 2009, told jailers during the booking process that she wanted to kill herself. Narayan diagnosed her with “Major Depressive Disorder” and “Methamphetamine Dependence,” and prescribed drugs intended to calm her. About a month later she complained to jail staff, saying “I think too much I cannot sleep at night.” Narayan changed her medicine and the timing and strength of her dosages.

By January 2010, the discipline order stated, “C.V. was flooding her cell at the [Fresno County Jail] and smearing feces and urine.” Without ever seeing C.V., Narayan wrote a note in her file, suggesting that her “primary problem appears to be personality disorder,” and again changed her medication. C.V. was eventually taken to Patton State Hospital.

Another prisoner, identified as M.M., arrived at the Fresno County Jail on April 30, 2011 following treatment at the Good Samaritan Hospital, where doctors placed him on a medication schedule. The discipline order said Narayan discontinued all of the hospital’s drugs and instead prescribed his own, without ever seeing or examining M.M.

Yet another case involved a prisoner identified as E.K., an attorney who was confined at the county jail in December 2008 following a domestic dispute with his wife. He had been treated for bipolar disorder for over 17 years prior to his imprisonment, but Narayan denied him his prescribed medication. E.K. ended up in a safety cell and restraint chair, and lost 62 pounds during the five months he was in custody. In 2009, a judge ordered that E.K. receive his medication after he was found incompetent to stand trial. His condition stabilized following his transfer to Atascadero State Hospital.

“[Narayan] committed an extreme departure from the standard of care” and “failed to adequately document his clinical thought process” in his treatment of prisoners, the discipline order stated, concluding that he was “subject to disciplinary action under section 2234 [of the Business and Professions Code] in that he engaged in unprofessional conduct in his care and treatment of patients.”

Narayan resigned in February 2013 to take a position with Avenal State Prison, where the California Department of Corrections and Rehabilitation pledged to “take the appropriate personnel action in response to the California Medical Board’s decision,” according to CDCR spokeswoman Terry Thornton. Dr. Narayan is currently listed as practicing forensic psychiatry at the Community Regional Medical Center in Fresno; he will remain on probation until 2019.

The current psychiatrist at the Fresno County Jail, Dr. Mayur Amin, claims that he now consults with prisoners’ attorneys, families and private doctors to ensure that proper mental health care is provided. See: “Stipulated Settlement and Disciplinary Order,” Medical Board of California, Department of Consumer Affairs, Case No. 08-2010-211824 (Sept. 19, 2014).

Additional sources: www.fresnobee.com, www.healthgrades.com

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