The opinions of experts in an ongoing lawsuit filed in the United States District Court District of Arizona are damning in describing the health care (or lack of health care) provided to inmates in Arizona prisons: “I have worked as a physician in jails and prisons for 27 years. My opinions in this case are derived from extensive experience in the design, administration and delivery of correctional healthcare as well as the national standards that govern the field … I have been involved in this action since 2013 as a medical expert for the Plaintiff class. I have submitted multiple reports and declarations regarding the delivery of healthcare in the Arizona state prisons, and most have been filed with this Court … These reports document that, since 2012, the ADCRR’s healthcare delivery system has been seriously deficient, placing the people who live in the prisons at serious risk of harm and death. At the core of these deficiencies has been a long-standing failure to provide enough competent clinical staff with the appropriate level of expertise to care for this population.”
“Dr. Stern also identified problems with provider (i.e., physicians, nurse practitioners and physician assistants) decision-making that were not detected with the existing performance measures. He explained that medical providers make clinical decisions in three general settings: (a) during face-to-face patient encounters, (b) in response to an inquiry from a nurse, and (c) upon receipt of test results or reports from a consultant … The problems Dr. Stern found in episodic care with provider judgment were mirrored in the chronic care program, in emergency response, and in care provided in the infirmary units.”
“I concur with Dr. Stern’s recommendations regarding the need to measure quality of care provided to patients in clinical encounters. Defendants’ consistent failure to comply with critical Performance Measures, in particular those related to timely access to specialty care and continuity of care when returning from hospitalization, endangered patients. However, even if Defendants had complied with all of the Stipulation’s Performance Measures, the patients would have continued to be at substantial risk of serious harm because when they did see providers and nurses, those clinicians often exercised poor clinical judgment and failed to provide clinical care that meets community standards for such care. As set forth below, the poor quality of clinical decision-making demonstrated by nurses and providers in the ADCRR harms patients and places them at an unreasonable and substantial risk of serious harm.” (emphasis in the original)
“Based on my visits to the ASPCs, interviews with patients, and extensive review of medical records and mortality reviews, it is my opinion that the healthcare delivery system in the ASPCs continues to harm many patients and continues to place all at substantial risk of serious harm. The problems I have found previously persist to this day. By design, healthcare decisions in the ASPCs are pushed down to the lowest possible level – nurses who are practicing poorly and far outside the scope of their licenses. There is a clear pattern of failure by nurses to complete an adequate nursing assessment, take patient reports seriously, recognize dangerous symptoms, and elevate concerns to providers. Too often, nurses simply send patients back to their housing unit and tell them to submit another written sick call request if symptoms worsen.”
“When a patient is referred to a provider, it almost always is to mid-level practitioners who miss, with alarming frequency, serious and urgent medical symptoms. Care for complex patients is scattered throughout the system so no one provider or physician is ultimately responsible for the patient, resulting in serious deficits in care. This problem is made worse by the medical records, which are incomplete, inaccurate, and hard to navigate, and which make it very difficult for anyone (including myself) to get a complete picture of a patient and their current needs. The painstaking, frustrating, timeconsuming reviews I undertook to piece together an understanding of needs and prior care for many of these patients is simply impossible for busy providers to perform before each appointment. That impossibility translates directly into inadequate care.”
“The ADCRR healthcare system also is missing the foundation of any credible healthcare practice: differential diagnoses. Far too often, healthcare staff “treat,” in a cursory manner, the symptom, but fail altogether to identify, test, and otherwise evaluate the underlying cause of the symptom. This practice has led to failure to diagnose accurately and to treat serious, life-threatening conditions. Providers often will order laboratory or other diagnostic tests without a diagnostic strategy. They rarely identify a differential diagnosis, and, when they do, the tests ordered are often not relevant to the condition they are trying to rule out. They fail to follow up on significantly abnormal results, and instead order to recheck labs or schedule a follow-up in an inappropriate time interval and then fail to reference previous results. They do not ensure continuity of care for their sickest patients returning from hospitals.”
“As discussed in more detail below, these problems appear to be the result of a combination of factors, including inadequate staffing, inadequate physician-level attention to problems, and poor attitude of medical staff, which probably is itself related to inadequate staffing and demanding workloads. In addition, the electronic health record in use within the ADCRR is poorly designed and greatly impairs the clinician’s capacity to synthesize a comprehensive picture of a patient’s healthcare. These problems have resulted in, and will continue to result in, permanent harm to patients, including avoidable death.”
If you or a loved one were injured due to deliberate indifference or the lack of appropriate medical care while incarcerated in a prison, jail, or other correctional facility in Arizona or in another U.S. state, you should promptly seek the legal advice of a local medical malpractice lawyer in your state who handles prisoner/inmate medical malpractice claims and may investigate your claim and represent you, if appropriate.
Visit our website or call us toll-free in the United States at 800-295-3959 to be connected with prisoner rights lawyers in your state who may assist you.
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