Relatives of Dead Inmate to Sue State

The family of a California inmate who died after he had a tooth pulled said Wednesday that they were suing the state over his death, as two legislators held a Capitol hearing to investigate why prison healthcare remains poor but increasingly expensive.

Relatives of Anthony Shumake, 41, said they would file a wrongful-death lawsuit because a medical pathologist’s report showed that he died of complications from the extraction.

The report from the San Joaquin County coroner’s office showed that Shumake died June 28 after his airway was constricted by an abscess in his throat. In an interview, Dr. Robert Lawrence, a pathologist, said a “rip-roaring infection” had caused extensive swelling, reducing air flow.

“The airway was not sufficiently open to allow a free flow of oxygen,” Lawrence said. “The lack of oxygen caused the heart to go into a fatal rhythm.”

Shumake’s relatives said other inmates told them that they had tried to get medical help for Shumake in the days after the dental work, as his neck turned red and swollen and he complained of continuing pain. But those requests, they said, went unheeded at Solano State Prison in Vacaville until he fell into respiratory distress and an ambulance was finally called.

Prison officials would not comment on the case, saying that an internal investigation was underway.

“It’s been very hard for our family to see a healthy young man have a tooth pulled and then wind up dead,” said the Rev. Andre Shumake, the inmate’s uncle and a neighborhood activist in the Bay Area city of Richmond. “Anthony was given a prison sentence, not a death sentence. These men may be inmates, but they’re human beings.”

The Shumake family traveled to Sacramento for a hearing that examined healthcare in the $6-billion California correctional system. Among the topics covered were reports from the California Medical Board, which licenses and disciplines doctors, that showed that one in five prison physicians had a blemished record or had been sued for malpractice.

That 20% rate is almost five times the figure statewide, the board said. Legislators called it unacceptable and indicative of a system in distress.

“To put it very bluntly and very simply, the healthcare system at the California Department of Corrections is sick,” said state Sen. Jackie Speier (D-Hillsborough).

Sen. Gloria Romero (D-Los Angeles), co-chairwoman, with Speier, of the hearing, agreed. “The sad fact is California has been growing its inmate population but has failed to provide adequate healthcare for those we lock away,” she said.

Under questioning by the senators, corrections officials acknowledged that major problems remain with the network of clinics, hospitals, treatment centers and outside medical contractors that cares for the state’s 164,000 inmates.

Dr. Renee Kanan, chief of healthcare for the system, said that “historically, our modus operandi has been very reactive. We’ve had plenty of fragmented exit strategies, but we’ve never had a comprehensive strategic plan.”

But progress has been made, she said, since a class-action lawsuit, which was settled in 2002, alleged that California’s prison healthcare amounted to cruel and unusual punishment.

The changes include tighter screening and monitoring of physicians and creation of an oversight committee to track healthcare costs, which have nearly doubled over the last five years and could hit $1 billion this year.

“We know we have many challenges in our efforts to provide quality healthcare,” Corrections Director Jeanne Woodford testified. “We want to fix what this committee has called a broken system ... and become known as a state that uses the best practices in all aspects of its healthcare system.”

Speier and Romero, who have conducted hearings focused on problems in the prisons, did not appear to be patient. They said that the Department of Corrections had been sued over healthcare numerous times over the last two decades, and that it seemed as if only court-imposed mandates had forced change.

Speier asked why the federal government had been able to reduce its prison healthcare costs while the state’s costs had soared -- a question to which she received no clear answer.

“The scratching of heads is no longer acceptable,” Speier said. “It is time to realize what [the prisons’] healthcare policies and practices are costing each and every Californian.”

One major challenge facing prison doctors is the condition of patients. Inmates tend to be sicker than the population at large, often because of unhealthy habits and a lack of medical care earlier in life. One in five has a serious mental illness; one-third are infected with hepatitis C. The rate of HIV/AIDS in prison is five times higher than the national average.

Dr. Jacqueline Tulsky, a professor at UC San Francisco Medical School who has studied prison healthcare, described the average California inmate as a 40-year-old male who is a high school dropout with alcohol addiction, a history of crack cocaine use and mild depression. His medical problems probably include hypertension, diabetes, elevated cholesterol levels and mild arthritis. Periodically, he needs treatment for injuries incurred on the prison yard.

“No healthcare plan in this state,” Tulsky said, “has the severity of illnesses you find in the Department of Corrections.”

Several prison doctors cited other crucial differences, including a shabby infrastructure that makes practicing medicine difficult at best. Dr. Scott Anderson, who works at the California Medical Facility, a prison in Vacaville, said physicians sometimes lack essentials as basic as an examining table, soap and towels with which to dry their hands.

A severe shortage of nurses and medical technical assistants, who provide security as well as clinical help, also affects care, he said. And perhaps the greatest problem facing prison physicians is technological: the absence of computers to track inmate medical records, view X-rays and help with medical decisions.

Corrections officials agree that working conditions are not ideal. They said that plans to give each prison doctor competency testing should root out those unfit to practice.

Doctors who testified criticized the plan, warning that it could have the paradoxical effect of driving good doctors out of the system. Anderson said he considered his board certification in specialties such as rheumatology and geriatrics a sufficient validation of his skills.

“I certainly don’t want to practice with doctors who are not competent,” Anderson said. “But I’m troubled by the thought of going through testing that might be arbitrary, capricious ... and may lead to a dark mark on our record that would follow us for life.”