Wexford Health Sources
1850 N. Central Ave. Phoenix
October 3, 2012
Families: this is evidence for your loved one's civil rights suits if they've been suffering as a result of medical neglect at the AZ DOC and still can't get relief. Print and mail it to them. They MUST follow the grievance process, and not just file more HNR's on the same issues. Take this to an attorney if you can afford one, and get the following material/resources to loved ones inside so they know how to protect themselves from this predatory corporation:
ACLU: Know your rights: The PLRA (READ FIRST!!!)
Columbia University: Jailhouse Lawyer's Manual (read chapter 1 to familiarize yourself, then download and print what chapters they need)
National Lawyer's Guild Jailhouse Lawyer's Handbook (more compact than the one above: download here or send the NLG $2 and the prisoner's contact info, and they'll send them a bound copy) - every prisoner needs one of these for the rest of their incarceration.
AZ Department of Corrections Policies: Inmate Grievance Procedures
AZ DOC Policies: Inmate Access to Health Care
AZ DOC Policies: Inmate Mental Health Care
AZ DOC Policies: Inmate Health Records
"Parsons v Ryan" Class action suit over medical neglect and abuse of the mentally ill before Wexford even came - they aren't the only culprits here. Anyone potentially suing the DOC for medical issues needs to have a copy.
Instructions for Prisoners filing civil rights suits in AZ - they need to know this is what their grievances lead to -mwhet they need to prepare for - if they don't get adminstrative relief from the DOC or Wexford- but they can get hurt if they don't file it right. Contact Middle Ground Prison Reform early in the grievance process for info about options for legal representation or professional criminal justice consultation services.
Report medical and conditions of confinement complaints to the ACLU-AZ
Contact Mary Lou Brncik at David's Hope to organize around mental illness in the criminal justice system.
Contact me (Peggy Plews: 480-580-6807/arizonaprisonwatch@gmail.com) to organize with other families and former prisoners who want to make a difference for all.
And have prisoners write to me directly at AZ Prison Watch PO Box 20494 Phoenix, AZ 85036, for packets of info about their rights...I will send them out as long as I am able to. They must be persistent if they don't hear back from me in a week, and keep me posted about changes in their status if we're working on something.
---from Middle Ground Prison Reform-----
On Tue, Oct 2, 2012 at 10:13 AM, DONNA LEONE HAMM <middlegroundprisonreform@msn.
Mr. Charles Ryan, Director
Arizona Department of Corrections
1601 West Jefferson
Phoenix, Arizona 85007
Dear Mr. Ryan:
Arizona Department of Corrections
1601 West Jefferson
Phoenix, Arizona 85007
Dear Mr. Ryan:
Yesterday,
Oct. 1, I received a telephone call from Dr. Lawrence D'Antonio, who
works for a contractor who provides professional healthcare workers to
Wexford. As you know, Wexford, in turn,
provides all medical care for prisoners within the Arizona Department
of Corrections. D'Antonio currently works at the Eyman
Complex/Rynning. He was originally supposed to work at Meadows, but now
only works at Rynning. He says the Meadows Unit is a "lost
cause." If I understood him correctly, he believes there is no doctor
currently assigned to Meadows Unit and that the Clinical Center there
is essentially inoperative. He has been a doctor (D.O.) for 27 years.
He has worked for the contractor who provides
doctors to Wexford since about July 2012.
D'Antionio says that Dr. Tom Bell is the Statewide Medical Director employed by Wexford. The Regional M.D. for Wexford is Dr. Hector F. Garcia. He is Dr. Bell's boss. Karen Grant is the Director of Nursing for Wexford. D'Antonio refuses to converse with or take orders from Grant. Grant was abusive, used obscenities with him, and was unprofessional during their initial conversation. He believes that it is ironic that only current physican at the Eyman/Rynning Unit (D'Antonio) has no communication with the Director of Nursing. He has advised his own employer that either Wexford needs to obtain someone other than Grant for him to communicate with or he will not work there at all.
He says "personnel (medical) are leaving in droves." Grant was ordering him to do things outside his training and outside of his expertise. She was ordering him to see patients who needed specialists; he is not a specialist. He says that Dr Bell ordered that certain medications are to be stopped for some inmates. When asked why the medications were to be stopped, Bell stated, "Because they are prisoners." He asked Bell, "Is this your own medical decison-making?" Bell replied, "This comes from Wexford."
Karen Grant has ordered D'Antonio to write prescriptions en masse for patients whom he has not seen. He refused to do so, stating that in most cases he needs to see each patient individually before he can prescribe a medication. He says Wexford is sabotaging everything by doing such things as excessive questioning of the doctor ("for more information") when he prescribes a medication. When he makes a referral for a patient to have a procedure, obtain a specialist's opinion, have additional testing, etc., Wexford has a procedure which they call a "collegial" conference call. Their staff get on a conference call and the vast majority of the time, they delay the additional procedure by requesting "additional information" from the referring doctor. This goes on and on, back and forth, so that the procedure itself never gets done or is so delayed as to be meaningless (or dangerous) for the patient.
He says that he was told that all prior referrals (for specialists, tests, etc.) made by DOC healthcare workers prior to July 1, when Wexford took over, are cancelled, and will not be honored. Instead, the inmate is required to go through the referral process all over again, thus further delaying what might be life-saving diagnostic testing. D'Antonio says that many of the referrals are "shelved" and continuously cycled through the "get more information" process over and over.
D'Antionio refers to the mistakes and unethical conduct going on by Wexford employees as "staggering" and "criminal." He says that while he does not consider himself to be soft on crime or criminals, "they are human beings and deserving of basic medical care." He has restricted his exposure to liability for the type of care being provided to inmates by limiting the days he will work, the hours he works, and the units at which he will work. He says what is happening at the Meadows Unit and throughout the Florence prisons is a "disgrace."
The doctor says that there are such people as what doctors refer to as "hatchet" doctors or "administrative" doctors -- they work for a corporation and have given up their ethics (and oath) to 'do no harm' by accepting a huge paycheck just to go along with corporate policies and directions. D'Antonio says there are doctors (or nurses) such as this that work for Wexford.
He says that each time he sees a patient, he must fill out a progress note. This is a form. When he orders lab work, an x-ray or a prescription, each requires a separate form. At the Meadows Unit, it was nearly impossible to find the forms needed, thus delaying and complicating the already dysfunctional process. He says chart work is ignored and there is no review process. He was originally hired just to do induction physical exams for incoming (new) prisoners, but that he has ended up doing everything from emergency care, chronic care, diagnostics, etc. and that they are so back-logged in reviewing charts that there is no reasonable way that each patient's chart can be reviewed in a timely manner.
He states that he has been told by Wexford employees that, "We are forbidden from talking about what happens here. . ." and that he has been advised, "Prisoners have died at the Meadows Unit due to lack of care since Wexford took over . . . ." (He was unable to provide me any names or DOC #'s of inmates who have allegedly died at Meadows Unit due to lack of medical care since Wexford took over on July 1, 2012).
He says that the Wexford formulary for approved medication is "archaic." He gave an example of the medication that Wexford has approved for hay fever. (I can't spell it). He says this was a medication that was being phased out in the 1980's (it was a medication that he would have taken as a child) -- and that the standard of care in today's world for allergies is an antihistamine and/or a nasal steroid spray. He says Wexford approves a salt water/ocean spray which is so outdated, it is laughable. So, when he writes a prescription for a timely/updated drug (a "non-formulary" drug), Wexford can't fill it (won't fill it) because it isn't in their formulary. So, there is a huge delay for the patient in obtaining non-formulary medication, and the formulary list itself is actually responsible for delay after delay after delay for patients to obtain a prescribed medication, including for serious medical problems. He states that Wexford would likely claim that their formulary medications are "great" and "adequate," but many of their medications are simply not used anymore in today's real world of medicine in the USA.
He says he works a 12-hour day with no breaks and he even eats lunch while charting. He works the hours by choice in order to get in his weekly hours in as short a time as possible to get out of there as quickly as possible. But the workload is so far behind, it would require a full team of doctors to get caught up and would take a year.
D'Antionio says that Dr. Tom Bell is the Statewide Medical Director employed by Wexford. The Regional M.D. for Wexford is Dr. Hector F. Garcia. He is Dr. Bell's boss. Karen Grant is the Director of Nursing for Wexford. D'Antonio refuses to converse with or take orders from Grant. Grant was abusive, used obscenities with him, and was unprofessional during their initial conversation. He believes that it is ironic that only current physican at the Eyman/Rynning Unit (D'Antonio) has no communication with the Director of Nursing. He has advised his own employer that either Wexford needs to obtain someone other than Grant for him to communicate with or he will not work there at all.
He says "personnel (medical) are leaving in droves." Grant was ordering him to do things outside his training and outside of his expertise. She was ordering him to see patients who needed specialists; he is not a specialist. He says that Dr Bell ordered that certain medications are to be stopped for some inmates. When asked why the medications were to be stopped, Bell stated, "Because they are prisoners." He asked Bell, "Is this your own medical decison-making?" Bell replied, "This comes from Wexford."
Karen Grant has ordered D'Antonio to write prescriptions en masse for patients whom he has not seen. He refused to do so, stating that in most cases he needs to see each patient individually before he can prescribe a medication. He says Wexford is sabotaging everything by doing such things as excessive questioning of the doctor ("for more information") when he prescribes a medication. When he makes a referral for a patient to have a procedure, obtain a specialist's opinion, have additional testing, etc., Wexford has a procedure which they call a "collegial" conference call. Their staff get on a conference call and the vast majority of the time, they delay the additional procedure by requesting "additional information" from the referring doctor. This goes on and on, back and forth, so that the procedure itself never gets done or is so delayed as to be meaningless (or dangerous) for the patient.
He says that he was told that all prior referrals (for specialists, tests, etc.) made by DOC healthcare workers prior to July 1, when Wexford took over, are cancelled, and will not be honored. Instead, the inmate is required to go through the referral process all over again, thus further delaying what might be life-saving diagnostic testing. D'Antonio says that many of the referrals are "shelved" and continuously cycled through the "get more information" process over and over.
D'Antionio refers to the mistakes and unethical conduct going on by Wexford employees as "staggering" and "criminal." He says that while he does not consider himself to be soft on crime or criminals, "they are human beings and deserving of basic medical care." He has restricted his exposure to liability for the type of care being provided to inmates by limiting the days he will work, the hours he works, and the units at which he will work. He says what is happening at the Meadows Unit and throughout the Florence prisons is a "disgrace."
The doctor says that there are such people as what doctors refer to as "hatchet" doctors or "administrative" doctors -- they work for a corporation and have given up their ethics (and oath) to 'do no harm' by accepting a huge paycheck just to go along with corporate policies and directions. D'Antonio says there are doctors (or nurses) such as this that work for Wexford.
He says that each time he sees a patient, he must fill out a progress note. This is a form. When he orders lab work, an x-ray or a prescription, each requires a separate form. At the Meadows Unit, it was nearly impossible to find the forms needed, thus delaying and complicating the already dysfunctional process. He says chart work is ignored and there is no review process. He was originally hired just to do induction physical exams for incoming (new) prisoners, but that he has ended up doing everything from emergency care, chronic care, diagnostics, etc. and that they are so back-logged in reviewing charts that there is no reasonable way that each patient's chart can be reviewed in a timely manner.
He states that he has been told by Wexford employees that, "We are forbidden from talking about what happens here. . ." and that he has been advised, "Prisoners have died at the Meadows Unit due to lack of care since Wexford took over . . . ." (He was unable to provide me any names or DOC #'s of inmates who have allegedly died at Meadows Unit due to lack of medical care since Wexford took over on July 1, 2012).
He says that the Wexford formulary for approved medication is "archaic." He gave an example of the medication that Wexford has approved for hay fever. (I can't spell it). He says this was a medication that was being phased out in the 1980's (it was a medication that he would have taken as a child) -- and that the standard of care in today's world for allergies is an antihistamine and/or a nasal steroid spray. He says Wexford approves a salt water/ocean spray which is so outdated, it is laughable. So, when he writes a prescription for a timely/updated drug (a "non-formulary" drug), Wexford can't fill it (won't fill it) because it isn't in their formulary. So, there is a huge delay for the patient in obtaining non-formulary medication, and the formulary list itself is actually responsible for delay after delay after delay for patients to obtain a prescribed medication, including for serious medical problems. He states that Wexford would likely claim that their formulary medications are "great" and "adequate," but many of their medications are simply not used anymore in today's real world of medicine in the USA.
He says he works a 12-hour day with no breaks and he even eats lunch while charting. He works the hours by choice in order to get in his weekly hours in as short a time as possible to get out of there as quickly as possible. But the workload is so far behind, it would require a full team of doctors to get caught up and would take a year.
He is concerned because many of the inmates are complaining they are not getting enough food and the doctor is concerned about the weight loss he has actually observed. His says he has heard comments from many people that the real reason for the recent riots/disturbances at Tucson and Rynning is because of an underlying tension or stress among the inmate population due to (1) not enough food; (2) being denied medical care. The DOC explained the reason for the riots to the media as "racial disturbances."
Dr. D'Antonio has openly discussed with Dr. Bell his concern that Dr. Bell could have a work-related breakdown over his job. He is deeply concerned about Dr. Bell's mental well-being and feels it is possible that Dr. Bell may become "overwhelmed" by his job duties as Medical Director. D'Antonio believes the various relevant Arizona professional medical boards and nursing board should immediately become deeply involved and investigate what is happening. The Hippocratic Oath: Do no harm -- is being violated directly. He says he is witnessing "outrageous" medical neglect and actions contributing to such neglect by staff.
When a patient is referred for an outside professional test, procedure or consultation, the referral goes to the Wexford "collegial board." He has asked, "What happens if it (the referral) is denied?" Dr. Bell told him, "Well, it goes back to the referring doctor." D'Antonio said, "Well, what happens if I refer the same patient a second time for the same procedure because I obviously believe he needs it?" Bell replied, "Well, then we fire you because you keep making referrals."
He says many doctors and nurses have quit. About 9-10 doctors have quit between the Florence and Eyman Complexes. Describing the situation as "under-manned" or "under-staffed" is a diversionary term by Wexford. The doctors who quit need to come forward to explain the reasons why they quit. The under-manned situation is a result of the very problematic things that are happening.
D'Antonio says that what is happening in the Department of Corrections with respect to inmate medical care is "nothing short of outrageous."
He will agree to an interview with the media or with the ADC Director, but will only do face-to-face. He lives in Tucson.
Mr. Ryan, on September 5, 2012, I wrote you an email expressing my concerns about the care being afforded to inmates by Wexford, and wondered why the company did not seem to be attempting to especially impress the Department during the early stages of their multi-million dollar, multi-year state contract. You did not respond to this email. It now appears as though Wexford sees the ADC as a cash cow for corporate profits at the expense of the very care they supposedly are contractually, legally, morally, and medically committed to providing. This cannot be permitted to continue, and corporate assurances of corrective action are fundamentally insufficient as a response to the level, nature, and depth of the issues that now are emerging as a result of the outsourcing of inmate medical care to Wexford.Just prior to the Sept. 5th email, I had notified you of a Wexford nurse who had ordered a female inmate to lick a powdered prescription medication from her own hand after the nurse had poured it into the hand. The inmate protested because of the unprofessional and unorthodox method of medication administration and ended up with a disciplinary sanction and movement to another yard. It is unknown if the nurse was sanctioned or terminated, but you did advise me that Wexford had "retrained" their nurses in the proper method of distribution of medication.Now, with the above serious information as provided to me, I have no choice but to contact the relevant Medical and Nursing Boards of the State of Arizona. Human lives are at stake.While we appreciate the recent well-written noncompliance letter from Joseph Profiri, that letter does not go far enough. For example, there is no mention that families can't get in touch with or recieve call back response from Wexford about their loved one's medical care. Families repeatedly complain to me that Wexford's "hot line" is completely non-responsive.Sincerely,Donna Leone Hamm, Judge (Ret.)
Executive Director
Middle Ground Prison Reform
(480) 966-8116
MIDDLE GROUND HAS BEEN ARIZONA'S PREMIER ADVOCACY ORGANIZATION PROTECTING THE RIGHTS OF THE INCARCERATED SINCE 1983
----------------EMAIL #2: OCTOBER 5, 2012----------------
October 5, 2012
Mr. Charles Ryan, Director
Mr. Charles Ryan, Director
Arizona Department of Corrections
1601 West Jefferson
Phoenix, Arizona 85007
Dear Mr. Ryan:
It is my understanding, based on information coming directly from Dr. Lawrence D'Antonio, that Dr. D'Antonio was escorted off the Rynning Unit by the Deputy Warden of the Unit and a security officer, after my recent email to you had been (apparently) forwarded to Wexford. This is apparently the procedure applied toward whistle-blowers by Wexford.
It is my understanding, based on information coming directly from Dr. Lawrence D'Antonio, that Dr. D'Antonio was escorted off the Rynning Unit by the Deputy Warden of the Unit and a security officer, after my recent email to you had been (apparently) forwarded to Wexford. This is apparently the procedure applied toward whistle-blowers by Wexford.
It is also my
understanding that Karen (or Caryn) Grant, Director of Nursing, resigned
very recently (since my email to you). I don't know if her resignation
is connected to the fact that when I filed a complaint against her with
the Arizona Nursing Board, they advised me that there is no "Karen
Grant" who is licensed to practice nursing in the State of Arizona at
this time, but that a "Karen Grant" was licensed up until 1991. I
believe that impersonating a nurse is a felony in Arizona.
Meanwhile, I have learned some additional very disturbing information from Dr. D'Antionio which, if verified as correct, amounts to an EMERGENCY situation. The following information cannot simply be passed along to the "appropriate personnel" as you advised about my previous email. Each and every prisoner who is incarcerated in the state Department of Corrections is entrusted to your department's care and custody, and you and your Department are ultimately responsible for their care, welfare and safety, which -- of course -- includes providing the community standard of care for serious medical needs.
During the time he worked at the Rynning Unit, Dr. D'Antonio personally observed that some inmates are given incorrect medications. He also observed that some inmates are receiving medications which are contraindicated for other conditions that they have (for example; no inmate who is a diabetic should take a beta-blocker, etc.). Some combinations are drugs which have the potential for being lethal. He also observed that some inmates are being given double doses of prescribed medication, each dosage from a different manufacturer with a different name. Once again, in some cases, the double dose could be fatal or seriously debilitating. He reported to me that he advised Dr. Tom Bell of his observations, and Bell essentially shrugged him off and did not seem to grasp the import of D'Antonio's concerns. As Dr. Bell had previously stated, "They are just prisoners."
Because you now are in possession of the above information as related to me by a licensed doctor in the state of Arizona and based upon his own personal observation, I believe that you are obligated to order an immediate audit/investigation of ALL inmate medical files for inmates housed at the Rynning Unit. The investigation must be conducted by an independent qualified doctor or doctors who are not connected to Wexford or to the Department of Corrections in any manner. Wexford should pay for the audit/investigation. Other units should be audited as well because there is no reason to believe that these egregious mistakes are isolated to the Rynning Unit only.
Meanwhile, I have learned some additional very disturbing information from Dr. D'Antionio which, if verified as correct, amounts to an EMERGENCY situation. The following information cannot simply be passed along to the "appropriate personnel" as you advised about my previous email. Each and every prisoner who is incarcerated in the state Department of Corrections is entrusted to your department's care and custody, and you and your Department are ultimately responsible for their care, welfare and safety, which -- of course -- includes providing the community standard of care for serious medical needs.
During the time he worked at the Rynning Unit, Dr. D'Antonio personally observed that some inmates are given incorrect medications. He also observed that some inmates are receiving medications which are contraindicated for other conditions that they have (for example; no inmate who is a diabetic should take a beta-blocker, etc.). Some combinations are drugs which have the potential for being lethal. He also observed that some inmates are being given double doses of prescribed medication, each dosage from a different manufacturer with a different name. Once again, in some cases, the double dose could be fatal or seriously debilitating. He reported to me that he advised Dr. Tom Bell of his observations, and Bell essentially shrugged him off and did not seem to grasp the import of D'Antonio's concerns. As Dr. Bell had previously stated, "They are just prisoners."
Because you now are in possession of the above information as related to me by a licensed doctor in the state of Arizona and based upon his own personal observation, I believe that you are obligated to order an immediate audit/investigation of ALL inmate medical files for inmates housed at the Rynning Unit. The investigation must be conducted by an independent qualified doctor or doctors who are not connected to Wexford or to the Department of Corrections in any manner. Wexford should pay for the audit/investigation. Other units should be audited as well because there is no reason to believe that these egregious mistakes are isolated to the Rynning Unit only.
Again, it is insufficient
to simply pass this message along to Wexford. This potentially dangerous
and/or lethal information must be addressed at once and I expect to
receive a report of the findings in a timely manner. A report that
addresses these issues would not have to reveal HIPPA protected
information because a code number could be assigned to each case. It is
imperative, however, that any incorrect medications, double-dose
medications or contraindicated medications must be identified at once;
hopefully, prior to an emergency situation induced by deliberate
indifference or by gross negligence.
Please advise.
Donna Leone Hamm, Judge (Ret.)
Criminal Justice Consultant
Executive Director
Middle Ground Prison Reform
(480) 966-8116 (or contact James Hamm at (602) 339-0176
MIDDLE GROUND HAS BEEN ARIZONA'S PREMIER ADVOCACY ORGANIZATION PROTECTING THE RIGHTS OF THE INCARCERATED SINCE 1983