Patient at Risk
Most people know the popular refrain: "Let him rot in jail." Most people also know it's just a metaphor for punishing a criminal. It isn't meant to be taken literally. Convicted criminals aren't supposed to putrefy and physically decompose while incarcerated. Right?
I just wanted a reality check, especially after learning about a Miami-Dade County jail inmate whose leg became so badly infected with virulent, drug-resistant bacteria that it may have to be amputated.
Though this contagious and potentially lethal strain of bacteria has been spreading in jails throughout South Florida and around the nation, the county's Corrections and Rehabilitation Department responded lethargically to the local outbreak, which was first detected in April. That disturbing fact, along with news that the department's medical compliance officer had his physician's license revoked for malpractice, so alarmed members of the medical establishment they decided to get involved. At its August 23 meeting, the Dade County Medical Association (DCMA) agreed to send a letter to corrections officials offering assistance and urging the department to re-examine the qualifications it requires for the medical compliance officer's position.
"This is a public-health issue, not a jail issue," says Dr. Bernd Wollschlaeger, a member of the DCMA's executive committee. "We are willing to help them remedy this situation in the form of a task force. We feel that anything that happens in the jail will affect us directly or indirectly when the prisoners are released. Nonetheless, inmates should receive the same high standards of medical care that any citizen of Dade County gets." The DCMA's decision comes not long after inmate David Famiglietti was forced to undergo emergency surgery to treat his infected leg.
In 1999 vascular bypass surgery had been performed on one of Famiglietti's legs. In 2000 he entered the county's jail system, charged with some pretty serious crimes, including attempted murder. He's still there. In mid-August, while housed in the Turner Guilford Knight Correctional Center, he became infected with the notorious, methicillin-resistant Staphylococcus aureus (also known as MRSA, pronounced mer-suh), which can withstand most antibiotics.
According to attorney Jason Wandner and a Famiglietti family member who asked not to be identified, David Famiglietti had requested to be seen by a doctor in early August when his leg became swollen and painful. After more than a week, he was allowed to visit the jail's infirmary. "He told me they sent him away, saying he was faking it," recounts the family member. "Then his toenails fell off."
On August 12, after the jail's medical staff finally examined him, they rushed Famiglietti to Jackson Memorial Hospital, according to the relative. When a surgeon opened him up, he found the infection had traveled up the vascular graft, left over from the previous operation on his leg, to his pelvis. During surgery, doctors drained 500 cubic centimeters of pus from his groin. He's stable now, but the fate of his damaged leg is unclear; it may still need to be amputated.
Corrections officials learned MRSA was spreading through their jail facilities after the family of one infected inmate who'd been misdiagnosed called the county's health department. Inspectors confirmed it was MRSA and then distributed a memo outlining steps that needed to be taken in order to prevent its spread. But corrections officers have complained that administrators did not put enough precautions in place. On August 30, there were six confirmed cases active in the jail system; 41 have been documented since April.
"I'm confident we're doing everything we can now," says corrections director Charles McRay. "We were meeting twice a week to monitor new cases. We put out a lot of information. We've had a lot of consultation with appropriate agencies, like the health department and the Public Health Trust."
What compounded the problem, in the view of the physicians on DCMA's executive board, was the revelation that the jail's medical compliance officer, Robert Gonzalez, had had his medical license revoked in 1987 for "gross or repeated malpractice" and "incompetency." The license was never reinstated.
It was Gonzalez to whom the health department sent the memo outlining measures to prevent the spread of MRSA, including such precautions as putting liquid soap in the communal showers. (The bacteria can be transferred on a bar of soap.) That still hasn't been done, according to several corrections officers. And while Gonzalez doesn't actually practice medicine inside the jails, he is responsible for reviewing inmate medical records in order to assess the jail system's needs.
The job doesn't require a medical license, and McRay, who took over the department in June, says Gonzalez's qualifications are "not in conflict with his required duties." He adds, "But I'm flexible. If I get additional information, I will process it. You realize, of course, that I didn't hire him. Who knows what tomorrow will bring?"
One thing it's going to bring is the letter from the DCMA, which represents about 1800 physicians. "We consider only licensed health-care professionals to be qualified to render health care to inmates in the jail system," says Wollschlaeger, who drafted the letter. "The reason is the following: If you're a licensed health-care provider, you're obligated to follow established standards of care. If you don't, you could lose your license. If you're not licensed, you don't have to follow any standards. We think the jail system should seriously review the qualifications required for health-care professionals."
With specific regard to Robert Gonzalez, Wollschlaeger stresses that he can express his personal opinion, but that he isn't speaking for the DCMA. "I have serious questions," he says, "about whether a person who isn't properly licensed can supervise the complex decision-making involved and follow the agreed-upon guidelines. My personal opinion is that they can't."
Wollschlaeger came to that conclusion after reviewing the job description for the medical compliance officer. "I don't know how the person could not be a licensed health-care professional," he says. "I'm board certified. I get recertified. And even in my position I probably could not take that job."
After listing the daunting amount of continuing education a doctor or nurse must keep up with, Wollschlaeger pauses for breath: "This is a very demanding job if you take it seriously. And I'm not convinced they are taking it seriously."
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