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Many prison doctors have troubled past
Second in a series
© St. Petersburg Times, published September 27, 1999
TALLAHASSEE -- Dr. Stanley Dratler lost his medical license for three years after he was charged with fondling his patients. He told them it was part of their treatment.
Dr. Frank Johanson is on probation after the Board of Medicine disciplined him in a case involving the 1988 death of an 85-year-old St. Petersburg patient.
Dr. Jose Gonzalez paid a fine and had to attend classes after the board concluded he gave the wrong medicine to a pregnant woman, causing her uterus to rupture and the fetus to die.
In today's highly competitive health care industry, any of these problems would make a doctor an unattractive job candidate. But all of these doctors found an employer willing to hire them:
The state Department of Corrections.
A St. Petersburg Times investigation found that 30 percent of the state's 129 prison doctors have a blot on their record that ranges from medical malpractice to defrauding federal insurers. The Times' review found:
Three of the prison system's doctors have engaged in what the Board of Medicine called sexual misconduct with patients.
Fourteen prison doctors -- or 11 percent -- have the relatively rare distinction of having disciplinary records with state medical boards. Seven were punished more than once and nine are listed in a book of Questionable Doctors put out by a national consumer group.
While most doctors' problems occurred before joining the Department of Corrections, two were brought before the Board of Medicine after inmates in their care died.
Sixteen doctors have paid off Florida medical malpractice claims.
Fifteen prison doctors are operating on temporary or restricted licenses. They may practice only where there is a critical need for doctors or under the supervision of a fully licensed doctor.
Overall, only one-third are certified in a specialty, a mark of competency that requires extra schooling and is generally necessary to work at a hospital or for an HMO. To be sure, it is a thankless job to be a doctor in one of Florida's prisons. In the bleak and increasingly unhealthy world behind bars, they make life and death decisions for society's rejects: burglars, murderers, drug dealers and the like.
The state pays far less -- $72,000 to $86,000 a year -- compared with the $120,000 the average doctor makes right out of medical school. But the prison system offers a safe haven for troubled doctors by allowing them to avoid malpractice insurance that inevitably goes up when a doctor has problems.
Dr. David Thomas, the man in charge of the state's prison doctors, acknowledged that economics play a role in the quality of the doctors he attracts. But he said the number of troubled doctors doesn't concern him: He points out that all the doctors working at the state's prisons have the blessing of the state Board of Medicine.
Besides, he argues, what better place is there to keep a troubled person on the straight and narrow?
"Clearly, you would prefer people that don't have any problems," Thomas said. "But I do think that there is a place for well-trained people who have made a mistake, and we may be well-placed to do that because we have a degree of control over our doctors that the outside world does not."
The Times reported Sunday that dozens of inmates have died after receiving inadequate health care since 1994. Some observers question the wisdom of putting a bunch of doctors with questionable backgrounds in charge of a $225-million health care system.
"Those numbers are pretty atrocious," said Randall Berg, a lawyer who advocates for prisoners' rights. "It shows they don't really care what level of care is provided -- they're operating on the cheap."
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Prison officials point to Dratler as one of the best examples of how the prison system is in a unique position to make use of well-trained doctors with problems in their past.
Dratler is a former Dade City private gynecologist. His license was suspended in 1986 for three years after he repeatedly misused his position as a doctor to engage in what he called "psychosexual treatment" of his patients. One patient was 16 years old.
The Board of Medicine again disciplined Dratler in February 1994, this time for violating a condition of his medical license that required he be supervised at all times by another physician. Dratler, who also has a medical malpractice claims history, unsuccessfully appealed the decision and was put on probation for five years.
Thomas said the 51-year-old Dratler's "problem with women" was easily solved. Since joining the department, he has worked only at prisons for men.
Dratler, the only doctor to respond to a request for an interview, said his troubles are behind him and points out that there are no restrictions on his Florida license.
"I am proud to be a valued member of the health services team for the Department of Corrections," he said. "It was a long time ago."
Still, in the outside world, any form of discipline by a state board is considered a serious matter that would raise "a red flag" to hospitals considering extending a doctor privileges to practice, said Lew Fishman, a lawyer specializing in advising hospitals and doctors on administrative matters. One reason it is taken so seriously is that the hospital could be subject to punitive damages if a troubled doctor makes a medical mistake, Fishman said.
"Where the Board of Medicine disciplines its own, that's generally pretty significant," Fishman said.
It is also rare.
The vast majority of doctors go without ever being disciplined by a state board, according to Dale Austin, deputy executive vice president of the Federation of State Medical Boards of the United States. Over the past year, for instance, less than half of 1 percent of the nation's doctors were disciplined.
At the Florida Department of Corrections, however, 11 percent of the doctors have disciplinary records with state boards.
"It is the exception, rather than the rule," Austin said. "Eleven percent definitely seems high."
John Burke, the department's chief medical administrator, said the department does an extensive background check on its doctors. But it does not have a formal policy to eliminate job candidates based on a medical board's actions.
One thing he takes into consideration is whether disciplinary actions stemmed directly from a problem with patient care.
For instance, the department is willing to hire physicians who commit crimes, as with Dr. Robert Briggs, the medical executive at Charlotte Correctional Institution since 1998. State records show that in 1981 Briggs pleaded guilty in federal court to preparing fraudulent Medicare payment invoices.
On the other hand, the state has hired some prison doctors who have been accused of harming their patients. Of the 14 prison doctors with disciplinary records, 10 were charged with making medical mistakes.
* * *
One was Dr. Efiong Andem.
As a military physician, Andem was disciplined in 1994 by the Army's Office of the Surgeon General on charges that included "lack of attention to detail, failure to assume responsibility for patients, failure to admit or recognize errors, failure to document problems, and failure to learn from mistakes."
The next year, he was hired by the Department of Corrections.
In 1997, Florida also disciplined him for his Army record. The board's punishment expresses a clear concern about letting Andem practice on regular Floridians: He must notify the board if he leaves the Department of Corrections and will be put on probation if he returns to private OB/GYN practice.
But for now, he is free to treat inmates.
Multiple disciplinary actions also did not prevent doctors from working at the state prisons.
Dr. Mireya Francis was disciplined by the Florida Board of Medicine in 1993 for handing out drugs to mentally ill patients without first performing psychiatric evaluations.
In 1995, she again was disciplined, this time for failing to notify the Florida board that her application to practice medicine in Ohio had been denied. The reason for Ohio's denial: She lied on her application.
Burke defended the department's decision to hire and keep Francis, saying only one of the disciplinary actions against her was the result of poor medical decisionmaking.
He said the department uses the Board of Medicine's records as guidelines but comes to its own conclusions.
"We may decide that the truth is, these were not egregious errors, even when a patient dies," Burke said. "You can have honest disagreements between physicians."
* * *
Most of the disciplined doctors came to the Department of Corrections after their troubles. Thomas, who oversees the prison's doctors, said he is quick to take action against doctors who get into trouble once they arrive at the state's prisons.
The department said it reported three bad doctors to the Board of Medicine from 1996 to 1998. By the time the department takes that step, Thomas said, "generally we've fired them."
But the department isn't entirely consistent. It kept two prison doctors even after they were brought before the Board of Medicine because inmates in their care died.
In 1998, the Board of Medicine placed Dr. Abigail Rosario-Rivera on probation for a year after she provided substandard care to an asthmatic inmate who died. Not only did she fail to follow her own treatment plan or properly medicate the 37-year-old, the board found, but she sent him back to solitary confinement when he should have been monitored.
Why wasn't Rosario-Rivera fired? Burke, the prison administrator, said he doesn't know.
In another case pending before the state medical board, North Florida Reception Center's Dr. Frederick Vontz was accused in May 1999 of failing to properly treat an inmate.
The 33-year-old inmate was recovering from surgery involving a liver biopsy and a hernia when he was placed in Vontz's care. Over the next two days, the patient's abdomen became distended, his urine turned dark, he ran a fever over 104 degrees and he repeatedly complained of pain. The patient died the next day of a raging infection and a perforated colon.
"A reasonably prudent" doctor would have diagnosed the problem, the Department of Health charged. "A reasonably prudent" doctor would have at least contacted the doctor who performed the surgery and would have arranged for a transfer to an area hospital.
That case is unresolved. Burke said it is unclear whether Vontz or the surgeon, a specialist who works on contract for the department, was responsible.
* * *
Even good doctors get sued for medical malpractice, and some settle claims because it's cheaper than going to court. But experts say they're especially wary of repeat offenders or especially egregious errors. "It depends on the nature," said Fishman, the lawyer who advises hospitals. "Certainly high-dollar verdicts would be something you want to look at, as well as frequency of claims, especially if it's close in time."
Ten of the 16 prison doctors with medical malpractice claims histories paid less than $100,000.
But six doctors had hefty malpractice payouts, and two had more than one. In some cases, the malpractice lawsuits were a harbinger of things to come.
Vontz, for instance, settled a malpractice case in 1984 for $442,149 for an abdominal surgery that went bad.
The department has some informal guidelines when it comes to evaluating malpractice cases: Three payouts would be a "red flag," Burke said.
But the department put one such doctor in a position of great power. Dr. Arnold Azcuy's insurers paid a total of $613,000 in three malpractice cases. Two of the claims, both in 1983, involved the deaths of Azcuy's patients.
Azcuy, a medical executive at the North Florida Reception Center, is in charge of reviewing cases statewide and making cost-control decisions about when to deny care. He decides which inmates need to be seen by specialists or transferred to outside hospitals for non-emergency care.
* * *
To work in private practice, a doctor must be fully licensed by the state. Not so at the Department of Corrections.
Because of an exception built into state law, doctors who have restricted licenses or have not passed either the Florida or the national medical exam but are licensed in another state can go to work for the Department of Corrections or the Department of Health.
One reason some may not want to become fully licensed in Florida is that the state has a reputation for being tough, said Tanya Williams, director of the Board of Medicine.
"We scrutinize applications in extreme detail," she said. "The other thing that's different about Florida is the level at which we examine malpractices cases."
Many of the prison doctors operating without full licenses are foreigners, Thomas said. And for some, Thomas said, poor English may be a factor in their decision not to take the national exam.
"Like any system, we have some people who in terms of bureaucratic certification may not look good, but happen to be outstanding doctors," he said.
Randall Berg, the lawyer who advocates for prisoners, worries about doctors who don't have full licenses or good communication skills.
"If you've got an African-American prisoner who uses a lot of street slang trying to communicate with a Vietnamese doctor who can't speak English, that can create a real problem," he said. Thomas said the department is working hard to improve the quality of doctors it employs. When he arrived three years ago, for instance, he said only a handful of doctors were certified in a specialty. Now, one-third have earned that distinction.
"On the whole, I think our doctors are good and getting better," he said. "We are looking to recruit and retain doctors who anyone would be willing to go to. That's our goal: is to have 100 percent that meet that standard. But we are not there yet."
-Times staff researcher Stephanie Scruggs contributed to this report. Times staff writer Jo Becker can be reached at (850) 224-7263 or firstname.lastname@example.org.
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