Practice of Medicine

Claims Lesson

Inmate's Death Case Results in Large Payout

November 26, 2013

The Case

The incarcerated patient was a single mother with a small-time criminal history, history of cocaine addiction, and was under psychiatric care, for paranoid thoughts, psychotic symptoms and depression. She was taking Haldol, antidepressants and mood stabilizers. Within the first 17 days of her incarceration, the patient had not had any medical complaints other than complaints related to her psychiatric condition. She thought she might be pregnant but was concerned that if she said anything about being pregnant, her psychiatric medications would be withheld. One evening, after five telephone calls to the Infirmary went unanswered, the prison guard assisted the patient to the Infirmary where she was seen by our insured staff for complaints of fainting, urinary incontinence and stomach pain. The patient was examined and found to be hypotensive with a blood pressure of 80/50, heart rate of 120, and hyperglycemic with a blood sugar of 370. The patient was negative for vaginal bleeding. The staff administered IV fluids to the patient and ordered a urine pregnancy test. The patient was observed throughout the evening. Apparently the staff never relayed the results of the positive urine pregnancy test to the on-call nurse practitioner. The patient remained hypotensive.

During the early hours of the next morning, the patient was returned to her cell. Prison guards thought that the patient’s frequent falls were faking, and did not communicate with the Infirmary. She urinated on herself several times, still complaining of nausea, vomiting, stomach pain, but hungry. Around 8:00 am, the patient was found in her cell in full cardiac arrest. The nurses called 911. Advanced Life Support treatment was not rendered by prison staff prior to EMS arrival. EMS administered both epinephrine & atropine. The patient was transported to the hospital ED where she was pronounced dead.

An autopsy revealed the cause of death was from a massive acute intra-abdominal hemorrhage due to a ruptured ectopic pregnancy; the patient had 3,000 cc of blood in her abdomen. A corneal pregnancy is a very dangerous type of ectopic pregnancy, rare, difficult to diagnose and hemorrhage occurs rapidly.

The Allegation

  • Prison system employees failed to attend to the patient in a timely manner; the evaluating nurse failed to recognize and appreciate the signs and symptoms of progressive shock and made no attempt to determine/treat the underlying cause of her complaints.
  • Prison system employees failed to monitor the patient and to contact a physician.
  • The Medical Director and prison failed to provide trained and qualified personnel; failed to properly supervise/train the nursing staff by failing to establish appropriate procedures and were negligent in hiring / retention the nursing staff.
  • The Infirmary failed to follow the guidelines set forth by the National Commission on Correctional Health Care, specifically the requirement that all inmates receive a History and Physical (H & P) within 14 days of admission. The H & P had never been completed on the patient in this Claims Lesson.
  • The Medical Director failed to establish and consistently implement appropriate procedures and protocols concerning response, evaluation and care of acutely ill inmates.

Disposition

We had weak expert support for the Medical Director and his staff. The prison had no expert support. The case was settled on behalf of prison health services and the Medical Director’s employees for a large amount.

Risk Management Commentary

Although our insured physician, the Medical Director, was not directly involved in the care and treatment of the patient, he did have responsibility as the managing/supervising physician for the staff and the medical program.

When a prisoner becomes ill or suffers an injury, they are entitled to receive the same medical treatment as any other patient. Although the care of some prisoners can be challenging, the fact that a person is incarcerated is not an excuse to deny them proper medical treatment or provide them with substandard treatment. The law recognizes several possible causes of action when a prisoner does not receive the proper medical care. These causes of action range from constitutional violations to state law medical malpractice claims.

Risk management issues in prison health services claims often involve allegations of Civil Rights violations, failure to diagnose, missed diagnosis, denial of treatment/improper treatment/delay in treatment, primarily delays in referring the patient to outside medical resources, and/or getting an inmate to the hospital when necessary. A number of more severe prison health services claims are related to how the system responds to trauma injuries, particularly those inmates who are in respiratory arrest.

Prison health system medical teams are strongly advised to develop and closely monitor a companywide risk management program that addresses:

  1. Civil Rights insurance coverage/li>
  2. Site-specific medical policies and procedures designed to meet or exceed National Commission on Correctional Health Care (NCCHC) and American Correctional Association (ACA) standards and guidelines
  3. Nursing protocols designed to assure all treatment and care is appropriate, timely and consistent, and allows correctional personnel to understand and communicate effectively with the physician, particularly in the absence of a medical professional on site.
  4. Periodic in-service training and emergency drills for medical professionals
  5. Inmate health education
  6. HIPAA and NCCHC Compliance

Further Reading

World Health Organization 2007, Health in Prisons: A WHO guide to essentials in prison health

NCCHC Resources & Links-National Commission on Correctional Health Care ncchc.org/resources/standards.html

American Correctional Association/ Prison Policy Initiative www.prisonpolicy.org

Disclaimer

The information provided in this resource does not constitute legal, medical or any other professional advice, nor does it establish a standard of care. This resource has been created as an aid to you in your practice. The ultimate decision on how to use the information provided rests solely with you, the PolicyOwner.