Could a new medication aimed at weaning patients off opioids hold promise?
Whistleblower Takes The Stand: Former Arizona Prison Doctor Makes Stunning Allegations In Federal Court
“Why didn’t you tell someone at ADC?” attorney Dan Struck shouted at Dr. Jan Watson in federal court on Tuesday.
Representing the Arizona Department of Corrections (ADC) in the Parsons v. Ryan prison health-care settlement, Struck wanted to know why Watson had brought her stories of woeful prison health care to the press instead of her supervisors.
Watson, well into her fourth hour of testimony, replied, “Because I did not believe anything would be done.”
Her testimony earlier that morning outlined her reasons for having no faith in the system.
Specialty Care Was Delayed, Denied
Watson spent the morning repeating allegations she first made to KJZZ in December. That story led U.S. Magistrate Judge David Duncan to schedule the Tuesday hearing to decide whether he could trust a state-run monitoring system adopted during the Parsons settlement.
David Fathi, an ACLU attorney representing inmates in Arizona prisons, led Watson through a series of allegations regarding the Arizona Department of Corrections and its private health-care contractor, Corizon Health.
Watson was a medical provider at the Eyman Prison Complex in Florence for six months in 2017. Seeing more than 20 inmates a day, three days a week, Watson would often treat patients with an urgent need: a broken bone, heart attack symptoms, uncontrollable seizures. These issues, she testified, required the attention of a specialist, outside of the prison clinic.
She would ask permission to send her patients off-site for specialty treatment. But Corizon Health, she says, would deny those requests and force her to deal with the issues on her own.
She said Corizon would issue an ATP, or alternate treatment plan.
“They would give me suggestions as to what I could do for treatment,” Watson said. But the very point of requesting a referral was to get outside help.
Even with more than 30 years of medical experience, Watson testified, there were certain areas, like monitoring cancer and HIV patients, that require specialty care beyond her means.
‘It Costs Too Much’
In case after case, Watson told the judge how specialty consults were repeatedly canceled despite her exhaustive efforts to get the treatment.
She told the court of a patient who would experience more than 10 seizures a day. To the best of her team’s efforts, she said, they could not control the seizures and the inmate was repeatedly falling and getting hurt.
Watson says she asked her medical director why, with a high-quality neurological center like the Barrow Neurological Institute nearby, they could not send the inmate for a diagnosis and treatment.
“It costs too much,” was his response, Watson said.
She said the alternate treatment plan for the inmate with uncontrollable seizures was to order him a helmet.
Watson said there were no helmets available to order and the inmate had not received one by the time she had left the facility in October.
Four-Month Wait For Crutches
Watson testified she was also unable to secure proper forearm crutches for a 21-year-old patient with cerebral palsy. Watson read from one of her many urgent requests for specialty care.
“He has severe spasticity in his lower limbs and that causes his feet to be turned inward. So when he walks he’s walking on the top of his foot.”
Watson testified that the screws on his old crutches were loose and a danger to his mobility.
“He’s unstable when he walks, and I am concerned about his gait,” she had written.
Fathi had Watson read yet another plea for new crutches.
“We have tried for four months to get him new forearm crutches with no success. Whoever orders them does not know how to get forearm crutches. … he has now fallen several times — he hasn’t hurt himself — yet.”
The Doctor’s Doctored Documents
In another stunning allegation, Watson said she believed Corizon staff were altering her treatment plans and notes under her name in the computer system without her knowledge or consent.
When Fathi presented Watson with a canceled consultation that was entered under her name, she denied being the author and said the accompanying notes had not been written by her either.
Watson told the court that it was common for Corizon employees to log in under other employees’ names. She said when she first started working for Corizon, she was not immediately given access to emails and logins and had to log on as a nurse practitioner.
Dodging Fines And Beating The Monitor
Watson told the court she would receive emails from Corizon staff asking her to cancel consultations so the company could avoid fines. Under the Parsons settlement, late consultations can lead to fines, and Watson said she believed the company was trying to dodge them.
Watson recounted a staff meeting with an Arizona Department of Corrections monitor. She said the monitor told the group how to “beat the monitor.”
“I was surprised that someone would say that publicly,” Watson said of the monitor’s language. “It was also not what I wanted to hear. I wanted to hear ‘what can we do to to improve the care’ not ‘what we could do to beat the monitor.’”
Judge Duncan asked Watson if she thought the monitor’s words could have had a different meaning.
“You mean like fudge the data?” Watson asked.
No, Duncan clarified. Perhaps, the judge posited, the monitor could have been offering advice on how to achieve their goal of compliance.
“I didn’t take it that way at all,” Watson said.
“Was she giving you tips and tricks to evade the monitor?” Duncan asked.
“Yes,” Watson affirmed.
During her time at the prison, Watson testified, she received an email from Corizon with the subject line “Operation Backlog.” Watson says she saved the email to have proof that she, and many of her co-workers, were overwhelmed and behind on their work.
The email shows in October 2017 there were more than 800 outstanding requests for medical treatment at the Eyman prison.
Making Runs To Walgreens For Pain Medication
Watson told the court not only did Corizon ask her to limit the amount and type of pain medication she prescribed, but many times her clinic simply ran out. Watson said on at least three occasions the clinic ran out of morphine and she had to send employees to Walgreens to purchase more.
Corizon’s pharmaceutical arm, PharmaCorr, is located in Oklahoma. Watson said it would take days to get refills on her supplies from the out-of-state pharmacy.
Again, Watson detailed pleas to her superiors for help that she said received no response.
She said she was also told by Corizon staff to stop prescribing ibuprofen to inmates over 50 because it was a “health risk.”
Watson said she knew that such medication should be used with caution but did not think there was research backing such a policy as prescribed by her medical director.
“I’m elderly and I take ibuprofen every day and I’m fine,” Watson said with a chuckle.
She says she was also told not to prescribe medications that were to be taken three times a day because there was not enough staff on site to distribute the doses at the proper times. Watson said that before the policy change, inmates were often given all three doses in an eight-hour period.
Diabetic Inmate Denied Insulin
Watson recalled a nurse refusing to give an inmate his insulin because he had not heard the call-out from the clinic and had missed the allotted time.
“I was standing in the med room when a guard brought up an inmate who did not hear the call,” Watson said.
She said she confronted the nurse: “I said, ‘Are you really not going to give him his insulin?’ And she she said, ‘No, we’re all adults here; they need to learn to be responsible.’”
Watson said she reported the nurse to her supervisors but does not know if any action was taken.
‘Keep Him Comfortable And Let Him Die’
Watson said there was one case that impacted her the most.
“A gentleman came in with chest pain,” Watson said of an inmate. “He was known to have heart disease.”
His symptoms, combined with an EKG, made Watson think he was having a heart attack, but she said couldn’t get approval to go to the hospital for hours.
After the referral was finally approved, Watson’s fears were confirmed. The inmate had suffered a heart attack.
Watson says her medical director, Dr. Rodney Stewart, reviewed the inmate’s test results from the hospital and conveyed the treatment plan to her and the inmate.
“He told me that’s what had happened with the patient. He had had a heart attack. None of his arteries could be bypassed and so there was nothing that could be done,” Watson said of her conversation with Stewart.
“I was told if he ever came in with chest pain again to just let him die, keep him comfortable, because there was nothing we could do about it,” Watson said.
Watson says she pulled the inmate’s medical record and looked at the notes from the hospital. She says what she saw conflicted with what the Corizon medical director told her.
“It didn’t say none of the arteries could be bypassed,” Watson said. “It only said one couldn’t. One could. And another could benefit either from medical management and or a stint.”|
Watson said she created a new plan. She prescribed the inmate nitroglycerine to take the next time he had chest pains.
Not The Corizon Way
Shortly after she changed the inmate’s plan, Watson says she was called in to a meeting with Stewart and the area medical director.
“I was told I was not doing things ‘The Corizon way,’” Watson said. She says when asked what the “Corizon Way” was, she was given a list of don’ts.
“Don’t make so many referrals. Don’t order so many splints. And I had to be faster. Don’t talk so much to the inmates,” Watson said.
She told the court that after this interaction, she put in her 30-day notice with Corizon.
After a morning of Watson recounting her experiences, Attorney Daniel Struck rose to cross-examine her. Struck had repeatedly objected to Watson’s testimony on the grounds that her previous medical expertise was as an OB-GYN.
“There’s no foundation for her testimony as a primary-care physician,” Struck said.
Judge Duncan overruled Struck, reminding him that the state had hired Watson to perform exactly that task.
Before he began his cross-examination, Struck addressed Watson as “Ms.” instead of “Doctor.”
Before attorney David Fathi could object, Duncan snapped at Struck: “I’m surprised at you.”
Struck immediately apologized. He then began his cross-examination, which repeatedly called Watson’s character into question.
Watson admitted to a series of omissions and mistakes on license and job applications. Watson said the mistakes were inadvertent and blamed poor memory for many of the discrepancies.
Watson also admitted to being involved in several malpractice suits over the course of her career, which she said were the result of practicing critical and emergency care services for decades.
Struck questioned Watson’s motives for going to the press with her story. Watson said she had attempted unsuccessfully to contact Duncan’s chambers and the ACLU before contacting KJZZ in October 2017.
Struck again questioned why Watson did not use internal channels to try to effect change.
“All of this substandard care had been going on for some time,” Watson said. “They had not done anything about it then, so why would I have any confidence that they would do something now.” Watson continued: “I could sit here until next week and list all of the things that they do on a regular basis that is substandard. I saw no advantage to reporting stuff to them that they already knew.”
On Wednesday, Struck will continue his cross-examination of Watson at a second, previously scheduled hearing. The court will then hear testimony from William Upton, a current inmate in the Arizona Department of Corrections.
Upton has been seeking cancer treatment for years but claims he has not been getting proper care. Attorneys for the Prison Law Office, a nonprofit organization that provides free legal services to inmates to help them improve their conditions of confinement, have written 11 letters to state officials on Upton’s behalf since October 2016.
In a letter to KJZZ, Upton writes that he was first diagnosed with cancer in September 2015. An inmate in Florence, Upton says for the next two years things progressively got worse.
“I began filing a series of health need requests and medical grievances,” Upton writes, “not only for further treatment of the cancer but for the severe pain associated with it.”
He says the cancer had spread to his bone marrow, making him weak and susceptible to breaks. Upton alleges Corizon would not approve treatments that would have prevented his cancer from spreading, and denied his requests for adequate pain management.
Also on the schedule for Wednesday is the issue of the state’s non-compliance with performance measures outlined in the settlement. For nearly a year, Duncan has been warning the state that it could face a $1,000 fine for every violation.
The state previously disclosed more than 650 violations at six state prisons for the month of December.
Another recent filing revealed more than 400 additional violations at the Florence prison for failing to meet a performance measure that guarantees “chronic disease inmates will be seen by the provider as specified in the inmate’s treatment plan, no less than every 180 days.”
The new violations would bring the total fines for December to more than $1 million.
Department of Corrections Director Charles Ryan told state lawmakers at a recent hearing that if the fines are enforced, Corizon Health would pay.
“I’ve already made it clear to the vendor that they’re on the hook,” Ryan said.
The hearings come as the Department of Corrections is reviewing bids for a new, five-year contract to provide health care to inmates.
Ryan confirmed that Corizon Health is one of the bidders and is seeking to renew its contract, which is potentially worth more than $140 million annually.
EDITOR'S NOTE: This story has been modified to correct the spelling and location of PharmaCorr.