Prison medical staff provided poor, incomplete or substandard medical care to the three inmates who died last year at Tutwiler Prison for Women, according to a physician who monitors the prison's medical system for a federal court settlement.
Dr. Michael Puisis of Illinois, an expert in correctional health care, also suggests in a report that negligent, error-ridden medical care might have led to two of the three deaths.
His report is based on visits to the Wetumpka prison March 7-10 during which he reviewed records, interviewed staff and toured parts of the prison. It was required by a 2004 federal court settlement of a lawsuit over crowded conditions and medical care at Alabama's only prison for women.
With current patients, Puisis reported that private contractor Prison Health Services lacked follow-up, made mistakes in prescribing drugs and gave substandard care to 19 of 22 prisoners whose charts he reviewed. Women with HIV, staph infections, diabetes and other conditions were consistently denied treatment, he wrote.
Among the mistakes the report cited in the three deaths:
"This patient's underlying medical conditions were grossly mismanaged," Puisis wrote about one woman, a lupus patient who suffered a brain hemorrhage and died in March 2004, a few months after Englehardt canceled tests recommended by an outside cardiologist. "There is no clinical basis for this decision," Puisis wrote.
"Care (of three chronic conditions) was substandard and may have contributed to her death," Puisis wrote about a prisoner who died in August. Her hyperlipidemia, a form of high cholesterol, was untreated and "unquestionably contributed to her death," he wrote.
This woman needed to go to a hospital, he wrote, but instead was kept in the prison infirmary and was not seen regularly by a doctor.
The third inmate hanged herself while on suicide watch. She was on suicide watch for five days, but was not evaluated by a mental health professional except for a phone call to a psychiatrist who prescribed medication. On Jan. 24, 2004, the woman was crying, saying "Daddy, don't hurt me anymore," and was banging her head against a wall, a nurse reported. The next day she hanged herself.
"It appears that the record is either incomplete or she was not seen for the duration of her suicide watch until she died," Puisis wrote. "This type of death review is inadequate and leaves many unanswered questions."