Unfortunately, since Director Ryan still hasn't responded to the following email I sent him 5 days ago, I don't know if any of those allegations I've made are true. For all I know, I'm about to be arrested for attempting to incite a riot or for promoting prison contraband. Or perhaps the DOC just made a huge mistake by messing with my free speech rights and diverting the US mail inappropriately.
We'll soon see. I'll keep you posted here...
On Sat, Oct 20, 2012 at 4:48 PM,
Arizona Prisonwatch <firstname.lastname@example.org> wrote:
While we're on the subject of rioting, I thought you should see these other two letters yourself and tell me if they warrant confiscation as well. I've hardly heard a word out of Perryville since mailing them to about 30 women there - nor much from the 40 men to whom I sent the one with Donna's emails - and suspect that either these letters have also been diverted from the intended recipients, or their voices are being repressed. A similar problem has befallen one of your Botulism patients - his mail from me about who victimized him and what he might be able to do to assure his rights are protected has definitely been interfered with, and he'll run out of time to exhaust his remedies and access the courts if he's kept in the dark about his options much longer. I'm also concerned about the possibility that his ability to advocate effectively for himself right now could still be impaired by the neurological damage done to him after your people at Eyman refused to get him to a hospital for a week. I don't trust that they now have his best interests at heart.
Are you aware of the escalating crisis of guys trying to get into your Protective Segregation program because the gangs are totally in control on medium and higher yards? The guys all are. Your prisoners also have the right to know why - after four months of filing HNRs or going through the grievance process - they are still suffering with an untreated urinary tract infection, or have gone without their Metformin since July, who is responsible for that kind of thing, and what they can do about it.
You have the duty to Arizonans behind bars and in the community alike to assure that you are doing no harm to those people entrusted to your care for rehabilitation, because 95% of them will someday have to come home to the rest of us. We'd like them to return with better social and employment skills than when they left, not come back to us more disturbed or violent than they ever were before.
The men are already "rioting", by the way, according to Dr. D'Angelo, because they are hungry and terrified of dying horribly due to gross medical neglect in your custody. I also think the fear that one is about to be assaulted if one doesn't strike first is contributing to the escalating rate of vicious attacks on vulnerable prisoners over things that previously would have gone unnoticed on the yards, and thus creates some of your 805 backlog.
The women will be rioting soon without me too, you know. That's your doing, however, not mine.
The men and women alike in your prisons are all tired of being expected to shut up and disappear when they resist sexual violence or extortion, say no to racism, and challenge the deliberate indifference of their health care providers. Those allegations about Wexford include some of criminal misconduct, not just the heartless greed that our ALEC-laden legislature happily expected they were satisfying when they mandated you to outsource the prisoners' health care for less...you didn't put up much resistance or educate them about better options, as I recall. None that I could see evidence of, anyway.
One way to reduce the level of violence in your prisons may be to empower people to learn and use the law and civil discourse in a constructive manner to protect themselves from harm instead of reaching for a gun or a gang to alleviate their fears - the deepest of which no one here talks much about, which is rape. I haven't even begun to look at your PREA reports lately; is sexual assault and exploitation on the rise, too?
Many prisoners are waiting to hear back from me on issues related to their health and safety, Director Ryan; they write to me begging for their lives. Please get with your lawyers and get back with me soon. I need to know whether you have some rogue mailroom employees absconding with my mail, or if what I've written to your prisoners deserves to be suppressed because it's more dangerous than the conditions that you've cultivated and are now allowing to fester.
Thank you for your attention to this matter.
Again, no one but myself is responsible for the contents of this email or the attachments. Be aware that it and any response it gets (or doesn't get), is hardly going to be kept between us.
Please read all the enclosed material carefully; I'm sending it to all the good addresses I have for women at Perryville. The Orange Gazette needs to do the bulk of the work from here, though. Spread my PO Box if nothing else, and I'll send whomever writes to me the same materials as long as I am able to. The enclosed are also posted at the Arizona Prison Watch blog, where your families can download the letter as well as info about how advocating for yourselves as prisoners, and mail it to you themselves.
If ever you were in a fight for your lives and real justice, it is now. It’s not just about you, either - you need to stand with the women suffering even more around you. I applaud those of you who have had the courage to do so already - facing certain reprisal. I know that if they don’t nail you now, they will once no one is looking at the prisons again.
I took your complaints and letters to the Sun City/ West Valley National Organization for Women last month, and their program committee is inviting me to come speak about Perryville’s conditions and the health care crisis for their November meeting. So for October I need to be kept up to date with what’s happening there - both in the way of improvements or deterioration of the situation for each of you individually and on your respective yards. If you have copies of grievances and responses you can send me, even better.
If you are willing to let me use your name and story publicly, please tell me - and be explicit if you would like me not to identify you as well… though don’t think your involvement in organizing with NOW will be a secret to the DOC if you write to me - they will no doubt be monitoring all of my correspondents, and their officers may repeatedly move you or search your cell to steal the evidence you accumulate against them. Your silence will not protect you either, though, as Audre Lourde once said. You each need to do what you have to do to survive your sentence, though. I respect that. You alone know what you can and can’t risk in there.
If you do correspond with me, please remember that I am not an attorney or a journalist - I’m just an artist and freelance writer in the community - a civilian doing my good deed before I leave this earth. Nothing you send me is privileged information, and I don’t know if the first amendment would protect my sources the way it does for the mainstream media. I sure don’t have a corporate legal team behind me to protect any of us if the state tries to harass or punish those of you courageous enough to correspond with me. But I need that information in order to get help in there to you, and it must be current and verifiable. If victims of and witnesses to abuse, neglect, and criminal activity by state or contract agents are willing to send signed statements you’ll swear by that I can publish and read aloud to the women from NOW, it would make the most impact.
Things often get worse before they get better when you are fighting people with this much power over your very right to survive. It may not even get better there before you leave - and some of you may die in the battle for women‘s rights. But the more of you who stand and speak out now, the safer it will be for others who come after you to keep up the fight, and really make a change from the inside out. You can’t count on the ACLU or the rest of us to rescue you - and we can’t do our part right without you.
So, you know where to find me. Be patient but persistent if I am slow to respond directly to your individual letters - I run out of ink and postage and have to juggle crises of varying magnitude. But I am listening, and I have friends out here who care about Perryville’s prisoners as well. So please, if you can, write to me. Send me your poetry, too. And letters from your kids, if you want - these women need to know just who I am asking them to help and why - you need to be real people to them; touch them, please. They are willing to hear you.
Let me know if any of this is contrabanded. There are two other pieces of paper enclosed - one is an AZ Republic Article from last week, and the other is an email to Chuck Ryan from Donna Hamm, both reporting on what’s really up with this BS with Wexford Health.
9545 E. Doubletree Ranch Rd.
Scottsdale, AZ 85258
Arizona Department of Corrections1601 West Jefferson
Phoenix, Arizona 85007
Dear Mr. Ryan:
D'Antionio says that Dr. Tom Bell is the Statewide Medical Director employed by Wexford. The Regional M.D. for Wexford is Dr. Hector F. Garcia. He is Dr. Bell's boss. Karen Grant is the Director of Nursing for Wexford. D'Antonio refuses to converse with or take orders from Grant. Grant was abusive, used obscenities with him, and was unprofessional during their initial conversation. He believes that it is ironic that only current physican at the Eyman/Rynning Unit (D'Antonio) has no communication with the Director of Nursing. He has advised his own employer that either Wexford needs to obtain someone other than Grant for him to communicate with or he will not work there at all.
He says "personnel (medical) are leaving in droves." Grant was ordering him to do things outside his training and outside of his expertise. She was ordering him to see patients who needed specialists; he is not a specialist. He says that Dr Bell ordered that certain medications are to be stopped for some inmates. When asked why the medications were to be stopped, Bell stated, "Because they are prisoners." He asked Bell, "Is this your own medical decison-making?" Bell replied, "This comes from Wexford."
Karen Grant has ordered D'Antonio to write prescriptions en masse for patients whom he has not seen. He refused to do so, stating that in most cases he needs to see each patient individually before he can prescribe a medication. He says Wexford is sabotaging everything by doing such things as excessive questioning of the doctor ("for more information") when he prescribes a medication. When he makes a referral for a patient to have a procedure, obtain a specialist's opinion, have additional testing, etc., Wexford has a procedure which they call a "collegial" conference call. Their staff get on a conference call and the vast majority of the time, they delay the additional procedure by requesting "additional information" from the referring doctor. This goes on and on, back and forth, so that the procedure itself never gets done or is so delayed as to be meaningless (or dangerous) for the patient.
He says that he was told that all prior referrals (for specialists, tests, etc.) made by DOC healthcare workers prior to July 1, when Wexford took over, are cancelled, and will not be honored. Instead, the inmate is required to go through the referral process all over again, thus further delaying what might be life-saving diagnostic testing. D'Antonio says that many of the referrals are "shelved" and continuously cycled through the "get more information" process over and over.
D'Antonio refers to the mistakes and unethical conduct going on by Wexford employees as "staggering" and "criminal." He says that while he does not consider himself to be soft on crime or criminals, "they are human beings and deserving of basic medical care." He has restricted his exposure to liability for the type of care being provided to inmates by limiting the days he will work, the hours he works, and the units at which he will work. He says what is happening at the Meadows Unit and throughout the Florence prisons is a "disgrace."
The doctor says that there are such people as what doctors refer to as "hatchet" doctors or "administrative" doctors -- they work for a corporation and have given up their ethics (and oath) to 'do no harm' by accepting a huge paycheck just to go along with corporate policies and directions. D'Antonio says there are doctors (or nurses) such as this that work for Wexford.
He says that each time he sees a patient, he must fill out a progress note. This is a form. When he orders lab work, an x-ray or a prescription, each requires a separate form. At the Meadows Unit, it was nearly impossible to find the forms needed, thus delaying and complicating the already dysfunctional process. He says chart work is ignored and there is no review process. He was originally hired just to do induction physical exams for incoming (new) prisoners, but that he has ended up doing everything from emergency care, chronic care, diagnostics, etc. and that they are so back-logged in reviewing charts that there is no reasonable way that each patient's chart can be reviewed in a timely manner.
He states that he has been told by Wexford employees that, "We are forbidden from talking about what happens here. . ." and that he has been advised, "Prisoners have died at the Meadows Unit due to lack of care since Wexford took over . . . ." (He was unable to provide me any names or DOC #'s of inmates who have allegedly died at Meadows Unit due to lack of medical care since Wexford took over on July 1, 2012).
He says that the Wexford formulary for approved medication is "archaic." He gave an example of the medication that Wexford has approved for hay fever. (I can't spell it). He says this was a medication that was being phased out in the 1980's (it was a medication that he would have taken as a child) -- and that the standard of care in today's world for allergies is an antihistamine and/or a nasal steroid spray. He says Wexford approves a salt water/ocean spray which is so outdated, it is laughable. So, when he writes a prescription for a timely/updated drug (a "non-formulary" drug), Wexford can't fill it (won't fill it) because it isn't in their formulary. So, there is a huge delay for the patient in obtaining non-formulary medication, and the formulary list itself is actually responsible for delay after delay after delay for patients to obtain a prescribed medication, including for serious medical problems. He states that Wexford would likely claim that their formulary medications are "great" and "adequate," but many of their medications are simply not used anymore in today's real world of medicine in the USA.
He says he works a 12-hour day with no breaks and he even eats lunch while charting. He works the hours by choice in order to get in his weekly hours in as short a time as possible to get out of there as quickly as possible. But the workload is so far behind, it would require a full team of doctors to get caught up and would take a year.
Dr. D'Antonio has openly discussed with Dr. Bell his concern that Dr. Bell could have a work-related breakdown over his job. He is deeply concerned about Dr. Bell's mental well-being and feels it is possible that Dr. Bell may become "overwhelmed" by his job duties as Medical Director. D'Antonio believes the various relevant Arizona professional medical boards and nursing board should immediately become deeply involved and investigate what is happening. The Hippocratic Oath: Do no harm -- is being violated directly. He says he is witnessing "outrageous" medical neglect and actions contributing to such neglect by staff.
When a patient is referred for an outside professional test, procedure or consultation, the referral goes to the Wexford "collegial board." He has asked, "What happens if it (the referral) is denied?" Dr. Bell told him, "Well, it goes back to the referring doctor." D'Antonio said, "Well, what happens if I refer the same patient a second time for the same procedure because I obviously believe he needs it?" Bell replied, "Well, then we fire you because you keep making referrals."
He says many doctors and nurses have quit. About 9-10 doctors have quit between the Florence and Eyman Complexes. Describing the situation as "under-manned" or "under-staffed" is a diversionary term by Wexford. The doctors who quit need to come forward to explain the reasons why they quit. The under-manned situation is a result of the very problematic things that are happening.
D'Antonio says that what is happening in the Department of Corrections with respect to inmate medical care is "nothing short of outrageous."
He will agree to an interview with the media or with the ADC Director, but will only do face-to-face. He lives in Tucson.
Mr. Ryan, on September 5, 2012, I wrote you an email expressing my concerns about the care being afforded to inmates by Wexford, and wondered why the company did not seem to be attempting to especially impress the Department during the early stages of their multi-million dollar, multi-year state contract. You did not respond to this email. It now appears as though Wexford sees the ADC as a cash cow for corporate profits at the expense of the very care they supposedly are contractually, legally, morally, and medically committed to providing. This cannot be permitted to continue, and corporate assurances of corrective action are fundamentally insufficient as a response to the level, nature, and depth of the issues that now are emerging as a result of the outsourcing of inmate medical care to Wexford.
Middle Ground Prison Reform
Mr. Charles Ryan, Director
It is my understanding, based on information coming directly from Dr. Lawrence D'Antonio, that Dr. D'Antonio was escorted off the Rynning Unit by the Deputy Warden of the Unit and a security officer, after my recent email to you had been (apparently) forwarded to Wexford. This is apparently the procedure applied toward whistle-blowers by Wexford.
Meanwhile, I have learned some additional very disturbing information from Dr. D'Antionio which, if verified as correct, amounts to an EMERGENCY situation. The following information cannot simply be passed along to the "appropriate personnel" as you advised about my previous email. Each and every prisoner who is incarcerated in the state Department of Corrections is entrusted to your department's care and custody, and you and your Department are ultimately responsible for their care, welfare and safety, which -- of course -- includes providing the community standard of care for serious medical needs.
During the time he worked at the Rynning Unit, Dr. D'Antonio personally observed that some inmates are given incorrect medications. He also observed that some inmates are receiving medications which are contraindicated for other conditions that they have (for example; no inmate who is a diabetic should take a beta-blocker, etc.). Some combinations are drugs which have the potential for being lethal. He also observed that some inmates are being given double doses of prescribed medication, each dosage from a different manufacturer with a different name. Once again, in some cases, the double dose could be fatal or seriously debilitating. He reported to me that he advised Dr. Tom Bell of his observations, and Bell essentially shrugged him off and did not seem to grasp the import of D'Antonio's concerns. As Dr. Bell had previously stated, "They are just prisoners."
Because you now are in possession of the above information as related to me by a licensed doctor in the state of Arizona and based upon his own personal observation, I believe that you are obligated to order an immediate audit/investigation of ALL inmate medical files for inmates housed at the Rynning Unit. The investigation must be conducted by an independent qualified doctor or doctors who are not connected to Wexford or to the Department of Corrections in any manner. Wexford should pay for the audit/investigation. Other units should be audited as well because there is no reason to believe that these egregious mistakes are isolated to the Rynning Unit only.
Donna Leone Hamm, Judge (Ret.)
Criminal Justice Consultant
Middle Ground Prison Reform
(480) 966-8116 (or contact James Hamm at (602) 339-0176
MIDDLE GROUND HAS BEEN ARIZONA'S PREMIER ADVOCACY ORGANIZATION PROTECTING THE RIGHTS OF THE INCARCERATED SINCE 1983