Incompetent Jail and Prison Doctors

Date01 June 2000
DOI10.1177/0032885500080002003
AuthorMICHAEL S. VAUGHN,DEAN A. DABNEY
Published date01 June 2000
Subject MatterArticles
/tmp/tmp-18m7BVTLjDkU36/input THE PRISON JOURN
Dabney, V
AL / June 2000
aughn / INCOMPETENT JAIL AND PRISON DOCTORS
INCOMPETENT JAIL
AND PRISON DOCTORS
DEAN A. DABNEY
MICHAEL S. VAUGHN
Georgia State University
Previous research has questioned the clinical qualifications and professional compe-
tence of physicians who work in correctional facilities. This article further explores
these issues by analyzing social control mechanisms that are employed against prison
and jail physicians who (a) have been sued in state court by prisoners for medical
malfeasance and malpractice, and (b) have had disciplinary action taken against
their license to practice medicine. Physicians who were subject to suit are categorized
by type of suit, medical complaint, plaintiff ’s injury, and disposition of the litigation.
Drawing on previous research, the authors also classified physicians’ rationaliza-
tions to prisoner litigation within Sykes and Matza’s techniques of neutralization
framework. Reporting that prison and jail doctors have higher rates of disciplinary
action taken on their license than physicians at large, the article uses the principle of
less eligibility to question the ethics of restricting problem doctors to work exclusively
in correctional facilities.

Correctional institutions are foreboding places in which some of society’s
least desirable, socially unskillful, and unhealthy individuals are housed
(Marquart, Brewer, Mullings, & Crouch, 1999). Commentators observe that
these facilities are filled with “vicious, predatory, cold-blooded, and
remorseless people who have no conscience” (Haney, 1998, p. 37). The typi-
cal prisoner who seeks correctional health care is viewed by staff as a “con, a
word that seems to indicate both a judgment that the prisoner is primarily a
criminal or convict, rather than . . . ill, and a sense that the symptoms of . . . ill-
ness may be malingered” (Schultz-Ross, 1993, p. 105). In this environment,
health care personnel are cautioned that “empathy [with prisoners] will be
your downfall” (Maeve, 1997, p. 504). Formal training programs instruct
health care personnel that they should “never touch [a prisoner] except when
An earlier version of this article formed the basis of a presentation at the 1999 meetings of the
American Society of Criminology, held in Toronto, Canada. Authorship is alphabetical; both
authors contributed equally to the completion of the article.
THE PRISON JOURNAL, Vol. 80 No. 2, June 2000 151-183
© 2000 Sage Publications, Inc.
151

152
THE PRISON JOURNAL / June 2000
absolutely necessary” (Maeve, 1997, p. 504), and that all “dealings with
[prisoners must be] characterized by distance and formality” (p. 507).
Because contemporary penal policy defines prisoners as enemies and
ascribes to them “attributes that make them initially less deserving of the
most basic amenities and civilities, and ultimately less than human” (King,
1998, p. 617; Vaughn, 1999), correctional health care systems do not provide
“attractive employment prospects for most” physicians (Friedman, 1992,
p. 942). Indeed, previous research has questioned the medical skills, compe-
tence, and ethics of physicians who work in correctional institutions (Vaughn &
Smith, 1999a, 1999b). The central question guiding this article is, Why
would a physician voluntarily work in a health care setting where staff
believe that all their patients manipulate providers and feign illness? Our
hypothesis is that correctional physicians’ employment opportunities are
limited, because they experience higher rates of disciplinary action and sanc-
tion against their license to practice medicine than physicians at large.
Grounded within the principle of less eligibility (Vaughn & Carroll, 1998),
we posit that prisoners’ low social status makes them less deserving of
high-quality medical care, explaining why physicians with questionable
medical qualifications practice disproportionately within correctional health
care systems.
To explore these issues, we examine two mechanisms of formal social
control employed against physicians in correctional facilities. First, we
assess lawsuits filed by prisoners in state courts seeking monetary damages
and injunctive relief for inadequate correctional medical care. Here, we ana-
lyze the content of court rulings to develop a descriptive profile of how
inmates, doctors, and the courts are defining and responding to medical mis-
conduct in U.S. correctional facilities. Second, we cross-reference physi-
cians identified in our case law analysis with physicians who have had state
or federal disciplinary action taken on their license to practice medicine. The
article concludes by questioning the ethics of sentencing incompetent doc-
tors to exclusively practice in correctional facilities, and by calling for more
systematic research on correctional physicians who have had disciplinary
action taken against their privilege to practice medicine.
LITERATURE REVIEW
FREE WORLD PHYSICIANS RATIONALIZE DEVIANCE
The Institute of Medicine within the National Academy of Sciences
(Kohn, Corrigan, & Donaldson, 2000) estimates that 44,000 to 98,000

Dabney, Vaughn / INCOMPETENT JAIL AND PRISON DOCTORS
153
patients die annually in the United States due to medical errors or mistakes.
News accounts (Pear, 1999; Stolberg, 1999) indicate that the public is both
shocked and concerned about the fact that such large numbers of mistakes
occur and, more important, that an organizational code of silence allows
these actions to go largely unchecked. Rosenthal (1995) documented that
free world physicians engage in a delicate mental and verbal exercise when
confronted with negative health outcomes. His interviews with physicians
revealed that they rarely admitted their mistakes and seldom accepted culpa-
bility when their patients experienced negative health outcomes. Instead,
physicians’ discussions of negative patient outcomes revolved around issues
such as “permanent uncertainty,” “necessary fallibility,” “shared personal
and professional responsibility,” and the “exclusivity of professional judg-
ment.” Rosenthal concluded that these verbal and cognitive exercises on the
part of doctors serve to reconstruct mistakes as accidents, and the doctors
adeptly convince themselves and others that they were (a) not at fault and (b)
should not be held directly responsible for their patients’ negative health
outcome.
Jesilow, Pontell, and Geis (1993) engaged in a similar exercise in which
they reviewed a sample of disciplinary proceedings taken against California
doctors accused of Medicare/Medicaid fraud. Categorizing physicians’ writ-
ten responses to charges using Sykes and Matza’s (1957) techniques of neu-
tralization, Jesilow et al. (1993) explored how physicians redefine their
behaviors so as to avoid the displeasures that go with negative personal and
public definitions of their improprieties.1 As predicted by Sykes and Matza,
Jesilow et al. reported that physicians use verbal and cognitive rationalization
schemes to account for or justify their behaviors. That is, physicians’ com-
ments and thought processes downplayed the fault associated with their
actions and, in doing so, drew on a finite set of explanations. Similar cogni-
tive exercises also have been observed among free world nurses (Dabney,
1995) and pharmacists (Dabney & Hollinger, 1999).
CORRECTIONAL PHYSICIANS’ COMPETENCE
There is a widespread belief in the medical community that correctional
physicians are inept and cannot find free world employment, necessitating
their appointment in prisons and/or jails (Becker, 1999a; Skolnick, 1998b;
Steptoe, 1986). Indeed, journalistic, scholarly, and legal representations of
the clinical qualifications and professional competence of correctional health
personnel paint a disturbing portrait. Journalists report that “disciplined doc-
tors who are not allowed to practice on the general public are permitted to do
so behind bars—even if they have lost their Drug Enforcement Administra-

154
THE PRISON JOURNAL / June 2000
tion (DEA) license for prescribing controlled substances” (Allen & Bell,
1998, p. G2). Although the exact number is unknown, investigative reporters
have estimated that somewhere between 15% to 78% of correctional physi-
cians practice medicine with restrictions on their medical license (Allen &
Bell, 1999). For example, 30% of the 129 doctors who work in Florida’s
prison system were “not fully licensed or have a blot on their record”
(Becker, 1999b, p. 1B). According to Skolnick and Bell (1998, p. G9), 9 of 35
prison physicians working for Correctional Medical Services (CMS) in Mis-
souri experienced disciplinary action on their license to practice medicine.
This means that 26% of CMS physicians in Missouri and 30% of Florida’s
prison doctors (compared to 2.4% of physicians in the general population)
have had sanction on their medical license for misconduct (Wolfe, Franklin,
McCarthy, Bame, & Adler, 1998, p. 5).
With respect to civil litigation, numerous courts have ruled that prison
health staff lack adequate training and credentials. A federal judge in 1994,
for example, ordered the District of Columbia to “ ‘replace its unlicensed’
personnel . . . finding that ‘many of the front line treatment staff were unli-
censed, inadequately trained, and poorly supervised paraprofessionals’ ”
(Vaughn & Carroll, 1998, p. 21; Lezin, 1996, p. 194). In another case, the
U.S. Court of Appeals for the Eleventh Circuit commented that “it is diffi-
cult . . . to obtain [medical] experts . . . who are willing to accept full-time
employment in a penal...

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