Dear CURE Members and Supporters: On September
21, 2002, Federal CURE posted an Action Alert for Jeffrey (Jeff)
Johnston, #97497-071, an inmate who suffers from Limb-Girdle Muscular
Dystrophy accompanied by associated and extraordinary complications.
The following is a copy of a new letter that I have sent to Dr.
Sawyer regarding Jeff Johnston.
What Federal CURE needs you to do is to immediately send follow
up requests to the following people asking that the Federal Bureau
of Prisons (FBOP) immediately provide Jeff Johnston with the medical
care he needs and to which he is entitled. Keep in mind that the
next request we send out could bear the name of your loved one incarcerated
in the FBOP.
The broader question the FBOP must continue to answer is who is
monitoring the quality of medical care they provide to federal inmates
in all their institutions. On a daily basis, Federal CURE receives
complaints from federal inmates about both the lack of medical care
and the poor quality of medical care in federal institutions. Please
contact the following people so that we can assist all federal inmates
in securing competent medical care:
Dr. Kathleen Hawk Sawyer - ksawyer@bop.gov
Dr. Newton E. Kindig - nkindig@bop.gov
MaryEllen Thoms - mthoms@bop.gov
Bryan Pownall - bpownall@bop.gov
Geraldo Maldonado - gmaldonado@bop.gov
Joe Kelley – jkelley@bop.gov
South Carolina Board of Medical Examiners - medboard@mail.llr.state.sc.us
CNN - public.information@turner.com
Fox News - comments@foxnews.com
NPR, Talk of the Nation - totn@npr.org
NBC, Michelle Cohen - Michelle.cohen@nbc.com
Human Rights Watch - hrwpress@hrw.org
Forbes - ppatsuris@forbes.com
The Post and Courier, Barbara Williams – Barbara@postandcourier.com
January 27, 2003
Dear Dr. Sawyer:
This letter is a follow-up regarding Jeffrey Johnston, #97497-071,
an inmate incarcerated at FPC Estill, Estill, South Carolina. Jeffrey
(Jeff) Johnston has been incarcerated since January 2002, with his
initial custody location at FMC Butner, North Carolina. At his own
request Jeff was transferred, to FPC Estill on or about June 12,
2002 to be closer to his family.
In my correspondence of September 21, 2002 on behalf of Jeffrey
Johnston, I requested that the Federal Bureau of Prisons (FBOP)
perform on specific recommendations to upgrade Jeff’s level
of care. Please note the following as my previous requests with
certain amendments and or additions:
1. Jeffrey Johnston be immediately examined by independent medical
specialists, including a neurologist and pain management specialist,
to assess and treat his conditions, including but not limited to
abuse or neglect on the part of FPC Estill and or the FBOP;
2. Jeffrey Johnston be immediately provided with all testing, treatment,
medication, and any other medical recommendations made by these
independent medical specialists. Further, the FBOP provide Jeff
the level of care as recommended in the opinions of Dr. Schwartz-Watts
in her comprehensive medical evaluation. The opinions were based
on 15 years’ medical records and notes from duly licensed
physicians, specialists, medical centers and hospitals;
3. The FBOP immediately determine the availability of bed space
at either FMC Butner, FMC Lexington or FMC Rochester and affect
an immediate transfer of Jeffrey Johnston;
4. The FBOP provide Jeff clear copies of all medical records, including
lab results for the period of January 2002, his medical intake at
FMC Butner, through to the present;
5. The FBOP conduct an investigation into the conduct of all FPC
Estill medical staff that have been involved in the absence and
or refusal of appropriate medical treatment in contravention of
community standards for medical care, international human rights
conventions, and the Federal Bureau of Prisons’ own policies;
6. The FBOP investigate and correct the violations of their own
policies and procedures set forth in specific Program Statements
that ensure prompt, consistent, competent medical care for all inmates,
and;
7. The Regional Office of the Bureau of Prisons in Atlanta, Georgia,
take immediate responsibility for assuring that Jeffrey Johnston
receive the same standard of care at FCP Estill that he would receive
if he were an unincarcerated member of the Estill, SC community.
These specific requests were based on the following information:
Prior to his incarceration at FMC Butner, Jeffrey Johnston sought
an independent medical evaluation from Donna Schwartz-Watts, MD,
the Director of Forensic Services and Associate Professor of Psychiatry
at the University of South Carolina School of Medicine Department
of Neuropsychiatry. The date of this evaluation was completed on
or about December 10, 2001. [Dr. Schwartz-Watts is Board Certified
in Forensic Psychiatry and has been qualified as an expert in Forensic
in South Carolina Courts of General Sessions, Common Pleas and United
States District Court.]
In Dr. Schwartz-Watts evaluation, she clearly addressed Mr. Johnston’s
extensive medical history, including his diagnosis of Limb-Girdle
Muscular Dystrophy and injuries sustained in a motor vehicle accident
in May 2000.
Jeffrey Johnston is confined to a wheel chair due to Limb-Girdle
Muscular Dystrophy (LGMD), diagnosed by doctors at the Mayo Clinic
in 1994 and verified by Dr. Schwartz-Watts’ evaluation references.
In addition to the Muscular Dystrophy, in 1994 doctors at Presbyterian
Hospital in New York diagnosed Jeff with a lipid related metabolic
myopathy. In April 1996, Jeff was referred to the Carolina Pain
Specialists due to chronic pain from his Limb-Girdle and “emotional
happenings” in his life. In remarks obtained from a report
issued by Dr. Wendt of Carolina Pain Specialists in May 1996, the
doctor said in addition to Jeff’s Limb-Girdle disease “he
has a component of myofascial pain and apparent degenerative changes
in the right shoulder, neck and left knee.” Further, Dr. Wendt
reported: “I really do not feel there will be any problem
with chronic opioid usage.”
Dr. Schwartz-Watts also referenced Jeff’s chronic history
of gastric complaints beginning in 1987. He was initially diagnosed
with probable peptic ulcer disease and later Irritable Bowel Syndrome.
During that period of evaluation and treatment, he was diagnosed
with Hepatitis B (cause undetermined), although later records indicate
he had Hepatitis D and that the cause may have been a stab wound.
In 1993, he was diagnosed with Heliobacter infection of the stomach
and duodenum and prescribed antibiotics. Jeff also reported he had
recently had a colonoscopy for melena and that he was placed on
the medications Nexium 40mg per day and Acophex 20mg per day for
his GI condition.
As recorded in Dr. Schwartz-Watts Psychiatric Evaluation, Jeff
was in a severe automobile accident that left him with some cognitive
deficits and multiple trauma. His injuries included multiple left
femur fractures including a subtrochanteric fracture, a right talar
neck fracture, and right femur fractures. A retrograde nail was
placed in the right femur. The subtrochanteric fracture was treated
with a plate. Jeff also states that a plate and pin were placed
in his right ankle. Jeff also suffered a sternal fracture with an
anterior mediastinal hemotoma, medial clavicular fractures, a grade
III liver laceration, a right cephalotoma, right rib avulsion and
traumatic sinusitis. He also had a Greenfield filter placed because
of his multiple long bone fractures. Neuropsychological testing
on September 10, 2000 revealed a persisting post-concussive syndrome
consistent with a closed head injury. The frontal structures of
the brain showed some abnormalities on testing. A follow-up neurological
exam by Dr. Frank O. Pusey on September 25, 2000 revealed memory
deficits. Shortly after his accident, Dr. Edward A. Woody, otolaryngologist,
performed an endoscopic ethmoidectomy on Jeff due to the trauma
to his sinuses from the accident.
In her evaluation, Dr. Schwartz-Watts noted that Jeff suffers from
chronic pain due to closed head injury, retrograde nail in left
and right femur, plate in left hip, pin in right ankle, esophageal
spasms secondary to sternal injury, and depression. She reiterates
what doctors at both the Presbyterian Hospital in New York and the
Mayo Clinic in Minnesota previously stated: Jeff will require for
the rest of his life medication to handle the chronic pain as a
result of these chronic conditions. She also reported that Jeff
was recently diagnosed with hypertension. Further, she reiterated
Jeff’s report that he was being evaluated for possible renal
stenosis. Dr. Schwartz-Watts added, “which may be the etiology
for his newly diagnosed hypertension.”
Dr. Schwartz-Watts issued the following opinions in her evaluation:
Mr. Johnston does suffer from chronic pain secondary to a degenerative
myopathic condition and complicating traumas. There is no indication
that he suffers from a substance abuse disorder. He could benefit
from continued education about his condition and medications so
that he does not develop a substance abuse disorder.
Mr. Johnston could benefit from psychiatric treatment while confined.
He does have depressive and cognitive symptoms, which could improve
with psychiatric management, including medication and therapy.
Mr. Johnson will require close medical supervision for both his
chronic conditions and acute gastric conditions and now his new
onset hypertension.
In September 2002, Jeff reported that he was not receiving medications
needed for his chronic conditions. Federal CURE confirmed through
the South Carolina Medical Board that Zoltan Vendel, the prison
doctor at the time, was not licensed to practice medicine in the
state of South Carolina. Jeff indicated Dr. Vendel appeared to have
no understanding of the complexities of his medical condition. In
a sick call visit to Vendel, Jeff was told his muscle enzymes (CPK
or creatine Kinase) level was 22,800. Muscle enzymes should be no
higher than 220 upl: Jeff's were 103.6 times above normal.
The results of this specific lab test were not unique. On two separate
occasions as reported in the Chronological Record of Medical Care,
FPC Estill, Standard Form 600 for the dates of September 19, 2002
(time: 1230) and October 3, 2002 (time: 1000), the attending Medical
Officer/Physicians Assistant recorded respective CPK levels of 1095
and 979. Further, MB iso-enzyme results on both occasions were recorded
as 4.3 with the normal referenced in the October 3 entry as “N
0.0 – 3.3.”
This elevation of muscle enzymes, called myoglobinuria, occurs
when too much myoglobin is in a person's system. Myglobin elevation
can clog the kidneys and result in acute renal failure. Elevated
muscle enzymes directly affect the liver enzymes also. Elevated
liver enzymes will cause liver damage, producing cirrhosis-type
hardening of the large and small lobes of the liver. The kidney
problems allowed fluid to buildup in Jeff's body, most significantly
in his lungs. This fluid buildup can result in Adult Respiratory
Distress Syndrome, fatal in 85% of cases like Jeff's.
According to Jeff’s Chronological Record of Medical Care,
FPC Estill, Standard Form 600 dated June 12, 2002 (time: 1520) Jeff’s
primary pain medication, MS-Contin, was scheduled to be tapered
over a 32-day period with his transfer to FPC Estill. On July 25,
2002, there is a Consultation Sheet “to neurologist”
from Dr. Vendel. The reason for request includes the following:
“41 y/o W/M, wheel chair bound, 2o Muscular Dystrophy since
1992. He has been in MVA – resulted multiple fx. Even more
he has chronic pain. He has been on non-narcotic and narcotic analgesics
for many years. One month ago we started him on a non-narcotic pain
management “with” Neurontin and Indocin after detoxification
from Morphine.” We are not in possession of any record or
further reference to any such consultation with a neurologist as
noted in this Consultation Sheet. We are, however, aware of Jeff’s
repeated complaints of chronic pain to FPC Estill’s medical
staff, as noted in his Chronological Record of Medical Care, FPC
Estill, Standard Form 600 for the period June 16, 2002 through October
3, 2002.
Further, in Chronological Record of Medical Care, FPC Estill, Standard
Form 600 dated October 3, 2002, Dr. Vendel references a discussion
with Dr. Parina, C.D. where they agreed “that after the neurolological
evaluation, which is scheduled for today, …” According
to a copy of a Georgia Neurological Institute Laboratory Order Sheet,
Jeff was seen by Thomas M. Stanley, MD on October 3, 2002. Dr. Stanley
prescribed two medications the names of which I cannot provide as
our copy is unreadable. There are no additional notes or records
of findings or treatment as a result of this examination.
We do know that Jeff has experienced severe kidney pain and bilateral
weakness in all muscle groups. He has been to sickcall regularly
requesting the medical staff do something to help him. Estill’s
medical staff’s response has been “they will check his
blood levels again in 30 days.” The staff, as recorded in
Jeff’s Chronological Record of Medical Care, FPC Estill, Standard
Form 600, consists of the following individuals: Zoltan Vendel,
MD, Staff Physician; Robert Giorno, PA; Mr. Calvo, PA; Luciano Guadalupe,
Infectious Disease Coordinator; and Mohammad Naeem, PA.
We have only limited information on Jeff's current medical situation.
We are also without the benefit of Jeff’s medical records
for the period of January 2002 to June 12, 2002 while in the care
of FMC Butner, and for the period October 3, 2002 to present while
incarcerated at FPC Estill. As expressed in our September 21, 2002
correspondence and according to Jeff, the medical care he received
at FMC Butner was sufficient to maintain a certain level of comfort,
including pain management, and effectively manage his extensive
medical requirements. FPC Estill has yet to achieve this level of
care.
According to Jeff and his mother, Gayle, FPC Estill’s case
manager, Ms. Roberts, informed Jeff and his mother during a family
visit on November 20, 2002 that he was being transferred to FMC
Lexington, Lexington, Kentucky. As of Friday, January 24, 2003,
this transfer had not been affected. Jeff has been told there are
no beds available.
Federal CURE in no way condones criminal activity, but we do believe
that the neglect of any inmates' medical needs, particularly where
it may result in death or unnecessary pain or suffering, is a serious
breach of the federal government's responsibility as well as a serious
breach of the inmate's human rights. We also want to remind the
FBOP of the need to provide medical treatment in a prompt, professional
and non-discriminatory manner to inmates regardless of the reason
for or duration of their incarceration. This deliberate indifference
to Jeff's medical needs clearly contravenes key international human
rights conventions and the FBOP's own Healthcare Rights and Responsibilities
statement found in Program Statement 6000.05.
The International Human Rights Convention, Principles 9 and 24
of the Body of Principles for the Protection of All Persons Under
Any Form of Detention or Imprisonment sets forth the standards for
inmate medical care that are relevant to Jeff's medical care or
rather the lack thereof. These principles provide that imprisoned
persons shall be given medical care and treatment whenever necessary.
According to the Federal Bureau of Prisons' Health Services Manual,
the mission statement of the Bureau Health Services Division is
as follows: "The health care mission of the Federal Bureau
of Prisons is to provide necessary medical, dental, and mental health
services to inmates by professional staff, consistent with acceptable
community standards." This claim stands in stark contrast to
the callous and deliberate indifference combined with gross negligence
of the FPC Estill medical staff in the case of Jeffrey Johnston.
Jeff is currently experiencing inhumane punishment which could result
in his death in custody. This situation is unethical, unprofessional
and unacceptable.
The Federal Bureau of Prison's Inmate Health Care Rights and Responsibilities
found in Program Statement 6000.05, state as follows:
Item 4 - You have the right to know the name and professional status
of your health care providers.
Item 5 - You have the right to be treated with respect, consideration
and dignity.
Item 6 - You have the right to be provided with information regarding
your diagnosis, treatment and prognosis.
Item 8 - You have the right to obtain copies of certain releasable
portions of your health record.
Item 10 - You have the right to receive prescribed medications
and treatments in a timely manner, consistent with the recommendations
of the prescribing health care provider.
In the case of Jeffrey Johnston, the reality is:
Item 4 - He was not made aware that the doctor treating him was
unlicensed.
Item 5 - Jeff has been treated with disdain by the medical staff.
His condition has been minimized and is going under treated or untreated.
His life has been placed in eminent danger as a result of the medical
staff's deliberate indifference to his medical needs.
Item 6 - Although Dr. Vendel told Jeff about his elevated enzyme
levels, he subsequently refused to provide the treatment ordinarily
provided to a person in Jeff's condition who is not incarcerated.
Vendel's treatment of Jeff in no way conforms to a reasonable standard
of care, as one would receive in the community in which the prison
is located. By law, health care services must be provided to inmates
at a level comparable to health care provided in the community or
else their negligence meets the court’s standard of deliberate
indifference.
Item 8 - Jeff has submitted repeated requests for copies of his
medical records so that he will know exactly what has been recorded
by the FBOP about his medical condition. At FMC Butner, Jeff was
being treated appropriately, but when he was transferred to FPC
Estill, FPC Estill medical staff outright ignored the treatment
regime established at FMC Butner. The FPC Estill medical staff have
refused to treat Jeff even to the extent of providing consistent
care at the level he was receiving and that was prescribed by the
medical staff at FMC Butner who did the medical intake screening
at the beginning of Jeff's incarceration.
Item 10 - Jeff is not receiving the medications that were prescribed
for him prior to his transfer to FPC Estill. The FPC Estill medical
staff is showing deliberate indifference by ignoring the assessment
of their colleagues performed at FMC Butner.
We are deeply concerned that there have been no appreciative actions
taken by the Federal Bureau of Prisons (FBOP) on behalf of Jeffrey
Johnston. While we recognize and appreciate that his case is medically
complex, we contend the FBOP has the duty and ability to effectively
deal with Mr. Johnston’s medical issues effectively and expediently.
The FBOP should undertake a careful review of medical standards
identified in Program Statement 6000.05 and determine, through an
extensive assessment, those facilities that are complying with the
clearly stated responsibilities of the FBOP.
Sincerely,
Karen S. Bond, J.D.
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