Cardiac & Resuscitation, News, Patient Care

Possible Medical Neglect In Inmate Deaths Stirs Concerns in Texas

AUSTIN, Texas — Eleven months ago, convicted murderer Larry Louis Cox died of injuries after scuffling with guards at a Huntsville prison and receiving limited medical care for more than a week as he lay in his cell. A medical examiner ruled his death a homicide due to medical neglect.

No one was prosecuted or disciplined.

In June 2003, a convicted sex offender hanged himself in front of guards at a prison near Wichita Falls, and, even though they immediately cut him down, he died after medical treatment was delayed.

No one was prosecuted or disciplined.

John Whitmire, chairman of the Texas Senate Criminal Justice Committee, said he fears that those deaths could be the tip of an iceberg amid a growing list of disturbing trends: Belt-tightening has left many prisons without medical staff at night. Other prisons operate with greatly reduced medical staffs. A shortage of prison guards could be further limiting access to medical care.

“It’s what I don’t know that scares me,” Whitmire said Tuesday as he asked the Texas Department of Public Safety and the FBI to investigate Cox’s death at the Huntsville prison unit. “We need to get to the bottom of this.”

From 2001 to 2005, federal statistics show, 1,933 convicts died in Texas prisons, more than in any other state including California, which had 1,672 deaths and has a larger prison system than Texas. California had 175,115 prisoners and Texas 172,889 as of June 30, 2006, according to the federal Bureau of Statistics.

Whitmire, D-Houston, has scheduled a Jan. 24 hearing of the Criminal Justice Committee to examine prison health care, which is provided by the University of Texas Medical Branch in Galveston and Texas Tech University. Both universities declined to comment Tuesday.

In Cox’s case, internal prison system investigation reports reveal, prison guards at times did more to aid the critically injured convict than did the medical staff.

On Jan. 23, 2007, the reports show, Cox, 48, began kicking at two guards at the Estelle high-security unit as he was being placed back in his cell. As they “forcefully placed Cox on the floor,” he hit his head on the edge of his bunk and on a footlocker. He was handcuffed at the time.

A nurse and prison medic examined him, and he was taken to Huntsville Memorial Hospital, where a CT scan of his head and neck showed no fractures. He was taken back to prison, where, within hours, Cox told guards he was paralyzed.

Because the prison clinic is closed at night, a guard gave him Tylenol, according to an investigative report. He went to the clinic the next morning and was given two oral prescriptions and sent back to his cell.

When a medic tried to give him his pills hours later, the report said, “Cox could not rise to accept it so (the patient care assistant) noted the attempt as ‘refused.'” A correctional officer “hand fed” him medicine a short time later.

The next morning, Cox could not rise to take the medicine, which the medic again noted as a refusal. By this point, Cox was defecating on himself and could barely move. Another exam at the prison clinic was followed by medications listed as “refused.”

Concerned that Cox appeared to be dying, a correctional officer ignored prison rules to alert his own stepmother — a nurse manager for UTMB — who arranged for a medic from another unit to examine Cox at night.

Cox was sent to UTMB’s John Sealy Hospital in Galveston, where his condition deteriorated steadily. By Feb. 6, 2007, two weeks after he was hurt, Cox was dead.

In an autopsy, Dr. Stephen Pustilnik , Galveston County’s medical examiner, ruled the death a homicide. “Medical neglect complicating blunt force trauma,” the report states.

“That’s the first time I remember that ever being listed as the cause of death,” said John Moriarty, the prison system’s independent inspector general. “Because of that, we felt this was a case we had to take all the way.”

However, a Walker County grand jury in Huntsville took no action after reviewing the details, said Gina DeBottis, chief prosecutor for the Special Prison Prosecution Unit that handles prison crimes.

Other state agencies and the FBI subsequently decided not to pursue the case, prison officials said.

Events were similar in the June 19, 2003, case at the Allred unit prison near Wichita Falls, where investigative reports show that Richard Mc Atee, serving 12 years for aggravated sexual assault of a child, hanged himself about 6:30 p.m. After delays at the prison infirmary, McAtee was rushed to a hospital, where doctors pronounced him dead at 7:39 p.m.

Investigators criticized the prison medical staff for their inability to respond quickly. Cardiopulmonary resuscitation was not immediately administered because one nurse forgot her medical bag, one report shows. At the prison infirmary, seven minutes elapsed before CPR was started because the nurse “was unable to locate a one-way breathing apparatus or ambulatory bag.”

Prison investigators referred a complaint over the delays to the state Board of Nursing Examiners. Moriarty said no one was disciplined.

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