Chapter 52: Red Tape and Bureaucracy

September 24, 1989, Southern Ohio Correctional Facility, Lucasville, Ohio

"He's faking," the middle-aged nurse, who was surly and unfriendly, declared. "Prisoners are always trying to scam the medical staff."

"I disagree, Nurse," I replied. "As I said, in addition to being a chaplain, I'm a trauma surgeon who works in the Emergency Department of Moore Memorial in McKinley. I'm confident that Kurt Bowman is not faking his TIA symptoms. He needs to see a physician immediately."

"What year are you?"

"PGY1."

She actually laughed, "A babe in the woods. I've been doing this for twenty years."

"That's 'Doctor Loucks', Nurse," I said. "Are you rejecting my report?"

"He's faking. I'm positive."

"And I am positive you are wrong," I replied. "Who is your supervising physician?"

"Call the Department of Rehabilitation and Corrections in Columbus. They'll answer any questions you have. And tell you that prisoners constantly fake symptoms."

"You took an oath," I replied. "Just as I did."

"And I have far more experience than you do, Doctor."

I was making zero headway, so I excused myself and left the infirmary. It was Sunday afternoon, so I was positive there was nobody in administration available, but I decided to verify that and followed a sign which directed me to the Warden's office. As I'd expected, it was dark, so I made my way back to the security door, and a guard let me out. I went to the main desk, signed out, then left the building. After going through the system of gates, I walked into the parking lot, where I saw Kris waiting with Rachel in my Mustang.

"How was the park?" I asked when I got into the car.

"Rachel met a boy!" Kris said mirthfully. "And they played together nicely."

"And so it begins," I chuckled.

"How did your visit go?"

"About as always, though Frank asked me to evaluate a fellow prisoner who is suffering from TIA — Transient Ischemic Attack — but who the prison nurse thinks is faking. She's wrong, but she was not receptive to my diagnosis."

"What can you do?"

"Not much at the moment. I tried to see the Warden, but given today is Sunday, nobody was in his office. I'll make some phone calls tomorrow."

"How dangerous is it?"

"TIA is, as the name says, transient, so it mostly resolves itself. That's the basic problem with the nurse — it's likely she hasn't observed the symptoms. Frank Bush, who is a trained physician, and who is with his friend all the time, has observed the symptoms. That said, he has no medical license and no equipment and would get in serious trouble if he tried to do an actual exam or tried to intervene. Strangely, someone without a medical license has more freedom than someone who has had one revoked or, in my case, has no authority to act as a physician outside the hospital or Free Clinic where I'm supervised by an Attending."

"What else did the nurse say?"

"Not much. She was dismissive and surly. I can't imagine she enjoys her job, given her attitude. Granted, she's in a prison which is, unsurprisingly, populated by criminals, which I'm sure makes her cynical. That said, she took an oath similar to mine, and the fact that she's treating murderers, rapists, drug dealers, and so on should be irrelevant. That's the one beef the cops have with me — that I don't distinguish between the 'good guys' and the 'bad guys' in the ED. Most doctors don't."

"I'd find that very hard, especially with a rapist or murderer."

"I didn't say it was easy," I replied. "I had to assist in treating Frank Bush when he was assaulted while in the County Jail. I'd give odds that the guards turned a blind eye to the assault because they felt Frank Bush was receiving 'rough justice' from his fellow prisoners."

"That's evil!"

"Yes, it is. My biggest problem with the prison system is that it is completely dehumanizing and focuses on punishment and retribution, not on rehabilitation. Are there some individuals who could never be released? Absolutely. Someone like Charles Manson is such a danger to society that nothing I could think of would justify releasing him, given what he and his followers did."

"What about the man who killed Martin Luther King?" Kris asked. "Or the one who killed Robert F. Kennedy?"

"James Earl Ray, the man who killed Doctor King, was a career criminal who had committed armed robbery and who had escaped from prison. He wasn't apprehended following his escape and killed Doctor King about a year later. He escaped from prison again about ten years later with other prisoners. They were recaptured three days later. Given he showed no remorse, recanted his confession, had a history of armed crimes, and had a murder conviction, releasing him would pose a grave danger to the public.

"As for Sirhan Sirhan, he confessed to plotting and planning to kill Senator Kennedy, but that was his only crime. He was sentenced, after a trial in California, to die in the gas chamber, but all death sentences in California were overturned by the California Supreme Court in 1972. That commuted his sentence to life in prison. Given he very specifically targeted Senator Kennedy and had no previous criminal convictions, I think it might be possible for him to be released at some point.

"And to answer a more recent question - John Hinckley, who tried to assassinate President Reagan and also shot James Brady and Timothy McCarthy — is mentally ill, which changes the entire picture. You know my take on psychiatric care, but if somehow Hinckley were found to not be a danger to himself or others, he ought to be released. That said, I'm not sure Jody Foster would agree he would ever not be a threat."

"The actress?"

"He had an obsession with her and shot President Reagan to impress her. I think she has a right to be concerned."

"What do you think about insanity defenses?"

"I think if you are truly unable to tell right from wrong, then imprisonment is not warranted. That said, being committed to a psychiatric facility, as much as I dislike them, is appropriate. Many states have changed their laws about insanity defenses since then because people were outraged that he was found 'not guilty by reason of insanity'. Fundamentally, it's a finding of non compos mentis — not of sound mind — and thus, not responsible for their actions.

"All of that said, my fellow citizens have decided that lengthy prison sentences are appropriate and that releasing felons poses a general danger to society. I can argue against that, and I will, but mostly, it's a lost cause, so I won't waste much breath or effort. Where I will tirelessly advocate and work, is to improve conditions for prisoners. A murderer is no less human than you or me and deserves to be treated as such. And we have to focus on rehabilitation, not punishment. A 'penitentiary' should be!"

"I'm sorry ... what?"

"A place where one goes to do penance or to repent. But the common usage has become 'prison', and the entire point of incarceration has changed. That said, we execute far fewer criminals than in the past, so the question of 'danger to society' is different from how it was for most of our history."

"Who will you call about Kurt Bowman?"

"I'll start with the Ohio Department of Rehabilitation and Corrections and take it from there."

September 25, 1989, McKinley, Ohio

"I can't believe Krista accused you, of all people, of trying to extort sex from her!" Kayla Billings exclaimed on Monday morning when I arrived at the hospital.

"I can't comment on that," I replied.

"OK, but making a tape recording? Wow!"

"Again, no comment," I replied. "Let's run the board, please."

"Five still here from overnight," Doctor Billings said.

"Busy night!"

"Twenty-year-old male waiting on surgery to remove a .22 slug from his right buttock."

I couldn't help but laugh, "How did THAT happen?"

"He and a buddy were drunk, and, believe it or not, he dared his friend to shoot him in the ass. You can guess what happened next."

"I'd say 'unbelievable', but I believe it! At least it was a .22 and not a larger round! Stable?"

"Yes. 5 of morphine for the literal pain in the ass, but only soft tissue damage. Surgery said they'll take him around 10:00am. Next is a sixteen-year-old girl waiting on a psych admission for cutting herself; she's sedated but stable. Twenty-three-year-old with an ectopic, who is going up momentarily; Al is waiting for the orderly with her. Fifty-four-year-old male rule-out MI but simply has severe indigestion. Monitor until 8:00am, then refer to his personal physician. Last but not least, twenty-two-year-old male heroin user with suspected hep-C waiting on admission to Medicine."

"I have it," I said. "See you tonight!"

Kayla left, and I went to the exam room for the ectopic.

"Morning, Al."

"Morning, Doctor Mike. This is Mary Frost; Mary, Doctor Mike."

"Good morning," I said. "I'm taking over from Doctor Billings. How are you feeling?"

"Scared," she replied.

"Our surgeons and OBs are excellent," I replied. "They'll take great care of you."

Just then, a pair of orderlies entered, so I forewent an exam, and Al and I helped the orderlies move Mary to the gurney.

"Go with her, please," I said to Al. "Then come find me."

"Will do!" he declared affirmatively.

Once they'd left, I checked on the other patients, all of whom were stable, though the sixteen-year-old psych consult had been given Haldol and a sedative, as she'd been extremely combative and had tried to refuse treatment.

"Mrs. Everton, When did this begin?" I asked the girl's mom.

"I didn't know about it until I saw blood on her jeans when I gathered the laundry last night. She seemed as if she was happy, though she was moody like all teenagers."

I nodded, "That is the problem with diagnosing these kinds of problems. I'm not implying anything about the cause of your daughter's actions, but a girl I had intended to marry was diagnosed with schizophrenia when we were in college. She'd shown signs in High School, but it was attributed to adolescence because, in the end, she seemed happy, was making good grades, and had a good relationship with her parents and friends."

I didn't feel the need to reveal the emotional and psychological trauma relating to her brother, as those had been definitively ruled out as the cause of Angie's behavior, a conclusion by Doctor Hoffman, with which I agreed.

"She seemed so happy," Mrs. Everton said. "I just don't understand it."

"I'm not an expert in the field, but self-harm is treatable; dialectical behavior therapy for adolescents is extremely successful. One of the main contributors to success is the entire family participating."

"I'll do whatever is necessary," Mrs. Everton said.

I was very tempted to strongly suggest she take her daughter to see a psychologist, given they couldn't prescribe drugs, but that was against protocol, and given Tracy was waiting on admission to Psych, I couldn't write discharge notes with that recommendation. And, given everything else that was going on, this was no time to pick a fight with Psych.

"Good," I said. "Someone from Psych will be down within the hour to take her upstairs. If you need anything, just press the 'call' button on the small box next to the bed."

"Thank you, Doctor."

I left the room, and Kellie came up to me and motioned to the consultation room.

"It's public," she said. "Including the fact that you recorded her."

"I heard from Kayla Billings. I had hoped against hope that it would stay secret, but I knew in my heart that wasn't likely to be the case."

"I heard some scuttlebutt in the locker room that Doctor Northrup is extremely pissed at you."

"Good for Doctor Northrup. And, frankly, he ought to be happy because he got his wish — she's bounced from the program. I suspect his complaint is that the dirty laundry is likely going to be aired in public, but that's his fault, not mine."

"Is it true that med students will be prohibited from fooling around in the hospital?"

"That was what Doctor Warren said, and there isn't a damned thing Northrup can do about it."

"You know he can really screw you over, right?" Kellie asked.

"If I were a trauma Resident, yes; as a surgical Resident? Not so much, because Doctor Cutter is fully behind me, and the tape recording was made at the direction of Shelly Lindsay. I don't know for a fact, but I'll lay odds that the idea came from above her, either from Doctor Roth or Doctor Cutter himself. Or, if not, then she cleared it with them first."

"Just be careful, Mike. All the nurses have your back. Ellie wishes you'd have her front!"

I chuckled, "She's made that clear! And I've successfully avoided her clutches for four years now!"

"Never tempted?"

"Not even for a second, given I didn't meet her until after I was married. And she's not my type!"

"But I am?"

"As you've said, under different circumstances..."

"Doctor Mike?" Al inquired from the door.

"Check the chart rack for a walk-in and call me after you do your workup," I said.

"On it!" he declared.

"There's one happy med student," Kellie observed. "He's going to get way more procedures and responsibility for another week."

"He'll handle it well," I replied. "He's one of the best Third Years and has the right attitude for emergency medicine."

"I concur," Kellie replied.

"Mike?" Ellie said from the door, "Psych is ready for your cutter."

"Thanks, Ellie. She's sedated, so we'll need orderlies with a gurney, not a wheelchair. Al is handling a walk-in, so would you ask Nate to make the call?"

"Sure thing!"

The morning was busy, and by 10:00am, I had resolved all the overnight cases Kayla had handed over, and after Al left, Jake, Heather, and I had seen another six patients, with two admissions and four treated and released. Just after 10:00am, Nate let me know I had a call. The consultation room was occupied, so I picked up the phone at the Clerk's desk.

"Mike Loucks."

"Doctor, this is Jason Firth. Do you have a moment?"

"I do," I replied.

"I need to take a full deposition from you with regard to a medical student, Krista Sandburg. I can do it at your convenience, even after hours."

"That's going to be tough, given my schedule," I replied. "How long will it take?"

"I'd estimate about two hours. I'm free every afternoon this week and most evenings."

"Let me see if I can clear a block of time with Doctor Gibbs. Could you come to the hospital?"

"Yes, or to your home, if necessary."

"I'll check right away and call you back."

"Thanks, Doctor."

"Mike is OK," I replied.

"Jason," he responded.

We said 'goodbye', I hung up and went to Doctor Gibbs' office.

"Learned your lesson?" she asked without even greeting me.

I suppressed a strong urge to roll my eyes.

"The true lesson is to give the medical student the benefit of the doubt and allow them to bounce themselves, rather than open the hospital to charges of harassment. We've been fortunate to not have been bitten in the ass by inappropriate behavior and mistreatment of medical students. Someday, we will lose, and then we're all going to pay the price. In any event, I need two hours to provide a deposition to Jason Firth, the legal counsel for McKinley Medical School. He'll come here."

She glowered, then said, "Fine. 1:00pm, though if there's some kind of major event, we'll need to pull you out."

"Understood."

"Dismissed."

I turned and left, then went to the desk and called Jason Firth to let him know I was available at 1:00pm. That completed, I saw five more patients before taking my lunch break. Rather than eat in the cafeteria, I bought my lunch and took it to the surgical lounge so I could begin what I expected would be a difficult task of obtaining medical care for Kurt Bowman. The State of Ohio didn't disappoint, as it took two transfers and a total of eleven minutes on hold to get to the office of the Chief Physician, who was the equivalent of our Medical Director.

"Private citizens are not permitted to request medical care for inmates," the assistant said. "That is limited to immediate next of kin and is subject to review."

"I'm a licensed chaplain and a physician," I replied. "I am not a 'private citizen' in the way you mean."

"Actually, you are, at least with regard to the prison system."

"Are you telling me that a report by a qualified physician of inappropriate care will be ignored?"

"You may write a letter reporting your findings and it will be evaluated, and if found to be accurate, action will be taken."

"And how long does that take?"

"Usually ninety days."

"That's unconscionable!"

"We comply with Ohio law in the matter. You are not next of kin nor authorized to treat inmates."

"And a request from next of kin?"

"Would be evaluated by the prison staff."

"The same ones who incorrectly assert he's faking?"

"In your opinion, Doctor. An opinion formed with no previous relationship with the inmate and no medical exam. Is there anything else?"

"No," I replied, then gritted my teeth and added a polite, "Thank you."

"Have a good afternoon."

We ended the call, and I considered my next move, and the only thing I could think of was to try to locate Kurt Bowman's next of kin and try that approach. I'd write a letter, but it was clear it would be ignored or given short shrift. That annoyed me, but I wasn't sure there was anything I could do about it.

I finished my lunch and returned to the ED, where I saw one patient before Jason Firth arrived. He'd arranged to use a small meeting room in the admin wing, so we walked to that room where a young woman with a steno machine was waiting, along with Doctor Warren, Doctor Worth, the Dean of Student Affairs, and Leland Crowe, the hospital legal counsel.

"This is friendly, Mike," Doctor Warren said when I stopped short walking into the room. "We're all on the same side."

"I was just surprised to see you all here," I replied.