CONCERNS ARISE OVER PREVENTABLE INMATE DEATHS

Oklahoma City - Between January 1990 and February 1999, at least 413
inmates died in state custody, according to a Tulsa World survey of
Department of Corrections and Medical Examiner's records.

The causes of those deaths ranged from pneumonia to an ulcer to an
array of cancers.

Claremore resident Karen Linduff hopes her daughter won't be added to
the list of inmates who die from causes that could have been treated
successfully in prison.

Since 1986, Karrie Linduff had been in and out of prison for
drug-related convictions, most recently beginning in February 1995 at
Mabel Bassett Correctional Center in Oklahoma City. While in prison,
she complained of menstrual complications, fearing that she had cancer.

In a July 2 letter to the prison's health services adminis trator, she
wrote: ``I know there is something wrong with me inside because the
pain is unbearable. . . . Can you please help me? I am really afraid
that it could be cancer or a cyst.''

When she was released from prison in December 1998, she discovered
that she did have cancer of the uterus and ovaries that had spread to
other organs. Linduff had surgery to remove it and is now taking
chemotherapy. One of her doctors has said her prognosis is poor.

Of 182 prisoners who died in DOC custody between January 1995 and
December 1998, the leading causes of death were cardiovascular
problems and cancer, according to the Tulsa World analysis. Other
inmate deaths resulted from cirrhosis, pneumonia and diabetes.

The largest percentage of deaths occurred at the Lexington Assessment
and Reception Center, with 90 deaths, and the Oklahoma State
Penitentiary, with 79 deaths excluding executions. Both are among the
system's largest facilities and have infirmaries that treat inmates
from other facilities.

There were 14,658 inmates in DOC facilities as of March
15.

U.S. District Judge Michael Burrage is to begin hearing arguments in
federal court in Tulsa on Monday about whether he should appoint a
receiver to oversee medical services in state prisons.

Tulsa attorneys Louis Bullock and Thomas Seymour allege that
deliberate indifference caused preventable deaths and unnecessary
suffering in state prisons. The U.S. Justice Department has filed a
brief siding with their request for a hearing.

The Department of Corrections says it has made changes in its medical
operations following a scathing evaluation done by Robert Greifinger,
a nationally recognized expert in correctional health care. Greifinger
found that DOC's handling of chronic diseases including tuberculosis,
asthma and diabetes did not meet accepted standards in many facilities.

Greifinger was also critical of DOC's handling of life-threatening
conditions, including failure to follow up on inmates who were
suspected of having cancer.

``Of the records reviewed of inmates with recent deaths, all
demonstrated that the deaths could have been postponed, with less
suffering and lower cost,'' Greifinger concluded.

Another study commissioned by DOC found that out of 41 inmates who
died between July 1997 and July 1998, 10 deaths were ``possibly
avoidable.'' The study was discontinued by DOC due to a lack of funding.

Greifinger's 1998 report wasn't the first time DOC's medical care had
been found lacking. In 1974, a federal court reviewed medical care at
Oklahoma State Penitentiary, saying the prison was "incapable of
providing, has failed to provide, and continues to fail to provide
adequate medical care for inmates."

Four years later, the court examined the entire system of care, saying
the care "remains so woefully inadequate that the Court cannot ignore
its obligation to insist on stringent steps to end this constitutional
violation."

`Quality care costs money'

Officials say that if a receiver is appointed, costs will rise.
Lawmakers will be forced to find a way to pay for the costs, which may
require cutting spending in other areas of government.

Figures show that while the prison population has grown over the past
several years, the percentage of funds spent on medical services to
inmates has dropped.

The Department of Corrections recently hired a new chief medical
officer, Dr. Armond Start, who says that in order to provide proper
care, the department should spend about 10 percent of its budget on
medical services.

The department currently spends only 5.46 percent, a figure that does
not include funds appropriated to state hospitals for the treatment of
inmates.

DOC officials once used the low dollar amount spent on medical
treatment for each inmate as evidence that they were controlling their
spending. Now, faced with possible federal intervention, corrections
officials use the figure to explain to lawmakers why they need an
additional $7 million for medical care.

While Oklahoma ranks third in the nation in the number of residents
per capita in prison, the amount it spends on inmate medical care is
near the bottom. According to a survey by Corrections Yearbook,
Oklahoma spends $4.05 per day per inmate on medical care, ranking
behind only four other states surveyed.

"All I can say is when you are the cheapest in the nation, it doesn't
mean necessarily you are providing total quality care, because quality
medical care costs money," said James Saffle, Oklahoma Department of
Corrections director.

But for countless Oklahoma families, quality was never an issue.
Simple access, they say, was denied.

Who pays for care?

Correctional medicine experts say inmate health care boils down to
paying now or paying later.

``The longer you delay treatment, not only does the disease progress
into something that might become more expensive, you also then have a
period of time when more and more people are exposed to that risk,''
said Edward Harrison, president of the National Commission on
Correctional Health Care, which develops standards for prison health
care.

The commission, which accredits 211 prisons and jails nationwide, has
not accredited any Oklahoma prisons. Oklahoma prisons are accredited
by the American Correctional Association, which has less stringent
medical requirements.

The bulk of inmates eventually return to society, some with hepatitis,
AIDS or tuberculosis. For ex-inmates who are indigent, society pays
the cost of health care and risks the spread of contagious diseases
that were not treated in prison.

Karen Linduff believes her daughter's cancer could have been detected
earlier had prison officials been more responsive. On a recent day at
her Claremore home, she leafed through a pile of envelopes containing
bills for various hospital izations, procedures and surgeries for her
daughter.

Her daughter has applied for public assistance to pay the bills,
Linduff said.

The cost of treating uterine or cervical cancer in the early stages is
much less expensive than treating it later because it is contained,
said Roderic Gottula, president of the Society of Correctional
Physicians and former chief medical officer for the Colorado
Department of Corrections.

Officials say they cannot seek Medicaid to cover the costs of indigent
inmate care. Once a person becomes a ward of the department, he or she
becomes ineligible for Medicaid, Gottula said.

The Oklahoma Department of Corrections recently joined several other
states in charging minimal fees to inmates for clinic calls and
medications. Inmates are charged $2 for prescriptions and $2 per
clinic visits. If they cannot pay, their inmate accounts are billed
and the costs are paid by any future deposits.

Staff becomes jaded

Over time, correctional doctors and nurses can become hardened after
frequently being "gamed" by inmates, said Gottula, who frequently
gives speeches on ethics and empathy in correctional health care.

Frustration with the correctional system, which is a difficult place
to practice due to security constraints, can create a jaded attitude,
he said.

As a result, correctional health professionals over time may not
believe inmates when they complain about perceived health problems.

"A good percentage of cases I have reviewed from a medical and legal
standpoint, the issue boiled down to the inmate not getting care
because they did not believe him when he said he was having chest
pain," Gottula said.

Changing that attitude has been a crusade for Gottula.

"You can start fixing it by doing some educational activities with the
jails and prison systems," he said.

Families who are frustrated with perceived poor medical care have
taken to calling wardens, health care administrators and physicians.
They are also writing to the governor and asking various civic groups
to intervene on their behalf.

Groups such as Oklahoma Cure and Families in Crisis have formed to
look out for the interests of inmates.

Some families say their attempts to help their ailing relatives in
prison have been rebuffed.

James Wagner died on Oct. 31, 1997, while in state custody. His family
said he suffered from hepatitis C and cirrhosis of the liver.

They tried unsuccessfully to put money on Wagner's books to pay for
expensive medicine to treat Wagner, but they were told that it could
not be done, family members said.

Jo Stealer of Tulsa tried to send her son, David Yenger, money so he
could see a private doctor for complications from Crohn's disease.
Stealer said she was given a variety of reasons why it could not be
done.

And Karrie Linduff worries about the health of many of the women she
left behind at Mabel Bassett.

"Some of the best people I met were in prison," Karrie Linduff said.
"They just made a mistake."