CLAIMS OF MEDICAL MISTREATMENT

A few hours after correction officers allegedly beat Thomas Pizzuto at
the Nassau County jail, the injured inmate was taken to the infirmary.
There, according to lawyers for his family and officials close to the
case, a jail medical technician made a simple diagnosis: He had a black eye.

The recovering heroin addict, who did not tell the technician that he
had been beaten or contradict a signed statement that he had fallen
and hit a sink, was given a dose of methadone for his cravings and
dispatched back to the cell, his face swollen, his body bruised, his
insides battered.

Three days later, the 38-year-old Hicksville man was overcome with
tremors and rushed to Nassau County Medical Center, which oversees the
jail infirmary and inmate care. After another three days, after being
moved out of the intensive care unit and into the hospital prison
ward, he died.

The death of Pizzuto from a ruptured spleen has been ruled a homicide,
but this account of his medical treatment, given by his family and
their lawyers and by sources close to the investigation, raises
questions about the care he received in the jail health care system.

Jail and hospital officials have refused to comment on the specifics
of the Pizzuto case, and NCMC chief executive officer Jerald C. Newman
declined again to do so yesterday. But Newman said that, in general,
inmate care has been ''adequate and appropriate'' and that top
hospital physicians have been filling in at the jail facility to
ensure that.

But as the FBI and the U.S. Justice Department probe whether
correction officers beat Pizzuto and whether there is widespread
brutality at the Nassau County Correctional Center, interviews with
attorneys, hospital and jail officials and critics, and a review of
complaints and state documents, portray an institution plagued for
years by claims of medical mistreatment.

In lawsuits, complaints and letters, inmates at one of the largest
county jails in the country have said they were denied medications
they needed and given only slipshod attention. Three times over the
past nine years, the State Commission of Correction has pointed out
failures in the jail's health care and suggested improvements. In
January, 1998, after an inmate with HIV gave birth to a baby in her
cell, Nassau District Attorney Denis Dillon said ''a woman collapsing
on the street would have received better care'' than the pregnant
inmate was given.

Dillon said in a letter then to Sheriff Joseph Jablonsky, who runs the
1,800-inmate facility in East Meadow, that the incident highlighted
''significant deficiences in the Correctional Center's
operation.''

''The medical care at the jail is a disaster,'' said a longtime
official at the Nassau County Medical Center. ''It is at a point where
people are getting hurt and people are getting killed,'' said the
official, who declined to be identified.

Though denying systemic problems, Newman said he began yesterday
implementing a comprehensive plan to increase medical staffing at the
jail, centralize care at the institution's infirmaries and minimize
transporting inmates to the hospital.

The plan, which he said was completed by the hospital Jan. 21 and
approved by County Executive Thomas Gulotta on Monday, calls for
adding more shifts for sick call and incoming-inmate physicals, as
well as hiring a full-time jail medical director and additional
doctors and nurses, including a podiatrist and pharmacists, a
dietician and dentist. The jail will also receive two secretaries or
clerks to speed up the processing of medical paperwork.

One of the linchpins of the plan, Newman said, is the appointing of a
health care coordinator in the Sheriff's Office. That person, he said,
would be responsible for producing monthly status reports on jail
medical care, reviewing procedures and incidents.

The program will be assessed by the Sheriff's Office and the hospital
on a yearly basis. Newman said it will not cost any additional money
because it replaces part-time positions with full-time staff and
reduces overtime.

''This is really making certain that the level of service will always
be what it should be,'' Newman said.

Deputy Undersheriff Ernest Weber said that while his office's role in
medical care is limited, over the years there have been vast
improvements in the physical plant at the jail, including opening a
new infirmary and a satellite infirmary in the early 1990s. Before
that, inmates were cared for in one ward built in 1955.

Weber said that the jail itself is working to manage cases better,
more fully meet the needs of individual inmates and efficiently
coordinate varying medical services.

These moves by the hospital and the jail come after years of
complaining from outside and within. The hospital has long had
difficulty retaining staff to work in the jail, considered an
undesirable posting.

In 1990, the state Commission of Correction recommended better
follow-up and more aggressive evaluation of inmates after inmate
Elizabeth Becker died when jail doctors failed to give her medication
for high blood pressure. Three years later in reaching a $50,000
settlement with the 71-year-old Hicksville woman's family, an
assistant county attorney said, ''We thought we had some exposure in
terms of the allegations of the case.''

Last December, the commission suggested similar improvements and the
appointment of a health care supervisor, following the death of
Christopher Jackson, an inmate with sickle cell anemia. The agency
found that medical staff did not sufficiently heed Jackson's
complaints, did not develop a plan to manage the 28-year-old Locust
Valley man's pain and did not monitor his condition after trips to and
from the hospital and the jail.

During his last few days, still trembling from a massive seizure,
Jackson was moved from the intensive care unit to the prison unit at
the hospital because of a bed shortage, the report found.

Fred Brewington, an attorney in Hempstead who represents the Jackson
family as well as an inmate who says he was beaten, said the
complaints of poor medical care and physical abuse show there is a
pervasive climate of callousness at the jail.

''They are interrelated issues that cannot be separated. They are
inextricably intertwined,'' he said. ''The frame of mind that allows
individuals to brutalize persons who are essentially helpless and in
their custody is essentially the same mentality that allows
individuals that are in dire need of medical treatment to go without
for a prolonged periods of time.''

In Pizzuto's case, sources familiar with the investigation said the
medical technician was presented with the inmate's statement that he
fell, and did not perform an examination. But Pizzuto's lawyers said
they couldn't believe no one noticed the gravity of the man's condition.

''You're not talking about a black eye, you're talking about severe
black and blue that runs the entire side of his face. We're talking
about massive facial trauma,'' said attorney Felice Muraca of Mineola.
''The only way you wouldn't pick it up is if you had every part of his
body covered.''

Robert E. Kessler and Robin Topping contributed to this
story.