THE DALLAS MORNING NEWS

January 5, 1997, Sunday, HOME FINAL EDITION

Eight prison doctors have discipline records State official defends quality of inmate care

BYLINE: Christy Hoppe, Austin Bureau of The Dallas Morning News

SECTION: NEWS; Pg. 1A

LENGTH: 1927 words

DATELINE: AUSTIN

AUSTIN – In June 1990, the state of Michigan revoked Dr. Robert A. Komer’s medical license for sexually abusing six patients; one of them attempted suicide after an encounter with him.
Dr. Komer did not contest allegations made in sworn affidavits that he drugged several severely depressed patients and then fondled them. Or that he instructed a woman with a personality disorder to perform oral sex on him at the end of therapy sessions, according to Michigan records.
Subsequently, citing the Michigan findings of sexual misconduct and incompetency, California, Ohio and Arkansas joined Michigan in revoking his medical license.
Currently, Dr. Komer is the psychiatrist for troubled inmates at the state Pack and Ferguson prison units in East Texas.
Dr. Komer is among eight doctors identified by The Dallas Morning News who practiced in state prisons last year after having been publicly disciplined by medical review boards.
Dr. Michael Warren, health care director for the Texas Department of Criminal Justice said that with almost 140 doctors on staff, it is not unusual that some would have problems.
Dr. Warren said that medical care at prison units is of high quality and that it is carefully monitored by supervisors at the unit, and at the regional and state levels. He said backup is available where needed.
Texas Board of Medical Examiners records show that five of the cited doctors are practicing with restrictions ordered by the board, and three others were on probation as recently as 1994.
The doctors were hired before a change initiated two years ago that has moved prison units into a managed-care system, state medical officials said.
Previously, prison medical staff members were Department of Criminal Justice employees. Under the new system, doctors and hospital and emergency services are provided under blanket contracts with the University of Texas Medical Branch at Galveston and the Texas Tech University Health Science Center.
The Criminal Justice Department’s medical personnel were retained in the transition, said Dr. Jason Calhoun, medical director at the UT Medical Branch.
“I think it’s a quality issue, and I think it’s appropriate that it’s raised,” said Dr. Calhoun of the cited doctors.
“At the same time, I think the university is slowly trying to raise the quality of physicians at the prison units,” he said.
Dr. Komer came to Texas and began working with prisoners in 1990, practicing under his medical license here. The Board of Medical Examiners, based on the Michigan findings, placed him under probation for three years and ordered him to undergo psychiatric treatment.
His Texas medical license was fully restored in 1994. He declined to comment for this article.
Since 1989, four of the doctors – Martin E. Baurer, Horace B. Halbert Jr., Wayne F. Keller and Francis Cherian – agreed to probationary terms or restrictions for overprescribing drugs, records of the medical board show.
Dr. Baurer said his probation ended in 1995, and he is no longer under any restrictions. He declined to comment further.
Dr. Halbert said he had done nothing wrong and agreed to the disciplinary actions because it was the quickest and easiest resolution.
Dr. Keller, who ended his employment at the McConnell unit in Beeville in November, and Dr. Cherian could not be reached for comment.
A fifth doctor, Martin H. Chaney, completed probation for improperly writing prescriptions in 1988 after officials reduced by three years the length of oversight. The board found that he repeatedly over a six-year period prescribed controlled substances to a family member, despite signing affidavits affirming that he would not. He also had lost his state and federal permit to prescribe such drugs.
Dr. Chaney did not contest the findings.
He faced the medical board again in November 1995, when it found that over a two-week period he had “failed to adequately evaluate” a 29-year-old inmate, who subsequently lapsed into a coma and died of complications from meningitis.
As a result, Dr. Chaney was told by the board that he “shall practice only in a facility of the Texas Department of Criminal Justice or in an institutional setting approved in advance in writing by the executive director of the board.”
Dr. Chaney, reached at the Goree unit in Huntsville, said he is fully capable of administering quality medical care. He declined to comment further.
Another of the disciplined doctors was Tommy E. Swate, who was not a state employee but worked under contract at the Briscoe unit in Dilley last year.
Dr. Swate was placed on probation for five years in January 1992 after evidence of 14 botched abortions, which included lacerating the cervix and uterus on one patient. There were additional indications that he perforated the uterus of one woman, aspirated the uterus of another and perforated the bowel of another patient.
The medical board found the abortions showed “evidence of professional incompetence which injured the patients involved.” He agreed to a five-year probation in January 1992, which included a prohibition from conducting abortions.
Dr. Swate subsequently worked with two Houston methadone clinics, which were shut down in 1993 by federal authorities after they were shown to display “a dangerous pattern of methadone dispensing.”
A federal show-cause action alleged that Dr. Swate, “had engaged in various violations” of federal and state regulations, including falsification of medical records and selling methadone to an undercover agent for no medical purpose.
In February 1996, the medical board reviewed the methadone report and concluded that Dr. Swate had committed “unprofessional or dishonorable conduct that is likely to deceive or defraud the public or injure the public.”
The board placed Dr. Swate on probation for 10 years, ordered 50 hours of continuing medical education, 120 hours of community service a year and ordered him to repeat a medical residency or limit his practice to an institutional setting.
In the course of the investigation, the board also found that Dr. Swate had falsified information regarding his medical practice to the Louisiana State Board of Medical Examiners. That board also placed him on probation for four years beginning in January 1994.
He is no longer working at the Briscoe unit and could not be reached for comment.
The eighth doctor disciplined is Walter K. Long Jr., who was cited by the medical board in April 1994 after several private-practice patients developed complications from gastric stapling procedures.
He was indefinitely prohibited from performing such surgeries.
Dr. Long said that he believes the board targets doctors who treat obesity with surgery, and he noted that there was no finding of medical negligence.
He also said that the restriction against him in no way limits his abilities to practice all other forms of medicine. “This is just saying, We chopped off your little toe.’ It doesn’t mean you’re unqualified to stand up,” he said.
That such doctors have been treating inmates is unfair andunwarranted, said Marta Glass, a nurse and prisoners’ advocate with Citizens United for the Rehabilitation of Errants.
Unlike most people, inmates have no choice in their medical care, and a disinterested or incompetent doctor could mean a death sentence, she said.
“I think the amount of tax money we’re paying to provide for these doctors dictates that we provide good medical care,” Ms. Glass said.
The salaries of the eight doctors ranged from $ 111,000 to $ 130,000 a year, according to state records obtained under the Texas Public Information Act.
All eight happen to work in prison units overseen by the UT Medical Branch. Under the managed-care contract between the Criminal Justice Department and the university hospitals, the UT Medical Branch is paid a maximum of $ 406 million to oversee the 70 prison units in South and East Texas. Texas Tech is paid a maximum of $ 65 million to care for the 25 West Texas units.
Ms. Glass said inmate maladies include cancer and AIDS, and prisons require careful medical attention because of the constant potential of tuberculosis or another contagious disease spreading quickly through a facility.
“A sick person is a patient, and you treat them with the same dignity you treat any other patient. Whether they robbed a bank 20 years ago has nothing to do with it,” Ms. Glass said.
Dr. Calhoun, the UT Medical Branch official, said that employment due process prohibits the facility or any state agency from firing doctors for past disciplinary actions that have been resolved by the medical board.
“None have violated the requirements of the Board of Medical Examiners, so as their supervisor, they have my support,” he said.
He said the doctors can only be judged on new infractions, should any occur.
Dr. Calhoun said that the medical board actions raise concerns and that he doubts he would hire doctors with histories of probation if they came in his door today.
“Right now, we’re at a point where we could be fairly selective,” he said.
Dr. Calhoun said that 47 physicians and psychiatrists have been hired for the prison units in the past two years.
Previously prison units, especially in rural areas, had difficulties attracting sufficient medical staff, but “by having the university here, we’re now able to bring in more qualified individuals,” he said.
Dr. Calhoun said he could not discuss any employee individually, but he acknowledged that the required monitoring and medical restrictions against some pose “a handicap.”
For instance, during their employment, three of the doctors were prohibited from administering certain prescription drugs.
“It requires us to pick up the gap. We have to make sure there is another physician there that is able to do that,” he said.
Dr. Warren, the Criminal Justice Department’s health director, said that as long as the restricted doctors “do whatever the board requests of them, and because of our supervisory programs, I think we’re fine.”
He also said he understands that patients can’t choose their doctor. “So it’s our responsibility to make sure the care they get is high quality, and that’s what we do,” Dr. Warren said.
Three of the men in question – Dr. Swate, Dr. Chaney and Dr. Halbert – have restrictions placed on them that mandate they work only at the Criminal Justice Department or another institution.
Dr. Halbert, a physician at the Ferguson unit in Huntsville, was prohibited from administering certain drugs to himself or family members until November 1991. In 1993, he was reprimanded again over allegations that he failed to keep complete patient records, which he denied.
The board has removed any restrictions against him as long “as he practices medicine in the institutional setting of the Texas Department of Criminal Justice.”
“The restrictions really didn’t limit the type of practice I was doing and was intending to do,” he said, adding that the quality of medicine “in the prison system is equivalent if not better than in the free world.”
The decision to restrict doctors’ practices to institutions is not a value judgment about patients, said Jeff McDonald, hearing section chief of the medical board.
“The board wants to make sure they have proper monitoring, and there is a great deal of supervision for doctors in the institutional divisions,” Mr. McDonald said.
Mr. McDonald estimated that of the 40,000 physicians licensed in Texas, about 340 are under probation.
“It’s a very small percentage,” he said.