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Gold Bricks: Five Reporting Tips from the Los Angeles Times' Prison Doctor Investigation

Gold Bricks: Five Reporting Tips from the Los Angeles Times' Prison Doctor Investigation

Picture of William Heisel

prison health, reporting on health, prison doctor, antidote, william heisel, reporting on health

At a conference recently, I told an official from a public watchdog organization that I had the perfect idea for their next cause: prison doctors.

Why are state medical boards disciplining doctors by sending them to work in prisons? Yes, there does seem to be some justice in that assignment, but does this truly captive set of patients, many of them incarcerated for nonviolent offenses, deserve to be treated by someone who may have harmed – or even killed – patients in the past? I thought the official would respond with a sense of outrage at a violation of basic human rights. Instead, the official said, "Nobody cares about prisoners."

But they do care about taxes.

After winning a Pulitzer Prize for exposing insanely high salaries and other misuses of public funds by the City of Bell, the Los Angeles Times may have found a new way to tell the prison doctor story. Reporter Jack Dolan found one of the least sympathetic public employees of all time, a doctor who had been disciplined by the state but still earned three quarters of a million dollars last year. Dolan wrote:

The highest-paid state employee in California last year, a prison surgeon who took home $777,423, has a history of mental illness, was fired once for alleged incompetence and has not been allowed to treat an inmate for six years because medical supervisors don't trust his clinical skills.

Since July 2005, Dr. Jeffrey Rohlfing has mostly been locked out of his job - on paid leave or fired or fighting his termination - at High Desert State Prison in Susanville, state records show. When he has been allowed inside the facility, he has been relegated to reviewing paper medical histories, what prison doctors call "mailroom" duty.

California prisons are a fat target and have drawn extensive media coverage, including great work by Mark Gladstone, formerly with the San Jose Mercury News, and more recent work by California Endowment Health Journalism Fellow Julie Small at KPCC. But reporters in other states should be looking for the same kinds of stories. Here are five tips from Dolan's investigation for health writers:

1. Learn to love HR. The California Personnel Board proved to be a huge benefit to Dolan. Most reporters probably don't even know whether their state has a personnel board. Find out which agency oversees the hiring and firing of public employees. Ask them for the Top 100 salaries paid last year, with a breakdown of the person's title, where they worked, and the type of pay. For example, Dr. Jeffrey Rohlfing received most of his $777,423 in 2010 through back pay.

2. Tap the feds. California's prison system offers a great opportunity for reporters because it has been essentially taken over by a federally appointed receiver. A federal court found that prison conditions were so lousy that the state could not be trusted to run its own show. That means reporters don't have to deal with the usual brick wall of silence that confronts any effort to probe the prison system. The receiver has been collecting documents and, while wanting the prison system to improve, does not have career advancement and political considerations clouding matters.

That's why the receiver's spokeswoman, Nancy Kincaid, told Dolan, ""We want taxpayers to know we had no choice in this. If you are ordered to bring somebody back to work, and you can't trust them with patients, you have to find something for them to do."

3. Pick the best pieces from the past. Dolan does a wonderful job summarizing the essential details from Rohlfing's lengthy history with state regulators. Any reporter would have felt like they had struck gold when they saw that a state prison doctor earning a high six figure salary had been faulted in a patient's death and for substandard care to other patients.

But the gold pile grew exponentially, I'm sure, when Dolan found out that Rohlfing had led cops on a car chase. "After he engaged in ‘bizarre, irrational and delusional communications,' co-workers called police. Rohlfing fled when they arrived, led a car chase through the streets and was caught at his house. Two involuntary 72-hour commitments to psychiatric wards followed."

4. Don't fall for the one-bad-apple syndrome. It's easy for a story like this to appear to be all about one extreme example that says little about the system as a whole. But, as with the great reporting the Times did on Bell, Dolan found that the Personnel Board's appeals system has allowed multiple doctors to mess up, fight their discipline and then cash in. He found that a doctor "fired for ‘extreme departure from the medically accepted standard of care,' was reinstated and collected $298,787 in lost wages. And a surgeon who had been fired, then put on three years' probation, for missed diagnoses that led to the deaths of two inmates, collected $193,779 in back pay.

California's corrections system has a history of employing troubled doctors. When a federal court installed the receiver in 2006, judges noted that ‘20-50% of physicians at the prisons provided poor quality of care,' and 20% had a black mark on their record when hired. Their shortcomings contributed significantly to the fact that a prisoner died ‘needlessly' every six to seven days in a state lockup, the judges said."

5. Understand that not all "public employee" salaries are fully paid by taxpayers. The Times had to print a clarification because, as it turns out, Rohlfing may not be the highest paid state employee. The state segregates salaries from the University of California that are a mix of public and private funding. As far as I can tell, this is not typical for public universities.

Stories about university salaries are an annual staple around the country, and the idea of keeping some of them off the books seems odd. As the Times wrote, "Some UC employees were paid more, though UC Media Relations Director Steve Montiel said significant portions of their earnings came from non-taxpayer sources."

Sounds like another public records request is in order.

Comments

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You ever want more stories about prison doctors, pls. come to me. I represent plaintiff attorneys. One in particular represented a woman in a medical malpractice case over failure to treat breast cancer. It was found while she was in jail in L.A., but once she got to prison, her 88-year-old urologist (!) treating doctor ignored it, as did everyone else. It wasn't til a guard told her she hadn't filled out the right form (3 years later), that it was even acknowledged. She tied, when she didn't have to. Even though she turned her life around, juries don't have much sympathy for former prisoners so such cases aren't of much worry to the prison system.

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I recently began working as a prison nurse and I have to say the nature of the prison environment makes it very difficult to provide quality care. All of our equipment is ancient. Paper charts are the norm. Paper charts make things more difficult because you cannot read the writing of folks and it takes far much more of your time to record on paper than it does on a computer. Trying to balance custody procedures with nursing care is also a challenge.
If an inmate is in a single cell and he is having a seizure, or clutching his chest and going to the ground, I can not enter that cell until I have 2 custody staff with me. If there are issues happening concurrently a patient can be down for several minutes before we can get in to do an assessment and provide care. Last year a nurse ignored this protocol and ended up having her cheek and neck sliced with a razor the inmate had concealed.

Inmates ask for an incredible amount of care. They have nothing to do so every bump, bruise and ache that each of us walks through our days with on a regular basis, they request care for, and we have to see each and every one of them. Inmates discuss with one another how to manipulate the system to get medications. They know exactly what to say to get certain meds. I would guess half the patients in the psych units are malingerers who are trying to either escape something on the mainline or get a psych diagnosis so they can apply for SSI upon their parole.

Its very hard to assess a patient population who are often habitual liars and are often highly assaultive. I am a new grad RN and the only reason I took the job is because the State is one of the few entities that are currently hiring new grad nurses, but I will soon be gone. There isnt much job satisfaction to be derived when you are always trying to discern who is sick and who is manipulating

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[...] Hat tip to @wheisel, who has tips from this investigation. [...]

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And here, Mr. Heisel, are some tips for you:

1. Google is your friend. It appears neither you nor Mr. Dolan make much use of it before hitting the "publish" button. Just about the time of the LA Times article, the CDCR finally got around to publicly admitting that this Dr. has been just fine and cleared him to return to seeing patients. He returned to thundering applause at HDSP, btw.

2. Check the real facts, not those erroneously reported: no one ever died at the hands of this Dr. and he was long ago officially cleared of ever having provided any substandard care to anyone. The medical board years ago deemed this man perfectly competent to practice medicine. You are missing the real story here. Documents, Mr. Heisel, not second-hand regurgitating, oops I mean reporting.

3. Check past lawsuits: this Dr. never lost any of them.

4. Bipolarity is an unfortunate handicap, but not an untreatable illness. This Dr. was treated in the mid-90s and never had another occurrence. We are all lured by infatuation with boogiemen now and then, but you are barking up the wrong tree, here.

5. Don't quote rhetoric from reporters who were tempted by bad apples. The truth behind this story is readily findable. An astute reader should be able to unearth it in 5 minutes max.

6. I urge you to take your own advice and research public records. Be prepared, however, that you may not like the result: in so doing, you may soon be embarrassed into having to publish a retraction of your article.

7. Visit Susanville and talk with nearly anyone there, especially those who work for the city and/or for the prison. Our residents will be more than happy to tell you the true story.

Are you sure you want to leave the impression that journalists might be guilty of the same thing you've jumped on the bandwagon to accuse this Dr. of? My, my, apparently soap opera stories sell better these days than the actual truth. So, have we failed to outgrow being entertained by fictitious villains and scapegoats because the truth isn't quite as sellable? Reality reporting, anyone?

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