Poor prison care causes HIV deaths, report says
27 August 2003
The Decatur Daily, Alabama
By Eric Fleischauer 
DAILY Staff Writer
eric@decaturdaily.com · 340-2435 

Dozens of HIV-infected inmates have died prematurely and miserably due to grossly negligent medical care at Limestone Correctional Facility, according to a medical report released today. 

Dr. Stephen Tabet, an infectious disease specialist, prepared the 125-page report after a prison visit. Miami-based lawyer David Lipman hired Tabet in connection with a lawsuit pending against thefacility. 

The Limestone prison houses 2,230 prisoners, about 200 with HIV. 

Tabet criticized the state's decision to segregate HIV-infected inmates in a single facility, but most of his criticisms involved what he called "grossly negligent" medical care at the prison. 

Warden Billy Mitchem did not immediately return telephone calls. 

A major failure cited by Tabet was the alleged failure of the prison to accommodate the disabilities of the ill inmates. According to the report: 

Inmates are only permitted to take showers - not baths - and many are too weak to stand for a shower. The result, said Tabet, is unsanitary conditions and high infection levels. The showers are not wheelchair-accessible, but many inmates are confined to a wheelchair. Inmates must stand in a long line to receive their medications. The sickest inmates cannot physically remain in line, so they frequently skip necessary medications. Tabet also criticized crowded conditions at the

"I suspect the patients will continue to keep getting and spreading boils and abscesses that spread like wild-fire given the over-crowded sleeping and living conditions at Limestone," Tabet wrote. 

He said many of the inmates he examined showed signs of a recent outbreak of skin infections. 

"Patients are treated like they are nuisances," Tabet said. 

He discussed one inmate who was blind - a condition that basic medical care would have avoided, Tabet said. 

Tabet reviewed the medical records of each of the 38 inmate deaths. He said every fatality was preceded by negligent care. Many of the deaths were either caused or accelerated by poor medical care, Tabet said. 

According to Tabet, a large number of the inmates died from preventable lung diseases. 

"Numerous patients are permitted to drown in their own respiratory secretions and suffocate," Tabet wrote. 

Other patients died of AIDS-related malnourishment. Tabet said doctors could have prevented many of these deaths with a better diet and nutritional supplements. He said none of the inmates received medications to increase their appetite. He noted one 6-foot-tall inmate who, at death, weighed 89 pounds. 

Tabet sharply criticized actions by staff doctors and nurses. He said nurses were quick to discontinue providing medications to inmates they deemed noncompliant, a step that should be left to a doctor. NaphCare Inc. was the health care provider for Alabama prisons until its contract was terminated recently by a new Department of Corrections commissioner, Donal Campbell. 

The lawsuit names both Naphcare and the state. 

"LPNs at Limestone are routinely practicing outside the scope of their licenses," Tabet said in the report, which the plaintiffs filed in Birmingham's U.S. District Court. 

A study commissioned by the state and released in February concluded the death rate from AIDS at Limestone is more than twice the national average in prisons and that efforts to control infectious and communicable diseases at Limestone were not adequately monitored or reported. 

Referring to one of the Capshaw deaths, Tabet said prison medical personnel give up too early on inmates.

"This patient, as were many others, was labeled with end-stage AIDS. This term became a death sentence for patients so labeled at Limestone Correctional Facility."