Women’s deaths add to concerns about Georgia prison doctor

For nearly a decade, a succession of inmates at one of the largest women’s prisons in Georgia has suffered agonizing deaths, some going days, weeks and even months before receiving treatment that might have saved or prolonged their lives, an Atlanta Journal-Constitution investigation has found.

Evelyn Spear’s complaints that she couldn’t swallow were treated as indigestion for three months before it was determined that she had cancer. By then, it had spread from her lungs to her lymph nodes.

Peggy Bean, suffering from a loss of blood to her intestines, was vomiting feces before it was realized she needed emergency surgery. She didn’t survive the operation.

Paula Cooper, who had breast cancer, was returned to the prison population after a mastectomy even though the incision was bleeding. It was still bleeding when she died five months later.

Those deaths and others paint a bleak picture of the medical treatment for inmates at Pulaski State Prison in Hawkinsville. All were under the care of Dr. Yvon Nazaire, raising fresh questions about the state’s decision to hire him as the prison’s medical director despite a well-documented history of negligence and patient deaths in New York.

The Budget Inn in Hawkinsville, where Nazaire has been living since he began his prison job nine years ago.

In a phone interview, Nazaire strongly disputed that inmates in his care died without appropriate treatment. Although he declined to meet with the AJC or answer questions in detail, he commented on some of the deaths documented by the newspaper and said he was unaware of others.

“I’m a Christian,” he said. “The same thing I would do for my wife, my family, I would do for my brothers and sisters in prison.”

Nazaire, who lives during the week in the Hawkinsville Budget Inn and commutes to his New Jersey home during off hours, added that inmates have confidence in him. “Fortunately, in spite of all the things you write, they trust me,” he said. “And do you know why they trust me? Because I am there for them day and night if necessary.”

In March, the AJC detailed how two inmates at Emanuel Women’s Facility in Swainsboro died after their symptoms went untreated for weeks when Nazaire briefly had oversight of that facility’s medical unit as part of his responsibilities.

But the AJC’s investigation of deaths at Pulaski, based on official records, inmate letters and dozens of interviews, suggests a wider problem.

At Pulaski, the AJC found, at least 15 women have died in custody while in his care, including two in the last 10 months and 11 in the last five years.

The AJC also found five other inmates who died within months after they were transferred from Pulaski to other facilities or released to their families due to the seriousness of their illnesses. In looking closer at those deaths, the AJC determined that, even though the inmates died elsewhere, most of their treatment occurred at Pulaski.

Twenty deaths in nine years in a prison population of roughly 1,000 isn’t, in and of itself, exceptional, experts in correctional health care said. The key is drilling down to know the details, they said.

“Even cancer, you might look on the surface and say, ‘Cancer’s cancer, and you will die of it,’” said Dr. Marc Stern, an educator and consultant who formerly served as the health services director for the Washington State Department of Corrections. “But if the cancer presented itself at an early stage and it was ignored or mismanaged, well, that was a preventable prison death.”

‘Everybody knew it was bad’

Some of the 20 deaths documented by the AJC appear to have been the inevitable result of diseases that took their natural course. But evidence suggests that at least seven occurred under questionable circumstances that were hard to ignore.

“To this day, I feel like I don’t have closure because I know there were things they could have done and they didn’t do them.”

Evelyn Spear’s daughter, Erica Spear

Seeing Bean vomiting feces, a sign of serious intestinal illness, so stirred emotions across the prison that it remains vivid five years later for those who witnessed it.

“It was bad,” said former inmate Janet Rice. “Everybody knew it was bad and everybody knew it was wrong.”

The painful months before Spear’s cancer diagnosis so rattled her daughter, a registered nurse, that eight years later she can’t get them out of her mind. “To this day, I feel like I don’t have closure because I know there were things they could have done and they didn’t do them,” Erica Spear said recently.

Spear, who for the past two years has worked in the medical unit that serves the Sumter County Jail and the Sumter County Correctional Institute, said the tests that revealed her mother’s illness were only conducted after she called a counselor at Pulaski and threatened to expose what was going on.

“I said, ‘Look, I’m a nurse, and if you don’t do anything, I’m going to call the warden and everybody else,’” she said.

Limited scrutiny

Although prison inmates are guaranteed adequate medical care under the Constitution, it’s often difficult to assess whether that level of care is being provided, experts in correctional medicine said. That’s because prison medical units are not monitored with the same scrutiny as hospitals and other medical facilities on the outside, they said.

“Correctional systems receive little oversight in many areas, including medical,” said Dr. Josiah Rich, a professor at the Brown University Medical School and co-director of the Center for Prisoner Health and Human Rights. “The only oversight we really have comes from the courts, with people suing, or the press.”

Tracking the number of women who have died after being in Nazaire’s care is complicated by the Department of Corrections’ record keeping.

Dr. Yvon Nazaire’s official Department of Corrections photo.

The department, responding to an open records request, provided the AJC with the names of 13 women who died in custody at Pulaski since September 2006, when Nazaire became medical director. However, in reviewing prison incident reports, the newspaper found two inmates who weren’t on the department’s list even though they died almost immediately after they were transported from the prison to Hawkinsville’s local hospital.

The number is also difficult to pin down because the deaths of inmates who are transferred or released while gravely ill aren’t counted as deaths in custody at Pulaski. The AJC tracked those deaths through the department’s records for hospital transfers and the inmates’ death certificates.

The AJC provided the Department of Corrections with a written outline of questions for this story, but the department declined to make anyone available to answer them.

Positive performance reviews

As the medical director at Pulaski, a sprawling facility that houses nearly a third of the state’s 3,500 female inmates, Nazaire holds a key position with Georgia Correctional Health Care, a branch of Georgia Regents University that provides medical services for the Georgia Department of Corrections.

The AJC obtained Nazaire’s annual performance evaluations for all nine years of his employment. They make no mention of inmate deaths or any other issues that might raise questions about his competency. Overwhelmingly positive, they have often cited his efforts to look for ways to cut costs, including limiting outside consultations.

“Dr. Nazaire is extremely vested in the success of the facility and is very important to the successful delivery of health care to the inmate population,” his most recent review, by Dr. Billy Nichols, medical director at Georgia Correctional Health Care, concluded.

Four malpractice suits alleged that patients who sought care in hospital emergency rooms in Brooklyn and Queens died because Nazaire misdiagnosed or ignored their conditions.

Nichols declined to be interviewed.

Those glowing appraisals mark a remarkable turnaround for Nazaire, who was placed in charge of the Pulaski medical unit just months after he left New York under a cloud of controversy.

Four malpractice suits alleged that patients who sought care in hospital emergency rooms in Brooklyn and Queens died because Nazaire misdiagnosed or ignored their conditions. One of those patients was a 28-year-old man who died of a heart attack a day after he was sent home with antihistamines. Another was a 34-year-old woman who died from a pulmonary embolism a day after she was released without being tested for that condition.

The New York State Board for Professional Medical Conduct found that Nazaire acted with gross negligence in his treatment of the heart attack patient as well as in his care of four other patients who weren’t the plaintiffs in the lawsuits. It placed him on three years’ probation and said he could practice only with close monitoring during that period.

The board’s order was still in force when Nazaire sought a Georgia medical license in February 2006, but the Georgia Composite Medical Board imposed no restrictions on him. Board officials have declined to explain the decision, which departed from the usual course of action when doctors with sanctions in other states seek licensure here.

Dr. Edward Bailey, who was the medical director at Georgia Correctional Health Care when Nazaire was hired, has repeatedly refused to answer questions from the AJC.

‘She felt like she was going to die’

Throughout Nazaire’s years at Pulaski, some inmates have languished without their illnesses being properly diagnosed, mirroring the way his career played out in New York, while others known to have serious conditions have not received care that might have eased suffering.

Document: Spear medical records, page 1

Spear’s medical records cite complaints of chest and throat soreness.

Before Evelyn Spear’s lung cancer was diagnosed in early 2007, her repeated complaints of difficulty swallowing and soreness in her chest and throat were treated with Mylanta and other indigestion medications, prison records show.

Spear’s daughter remembers her mother crying on the phone, describing pain that wouldn’t let her sleep.

“She said every time she’d lie down she felt like she was going to die.” Erica Spear said.

That went on for three months until she was given a CT scan. It showed that the 52-year-old had a tumor that had spread from her lungs to her lymph nodes and surrounded her windpipe.

Document: Spear medical records, page 2

A CT scan revealed that a tumor had spread from her lungs to her lymph nodes and surrounded her windpipe.

After the diagnosis, Evelyn Spear was transferred to Metro State Prison in Atlanta to receive chemotherapy and radiation. She was there five months before being released. She died a month later.

“I think it got to the point where they knew she was going to die so they let her out,” Erica Spear said.

Dr. Len Lichtenfield, deputy chief medical officer for the American Cancer Society, said lung cancer can be difficult to diagnose before it has progressed. However, if symptoms like those exhibited by Spear persist beyond several weeks or a month, there would be reason for further evaluation, he said.

“Your level of concern does increase if symptoms continue over that period of time,” he said.

No follow-up planned

In the case of 38-year-old Paula Cooper, her death from breast cancer in March 2008 followed a hurried effort by her mother and pastor to secure her release because they believed there was no plan in place at Pulaski to treat her illness.

Cooper’s mother, Joanne, said she only learned that her daughter had undergone a mastectomy when she received a call from another inmate’s father. Then, she said, she visited the prison and found her daughter in her dormitory with the incision still bleeding.

“She said, ‘Well, they just took my breast because I have cancer.’ And I said, ‘But what are they going to do?’ And she said, ‘Nothing.’”

Joanne Cooper, Paula Cooper’s mother

“I asked her, ‘What are they saying?’” Joanne Cooper said. “She said, ‘Well, they just took my breast because I have cancer.’ And I said, ‘But what are they going to do?’ And she said, ‘Nothing.’”

At that point, Cooper turned to her pastor, Donald L. White of Morning Star Baptist Church in Rockmart, who worked to make it possible for Paula to return to Rome, the family’s home town.

Paula Cooper underwent chemotherapy, but her final months were made even more painful as the incision from her surgery never healed, her mother said. “She lived five months and she bled the whole five months,” Joanne Cooper said.

White, the former chaplain at Hays State Prison, said he, too, sensed in his conversations with prison officials that they were not planning any follow-up treatment.

“I don’t want to say she was thrown away,” he said. “It was more like, ‘It’s not our problem.’”

Vile symptoms

When Peggy Bean died in March 2010, the situation was particularly noticeable because of her vile symptoms.

Known to her family and friends as “Susie,” the 51-year-old needed help walking “after she got so weak from throwing up pure feces” in the days before her death, inmate Lila Cumbee wrote in a letter to Bean’s family.

Document: Bean incident report

“I have many pages that I’d like to send to explain how Susie was denied medical attention from 6:30 (Saturday) evening til  she was admitted to medical around 9 a.m. Monday,” Cumbee wrote.

Bean was hospitalized the following Tuesday and immediately underwent surgery after doctors there determined that a section of her bowel had died because its blood supply was cut off, according to a prison incident report. But her condition was quickly determined to be irreversible.

On Bean’s death certificate, it was noted that she had suffered from a lack of blood to her intestines for days.

According to Bean’s brother-in-law, Dave Hurd, part of the inmate’s colon was removed several years earlier when she underwent surgery for a blockage. That in itself should have created greater urgency, he said.

“She had a history, and she was throwing up feces,” Hurd said. “You don’t have to be a medical doctor to see the problem.”

Dr. Avlin Barlow Imaeda, a specialist in digestive diseases at the Yale University School of Medicine, said vomiting feces is actually a backup of bacteria indicating a blockage or other serious intestinal disease that needs immediate attention.

“I would say that is something that should trigger a hospital visit pretty quickly,” she said.

In a brief discussion of Bean’s death, Nazaire said he was spending time at his New Jersey home and didn’t learn the extent of the inmate’s illness until he spoke to a nurse upon his return.

“I was so furious about that nurse, she was fired, I think, the same day,” he said.

Months with COPD

A similar situation unfolded in March when 58-year-old Bonnie Rocheleau died from double pneumonia less than two hours after it was diagnosed in the prison infirmary.

Writing to Rocheleau’s brother, Carl Fender, inmate Leasa Hunter described how Rocheleau struggled with COPD and had been nearly immobile because of it for months.

“On a good day, it was a task for Bonnie to make the walk to medical,” Hunter wrote. “I know. I took the walk daily with her for pill call. … Once there, they did administer a breathing treatment. She was by no means stable. They sent her back to the dorm. Nothing else was done for her.”

Another inmate said Rocheleau was helped to the infirmary four times in the days preceding her death and was returned to her dormitory each time. Finally, on her last trip, her lips were purple, the inmate said. The AJC agreed to protect the inmate’s identity because of her fear of retribution.

Document: Hunter’s letter to Rocheleau’s brother

Dr. Albert Rizzo, senior medical advisor for the American Lung Association, said pneumonia is unpredictable and can quickly become deadly. However, patients with compromised lung function are more predisposed to the disease and should be treated “with a little more caution,” he said.

Nazaire said Rocheleau’s condition was not ignored and that in fact he sent for her on the day the pneumonia was discovered.

“When she came (to the infirmary), I said, ‘She’s not in great shape,’ and got her an X ray,” he said.

In letters to Fender last December, Rocheleau discussed her COPD and how it had affected her breathing.

“Quit smoking … over four years ago, thought I was getting better,” she wrote. “When the COPD kicked in, it broke my heart.”

Her goal was to be paroled in August, she wrote, adding that she hoped her family would help by contacting the parole board.

“Today I’m OK,” she wrote. “Can’t tell you about tomorrow.”

How we got the story

Atlanta Journal-Constitution investigative reporter Danny Robbins began examining Georgia’s prison doctors late last year, detailing how one in five were hired despite state board orders for substandard care and other transgressions. One of the physicians spotlighted in that story was Dr. Yvon Nazaire, who was licensed without restriction in Georgia and hired for his prison job even though he was in the midst of a three-year probation for negligence in his treatment of patients in New York.

Next, Robbins reported on how two inmates died after their symptoms went untreated for weeks in at Emanuel Women’s Facility when Nazaire had responsibility for their care. In response to that March 28 story, the AJC received dozens of calls and emails raising questions about the medical treatment of inmates at Pulaski State Prison, a larger facility where Nazaire has been the medical director for nine years

Robbins then began seeking to determine how many inmates have died at Pulaski after being in Nazaire’s care and whether those deaths also occurred under questionable circumstances. From the Georgia Department of Corrections, he obtained the names of 13 women who died in custody, but he also found, through prison incident reports, two others who died immediately after being hospitalized. He also examined prison records for hospital transfers and found another five inmates who died from their illnesses in a matter of months after they were transferred to other facilities or released. Using death certificates, Robbins looked closer at the circumstances, found family members and obtained inmate letters, medical records and other documents. This story and one coming later this week are the results of that effort.