Rules on inmates’ care need review

State prisons are required by the U.S. Constitution to provide adequate medical care to inmates, but a recent case has fueled questions about whether Hawaii has fulfilled that role. A medical claims panel’s recommendation backing an inmate who nearly died because of alleged malpractice should prompt an examination of the state prisons’ medical response procedures and improvements in policy, as needed.

Dr. Steven DeWitt, the former medical director at Halawa Correctional Facility, testified in an October 2011 parole hearing that he had never seen an abdominal disorder like that of inmate Thomas Lauro "because it doesn’t happen to people given appropriate care." DeWitt, who died a year ago, said Lauro would "pay a big price" living with the consequences and the state Department of Public Safety (DPS) also would "pay a big price." Indeed, the state Medical Claims Conciliation Panel recommended that the state pay Lauro $5 million in compensation for ignoring symptoms that led to deterioration of a pre-existing gastrointestinal disease, which eventually led to colon removal.

State prisons are required to provide inmates with adequate medical care in compliance with the Eighth Amendment’s ban of cruel and unusual punishment. The U.S. Supreme Court ruled in 1976 that the amendment prohibits the "unnecessary and wanton infliction of pain," including serious denials or delay in access to medical personnel.

DPS spokeswoman Toni Schwartz maintains that prison officials "recognize our responsibility to provide medical care on a timely basis for everyone in our prison population." That, of course, is the issue at hand — and those in charge need to ensure responsible treatment for all who require it, both as a matter of humanity and as a prudent fiscal call. Ignoring real medical symptoms only allows the illness to worsen, requiring more costly emergency or drastic treatment, plus the possibility, as shown in this case, of expensive lawsuits. The axiom applies in prison as it does on the outside: An ounce of prevention is worth a pound of cure.

The Lauro case was not an isolated one, according to Eric Seitz, who is not Lauro’s lawyer but has represented multiple inmates who have reached out-of-the-court settlements with the state from allegations of substandard care. Kat Brady of the Community Alliance on Prisons added, "People are treated inhumanely. I think a lot happens that we don’t hear about."

In recent years, DPS has significantly increased prison medical expenditures, from an average of $3,553 a year per inmate in 2001 to $5,260 a year in 2008, according to the federal Bureau of Justice Statistics. However, Seitz maintains that the state tries to save money by holding off on referring inmates to outside specialists for as long as possible.

Lauro’s case claims he endured a half-year of worsening abdominal pains, untreated by prison medical staffers, before he was rushed into emergency surgery with a life-threatening abdominal condition in June 2011. His colon was removed. In July 2012, he had a second emergency surgery and nearly died.

Lauro, 51, is serving a five-year sentence for second-degree theft, a Class C felony, and said he has spent the last 10 months in the prison’s psychiatric ward in solitary confinement. In his letter to the Star-Advertiser, Lauro said he has been subjected to abuse and torture, being left in unsanitary conditions because of frequent leakage of his colostomy bag. He was left in solitary confinement, subjected to a feces-stained cell, according to his lawsuit.

The state has denied Lauro’s accusations — but a broad review is needed to determine the prison system’s practice of providing medical care to its inmates, including the use of outside specialist services in a timely and humane manner. DeWitt had hinted at procedural changes due to the Lauro case — and it behooves prisons administrators now to improve any deficiencies in medical policy, or we all end up paying for those inadequacies.