Georgia must fix a system that has allowed women in the state's prisons to receive medical care that's inferior to their male counterparts, a state report says.

The report by Augusta University, prompted by an Atlanta Journal-Constitution investigation, says the care of thousands of female inmates by Dr. Yvon Nazaire "fell below an acceptable standard of care" and factored into the deaths of at least three women.  The report also questioned the former prison medical director's treatment of two inmates whose cancers went undiagnosed until they left his care.

But perhaps the most significant aspect of the document, prepared by a long-time university administrator and released to the AJC Wednesday, takes the prison system to task for giving female inmates lesser care.

Dr. William Kanto, a physician with experience investigating hospital incidents, wrote that his review left him with a “positive impression” of the medical system for male inmates, but “unfortunately, there’s not a similar system for female inmates.” Kanto said the small number of women’s prisons and the limited number of medical personnel working in them has led to lax oversight.

“We should have a heightened sense of awareness of what transpires within these smaller prisons and provide a heightened level of attention to the appropriateness and quality of the care provided,” he wrote.

Kanto said physicians in those prisons should have experience in women’s health and also should be comfortable working in a more independent environment.  In addition, he suggested that an electronic health-record system be installed and that it should be implemented first in women’s prisons.

The doctors and other medical personnel working in Georgia’s public prisons are employees of Georgia Correctional Health Care, a branch of Augusta. The school, formerly known as Georgia Regents University, receives $170 million a year from the Georgia Department of Corrections to provide the service.

Kanto's review began after the AJC raised questions about Nazaire's background as well as his treatment of inmates at Emanuel Women's Facility and at Pulaski State Prison, 80 miles apart in south Georgia. The AJC found that at least nine women had died under questionable circumstances in the nine years since Nazaire was hired despite a well-documented of history of patient neglect as an emergency room physician in New York.

Nazaire was at first placed on administrative leave during the review and then was fired after officials confirmed an AJC report that he misrepresented his work history when he applied for the state job.  That matter, a potential felony, is the subject of a probe by the Georgia Bureau of Investigation.

Kanto's report did not identify anyone by name, but it said three of the deaths disclosed by the AJC "clearly demonstrated care which fell below the community standards." It also said two inmates with cancer cited by the AJC were treated in a similar manner.

"My recommendation is that Dr. Nazaire be permanently barred from seeing patients for GCHC and that our actions and findings be referred to the (Georgia) Composite Medical Board for their review," Kanto wrote.