Randy Sauls, the Department of Corrections’ assistant commissioner of health services, acknowledged that there is a backlog of pending cases that typically stays around 2,000, but he said he doesn’t consider it a problem. That’s because the system, which receives between 150 and 200 new requests a day, is focused on making sure the most urgent cases are approved expeditiously, he said.
“You would like it to be as close to zero as you could make it,” Sauls said in an interview. “But (the requests) come fast. And a lot of them are routine. They are just follow-ups.”
However, some experts in correctional medicine said the backlog indicates a process that appears alarmingly dysfunctional, particularly with so many orders still pending approval after 60 days.
“Generally, if someone has a delay of more than 60 days, they need to see a provider to make sure there’s no harm occurring because of the extended delay,” said Dr. Michael Puisis, a Chicago physician who has spent more than 30 years working in correctional medicine.
The responsibility for approving consults belongs to the Department of Corrections’ utilization management unit. The department has oversight even though it contracts with Georgia Correctional HealthCare, a division of Augusta University, to provide medical care in the state’s public prisons.
Utilization management is under the direction of GDC's statewide medical director, Dr. Sharon Lewis. When doctors, physician assistants or nurse practitioners order consults for inmates, the information is entered into a database. A team of five nurses working out of the GDC headquarters in Forsyth then reviews the orders, looking to see whether the service is available, medically appropriate and necessary.
The documents the AJC obtained showing the backlog don’t identify the inmates whose cases are pending. However, they do list the services requested. And those suggest that some inmates with serious health issues are being forced to wait unreasonably long periods for care.
Among the cases shown as still pending after 60 days last week were eight consults with oncologists, eight with cardiologists, seven with neurosurgeons, seven with pulmonary specialists and nine with infectious disease specialists. Also shown as still pending after 60 days were 14 colonoscopies, 24 MRI scans, 22 CT scans and 17 sonograms.
In one instance detailed in a separate document obtained by the AJC, a colonoscopy was ordered for an unnamed inmate in mid-July. The order, categorized as routine, was because of rectal bleeding. It wasn’t approved until mid-September. And, as of early this week, the procedure still hadn’t been done, meaning the inmate remains in limbo five months after his symptoms were recognized.
Puisis, who has served as a jail and prison medical director in Illinois and New Mexico, said colonoscopies don’t always require quick approval, but one ordered for an inmate with rectal bleeding would probably be cause for immediate attention.
“If you were getting a routine, preventive colonoscopy, (the timing) might not be a big deal,” he said. “But if you have blood in your stool, it would be a big deal.”
Told that eight oncology consults remained pending even though they were requested more than 60 days ago, Puisis expressed surprise.
“Oncology?” he said. “I mean, you can make the assumption that that’s probably not good.”
A prison doctor recommended that inmate Robert Carey Seymour see a specialist about a small growth on his face. When he was finally seen by a cancer specialist months later, a second, larger growth had appeared. He has undergone surgery to remove the tumor.
Herring said she grew increasingly concerned as Seymour, incarcerated at the Burrus Correctional Training Center in Forsyth on a murder conviction from the mid-1990s, complained that he wasn’t being seen by an oncologist for a growth on his left temple discovered early this year.
“He kept saying, `I don’t know why I’m not on the list,’” she said. “This went on for months.”
Herring said she was horrified when she saw Seymour in April because, by then, a second growth was “protruding” from his face. That led her to contact a family friend in state government for help in making sure her brother got his appointment.
“It took (the friend’s pushing) for Carey to see the oncologist,” she said.
Sauls, who was hired for his position in August 2016 after 25 years in hospital administration, said he wasn’t familiar with Seymour’s case. Some consults may be delayed because of inmate movement and other non-medical issues, but most that require serious attention are quickly flagged by the utilization management nurses, he said.
“The nurses know from looking at the charts which ones should go first,” he said.
Practitioners are expected to mark consults as routine or urgent, and they can always call the nurses to clarify their orders, Sauls added.
Problems with utilization management have been known to Georgia corrections officials since a state audit of inmate healthcare a decade ago. The audit cited a "growing backlog of requests pending review by UM staff nurses as well as an increasing number of approved requests (appointments) that have yet to occur."
In response, officials noted that a physician had been hired to assist with the process and changes in standard operating procedures for the unit had been proposed.
But the documents obtained by the AJC show that the backlog remains both a problem and a subject of controversy within Georgia’s correctional healthcare community.
In an email sent to prison medical directors and other correctional healthcare employees in March, Lewis reported that the number of consults “in queue” continues to surpass 3,000 “at any time.”
“All UM staff are working very hard to process these as quickly as possible and I have asked for your help via conference calls and several previous emails,” she wrote.
Lewis went on to say that consults should only be ordered when needed and appropriate.
“AS OF TOMORROW, FRIDAY MARCH 17, I DO NOT WANT TO SEE ANOTHER CONSULT ENTERED THAT DOES NOT APPLY,” she wrote.
More recently, the backlog has become cause for alarm in the operating room at Augusta State Medical Prison, where many of the procedures would be performed.
In late October, the facility’s perioperative manager, Leah Anderson, wrote Dr. Billy Nichols, Georgia Correctional HealthCare’s statewide medical director, to warn that she was suddenly seeing an “influx of approvals” from as long ago as July. Because of the facility’s own scheduling backlog, the new approvals wouldn’t get immediate attention, she wrote.
“Everyone is booked out for months already so some of these patients are now waiting up to six to seven months for their procedures,” she wrote. “Could this be communicated to Dr. Lewis?”
After Nichols replied that he could offer extended overtime to help with the backlog, Anderson wrote that additional overtime wouldn’t do any good.
“There is no extra room on our schedule,” she wrote. “The only other alternative is to cancel clinic and do procedures all day on their blocked days. This however causes clinic appointments to backlog, and then there is the risk of not enough bed space here. We are being routed more than we can keep scheduled in a timely manner.”
In a series of stories, investigative reporter Danny Robbins has examined medical care in Georgia prisons, revealing conditions that stunned doctors and nurses and cost taxpayers hundreds of thousands of dollars. To read more about the problems, see these reports: