HJNO Jul/Aug 2020

challenge providing medical care at Angola is who is telling the truth,” he said. “People don’t want to go to work. So, you know, a lot of them use the medical department for reasons not to go to work.” Lavespere’s views may have been shaped by his own experience behind bars: He served two years of his three-year federal sentence for buying methamphetamine with the in- tent to distribute it. (According to the state medical board, he was also diagnosed with amphetamine, cocaine and marijuana ad- diction, along with a psychological adjust- ment disorder with antisocial, narcissistic and avoidant features.) Like most Angola doctors, however, Laves- pere was permitted to resume his medical practice on a probationary status, while re- stricted to institutional settings like a prison. He has said he felt “a calling” to serve at An- gola. But he appears to have had few other options. Singh, who preceded Morrison as the cor- rections department’s medical director, said the state board routinely recommendedAn- gola and other prisons to physicians who had lost their licenses for criminal, ethical and substance-abuse issues. He had struggled to recruit doctors with “clean” licenses, Singh said, because they rarely wanted to work in Angola’s remote, high-stress environment. Using doctors with licensing problems, he said, was the “Louisiana solution.” Apart from a psychiatrist whom Singh recruited from LSU (and who earned a sal- ary of nearly $322,000 last year, more than double that of the state’s corrections chief), all the staff physicians now at Angola have had licensing issues. Including Lavespere, at least three dispensed drugs illegally, were ad- dicted to illegal drugs or both. One commit- ted sexual misconduct with a patient; another struggled with alcoholism. (Singh was dismissed in 2018 after a sexual harassment complaint by a colleague who said he drunkenly hit on her during a social event at a Lake Charles casino. He sued the department for defamation, and the case is still pending in a state court.) Prisoners at Angola did not dispute that considerably higher percentages.) OneAngola inmate, who spoke on the con- dition he not be named, said that during a two-week period in which he had been most sick — he had trouble breathing, body aches and a loss of appetite, among other symp- toms — the screeners told him repeatedly that he did not meet their criteria for assistance. “You ain’t got no fever, so there ain’t noth- ing we can do for you,”the man quoted them as saying. Medical screening atAngola has long been a contentious issue. Under normal circum- stances, inmates are required to pay formedi- cal attention, and they ask for it only sparingly. Aroutine “sick call,”as it is known, costs $3—a huge sum that low-level workers might labor 75 hours to earn. Emergency calls cost $6, and even paying that amount does not guarantee that an inmate will be seen by a nurse or doc- tor. Those fees have been temporarily waived during the pandemic. The experts also highlighted the mistrust of theAngola medical staff — from the medics and nurses to physicians — as a fundamental problem with the system of care. The paramedics who normally screen pa- tients seeking medical care vary widely in their training; some have as few as 140 hours. Still, they regularly dispense medical care and even medicine without being licensed to do so, according to an expert who testified in 2017 in the federal lawsuit. And while doc- tors and nurses are supposed to supervise the paramedics closely, they rarely do, the expert said. The result is that the EMTs make daily judgments about which inmates are truly sick and which might be faking in order to escape work or some other circumstance. They often do so without meaningful ex- aminations, medical records or even medi- cal equipment, much less laboratory tests. “Thus,” the experts wrote in court filings, “it is not surprising that virtually all EMT as- sessments are inadequate.” Angola’s medical chief, Lavespere, said in a court deposition that he shares the skep- ticism with which paramedics often view inmate medical complaints. “The biggest When the prison allowed them to contact their families with two free telephone calls a week during the pandemic, many breathed into the same few phones. Jackson did not expect hospital-grade hygiene. Still, he was shocked by the pris- on’s difficulty with even basic containment measures, and he was even more dismayed to see how the medical staff cared for those who got sick. One morning, as infections in his dorm seemed to be peaking, Jackson awoke to find guard-paramedics checking on a man who had collapsed and was struggling to breathe. He had been showing symptoms of the virus for more than a week but was diagnosed with dehydration. Another man called the EMTs to complain of chest pains; he was diagnosed with gas. “Two guys with terrible migraines vomit- ed and passed out, which could be cardiac symptoms,”Jackson recalled. Although they were taken away by ambulance, the two men were brought back to their dormitories the same day. In addition to regular “sick calls” by para- medics, coronavirus screening teams moved through the prison daily, pointing their infra- red thermometers at the forehead of each inmate to take their temperature. But sev- eral prisoners reported getting readings so low — sometimes 93 and 94 degrees — that they should perhaps have been treated for hypothermia. Studies have shown that such devices can be less accurate than other types of ther- mometers. But the more serious problem may have been that fever of over 100 degrees was used as the one overriding criterion to determine whether a sick inmate required medical attention. Although fever has always been the bench- mark symptomof infection, the CDC’s clinical guidance on Feb. 12 cautioned that “the fever course among patients with COVID-19 is not fully understood; it may be prolonged and intermittent.” In April, a study of 5,700 pa- tients hospitalized in NewYork showed that fewer than one-third had fevers when they were admitted. (Other studies have shown 22 JUL / AUG 2020  I  HEALTHCARE JOURNAL OF NEW ORLEANS PRISON HEALTH