Thursday, July 14, 2011

You Get What You Pay For

Except in California, where you pay for something, bigtime, that you don't get. Who is the biggest pig feeding from the trough? The governor? The Speaker of the Assembly? The President Pro Tem of the Senate? Nope--it's a prison doctor who is not allowed to practice medicine in the prisons. The price? $777,423.00 last year.

Dr. Jeffrey Rohlfing has been on paid leave, fired, suspended, locked out, assigned other duties, or just fighting his termination since 2005. My son-in-law, who is a state corrections officer, tells me that the duties the doctor is presently performing are called "mailroom" duty, because it has nothing to do with his job description. The good doctor is currently "reviewing" medical histories at the State Prison in Susanville. In other words, he's a file clerk. The only reason he's doing anything at all is that the State Personnel Board found that he had been wrongfully terminated, so as long as the taxpayers are paying him his regular salary of $235,740.00 per year, he might as well be doing something. The rest of the $777,423.00 from last year is back pay.

There is some reason to believe the Board may have been wrong (irony intended). In 1996, Rohlfing had a psychological breakdown at a Fresno hospital. It's almost Marx Brothers material. He was described as "engaging in bizarre, irrational and delusional communications." Doctors and nurses at the hospital called the police, whereupon Rohlfing fled, leading the police on a high-speed chase until he was caught at his home. He was subsequently committed, twice, to psychiatric 72-hour lockups. At that point, the California Board of Medical Quality Assurance (BMQA) placed him on five years probation.

After working for a short time as a substitute doctor at Susanville, he was hired full time in 2003. In 2005, an inmate died under his care, and Rohlfing's clinical privileges were revoked. The BMQA reinstated the probation, but with clinical privileges suspended, it effectively meant Rohlfing was no longer to practice medicine. During his tenure at the prison, two cardiac patients complained of chest pain and dizziness, with symptoms visibly apparent to other personnel, but Rohlfing sent them back to their cells without a full workup or followup. Neither died, but both were later independently diagnosed as having had "coronary accidents."

BMQA rules and standards require a prison doctor to follow ordinary medical procedures, and if the prison doesn't have the facilities to perform necessary tests, the patient is to be transferred to another prison which does have the facilities, or to an outside emergency room. Rohlfing failed to do so. His supervisor determined that the tests were necessary and proper. As a result, the doctor was placed on paid leave for eighteen months.

Rohlfing's attorney argued before the Personnel Board that Rohlfing's examinations "may not have been textbook perfect," but they did not amount to inexcusable neglect of duty required for termination of a prison doctor. Though the supervisor testified that Rohlfing's medical procedures were "significantly substandard" (a nice way of saying "malpractice"), the Board found in the doctor's favor. Upon his return to the prison, the Director determined that Rohlfing was not fit to treat patients. Thus, a medical file clerk earning $235,740.00 annually, on the taxpayers' backs.

According to prison officials, Rohlfing is hardly the only doctor in this type of position. Nancy Kincaid, spokeswoman for the court-appointed receiver in charge of California's inmate healthcare (yes--read "bankruptcy"), said: "It's the standard assignment given to physicians when questions arise about their clinical ability. Some eventually return to treating patients, some quit, and others are ultimately fired." How many? she was asked. "Dozens," she replied. With obvious distaste, Kincaid added: "We want taxpayers to know we had no choice in this. If you are ordered to bring somebody back to work, and you can't trust them with patients, you have to find something for them to do."

When the federal court first ordered a receiver to take over management of the prison healthcare funds, the judicial panel found that "20% to 50% of physicians at the prisons provided poor quality of care, and 20% had serious black marks on their record when hired. Their shortcomings contributed significantly to the fact that a prisoner died needlessly every six to seven days in a state lockup (emphasis added)."

Although the Corrections Department was unsuccessful in ridding itself of Dr. Rohlfing, at least for now, it had one minor success at the Personnel Board hearing. As a result of Rohlfing's case, which may have been the straw that broke the camel's back, new procedures have been ordered. The receiver convinced the Board that such decisions were based on overly strict reading of state service rules rather than the welfare of the patients. She petitioned the court to order the Board to hire outside medical experts for assistance with future potential disciplinary problems and/or incompetent doctors. If Rohlfing or someone like him fouls up a patient's care, perhaps it will be a little easier to relieve the taxpayers of paying quarter-million dollar salaries to quacks.

22 comments:

Tennessee Jed said...

when I first read this, I thought of the O.J. trial and Mark Furman and his breakdown. I can fully understand police having breakdowns given the stress of what amounts to being in a war zone with gang bangers who outarm the police on a regular basis. (The movie colors comes to mind.) That said, while I can think of more fun places to practice medicine, the people on the payroll in the prison system are clearly more than handsomely rewarded. Per Obama they make too much.

Still, this is a screw up of major proportions in the system, and it is clearly a example of everything bad about big bureaucracys. The same crap happens in big corporations, by the way, and it all started when our thinking evolved the notion that employees serve as the pleasure of the employer . . . period.

Just wondering, is there a union involved, by any chance

Tennessee Jed said...

I meant evolved beyond the notion, sorry.

Joel Farnham said...

LawHawk,

I have mixed feelings on this. I don't think the inmates have qualified for the best of civilized care that money can buy. Which is probably why this situation has been allowed to fester.

If we are required by law to administer to the health of the criminals, I feel that we need to get a decent physician to accomplish that end. Clearly this doctor is not up to snuff.

It seems to me that the good doctor had acquired the services of a more than competent lawyer. I wish he had Marcia Clark help him. If he had done so, he would be inhabiting one of the cells waiting for that guy with the sickle.

Unfortunately, in the State of California, this same situation is duplicated in all the bureaucracies. It comes from liberal laws compounded by boards dominated by liberals. Unless there is a drastic change in thinking, California will collapse.

As an aside, on that election last Tuesday, I think there was some false counting. Why else would it take them most of the night to count up the votes? I think there should be a time limit on getting the votes counted. One hour. Two hours to be generous. If it takes any longer, then the votes won't apply until a bipartisan commission can certify them. Just a thought.

AndrewPrice said...

Everything I've seen in my dealings with the system tells me that prison medicine is horrible and the doctors are usually the bottom wrung. I'm surprised they bothered firing this guy, even if it was causing deaths.

rlaWTX said...

off the subject --
at http://sweetness-light.com/archive/obama-picked-up-his-peas-and-went-home

[the 1st is a quote from the news story; the 2nd is Sweetness & Light's commentary]

"...He told Cantor that no other president — not Ronald Reagan, the president said — would sit through such negotiations. ..."

‘Mr. Obama, we knew Ronald Reagan, Ronald Reagan was a President of ours. You, sir, are no Ronald Reagan.’

the commentary made me laugh instead of bang my head on my desk at the rest of the story...

T-Rav said...

This sounds a lot like that corrupt-doesn't-even-begin-to-describe-it school system in New York, where poor-performing or lawbreaking teachers were taken out of class and put in the "rubber room," but still got paid because of the union stranglehold. True enough, there is a somewhat greater risk for prison doctors, but c'mon.

BevfromNYC said...

I'm torn, but when we have hardworking people unable to get affordable healthcare, I find it hard to be sympathetic to an inadequate healthcare of some inmate with heart trouble. And these subpar doctors should be paid a subpar salary. They are getting paid more than a topnotch Family practitioner! Why do they deserve to be paid that well to begin with?

That being said, why don't they just re-assign these doctors to the maximum security death row inmates. I mean...you know where I'm going with this, right?

LawHawkRFD said...

Tennessee: The doctors who practice in the prisons have very little chance of facing the same kind of daily threat that guards do. The patients are obviously going to be difficult, and it ain't exactly a Beverly Hills practice, but I imagine the volunteer and low-paid doctors who work in clinics in the ghetto and barrio are in more danger at any given time than these overpaid practitioners.

My son-in-law (the prison guard) says jokingly that he and his fellow guards almost look forward to a riot just to break the monotony. He's a pretty brave guy, and big and tough, but at the same time, he does say that the dangers of working in a prison are not at all like what you see on TV and in the movies most of the time.

LawHawkRFD said...

Tennessee: I knew what you meant. But I didn't answer your question about the doctors belonging to a union. The answer is that most of them do. It's called the Union of American Physicians and Dentists. When Rohlfing was making his early fatal mistakes, he was not yet a member of the union. Provisional and emergency physicians are not required to belong to the union, and other exceptions have been carved out as well. He later joined, though I can't find any record that they were directly involved in the current brouhaha (seems likely, though).

LawHawkRFD said...

Tenessee: I should also add that in 2005, the union sued the state for imposing the same standards on prison doctors that they had recently upgraded for all general practitioners statewide. The union lost. But here's the irony. The standards that were imposed were the same ones that Rohlfing is presently charged with violating. It's one thing to misdiagnose a rare form of cancer with unusual and covert symptoms, and quite another to dismiss a man who is clutching his chest, turning blue, and gasping for air. That's negligence by anyone's standards.

LawHawkRFD said...

Joel: I don't expect society doctors and nobel prize winners to be practicing in the prisons, but as you said, even prisoners are entitled to competent medical care and humane treatment (on much the same theory as they were entitled to competent counsel earlier on). That said, you're right. They deserve the standard of care the average guy on the street could get, not the services of the best and brightest (and most expensive).

The problem with Rohlfing getting put back into the system is not that much of a good lawyering situation as it is a product of the vicissitudes of administrative law. The system is run by bureaucrats (most of them belonging to a union), and the administrative law rule in California is that all disputed facts must be viewed in the light most favorable to the accused. Marcia Clark or Chris Darden probably would have won this case.

LawHawkRFD said...

Andrew: Like everything else about California, things are different here. If you get a minor infection while serving time in a county jail, you have a substantial change of dying from it. But the prisons are a whole different thing. Big crime, big medicine. The California prison doctors are largely comprised of those who don't have the moxie to open their own practices or are somehow otherwise deficient. But most are at least competent, if not the kind of physician we would want in the private sector. Many others are dedicated liberals and bleeding-hearts, but also very competent. It's easy to be a humanitarian at $250,000.00 per year. Still, despite my saying all that, the receiver pointed out that there are "dozens" of Rohlfing types throughout the system.

LawHawkRFD said...

Joel: As for the votes in the 36th district, at least an hour or two are wasted just in getting the ballots to the Norwalk Processing Center, depending on freeway traffic and the distance from the given precinct to the Center. Then the "professionals" have to organize the ballots. At that point, almost everything is done by computer, so some of the delays can be accounted for, and the speed with which the returns started to come in once the ballots arrived and were fed into the computers tends to support legitimacy. But it doesn't account for all the delays, and I'm automatically suspicious of Democrat-leaning districts being counted at a Democrat-controlled processing center miles from the precincts.

LawHawkRFD said...

rlaWTX: Thanks for the comment. We do need to lighten up a bit from time to time. This President in short pants needs to be ridiculed often and mercilessly, but we almost never get to see that from the MSM. As my mom would have said: "He got in a huff, grabbed his jacket and bonnet, and went home."

LawHawkRFD said...

T-Rav: That parallel occurred to me as well. The trash is overflowing into the sanitary areas, and we're paying the rent for the trash.

LawHawkRFD said...

Bev: You miss the point. The prisoners already have Obamacare. LOL

We're talking about minimum medical standards here. These people are in prison for a reason. But in order to be better people than they are, we need to at least support a minimal standard. That standard isn't actually very high anyway, but this doctor couldn't even attain that level. Paying incompetent doctors $250,000.00 per year is as outrageous as the violations of minimal care.

Your solution is perfect. If we can't get the system to carry out the people's will of capital punishment one way, that would be the alternate way to do it.

T-Rav said...

On a related note, LawHawk, you'll be happy to know that San Fran made businessinsider.com's list of the 14 cities in America being most crippled by their public workers. Among the highlights: a pension plan with an unfunded liability of $4.4 billion, a budget deficit of over $300 million, employee wages and benefits making the deficit progressively worse (no pun intended), etc. San Jose, Stockton, and Costa Mesa also made the list, as did NYC, Chicago, Newark, and others. Aren't you proud?

LawHawkRFD said...

T-Rav: As if the public employees and their pensions aren't bad enough, certain high-rise apartment/condo developments on the waterfront are required to maintain a large portion of their buildings for sale or rent to public employees only. The City then adds on the requirement that the apartments/condos be "affordable" to public employees even though non-public abodes in the same building my run a million dollars or more. This is prime real estate we're talking about, not instant slums. This is allegedly so the City employees will choose to live in the City and support its tax base. Spare me!

AndrewPrice said...

Lawhawk, Wow. In the state I did most of the criminal work in, they literally got to see doctors by teleconference unless there was something broken that had to be fixed. And it took months to get to see anyone for anything even semi-serious.

LawHawkRFD said...

Andrew: See? I toldja California was civilized, didn't I? Please don't let me mislead you into thinking that I'm saying medical care in the California prisons is good. But in most cases, it's adequate. In fact, it's not a lot different from going to a County Medical Center in L.A. on a busy day (or night). There have been some major overhauls at LA County/Martin Luther King Jr. Medical Center recently, but at one point you were more likely to die from the care at the Center than you were from the care at Folsom Prison.

Koshcat said...

As a physician, gross incompetence like this makes me I'll because they give the whole medical system a bad name. This guy shouldn't even be liscenced to practice medicine.

Not all prisoners are animals and not all medical personelle who work there are bad. My father in law is a retired dentist. He worked at the jail for years. His primary job was teaching students at the dental school. For many of the inmates, he was the first dentist they had really ever seen. He really helped a lot of guys out who were in a lot of pain. He stated most were very appreciative.

Just because a person is in prison doesn't mean they should be treated inhumanely. Kidney transplants? No way. Aspirin, ekg, and a couple lab tests? Standard and simple to do.

LawHawkRFD said...

Koshcat: I agree on all points. Now, if we could just get the state to stop paying for gender reassignment surgery.

Post a Comment