Special Report:
Dying to get out CMS keeps physicians under wraps

By MIKE FUHRMAN of the Tribune's Staff
Published Tuesday, October 1, 2002

Correctional Medical Services refused to provide the Tribune with the names of doctors the company has contracted with to staff Missouri's prisons.

CMS spokesman Ken Fields scoffed at the notion that the company's policy prohibiting disclosure of the doctors' names was secretive. He equated the request to CMS officials asking the newspaper for a roster of its employees. The newspaper is not paid more than $70 million annually from the state's coffers for work it does on behalf of the Missouri Department of Corrections.

Ailing inmates, their advocates and the families of men and women who died while in DOC custody have complained to the newspaper about the level of skill and compassion demonstrated by CMS-contracted physicians.

The Tribune's investigation revealed that 9.3 percent of the doctors who contracted with CMS to work in Missouri prisons in June had disciplinary records. Saying that most of the CMS-contracted doctors had tenures of "several years," DOC officials agreed to provide the newspaper with a list of names for that month.

The percentage of CMS-contracted doctors who have been disciplined compares less than favorably to statewide figures. About 1.9 percent of the 19,966 doctors licensed to practice in Missouri have disciplinary records, according to the state Board of Registration for the Healing Arts.

The newspaper uncovered disciplinary records for three of the 32 doctors who worked in Missouri prisons in June, including Elizabeth Conley, whom CMS recently promoted to regional medical director.

As part of her job, Conley approves or denies CMS-contracted doctors' decisions to send inmates to outside specialists. Yet she was disciplined by the state medical licensing board in 1996 because of her inability or unwillingness to do the same for at least one of her patients.

The board found the service she provided an obstetrical patient to be "below accepted medical standards."

Conley "did not possess the training or skills to manage the pregnancy and delivery, she failed to appropriately manage the pregnancy, and she failed to refer the patient to an obstetrician who was capable of managing the pregnancy and delivery when complications were discovered," the board determined.

Details of the events that led to the disciplinary action are closed to the public by state law, said Tina Steinman, executive director for the licensing board.

Conley told the Tribune that "the facts aren't always given" accurately in reports of disciplinary action. She said she did not fight the restrictions on her license because she was no longer practicing obstetrics.

The restrictions on Conley's license were lifted in March 2001 after she received additional training. She has since been board certified in family medicine.

CMS hired her as the medical director for female inmates at Tipton Correctional Center the same year she was disciplined.

In her new position, Conley said she has approved the vast majority of referrals for specialized care made by the inmates' primary physicians. "I don't think we ever flat-out deny" any, she said.

DOC officials said 97 percent of all referrals are initially approved by CMS administrators.

Manuel Largaespada, another CMS-contracted physician working in Missouri, has a troubled history in Indiana. After Largaespada was the subject of numerous malpractice complaints involving "incompetent surgical practices," that state's licensing agency placed him on "indefinite probation."

Missouri's medical licensing board allowed him to practice medicine with the stipulation that he not perform any surgery that requires spinal or general anesthesia or any obstetric or gynecological procedures.

A third CMS-contracted physician, John Williams of St. Louis, was reprimanded for failing to timely report completion of continuing medical education.

Fields, the CMS spokesman, said all three doctors were cleared to work in Missouri prisons by company administrators. DOC also signed off on each doctor.

"CMS carefully reviews the credentials of physicians the company engages to provide services to clients," Fields said. "Restrictions on particular specialty practices are not that uncommon. Those physicians remained fully licensed to provide good, quality patient care."

Reprinted with Permission