Anthony Shumake Death
This is the family of Anthony Shumake sitting on a bench in the Assembly hallway of the Sacramento Capitol. They are flanked by Attorney Mark Ravis far left and B. Cayenne Bird, UNION Director far right just after serving Governor Schwarzenegger who is named in their legal action on September 29, 2004.
REGION & STATE
September 30, 2004
SACRAMENTO — The family of a California inmate who died after he had a tooth pulled said Wednesday that they were suing the state over his death, as two legislators held a Capitol hearing to investigate why prison healthcare remains poor but increasingly expensive.
Relatives of Anthony Shumake, 41, said they would file a wrongful-death lawsuit because a medical pathologist's report showed that he died of complications from the extraction.
The report from the San Joaquin County coroner's office showed that Shumake died June 28 after his airway was constricted by an abscess in his throat. In an interview, Dr. Robert Lawrence, a pathologist, said a "rip-roaring infection" had caused extensive swelling, reducing air flow.
"The airway was not sufficiently open to allow a free flow of oxygen," Lawrence said. "The lack of oxygen caused the heart to go into a fatal rhythm."
Shumake's relatives said other inmates told them that they had tried to get medical help for Shumake in the days after the dental work, as his neck turned red and swollen and he complained of continuing pain. But those requests, they said, went unheeded at Solano State Prison in Vacaville until he fell into respiratory distress and an ambulance was finally called.
Prison officials would not comment on the case, saying that an internal investigation was underway.
"It's been very hard for our family to see a healthy young man have a tooth pulled and then wind up dead," said the Rev. Andre Shumake, the inmate's uncle and a neighborhood activist in the Bay Area city of Richmond. "Anthony was given a prison sentence, not a death sentence. These men may be inmates, but they're human beings."
The Shumake family traveled to Sacramento for a hearing that examined healthcare in the $6-billion California correctional system. Among the topics covered were reports from the California Medical Board, which licenses and disciplines doctors, that showed that one in five prison physicians had a blemished record or had been sued for malpractice.
That 20% rate is almost five times the figure statewide, the board said. Legislators called it unacceptable and indicative of a system in distress.
"To put it very bluntly and very simply, the healthcare system at the California Department of Corrections is sick," said state Sen. Jackie Speier (D-Hillsborough).
Sen. Gloria Romero (D-Los Angeles), co-chairwoman, with Speier, of the hearing, agreed. "The sad fact is California has been growing its inmate population but has failed to provide adequate healthcare for those we lock away," she said.
Under questioning by the senators, corrections officials acknowledged that major problems remain with the network of clinics, hospitals, treatment centers and outside medical contractors that cares for the state's 164,000 inmates.
Dr. Renee Kanan, chief of healthcare for the system, said that "historically, our modus operandi has been very reactive. We've had plenty of fragmented exit strategies, but we've never had a comprehensive strategic plan."
But progress has been made, she said, since a class-action lawsuit, which was settled in 2002, alleged that California's prison healthcare amounted to cruel and unusual punishment.
The changes include tighter screening and monitoring of physicians and creation of an oversight committee to track healthcare costs, which have nearly doubled over the last five years and could hit $1 billion this year.
"We know we have many challenges in our efforts to provide quality healthcare," Corrections Director Jeanne Woodford testified. "We want to fix what this committee has called a broken system … and become known as a state that uses the best practices in all aspects of its healthcare system."
Speier and Romero, who have conducted hearings focused on problems in the prisons, did not appear to be patient. They said that the Department of Corrections had been sued over healthcare numerous times over the last two decades, and that it seemed as if only court-imposed mandates had forced change.
Speier asked why the federal government had been able to reduce its prison healthcare costs while the state's costs had soared — a question to which she received no clear answer.
"The scratching of heads is no longer acceptable," Speier said. "It is time to realize what [the prisons'] healthcare policies and practices are costing each and every Californian."
One major challenge facing prison doctors is the condition of patients. Inmates tend to be sicker than the population at large, often because of unhealthy habits and a lack of medical care earlier in life. One in five has a serious mental illness; one-third are infected with hepatitis C. The rate of HIV/AIDS in prison is five times higher than the national average.
Dr. Jacqueline Tulsky, a professor at UC San Francisco Medical School who has studied prison healthcare, described the average California inmate as a 40-year-old male who is a high school dropout with alcohol addiction, a history of crack cocaine use and mild depression. His medical problems probably include hypertension, diabetes, elevated cholesterol levels and mild arthritis. Periodically, he needs treatment for injuries incurred on the prison yard.
"No healthcare plan in this state," Tulsky said, "has the severity of illnesses you find in the Department of Corrections."
Several prison doctors cited other crucial differences, including a shabby infrastructure that makes practicing medicine difficult at best. Dr. Scott Anderson, who works at the California Medical Facility, a prison in Vacaville, said physicians sometimes lack essentials as basic as an examining table, soap and towels with which to dry their hands.
A severe shortage of nurses and medical technical assistants, who provide security as well as clinical help, also affects care, he said. And perhaps the greatest problem facing prison physicians is technological: the absence of computers to track inmate medical records, view X-rays and help with medical decisions.
Corrections officials agree that working conditions are not ideal. They said that plans to give each prison doctor competency testing should root out those unfit to practice.
Doctors who testified criticized the plan, warning that it could have the paradoxical effect of driving good doctors out of the system. Anderson said he considered his board certification in specialties such as rheumatology and geriatrics a sufficient validation of his skills.
"I certainly don't want to practice with doctors who are not competent,"
Anderson said. "But I'm troubled by the thought of going through testing
that might be arbitrary, capricious … and may lead to a dark mark on our
record that would follow us for life."
Posted on Wed, Sep. 29, 2004
California should mimic federal prison health care, senators say
SACRAMENTO - Health care costs at California's prisons have nearly doubled in five years even as inmates die at the hands of unqualified doctors, senators said Wednesday at another hearing into the state's troubled corrections system.
In one case in February, a 72-year-old inmate starved to death in front of health care workers.
In June, a 41-year-old inmate died six days after having a wisdom tooth pulled, and after being shuttled more than two hours to medical care instead of being rushed to either of two closer hospitals.
"My nephew, Anthony Shumake, had a tooth pulled and now he is dead," the Rev. Andre Shumake told senators. Shumake "was given a prison sentence, not a death sentence. ... No one should have a tooth pulled and die in this day and age."
Shumake's fate shows the worst of the system that wastes millions of dollars a year but still brings poor results, said Sen. Jackie Speier, D-Daly City.
California should emulate the federal prison system, which has cut per-inmate spending amid rising medical costs, senators said during the hearing.
While they downplayed suggestions by Gov. Arnold Schwarzenegger's Corrections Independent Review Panel to privatize inmate health care in cooperation with the University of California, they said private and university experts should be recruited to recommend reforms.
Taxpayers will spend $1 billion this year to provide health services to the 164,000 inmates in the nation's largest state prison system, the fastest-growing component of the state's annual $6 billion corrections budget.
For all that money, inmates receive poor care often by doctors untrained for the positions they hold, according to a recent audit. Twenty percent of those physicians have malpractice or disciplinary problems.
Speier, who heads a government oversight committee, co-chaired Wednesday's hearing with Sen. Gloria Romero, D-Los Angeles, who leads a corrections review panel.
Their joint hearing is the seventh in 18 months on a system where management and spending is out of control, say auditors, national experts, Senate witnesses and a federal court monitor.
The administration, which says reforms are underway, recently settled the latest in a series of lawsuits over inmate health care. Recommendations by the prison review panel headed by former Gov. George Deukmejian are under review by the administration - though not quickly enough, the senators said.
It's a complicated problem, Romero said, because inmates are frequently in poor health, and diseases such as tuberculosis, AIDS and hepatitis can spread easily. Also, care must be provided in remote locations under extraordinary security restrictions. Inmates frequently are mentally ill or drug addicted, and strict sentencing laws are turning some prisons into "nursing homes" for geriatric patients.
California fights these problems with a "mind-blowing" lack of modern medical technology, including virtually nonexistent use of computers, the Internet, even cell phones and voice mail that can stall coordination and communication across the system, testified Dr. Jacqueline Tulsky of the University of California, San Francisco.
Still, the biggest problem is a prison medical staff that often is "barely licensable," Tulsky said. But several prison doctors denied the majority of physicians are unqualified, blaming problems instead on prison bureaucracy and a lack of equipment, nurses and medical technicians.
In July, a state audit found California prisons paid local hospitals as much as eight times more than Medicare would have paid for the same medical procedure, leading to an average 21 percent annual increase in health care costs the last five years.
"The (federal) Bureau of Prisons was in a position very similar to what the California system has seen" because of its rapid uncoordinated growth, testified Theodore Willich, vice president of a private federal health services contractor, Medical Development International. "It really just got out of control."
Senators said the state could cut costs as the federal government has, by paying only Medicare rates and providing care at prison infirmaries instead of outside hospitals. The state should have more centralized control over health care instead of having 32 decentralized prison "fiefdoms."
Schwarzenegger's administration says it's already doing more of that, leading to a projected $26 million cut in medical costs this year.
ON THE NET
California Department of Corrections: http://www.cdc.state.ca.us
More care needed
Saturday, August 21, 2004 -
The $18 million in back payments not paid to the local hospital near the California State Prison at Solano County is most likely the reason that Anthony Shumake is dead. Deadbeat prisons are costing billions, but we can't provide basic medical care? This is a flashing signal that there are too many people in prison.
The taxpayers need to demand the immediate release of nonviolent prisoners right now before any more blood is spilled. If we can't take care of people, we have no business locking them up in cages.
Denise Marks, Sacramento
Autopsy won't end questions
Inmate dies in a Manteca hospital days after having a wisdom tooth removed at CSP-Solano.
By Brian Hamlin/Senior /Staff Writer
Roughly two months ago, California State Prison inmate Anthony Shumake
underwent what is normally considered a routine dental procedure - the
removal of a wisdom tooth - at the Vacaville prison.
The San Joaquin County Coroner's Office, which released its autopsy findings this week, ruled the death "accidental, complication of therapy" involving hypoxic cardiac arrhythmia (irregular heartbeat due to lack of oxygen) and an apparently undiagnosed abscess that caused throat swelling and difficulty breathing.
According to the coroner's report, Shumake, 41, was taken by ambulance from the Vacaville prison at 3:45 p.m. on June 28 en route for treatment at Doctor's Hospital in Manteca. He arrived at 6:20 p.m. and was given anti-inflammatory and antibiotic drugs.
At 8:57 p.m., the coroner's report stated, "The decedent was in respiratory arrest. The decedent was sitting upright on the bed and had a panicked look on his face and had his hands to his throat indicating he was having difficulty breathing."
Despite medical efforts to stabilize Shumake, including cardio-
pulmonary resuscitation, he was pronounced dead at 9:45 p.m. the same day.
What remains unclear is why Shumake's condition was allowed to worsen for several days prior to his being taken for outside medical care, and why that medical care was sought in Manteca - roughly a 2 1/2-hour drive from Vacaville - instead of in the emergency room at nearby Vaca Valley Hospital, which is about 10 minutes from the Peabody Road prison.
The Department of Corrections reportedly has launched an internal investigation into the circumstances leading up to Shumake's death, but has released no conclusions.
B. Cayenne Bird, founder of the prison reform organization UNION (United for No Injustice, Oppression or Neglect), charged that Shumake's case is typical of prison medical care in California.
"He obviously suffered. He knew he was sick. He had no place to go," Bird said. "The inmate's life has zero value."
The UNION organization recently sponsored a rally at the state Capitol during which Shumake's uncle, the Rev. Andre Shumake of Richmond, demanded answers.
"As a family, we are crying out for help. We would like to know why the policies and procedures of the CDC are being violated. We are concerned that inmates do not receive proper medical treatment and, in many cases, are actually denied medical treatment," the Rev. Shumake said. "We want to know if CDC guards are trained to recognize serious ailments or behavioral changes that indicate illness. We want to know if the doctors and medical personnel are competent, and, most of all, if they are truly concerned about the inmates' medical needs."
Both state Sen. Jackie Speier, D-Hillsborough, and Assemblywoman Loni Hancock, D-Berkeley, also have contacted the Department of Corrections about the Shumake death.
Brian Hamlin can be reached at email@example.com .
Sacramento -- A state prison in Vacaville that sent a sick inmate who later died to a hospital more than two hours away is embroiled in a legal fight with the local hospital, which is suing the prison to recoup up to $18 million in unpaid health care bills.
Whether the litigation played a role in the decision to send inmate Anthony Shumake on a 76-mile ambulance trip, instead of a five-minute ride to nearby Vaca Valley Hospital, is a question now being asked by a state senator who has led efforts to reform California's troubled prison system.
In a letter sent Tuesday, Sen. Jackie Speier, D-Hillsborough, is asking corrections officials for information on Shumake's death and if the lawsuit was a factor in where Shumake, 41, was transported when prison doctors realized he needed help they could not provide.
Prison officials and a spokeswoman for Vaca Valley Hospital, however, said the lawsuit had not prevented inmates from seeing emergency physicians.
Shumake of Richmond was suffering from a dental infection that had caused his neck to swell and prevented him from eating for six days, according to his statements to paramedics compiled in an ambulance report. Wheezing and spitting up, he was taken from Solano State Prison at 3:44 p.m. June 28 and delivered to the emergency room at Doctors Hospital in Manteca at 5:51 p.m., according to the report, which was given to Shumake's family, who provided a copy to The Chronicle.
Shumake, who was serving a 12-year sentence for corporal injury to a spouse, stalking and possession of a controlled substance, was pronounced dead at the hospital later that night.
Solano State Prison has a contract for medical services with the Manteca facility, although it is not for emergency care.
Prison officials, citing medical confidentiality rules, have refused to discuss details of Shumake's death or why his sickness was not deemed enough of a problem to rush him to the nearest emergency room.
But they are adamant in saying that an inmate with a medical emergency would be taken to the nearest hospital.
"Costs don't enter into it,'' said Margot Bach, a Department of Corrections spokeswoman. "We have to take them to the appropriate place.''
In 2002, NorthBay Healthcare Corp., which runs Vaca Valley Hospital in Vacaville and another hospital in nearby Fairfield, sued the Department of Corrections over millions of dollars in unpaid bills, saying it had provided emergency services for inmates from two prisons in Vacaville, including Solano State, without payment.
The lawsuit stems from a dispute between the state and the hospitals over the cost of care. State officials contend the hospitals have charged exorbitant rates for emergency room visits because it is the only provider in the area.
As a consequence of the dispute, the two prisons in Vacaville have not had a contract with any hospital for emergency services since 1998. They still send inmates to the emergency room at Vaca Valley, however, and hospital officials contend the prisons have racked up an $18 million bill.
A spokeswoman for NorthBay said that while the nonprofit company was demanding payment from the state, they still took care of sick inmates when needed. Vaca Valley, a 50-bed facility, has seen two inmates in the last week, said Joanie Erickson.
"We take care of their patients all of the time; we've never balked at treating anyone,'' Erickson said.
Speier wants to hear from corrections officials, however, about whether the unpaid bills may cause prison doctors to avoid the local emergency room if possible.
She noted that sending any inmate on a long ambulance ride to a faraway emergency room "doesn't make sense.''
"Was this a medical error in diagnosing his condition to be non-urgent, or was it a decision made because they're involved in a lawsuit with the closest hospital?'' Speier asked.
She also criticized prison officials for failing to have a contract for emergency services for the two Vacaville lockups. In addition to Solano State, the other Vacaville prison is the California Medical Facility, which is designed specifically for inmates who are terminally ill or have AIDS, and it offers extensive mental health services.
"You're going to have emergencies,'' Speier said. "Not having a contract for that is an invitation for lawsuits.''
Shumake's family has hired a private firm to conduct an autopsy while the San Joaquin County coroner's office conducts its investigation into the death. Coroner's officials say the probe could take six weeks.
The Rev. Andre Shumake, a prominent activist in Richmond's Iron Triangle neighborhood and Anthony Shumake's uncle, said the family was frustrated with prison officials who have been reluctant to provide them details about the death.
Meanwhile, a funeral has been scheduled for Friday at North Richmond Missionary Baptist Church.
"We're going to have a funeral without knowing how he died,'' Shumake said.
E-mail Mark Martin at firstname.lastname@example.org .
Posted on Sat, Jul. 03, 2004
Legislator to investigate prison inmate's death
By Karl Fischer and Rebecca Rosen Lum
An aide for Assemblywoman Loni Hancock, D-Berkeley, said Friday her office intends to investigate the death of a prison inmate from Richmond who had a dental infection so severe that he could not swallow for days before officials sent him to an outside hospital.
A report from the ambulance that took 41-year-old Anthony Shumake from California State Prison Solano in Vacaville to a Manteca hospital on Monday stated that his neck "was swollen and red in color down to his clavicle ... patient was also spitting up gray sputum." Shumake died hours later at the hospital.
"The way it was handled raises some serious questions," said Hans Hemann, Hancock's chief of staff. "We'll be looking into it very thoroughly. It raises questions about the entire system as well as for this one family, who must be going through unbelievable anguish."
Prison officials said Friday state law forbade them from commenting about a prisoner's medical issues, adding that the facility's medical staff followed procedure after finding they could not properly care for Shumake.
But the death prompted mistrust and criticism from parts of Richmond's political establishment, led by the Rev. Andre Shumake, a prominent Iron Triangle activist and the prisoner's uncle.
Family members said prison officials have told them next to nothing since sending a telegram Tuesday morning informing them that Anthony Shumake had died and that the body would be cremated if they did not retrieve it.
"There has been tremendous negligence. Now it seems like they're trying to cover everything up," the Rev. Shumake said. "They didn't even have the decency to knock on the door."
Prison officials and the San Joaquin Coroner's Office said Friday they would not release the cause of death for several weeks. Several inmates who knew Shumake told the family he died of heart failure.
Prison doctors did not find that Anthony Shumake needed emergency medical care, but did need care the facility could not provide, Department of Corrections Lt. Mary Neade said. So they called for a basic life-support ambulance to take Shumake on a two-hour ride to Doctors Hospital in Manteca, a facility with which the prison contracts.
"When an inmate is sick we try to treat him here. If the ... medical department feels he can't be treated here, we send them out to the hospital," Neade said. "If staff determines he needs immediate attention, they call 911 and he's treated at the nearest hospital."
The ambulance company did not return calls Friday. A hospital spokesman said the cause of death remained officially "undetermined" pending results of the coroner's autopsy and toxicology tests.
Shumake told the ambulance crew that he'd had a tooth pulled six days earlier and that his wound had become infected, according to the report. The swelling in his neck made it impossible for him to eat and difficult for him to breathe.
The private ambulance crew checked Shumake's vital signs three times during the trip and found no significant changes, the ambulance report shows.
It was the second prisoner death of the year at Solano, a medium-security prison housing about 6,000 prisoners, Neade said. In January a terminally ill prisoner died of natural causes at an area hospital.
Records show Shumake was serving a 12-year, eight-month sentence for
convictions in 2000 of corporal injury to a spouse, stalking and drug possession,
as well as a parole violation from a 1994 attempted robbery conviction.
Reverent Andre L. Shumake, Sr. - Rally Speech