Some states allow doctors who would otherwise not be licensed, to treat only inmates.
When Nancy Blumenthal was interviewed by the jail psychiatrist, she had no idea that he had spent time behind bars himself. Dr. Harvey Lothringer served four years for killing a college sophomore in the 1960s in a botched illegal abortion and then trying to hide his crime by cutting her up and flushing her down his toilet.
It wouldn't have mattered if Blumenthal had known about Lothringer's past. Prisoners have no choice of doctors. And to fill the need for doctors at jails and prisons, many states and counties are hiring physicians who have been convicted of crimes or were disciplined for professional misconduct.
Some states even grant restricted medical licenses to doctors who lost their license in other states, if they are willing to work in prisons.
The Blumenthal case is one of several around the country in which the troubled pasts of doctors working in correctional facilities was brought to light by an inmate death.
Blumenthal was a 17-year-old girl with a history of psychiatric problems. She was in jail accused of robbery and threatening her mother with a kitchen knife.
Jail records indicate she was depressed and suicidal when she was admitted to the Westchester County Jail in Valhalla, N.Y., on April 17, 1996. The next day Lothringer interviewed Blumenthal for about 20 minutes, then took her off anti-depression medication she had been taking for more than a year. Four weeks later, she was found dead in her cell hanging from a bed sheet.
A report by the Westchester County health commissioner criticized Lothringer for taking the girl off her medicine without consulting her family, her physician, or psychotherapist. Lothringer said she told him she didn't want to take the drug because it made her violent. Her parents, Wendy and Lawrence Blumenthal, said Nancy didn't object to taking the medicine.
Lothringer, 77, was a part-time employee for EMSA Correctional Care, the private company that provides health care for the county's jail inmates.
Westchester County and EMSA settled a wrongful death lawsuit with the girl's family in June 1997. The family's attorney, Jonathan Lovett, said the county paid $745,000 and EMSA $700,000. The settlement was reached quickly because the defendants feared what a jury might award after hearing the details of Lothringer's macabre crime, he said.
In 1962, Lothringer fled the country to avoid arrest after a plumber working on the drain in the doctor's home discovered parts of the girl killed in the botched abortion. He was apprehended in Europe, returned to the United States and served half of an eight-year sentence after he pleaded guilty to second-degree manslaughter in 1964. In 1973, one year after his parole ended, the New York State licensing board reinstated his medical license. He went to work for the Westchester County jail in 1978.
Lothringer did not reply to a written request for comment.
Filling a special need
The board of the Society of Correction Physicians opposes the practice of giving bad doctors a license to practice in prisons, said Dr. Roderic Gottula, president of the society and assistant professor in the department of medicine at the University of Colorado Health Sciences Center.
"The society's board believes that a physician should not have a license restricted to practice in corrections," he said. "That policy is detrimental to the practice of correctional medicine."
"The use of special licensing arrangements that allow physicians who cannot be licensed to treat the public, to treat sick and mentally ill inmates in prisons or jails is a scandal," said Dr. E. Fuller Torrey, an expert on the treatment of the mentally ill in jails and prisons and executive director of Stanley Foundation Research Programs/National Alliance for the Mentally Ill (NAMI), in Bethesda, Md.
Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, in Washington, agreed: "It is unethical and inhumane to say that a physician isn't good or trustworthy enough to treat people in the community, but that he or she is good enough to care for inmates of correctional facilities."
The recidivism rate for sexual offenses is too high to risk patient safety by recycling physicians who may offend again, Wolfe said. "Because prisoners are powerless and vulnerable to exploitation, we need to be more -- not less -- careful in placing them under the care of health professionals who have a history of victimizing patients."
Prisoners are widely perceived as complaining, manipulative, and dishonest, so their complaints often are not taken seriously. And they may fear they won't get medical care when needed if they complain about abuse from a prison doctor, Wolfe said.
But some justify giving disciplined doctors another chance if it will provide medical services in correctional facilities. Each week the nation has to add 1,000 more prison beds to keep up with explosive growth.
Many jails and prisons have a hard time finding doctors willing to take on correctional medicine, where prisoners are difficult and security is a concern. Prison and jail doctors get little public and professional respect. The lack of respect comes partly from the public's hostility toward prisoners, and from the misguided belief that all physicians who work behind bars cannot get a job elsewhere.
"The practice of staffing corrections with doctors who can't get jobs otherwise does make it harder to draw good doctors," said NAMI's director of legal affairs, Ron Honberg. "It sends the message to doctors who otherwise would be interested in entering correctional health that to join this field means being looked down upon ... That is not the way to solve the shortage of correctional health professionals."
Reprinted with permission of the St Louis Post-Dispatch, copyright 1998.