The following is a copy of the letter that I have sent to Dr. Sawyer in regard to Eduardo Mantilla, #14869-050. I have attached Federal CURE's initial request for action on his behalf for your background information.

What Federal CURE needs you to do is to send follow up requests to the following people asking that the BOP immediately provide Eduardo Mantilla with the medical care he needs at Leesburg Regional Medical Center, where he was receiving appropriate treatment for his critical medical condition under appropriate FCI Coleman supervision.

The broader question that the BOP must begin to answer is who is monitoring the quality of medical care that they are providing to federal inmates in all their institutions. On a daily basis, Federal CURE receives complaints from federal inmates about both the lack of medical care and the poor quality of medical care in federal institutions. Please contact the following people so that we can assist all federal inmates in securing competent medical care:

Dr. Kathleen Hawk Sawyer - ksawyer@bop.gov
Dr. Newton E. Kindig - nkindig@bop.gov
MaryEllen Thoms - mthoms@bop.gov
Bryan Pownall - bpownall@bop.gov
Christopher Erlewine - cerlewine@bop.gov
Carlysle Holder - cholder@bop.gov
Robin Cuffey - rcuffie@bop.gov
R.L. Matthews - rmatthews@bop.gov
Florida Medical Board - MQA_Medicine@doh.state.fl.us
CNN - public.information@turner.com
Fox News - comments@foxnews.com
NPR, Talk of the Nation - totn@npr.org
Michelle Cohen - Michelle.cohen@nbc.com
Forbes - ppatsuris@forbes.com

January 15, 2003

Dear Dr. Sawyer:

This letter is an initial inquiry in regard to Eduardo Mantilla, Inmate #14869-050. On Monday, January 12, 2003, I received a copy of a letter directed by Catherine M. Falkenberg to Captain Newton E. Kending, II, MD regarding the medical treatment of her father, Eduardo Mantilla.

Eduardo Mantilla, has been in the custody of the Federal Bureau of Prison since 1991, has suffered two heart attacks, undergone a six vessel coronary artery bypass, and is currently experiencing chest pains and considerable shortness of breath. Dr. Garcia and Dr. Kim at Leesburg Regional Medical Center examined Eduardo Mantilla on Monday, January 6, 2003. The doctors performed three procedures: left heart catheterization, left ventriculogram and thoracic aortogram.

The left heart catheterization determined: Caliber vessel with a branching distal segment. The OM2 was 100% occluded. The right coronary artery was diffusely degenerated and had severe obstructive disease with a 40% proximal stenosis, 80% mid stenosis, and a 50% mid to distal stenosis. There was diffuse degeneration throughout. The PLV was a small caliber vessel with an 80% proximal stenosis. The PDA had a diffuse 20% to 30% stenosis.

The saphenous vein graft to the distal circumflex was diffusely degenerated with 10% to 20% diffuse luminal irregularities. There was a 30% proximal stenosis of the PLV branch. The saphenous vein graft to the RCA was occluded proximally. The LIMA was nonselectively visualized, was patent, and was not used for bypass.

The left ventriculogram determined: The EF was 45% to 50% with interior lateral kypokinesis. No mitral regurgitation.

The thoracic aortogram determined: There is an occluded saphenous vein graft to the RCA.

These three procedures concluded the following:

1. Severe three vessel coronary artery disease.
2. Occluded saphenous vein graft to the RCA.
3. Patent, but degenerated saphenous vein graft to the distal circumflex PLV branch.
4. High grade 90% mid LAD stenosis involving the first diagonal.
5. Diffusely degenerated and diseased right coronary artery.
6. Overall preserved ejection fraction with inferior hypokinesis.
7. Mild aortic insufficiency.
8. Mildly elevated filling pressures at rest.

The specific recommendations by Drs. Garcia and Kim were as follows: Recommend CT surgery consult for redo bypass surgery.

Rather than undergoing the recommended medical procedure, Eduardo Mantilla was sent back to FCC Coleman without further medical treatment. As of, Tuesday, January 14, arrangements had not been made to initiate the proper medical care he urgently needs.

According to the FBOP Clinical Guidelines for the Management of Coronary Artery Disease (Sept. 2001), Eduardo Mantilla is an inmate with “high to intermediate risk for an acute MI or sudden death and should be aggressively managed as having significant risk for an evolving MI and transferred to a community hospital setting in a timely manner,” (page 15). This proper and urgent measure had not been taken as of Tuesday, January 14, 2003 when Eduardo Mantilla last called his daughter, Ms. Falkenberg. Ms. Falkenberg was not able to secure from the medical personnel at FCI Coleman assurance that she would be notified when her father’s surgery was scheduled. She was simply told that next of kin would not be notified in case of a “routine medical procedure”. Further, Ms. Falkenberg was directed to speak with Mr. Brian Pownall, Chief Nurse Jan Ulston, Ms. Whitock and Mr. DeJesus at Coleman, none of whom provided an informative response.

In a call to Ms. Liz Nagy on January 14th, Ms Falkenberg was informed that the Medical Director’s Office had made the decision not the transfer Eduardo Mantilla to a Federal Medical Center since the resources were available in the community to perform the necessary surgery. No additional information on a set surgical appointment had been established.

Although it is true that federal prisoners forfeit many of their pre-conviction constitutional rights upon entering prison, “the one right they do retain, under the Eighth Amendment, is the right to be protected against cruel and unusual punishment.” Bell v. Wolfish, 441 US 520 (1979). In Wolf v. McDonnell, 418 US 539 (1974); the Court stated that there was “no iron curtain drawn between the Constitution and the prisons of this country.”

Two years later, the Court stated “an inmate must rely on prison authorities to treat his medical needs; if the authorities fail to do so, those needs will not be met. In the worst cases, such a failure may actually produce physical torture or death.” Estell v. Gamble, 429 US 97 (1976). In Gregg v. Georgia, 428 US 153 (1976), the Court held that the “infliction of such unnecessary suffering [is] inconsistent with contemporary standards of decency.” When the Court set forth its “deliberate indifference” standard in Gamble it was addressing the degree of indifference that resulted in unnecessary infliction of pain.

Unarguably, the directives contained in the BOP healthcare policy statements appear to rise to the level of humane treatment mandating the provision of necessary medical care at levels comparable to accepted community standards. BOP Program Statement 6000.05 assures humane treatment of prisoners, yet in reality healthcare at FCI Coleman appears merely symbolic in nature. The vast divide between BOP healthcare policy and the reality of healthcare provided by FCI Coleman medical staff contravenes both Supreme Court rulings and congressional mandates. Given the paucity of medical care being provided Eduardo Mantilla, one could easily conclude that the BOP operates a symbolic healthcare system.

Although quick to hide behind the U.S. General Accounting Office report when reducing inmate phone calls to 300 minutes per month, clearly the BOP ignores a 1994 report by that same office that describes the inadequate healthcare system available to federal prisoners. Are we to conclude then that the BOP places more importance on limiting criminal conduct via inmate phone calls than it does on the healthcare needs of federal inmates?

Recognizing that accountability of prison medical personnel has become a pervasive issue; some federal courts have recently limited the defense of qualified immunity where prison officials should reasonably know that their actions are violating an inmate’s constitutional rights. The Seventh Circuit recently held that Dr. Ivy Benjamin, Dr. Adrian Feinerman, Dr. Ansar Ansari, Dr. Virgilio Pilapil, Nurse Pamela Dunbar and Nurse Vickie Rowland were “deliberately indifferent” when Inmate Walker repeatedly complained of pain and manifested physical indications that he was in pain. The Walker court clearly indicated that the deliberate indifference standard was applicable to pain medication. Perhaps, the medical staff at FCI Coleman is not aware that they can now be found personally liable for their deliberate indifference.

The bottom line is how much longer must Eduardo Mantilla suffer because of the deliberate indifference of FCI Coleman’s medical personnel? That’s a question that Federal CURE cannot answer. The answer lies solely in the control of the Federal Bureau of Prisons. The liability lies solely with FCI Coleman’s medical personnel and the BOP personnel under whose supervision they work which include Camp Administrator Cuffey, Warden Holder, Regional Administrator Matthews, Medical Director Dr. Newton Kindig, Assistant Director of the Health Services Division MaryEllen Thoms, and ultimately, with Federal Bureau of Prisons Director Dr. Kathleen Hawk Sawyer.

FCI Coleman’s medical personnel have not followed appropriate recommendations. On January 6, 2003, the treating physician at Leesburg Regional Medical Center recommended that Eduardo undergo “CT surgery consult for redo bypass surgery.” We are requesting that Eduardo Mantilla be immediately transferred via an emergency medical transport to Leesburg Regional Medical Center for the recommended treatment, and any other necessary and appropriate treatment.

Sincerely,

Karen S. Bond, J.D.