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Dear CURE Members and Supporters:

On September 21, 2002, Federal CURE posted an Action Alert for Jeffrey (Jeff) Johnston, #97497-071, an inmate who suffers from Limb-Girdle Muscular Dystrophy accompanied by associated and extraordinary complications. The following is a copy of a new letter that I have sent to Dr. Sawyer regarding Jeff Johnston.

What Federal CURE needs you to do is to immediately send follow up requests to the following people asking that the Federal Bureau of Prisons (FBOP) immediately provide Jeff Johnston with the medical care he needs and to which he is entitled. Keep in mind that the next request we send out could bear the name of your loved one incarcerated in the FBOP.

The broader question the FBOP must continue to answer is who is monitoring the quality of medical care they provide 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
Geraldo Maldonado - gmaldonado@bop.gov
Joe Kelley – jkelley@bop.gov
South Carolina Board of Medical Examiners - medboard@mail.llr.state.sc.us
CNN - public.information@turner.com
Fox News - comments@foxnews.com
NPR, Talk of the Nation - totn@npr.org
NBC, Michelle Cohen - Michelle.cohen@nbc.com
Human Rights Watch - hrwpress@hrw.org
Forbes - ppatsuris@forbes.com
The Post and Courier, Barbara Williams – Barbara@postandcourier.com

January 27, 2003

Dear Dr. Sawyer:

This letter is a follow-up regarding Jeffrey Johnston, #97497-071, an inmate incarcerated at FPC Estill, Estill, South Carolina. Jeffrey (Jeff) Johnston has been incarcerated since January 2002, with his initial custody location at FMC Butner, North Carolina. At his own request Jeff was transferred, to FPC Estill on or about June 12, 2002 to be closer to his family.

In my correspondence of September 21, 2002 on behalf of Jeffrey Johnston, I requested that the Federal Bureau of Prisons (FBOP) perform on specific recommendations to upgrade Jeff’s level of care. Please note the following as my previous requests with certain amendments and or additions:

1. Jeffrey Johnston be immediately examined by independent medical specialists, including a neurologist and pain management specialist, to assess and treat his conditions, including but not limited to abuse or neglect on the part of FPC Estill and or the FBOP;

2. Jeffrey Johnston be immediately provided with all testing, treatment, medication, and any other medical recommendations made by these independent medical specialists. Further, the FBOP provide Jeff the level of care as recommended in the opinions of Dr. Schwartz-Watts in her comprehensive medical evaluation. The opinions were based on 15 years’ medical records and notes from duly licensed physicians, specialists, medical centers and hospitals;

3. The FBOP immediately determine the availability of bed space at either FMC Butner, FMC Lexington or FMC Rochester and affect an immediate transfer of Jeffrey Johnston;

4. The FBOP provide Jeff clear copies of all medical records, including lab results for the period of January 2002, his medical intake at FMC Butner, through to the present;

5. The FBOP conduct an investigation into the conduct of all FPC Estill medical staff that have been involved in the absence and or refusal of appropriate medical treatment in contravention of community standards for medical care, international human rights conventions, and the Federal Bureau of Prisons’ own policies;

6. The FBOP investigate and correct the violations of their own policies and procedures set forth in specific Program Statements that ensure prompt, consistent, competent medical care for all inmates, and;

7. The Regional Office of the Bureau of Prisons in Atlanta, Georgia, take immediate responsibility for assuring that Jeffrey Johnston receive the same standard of care at FCP Estill that he would receive if he were an unincarcerated member of the Estill, SC community.

These specific requests were based on the following information:

Prior to his incarceration at FMC Butner, Jeffrey Johnston sought an independent medical evaluation from Donna Schwartz-Watts, MD, the Director of Forensic Services and Associate Professor of Psychiatry at the University of South Carolina School of Medicine Department of Neuropsychiatry. The date of this evaluation was completed on or about December 10, 2001. [Dr. Schwartz-Watts is Board Certified in Forensic Psychiatry and has been qualified as an expert in Forensic in South Carolina Courts of General Sessions, Common Pleas and United States District Court.]

In Dr. Schwartz-Watts evaluation, she clearly addressed Mr. Johnston’s extensive medical history, including his diagnosis of Limb-Girdle Muscular Dystrophy and injuries sustained in a motor vehicle accident in May 2000.

Jeffrey Johnston is confined to a wheel chair due to Limb-Girdle Muscular Dystrophy (LGMD), diagnosed by doctors at the Mayo Clinic in 1994 and verified by Dr. Schwartz-Watts’ evaluation references. In addition to the Muscular Dystrophy, in 1994 doctors at Presbyterian Hospital in New York diagnosed Jeff with a lipid related metabolic myopathy. In April 1996, Jeff was referred to the Carolina Pain Specialists due to chronic pain from his Limb-Girdle and “emotional happenings” in his life. In remarks obtained from a report issued by Dr. Wendt of Carolina Pain Specialists in May 1996, the doctor said in addition to Jeff’s Limb-Girdle disease “he has a component of myofascial pain and apparent degenerative changes in the right shoulder, neck and left knee.” Further, Dr. Wendt reported: “I really do not feel there will be any problem with chronic opioid usage.”

Dr. Schwartz-Watts also referenced Jeff’s chronic history of gastric complaints beginning in 1987. He was initially diagnosed with probable peptic ulcer disease and later Irritable Bowel Syndrome. During that period of evaluation and treatment, he was diagnosed with Hepatitis B (cause undetermined), although later records indicate he had Hepatitis D and that the cause may have been a stab wound. In 1993, he was diagnosed with Heliobacter infection of the stomach and duodenum and prescribed antibiotics. Jeff also reported he had recently had a colonoscopy for melena and that he was placed on the medications Nexium 40mg per day and Acophex 20mg per day for his GI condition.

As recorded in Dr. Schwartz-Watts Psychiatric Evaluation, Jeff was in a severe automobile accident that left him with some cognitive deficits and multiple trauma. His injuries included multiple left femur fractures including a subtrochanteric fracture, a right talar neck fracture, and right femur fractures. A retrograde nail was placed in the right femur. The subtrochanteric fracture was treated with a plate. Jeff also states that a plate and pin were placed in his right ankle. Jeff also suffered a sternal fracture with an anterior mediastinal hemotoma, medial clavicular fractures, a grade III liver laceration, a right cephalotoma, right rib avulsion and traumatic sinusitis. He also had a Greenfield filter placed because of his multiple long bone fractures. Neuropsychological testing on September 10, 2000 revealed a persisting post-concussive syndrome consistent with a closed head injury. The frontal structures of the brain showed some abnormalities on testing. A follow-up neurological exam by Dr. Frank O. Pusey on September 25, 2000 revealed memory deficits. Shortly after his accident, Dr. Edward A. Woody, otolaryngologist, performed an endoscopic ethmoidectomy on Jeff due to the trauma to his sinuses from the accident.

In her evaluation, Dr. Schwartz-Watts noted that Jeff suffers from chronic pain due to closed head injury, retrograde nail in left and right femur, plate in left hip, pin in right ankle, esophageal spasms secondary to sternal injury, and depression. She reiterates what doctors at both the Presbyterian Hospital in New York and the Mayo Clinic in Minnesota previously stated: Jeff will require for the rest of his life medication to handle the chronic pain as a result of these chronic conditions. She also reported that Jeff was recently diagnosed with hypertension. Further, she reiterated Jeff’s report that he was being evaluated for possible renal stenosis. Dr. Schwartz-Watts added, “which may be the etiology for his newly diagnosed hypertension.”

Dr. Schwartz-Watts issued the following opinions in her evaluation:

Mr. Johnston does suffer from chronic pain secondary to a degenerative myopathic condition and complicating traumas. There is no indication that he suffers from a substance abuse disorder. He could benefit from continued education about his condition and medications so that he does not develop a substance abuse disorder.

Mr. Johnston could benefit from psychiatric treatment while confined. He does have depressive and cognitive symptoms, which could improve with psychiatric management, including medication and therapy.

Mr. Johnson will require close medical supervision for both his chronic conditions and acute gastric conditions and now his new onset hypertension.

In September 2002, Jeff reported that he was not receiving medications needed for his chronic conditions. Federal CURE confirmed through the South Carolina Medical Board that Zoltan Vendel, the prison doctor at the time, was not licensed to practice medicine in the state of South Carolina. Jeff indicated Dr. Vendel appeared to have no understanding of the complexities of his medical condition. In a sick call visit to Vendel, Jeff was told his muscle enzymes (CPK or creatine Kinase) level was 22,800. Muscle enzymes should be no higher than 220 upl: Jeff's were 103.6 times above normal.

The results of this specific lab test were not unique. On two separate occasions as reported in the Chronological Record of Medical Care, FPC Estill, Standard Form 600 for the dates of September 19, 2002 (time: 1230) and October 3, 2002 (time: 1000), the attending Medical Officer/Physicians Assistant recorded respective CPK levels of 1095 and 979. Further, MB iso-enzyme results on both occasions were recorded as 4.3 with the normal referenced in the October 3 entry as “N 0.0 – 3.3.”

This elevation of muscle enzymes, called myoglobinuria, occurs when too much myoglobin is in a person's system. Myglobin elevation can clog the kidneys and result in acute renal failure. Elevated muscle enzymes directly affect the liver enzymes also. Elevated liver enzymes will cause liver damage, producing cirrhosis-type hardening of the large and small lobes of the liver. The kidney problems allowed fluid to buildup in Jeff's body, most significantly in his lungs. This fluid buildup can result in Adult Respiratory Distress Syndrome, fatal in 85% of cases like Jeff's.

According to Jeff’s Chronological Record of Medical Care, FPC Estill, Standard Form 600 dated June 12, 2002 (time: 1520) Jeff’s primary pain medication, MS-Contin, was scheduled to be tapered over a 32-day period with his transfer to FPC Estill. On July 25, 2002, there is a Consultation Sheet “to neurologist” from Dr. Vendel. The reason for request includes the following: “41 y/o W/M, wheel chair bound, 2o Muscular Dystrophy since 1992. He has been in MVA – resulted multiple fx. Even more he has chronic pain. He has been on non-narcotic and narcotic analgesics for many years. One month ago we started him on a non-narcotic pain management “with” Neurontin and Indocin after detoxification from Morphine.” We are not in possession of any record or further reference to any such consultation with a neurologist as noted in this Consultation Sheet. We are, however, aware of Jeff’s repeated complaints of chronic pain to FPC Estill’s medical staff, as noted in his Chronological Record of Medical Care, FPC Estill, Standard Form 600 for the period June 16, 2002 through October 3, 2002.

Further, in Chronological Record of Medical Care, FPC Estill, Standard Form 600 dated October 3, 2002, Dr. Vendel references a discussion with Dr. Parina, C.D. where they agreed “that after the neurolological evaluation, which is scheduled for today, …” According to a copy of a Georgia Neurological Institute Laboratory Order Sheet, Jeff was seen by Thomas M. Stanley, MD on October 3, 2002. Dr. Stanley prescribed two medications the names of which I cannot provide as our copy is unreadable. There are no additional notes or records of findings or treatment as a result of this examination.

We do know that Jeff has experienced severe kidney pain and bilateral weakness in all muscle groups. He has been to sickcall regularly requesting the medical staff do something to help him. Estill’s medical staff’s response has been “they will check his blood levels again in 30 days.” The staff, as recorded in Jeff’s Chronological Record of Medical Care, FPC Estill, Standard Form 600, consists of the following individuals: Zoltan Vendel, MD, Staff Physician; Robert Giorno, PA; Mr. Calvo, PA; Luciano Guadalupe, Infectious Disease Coordinator; and Mohammad Naeem, PA.

We have only limited information on Jeff's current medical situation. We are also without the benefit of Jeff’s medical records for the period of January 2002 to June 12, 2002 while in the care of FMC Butner, and for the period October 3, 2002 to present while incarcerated at FPC Estill. As expressed in our September 21, 2002 correspondence and according to Jeff, the medical care he received at FMC Butner was sufficient to maintain a certain level of comfort, including pain management, and effectively manage his extensive medical requirements. FPC Estill has yet to achieve this level of care.

According to Jeff and his mother, Gayle, FPC Estill’s case manager, Ms. Roberts, informed Jeff and his mother during a family visit on November 20, 2002 that he was being transferred to FMC Lexington, Lexington, Kentucky. As of Friday, January 24, 2003, this transfer had not been affected. Jeff has been told there are no beds available.

Federal CURE in no way condones criminal activity, but we do believe that the neglect of any inmates' medical needs, particularly where it may result in death or unnecessary pain or suffering, is a serious breach of the federal government's responsibility as well as a serious breach of the inmate's human rights. We also want to remind the FBOP of the need to provide medical treatment in a prompt, professional and non-discriminatory manner to inmates regardless of the reason for or duration of their incarceration. This deliberate indifference to Jeff's medical needs clearly contravenes key international human rights conventions and the FBOP's own Healthcare Rights and Responsibilities statement found in Program Statement 6000.05.

The International Human Rights Convention, Principles 9 and 24 of the Body of Principles for the Protection of All Persons Under Any Form of Detention or Imprisonment sets forth the standards for inmate medical care that are relevant to Jeff's medical care or rather the lack thereof. These principles provide that imprisoned persons shall be given medical care and treatment whenever necessary.

According to the Federal Bureau of Prisons' Health Services Manual, the mission statement of the Bureau Health Services Division is as follows: "The health care mission of the Federal Bureau of Prisons is to provide necessary medical, dental, and mental health services to inmates by professional staff, consistent with acceptable community standards." This claim stands in stark contrast to the callous and deliberate indifference combined with gross negligence of the FPC Estill medical staff in the case of Jeffrey Johnston. Jeff is currently experiencing inhumane punishment which could result in his death in custody. This situation is unethical, unprofessional and unacceptable.

The Federal Bureau of Prison's Inmate Health Care Rights and Responsibilities found in Program Statement 6000.05, state as follows:

Item 4 - You have the right to know the name and professional status of your health care providers.

Item 5 - You have the right to be treated with respect, consideration and dignity.

Item 6 - You have the right to be provided with information regarding your diagnosis, treatment and prognosis.

Item 8 - You have the right to obtain copies of certain releasable portions of your health record.

Item 10 - You have the right to receive prescribed medications and treatments in a timely manner, consistent with the recommendations of the prescribing health care provider.

In the case of Jeffrey Johnston, the reality is:

Item 4 - He was not made aware that the doctor treating him was unlicensed.

Item 5 - Jeff has been treated with disdain by the medical staff. His condition has been minimized and is going under treated or untreated. His life has been placed in eminent danger as a result of the medical staff's deliberate indifference to his medical needs.

Item 6 - Although Dr. Vendel told Jeff about his elevated enzyme levels, he subsequently refused to provide the treatment ordinarily provided to a person in Jeff's condition who is not incarcerated. Vendel's treatment of Jeff in no way conforms to a reasonable standard of care, as one would receive in the community in which the prison is located. By law, health care services must be provided to inmates at a level comparable to health care provided in the community or else their negligence meets the court’s standard of deliberate indifference.

Item 8 - Jeff has submitted repeated requests for copies of his medical records so that he will know exactly what has been recorded by the FBOP about his medical condition. At FMC Butner, Jeff was being treated appropriately, but when he was transferred to FPC Estill, FPC Estill medical staff outright ignored the treatment regime established at FMC Butner. The FPC Estill medical staff have refused to treat Jeff even to the extent of providing consistent care at the level he was receiving and that was prescribed by the medical staff at FMC Butner who did the medical intake screening at the beginning of Jeff's incarceration.

Item 10 - Jeff is not receiving the medications that were prescribed for him prior to his transfer to FPC Estill. The FPC Estill medical staff is showing deliberate indifference by ignoring the assessment of their colleagues performed at FMC Butner.

We are deeply concerned that there have been no appreciative actions taken by the Federal Bureau of Prisons (FBOP) on behalf of Jeffrey Johnston. While we recognize and appreciate that his case is medically complex, we contend the FBOP has the duty and ability to effectively deal with Mr. Johnston’s medical issues effectively and expediently.

The FBOP should undertake a careful review of medical standards identified in Program Statement 6000.05 and determine, through an extensive assessment, those facilities that are complying with the clearly stated responsibilities of the FBOP.


Karen S. Bond, J.D.