‘Sub-Optimal’ HIV Care Continues at Alabama Prison Despite Some Improvements, Court-Ordered Monitor’s Report Says
"Sub-optimal" HIV treatment continues to occur at the Limestone Correctional Facility in Harvest, Ala., according to a federal court-ordered monitor's report presented on Friday, the Birmingham News reports. The report -- which was conducted by prison medicine expert Joseph Bick after a visit to the prison in late May and filed on July 7 with Magistrate Judge John Ott -- says that Limestone has not provided an infectious disease specialist to treat the facility's more than 200 HIV-positive inmates for much of the past year despite an April 2004 federal court settlement in which the Alabama Department of Corrections promised to hire a specialist (Crowder, Birmingham News, 7/16). Under the settlement, which was reached in response to a 2002 federal lawsuit filed by HIV-positive inmates, the department is required to provide various improvements in living conditions and medical care for the inmates, including allowing a medical consultant to monitor the conditions of the HIV unit on a quarterly basis for two years and hiring a full-time nurse to coordinate infection control and medical care (Kaiser Daily HIV/AIDS Report, 5/3).
During his weeklong visit to Limestone, Bick found that substitute physicians incorrectly combined drugs; patients who had rising HIV viral loads did not receive changes to their drug regimens; patients with failing regimens had their regimens changed by only one drug, going against standard treatment practice; and doctors made treatment changes without telling the patient. Bick's report also said that having one physician and one nurse practitioner in charge of care for 1,800 other inmates and 135 work-release prisoners is "inadequate." However, he lauded Prison Health Services -- the private company that oversees health care in Alabama prisons -- for improving Limestone's nursing staff, medical record-keeping and attention to inmate complaints, as well as for halting the sharing of medicines among inmates.
Bick recommended that "every effort be made to retain physicians once they are hired" and said that the facility should hire three full-time physicians. About one month after his visit, Nancy Garcia, an HIV specialist from the Medical College of Georgia, began working at the prison, according to the News. Two physicians previously hired for the position left within weeks or months. PHS in a statement said that many of the problems cited in the report were related to that position being vacant. "It's difficult to recruit a highly qualified HIV specialist, especially to a rural area," the statement said, adding, "The latest Bick report clearly indicates great progress has been made in delivering quality care to our patients" (Birmingham News, 7/16). State prison officials on Friday declined to comment on the report, saying it was supposed to have been sealed at their request (AP/Decatur Daily, 7/17).