LITTLE ROCK — If medical workers at the federal prison in Forrest City had simply offered basic medical care when an inmate hurt his ankle in 2004, it could have saved him years of pain and the government an $813,000 malpractice judgment, a Little Rock attorney said Wednesday.
“It wouldn’t have been complicated if they had just taken some steps to resolve it,” attorney Milton DeJesus said about an ankle injury that health-care workers ignored for a month, eventually leading to five years of litigation that ended Oct. 15 in a victory for the former inmate.
DeJesus’ client, Jose Luis Gonzalez, now 54, was in his fifth month of serving a drug-trafficking sentence at the medium-security prison when, on July 28, 2004, during a softball game on prison grounds, another player slid into him as he covered second base, causing serious injury to his left ankle and lower left leg.
Gonzalez sought treatment for his injuries the next morning, but G. Toliver, a registered nurse at the prison, turned him away, telling him to return the next morning during “sick-call hours,” according to court documents.
When Gonzalez returned as instructed, making clear he had an “emergency” and a possible fracture, Toliver told him he couldn’t be treated until the next week and that he must make an appointment, according to U.S. District Judge Susan Webber Wright’s 22-page order.
When Gonzalez protested, Toliver simply called out, “Next,” the order said, citing testimony taken during a nonjury trial in Wright’s Little Rock courtroom in late August.
The order shows that Gonzalez returned to the clinic on Aug. 6, where a Spanish-speaking physician’s assistant, Yvette Toro, assessed his pain level at “6” on a scale of 1 to 10.
Toro requested X-rays, but said later that it wasn’t because she suspected a fracture, but because she feared a skin infection had worsened.
However, despite those claims of Toro and her supervisor, Clinical Director Edna Prince, concerns about the infection weren’t mentioned in a written radiology request, Wright noted.
Reports show that Prince, a physician, also saw Gonzalez that day, although she later claimed it was only for a diabetes checkup. Prince denied at trial that she wouldn’t allow Toro to serve as an interpreter during the visit.
“Certainly, Dr. Prince did not always utilize the services of an interpreter in her gathering of information to determine what the patient was trying to tell her,” Wright noted.
The judge cited records showing that in response to several requests for assistance from Gonzalez, who wrote them in Spanish, Prince simply made a notation, “Cannot read Spanish,” or, “In English, please.”
The order shows that when DeJesus asked Prince at trial whether she had made any efforts to have Gonzalez’s requests translated, she replied, “I asked him to get it interpreted for me. That, I think, is part of his responsibility for communicating with medical staff.”
Prince maintained at trial that she didn’t think Gonzalez was in pain. Wright noted that he wasn’t provided with a wheelchair or crutches, nor was he provided pain medication other than Motrin or ibuprofen that Toro had earlier prescribed for him.
Gonzalez was finally called in for an X-ray on Aug. 17 that had been ordered two weeks earlier. But, to make matters worse, the technician got him mixed up with another inmate and X-rayed his chest instead, the order notes. When the technician realized the error, he told Gonzalez he would have to reschedule his leg X-ray for another day.
An X-ray finally taken on Aug. 26 showed fractures of Gonzalez’s fibula and ankle, and prompted health-care workers to place him in a wheelchair and transport him to St. Francis Hospital in Memphis, where surgery performed the next day required the placement of two screws in his ankle.
Doctors at the hospital gave Gonzalez a narcotic for pain, but Prince withheld it from him when he was returned to the prison later that day, the order notes.
The judge noted that for several days after Gonzalez’s discharge from the hospital, Prince confined him to a holding cell where records show he was provided pain medication only twice in 12-hour intervals, he was never checked for fever or problems with his vital signs, and he wasn’t catheterized or provided assistance defecating and urinating, or monitored by medical personnel.
Gonzalez wore a cast for three or four weeks after surgery, then was placed in a “walking boot” before the ankle was healed enough that he could place weight on it, the order said. He was later transferred to another prison before being released on Nov. 14, 2008, and being deported to Mexico, where he continues to suffer pain in his ankle and is restricted in his day-to-day activities, Wright said.
Her order noted that less than two weeks before trial, the government conceded liability, admitting it breached the standard of care and was liable for Gonzalez’s pain as a result of failing to obtain an X-ray for nearly a month after the injury.
Wright said “it is not clear why” the government waited so long to admit liability, but DeJesus said it was because government attorneys didn’t think until then that he would really pursue the case to trial.
Wright wrote that the failure to treat Gonzalez’s fractures in the four weeks before the X-rays being taken “is nothing less than gross negligence.”
In determining the amount of damages to award Gonzalez, Wright cited the testimony of a doctor for the plaintiffs who said ankle fractures are “on the top end of the pain scale” and that the “traumatic injury” would have been “clear to a general practitioner such as Prince.”
Wright awarded the former inmate - who couldn’t attend his own trial because he had been deported - $10,000 a day for pain and suffering, and mental anguish, for the 28 days until he received treatment. She also awarded him $528,000 for the permanent injury he will suffer for the rest of his life, which she estimated at another 22 years, for a total of $813,000 in compensatory damages.
Phone calls Thursday to the Forrest City prison’s main telephone number went unanswered.
Traci Billingsley, a spokesman for the federal Bureau of Prisons’ main office in Washington, said Thursday that she didn’t know immediately whether the health-care workers at Forrest City who were mentioned in the judge’s order are still employed there, or if the judgment will result in any policy or procedural changes at the prison.
Arkansas, Pages 11 on 10/29/2010