AWARDS OFFER ANDREW SKOLNICK LITTLE SOLACE

[Correctional Medical Services (CMS) is the largest provider of prison medicine in the United States, receiving about $550 million annually in taxpayer dollars. Harper’s Magazine recently published an 8,000-word article that recounts widespread medical neglect by CMS of prison inmates that could lead to a public health crisis as scores of prisoners with untreated hepatitis C are released back into society. It’s not the first time CMS has come under fire. The quality of prison health care was the subject of an award-winning 1998 St. Louis Post-Dispatch investigative series. One of the writers was NASW member Andrew Skolnick, who paid a high price for reporting the story—LTF.]

by Wil S. Hylton

(The following is an excerpt.)

In the course of nearly a decade, only two newspapers had undertaken major investigations of CMS, and both were located in Missouri, which has become a kind of ground zero in the debate over prison medicine, largely because CMS is headquartered there. Even more discouraging, the reporters who wrote those stories had, in the aftermath of their work, become just as tortured and frustrated as everyone else who confronts the company. Not long ago, one of them agreed to meet with me in the basement of his office, but within the first two minutes of our conversation he insisted that I keep his name out of my story. In the weeks after his articles appeared in the Columbia Daily Tribune, he said, he had been under attack by CMS lawyers and publicists, who deluged his editors with denunciations, and he didn’t want to be perceived as settling the score. He sat nervously with me, fidgeting, smiling, and trying to be as helpful as possible without getting further involved.

The other reporter I spoke with was less reserved, but only because he had less to lose. He had already lost it all. In 1998, Andrew Skolnick had been an editor at the Journal of the American Medical Association, a recent recipient of the Harry Chapin Media Award, and an inaugural fellow of the Rosalynn Carter Fellowship in Mental Health Journalism, which is a $10,000 grant.

Using these lofty connections, he had managed to get himself and two journalists from the St. Louis Post-Dispatch into CMS facilities, where they spoke with several inmates and doctors before publishing articles in both JAMA and the Post-Dispatch revealing a national pattern of abuse and neglect by CMS.

As the organizing force behind both projects, Andrew had helped expose several CMS doctors with checkered histories and had revealed more than a dozen cases of egregious mistreatment, some of which resulted in death.

One story revealed a memo from the medical director of the New Mexico corrections department explaining that several prison doctors had quit because CMS administrative officials were “changing physicians’ orders and adding orders without seeing the patient or consulting the physicians directly.”

Another story exposed a CMS doctor in Alabama who had been convicted of having sex with a sixteen-year-old “mentally defective” patient in Tennessee. Another described the chief of mental-health services for CMS in Alabama, whose license had been revoked in both Michigan and Oklahoma after he was found guilty of sleeping with patients, harassing female staff members, and defrauding insurance companies.

The newspaper series had won awards from both Amnesty International and the American Medical Writers Association in the late 1990s, but even still, looking back, Andrew said that he wasn’t always certain it had been a good idea to publish it. After the articles appeared, he told me, CMS had sent a letter to JAMA accusing him of hiding his involvement with the Post-Dispatch, which they called “fraud,” and threatening to sue the journal. Within a week, JAMA had fired Andrew and, although CMS later paid him to settle a defamation lawsuit, his professional life never quite recovered. Even today, the editors of JAMA refuse to comment on “the conditions surrounding his termination” or to defend his award-winning expose, which has never been refuted or retracted.

“I had an exploding career,” Andrew told me, “and it crashed. We may have won some awards, but the horrible fact is we lost. CMS won. After the articles appeared, they went to the state legislature in Missouri and protected themselves. They got a law passed expunging the records of physicians who are accused of malpractice in correctional facilities. So now, any time the medical board doesn’t take action on an allegation they disappear it. This means no pattern can emerge against a doctor. That is our legacy. That’s our achievement. We actually made it worse.”

But Andrew’s investigation had a resonance far beyond that. It was his work that started CMS down the path of information lockdown, building barricades to public scrutiny, hiding numbers and statistics and the names of employees, refusing even to sit for a formal interview, and stifling the efforts of journalists to cover the field at all. Andrew’s series had put pressure on CMS, but that pressure had only deepened the company’s aversion to publicity. CMS officials were happy to continue operating with public funds, but they were no longer willing to provide any serious accounting of them.

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“Sick on the Inside: Correctional HMOs and the Coming Prison Plague,” Harper’s Magazine, August 2003. Wil Hylton is writer at large for GQ magazine.