Correctional Physician Fails To Diagnose Brain Abscess In Symptomatic Inmate

This case involves an incarcerated woman who presented with complaints of headaches. She was seen by a correctional physician who diagnosed her with a chronic pain disorder. Within a few weeks, the patient was complaining of severe headaches. She was seen again by the same correctional physician who diagnosed her with an infection and prescribed an over-the-counter anti-inflammatory. Over the following 2 weeks, the patient made complaints of debilitating headaches to the correctional nurses every other day. However, no blood work, cultures, or imaging studies were ever performed. The patient eventually suffered a seizure in her cell and was found in an altered state of consciousness by a corrections facility staff member. She died in transfer to the hospital. It was later discovered that the patient had a large brain abscess. An expert in correctional medicine was sought to review the records and opine on the standard of care.

Question(s) For Expert Witness

1. Do you have experience treating prisoners with severe headaches, neck pain, and vomiting?

2. What are the triggers for ordering blood work, cultures, imaging, or transfer of the prisoner to a hospital?

3. Can nurses in a correctional facility perform diagnostic and treatment plants without the knowledge of a supervising physician?

Expert Witness Response E-037152

I am the chief medical officer of a county sheriff's department overseeing 5,800 daily inmates and 84,000 annual bookings for all medical, mental health, and dental care for inmates. My role is administrative and for quality control on all medical providers. I am also a practicing board-certified emergency department physician and have dealt with many patients presenting with headaches, neck pain, and vomiting. If a headache is persistent, further imaging is usually recommended. If the patient has a fever and headache, usually a complete workup including head CT, lumbar puncture, and labs would need to be done. It is out of the scope of nursing staff to make a diagnosis and form a treatment plan without knowledge of a supervising physician. I have reviewed many cases as a correctional medicine expert around the country and have done both deposition and trial testimony. It is concerning that further workup was not done after multiple complaints of the symptoms and that nursing staff made a diagnosis and treatment plan.