Lawsuit Offers Insights Into How Medical Decisions Are Made

By Jessica McBride and Mary Zahn

of the Journal Sentinel staff

An eight-month Journal Sentinel investigation has found dubious medical decisions and a pervasive lack of accountability in the deaths of Wisconsin inmates.

Dozens of Wisconsin inmates have died under questionable circumstances during the last decade. And the final Department of Corrections reviews of prison deaths are kept secret - even from family members.

The state Department of Corrections medical chief has more power than just about anyone else over life-or-death decisions made for state prison inmates.

George M. Daley, a Milwaukee-area physician, has held that position since 1993. Although he declined to be interviewed, the 1999 court case of inmate Cedric Johnson sheds some light on who Daley is and how medical decisions within the department are made.

Johnson alleged that Daley denied him the right to be a candidate for a liver transplant based on Daley's belief that, as an alcoholic, the inmate was not a suitable candidate.

In January 2000, the state paid $40,000 to Johnson, who was serving time for armed robbery, based on a jury verdict in the case. During the Johnson case, Daley testified that if Corrections medical staff members disagree with him, they can discuss it.

"Their only recourse is to try to get you to change your mind, in other words?" Daley was asked.

"That's right," he said.

Daley added that only Corrections Secretary Jon Litscher can override a decision he's made. But Daley testified that there is no formal review process and no one has ever gone to Litscher.

He added that Sharon Zunker, head of the department's Bureau of Health Services, "really has power over me, but I doubt if she'd ever - she's a nurse, not a doctor."

Without Johnson's history of alcoholism, Daley said, he would have approved him for a transplant. Instead, he refused at first to put Johnson on a waiting list.

"Once an alcoholic, always an alcoholic," Daley testified. "You never recover from alcoholism. Once he gets out and if he starts drinking again, his liver is going to fail again."

Daley testified that the Corrections Department has no policy on organ transplants. In June 1999, Daley finally agreed to put Johnson on the organ list. Johnson remains on the list.

"In most cases it will be my determination," he said.

Nevertheless, Daley testified that alcoholics and drug abusers get the same treatment as everyone else in the system.

His staff, he said, attempts to ensure health care that reflects "community standards," but he said "community standards is a very vague thing." He said internal reviews are used to ensure good health care services are delivered.

And even though he is responsible for overseeing medical decisions systemwide, Daley also is one of the main reviewers of whether inmates' medical needs were properly handled before the inmates died. He usually writes one of the preliminary mortality review reports into all prisoner deaths.

The Journal Sentinel found that many of his preliminary reports contain sketchy and missing information. Corrections officials have refused to release copies of the final mortality review reports in inmate deaths, arguing that they are peer reviews and hence exempt from public disclosure.

According to Daley's testimony, he sometimes is in his Corrections office in Madison only one day a week. On other days, he travels to state prisons to review charts and see inmates whom doctors are having trouble with.

Daley graduated from Marquette University medical school in 1952. He specialized in general surgery. He was a surgeon at Milwaukee area hospitals until 1989. From 1989 until the end of 1992, he was a consultant for an occupational medical clinic.

Daley continued working part time as medical director of the St. Joseph's Independent Physicians Association doing a "quality review of what the physicians were doing." He also worked part time at a Milwaukee clinic as a primary care physician.

He became Corrections medical director on a part-time basis in 1993 and went full time in 1995. Daley said he had no experience with correctional health care before that time, but he was interested in the job because he wasn't working enough hours and thought it would "fit in well" with his other job at the physicians association.

"I do like to work," he testified.

Daley testified that he stopped working as a surgeon at several Milwaukee hospitals in 1989 because the men who referred patients to him "were dying or retiring."

Appeared in the Milwaukee Journal Sentinel on Oct. 24, 2000.

Copyright © 2000 Journal Sentinel Inc.

This article posted November 4, 2000.