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PLN editor quoted in WA article about horrific prison medical neglect

Seattle Times, Jan. 1, 2007.
PLN editor quoted in WA article about horrific prison medical neglect - Seattle Times 2007

Ex-inmate sues state over disfigurement

By Jonathan Martin
Seattle Times staff reporter

For two days, Charlie Manning lay in an infirmary of the Stafford Creek Correctional Center near Aberdeen in agonizing pain, his groin afire, his torso mottled with rash, his body slowly sliding into septic shock.

The prison's medical staff diagnosed Manning with an allergic reaction to cold medicine. They gave him an ice pack and some Benadryl and told him not to scratch.

But Charlie Manning wasn't having a mere allergic reaction. He had a freakish case of necrotizing fasciitis — flesh-eating bacteria — caused by a severe infection. By the time he was finally airlifted to Harborview Medical Center in Seattle, surgeons would be forced to perform "radical surgery" to save his life.

He had arrived in prison with a 13-month sentence for threatening his neighbor and stealing the man's pistol in a drunken argument. He left prison with no penis and only one testicle. In addition, six pounds of flesh were removed from his pelvis.

Now Manning is suing the state Department of Corrections (DOC) and the head prison doctor who Manning says misdiagnosed his disease, a physician who is now practicing in Aberdeen and presents himself as an expert in infectious diseases. Amid the dozens of lawsuits filed by inmates each year, Manning's case, filed in federal court in Tacoma, stands out for its extreme nature.

And while both the doctor and the DOC both say many of Manning's allegations of malpractice are false, critics of the state's prison medical system say his case highlights an issue they have been complaining about for decades: a callousness toward inmate complaints that can let serious problems go untreated.

"This is the most outrageous case of medical neglect in a prison or jail in this country I've ever seen where a patient lived," said Paul Wright, editor of the Seattle-based Prison Legal News, a national prison-watchdog magazine he started while serving time for murder in a Washington prison.

"This has all the common elements of the prison medical-neglect cases: It starts with something easy to diagnose, they botched the diagnosis, and they botch the treatment. It's a miracle the guy didn't die."

Delusional with pain

Manning, now 60, is a slightly built former housepainter with a history of mental illness, alcoholism and an IQ of 78. When he arrived at Stafford Creek from another prison in March 2004, he was considered a low risk.

He had at least two drunken-driving convictions and three felonies on his record, including convictions for harassment and gun theft in Mason County in 2004. He had already been in and out of alcohol treatment.

On July 4, 2004, three months after he arrived at Stafford Creek, he developed an infected hemorrhoid. Manning claims he repeatedly asked for medical attention but received no response until July 6.

By then, he was so delusional with pain that he hid under his bunk, he now says. His genitals were swollen, he was bleeding from his rectum, had a rash on his torso and was running a fever. According to DOC medical records released to The Seattle Times, over the next two days Manning's blood pressure dropped, his pain increased, and blisters began to form on his genitals.

Stafford Creek's head doctor, A. Muhammad Khurshid, stood at Manning's bedside a few hours after he was admitted on July 6. There is no record that he performed an exam.

Khurshid opted for a wait-and-see approach and left Manning's care to other staff, according to the records. In addition to fluids, Benadryl and a pain reliever, Manning was prescribed Medrol, a steroid for inflammation. But Medrol also depresses the immune system.

"Filleted like a salmon"

Finally, on July 8, Khurshid stepped in. By then, Manning had dark blotches — a sign of dead tissue — on his penis and open sores on his scrotum.

Khurshid diagnosed an infection and sent Manning to Grays Harbor Community Hospital in Aberdeen. A doctor there quickly recognized "Fournier's gangrene," a type of necrotizing fasciitis that kills about a quarter of the people who get it.

Manning was immediately airlifted to Harborview, where Manning remembers a surgeon standing over him asking, "Where have you been? You're terribly sick."

Over the next week, Manning endured four "debridements" — cutting away dead tissue — which left him scarred from rectum to ribs. Surgeons eventually made a replacement penis with skin from his thigh.

Manning says he owes his life to the Harborview staff. The staff has declined to discuss his case.

Manning was at Harborview for about two weeks. Then he was sent back to Stafford Creek. His intake chart there still listed him as allergic to the same cold remedies that were wrongly linked to the pain in his groin.

Manning got out of prison in October 2004, and now lives in a dilapidated motor home in Hoodsport, Mason County. Extensive surgeries have left him disabled. He takes at least 30 milligrams of morphine a day for pain.

"He's been filleted like a salmon," said Roger Grissom, a friend who helps take care of him.

Doctor blamed

Manning's lawsuit pins much of the blame on Khurshid, accusing him of "deliberate indifference."

Manning's lawyer, Daniel DeLue of Seattle, contends Khurshid's delay in diagnosis let the infection spread, causing permanent disfigurement.

"There will never be a return to normal" for Manning, DeLue said. "No individual who's been compromised physically and emotionally at this level can ever return to normal."

Dr. Beck Bay, a Seattle expert in prison medical care hired by DeLue, said Khurshid and his staff failed to recognize obvious signs of infection and failed to order blood tests.

"That is off-the-charts unacceptable," Bay said. "It's hard for me to understand what they were thinking."

And prescribing immune-suppressing Medrol was "like putting gasoline on the fire," DeLue said.

The DOC officially denies all of Manning's allegations and won't speak about the lawsuit in detail.

"We've had Mr. Manning examined by a medical doctor, who didn't find support for many of the medical claims," said Eric Mentzer, an assistant attorney general.

A history of complaints

Khurshid is a Pakistan-trained physician who got his Washington state medical license in 2000 after an internship at an Illinois hospital. He finally passed the exam required of foreign-trained doctors on his fifth try.

Since Khurshid was hired by the DOC in 2001, 11 complaints have been levied against him to the state Department of Health. In one case, an inmate claimed Khurshid gave him inadequate treatment for methicillin-resistant Staphylococcus aureus, or MRSA, a deadly so-called "superbug" currently troubling public-health officials nationwide.

But that complaint and all the others were eventually dismissed by the Health Department, records show.

It's unclear how the number of complaints Khurshid received compares to other prison physicians in Washington.

The DOC won't comment on the issue.

In 2004, three months before Manning's infection, health inspectors cited Khurshid's clinic for poor infection control. Hospital staff, including Khurshid, had delayed liver biopsies in suspected cases of hepatitis C.

In 2006, two years after Manning's infection, the DOC suspended Khurshid for three days without pay for accepting about $10,000 from drug companies, a violation of the department's ethics code.

Khurshid left DOC in August. In a brief telephone interview last week, he said he left because "another opportunity had come around" at a clinic in Aberdeen, where he still lives. He previously had set up a side business, Harbor Infectious Diseases, to act as a consultant on infection control.

He denied misdiagnosing Manning but declined to answer questions, citing Manning's lawsuit. "Unfortunately, our patients say a lot of things that are not true at all," Khurshid said.

At his home near Hoodsport, Manning said he isn't angry anymore. He said he's suing because he can't even walk more than one block without severe pain, let alone work.

The case is set for trial next year.

"I'm just sad and disgusted," he said.

"I just want to get on with what life I have left. I've made a lot of mistakes in life myself."