The infection is ever-present. Even with the almost daily doses of antibiotics, it won’t go away.
The small bumps on Amanda Lawson’s skin, sometimes transforming into painful boils, regularly remind her of the virulence of the raging MRSA bacteria.
They also remind her of a breast augmentation procedure that went horribly awry and the surgeon she says “pretty much demolished my life.”
Lawson’s ordeal is just one chapter in the checkered career of Dr. David Cheney, a Baxley physician.
The Georgia Composite Medical Board barred Cheney from doing any type of surgery two years ago after investigating 19 breast augmentation procedures he performed at a Waycross clinic. In almost every instance, the board found, patients experienced serious complications, including infection and disfigurement.
Eight years earlier, the New Hampshire Board of Medicine documented similar blunders when it looked into two hospital procedures he performed in that state. One caused the patient’s death.
Yet none of it has stopped the 61-year-old from practicing medicine. Instead, he has simply taken on another role: Georgia prison doctor.
Cheney is the medical director at Telfair State Prison in Helena, one among a disproportionate number of physicians with troubled backgrounds who have found work in Georgia prisons.
An Atlanta-Journal Constitution investigation found that one in every five physicians working in Georgia’s public prisons was hired despite medical board orders citing them for various forms of misconduct, raising the specter that the state is pushing bad doctors onto one of society’s most vulnerable groups of people.
“This is a disadvantaged, impoverished and ill population,” said Dr. Josiah Rich, a professor at the Brown University School of Medicine and co-director of the Center for Prisoner Health and Human Rights. “To take that population and compromise the care you give them … is perhaps doubly wrong.”
The AJC examined the disciplinary records of the 50 physicians currently working in Georgia’s 31 state-operated prison facilities. It found that 11 were hired despite public orders for misconduct issued by the Georgia medical board or boards in other states.
Compared to the state’s doctors as a whole, that’s a far greater percentage. Only 2.4 percent of the state’s more than 32,000 licensed physicians have had such orders during their careers, according to Georgia medical board data analyzed by the AJC earlier this year.
Seven of the disciplined physicians are general practitioners working for Georgia Correctional Health Care, a division of Georgia Regents University that hires and supervises most of the physicians in the state’s public prisons under an inter-agency agreement with the Georgia Department of Corrections.
Moreover, six are prison medical directors and four were hired for their jobs even though they had been sanctioned for failing to diagnose or treat serious medical conditions. In all four of those cases, patients died.
Dr. Billy Nichols, Georgia Correctional Health Care’s medical director, said it’s wrong to think that his unit settles for whatever doctors it can get. He pointed out that physicians are only hired after a lengthy interview process and their work is regularly monitored.
“The proof is in the quality of outcomes we have,” he said. “We haven’t had a lot of bad outcomes around here.”
The medical director for the Georgia Department of Corrections, Dr. Sharon Lewis, declined the AJC’s interview requests.
`Not for everybody’
Working in a prison requires doctors capable of dealing with a full range of challenges, from the smallest injuries to the most serious diseases. According to data compiled by the Georgia Department of Corrections, 37 percent of the state’s 44,000 inmates have chronic illnesses, including hepatitis C, cancer and HIV.
But finding physicians willing to fill prison jobs isn’t always easy, often because the pay doesn’t measure up to that in other medical fields. The physicians working for Georgia Correctional Health Care earn between $150,000 and $190,000 a year, less than the average general practitioner in the state.
Hiring better doctors for prisons is “a matter of resources and also vision,” Rich said.
“It’s not for everybody, but there are certainly ways to attract quality people,” he said.
One current Georgia prison physician was hired a year after being sanctioned by the medical board for failing to properly diagnose a spinal cord injury that led to the patient’s death. The physician, working in a hospital emergency room, failed to diagnose the injury even though the patient, who had been in a bicycle accident, complained that he couldn’t move his legs, the board found.
That doctor has continued to work for the prison system despite a second disciplinary order for prescribing medication without proper justification at an Atlanta pain clinic.
Another physician working at a Georgia prison was hired five months after being cited by the board for his treatment of a patient who died as a result of complications from Stevens-Johnson syndrome, a rare and serious skin condition. The physician was later terminated for taking an unauthorized leave but has since been rehired.
Leaders in correctional health care acknowledged that certain issues in a physician’s past can be accepted. They noted that it wouldn’t be out of line for a doctor cited for misconduct with female patients to be hired to work in a prison with male inmates.
However, given the serious health problems that can arise in a prison setting, the number of physicians in the Georgia system with histories of failure in diagnosing and treating injury and disease is unsettling, they said.
“These folks, they should be able to earn a living,” said Dr. Michael Puerini, an Oregon prison doctor and a past president of the Society of Correctional Physicians. “But if you don’t know how to practice medicine, prison is not the place for you.”
In some cases, the AJC found, physicians with disciplinary records have practiced in Georgia prisons in essence because they were restricted to those jobs by the medical board.
Some orders from the board have stated directly that physicians must practice in correctional facilities. That conflicts with the standards of the National Commission on Correctional Health Care.
Other board orders have been more broadly written, limiting physicians to “institutional” or “structured” settings and listing examples such as prisons, VA hospitals and free clinics.
Sarah Geraghty, a senior attorney at the Atlanta-based Southern Center for Human Rights, said even those directives that suggest multiple places of employment are “disgraceful.” They imply that there’s “a certain class of people for whom these (disciplined doctors) can provide services,”she said.
In addition to prohibiting Cheney from performing surgery, the board initially restricted his practice to Georgia Correctional Health Care. However, the order was amended six weeks later to eliminate that language and say he could only work “at a practice or facility approved in writing by the board.”
Officials with Georgia Correctional Health Care said they sought the change because Telfair State Prison was scheduled for an accreditation visit by the Medical Association of Georgia, which uses the national commission’s standards in its accreditation process.
The association’s executive director, Donald Palmisano Jr., confirmed that the new language made Cheney’s license acceptable to the organization. But he couldn’t say if the change was simply a matter of semantics.
“I can’t answer for the board, what they were thinking. But in terms of what we do, in terms of accreditation, (his license) meets the standard for health services in prison,” Palmisano said.
Georgia medical board officials said orders restricting physicians to certain settings typically arise from negotiated settlements in which the physicians are already working in those positions and want to remain in them. If it’s believed those settings can offer sufficient structure and oversight, the board will agree, they said.
“These things are worked out as examples to help the doctor find a place that we think would be safe for him or her to practice,” said Dr. Jean Sumner, the board’s medical director.
However, a prison might not be the best place for a doctor who needs supervision, some correctional health care experts said.
“In a correctional facility, you can argue that (physicians) are going to have even less oversight,” Rich said. “If you go to a doctor in the community and he does something terrible to you, you can call a (medical) board, a newspaper, complain to any number of places. If you get lousy care in prison, you’re locked up.”
A history of errors
Cheney’s position as the medical director at Telfair, a facility that houses 1,150 male inmates, raises particular questions because he was hired seven years ago after being disciplined for one set of serious problems in treating patients and has continued in his role while under sanction for others.
In New Hampshire, he was reprimanded by the medical board for a series of errors that occurred during a colonoscopy and a laparoscopic surgical procedure.
During the colonoscopy, the patient’s bowel was perforated, and the patient, a 64-year-old woman, died four days later, according to a lawsuit filed by her family. The laparoscopic procedure caused “an unrecognized bowel injury,” resulting in infection, sepsis, septic shock and multi-organ failure, according to a lawsuit filed by that patient, a 37-year-old woman. Both suits were settled out of court.
Two years after being hired at Telfair, Cheney began doing breast augmentation and other forms of cosmetic surgery during his off hours. He performed the procedures at Southeast Laser & Plastic Surgery, a clinic in which he was a part owner.
Located in a Waycross strip shopping center, the facility was never accredited, and its newspaper advertising listed Cheney as a plastic surgeon even though he’s never been board certified in that specialty.
Court records and other documents describe a place where patients under local anesthetic were awake and sometimes in pain as Cheney and an assistant, a women with no medical training, inserted the implants.
“After the implants were filled, Dr. Cheney began pushing very hard on the left breast,” one patient, 38-year-old Georgina Harrell, wrote in a detailed narrative of her experience she provided to the AJC. “I told him that it was hurting bad. He said that it would hurt some, but that there was nothing he could do.”
Harrell wrote that the procedure left one of her breasts considerably higher than the other — less than an inch from her collarbone — yet Cheney was unsympathetic when she returned for a follow-up visit.
“I showed him my breast and was about to cry,” she wrote. “He said, `Boo hoo.’”
The board weighs in
After reviewing the records of 19 women who underwent breast augmentation procedures at the clinic during a six-month period, the Georgia medical board cited a multitude of problems: Cheney didn’t examine patients before their surgeries. The drugs used for sedation were “totally insufficient.” Vital signs weren’t monitored. And almost every patient required a second procedure to correct the placement of their breasts.
The board also found errors with a procedure performed by Cheney at a Baxley hospital in 2006. In that case, a chest tube intended to draw fluid from around a patient’s lungs instead pierced organs, drawing a large quantity of blood.
The patient, a 44-year-old woman, lost consciousness and went into cardiac arrest before she was stabilized, according to a lawsuit she filed. The woman received an out-of-court settlement of $900,000.
Despite those incidents, the medical board chose not to revoke Cheney’s license even though state law could have allowed it on several grounds, including engaging in “deleterious conduct or practice harmful to the public.”
The board’s executive director, LaSharn Hughes, declined to discuss the decision, citing state law that restricts board officials from commenting on specific cases.
Cheney declined to be interviewed for this story. In an email, he said his superiors at Georgia Correctional Health Care hadn’t given him authorization to speak to the AJC.
Nichols defended Cheney, saying that the physician has performed admirably at Telfair. He said Cheney’s issues as a surgeon should not raise red flags regarding his prison work.
“You’re comparing apples to oranges,” Nichols said. “You’re talking about a surgical specialty where an antiseptic approach is very important. You’re talking about doing invasive things like making incisions. He’s not doing that.
“All the stuff you describe, I’m not condoning that. All I’m saying is you can’t compare being a plastic surgeon and his inability to do that to his ability to be a primary care doctor.”
Police in Waycross also investigated the clinic after being alerted to it by an investigator from the medical board. The police report said “numerous” clients described how Cheney would perform augmentation on one breast while his assistant, Sharon Chavez-Yawn, worked on the other.
Nine women ranging in age from 28 to 67 and living in six different south Georgia towns were listed as victims.
But no charges were filed. The officer who supervised the investigation, Capt. Hilton Boyett, said the report was submitted to then-Ware County District Attorney Rick Currie, who declined to prosecute.
“We kept saying, `These women have suffered,’ but the district attorney is the sole decision-maker on criminal charges,” Boyett said.
Currie said he considered bringing a case against Chavez-Yawn for practicing medicine without a license but ultimately decided that the evidence wasn’t clear enough.
“I was amazed they were doing that kind of thing there, but sometimes the criminal laws aren’t able to handle all things that should be criminal,” he said.
Chavez-Yawn did not respond to a message on her Facebook page. Other efforts by the AJC to contact her were unsuccessful.
`It’s not really happening’
In the end, no one suffered more than Lawson. The 35-year-old Douglas woman was twice hospitalized in the weeks after receiving her implants and eventually had them removed. At one point, a catheter was inserted in her arm to pump antibiotics directly to her heart.
All her emotions spilled out in a Ware County court room in June when a lawsuit she filed against Cheney, Chavez-Yawn and the clinic went to trial. After two days of testimony, the jury deliberated for 45 minutes and awarded her $1 million.
In her testimony, the single mother of two described lying awake as Cheney and Chavez-Yawn struggled for nearly four hours to insert implants that were too large for her body.
“By that time … it’s like it’s not really happening,” she told the jury. “This don’t happen. It happens in a horror movie maybe.”
As the procedure dragged on, Lawson testified, Cheney became frustrated and violently opened a drawer, causing its contents to spill on the floor. He then picked up an implement from the floor and used it during the procedure, she testified.
Days after the procedure, she testified, “warm liquid started draining down from under my bra and made puddles on the floor at my feet.” Not even Kotex pads, doubled up, could stop it, she said.
In his trial testimony, Cheney recalled that Lawson’s surgery was more difficult than normal and that he was angry about it, but he denied doing anything out of the ordinary.
“I would not consider myself the world’s most experienced surgeon, but I do consider myself adequately experienced and trained,” he said, referring to his participation in a fellowship program for plastic and reconstructive surgery.
The verdict is under appeal, and Cheney’s attorney, Matt Coles, said he believes there are several evidentiary issues that could lead to it being overturned.
In a recent interview, Lawson said she continues to take an array of medications, including one that costs more than $100 a week, yet she doesn’t know if she’ll ever see any part of her damage award. Cheney, who the jury found responsible for $500,000, has no malpractice insurance; Chavez-Yawn didn’t show up for the trial.
“It’s not easy to deal with, because I blame myself a lot for this,” Lawson said. “I keep telling myself, `You shouldn’t have gone.’”
The fact that Cheney probably can’t work anywhere besides Telfair State Prison offers little solace.
“I know they are prisoners, but even they deserve better,” she said.
The Atlanta Journal-Constitution has been writing about physicians in Georgia for the better part of the year. In previous stories, the AJC has revealed how more than 2,500 do not have malpractice insurance. It also has detailed how some physicians have been approved to practice in Georgia despite losing their licenses due to misconduct in other states.
For this story, the AJC used the Georgia Open Records Act to try to learn the identities of the physicians practicing in Georgia’s 31 public state prisons. The newspaper then checked to see whether those doctors had been publicly disciplined by the Georgia Composite Medical Board or boards in other states. (In some cases, usually involving drug or alcohol dependency, boards issue private orders that aren’t publicly disclosed.)
Georgia Correctional Health Care, the division of Georgia Regents University that hires and supervises most of Georgia’s prison doctors , provided information on 32 general practitioners. The AJC found that seven had been hired despite being disciplined for professional misconduct and four had been cited for serious issues related to patient care. The AJC then sought to flesh out those incidents by reviewing board orders, court records, personnel files and other documents. It also spoke to victims and others with knowledge of those matters.
MHM Services Inc., a Virginia company that provides mental health personnel under a contract with the Georgia Department of Corrections, identified 13 psychiatrists working in Georgia prisons. The AJC found four who were hired despite disciplinary histories. The AJC then used an Open Records Act request to seek the personnel files for some of those physicians, but MHM has yet to comply.
In addition, the AJC was given the names of five prison psychiatrists employed by Georgia Regents University. None were found to have disciplinary records.