Court monitor
finds erratic care of HIV-positive inmates in Alabama

A court-appointed monitor warns that erratic treatment of HIV-positive inmates in an Alabama prison could develop into treatment-resistant HIV.

A new report by Joseph Bick, MD, issued that warning a year after the state corrections department agreed to improve medical treatment for the HIV-positive prisoners.

Bick documented four types of "sub-optimal" HIV treatment at Limestone Correctional Facility, where more than 200 HIV-positive inmates are housed. A California expert in prison medicine, Bick was appointed by U.S. magistrate judge John Ott to visit Limestone four times a year and evaluate whether the state and its medical contractor provided dozens of improvements required in a lawsuit settlement. Although state officials promised in the settlement last year to hire an HIV specialist for the men, there has not been one during much of the year, leading to erratic treatment.

"The lack of an HIV specialist continues to negatively impact upon the health of this inmate population," Bick wrote after a prison inspection in May.

HIV specialist Nancy Garcia of the Medical College of Georgia began work at the prison a little more than a month after Bick's visit. Tennessee-based Prison Health Services, the private company that oversees care in Alabama prisons, says many of the problems Bick found were related to that position's being vacant until Garcia's appointment. "It's difficult to recruit a highly qualified HIV specialist, especially to a rural area," the company said in a statement. Two specialists PHS previously hired left the job within weeks or months.

Bick warned that the mistakes in previous care could have irreversibly harmed patients. During his weeklong visit in late May, Bick found substitute doctors who had mixed drugs that were not supposed to be used together, patients with rising viral loads who had not been seen for treatment changes or whose failing regimens were changed only one drug at a time, and doctors who made treatment changes without telling the patient.

State prison officials declined Friday to comment on the report, saying it was supposed to have been sealed at their request. The report was posted on a federal court Web site. Only sections revealing inmates' names and conditions were sealed.

Bick's reports have noted some improvements, but he has continued to focus on the facility's inability to keep doctors and to keep critical positions filled. "Due to the fragile nature of this medical program, I recommend that every effort be made to retain physicians once they are hired," Bick wrote in the new report. (AP)