A patient going into cardiac arrest without adequate treatment. A doctor using a drill from the maintenance department to treat an inmate. These are some disturbing allegations of medical mistreatment in the Department of Corrections. The examples come from the State's own investigators. Dr. Faisal Ahmed, a physician for the Department of Corrections, lived most of his life in Saudi Arabia and Pakistan. He came to the United States in 1994. A physician exchange program allowed him to practice at the Nebraska Department of Corrections as long as he worked in areas of need like a prison medical facility. Correctional administrators say it's extremely difficult to attract physicians to work in prison hospitals.
[Bob Whitson, DCS Healthcare Administrator] Generally this may be one of the last places in the world where a medical practitioner will want to come. There is a perceived danger of working around inmates. There is a negative stigma to correctional medicine. And that goes to do with the barbed wire and the prison setting and again, the clientele that they're dealing with.
When Whitson discovered a government program where they could recruit new physicians from other countries, he thought his problems were solved. However, things would take a turn for the worse. Dr. Ahmed encountered problems soon after he started working in the medical facility. When Ahmed witnessed an inmate die of cardiac arrest in 1998, he talked to Attorney Eric Brown. Brown does not want Ahmed to talk to the media for fear of retaliation from the Department of Corrections.
[Eric Brown] The thing that has been hardest for him has been the care that's been given to the inmates. I've seen him in tears before talking about the care or lack thereof that is given to certain inmates and some of those concerns were made to the ombudsman.
Brown recommended that Dr. Ahmed go to the State ombudsman and tell his story.
[Carl Eskridge, Asst. Ombudsman] It was completely out of the blue that Dr. Ahmed would come to us and so there was a great amount of shock and surprise.
The ombudsman is a public counsel that typically investigates complaints against State employees and elected officials.
[Eskridge] Of course then when he described what was going on, then the sense of shock and urgency really set in.
Dr. Ahmed's visit to the ombudsman's office sparked a year-long investigation of the correctional service's medical system. The end result, four bound books packed with more than 400 pages of information, interviews, letters, research, and a number of recommendations. The report attacked the way the Department of Corrections medical staff treats its patients.
[Marshall Lux, State Ombudsman] This is one of the-- clearly one of the most important things we have ever done if not the most important.
Inmate Robert Zolper went into cardiac arrest in September of 1998. The events following his treatment bothered Dr. Ahmed when he arrived on the scene. According to the report, Ahmed claims some staff members did not know where the equipment was and that Zolper wasn't even on oxygen. Ahmed was emotional. "For crying out loud," he said, "does a dying man not deserve that? Never before did I see anything like this and it seems like I was the only guy who was ever worried about saving the poor inmate's life."
[Brown] You had a period anywhere from 19 to 29 minutes before advanced cardiac life support was started on this man. It's no wonder he died.
But Correctional administrators say Dr. Ahmed's behavior during this particular episode was troublesome and fingers should not be pointing at the staff but instead at Dr. Ahmed.
[Harold Clarke, Corrections Director] After Dr. Ahmed lost his patient, he, as described by others, threw a tantrum and started accusing nurses and all those present of inadequate performances and so forth. And so after an investigation ensued, Dr. Ahmed to protect his interest, in my estimation, went to the ombudsman's office to complain about medical services being provided.
Shortly after, Dr. Ahmed was suspended for six months. Ahmed's attorney says it was retaliation against the doctor by the Department of Corrections. This winter the State personnel board would agree.
[Terry Ford, Deputy Ombudsman] When a whistle blower makes such a report, the law forbids taking certain personnel actions against him in retaliation for bringing those things to light. Dr. Ahmed blew the whistle and he was retaliated against at least three times.
The Department of Corrections denies their action was vindictive but in response to concerns about Ahmed's professionalism.
[Whitson] Problems did begin to surface even before the incident of the inmate death, such things as arriving late or leaving early, not being there in the hospital when the nurses were expecting him to make rounds.
[Brown] It's interesting that he brings that up because I can show you Dr. Ahmed's performance evaluation from just three months prior to the Zolper incident. Excellent.
Ahmed's supervisors gave him good marks in his performance reports. He was even given the top score of "exceeding expectations" three times. The rest of the report, it reads "expectations were fully met." His supervisor, Dr. Cherry even wrote comments that he was "pleasant and appropriate and he does what is needed."
[Brown] And there was no mention at all of any problems that Dr. Ahmed had experienced. So if there were those problems, you know, they have regularly-scheduled performance reviews. Why wasn't anything in writing?
According to the report, the problem goes well beyond the Dr. Ahmed controversy. The actions of other medical professionals are targeted as well. Ron Linneman was an inmate in the State penitentiary who served 18 months for driving on a suspended license and escaping from police. Today he walks with a bad limp and says he can only walk for short periods of time. Prior to his arrival at the State pen, he was in a car accident. Doctors at an Omaha hospital inserted pins in his pelvis connected to a brace. He was then transferred to the prison hospital. When it was time to remove the pins, Linneman says he was put off by Medical Director Dr. John Cherry. When Cherry finally did try to take the pins out, the method was a bit surprising to Linneman.
[Ron Linneman, former inmate] He brought a maintenance man to my room with a hammer drill and told me he was going to remove the pins out of me that day and I refused to get in my bed because I seen this dirty hammer drill and everything he was going to use and I wouldn't let him do it.
According to an incident report filed by Maintenance Supervisor Tim Law, Dr. Cherry asked if he could use Law's maintenance tools for about five minutes. Law was using a hammer drill to build some shelves. He took his drill and extension cord and followed Cherry to the hospital where he stood outside one of the patient's rooms. When Linneman saw the maintenance worker holding the hammer drill, he couldn't believe his eyes. Dr. Cherry would not comment to "Statewide," but administrators say it was Cherry's idea of a joke.
[Dan Danaher, Physician Assistant] Dr. Cherry attempted to remove those and was going to use some equipment that was felt to not be appropriate and that action was addressed. Dr. Cherry said it was in jest that he was going to do that.
[Linneman] No, I didn't think it was a joke. I thought it was one of the worst things that ever-- I have been in a lot of bad accidents and things in my life but I have never been through anything that somebody would pull-- I wasn't in a situation to have a joke pulled on me. I was in total pain.
Linneman filed a complaint with the ombudsman's office. They said he had a right to complain.
[Lux] All I do know is that there was one entry in the medical record that appeared to have been signed by Dr. Cherry which said that a drill and wrench should be secured from the maintenance department of the penitentiary.
This is a regular drill you would find at a hardware store?
[Lux] Obviously. That's right.
Is that anything that other surgeons use?
[Lux] I wouldn't think so, no. And it doesn't sound anything like the kind of handling that this patient would have gotten had he been taken to the orthopedic surgeon at the hospital with the anesthesiologist present. Obviously there is a big difference.
The longer the pins stayed in Linneman's body, the greater the chance of infection. A Lincoln orthopedic surgeon at this clinic who previously treated Linneman requested he have the procedure done here, not at the prison, but that never happened.
[Lux] It was much cheaper to do it the way it was done and we've got some documentation in the report talking about the ongoing concerns for cost.
Linneman grew desperate. Dr. Cherry ended up removing the pins with a wrench and no medication.
[Linneman] He come into my room and he brought a Mikita drill that carpenters use and an old rusty crescent wrench, and I had to take them out. I had to let him. It was either that or die.
Linneman filed a complaint with the deputy warden. His response stated that "the investigation essentially substantiated your complaints. All culpable staff are being held accountable for their actions. This should resolve your concerns." Linneman shows his scars from the pins. He says he still seeks medical treatment for his condition. Currently he is looking for an attorney to move forward with his grievance.
[Lux] The troubling thing about Dr. Cherry was that he was so be often featured in the complaints we got from inmates. And so we were particularly interested in him, and one of the things that bothered us was the difficulty in getting more information about him.
During a deposition with Dr. Ahmed's attorneys, part of Cherry's past came out. He had lost his privileges at Lincoln General Hospital back in 1993. The transcript reads: "why is it that you lost your privileges at Lincoln General?" Dr. Cherry answered: "there was concern over four patients of mine that died." Medical Administrator Bob Whitson says they do extensive background checks on all hires.
[Whitson] If their license is in current good standing and there are no restrictions upon it to practice in our setting, then I have to take them at their word. They are the governing agency and they say he is ok to practice.
Dr. Cherry lost his job as medical director but he continues to treat inmates as a staff physician. When he was demoted from medical director, did that have anything to do with all of this?
[Whitson] Maybe indirectly.
Although Dr. Ahmed's case spurred a year-long investigation by the ombudsman office, he wasn't the first staff member to come forward. Arlene Trainor worked as a nurse in the department for 14 years. When she started questioning similar problems in the department such as inadequate care of inmates and physician assistants having more power than doctors, she was suspended.
[Arlene Trainor, Registered Nurse] In fact, since I was even bringing up these questions, I was told that I was going to be suspended and I was suspended with pay.
For how long?
[Trainor] For a month.
Trainor took her complaints to State senators, the Department of Health and Human Services, and the Attorney General's office. Nothing happened but she did feel relieved that she brought her complaints forward.
[Trainor] From the top down, the director of personnel said to one of the nurses, well, these are thieves and robbers and murderers, and it was like so now let me see, do we have a different standard of care for thieves and then something different for murderers? For medical people to look at that diagnosis-- or their sentencing stuff and then make decisions on how to treat them medically was a real problem.
Trainor says others have issued complaints about medical staffers as well but many of them didn't go beyond these walls. Trainor hopes the ombudsman's report will shed some light on the situation.
You actually-- when you start reading it, you get into it, you actually get the same kind of feelings that you had then, you know. All the anxiety and the stress and stuff, all that came back.
Correctional administrators admit some changes do need to be made and they say they will take a closer look at the ombudsman's report.
[Whitson] If we can make this medical department better, we will do everything that we can. Right now we think we are operating very well.
Meanwhile, Governor Johanns announced a task force of medical professionals will look into the ombudsman's report and complete their own investigation. Director Harold Clarke hopes it will prove the ombudsman's report to be misleading.
[Clarke] It gives the impression that there is wide-scale inefficient practice of medicine within the department and I don't see it that way. I will put our department up against any in the country.
State Ombudsman Marshall Lux hopes his department's recommendations will be taken seriously so the medical system can be improved.
[Lux] As I worked on this, the truth is it became more than just a part of my job. Given what we saw and how serious some of this is, it really became a matter of conscience to do a good job, almost a moral imperative.
The task force will complete their investigation in six months. Reporting for "Statewide," I'm Andrea Gallagher.

Captioning by Nebraska Captioning Center, Lincoln, Nebraska .