While in an Alabama prison, 18-year-old Calvin Moore melted before the eyes of correctional doctors and nurses. Moore, a burglar who suffered from severe mental illness, lost 56 pounds in less than a month - more than one-third of his body weight. On Feb. 21, 1996, he died from dehydration and starvation in the care of St. Louis-based Correctional Medical Services, the industry giant in the rapidly growing field of privatized correctional health care.
CMS said it provided Moore with appropriate and compassionate care. A state report attributed the death to natural causes. However, a renowned expert on forensic medicine and pathology from the University of Colorado described Moore's death as "a homicide resulting from criminal negligence."
Word of Moore's death prompted the St. Louis Post-Dispatch to spend five months looking at the privatized correctional health-care industry. Reporters found more than 20 cases in which inmates died as a result of alleged negligence, indifference, under-staffing, inadequate training or cost-cutting by for-profit HMOs.
Information obstacles
The search for information was not easy. State correctional agencies were generally uncooperative, concerning the backgrounds of CMS physicians. We knew from anecdotal evidence that some had checkered pasts. The problem was obtaining a list of all CMS doctors and matching them against a database of disciplinary actions by state medical boards.
Although the data we needed existed, it required sweat to obtain and make usable. A database of unprofessional and incompetent behavior by medical doctors, called the National Practitioner Data Bank (www.npdb.com), is maintained by the U.S. Department of Health and Human Services. However, federal law prohibits the names of the doctors in the database from being divulged to the public. That information is only disclosed to hospitals, health care entities, state licensing boards, and, in some cases, attorneys.
The Missouri State Board of Registration for the Healing Art is more open with disciplinary data. The board even posts the physician license database, which includes a field of disciplinary actions (www.ecodev.state.mo.us/prl).
Index end-run
The only comprehensive database available to the public is provided by Public Citizen, a consumer group founded by Ralph Nader. The data come in a four-volume set of books priced at $307.50. It can be ordered from the Web site (www.publiccitizen.org). Regional listings are available for $23.50.
The books provide an abstract of actions taken against doctors (including arrests), actions taken by state licensing boards, and actions taken by the Drug Enforcement Administration. While it is a gold mine of information, it is organized by state rather than by doctors' names - a problem since many doctors with disciplinary histories move around. Even the index was difficult to navigate, because it was grouped by type of action.
We solved these problems by scanning the 75-page index and writing a short program in Visual Basic to parse the fields into a database. We posted a search form on a password-protected Web site that we shared, at first, only with members of the project. When the series ran, we made that database available to everyone in the newsroom on our Intranet. The Web site allows reporters to search doctors by name.
Prying with contracts
Our bigger problem was obtaining the names of doctors working for CMS in order to match them against our data. Our computer-assisted-reporting specialist, Julie Lucas, contacted 26 states in which CMS does business to ask for a list of doctors working there and the contract the state signed with CMS.
In virtually every case, the states at first refused to provide us with the list of doctors, claiming that they did not have that information or directing us to contact CMS directly. (CMS declined to share the data as well.) We did routinely obtain the CMS contracts, however. In some cases, those contracts provided the leverage we needed to pry the list of CMS doctors from the states. In nearly every contract, CMS was bound to provide the state correctional department with a current list of their doctors. We used that contract language to persuade several states that the doctors' names were a public record.
Even so, two states, Virginia and Arkansas, claimed that we weren't entitled to the information because their open record acts apply only to state residents. In actuality, Virginia's law specifically states that newspapers circulating in the state are entitled to public records. We proved that we sell some papers there. In Arkansas, we enlisted the help of Jeff Porter, the computer-assisted reporting editor at the Arkansas Democrat-Gazette, who managed to get the list of doctors within a day.
Our efforts paid off. We had numerous hits on our database from the list of doctors we received from the states. In fact, doctors with questionable backgrounds became a major theme in the series.
David Heath can be reached by e-mail at dheath@gw.pulitzer.net