One man died with a festering abdominal wound. Another lay struggling for breath in his final weeks of life as his lungs deteriorated. A third was left untreated for days with a pencil stuck inside his bladder.

They’re among six inmates at Monroe Correctional Complex who suffered due to inadequate medical care — including three who died — according to a Department of Corrections (DOC) investigation that led to the firing of the head doctor at the prison earlier this year. State medical authorities are now investigating those six cases plus an additional four inmate deaths.

Dr. Julia Barnett, the medical director at Monroe, was placed on paid leave in October and fired for misconduct in April after DOC concluded that she’d “failed to advocate for these patients and delayed emergency medical care, which was essential to life and caused significant deteriorations in patients’ medical conditions.”

Dr. Julia Barnett, fired as facility medical director at the state prison in Monroe, is facing an investigation over allegations of inadequate patient care. (Washington Medical Commission)
Dr. Julia Barnett, fired as facility medical director at the state prison in Monroe, is facing an investigation over allegations of inadequate patient care. (Washington Medical Commission)

The care provided or supervised by Barnett was called “shocking” and “negligence” or “bordering on … negligence” by other DOC doctors who reviewed her work, according to more than 2,000 pages of investigative and medical records released to The Seattle Times in response to Public Records Act requests.

Dr. Patricia David, DOC’s medical director of quality and care management, described Barnett’s conduct to an investigator in January as “a breach of care, insufficient care, insufficient oversight and then really poor clinical decision-making.” She said she didn’t think Barnett made “the right decision on several of these cases and that resulted in bad outcomes and even death.”

Barnett’s management of the Monroe medical ward led staff there to submit a vote of “no confidence” in November to DOC administrators. In a letter, they wrote she’d created “a toxic environment” and appeared to make decisions “to reduce health care costs rather than for the benefit of the patient or for the benefit of her staff.”

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The DOC probe found inadequate care of six Monroe inmates, including three who died. The agency sent its findings to the Washington Medical Commission, which opened an investigation that has expanded to include four additional inmate deaths in 2017 and 2018. The commission investigation is ongoing and Barnett remains licensed to practice medicine.

Barnett declined an interview request through her Seattle attorney, D. Jeffrey Burnham. In a statement provided by Burnham, Barnett said she is appealing her “wrongful dismissal” and hopes DOC “will do the right thing and reinstate me.”

“As a general matter, the care I provided was appropriate in all respects, particularly in this medical setting. I cannot discuss the specifics of that care, however, because I need to protect the privacy of our patients,” Barnett’s statement said.

“This is particularly true with this patient population, who all know of one another, and who have an unusually large amount of personal information already in the public record. So, while the Department might provide patient information pursuant to a public information request, my obligation is NOT to discuss it publicly, even when doing so would be in my best interest,” she added.

DOC faces several tort claims from inmates saying they’ve been harmed by inadequate medical treatment while Barnett ran Monroe’s medical facilities. One inmate has filed a lawsuit seeking $1.5 million for alleged misdiagnosis and negligent treatment of diabetic lesions on his feet.

Jeremy Barclay, a DOC spokesman, said the agency has not notified affected inmates or their families of its findings in the Barnett investigation.

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Pharmacist turned physician

A former pharmacist who graduated from Tulane University School of Medicine in 2007, Barnett was hired by DOC after working as medical director at Lewis Prison in Arizona, where she was employed by a for-profit health-care provider, Corizon Health, according to personnel records.

Barnett started at DOC in March 2017 as a temporary doctor and was promoted two months later to facility medical director at the Monroe prison, where she was making $260,000 a year at the time of her dismissal.

When she was hired, Barnett lacked some of the stated credentials for the medical director job. She had not completed an approved medical residency and was not board-certified, according to the DOC.

Barclay cited a shortage of qualified doctors interested in the medical director job. Two others besides Barnett applied for the position, but one withdrew and another was ruled out in the interview process.

DOC deemed her overall experience “adequate” given her past work in a prison, Barclay said.

Burnham, Barnett’s attorney, said in an email that she was promoted to medical director over another applicant who had completed a residency in internal medicine “after a period evaluating both of them on the job, caring for patients.”

In her role as medical director, Barnett supervised two other doctors, as well as several physician assistants and nurses. Monroe is the state’s third-largest prison, with about 2,400 inmates.

Most of the inmates who suffered alleged harms were serving long sentences for crimes including murder, rape, assault, child molestation and possession of child pornography.

One man, serving a comparatively short sentence of 22 months for illegal possession of firearms, did not get adequate treatment for an infection in his mouth, the DOC investigation said. He complained he was having trouble breathing or swallowing, leading to an emergency hospitalization.

Regardless of any of the crimes they committed, prison inmates have a right to adequate medical treatment under the U.S. Constitution’s 8th Amendment, which forbids “cruel and unusual” punishment, said Nick Allen, directing attorney for the Institutions Project at Columbia Legal Services.

“Poor medical care is not part of the punishment for a criminal conviction,” Allen said. “When you show up at court for sentencing the court doesn’t say I sentence you to 10 years in a state prison and 10 years of poor medical care.”

Columbia Legal filed a federal lawsuit against DOC in 2015, two years before Barnett’s hiring, on behalf of inmates who alleged a pattern of “withholding necessary medical care from patients with serious and painful medical conditions.”

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The lawsuit was dismissed after a judge in 2017 denied it class-action status, ruling that despite evidence of “poor performance — or even malpractice” DOC had not been proved to be “deliberately indifferent” to inmates’ health-care needs.

Delays in care

The DOC investigation of Barnett found seriously ill patients went “long periods” without being examined by doctors, and that delays in care jeopardized inmates’ health.

One inmate, Lee Johnson, who had a lung disease, deteriorated over the summer of 2018 with declining oxygen levels in his blood. As his condition worsened and he gasped for breath, a lack of adequate care may have led to increased suffering in the final weeks of his life, according to the DOC investigation.

“I’d be calling an ambulance to come get this patient,” Dr. Sara Kariko, DOC’s chief medical officer, told an agency investigator after reviewing medical records, which indicated Barnett never personally examined Johnson.

“You have a patient that has a medical condition and you don’t treat, and you are watching them deteriorate. This is negligence in my opinion,” Kariko said.

By Aug. 24, Johnson’s blood-oxygen saturation plummeted and he grew agitated. When he complained, he was told by staff that he’d already qualified for a possible lung transplant “and he did not need to prove his illness or worse[n] it further,” according to DOC records.

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It was an absurd accusation. “There is almost nothing you can do to volitionally lower your oxygen saturation,” Dr. Frank Longano, DOC’s deputy medical director, told a DOC investigator after reviewing Johnson’s medical records.

The next day, Johnson’s lips and fingernail beds were turning blue. “I don’t want to die here,” he told nurses. Sent to a hospital emergency room, he died a week later.

Longano called the treatment of Johnson troubling. “I don’t want to use the word  neglect but it’s bordering on sort of negligence in the way that you approach cases,” he told the DOC investigator.

Johnson, 58, was serving a life sentence for a third-strike felony assault conviction stemming from a 2015 domestic violence attack on a woman in Kent, according to court records.

Perforated bladder

A few days before Johnson’s death, a 41-year-old Monroe inmate told a physician assistant he’d inserted a 6-inch-long pencil into his urethra to relieve “an itch.” He had painful cramps and blood in his urine. A nurse suspected the pencil had worked its way into the man’s bladder, records show, presenting a risk of a rupture and infection.

When asked about a treatment plan, Barnett said, “We ‘don’t do anything as long as he can urinate’ and it is unlikely that he pushed it all the way in,” according to a nurse’s handwritten notes. There was no record of Barnett examining the man.

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For five days, the inmate was not sent to the hospital or the prison infirmary, Kariko told the DOC investigator. The man, serving a 20-year sentence for child rape, was instead placed in the prison’s “close observation area” that is overseen by a nurse.

On Sept. 4, after an X-ray, he was sent to Providence Regional Medical Center Everett in extreme pain. The pencil had perforated his bladder and was removed by a surgeon.

“He needed emergency surgery. He could have gone into septic shock,” Kariko told the DOC investigator.

“No plan of care”

Also in August, faulty care may have contributed to the death of a 57-year-old inmate, according to DOC’s investigation. John Kleutsch, a convicted child molester, had been transferred to Monroe from another state prison after cancer surgery.

Kleutsch’s abdominal incision was not healing properly. Nurses trying to clean the wound noticed that when they irrigated it, the fluid did not come back out, leading them to worry about fluid buildup. What followed were “multiple days of abdominal pain, nausea, vomiting, no exams, no written notes, and no plan of care,” Kariko told the DOC investigator.

After he worsened further, with shortness of breath and extreme pain, Kleutsch was sent to a hospital emergency room. By that point he had a perforated intestine, pancreatitis and an infection, DOC records show. He died six days later.

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“That’s a death that may not have occurred” if he’d received proper medical care, Kariko concluded. David agreed, telling a DOC investigator, the death may have been avoided, or “at the very least he wouldn’t have passed with such pain.”

In an interview with The Seattle Times, Kariko said DOC administrators have strengthened oversight of prison medical directors in the wake of the Barnett investigation, and will conduct more detailed examinations of inmate deaths.

“We will review every death that occurs in the department and come up with ways from a clinical standpoint we can improve patient care,” she said.

News researcher Miyoko Wolf contributed to this report.