Side Effects

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At least two DRDC veterans who testified at Gusich's hearing had already been involved in personnel cases against the DOC. Staffers are blunt about their paranoia over tenure. Wiliford, a male nurse who was subpoenaed to appear in Gusich's case, insisted that after testifying about the clinic's working conditions, "I'll be a marked man in the DOC."

"People are scared to speak out," says another nurse, who didn't want to be named. "They [the management] look for scapegoats. Taxpayers are funding this type of mentality."

At the corner pharmacy, law-abiding citizens receive their pills in little plastic bottles with childproof caps. At the DRDC, prisoners get their prescriptions in the med line.

Three times a day, scores of inmates line up outside a bullet-proof window set into a door made from three-inch-thick steel. Through a small opening in the window, a nurse hands out painkillers, psychotropics and other drugs, one dose at a time. Inmates are required to take their medication right there, and guards are on hand to make sure the patients aren't "lipping it," or holding the pills inside their cheeks so they can smuggle out the goods and sell them later.

The pills are kept in heat-sealed "cards," similar to the foil-backed pop-out packets that decongestant capsules come in. Each card is labeled with an inmate's name. But when a patient arrives and the nurse can't find a card for him, she might borrow from another inmate's card. And when that card runs empty, she'll borrow from yet another.

Gusich spoke out against this "borrowing," saying it made it impossible to figure out which meds were going where. His protests were largely ignored. However, recently the practice of borrowing has decreased "dramatically," Shoemaker explained during the hearing, "largely because of Mr. Gusich's issues."

Today more nurses seem concerned about the med line schedule. The first line runs from 6:30 to 8 a.m., the second from 2 to 3:30 p.m., and the third -- or "bedtime" med line -- from 6:30 to 8 p.m.

"Lights aren't out until 9 p.m.," says a nurse who sees sleeping medication and nighttime meds given out as early as 6:30 p.m. Patients who are supposed to take pills three times a day -- every eight hours -- sometimes have to go more than twelve hours between doses.

Shoemaker has promoted a "self-med" program that would allow inmates to keep quantities of medications in their cells and avoid the med line altogether -- a practice that was halted by a doctor during his tenure at the DRDC, a nurse explains. Now the practice has started up again, the nurse says -- even after staffers discovered a dialysis patient had mixed all his costly pills together in an unlabeled coffee can.

Nurses report a dearth of even the most basic supplies in the clinic. "The EKG machine breaks down just about every week," reports one exasperated staffer. "There have been days there hasn't been a thermometer around," adds another. The clinic suffers an acute shortage of blood-pressure cuffs and has none that can fit around the bulging biceps of the DOC's burlier residents.

Every year, the Colorado Board of Pharmacy makes a surprise visit to inspect each of the state's 800 retail drug outlets, including the handful of prison pharmacies. During visits to the DRDC and CTCF pharmacies over the past three years, inspectors primarily found that paperwork from the U.S. Drug Enforcement Administration, designed to trace the flow of legal narcotics, wasn't being filed properly. That type of error is not uncommon or particularly alarming, inspectors say. Likewise, finding expired drugs on a pharmacist's shelf, as Gusich did in Cañon City, "is an omnipresent problem," they say. They also dismiss Gusich's concerns about DOC staffers tossing expired meds down the toilet or into the sink; the state's health department doesn't object, either. As for "borrowing" medications in a public institution, as in the DRDC med line, "Is it okay? No. But in a practical sense, it happens," says the board's program administrator, W. Kent Mount. "It's not a good practice."

Transactions in the med line are recorded by hand. The DRDC doesn't use a computer to track drugs and their use, although a state audit report urged the implementation of "an integrated medical information system" for the DOC's clinical services back in 1996.

Meanwhile, the DOC spent $60,000 on a telemedicine system so that doctors at Colorado prisons could consult with their colleagues at regular hospitals on a video monitor without having to transport an inmate to the hospital. "The nurses were furious," says one, who claims the video system is hardly ever used. "With this new toy, we could have paid for another full-time employee."

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Gayle Worland