March 1 Testimony

Dr. Raymond Patterson, forensic psychiatrist, was cross-examined by defense counsel for SCDC on Thursday, March 1, 2012.

Defense counsel Andrew Lindemann cross examined Dr. Patterson on behalf of SCDC.  SCDC Counsel began his cross by questioning Dr. Patterson about a previously introduced Department of Justice document, which identified deficiencies in health care provided at SCDC.  Lindemann questioned the letter's relevance to this case, suggesting that it was written specifically about HIV inmates. Dr. Patterson pointed out that many of the Department of Justice findings were consistent with his own, that there were issues across the system relating to medications management.  In reference to a portion of the Department of Justice letter that suggested the possible need for judicial intervention, Lindemann asked Dr. Patterson whether he was suggesting that Jon Ozmint, former director of the South Carolina Department of Corrections, was asking for a lawsuit.  Dr. Patterson replied that he did not know what Mr. Ozmint was asking for.

Lindemann asked a series of question related to SCDC's ability to control who is incarcerated in its prisons.  He asked, isn’t it true that “SCDC doesn’t have control over where they are sent? They can control what facility within the Department that the inmate is sent to, but my point is the judge’s orders cannot be ignored. They don’t have recourse to send them back to court, or to the Dept. of Mental Health (DMH), but must send to SCDC system. Isn’t that correct?”  Dr. Patterson agreed.

SCDC's counsel also detailed a number of funding requests that the Department has made in previous years, and asked Dr. Patterson whether he knew if any of those requests were  provided by legislature. “I don’t know that,” he said. “I do know there is not a new facility or sufficient staff. The request is to provide services needed to comply with state and federal laws to provide care for people with special needs."

When Dr. Patterson was asked whether he is an advocate for mental health care – as a medical practice, he responded “I am in favor of health care – appropriate health care – and, as a psychiatrist, I am an advocate for appropriate mental health care.”

Dr. Patterson was questioned about a general shortage of psychiatrists throughout the country, particularly in South Carolina.  Dr. Patterson disagreed that psychiatrist availability is as bad as Lindemann suggested, pointing out that he is encouraged by younger doctors’ increased interest, which is occurring because of an increase in fellowships and because they find they can treat people … long term in institutional settings.  He also explained that “the scope of what I was evaluating and the opinions I am presenting do not fall into the realm of whether there is a shortage. My opinion is that there is a need for these positions to be filled in order to meet the standards of care necessary.”

Patterson is advocating the hiring of 14.5 additional full-time equivalent positions for psychiatrists (FTEs) in South Carolina.  Lindemann asked, “have you done any assessment as to whether it is feasible for SCDC to hire that number of psychiatrists?”  Dr. Patterson explained that he did not conduct a feasibility study.

Lindemann questioned Dr. Patterson about the sudden gap in mental health coverage created by the rapid departure of a privately contracted firm that once provided mental health services at the Department.  Dr. Patterson said that departure was not the only reason that SCDC was in crisis at that time, and suggested that there are ways of planning for the pitfalls of contracting out medical services, such as including penalties for such a sudden departure.  Dr. Patterson also pointed out the value of having a mental health professional present during those contract negotiations.

Lindemann asked a series of questions that suggested difficulties in getting psychiatrists to work in a corrections environment.  Regarding pay, Dr. Patterson suggested that the pay was not necessarily better in the private sector explaining, for example,  that it used to be that psychoanalysis was one of the more lucrative areas of psychiatry.  However, since insurance often no longer covers this type of therapy, and it is often necessary for patients to attend four or five sessions a week,  you have fewer patients who are willing and capable of paying the fees. Dr. Patterson also pointed out that factoring in benefits and malpractice insurance, psychiatrists are more willing to work in the public and corrections sectors provided the pay is sufficient.

Regarding the prison work environment, Dr. Patterson stated that he feels safe providing services in a prison because patients are checked for threats and security is always near by, as opposed to his own office where someone could potentially carry a weapon and there would be no backup.

Lindemann asked about a rash of counselor terminations and resignations at Perry. Dr. Patterson described the "exodus" of counselors from Perry as more evidence of deficiencies in training, quality of staff, and appropriate supervision, explaining that to have that many people terminated for improper behavior at the same time is unusual, but "it is a system issue; it did not occur from some alignment of the stars. Where is the supervision? Where is the adherence to policy?”    

The cases of terminated counselors were explored at length. In regard to his statement about a lack of quality management, Dr. Patterson was asked to define quality assurance and quality management and how they have evolved over the years. He stated that the goal is now continuous quality improvement over time, rather than as a snapshot. He said if you are not reaching thresholds, you continue to design ways to achieve them.

Lindemann asked questions about the newly implemented counselor audit practice: “You didn’t have any problems with Ms. Delgado’s audits, right?”  “Wrong,” Dr. Patterson replied. “It was the methodology of the audits I had problems with. They didn’t include criteria for establishing what is satisfactory and unsatisfactory." Dr. Patterson also suggested there was a lack of directive design to remedy unsatisfactory performances. “It is not sufficient for her to say ‘follow policy.’ There must be a mechanism – a part of that is a re-audit … but the next audit period is too late. It should require ‘meet with supervisor weekly to assure you are having timely meetings with inmates.’”  When Lindemann pointed out that in one counselor termination case, dates were given for a re-audit in seven months, to which Dr. Patterson replied, “too late."

Lindemann replied, “It was certainly less than a year.” “Yes, but still too late,” Dr. Patterson reiterated. “The reason for an audit is to correct errors. You must provide training and support so they don’t keep making the same mistakes.”

Lindemann then suggested that the issue with counselor audits is a catch-22 for SCDC, suggesting that if all of the audits returned satisfactory results, Dr. Patterson would then criticize that. Dr. Patterson responded that he certainly would because his work in this case has established that would clearly not be reality.

Dr. Patterson explained: “The idea is that you want to have a meaningful audit. You want to make sure the audits are focused on performance, and then you want to translate the employee performance into the system. If the audit says everything is great, I want to know what it is based on – if you just talked to employees and looked at no records, it is flawed; if you only look at a few records, that is flawed. I need to have criteria for what is done.”

Later in the day a discussion of a Colorado study of long term segregation’s effect on inmates began.

The study had the premise that long-term segregation can exacerbate mental illness and cause mental illness where none previously existed, however the findings did not bear out the hypotheses.

Dr. Patterson expressed his concerns about the comparability of the study to SCDC, as he had in direct testimony. One such concern was that the Colorado study was limited to one year, where Dr. Patterson had testified in this case regarding stints in segregation spanning several years. He also expressed reservations because the study had not been replicated.

Lindemann also showed Dr. Patterson charts during cross examination depicting suicide rates in prisons across the country, suggesting that South Carolina has a lower rate even than New Jersey and California, two states in which Dr. Patterson has been asked to provide input into suicide prevention policies. Dr. Patterson testified that he indeed provided advice regarding suicide prevention policies, but he could not say to what extent his suggestions were applied.  

Following a brief redirect, the witness was excused.

Court will reconvene at 9 a.m. Friday, March 2, 2012, with Defendants calling their first witness, SCDC Director of Mental Health, Dr. Pamela Whitley.