Tyrone Williams, (#DU 7387) died in prison from medical neglect. It's a tragic case, but not unusual and since he was a black man, nobody much seemed to care. More about Mister Williams' case in a moment. Another inmate, I'll call him "C.L.," in the same mismanaged Central Pennsylvania state prison, had long suffered from painful hemorrhoids. They bled and obviously required surgery. But, being a Pennsylvania prisoner, CL had to endure treatment by Wexford, the contractor which (for a price) was supposed to care for sick and injured inmates. What the contractor really cared (and cares) about was its profits. Wexford employs only a few actual doctors. Prisoners hardly deserve real medical care. Wexford relies instead on "physicians' assistants" to provide medical care. These are under-educated, incompetents who pretend to be doctors and illegally use the title "doctor" within the prison. Most prisoners don't realize that the "PAs" have virtually no medical skills. The inmates believe that they are being treated by trained medical doctors. They aren't! A physicians assistant, I'll call him "Huffy," had fiddled around at treating CL's hemorrhoids using the cheapest, most ineffectual approaches. Of course the treatments failed. They simply prolonged CL's suffering and allowed his condition to worsen. Huffy decided on surgery. Instead of sending the patient out to a qualified surgeon or even getting a real doctor to do the cutting, Huffy did it himself! In an open, unsterilized prison examining room, the phony doctor stripped the prisoner's rump and proceeded to hack away at his bleeding anus. It's illegal for a PA to perform surgery, but Huffy was used to doing illegal things. Everyday he illegally prescribed dangerous drugs, performed critical examinations and pretended to be a doctor. He bumbled many of his procedures and made many prisoners suffer. For the hemorrhoidectomy (as the removal of hemorrhoids is sometimes called), the prisoner/patient was improperly and inadequately anesthetized by Huffy himself, another illegal procedure for a PA. The patient was exposed in a polluted room with the door standing ajar. Other sick prisoners, guards and staff wondered past, coughing and peeking in. Huffy used the opportunity to "teach" the prison's other PA, a woman, how to snip and sew the poor man's rear, no bother with masks or any medical precautions, just hack at CL's seat. He was only a prisoner, after all. After the butchery, CL suffered continually. He couldn't sit or move his bowels. The wounds became festered. Huffy prescribed nothing but Motrin. Months later he suffered sexual problems. This is a true story which has been slightly edited to protect the prisoner's privacy. All the stories in this article are true, just camouflaged to obscure real identities. CL's treatment is only one of hundreds of stories of how Huffy and other PAs violate the law and medically abuse prisoners. I've focused on "Doctor" Huffy because of his fondness for pretending that he's not just a doctor, but a surgeon. Prisoners apparently don't matter much to him. He willingly used one as a teaching-aid where real professionals may have used a cadaver. Prisoners are less important than cadavers, so Huffy has no qualms about endangering their lives by cutting them open. Wexford, his employer, appears to encourage PAs to break the law. It saves them a bundle; ten bucks for a surgery that they get $4000 for from the state. Consider "DR." He had a very painful cyst at the base of his spine. He could neither lie on his back nor sit down, even to eat. Such cysts often impinge on the nervous system essential to bowel functions and sexual enjoyment. They require treatment by a specialist. None of that was provided for DR. Instead, Huffy went to work on him. The amateur operation took place in the PA's unsanitary little cubbyhole on a plastic upholstered bench still filthy from the last prisoner's dirty baseball pants. Huffy didn't care that the man had a history of heart problems and actually had had a heart stint installed. "Doctor" Huffy just rooted into the prisoners back and after considerable effort, pried free the cyst. The wound wouldn't heal properly. For weeks it had to be packed. DR became infected and had to take antibiotics. He endured ceaseless pain with no medication except the occasional Motrin. The gaping pit stunk and oozed yellow pus. It hadn't healed in six weeks. Take another case, that of prisoner "W.W." He made the mistake of going to the medical department for a minor problem. While he was there, Huffy noticed that the prisoner had a discolored patch on the back of his hand. Huffy told the man that it might be cancer. No tests were done, no care shown. Huffy hustled the victim into an unsanitary examining room, gouged out most of the mark and tossed it in the garbage. There was no pathology tests or follow up. Many cancers spread where their margins are not completely removed and/or where the surgery allows cancerous cells to escape and migrate to other parts of the body. But, keep it in perspective, WW was only a prisoner. What did Huffy care? Take the case of "N.R.," a large man in his prime, a weight lifter. He developed a growth on his upper back. It was snug to his spine. Its removal might impinge on nerves even those vital to the man's heart. Again Huffy played doctor. He laid the prisoner out on the unsterilized examining table, and without any proper medical safeguards, slashed out the growth. He decided that it was just a cyst. He didn't bother with any testing. That costs money. The growth didn't look like a cancerous tumor to Huffy's untrained eye. Even expert surgeons have growths tested; not PA Huffy. The case of the one-armed "C.S." is similar. The man had a long and ugly medical history including the amputation of an arm from gangrene. Like NR, he developed a growth on his upper spine. Again, Huffy whacked it off without any proper medical care or sanitation, leaving a large, angry scar. Then there's the case of "S.T." He had a family history of cancer. His mother had died from cancer of the lymphatic system. To his dismay, he developed a lump on his upper chest. Not to worry, Huffy hacked it out. Was it cancer? Nobody knew or cared. Did the surgery spread the disease? Who cares? Certainly not Huffy. ST had a second lump, this one on the other side of his chest, apparently in his lymphatic system. Huffy was there with a knife to slice off the growth, again leaving a hideous scar. The prisoner is only in his early thirties, but no one is sure how long he'll last now that Huffy has invaded his body. Huffy's most common treatment is no treatment at all. Two young men, "J.L." and "K.N.," both had badly injured knees where tears made movement excruciatingly painful. Every part of the prison is in a different building separated by long walks. The medical department, for example, is 400 yards from where the men are housed. The mess hall is almost as distant. For three months Huffy gave the men no treatment except pairs of crutches and a few hits of Motrin. But back to the now dead Tyrone Williams. He was only in his early forties, but he'd been sick for a long time. He walked with a cane, suffered from diabetes and a liver malady. He had a nasty abdominal hernia which protruded like a softball. The poor man had to hold it in when he walked. The prison PAs and medical staff provided him with minimal treatment. The man's abdomen started to swell and he had increasing pain and distress. Repeatedly he sought medical treatment, but it was wanting. Finally, in agony, Mister Williams died. Huffy and his cohorts failed to give him the care he needed. Even the arrogant "Doctor" Huffy was reluctant to risk abdominal surgery in the cramped filth of his cubbyhole examining room. Not all cases are nearly so extreme. Nonetheless, they reflect the gross inadequacies and callousness of the prison medical system. An asthmatic prisoner, "G.F." was having great difficulty breathing. The distress continued for days. He couldn't climb steps or even walk without panting. Fearing that he might suffocate, the prisoner wrote to a PA trying to get treatment with a nebulizer. The PA was uninterested. The prisoner was told that if he had a problem, he should sign-up for "sick-call," pay two bucks and in a week or less, he'd be seen. Believe it or not, GF survived to be mistreated another day. Not all physicians assistants are as bad as Huffy. Some are less bad than others. Still, even in prisons, PAs should only be employed for the tasks for which they are qualified: taking histories, assisting a doctor, changing dressings and so forth. They should never be used as substitutes for real doctors, to prescribe drugs, run "sick-call," do critical examinations, provide vital treatment or perform surgery. No PA should be allowed to use the title "doctor" or to perpetrate the fraud on a prisoners that he is a medical doctor.