ELY, NEV. — When Nevada death row inmate Charles Randolph asked for a specific medicine to address his heart condition earlier this year, Max Carter, the prison's physician assistant, sent a curt reply: The medication was the wrong kind and potentially lethal, but he would be happy to prescribe it "so that your chances of expiring sooner are increased."
When another prisoner, John O. Snow, asked for pills in July to ease the pain from his deteriorating joints, Carter's denial came with another stinging missive, stating that he was "gonna let you suffer."
To many prison observers, Carter's responses exemplify the callous indifference custody officials at the maximum-security Ely State Prison have for sick prisoners. There has been no staff doctor to handle the medical needs of any the 1,000 inmates here for more than 18 months. Carter is the highest-ranking medical worker at the men's prison; the last staff doctor was a gynecologist.
According to interviews and records obtained by The Times, prisoners at Ely have been denied care for heart problems, diabetes and other serious medical conditions. Earlier this year, a nurse was fired after complaining about substandard care at the facility, which she said led to one inmate needlessly dying of gangrene.
Attorneys for some Ely inmates say they believe the lack of medical care has played a role in a high percentage of death row inmates giving up their appeals and "volunteering" to be executed. All but two of 12 inmates executed in the state in the last 30 years have been volunteers. No other state in the country has had close to that percentage of volunteers, records show.
Recently, the American Civil Liberties Union's National Prison Project has taken up the cause at Ely. ACLU attorneys Amy Fettig and Margaret Winter have met with corrections officials and pressed for reforms to improve inmate care.
A doctor working with the ACLU was granted access to 35 inmates and their medical records in October, and he came to a stark conclusion.
"The medical care provided at Ely State Prison amounts to the grossest possible medical malpractice, and the most shocking and callous disregard for human life and human suffering that I have ever encountered in my 35 years of practice," Dr. William K. Noel said in a report sent Wednesday to Howard Skolnik, director of the Nevada Department of Corrections.
"It is highly unlikely that these 35 cases are aberrations," Noel wrote. "These cases show a system that is so broken and dysfunctional that, in my opinion, every one of the prisoners at Ely . . . who has serious medical needs, or who may develop serious medical needs, is at enormous risk."
Skolnik said Wednesday he had not seen Noel's report and could not comment on any specific allegations. However, he added: "I do know that I have recently been informed through some other auditing that the access to medical care and the quality of care provided by the department meets or exceeds community standards."
An attorney who represents the corrections department said she could not comment, as did an assistant to prison warden E.K. McDaniel.
Max Carter did not respond to messages left for him at the prison's medical department.
Dr. Steven MacArthur, the obstetrician-gynecologist who was the prison's last staff doctor, said it was difficult to treat inmates with severe psychological problems and who cursed and spat at staff. Some prisoners refused to visit the infirmary simply because they couldn't smoke there, he said. Nonetheless, he said, they were well cared for.
"Most inmates age in dog years. They beat the hell out of themselves," he said. "They have lots of aches and pains."
In his report, Noel said he found instances of prisoners being denied medical attention despite suffering from seizures, syphilis, deep vein thrombosis and rheumatoid arthritis. He acknowledged that many Ely prisoners "have committed horrible crimes" but said physicians took an oath to make "no judgments as to character or morality" when treating a patient.
Under a 1976 Supreme Court decision, based on the 8th Amendment's prohibition against cruel and unusual punishment, government officials are obliged "to provide medical care for those whom it is punishing by incarceration."
In a letter accompanying Noel's report, ACLU attorneys Fettig and Winter asked the director of corrections to set up a meeting with Gov. Jim Gibbons because the "medical crisis" at the prison goes far beyond the lack of a doctor and it "seems unrealistic to expect" the department "to summon the resources to resolve the problems without the assistance of the governor and the Legislature."