Physician assistant faces hearing in inmate's death

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WALLA WALLA — A Walla Walla physician assistant is accused of unprofessional conduct in connection with the treatment of a Washington State Penitentiary inmate who later died.

A Washington State Department of Health investigation alleges that Kenneth E. Moore did not adequately treat the inmate. Moore, licensed in 1993, contracted with the Department of Corrections in August 2009 as part of a team of health service providers.

He has been ordered to appear before an administrative health law judge Oct. 31 in Olympia for a hearing on the noncriminal charge.

The inmate, whose identity was not disclosed, came under Moore's care on Dec. 24, 2010, with a history of rectal bleeding throughout the year, according to Department of Health statement of charges. The patient had been diagnosed two months earlier with chronic ulcerative colitis, a disease that can cause perforation of the colon, severe infection, massive bleeding and abdominal, rectal and joint pain, among other symptoms.

Treatment for the inmate's colitis began Oct. 18, 2010. About three weeks later the man was "declared a medical emergency with symptoms of 'burning up,' vomiting, aching body and elevated temperature," according to the charging statement.

A number of symptoms continued and in January 2011 the inmate was seen for mouth and throat ulcers. His condition worsened over several days, including the development of large, widespread skin blisters.

Moore was on call Jan. 14-16, 2011, when the inmate's symptoms "strongly indicated" his condition was deteriorating, the state said. However, Moore's action indicated he did not recognize the situation — he failed to respond to a delay in the patient's prescription, examine the patient or notify a doctor of the problem.

Signs of sepsis

On Jan. 15, 2011, registered nurse Vickie Holevinski recognized the inmate was exhibiting signs of sepsis, indicating widespread infection with a threat of multiple organ failure, the state said.

Moore arrived after 8 a.m. and examined the prisoner. Holevinski told Moore the patient might be septic and not stable enough to return to his cell. According to the charging document, Moore reacted angrily at the nurse's intervention, refused to admit the patient to the prison's inpatient clinic and left without issuing care orders.

Upon being contacted again by the nurse, Moore admitted the inmate to the prison clinic and diagnosed his condition as cellulitis, a bacterial skin infection. Moore's prognosis at the time was that the inmate would improve over the next few days and be able to return to his cell. The inmate, however, was septic with a rapidly developing skin infection, the state said.

A few hours later, prison medical staff sent the inmate by ambulance to Providence St. Mary Medical Center in Walla Walla, where he was subsequently airlifted to Sacred Heart Medical Center in Spokane. Moore notified his supervisor of the situation after the inmate was transferred.

The inmate underwent emergency surgery but died Jan. 16, 2011, of sepsis caused by infection about seven hours after arriving at Sacred Heart.

Mike Farrell, legal unit manager for the Washington State Medical Quality Assurance Commission, said in an interview that the initial complaint was received by the Department of Health in March 2011 and has since undergone two levels of investigation and review by a medical expert.

"These are serious actions and we have to be very careful and sometimes that takes time," he said.

Donn Moyer, spokesman for the Department of Health, said Moore could be found not guilty or a settlement could be reached that might include components such as probation, monitoring of his practice, suspension or termination of his credentials.