Senator Eliot Shapleigh - El Paso, Texas

A medical examiner ruled the Feb. 6 death a homicide due to medical neglect, the first such ruling in a state prison in decades. Cox was serving 20 years for burglary with intent to commit sexual assault and 15 years for murder in the killing of a cellmate at the Stiles Unit in Beaumont.(photo courtesy www.acc-tv.com)

Texas' critical shortage of corrections staff extends to its prison clinics and might have contributed to the death last year of a convict who was given Tylenol for a broken neck and back, a legislative committee was told Thursday.

Opening its own inquest into the death of killer Larry Louis Cox, 48, the Senate Criminal Justice Committee appeared shocked to learn that low-level staff appeared to have made key medical decisions because properly qualified medics were not assigned to the Estelle maximum-security prison near Huntsville.

A medical examiner ruled the Feb. 6 death a homicide due to medical neglect, the first such ruling in a state prison in decades. Cox was serving 20 years for burglary with intent to commit sexual assault and 15 years for murder in the killing of a cellmate at the Stiles Unit in Beaumont.

Prison medical officials, who said his death was regrettable but not due to criminal negligence, revealed at the Capitol hearing that three of the five medics involved in Cox's case are no longer working in prisons, and two have been brought up on charges before a state medical board.

In all, they said, the prison clinics in the eastern two-thirds of Texas are operating 15 percent short on physicians and 18 percent short on registered nurses and midlevel medical practitioners.

"If you set up a system that has the potential for bad outcomes, then you're going to have bad outcomes like this one," said state Sen. Bob Deuell, R-Greenville, a family practice physician. "This case is a symptom of a larger problem. They absolutely need more staffing."

Committee members focused on why prison medics did not do more, sometimes quizzing witnesses at length about a minute-by-minute timeline of Cox's medical treatment after he scuffled with two guards while handcuffed and fell, hitting his head on his bunk and a footlocker.

"Days and days after the injury occurred, he was taken to (a prison hospital in) Galveston," said committee Chairman John Whitmire, D-Houston. "The ME (medical examiner) says that by then, it was too late."

Deuell and Sen. Kyle Janek, R-Houston, an anesthesiologist, repeatedly asked why a licensed vocational nurse and a patient care assistant — neither qualified to make medical decisions in a case with such a severe injury — appeared to have done so.

And they and other committee members questioned why medics did not do more after Cox's condition deteriorated rapidly — as he lost use of his arms, defecated and urinated on himself and at one point complained that he was paralyzed.

"When you have a PCA (personal care assistant) who goes around and sees the patient who says, 'I can't move,' someone else should have been called in," Janek said.

"They weren't until it was too late," Whitmire added.

"I've seen people fake it (injuries or pain)," said Janek, who said he had practiced in the prison hospital for a time. "I've never seen anyone lie in their feces and urine."

Dr. Ben Raimer, a vice president at the University of Texas Medical Branch at Galveston, which runs the Estelle clinic, said Cox had a mild form of multiple sclerosis that contributed to the inability of prison medical staff to properly diagnose his condition.

Added to that were reports from guards that Cox was "moving around" his cell after he claimed to be paralyzed, and a CT scan taken at a Huntsville hospital that showed no fractures in his neck or back.

"All of these let the index of suspicion (to run further medical tests) be decreased," said Dr. Glenda Adams, a senior medical director for UTMB.

Cox was returned to his cell, but a corrections officer concerned about his condition contacted a relative, who was a nurse at another prison, to examine Cox. That led to his transfer to UTMB in Galveston, where doctors found he had three broken vertebrae and a spinal fracture.

"The ME felt as if they (prison medical staff) looked at Cox as just another inmate," Whitmire said, suggesting that's why they may have let the seriously injured convict languish. "If we get to the point where we have that attitude, then we're no better than the people we're locking up."