State Medical Board targets former Fresno County Jail psychiatrist

The Fresno BeeDecember 13, 2013 

Paxil and Prozac on top self and other medication in blister packs seen in a storage cabinet at the Fresno County Jail's dispensary July 30, 2013. Dr. Pratap Narayan, former chief of psychiatric services at Fresno County Jail is accused of failing to meet with patients before describing psychotropic drugs, misdiagnosing inmates and under-prescribing drugs.

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The former chief of psychiatric services in Fresno County Jail has been accused of gross negligence, incompetence, unprofessional conduct and inadequate record-keeping in his treatment of inmates.

If the 18 disciplinary allegations against Dr. Pratap Narayan are upheld, the Medical Board of California could revoke his license to practice medicine. The allegations include failing to meet with patients before prescribing psychotropic drugs, misdiagnosing inmates and underprescribing drugs.

Narayan's treatment presented "a troubling pattern that evidences a lack of knowledge and/or ability in the practice of psychiatry that constitutes incompetence," said one of the 18 "causes for discipline" in the 53-page accusation.

Narayan, who worked at the jail for five years before resigning in February to take a position at Avenal State Prison, did not return telephone calls seeking comment on Friday.

The treatment of mentally ill inmates was a focus of The Fresno Bee's Watchdog Report "Locked In Terror," which chronicled that for years during Narayan's tenure inmates were not given psychiatric drugs they needed while behind bars and were then deemed incompetent to stand trial and shipped off to state hospitals, often more than once.

A hearing has not been scheduled for Narayan, said Cassandra Hockenson, a spokeswoman for the Medical Board of California. If found guilty of the accusations, Narayan also could face license suspension and revocation, probation, and suspension of his authority to supervise physician assistants. Narayan graduated from Andhra Medical College in India in 1984 and completed both a psychiatric residency and a fellowship in forensic psychiatry at the University of Florida.

His job with the California Department of Corrections and Rehabilitation will be under review, a department spokeswoman said Friday.

"There is clearly an action taken against him by the California Medical Board, so it clearly concerns us and what we do," said Dana Simas.

Narayan had already come under fire by Fresno defense attorneys whose clients claimed he refused to prescribe medications they were previously treated with or lowered their dosages, which would cause their symptom to worsen.

It led to a lawsuit by the Berkeley-based Prison Law Office, which contends that inmates were not getting even the most basic levels of care. That suit is in settlement negotiations with Fresno County, attorney Kelly Knapp said.

Knapp would not comment on the Medical Board accusation against Narayan.

Jail conditions have improved, said Mike Woods, a private attorney representing the county in the Prison Law Office lawsuit.

"The (Narayan) accusation focuses on past treatment that is not ongoing and therefore will have no effect on the current litigation," he said.

The jail's current psychiatrist, Mayur Amin, has told The Bee that jail psychiatrists now maintain inmate prescriptions that originate at state hospitals and also confer with inmates' families, lawyers and physicians. Psychiatrists and psychologists who work in the jail say care for inmates has improved dramatically since earlier this year.

Lawyer Eric Green, who represented inmate David Anguiano, whose problems were outlined in the state accusation, said his client was fit for court hearings only after he was treated at Metro State Hospital in Los Angeles.

When Fresno County Jail doctors refused to give him medications prescribed at Metro, a judge ruled that Anguiano should be sent to Metro whenever there was a break in his trial. He went to state hospitals nine times during his court hearings in Fresno.

"Why didn't they just give him the meds that he came back from the state hospital with so he was stabilized and we could go to trial?" Green asked. "It was the county psychiatrists versus the state hospital people."

County jail officials denied that medications were restricted to save county taxpayer money.

But, savings between 2007 and 2012 were dramatic: The amount spent yearly on psychotropic drugs dropped 89% in five years, from $924,372 in 2006-07 to $99,302 in 2011-12. Drug costs that had consumed 28% of the $3.3 million jail psychiatric budget dropped to 3%.

Savings on medications were severely overshadowed by state hospital costs, however. An average six-month state hospital stay costs $108,000. A six-month course of Abilify -- a drug that several families said their relatives needed but never got in the Fresno County Jail -- is about $9,000. In 2011-12, 75 inmates were sent to three of the state's four mental hospitals.

Based on an average stay, the cost to state taxpayers would have been an estimated $8.1 million. The state was unable to provide actual costs.

"They don't realize how much it cost them in David's trial alone," Green said.

Narayan also is accused of improperly treating Fresno lawyer Scott Kinney, who was jailed for a domestic dispute with his wife and a second assault case in late 2008.

Prior to his arrests, he had been treated 17 years for bipolar disorder, the accusation said.

After he was jailed, a family member delivered his medication to the jail but was turned away. But when Kinney refused to take medication prescribed at the jail, he wound up in a safety cell and restraint chair.

In five months while awaiting trial, Kinney -- paranoid that others might be trying to poison him -- lost 62 pounds.

At separate hearings a month apart in early 2009, a judge ordered that Kinney get the medication he needed to regain his mental balance. He never did. He ultimately was ruled incompetent to stand trial and went to Atascadero State Hospital, where he finally received his medications.

"I was insane from January 2009 until I got to Atascadero," Kinney said Friday.

Narayan told medical board investigators that he had personally visited with Kinney, but Kinney said he doesn't recall seeing him.

Narayan's clinical diagnosis: Kinney was malingering, faking his symptoms to avoid court or prison, and Narayan "found no conclusive evidence of psychosis or bipolarity."

The best day at the jail, Kinney said, was the day he went to Atascadero.

"I didn't know if they were going to take me to another jail, Atascadero or take me out to a field and shoot me, I was happy to be leaving," Kinney said. "Let's just say I wasn't fighting them for extracting me from the cell."

The reporter can be reached at (559) 441-6166, mbenjamin@fresnobee.com or @beebenjamin on Twitter.

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