Friday, Esfand 29, 1387

March 20, 2009

At 11:00 A.M. on Wednesday, March 18, 2009, Mr. Abbas Khorsandi, a friend from Section 7 of Evin prison delivered the news of Mr. Mirsayafi’s attempted suicide and dire medical condition to me.  He noted that the prison health authorities have not been giving him due medical attention.

I swiftly ran to the medical office of Section 7 and witnessed Mr. Mirsayafi’s weak, pale, and cold body.  Upon my arrival, I noticed that there was no caregiver by the bedside and no plan of care was apparent.  His radial pulse was not palpable, but I examined the pulse on his neck and noted 40 beats per minute.  I attempted to measure his blood pressure, but the machine would not register presumably due to his severely low blood pressure.

I informed one of the caregivers in the office of Mr. Mirsayafi’s critical condition, and he arrived and attempted to place a nasogastric tube to lavage his stomach but did not succeed.  I suggested that we needed to promptly obtain an intravenous line and administer fluids to improve his blood pressure, and, once stable, transfer him along with a prison physician to a poison control and toxicology center.  At this time, “Mr. Sedghi,” who introduced himself as one of the healthcare personnel, asked me to leave the resuscitation room and closed the door.  I promptly went to the office of Dr. Rezai, the on-call prison physician, and informed him of the critical condition of Mr. Sayafi and asked that I participate in his care as I was intimately familiar with his medical history.  Dr. Rezai showed me the medical file for Mr. Mirsayafi and noted that the psychiatrist had prescribed clonazepam for him.  In disbelief, I retorted how can the treatment of someone with a history of multiple suicide attempts be limited only to clonazepam and nothing more comprehensive?

In response, Dr. Rezai stated that the prisoners commonly feign illness.  I responded that a pulse rate of less than 40 beats per minute and a systolic blood pressure of less than 60 are not consistent with feigning illness in a patient with a history of attempted suicides.  I insisted that he be transferred to a medical facility and returned to the resuscitation room.  I found Mr. Sedghi there and asked that saline solution and atropine be given intravenously to help stabilize the patient for transfer.  For the second time, he dismissed me from the room and insisted that the patient was doing well, did not need any treatments, and that my interference would not be welcomed.  

From the time of my arrival to the patient’s transfer to the main prison treatment center 1.5 hour elapsed.  He was transferred without a stretcher or an accompanying physician.  None of his friends were permitted to travel along with him.  Even though I am a physician and familiar with his health history, I was not allowed to accompany the patient.  These events have raised many questions for me and I demand that the authorities answer them thoroughly.

   1. Why would a prisoner, who after rigorous interrogation procedures has developed major depression, be detained without access to appropriate medical care?

   2. Why is it that the prison psychiatrist did not order suicide precautions for this patient, even though he had, on multiple occasions, voiced suicidal ideation to the psychiatrist and this constitutes a medical emergency?

   3. Why would someone with major depression resulting from interrogation be forced to serve his prison sentence without access to critical medical care or treatment?

   4. Why would there be a delay in care of a patient with attempted suicide by overdose of medications?  Why would this care occur only after my insistence even though I am another prisoner and not an authority for the prison?

   5. Why did the prison physician, after 1.5 hour delay, transfer the patient without an accompanying physician or a stretcher?

   6. Why was the patient not transferred to an outside facility with more expertise when it was amply clear that he was too critical to be cared for at the prison facility?

   7. Why is there a tendency amongst the physicians and other caregivers in prison to place feigning illness atop their differential diagnosis of patients with psychological or physical ailments?

Unfortunately, no one will fault the physicians or other caregivers for such situations as no where in the world would anyone doubt that any physician would allow severe injury or death of a patient on his watch.  The main issue at hand is a culture of violation of prisoners’ rights and access appropriate care that leads to such catastrophes.

It is noteworthy that a person’s station as a human being is independent of his status as a suspect or a criminal, and he should enjoy his right to proper healthcare.  As a physician who has taken the Hippocratic Oath, I testify that the death of Mr. Mirsayafi was in reality due to indifference and shortcomings of the authorities.  Who will be responsible for the unprofessional behavior of the authorities that led to a preventable death?  Within the past few months, lack of proper prison procedures, access to care, and indifference have led to a few prisoners’ loss of life and several mourning families.  Who is willing to take responsibility and who will vow to reform treatment of prisoners, so that such catastrophes may be prevented in the future?