By Michael Miner
AMA Fires a Loose Cannon
Few newspaper readers lie awake at night worrying about the quality of medical care in American prisons. But the subject mattered enough to reporter Andrew Skolnick that last year he applied for and received a $10,000 fellowship from Atlanta's Carter Center to study the treatment of mental illness in the criminal justice system.
What he discovered prompted a five-month investigation by the Saint Louis Post-Dispatch, which on September 27 published a 12-page special section Skolnick helped write, "Death, neglect and the bottom line." Examining companies in the obscure business of providing health care to inmates for profit, the paper reported "a disturbing pattern of deaths and untreated illnesses behind bars."
Consider Calvin Moore, an 18-year-old burglar who "literally died of dehydration and starvation in an Alabama prison" where medical care was provided by Correctional Medical Services, a Saint Louis firm that dominates its industry. Skolnick reported that one CMS doctor in Alabama had lost his license to practice medicine in two other states and that another had a criminal record.
As you'd expect, Correctional Medical Services protested. As you might not expect, CMS got satisfaction. Skolnick was fired on November 3. But not by the Post-Dispatch--Skolnick wasn't a Post-Dispatch employee. He was fired by Chicago's Journal of the American Medical Association, where he'd been an associate editor for the last nine years.
"I believe the AMA terminated my employment as a way of protecting itself," says Skolnick. Could be--though Skolnick handed the AMA rope to hang him with. You were fired, said a memo from AMA employee relations, because "you did not inform your supervisor or receive consent to work on [the Post-Dispatch] articles which were on subject matters very similar to that which you were currently working on for JAMA."
Furthermore, the memo reminded Skolnick, when he received a hostile letter from a Florida corporation, Imaging Diagnostic Systems, Inc., that was the target of an unrelated investigation, he notified neither his boss nor AMA attorneys. The AMA discovered it might have a problem only when the next letter threatened a lawsuit.
Unfortunately for the AMA, its credibility just now is at rock bottom. Last Friday the Chicago Tribune's David Greising, ridiculing a new AMA strategy to reduce conflicts of interest, concluded, "After the embarrassment and outrage of the Sunbeam debacle, the good doctors still cannot tear themselves away from the loose change that trickles in from deals like Sunbeam's." (The AMA had been vilified for agreeing to endorse Sunbeam products for money.) Now when the AMA takes an action--such as firing Skolnick--that can be construed as either principled or craven and expedient, it doesn't get the benefit of the doubt.
"Your supervisor," the memo of termination concluded, "indicated that she felt your journalistic approach of confrontation and criticism of those on whom you are reporting was inappropriate and potentially damaging to the AMA and JAMA." Yet accusing Skolnick of failing as a goodwill ambassador falls immeasurably short of saying he ever wrote anything untrue.
The AMA refused to comment on Skolnick's dismissal.
Early this year Skolnick was telling his friend William Allen, a Post-Dispatch science writer, about the Calvin Moore story he'd come across as a Carter Center fellow. That's a Saint Louis company, he said--you ought to look into it.
Out of this conversation grew the Post-Dispatch investigation. In August Allen, the lead reporter, invited Skolnick to lend a hand. Skolnick says he took a week's vacation from JAMA in early September and spent the time in Saint Louis producing three stories for the Post-Dispatch. The basis of these stories was research he'd already done as a Carter fellow. He says that contrary to the termination memo, he wasn't "currently working" on the same subjects for JAMA. He'd already turned in those articles on prison health care, and they were supposed to be published four days before his Post-Dispatch articles came out. Unfortunately they didn't run in JAMA until late October, but he says that's because the journal pulled them at the last moment to show them to lawyers.
Did Skolnick ever tell anyone at JAMA that he was recycling his reporting in the Post-Dispatch? No. How does he explain that astonishing oversight? "I would characterize the unwritten policy [at JAMA] as 'Don't ask, don't tell' when you do freelance work. The only rule is don't write for a competitor, don't use company resources, and don't write on company time. My reporting was financed by the Carter Center and I represented myself as associate editor for JAMA and a Carter fellow in mental health journalism. I had a duty to publish this information as broadly as possible. I feared JAMA wouldn't publish it. I didn't want it to die."
He supposes his bosses found out about the Post-Dispatch articles on October 26, when George Lundberg, editor of JAMA, received a letter from the chief medical officer of CMS. Dr. Louis Tripoli alluded vaguely to "inaccurate assertions" but identified none. But pointing out that he'd been "a loyal member of the AMA for my entire professional career," Tripoli complained that Skolnick had "repeatedly used the name of JAMA" while reporting and "never mentioned to us that he was working on behalf of the Post-Dispatch. We trust that JAMA would not condone or reward the misleading use of the AMA's name."
Well, that's true, says Skolnick. "I couldn't tell them I was working for the Post-Dispatch, because I wasn't working for the Post-Dispatch. When I went to the Post-Dispatch my articles were done and accepted for publication in JAMA." (Tripoli did not return my phone call.)
If you want to get to know Andrew Skolnick better, go on-line. His Web site (www.nasw.org/users/ASkolnick) allows us to survey his education and professional history, honors and fellowships, important speeches, a sampling of his photographs, and of course his journalism. There are also links to sites he deems especially distinguished or dubious--a good example of the latter being sites touting transcendental meditation. (Skolnick and the editor of JAMA were sued for defamation in 1992 by a Maryland foundation that promoted stress reduction through TM. The suit eventually was dismissed.)
Skolnick is also an on-line presence at a bulletin board that argues the merits of Imaging Diagnostic Systems, Inc. IDSI is promoting a new technology it calls "computed tomography laser mammography," and Skolnick doesn't buy it. In September a letter arrived in his mail from IDSI's general counsel, Rebecca Del Medico. "You have posted several messages on the Internet under the name Andrew Abraham and other aliases alluding to improper actions by the Company," Del Medico told Skolnick. One alleged impropriety stood out in her mind: she told Skolnick that in fact the Food and Drug Administration does not deem it a conflict of interest that a physician on the IDSI institutional review board happens to be married to an IDSI engineer. Del Medico declared, "As a direct result of your reckless and malicious postings, the Company has sustained substantial damage."
Skolnick replied immediately. "Your letter contains a number of errors and misconceptions," he began. One of them had to do with what the FDA considers a conflict. Another was that business of an alias. "My dictionary defines 'alias' as 'an assumed name; another name.' I posted under my first and middle names; I did not use an alias." Skolnick enumerated Del Medico's other errors and misconceptions, signed his name to the letter, and sent it off.
Shouldn't a letter from IDSI's lawyer have been shown to the AMA's lawyers? "I routinely talk to lawyers," Skolnick says. "I didn't take her bluster and evasion as any kind of threat. I listen to lawyers rattle sabers all the time."
IDSI's response was what Skolnick calls a "preemptive strike." A New York law firm retained by IDSI wrote Michael Ile, general counsel of the AMA, and accused Skolnick of operating under aliases, disrupting corporate press conferences with "abrasive comments," making "false and misleading claims" about IDSI research, seeking to "blacken the reputation" of the company's founders, and refusing "express invitations" to visit the company. The letter threatened "immediate legal action."
Skolnick--who had yet to publish a word on IDSI in JAMA--now never will. Four days after this letter arrived, JAMA canned him.
Psst--Wanna Buy a Wire Service?
The directors of the Chicago Medill News Service tell me not to expect Medill to take over the floundering City News Bureau, which has announced it will shut down March 1. "Buying it is financially out of the question," says director Mindy Trossman. "Even replicating it is out of the question."
The three-year-old news service is a pale imitation of CNB, which may be why rumor's had it that Medill might step up and buy the real thing. The Medill News Service covers many of the same Chicago beats as CNB, but it covers them at the convenience of the 35 or so graduate students who staff it each quarter. There's no overnight shift, and "on Christmas break we're on Christmas break," says Trossman. Medill charges its clients just enough to cover expenses, and it has only three clients: the Daily Herald, the Daily Southtown, and the Munster, Indiana, Times.
The Medill News Service is, in fact, a client of CNB. "We really rely on their daybook," says codirector James Ylisela. "Everybody uses that. We're going to have to replace that one way or another." Though CNB charges Medill its lowest rate, it proposed to hike that rate to a level Medill, like other CNB clients, considered intolerable. "It was going to go up to some figure we couldn't pay for," said Ylisela. "Our news service is not a moneymaking enterprise, and we weren't going to be able to justify it."
Meanwhile the president of CNB's Los Angeles-based equivalent, City News Service, was in town last week looking over the dying Chicago operation. Any chance you'll buy it from the Tribune and Sun-Times? I asked Douglas Faigin. "It's too early to tell," he said. When won't it be too early? I said. "It's inappropriate to say."
Faigin calls City News Service, which was founded in 1929, the "nation's largest regional wire service. We serve pretty much all the media in southern California" (it expanded two years ago from LA into San Diego County). Like CNB, it's a round-the-clock operation, with a "budget" that's as indispensable to news directors planning coverage as the CNB daybook. Unlike CNB, it doesn't consider itself a training ground. It hires reporters with a year or two of experience--"like a suburban daily," Faigin says. "And people stay with us for a long time."
Unlike CNB, says Faigin, City News Service is healthy. It charges rates comparable to the ones CNB's clients now refuse to pay. If those clients have a change of heart--as March 1 approaches and news directors argue they'll be lost without the daybook--CNB would go on under someone's ownership. But the dailies, particularly the Sun-Times, see no reason to subsidize Chicago's radio and TV news operations.
Whatever happened to checking the clips? Esther Rolle starred in Steve Carter's drama Dame Lorraine at Victory Gardens in 1981, but neither of the dailies' generous obituaries last week mentioned that local angle.
The coverage of the Reverend Fred Phelps's visit to Broadway United Methodist Church last Sunday pulled its punches. Phelps, said the Sun-Times, "was protesting a gay marriage performed recently at the church." Phelps showed up "to protest a local minister who presided over a gay marriage ceremony," said the more forthcoming Tribune, which went on to say that Phelps and his family carried signs "insinuating" that slain college student Matthew Shepard "had been consigned to hell." But it wasn't an argument over gay marriage that brought 1,500 counterdemonstrators out into the streets. It was blatant homophobia. A sign that says "God Hates Fags" isn't merely protesting, and a picture of Shepard with the legend "Burns in Hell" isn't merely insinuating.
Art accompanying story in printed newspaper (not available in this archive): Andrew Skolnick photo by Jon Randolph.