UNIVERSITY OF TEXAS MEDICAL BRANCH

CORRECTIONAL MANAGED CARE

Lane Murray Facility

1916N.Hwy.36 Bypass

Gatesville, Texas 76596

Phone: (254) 865-2000 Ext 297

Fax: (254) 865-2000 Ext 283

Mav 21,2004

Linda Hull

7830 Sun Forest Drive

San Antonio, Texas 78239-3223

RE: Offender Serena Cleveland, TDCJ-ID # 1098662

Ref# 040109866200021

Ms. Hull:

I am in receipt of your May 11, 2004 Internet correspondence to TDCJ Health Services on behalf of offender Serena Cleveland. A copy of the authorization to release information signed by offender Cleveland is attached.

In reference to the facility not following recommendations made by a John Sealy physician, please be advised that the facility health care provider is not mandated nor obligated to follow orders emanating from a specialty clinic. The system of specialist recommendations directly parallels the community-based practice of me primary care provider maintaining responsibility for providing individual care.

Recommendations received from specialty clinics are a means of providing professional consultation opinions to the unit health care provider who may incorporate them into the individual's treatment plan as the health care provider deems appropriate based on his/her professional review.

Dr. David Curtis most recently examined offender Cleveland May 11,2004. A review of his notes indicate in his professional opinion narcotic medication is not indicated. During this visit the patient was given multiple restrictions and non-steroidal anti-inflammatory medication for discomfort. She was also instructed and observed by Dr. Curtis to use non-weight bearing crutches appropriately and without difficulty. I cannot

address the allegation that Ms. Cleveland is being forced to walk on her broken ankle, as the alleged

responsible party is not defined in your correspondence. I will notify the facility administrator. Warden

Nancy Botkin of this allegation for her information and action as appropriate.

Thank you,

R. Valladares

Practice Manager

c: J. Saxon, Cluster Practice Manager

Risk Management/Quality Services-UTMB

G. Smith, Program Administrator III