Shortly after Maryland hired a private law firm last year to take over defense of the state in a decades-old lawsuit challenging health care and mental health conditions in Baltimore jails, its attorneys focused the blame on a single person.

Dr. Michael Puisis, the independent medical monitor tasked with assessing how Baltimore jail staff were treating incarcerated people, was holding the state corrections department back from coming into compliance with a 4-year-old settlement agreement to improve health care in the jail, the attorneys argued.

Despite staffing shortages in its facilities and a rotating cast of oft-criticized private medical vendors hired under questionable contracts, the attorneys pointed to what they described as Puisis’ ever-shifting and ambiguous standards. If given the opportunity to be judged fairly, they said, the state would be making significant progress.

About a year ago, following a monthslong campaign of legal filings by the state, Puisis resigned without explanation, leaving his position as independent arbiter of medical care in city jails vacant, and setting the stage for the current pivotal moment in a case that dates back more than half a century.

Attorneys from Butler Snow LLP, the law firm retained by the state that gained notoriety for defending prison systems in the Deep South, have put forward three doctors to take his place as medical monitor. Meanwhile, the plaintiffs challenging Baltimore jail health care, led by the ACLU’s National Prison Project, have nominated three of their own selections.

On Friday afternoon, U.S. Judge Matthew J. Maddox will hear arguments from both sides before deciding who will succeed Puisis. His ruling is certain to be a consequential one for the state government, which suffered a stinging rebuke in October when Butler Snow attorneys failed to convince the judge that the settlement agreement keeping the state locked into the lawsuit had actually expired. Maddox extended the terms of the settlement for two years.

But a ruling in the state’s favor on Friday would almost certainly accelerate its efforts to extricate itself from a lawsuit that has placed considerable strain on its already beleaguered corrections department.

In a recent filing, the ACLU attempted to head that off: criticizing the state’s selected doctors over their ties to the law firm nominating them, their collective lack of experience overseeing federal court cases as independent monitors, and several instances of judges finding their testimony less than credible, as well as specific cases and conditions in jails and prisons that the doctors had defended.

One of the state’s nominees, Dr. Randall Stoltz, defended a Michigan prison’s treatment of a man with multiple sclerosis whose condition deteriorated so badly that he was eventually released on medical parole with such severe brain damage that he “had regressed to sucking his thumbs and consuming his own feces,” the ACLU attorneys wrote in their brief.

“While they appear to have experience as retained experts, primarily for defendants, in litigation against correctional facilities and private correctional health care corporations, the role of a monitor — a neutral fact finder and an agent of the court — is very different than that of a partisan advocate for one side,” the ACLU argued.

Meanwhile, the state has similarly argued against the plaintiff’s selections, framing the doctors as biased in favor of the plaintiffs and saying their experience is more in line with “monitoring based on best practices and standards outside constitutional minimums,” contending that would replicate the issues the state faced under Puisis.

“The history of this case demonstrates the problems, expenses, and sheer waste of time and resources if a monitor fails to perform in an appropriate manner,” the state said in its objections to the ACLU’s nominations.

The state went on to describe Puisis’ tenure as a “colossal failure, illustrating the disasters flowing from unfair monitoring” and said that if the judge “hopes to establish a fair and objective measure of monitoring, the state respectfully requests that the court reject each of these candidates.”

The state’s choices

The state has nominated three people to be next medical monitor overseeing healthcare and mental health services in Baltimore jails:

• Stoltz: The state argues that Stoltz, who served as medical director in an Indiana jail for decades, is an expert in “clinical operation policies and procedures, quality improvement and clinical staff oversight.” The ACLU emphasized that Stoltz has appeared as an expert witness in at least nine cases for defendants in correctional healthcare lawsuits, represented by the same law firm, and that he “ventures far outside the scope of his expertise,” opining, for example, on the credibility of sexual assault victims, suggesting it was “suspicious” that one alleged victim waited eight days to file a report.
• Dr. Carl Keldie: Most recently working as a correctional health care consultant, Keldie was previously the senior vice president of clinical Affairs at Wellpath, a private correctional health care provider that recently declared bankruptcy. The state argues that Keldie “holds more than four decades of clinical and administrative experience.” The ACLU countered that, in Alabama, a judge found Keldie’s expert testimony not credible and unreliable after he contended that two hours was sufficient time for an on-site prison inspection.
• Dr. David Mathis: The state argued that Mathis has worked as a prison physician for more than 25 years in Virginia, Maryland and California, and that his experience in correctional settings spans emergency care, acute care, chronic care, hospice care and “utilization management.” The ACLU noted that Butler Snow presented Mathis’ testimony in Louisiana when it unsuccessfully defended the prison system there. A judge also noted that he has “never been tasked with evaluating the overall delivery of medical care at a prison” and had evaluated only one jail. The ACLU also included in its argument that the judge found Mathis’ opinions were “ill-supported and unpersuasive” after “almost half” of his chart-review section, about 50 pages, was found to be “verbatim copy of [the prison’s] mortality reviews with no independent analysis or comment.”

Who the ACLU wants

The ACLU and other local advocacy groups nominated three of its own chosen doctors to be the next medical monitor:

• Dr. Muthusamy Anandkumar: The ACLU cites Anandkumar’s experience as a court-appointed medical monitor and his time as a medical director at a Dallas jail as qualifying him for the Baltimore role. Despite his résumé, the state nonetheless contended his experience “appears ... limited to advocating for plaintiffs instituting litigation — primarily serving as an advocate for the Department of Justice and the Office of Civil Rights and Civil Liberties.” The ACLU called that description “false” in a response to the state’s objections.
• Dr. Lisa Anderson: Working for the Washington State Department of Corrections for 16 years, Anderson rose to the level of chief quality officer for the health services division. In that role, the ACLU said, she “chaired multiple quality improvement committees, while leading department-wide and statewide quality improvement initiatives and spearheading patient safety and morality case reviews.” The state objected to Anderson’s nomination, saying her background and expertise adheres too much to “best practices” and “bears no relationship to the constitutional level of care mandated here.” Anderson has since withdrawn her nomination.
• Dr. Todd Wilcox: The ACLU pointed to Wilcox’s experience as medical director in the Salt Lake County jail system in Utah and the Maricopa County jail system in Phoenix, Arizona. Wilcox, the ACLU pointed out, has served as a consultant for both defendants and plaintiffs in correctional health care lawsuits. The state pushed back, saying he has no relevant experience in “properly monitoring and managing a correctional system” and saying that Wilcox had already served as an “advocate” for the ACLU in the Baltimore jail case. “No one could rationally expect anyone working within the state’s system to trust someone who worked so closely with the ACLU in making claims against this system — much of which the state disproved and all of which the state disputed,” the state argued in its filing objecting to Wilcox. The ACLU countered that it is not unusual or improper for doctors to serve as expert witnesses in a case they are later appointed to monitor.

Stoltz represented defendants in at least 9 correctional healthcare lawsuits for the same law firm, the Chapman Law Group. An earlier version of this article misstated the law firm he worked with.