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Life Sentences: Women,
Prison and the Invisible Health Crisis
Women's Health Activist Newsletter
November/December 2003
http://nwhn.org/life-sentences-women-prison-and-invisible-health-crisis
by Leah Thayer
Prostitution isnt normally a capital offense, but it was for
Lisa Watson. Watson, the pseudonym of an actual prisoner in the
Central California Women's Facility, had just begun a four-year
sentence for prostitution when she started experiencing
debilitating headaches that left her unable to stand or
function.1 A CT scan performed at the prison revealed a tumor
and Watson feared the worst, as her father had died of brain
cancer at age 51, and her own HIV-positive status made her
susceptible to opportunistic forms of cancer. She urgently
needed to see a neurosurgeon the only person capable of
determining the tumor's cause, malignancy and treatment plan.
It took a full six months before Watson saw the specialist, and
only then with advocacy assistance from Justice Now, a
non-profit organization providing legal services for women
prisoners.2 Although the tumor turned out to be benign, it had
grown so much during the six-month delay that it became
entangled with Watson's brain stem, threatening her life. An
emergency craniotomy was performed to remove as much of the
tumor as possible. As described by Justice Now cofounder Cynthia
Chandler in an article on women in prison: "Less than a week
after her surgery, she was returned from an outside hospital to
the prison, where I met with her the next day. During our visit.
Lisa did not talk about the pain she was in, her anger at the
delayed treatment she received, or the legal case she had begun
on her own behalf against the state for negligent care. Instead,
she told me of her fear that she would not be able to keep the
incision on her head clean and her dressings changed. She told
me how, since she had AIDS, she would die if it became infected,
and she would never get to see her daughter again. Lisa died two
weeks later, after an abscess developed in her wound."3
The nation's prison system is rife with stories like that of
Watson. Locked up for crimes related to poverty and addiction,
denied access to basic hygiene or control over their bodies,
isolated from families and friends, and routinely subjected to
medical neglect, mistreatment and abuse, women prisoners are at
the center of an epidemic of preventable illness, unnecessary
suffering and premature death. There are no official numbers on
how many women die in prison each year; although state
corrections departments are "supposed to release their morbidity
and mortality statistics, we've never been able to get those
statistics," said Chandler in a phone conversation "There's an
incredible lack of accountability. But even if they did release
the report, I would be very skeptical." Her organization has
found that if a patient has a chronic illness and dies, that
illness is listed as cause of death, no questions asked.
Which brings us back to Lisa Watson. Because she was
HIV-positive, the California Department of Corrections
classified her death as expected and HIV-related. In fact, she
died from an infection that developed because life behind bars
made it impossible for her to keep her wound clean.
The Punitive Response
These are heady times for the nation's prisons, especially those
that house women. From 1977 to 2001, the population of women in
federal and state prisons grew by 592 percent, compared to 338
percent for that of male prisoners. During 2OO2 alone, the ranks
of women in these prisons grew 4.9 percent (double the rate for
men) to 97,491, with tens of thousands more in local jails.4
Although the numbers might suggest that women have become more
violent, the opposite is true. The Bureau of Justice Statistics
(BJS) admits that "the rate at which women commit murder has
been declining since 1980."5 Instead, women's surging
incarceration rates correspond to what Chandler calls a shift
from welfare to crime control the war on drugs, zero-tolerance
policies and other politically popular means of addressing
"social problems and human suffering with a punitive response
... [that] arguably renders some of the most vulnerable people
in our society the most vulnerable to imprisonment."6
At the same time, the widening gap between rich and poor has
driven more women into poverty, exacerbating any sense of
powerlessness they may already have. Chandler, a Harvard-trained
lawyer who has represented hundreds of women prisoners in
California, noted that "the more stigmatized an individual is,
the less likely she is able to exercise any techniques to take
care of her health and wellness." And the more likely she is to
engage in "survival behavior," such as sex for money and
self-medicating with drugs, and "to be targeted by law
enforcement for surveillance." Women of color are affected
disproportionately. The Sentencing Project, citing BJS
statistics, notes that 43 percent of women prisoners are African
American and 12 percent are Latinas, and that these women are
significantly more likely to be incarcerated for a drug offense
than white women.7 An African-American woman is more than seven
times as likely as a white woman to spend time behind bars.8
Chandler added that the rising political sway of the pro-life
movement has capitalized on women's vulnerability as well. Women
have been "sentenced to life for allegedly causing miscarriage
or stillbirth. I just heard a case of a woman being sentenced
for child neglect for drinking while pregnant." A chilling
consequence of such prosecutions is that many pregnant women
with drug or alcohol addictions opt to forego any treatment
even prenatal care.
Mortin for Cancer: Systemic Abuses
However you dissect the incarceration boom, the sum of its parts
is a steady influx of women entering prison with serious medical
and emotional disorders (see bottom of article, The Prison
Health Index). Yet many people, even those who consider
themselves progressive - feel that women prisoners are lucky to
have any health care at all, given that millions in the "free
world" have none. Chandler acknowledged this paradox, noting
that prison has become one of the few places where poor people
can get health care. But she pointed out that "prisoners don't
take health care away from anyone." More importantly, the
medical attention they receive in prison "is almost more the
appearance of health care." Behind the flimsy facade are these
realities:
Inadequate, indifferent or incompetent medical attention.
California has just one skilled nursing facility (with
approximately 50 beds) tor more than 11,000 women prisoners.
Nationwide, pain management is inadequate or nonex istent
prison officials tend to believe that prisoners just want the
drugs to feed their addictions. Wrote Chandler: "One of my
clients with metastasized breast cancer was refused pain
management stronger than Motrin until the cancer had spread to
her bones and had fully eaten away both of her hips." Prisons
sometimes medicate and or operate on prisoners without informing
them of their diagnosis or asking their consent. Women prisoners
undergo surgery, give birth and even die while chained to their
hospital bed. Prisoner advocates also question the quality of
prison physicians. Civil Service rules do not require prison
doctors to be board-certified tor specialties, according to an
article in the Poughkeepsie Journal. "It's almost equivalent to
a lawyer not passing the bar," said an official with the
Correctional Association of New York.9
Additional risk factors inside prisons. Even if they enter
prison relatively healthy, "[incarceration itself can increase
the risk of infection, sexual assault, and improper medical care
or contribute to posttraumatic stress disorder," according to an
article in the American Journal of Public Health.10 Tattooing --
common in prisons -- spreads the hepatitis C virus, but prisons
have no sterile tattooing tools. Result: prisoners reuse ink
wells with the live virus in the ink. Likewise, intravenous
drugs are readily available, but safety paraphernalia such as
bleach and syringes are either nonexistent or prohibitively
expensive. Guards routinely pressure inmates into sex, using
their power to convince the women that the relationships are
consensual when the women know that saying no can lead to their
loss of basic services or rights.
Denial of basic nutrition and hygiene. Once their immune
system is compromised, prisoners must fight an uphill battle to
maintain their health. An estimated 5 percent of hepatitis
C-infected inmates receive drug treatment.11 Even without drugs,
most people with the virus find that eating lots of fresh fruits
and vegetables keeps the virus in check. But food in women's
prisons is notoriously unhealthy - not one has a salad bar,
though several men's institutions do. "A salad bar sounds
trivial, but it could really make a difference for someone with
hepatitis, said Chandler. Even basic hygiene products are
restricted. California prisoners' monthly ration of soap is a
travel size bar that they must use to clean their bodies as well
as their cells.
A system modeled on men. Prisons are an economy of scale, and
since male prisoners far outnumber women they also tend to set
the standard of care. Chandler noted that a review of prison
medical records showed that women inmates with hepatitis B were
being given "the dosage that would normally be prescribed to a
200- pound man." Gynecological care "is treated as a specialty
service" and is thus "the first to go if there's a financial
problem." Another example, from Chandler's article: "The
California Department of Corrections terminated women prisoners
access to special medical diets such as low-sodium,
high-protein, or low-sugar diets for women with heart disease,
liver disease, or diabetes respectively unless women are
housed in a skilled nursing facility." This policy change did
not affect male prisoners. Staples of women prisoners' diets
include the likes of pancakes, bologna, American cheese, chips,
corn dogs, potatoes and Jell-o. California also spends half as
much money on women prisoners' food as on men's $1.25 a day vs.
$2.45.
Prison profitability "at any human cost." Chandler calls the
current push to turn prisons into profitable enterprises one of
the most significant factors (along with the shift from welfare
to crime control) impacting prisoner health. The trend puts
nearly all prisoners to work (refusing to work can prolong a
sentence) while allowing the companies that employ them to pay
pennies an hour.12 It also results in prison commissaries
selling basic items like soap, toothpaste and relatively healthy
alternatives to prison food at grossly inflated prices. "Within
this economy of human chattel," wrote Chandler, "there is no
space for the sick or permanently disabled." She cited a former
client who broke a foot, then, by overcompensating for the foot,
developed an ulcer on the other foot. "Since she is a diabetic,
the ulcer would not heal. She could not walk or stand, and the
ulcerated foot was gravely infected. Yet the prison refused to
recognize her medically compromised status. She continued to be
assigned a job requiring that she stand during an entire shift."
A year later, her wound "has escalated to the point at which a
bone now protrudes from her foot," and amputation may be
necessary.13
Amid these conditions, incarcerated women are physically and
emotionally isolated from their families and communities. Most
prisons constructed during the building boom of the 1980s and
'90s are in remote rural areas far from public transportation.
Even prisoner advocates, lawyers and the media are thwarted by
restricted visitation policies, restricted litigation rights and
severely capped attorney fees. Without outside assistance, women
prisoners have few means of filing grievances against the prison
system. Phone usage is monitored as well as prohibitively
expensive (prison phones generate as much as $1 billion in
profits each year for prisons and the phone companies they
use).14 And although "most prisons have set up complaint
procedures, they're inherently flawed when they ask the prison
to police themselves," observed Chandler.
Hope From the Underground
It's difficult to imagine a happy outcome tor many women
prisoners, but a few budding trends suggest that some former
inmates perhaps even a growing percentage of them will reenter
the free world with a stronger sense of their empowerment and
individual rights. A significant force behind this hope is
peer-education programs in which health professionals train
prisoners to take care of their own health, and the prisoners go
on to train others. (It would be difficult to understate the
need tor this kind of education. A letter from an inmate at the
Federal Medical Center at Carswell, Texas, where some 1,400
women inmates are treated, said the center has exactly one book
on hepatitis, one book on lung and breast cancer and one book on
HIV/AIDS.16)
Momentum is also building tor rape crisis training -- teaching
prisoners how to set up their own rape-crisis centers. Not
surprisingly, prison officials don't always support these
programs, noted Chandler, so her organization sometimes "funnels
information underground" to circumvent authorities. "It takes a
lot of perseverance to get in, but the prisoners are extremely
grateful."
Finally, more people are challenging the prevailing argument in
favor of imprisonment for even minor infractions. A growing body
of research shows that prisons are not the economic forces many
perceive them to be, and in fact drain local economies by
putting enormous wear and tear on the infrastructure and the
environment, among other factors. Similarly, individuals are
questioning whether prisons actually make them safer. The
reality, according to Chandler, is that aggressive imprisonment
"has alienated many people of color and is contributing to the
fragmentation of families in communities of color." This
emerging thinking has fostered the rise of grassroots groups
that want to redirect public funds from prison development to
programs that make life outside prisons healthier in the first
place. California's Education Not Incarceration (www.may8.org),
consisting of politicians, teachers, students, parents and
unions, noted that the state's 2003 - 04 budget called to cut
$11 billion from K- 14 education while adding $40 million to
prison spending the only area of spending slated for an
increase.15
Asked what steps ordinary individuals can take to improve the
health care of women prisoners. Chandler suggested that "they
look at this differently than they would a health issue in the
outside free world," where the common approach is to ask for
more money. When prisons get money, "they don't put it into
health care; they put it into guards and buildings," thus
decreasing the pool for services "that make communities
stronger." To that end, she recommended contacting legislators
and asking that they decrease prison funding and increase
funding for services such as education and universal health
care.
What Else Can You Do?
Intervene if you know somebody who has been arrested.
Educators, social workers, legal aid workers, medical providers
and "basically anyone who works with all races" can have a
profound influence by writing a quick letter to a judge, said
Chandler. She suggested outlining the person's medical history
and explaining why it's important that the person get health
care in the community. (Sample letters are available from
Justice Now: www.jnow.org)
Build awareness of prison life within your own community.
Organizations that work with prisoners and give presentations to
community groups include the ACLU Prison Project (www.adu.org),
Citizens United for Rehabilitation of Errants (www.curenational.org)
and the Prison Activist Resource Center (www.prisonaetivist.
org) .
Organize health fairs inside prisons. Besides rape-crisis
training and peer-education training, as noted earlier,
possibilities include teaching battered women how to improve
their self-esteem and how to stop the cycle of violence.
The Prison Health Index
Odds that a woman prisoner was using alcohol, drugs or both
when she committed the offense for which she was incarcerated:
one in two
Reason one-third of women in prison committed the offense: to
buy drugs
Percentage of women prisoners who had experienced physical or
sexual abuse prior to incarceration: 60
Likelihood that a U.S. prisoner is mentally ill: one in six
Prevalence of mental illness among inmates versus that among
the general population: three to one
Percentage of women prisoners who are mothers: 80
Percentage of incarcerated women in the District of Columbia
who are HIV positive: 41
Percentage of incarcerated women in New York State who are HIV
positive: 18.2
Chances that a woman prisoner in California is infected with
the Hepatitis C virus: between 40 and 60 percent.
Leah Thayer is editor of The Women's Health Activist.
REFERENCES:
1 Watsons story and other parts of this article (as indicated)
were excerpted from "Death and Dying in America: The Prison
Industrial Complex's Impact on Women's Health," by Cynthia
Chandler. Berkeley Women's Law Journal Volume 18, 2003, and
clarified in two phone discussions and follow-up e-mails with
Chandler.
2 As noted in an e mail from Chandler. Justice Now advocated for
Watson to see a neurosurgeon for six months. "During that
period, she was sent to a neurosurgeon times by the prison, but
each time the prison forgot to send the ct scan with her and the
specialist had to send her back untreated.... It was tragically
comical. After months, she finally got the tests and ct scan
review required to diagnose/treat the tumor."
3 Chandler. "Death and Dying in America."
4 Women's Prison Association & Home. Inc WPA Focus on Women &
Justice. August 2003.
5 Bureau of Justice Statistics Special Report: Women Offenders
December 1999, revised October 2000.
6 Chandler. "Death and Dying in America.
7 The Sentencing Project. Factsheet: Women in Prison. May 2003.
8 Nicholas Freudenberg, "Adverse Effects of US. Jail and Prison
Policies on the Health and Well-Being of Women of Color,"
American Journal of Public Health, December 2002.
9 Mary Beth Pfeiffer, "Prison is riskiest for the sick."
Poughkeepsie Journal, January 5, 2003.
10 Freudenberg, "Adverse Effects."
11 According to Michele Bonan, assistant legislative affairs
director for the Gay Men's Health Crisis, quoted in "Inmates'
health care is in crisis, panel told." By Mary Beth Pfeiffer,
Poughkeepsie Journal, November 15, 2003.
12 In California, "prisoners collect seven to thirteen cents per
hour, on average." From Chandler. "Death and Dying in America."
citing California Department of Personnel Administration, Fair
Labor Standards Act Manual.
13 Chandler, "Death and Dying in America.
14 Robert Tanner. The Associated Press. March 30, 2003.
15 Education Not Incarceration Final Report, available at
www.may8.org.
16 Letter from Carolyn McGuire, July 2003.
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