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On
the evening of February 20, the prisoners rights
activist group California Prison Focus hosted a
"Speak Out" event at the Quaker Meeting House
in San Francisco. Activists, former inmates and families
of current prisoners spoke to the news media and the
public about health-care conditions in California's
state prisons.
A
recent parolee and type II diabetic named Frederick (who
did not give his last name) described how, when he was
sent to prison in California a few years ago on a theft
charge, he could walk and see as well as any other
person. By the time the state released him a few months
ago, he was legally blind and confined to a wheelchair.
He
described to a crowd of about 40 people how prison staff
neglected his medical condition until a 1999 stroke left
him severely disabled. For instance, even though he is
diabetic and has special dietary needs, he was served
the same food as the other inmates. In addition, he
added, "many of us diabetics weren't even getting
our daily insulin injections in a timely manner."
With
over 157,000 inmates in 33 facilities and an annual
budget of nearly $5 billion, the California Department
of Corrections operates the largest prison system in the
nation. Yet critics charge that sick or injured inmates
receive substandard and intermittent care.
"California is the model for what a large prison
system can do for a very ill prison
population," said Judy Greenspan, the event's
coordinator and chair of the HIV/Hepatitis C in Prisons
Committee of California Prison Focus. "I think that
it falls flat on its face."
In
a subsequent telephone interview, CDC spokeswoman Terry
Thornton disputed Greenspan's assessment, saying that
the agency is required by law to serve the health-care
needs of its inmates. "Inmates have a
constitutional right to health care. Those of us who are
not incarcerated do not," she said. "Is it a
perfect system? No. I don't think any health-care
provider has a perfect system."
Regarding
the dietary needs of diabetics like Frederick, Thornton
said that all inmates -- diabetic or not -- are offered
the opportunity eat meals based on a "Heart
Healthy" food plan developed by CDC health
officials in 1998 for inmates who have "medical
diet-management" needs.
Hepatitis
Behind Bars
The
main focus of Greenspan's committee is the hepatitis-C
epidemic among California's prison population. The CDC
reported only 14,305 known cases as of last fall,
largely because California prisons do not automatically
test all inmates for it, but both the agency and
California Prison Focus estimate that more than a third
of inmates -- or over 50,000 -- have the disease.
"For
prisoners who are hepatitis-C positive, very few of them
have access to any treatment," said Greenspan.
"I have not seen one prison in the state that has a
hepatitis specialist, that has a gastroenterologist on
staff, that has somebody who is knowledgeable about
hepatitis on staff."
Thornton,
in response to Greenspan's comment, noted that the CDC
works with outside specialists and hospitals when it
needs that kind of specialized service: "Any level
of care that an inmate cannot receive in prison, they
would receive at a contract facility. In fact, an inmate
recently received a heart transplant."
Thornton
also stated that the CDC now takes care of its hepatitis
patients and is doing its best to keep up with newly
developed treatments. "We have started using
pegylated interferon, the newest treatment
recommendation, and we also encourage interferon
recipients to receive substance-abuse treatment,"
she said.
According
to parolee Charles Watson, 44, who attended the
"Speak Out" program, this was not always the
case. Watson, one of the first California inmates to be
treated for hepatitis C, in 1999, said that it took him
19 months to plow through the necessary paperwork before
receiving treatment. Finally, less than two months
before his parole date, the treatments finally began.
Watson
said the treatments were supposed to last for at least a
year. "Had they started treating me in the
beginning, they would've been out thousands and
thousands of dollars," he claimed. "So they
waited till I was six, seven weeks from paroling, and
then they began the treatments, to save money."
Chronic
Costs
Regardless
of one's opinion on the quality of inmate health care,
there can be no doubt that it is expensive. The CDC's
$750 million health-care budget has tripled from just a
few years ago, according to Thornton.
Yet
the CDC's pharmaceutical costs have more than tripled
over roughly the same period, she said. "We, as a
society, are responsible for making sure that when
[inmates] get sick, we do whatever we can do to make
them get better, and that costs time and money,"
Thornton added. "If you talk to any person who
provides health care, money is always an issue."
In
addition, inmates are more likely to suffer from chronic
diseases, such as hepatitis, which are often expensive
and difficult to treat. "People come in, and they
already have been underserved by the medical
establishment," said Greenspan. "They are
poor, they have a drug addiction and the prisons are not
set up to deal with that. "People need to
understand that it's a sicker-than-average population
because of substance abuse and criminal lifestyle,"
said Thornton. "We're always looking for ways to
improve health care, particularly in the area of chronic
care."
Frederick
disagrees, alleging that physical therapy and
rehabilitation for disabled prisoners is
"practically nonexistent." Disabled
ex-convicts are eventually released into the general
population, unable to take care of themselves. "I
essentially was paroled in a wheelchair, blind and with
nowhere to go," he said. "My parole agent
basically dumped me out on a street corner."
Fortunately, Frederick has since regained a limited
ability to walk.
If
prisons better rehabilitated disabled inmates, he
continued, they would be less of a drain on society
after their release. Every time a disabled inmate is
"dumped" back onto the streets, taxpayers have
to pick up the tab for the additional weeks, months or
years of social services required to make that person
self-supporting. It's "not just the cost of the
incarceration," he said. "Now you're paying
the cost of rehab on the street, disability benefits, on
and on and on.
Family
Matters
Not
only sick or injured inmates, but also their families,
complain about how they are treated by the CDC.
Summerlynn Salamida's husband has both HIV and hepatitis
C and is serving time at San Quentin. She doesn't
understand why prison authorities haven't kept her
informed about his condition. "Even though we're
married, I haven't gotten any kind of a progress report
as to his health status or anything like that," she
said.
Salamida
also suffers from both HIV and hepatitis C, and because
she is homeless, she hasn't yet been able to visit her
husband in prison or exchange letters with him.
The
emotional stress of not being in contact with her
husband has had a negative effect on her own health, so
she attended the "Speak Out" program, while
she can still make the effort, to find out what her
legal options might be. "We don't know how much
time we have left, you know," she added.
According
to Thornton, the CDC has always made an attempt to keep
the families of inmates informed about medical problems.
"But we're going to try to do that better,"
she said, adding that the CDC expects to announce a new
policy in about a month.
No
Relief From Pain
Chronically
ill patients, occasionally violent patients, the
inherently depressing atmosphere of a prison -- it's no
wonder health-care providers who work behind bars have a
reputation for developing thick-skinned attitudes toward
their patients. Yet some former inmates testified how
such a lack of compassion can have dangerous
consequences.
Former
inmate Lavette Arnold addressed the crowd about
undergoing hemorrhoid surgery in a California prison
hospital. She charged that the doctor botched the
operation, handling her internal organs so roughly that
she received severe damage to her rectal area.
Like
Frederick, she ended up in a wheelchair for three months
and saw her weight plummet from 155 pounds to 111
pounds. "There were times that I wanted to kill
myself," she said. "I felt raped by this
doctor."
Yet,
added Arnold, after the operation the head nurse refused
to treat her for the pain and bleeding. "I showed
her blood -- the tissue was soaked. She said, 'That's
not good enough. I want it dripping down your leg before
I help you.' It felt like somebody stabbed me in my
rectum and my spine. I mean, no pain medicine -- how are
they going to send me to the yard like this?"
Fortunately,
other female inmates secretly shared their own pain
medication with Arnold, risking punishment if caught.
"If the doctor don't help, we will help each
other," she said. "You know, 'I got an extra
Tylenol,' or something."
Greenspan
cites instances like this and voices disagreement with
the current practice of hiring full-time prison medical
staff to provide most primary-care services. She would
prefer to see the CDC contract with more private
physicians who already have outside practices in the
community. "[Medical] people who are locked into
the correctional system develop a certain
callousness," she said. "They think that
prisoners are always lying. People have died because of
that type of callous treatment."
Thornton
denied that CDC medical personnel have such negative
attitudes. She also said doctors employed by the CDC
enjoy being able to focus entirely on patient care
without the financial and administrative distractions of
running their own private practice. "All the
doctors I've met, they work in prisons because they want
to," she said. "They get to do nothing but
practice medicine."
She
noted that in addition to employing in-house staff, the
CDC does sometimes contract with outside doctors and
nurses. She also said that any allegations of staff
misconduct are vigorously investigated.
California's
prison system is faced with some very complex health
problems, only a few of which have been touched on here.
While the state spends hundreds of millions of dollars
every year, complaints persist that prisoners do not
receive competent and compassionate care.
Prison
rights activists would have us believe that the system
is barely functioning. The CDC claims that problems are
few and far between. As always, the truth probably lies
somewhere between the two positions. What is important,
however, is that we not consider health care a luxury
for anybody -- even a convict.
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