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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”


Healthcare Behind Bars
California prisoner well-being is a concern for many

David Bragi, Special to SF Gate

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.