Barriers To Basic Care
As the fastest growing population in American
prisons, women face medical neglect and malpractice in epidemic
proportions
Victoria Law
Medical neglect and malpractice are issues faced by prisoners across
the United States. Women in prison, however, face the additional
challenge of trying to obtain adequate care for specifically female
health concerns from prison administrators and medical staff trained
and accustomed to treating male prisoners. Despite the lack of outside
support and the prevailing notion that female inmates do not organize
to change prison conditions, women in prison have been and continue
to be proactive in demanding adequate medical care.
Pregnancy is one of the more common female health concerns, yet
even prison wardens agree that several of its needs “have yet
to be dealt with in any of the facilities,” including adequate
resources to deal with false labors, premature births and miscarriages;
maternity clothing; changing the requirement that pregnant inmates
wear belly chains when transported to the hospital; and a separate
area for mother and baby. A 1999 study by the Department of Justice
indicated that six percent of women entered jail and five percent
entered prison while pregnant. However, only three percent of pregnant
jail inmates and four percent of pregnant state prisoners were found
to have received prenatal care since admission. Pregnant women are
also not provided with the proper diets or vitamin supplements, given
the opportunity to exercise or taught breathing and birthing techniques.
In one instance, a twenty-year-old woman, who was almost five months
pregnant when incarcerated, began experiencing vaginal bleeding,
cramping and severe pain. She requested medical assistance numerous
times over a three-week period, but there was no obstetrician contracted
with the prison. She was finally seen by the chief medical officer,
an orthopedist, who diagnosed her without examining her physically
or running any laboratory tests, and given Flagyl, a drug that can
induce labor. The next day, the woman went into labor. Her son lived
approximately two hours.
Pregnancy is not the only female medical concern ignored by prison
officials. Prevention, screening, diagnosis, treatment, pain alleviation
and rehabilitation for breast cancer are virtually non-existent in
prisons. In 1998, a study at an unnamed Southern prison found that
seventy percent of the women who should have had mammograms under
standard medical protocol had not been tested. Although many of the
women were at high risk because of family histories, they were not
provided with a clinical breast exam, information or basic education
on self-examination upon admittance. At the California Institute
for Women, Sherrie Chapman pleaded for nine years before receiving
medical attention for the lumps on her breasts. By that point, cancer
had progressed and she was forced to undergo two mastectomies and
a hysterectomy.
Similarly, cervical cancer and other female illnesses are commonly
misdiagnosed and mistreated, sometimes with alarming consequences.
At Oregon’s new women’s prison, Coffee Creek Correctional
Facility, Danielle Conatser was given a Pap smear which came back
with abnormalities. The prison’s doctor informed her that she
had cervical cancer. Conatser, who had given birth six weeks earlier,
requested a second opinion. She was then told she would be put to
sleep for a biopsy. When she awoke, she was told that the doctor
who had originally diagnosed her had removed a good portion of her
cervix, thus making it unlikely that she would have children in the
future. Conatser never received a second opinion or any follow-up
care. She continues to live with the fear that she has cancer.
Not only are the particular health care needs of women ignored or
dismissed, but health care in general is often inadequate or life-threatening.
Darlene Dixon recalled her visit to a private clinic contracted by
her prison: “There was no disposable paper on the table to
create a sanitary barrier between my body and the examination table.
The room was basically in disarray; there were spilled liquids on
the counter tops as well as debris on the floor.” In the restroom
was a sink filled with “soiled and bloody tubes, lids and bottles.
Even more disturbing were the clean ones located on top of the toilet
tank beside it. It rapidly became apparent to me that these items
were being washed and reused.”
In addition, illiteracy and poor literacy can be an obstacle to
obtaining medical care. As Ellen Richardson, an inmate at Valley
State Prison for Women (VSPW) in California, testified: “The
medical staff triage [is] based on how the patient states her symptoms
on paper.” This procedure ignores the fact that the average
literacy level at VSPW is less than ninth grade, that over seven
hundred women have less than a sixth-grade reading level and that
approximately one hundred are illiterate or speak English as a second
language. “A woman may have extreme stomach pain and cramping,
but only have the literacy level to write, ‘I have a tummy
ache.’ That is not enough for medical staff to let her see
a doctor.”
Medical neglect has sometimes led to preventable deaths. In February
2000, Wisconsin prisoner Michelle Greer suffered an asthma attack
and asked to go to the Health Services Unit (HSU). When the guard
and captain on duty contacted the nurse in charge, he did not look
at Greer’s medical file, simply instructing her to use her
inhaler (which was not working). Half an hour later, Greer’s
second request to go to HSU was also ignored. After another half
hour, Greer was told to walk to HSU but collapsed en route. When
the nurse in charge arrived, it was without a medical emergency box
or oxygen. A second nurse arrived with the needed emergency box,
but again with no oxygen. Forty-five minutes after her collapse (and
less than two hours after her initial plea for medical help), Greer
died.
However, women have been active about trying to change their sometimes
life-threatening medical neglect. The most successful and well-known
prisoner-initiated project organized around health care is the AIDS
Counseling and Education Project (ACE) at Bedford Hills Correctional
Facility in New York. AIDS is the leading cause of death among U.S.
prisoners, being five to ten times more prevalent in prison than
in the outside society. In 1999, the New York State Department of
Health found that the rate of HIV infection among women entering
the New York State Correctional Facilities was nearly twice that
of their male counterparts. In 1987, inmates at Bedford Hills, motivated
by watching their friends die of AIDS and by the social ostracism
and fear of people with AIDS, started ACE.
ACE founders hoped to educate and counsel their fellow inmates about
HIV/AIDS as well as help to care for women with AIDS in the prison
infirmary. Although the prison superintendent gave the group permission
for the project, ACE continually faced staff harassment and administrative
interference. For instance, because both Kathy Boudin and Judith
Clark, alleged members of the Weather Underground, were active ACE
members, the group was constantly monitored and sometimes prevented
from officially meeting. Fear that the one-to-one peer counseling
sessions would lead to inmate organizing as well as the staff’s
own ignorance of HIV/AIDS led to staff harassment and interference.
Educators from the Montefiore Hospital holding training sessions
were banned from the facility for suggesting that the Department
of Correctional Services lift its ban on dental dams and condoms.
A year after its formation, ACE members were prohibited from meeting
at their regular time, from using their meeting room, giving educational
presentations or to referring to themselves as “counselors.”
Despite these setbacks, the members of ACE not only managed to implement
and continue their program, but also received a grant for a quarter
million dollars from the AIDS Institute and wrote and published a
book detailing the group’s history and its positive impact
on women with AIDS as a guide for other prison AIDS programs. One
interesting aspect is that despite ACE’s success, male prisoners
attempting to set up similar programs at their facilities continue
to meet with administrative resistance and retaliation.
Other women political prisoners have also focused on the AIDS crisis
behind bars. Marilyn Buck, for example, started an AIDS education
and prevention program in California. In 1994, three HIV-positive
inmates at Central California Women’s Facility (CCWF) began
a peer-education program encompassing not only HIV and AIDS, but
also other sexually transmitted diseases, tuberculosis and Hepatitis
C.
Women have also worked individually and without the auspices of
administrative approval to change their health care. Until her recent
death, California prisoner Charisse Shumate worked with her fellow
inmates with sickle-cell anemia to understand the disease and the
necessary treatments. She also advocated the right to compassionate
release for any prisoner with less than a year to live and was the
lead plaintiff in the class-action lawsuit Shumate v. Wilson, challenging
medical conditions throughout the state’s prison system.
Unfortunately, Shumate herself died at CCWF, away from family and
friends, because the Board of Prison Terms recommended clemency rather
than compassionate release. Governor Gray Davis refused to approve
the Board’s recommendation. Four years before her death, Shumate
wrote : “I took on [the battle] knowing the risk could mean
my life in more ways than one…And yes, I would do it all over
again. If I can save one life from the medical nightmare of CCWF
Medical Department then it’s well worth it.” Her work
did not cease with her death. Women who had worked with her continue
the task of teaching others how “to understand their lab work
and how to chart their results, keep a medical diary, hold ‘these
people’ accountable to what they say and do to them.” Sherrie
Chapman, one of the 26 inmates who testified in Shumate v. Wilson,
became the primary plaintiff in a class-action suit over medical
conditions as well as filing a civil suit charging the CDC with cruel
and unusual punishment after being forced to wait years for cancer
treatment.
In Wisconsin, an anonymous female prisoner telephoned the Milwaukee
Journal Sentinel to report the medical neglect leading to Michelle
Greer’s death. This one phone call prompted Sentinel reporter
Mary Zahn to begin investigating. Two weeks after Greer’s unnecessary
death, Zahn not only publicized the story, but also turned the death
into a “minor sensation.” The publicity led the Wisconsin
Department of Corrections to investigate the incident and suspend
the two nurses who initially ignored Greer’s requests for medical
assistance and then bungled their eventual response, leaving her
to die. The article also prompted the state’s Assembly’s
Corrections and Courts Committee to hold investigative hearings into
the incident.
This one story led to the paper’s own investigation as to
whether the neglect causing Greer’s death was an isolated incident.
For the following eight months, Zahn and a fellow journalist Jessica
McBride investigated every prisoner death since 1994, revealing “a
dysfunctional health care system in which gravely ill prisoners,
often while literally begging for medical treatment, are ignored — and
sometimes even disciplined for being ‘aggressive’ or ‘disruptive.’” Their
findings led to a series of articles about the inadequate and often
times life-threatening medical care in Wisconsin prisons, prompting
the state’s lawmakers to introduce legislation requiring better-trained
medical staff, improved medical record-keeping, and the creation
of an independent panel of outside medical experts to review prison
deaths.
This anonymous woman prisoner protested the conditions of the prison-industrial
complex and ensured that Greer’s death, as well as those of
other Wisconsin inmates, would not remain swept under the rug. Similarly,
the works of ACE, Marilyn Buck, Charisse Shumate and other women
address crucial issues facing women in prison and contradict the
notion that women do not and cannot network and organize to change
their conditions.
Further Reading
Amnesty International. “’Not Part of My Sentence’:
Violations of the Human Rights of Women in Custody.” March
1999.
The Women of the ACE Program of the Bedford Hills Correctional
Facility. Breaking the Walls of Silence: AIDS and Women in a New
York State Maximum-Security Prison. Woodstock, NY: The Overlook
Press. 1998.
California Coalition for Women Prisoners: womenprisoners.org |