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