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Indybay Feature

Medical treatment in women's prisons range from brutal to non-existant

by prisoner advocate
Death was not a part of their sentence.
The Nation

May 6, 2002

A Cancer Grows : MEDICAL TREATMENT IN WOMEN'S PRISONS RANGES FROM BRUTAL TO NONEXISTENT

By Cynthia Cooper

Feeling a lump in her breast, Sherrie Chapman, an inmate at the California Institution for Women, in Frontera, first raised an alarm to her assigned doctor in 1991, explaining her family history of breast cancer. The doctor belittled her complaints. Persisting, Chapman managed to score a mammogram two years later. The recommended follow-up took place in 1995, after another two and a half years. Outside doctors ordered an immediate radical right-breast mastectomy and the removal of four lymph nodes.

Shackled in a hospital holding room, Chapman curled up on a bench. "I tried to focus, not cry, not feel bad, not hurt--so many emotions running at one time, and nobody there to make you feel better at all," she says.

More troubles ensued. Postsurgery, guards signed her out against medical advice and confiscated her pain medication. Correctional officers ignored chemotherapy appointments. "There was a lack of care, concern, compassion, sympathy, anything," says Chapman. The cancer spread, and in 1997 Chapman had a left-breast mastectomy. Now 44, she says she can feel lumps on her neck. "Whether [out of] willful disregard or [because] they just blew it off, her doctors did not follow rather standard practice," explains Yuri Parisky, director of breast imaging services at Norris Comprehensive Cancer Center of the University of Southern California. Chapman achieved one rare victory: She won a settlement from the state.

"It's hard not to feel outrage," says Ellen Barry, founder of Legal Services for Prisoners with Children, in San Francisco, which represented Chapman. "People would see this in another country and think it's a human rights violation. This is our own backyard."

Although the silent and insidious killers of women--breast, ovarian and cervical cancer--are finally commanding pink-ribbon attention and activism in the outside world, inside prisons, women might as well be living in the dark ages. Healthcare for prisoners, male as well as female, is decidedly subpar, but women face exceptional hardships in a system based on a military design, with young and healthy men as the treatment model.

The number of women in prison has risen rapidly because of mandatory drug-related sentencing, doubling the female population in ten years, to 162,000 in 2000. Yet women are easily forgotten in corrections, where they are only 8.4 percent of 1.93 million prisoners. Few women get the death penalty many get damaging, even deadly, medical treatment. In the area of reproductive and breast cancers, prisons fail in prevention, screening, diagnosis, treatment, continuity of care, alleviation of pain, rehabilitation, recovery--and concern.

Across the continent from Chapman, in the Danbury Federal Correctional Institution in Connecticut, Susan Rosenberg faced the opposite dilemma in March 2000. A mammogram showed changes in breast calcifications. Rosenberg, a prisoner for sixteen years until she was released in January 2001, underwent a biopsy in chains, shackles and with four armed guards in the operating room. Afterward, the prison doctor verbally reported the results. "For a week, I thought I had breast cancer and was almost ready to have a mastectomy," said Rosenberg. A health advocate in prison and a political activist, Rosenberg demanded the pathology report, contacted lawyers and got a Congressional Representative to intervene. She discovered that she had "lobular carcinoma in situ"--a condition that requires close monitoring but not breast excision. After a second opinion (something rarely granted to a prisoner), the mastectomy was rejected. "I almost went and had a breast cut off unnecessarily," says Rosenberg. But most prisoners, she says, cannot round up the same resources.

"All other issues pale before the issue of physical and psychological health of women in prison. If women are dying, what does it matter what other programs there are?" says Leslie Acoca, a former researcher with the National Council on Crime and Delinquency and president of In Our Daughters' Hands, in San Francisco. It is, says Acoca, "a tsunami." Fears about breast and reproductive cancers run high in prisons, as in society, but the diseases receive dreadfully little institutional attention. Egregious violations of women's medical care in general were documented by Amnesty International in a 1999 report, "Not Part of My Sentence," and Amnesty issued an alert in 2001 questioning the unexplained death of nine women in the California system.

Cervical cancer took the life of Gina Muniz, who was 29 and the mother of a 9-year-old. Muniz was diagnosed and treated for stage 2B cancer in pretrial custody in Los Angeles, according to her mother, Grace Ortega. Upon sentencing in June 2000, Muniz was sent to the Central California Women's Facility in Chowchilla. Chowchilla has a chilling reputation. A national consultant, speaking on condition of anonymity, described it as horrifying.

At Chowchilla, Ortega visited weekly, watching her daughter wither away--unable to eat, unable to walk, hurting. "That was the ugliest thing to see. It's so much pain in my life. They broke my heart. No one lifted a finger," Ortega says. When Muniz complained of severe stomach cramps, prison officers prescribed Metamucil. In late August, the prison rushed Muniz to an outside hospital, where intensive-care doctors found a large tumor in her bladder and her kidneys failing. She never recovered. A spokesperson for the California prisons declined to comment, and Ortega is still seeking explanations.

Effectively protected from public scrutiny, the barbed-wire medical system is uncoordinated, underfunded and has almost zero accountability. Doctors are ill trained and overburdened, and even competent ones can be trumped by correctional personnel. "It's like Alice going down into a rabbit hole," says Bonnie Kerness, a lawyer who directs the American Friends Service Committee's Prison Watch project in New Jersey.

A pattern of failures across the nation points to systemic pathology. "Every single state will tell you women's healthcare is the top problem in women's prisons," says Lucy Armendariz, a former ombudsman for women prisoners in California, now working as counsel to the state's legislature. The federal government refuses Medicaid payments for prisoners, placing the entire burden on states. "And it's pretty much political suicide when you say, 'Let's give more money for prisoners,'" explains Armendariz.

A web of social, medical, legal and political circumstances conspire against the medical care of women inmates. "Women have gynecological issues that men don't have," said Nawal Ammar, an associate professor at Kent State University who researched women in Ohio prisons. "Women have issues of abuse that are different. Women have self-image problems. Women are more depressed. These are all issues that impact on healthcare in prison." Yet Ammar found Ohio institutions operating with an emergency-ward mentality, where systemic diseases can be pushed aside.

From the point of entry, women present more health problems. A 1997 Bureau of Justice study discovered that 30 percent of women in federal facilities reported a medical problem, compared with 23 percent of men. Poverty, substance abuse and lack of access to community healthcare all take a toll. "Pervasive and severe" histories of prior sexual and physical abuse affect 94 percent of incarcerated women, according to Angela Browne, a senior research scientist at the Harvard Injury Control Research Center of the Harvard School of Public Health. This factor alone complicates medical care. The National Commission on Correctional Health Care warned that sexual assault histories require special sensitivity in gynecological examinations and Pap smears.

Danger signals for cancer appeared to be pervasive in a unique comprehensive health survey of 115 women held in Connecticut's York Correctional Institution. "You can see they are at risk for cancer," says public health researcher A. Siobhan Thompson, who found that the women self-reported cancer at a rate six times the rate men did and had unusually high numbers of parental deaths from cancer.

Despite community attention to early detection and effective treatment as a strategy to prevent breast cancer deaths, screening programs are virtually nonexistent in women's prisons. In 1998 Roma Williams, then an associate professor at the University of Alabama School of Nursing, conducted one of the few correctional research projects specifically on breast cancer, in an unnamed Southern prison. Although she found women at high risk because of family histories, she learned that inmates were not provided with a clinical breast examination upon entry, information or basic education on self-examination. Seventy percent of the women who should have had mammograms under standard medical protocol had not been tested.

The federal Bureau of Prisons generally conducts yearly mammograms for women over 40, according to Susan Rosenberg, but that does not guarantee competent analysis. Liz Fink, a Brooklyn prison lawyer, says that misdiagnosis is rampant. "Medical care in the BOP is a scandal, a can of worms as big as a house," says Fink. One of her clients, Silvia Baraldini, was deemed fine after a mammogram in 1999. But when Baraldini, an Italian national, was transferred to a prison in Italy shortly afterward, doctors reviewed the same tests and detected cancer. Baraldini underwent a lumpectomy, removal of lymph nodes and chemotherapy. In contrast to US policy, prisoners with breast cancer in Italy are discharged, and Baraldini was sent home to recover in May 2001, although under restrictions demanded by the United States.

The medical complaints of women inmates are regularly ignored, according to Patricia Arthur, project director of the Columbia Legal Services Institutions Project in Washington State, which sued to secure acceptable healthcare for women in prison. "The presumption is 'you're not telling the truth.' Women are discounted, misperceived to be drug seeking or trying to get attention," says Arthur.

Gruesome stories roll out across the country:

In New Jersey, Margaret De Luca, 52, was sentenced to prison in April 2000 after having received a diagnosis of stage 3A breast cancer and a left-breast mastectomy. She endured eleven-to-fifteen-hour trips, sometimes without food, for radiation and chemotherapy. "Whenever I returned to this facility or needed medication for my pain, nausea, whatever--even though it was prescribed by the medical oncologist--I have to battle this staff to get it," she wrote in a letter. Her cancer has spread to vital bone areas, De Luca says. Lawyer Bonnie Kerness has sent thirty letters complaining about De Luca's treatment to Correctional Medical Services, the private corporation that has an annual $89 million contract for New Jersey's correctional healthcare. The company has contracts with more than 300 prisons and jails in thirty-one states.

In Chicago, Rochelle Bowles, former director of the transitional program Grace House, tried to sort out the medical records of a 52-year-old resident diagnosed with breast cancer shortly before her incarceration in fall 2000. Zero treatment or care had been provided in her six-month incarceration, and her condition worsened. "It boggles the mind," says Bowles.

After a review of more than 1,200 medical complaints of California women prisoners, professor Nancy Stoller of the University of California, Santa Cruz, reported scores of calamities. They included a woman with cancerous cells in her reproductive system who was denied a hysterectomy because of cost a prisoner who underwent removal of a breast lump but had not received results a doctor who broke a speculum inside a woman during a biopsy and used unsterilized pliers to remove it.

Recourse for the women is, unfortunately, limited. Copies of records are difficult to secure. Prisoners must file a formal grievance to appeal a medical decision, since healthcare is intertwined with strictly correctional functions.

To navigate the bureaucracy, lawyers are as necessary as doctors, but they too are handicapped. Prisoner advocates feel that judges let prisons off the hook, prematurely releasing them from complying with hard-won improvements in women's healthcare after legal settlements were obtained in Washington in 1995 and in California in 1997. Attorney Patricia Arthur in Washington says issues of inadequate care and chaotic staffing remain, and an appeal is pending.

In any case, under rulings of the US Supreme Court, no remedies are available unless prisoners can meet the monumental standard of showing that there was "deliberate indifference to serious medical needs." As the health concerns for women intensified with the prisoner influx of the 1990s, the federal government further closed courtroom doors through stiff hurdles to lawsuits via the Prison Litigation Reform Act of 1996, inscribing onerous pre-filing requirements, placing time limits on remedies and jacking up costs.

Advocates want to see women prisoners treated by the standards of acceptable medical care in the outside community. The mainstream National Commission on Correctional Health Care agrees, and even adopted the guidelines of the American Cancer Society and American College of Obstetricians and Gynecologists for breast and reproductive cancer testing and treatment.

Prisons, however, seem unwilling or unable to meet those standards. "If there is no means of redress, what would motivate them to want to treat you?" Fink asks. Deprived of adequate legal or medical recourse, and with hardly a nod from the flourishing and powerful women's health or breast cancer organizations, incarcerated women with health problems seem to have bleak prospects. "Part of me wants to see the silver lining, and it's hard these days," says Ellen Barry.

Cloistered inside the walls, Sherrie Chapman presses hard to send a message: "There are women with serious medical conditions, and they are scared to approach medical, scared of the repercussions. They'll tell you they have lumps in their breasts, in their thighs, all kinds of things. I've seen so many women die. It's really sad, you know?"


Cynthia Cooper, an independent journalist in New York City, is the author of Mockery of Justice (Dutton).
Add Your Comments

Comments (Hide Comments)
by Tough Love
Crime doesn't pay.
by Carlo (caji5 [at] aol.com)
After a brief stint fifteen days for a violation of probation
for a crime that wasn't comitted, a violation that wasn't either save for coercion, books should be written about how they treat an ordinary citizen and how they treat the spoils of war. Call them fiction for the uninformed citizen doesn't care or won't believe. Teachers not bombs and jails.

Wake up America, there is more going on than the activity in our front yards. The world needs us, we need the world.

How about some comunity involvement at the local jail level and some sensitivity training for our jailers. They are people too, most of them.

My old friend Clarence an intelligence Officer who helped plan the Gulf War . . . War and peace don't just happen[they are planned] cracked up after he saw the results of his plans. Went to work after a forced early retirement from the military. Went to work as a corections officer and it pushed him furhter under a rock. The man is a genius and has been crushed by what his service has opened his eyes to. His inability to understand the construction of integrity and Mother Earth . . . the important role we all play in it . . .

I don't judge, just try to live and accept things at face value. Be part of the solution if there is a problem? It isn't easy building a world. . . not for capitalists.

Think nationally if not globally or Universally.

By help of God.
by interested (bluejollyrancher14 [at] yahoo.com)
I'm a senior in high school taking a college course at a local community college. my english class just got done reading an article by Wil S Hylton from Harper's magazine called "Sick on the Inside"..basically the article talks about CMS (correctional medical services) and how NEGLECTFUL they are with prison inmates. it sickened me and appalled me to read that article and everything that was going on to those people who needed treatment for hepatitis. after reading it, I was interested in looking up CMS online..and I've found many law cases of people suing CMS, but have gotten nowhere. CMS is using $550 million of taxpayers money to fund it, but they aren't required to tell where all of this money is going to. Most of it is probably being pocketed! If anybody wants to read the "sick on the inside" article, email me and I'll be more than happy to send you the link to the article. its just sickening how people are treated in prison. Sure..maybe they've done something wrong, and "deserve whats coming to them"..but these people are SICK and need medication just like everybody else.
meagan
by tina
I work in a prison as a registered nurse, and I would like to say I am a great nurse who works in the medical unit, mental health unit, ect. I feel the inmates come in to jail and this is basically their first exposure to medical services. They have medical services(inpatient and outpatient), mental health(Inpatient and outpatient, dental clinics, eye clinics, obgyn doctors, medical doctors, etc. Everybody does the best they can and I have only seen them treated fairly.
by Jeanni
I work in a state correctional facility. I see what our provider (doctors, nurses, specialist, etc.) do every day. They work very hard at getting what the patient needs. It is hard when some can't remember who their doctor was because they only seen him/her one time and had not follow up care or the bounce around from one emergency room to another. I've seen a (roughly) 45 year old woman who didn't know what a pap smear was. I've worked with dentist and they had to in the end pulling almost half of the patients teeth because for the last 20 years they never seen a dentist and the use of some illegal drugs did not help their teeth much less their bodies. I believe the public needs to look hard at where these offenders come from and how they have led their lives. People die on the streets every day and those deaths are not investigated. These prisons are small communities and there will be deaths and imperfections just as there are in the real world. If the real world was perfect we wouldn't what the call malpractice.
by Debbie & Rudy (fogherrera [at] msn.com)
Just remember when you serve the least of these (those who are in prison) you are doing unto God. Please look up to God He will be our judge in the end.
by CT
I was in prison in California, including Chowchilla, VSP and CIW. I spent alot of time going in and out before I finally figured it out....I've turned my life around now. But I still keep in touch w/many of my lifer friends in CA prisons, particularly CIW. I have first hand knowledge of the lack of medical care there, and in the other prisons as well. I almost died at CIW because of a blockage in my small intestines that the esteemed medical staff insisted was hepititus, "because you're a drug addict, it must be hep". It wasn't. Many of my friends write to me about what is STILL going on there, and it's terrible. And for the person who said "don't do the crime" or whatever it was....no one deserves to die like women are dying in CA. You don't have a clue what goes on in there.
by trina p.
i hope articles like this, and the people doing the advocacy work in them, help make posititve changes in prisons and society. and i hope someone sends this article to the big breast cancer fund raising institutions to get some of their money and staff to alleviate this needless and sadistic pain caused women prisoners. and how can the politicians, etc., justify not paying for any medical care [and drug treatment and abuse prevention programs to begin with], when prisons and legal / court and emergency medical care are so much more expensive than preventitive care?!! plus, to give lip service to helping children / families while punishing the mothers is hypocritical and absurd. get a clue, people; stop treating people in povery like they have some kind of moral failing--poverty is not a crime, and it needs to stop being treated like one. lastly, please put the men who make and distribute the drugs, and rape and pimp and beat up the women and children in jail, not their victims!!!
by leviguy (oakstan [at] sc.rr.com)
You obviously don't know what goes on in many womens' prisons. In GA state prisons the women have to pay $5.00 each time they go to sick call. If they don't have the money it is shown as a debit on their account and sucked up if they receive any support from the outside. $5.00 if they need a bandaid, or have pneumonia. Doctors will not prescribe adequate pain medication and will not recognize prescriptions written by contract specialists employed by GDC. The most powerful pain medication they carry is Darvocet. Nurses are insensitive and ignore even complaints of patients with life endangering diseases such as Hepatitis B or C, AIDS, Heart Disease, etc. I correspond with women in GA prisons and am involved with advocacy groups. There is, to be kind, a general lack of concern by and competence of GDC medical personnel in womens' prisons, lack of public support to insist on better medical care, and lack of concerned family members and friends who could go a long way in bringing individual cases to public awareness. Even if staff cared as they should, (as you observe) GDC is mandated only to provide the bare bones minimal medical care.
by a.e. (dokter_jones [at] hotmail.com)
I understand the severity of the problem, as well as the gruesome goings on within these prisons. However, a lot of these problems would be eliminate with money. But who is going to pay for it. Everyone complains about the taxes they pay already, and that is where the money would be derived from, our pockets. If you are so upset about this, help Amnesty Internation out, or organize your own fundraisingm or volunteer medical services if you are able to. Instead of whining, do something about it, act on it, use your skills to help. This needs more than media attention, this problem needs help.
by WB
Nothing has changed since was posted. There are still $5 for any medical visit or even a request for a bandaid. My husband has a disease and Im seeing first hand the battle I have to fight on his behalf to try to get him proper medical care. The facility he is in has had two different doctors in the last year and in the last 3 months no doctor. Two of the medications my husband is on requires weekly blood test in order to adjust the dose. He is given his medications 30 days at a time. So when the 30th day comes there is no doctor to re-issue his drugs. So not only is he not receiving blood test but he often goes without his meds for up to two weeks till they get a doctor over there to review his case. Still no blood test.
An operation was ordered by an outside specialist 2 years ago, it has since been cancelled by the MDOC.
Sometimes my husband looks not too bad, and then the next visit his eyes are bulging and he is covered in sweat. He can easily lose 20lbs in a week. Ive been battling this for a few years now and getting absolutely no where. Why doesnt anyone care. The cuts in the budget for the state of Michigan this year didnt help either and that is why his operation has been cancelled. That is why there is no doctor at his facility anymore. That is why they cancelled the MRI he was suppose to have.
I just hope they know that I have documented everything and if anything happens to my husband, I will make it internation news !!!!!!!!!
I fully suggest that anyone with a loved one in prison who is sick, gets the proper legal forms filled out in order to have full access to your loved ones medical records.
The medical facilities, staff and care are a disgrace in the prisons in America.
It is the law that prisoners have the right to free and reasonable health care.
I read the article, and I do symphathize with the prisoners, who are not getting the right treatment. It is unhumane, and this country we live in should care about their prisoners. I have a GF in the VSPW in Chowchilla, Cal, and i know others there, and I do not want to see this kid of treament, on our prisoners. Can't csomething be done about it. i am a concerned citizen, of the USA. As an older women, i have seen the two facilities built , when I lived in Madera, Cal, and I think men as well as women prisoner's should get better medical treament.
Very Sinverely Lady Char, Schreffler
by Lee
For almost 2 years, I was a nurse at the local jail in upstate New York. I saw firsthand, just how difficult it was to provide adequate healthcare to these individuals who found themselves incarcerated. Although we were usually understaffed, most of us nurses tried our darndest to be the professionals that we were trained to be. Look at people as patients first. I always took their concerns/questions seriously and responded timely with actions appropriate to their medical situation(s). Ultimately, my professional views conflicted with management and I left the facility. I encourage any/all inmates to be peristent with the medical staff if there is a true medical situation. Remember, though, that respect is a two way street. Talk to people the way you want to be talked to. You will find people much more responsive to your request.
by KYGIRL
Thanks for treating people with respect.
I spent 8 months on the medical yard in Chowchilla Womens Prison. Not being sick myself I got a very good view of the importance that prisons put on female medical attention. My take on it was the training of medical professionals lacked. Not only schooling but compassion. When you are an inmate, no matter what your crime may have been you are all treated the same, no compassion,with no understanding, you are lucky if a guard will give you the time or allow you the opportunity to seek help. There are restricted times when you must fill out a sick call card, wait one to three days and sometimes in great pain before the slowly come call you for your quick and almost inhumane exam. Usually getting sent right back to your upper bunk where you were required to in any way shape or form manuveur your sickly,painfull body up there on your own. Thank God for the hand full of guards who actually took concern and care to those suffering and treated them with the dignity and respect we all gave them. Who with a brain in their heads fake pain,and agony only to be prescribed the usual medication of sudifed. If narcotics where being freely given out and the amount of complaining women all of the sudden rose I would question that. To be honest you could get better, stronger and bigger quantities of street drugs right threw the prison mail system more readily.
by J.L. DIXON
I had a family member who was incarcerated at Tutwiler Prison for Women in Alabama. This is THE only prison for women in the whole State and of course, as you can imagine, it is waaaayyyy overcrowded. She told me of a girl that came from the same county jail where she was and this girl had some type of female cancer. This girl found out soon after arriving at the prison that she was, in fact, dying from the cancer so she had to remain in the so called "medical unit". In order to get medication in this prison, women had to stand in what they call a "pill line" and I'm told these lines can be a 100 long and last for hours. With no air conditioning and having a terminal illness, they still made this girl with cancer stand up in this line and wait for her medication instead of just giving it to her in her bed. I was told that the medical ward was of course, within the infirmary and the girl's bed wasn't 10 feet from the medication room. As I'm sure you can guess, this girl got worse as time passed (who wouldn't w/no love or caring), and before long she could not hardly stand at all. But those guards and nurses STILL made her stand up in this "pill line" and wait, sometimes for over an hour, to get her pain medication. She would wimper like a sick little puppy because she was in so much pain and could not take anymore. No one there who had the power to do anything about this, ever did a thing and right up under the very hour she died, they made that poor girl stand in that pill line just to get her medicine. I was told she would get so weak in line that the other inmates would try to help her and were told by the officers guarding over the pill line, "to leave her be, if she wanted her pain medicine, she would have to stand and get it like everyone else". They actually taunted her about her pain medicine, saying she was "just another addict with a good excuse to get narcotics". They were only giving her DARVOCET for her pain and I also found that to be absolutely UNBELIEVABLE. But I did find out that it was a true story because it hurt me so badly inside that I checked. I found out where she is buried and that she did not, in fact, have any outside people who cared one single thing about her. So she had no help and the prison system, in my opinion, used her as an example to show the other women how bad it could be if you have to stay there for a long long time especially if you are sick. MY PRAYER IS THAT NO WOMEN GOES TO PRISON IN ALABAMA ESPECIALLY AND ESPECIALLY NO ONE WHO HAS A TERMINAL ILLNESS. WHEN I THINK ABOUT THIS STORY, IT MAKES ME SO MAD AND SO HURT IN MY HEART BECAUSE EVERYTHING THAT HAPPENED TO THAT POOR GIRL COULD HAVE SO EASILY BEEN AVOIDED. PEOPLE, EVEN IN THE CORRECTIONS SYSTEM, DON'T HAVE TO BE THAT CRUEL......
by Tim McDonald (treeh2o [at] earthlink.net)
In my lifetime of activism (I am 64) I have seen how mainstream women's group ignore the plight of women in prison. Story has it that Sojourner Truth appeared before suffragists in the 1850's and said "Ar'n't I a Women?" She was turned away. Suffragists were out to get the vote and equality for white women not Black women. Nothing has changed today. Groups fighting violence against women ignore rape in prisons and jails. The article mentions "hardly a nod from the flourishing and powerful women's health or breast cancer organizations." The message is clear, goodly women seek protection, health, and votes for their own class but any idea that women, be they suffragists or modern feminists, believe all women equal is nonsense. Since prison women are not equal why does anyone expect us to believe in equality for any woman?
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