Sunday, May 2, 2010

Prisons lacking proper care - by Judge Jim Gray

During my time as a trial court judge, I heard many disturbing stories about substandard medical treatment being given to the inmates in our prison system, and recently the federal courts have begun threatening to take action about the situation.

So in an effort to educate myself, I asked Earl Fuller, a good friend of mine and a retired medical doctor who had volunteered to provide medical services in the women’s prison at Chowchilla, if he would share with me some observations about his experiences while he was there.

He agreed to do so, and I am passing his comments along to you as indications about some of the conditions that existed in 1996 that the federal courts would probably have been hearing about.

Why do they care, or why do we? Because one of the responsibilities of a just and moral society is to protect and take care of everyone who is in our custody, whether they be Charles Manson or Jack the Ripper.

The following is a paraphrasing of Fuller’s comments.

You asked me to write about some of my experiences as a prison physician. I retired as a practicing obstetrician and gynecologist after 32 years in Fullerton.

My first position was at the California Women’s Prison in Chowchilla, Calif., and I was there in the spring or early summer of 1996 as a relief physician who took over for regular doctors on leave.

My first assignment was to a “yard” that housed several barracks of inmates. The women were not allowed to have prescription drugs in their possession, so they were dispensed by guards in the morning, noon and evening. Nevertheless, a certain amount of illegal drugs was always available. The inmates also made a horrible home brew called “prunella,” which caused some drunkenness after fermentation.

I was faced with a medical potpourri that was fascinating and would have supplied any medical school with more pathology than the students ever could have handled.

For example, I would see at least four patients a day with hepatitis A, B and C. Generally when a person has all three viruses it is as a result of unclean needles from injecting drugs.

There would also usually be at least four women with syphilis, two women with treated tuberculosis, and large numbers with diabetes, hypertension and arthritis.

Throughout my time there, it was my experience that the prison system’s main financial goal was to house these women as inexpensively as possible. Of course, medicine could be an irritating demand on the budget, so almost any request that could be safely denied was.

I also remember an inmate who requested long socks. She was a rather large woman and was fitted with leather high-top shoes because they were the only ones that fit her.

Unfortunately, the supply room only had short socks that would not come to the tops of her shoes, so her ankles had been rubbed raw and were bleeding from contact with the leather.

She cut the short socks to cover her ankles, but then her uncovered instep rubbed so much that it also became raw. I made four requests for appropriate socks, but they were never granted by the time I left.

Another deeply disturbing expense-saving idea I encountered was not to treat hepatitis until the liver enzymes began to rise, suggesting that the entire liver was beginning to fail.

The liver is a wonderful organ that keeps on functioning until it is almost destroyed.

So when the enzymes are rising because of hepatitis, there is probably less than 10% of the liver remaining.

When faced with the first signs of liver failure, I began treatment immediately. Unfortunately treatment is expensive, as uncomfortable as chemotherapy, and time consuming for the nursing staff.

This made me unpopular with the staff, but medically it was necessary to save as much of the liver as possible or a liver transplant would be the only option.

During my second month, I was moved to do admitting histories and physicals on new inmates. I couldn’t do much but diagnose in this position, because treatment was left to the other physicians. But I do remember talking with a woman who was sent back to prison for violating parole. She said she was riding in a car with her boyfriend when the police stopped them and found a half-smoked marijuana cigarette on the floor in the back seat.

That resulted in her parole being revoked and her being placed back in prison.

Maybe she lied to me, but if not we are paying $35,000 a year to keep her there.

Finally, I can tell you that significant numbers of inmates are in custody for drug problems. But during my entire time working in the prisons, I do not remember seeing any drug treatment, counseling or classes to help the addicts.

We seem only to be punishing them to nobody’s advantage, which is terribly expensive for the taxpayers, and everybody else.

Those are some of Fuller’s comments. So let me ask you. If you or people you hold dear were in prison with untreated failing livers, or feet being rubbed raw for lack of higher socks, how would you feel? What would you do?

Next week we will talk about this issue some more.



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Anonymous said...

Thank you for this post, your Honor.

Having worked at Corcoran II in its SATF yard as a Clinical Coordinator, I am relieved that at least one judge is aware of this medical atrocity that reigns within the prison system.

I for one, had to assign A days, meaning days of absence instead of pursuing medical treatment for inmates assigned to my building in light of the glaring medical signs that the man was ghastly ill. Even after going through my chain of command plus the ranks in the prison's administration, one inmate served 6 months above and beyond his sentence due to the A days I had to give him because I didn't have enough authority to say the man was ill. The inmates alternated their own personal time to take care of his acute medical needs. The man would lose his bowels anytime day or night. Time or activities had nothing to do with it. It could very well have been IBS, however, my credentials didn't include the capacity of a medical doctor. I felt so badly yet my hands were tied. I had done all that I knew to do and to no avail. At that, I had overstepped my concern according to my supervisors.

The inmate understood when I shared my findings however I felt useless although I was accountable and responsible for 62 inmates out of a 710 capacity yard.

Ultimately, the inmate graduated plus lost over 75 pounds before he fulfilled his sentence which included the A days. The judge he stood before had ordered him to serve was 6 mos. He served 14 mos before he graduated to a half way house.

I no longer work at SATF. I retired in 2002 due to medical issues.

As always I remain,
Mary Ann

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