that female inmates often report distrust of physicians and disappointment with their interactions with providers. researchers have found that most of the women interviewed in the 2005 california state prison study had negative perceptions of their gynecologic tests and treatment. according to the women interviewed, the prison doctors who performed their tests were often unprofessional and disrespectful. one woman described her experience, saying: "they expect us to give them respect, but they don't respect us. they treat us like we are animals just because we are incarcerated." the california prison system employs corrections officers who are also trained to be licensed nurses (called medical technical assistants). similarly, in chicago, the county jails train corrections officers as doulas and birth attendants. inmates generally must request medical treatment through either these officers, or through other, non-medically trained correctional staff, and studies have shown that female patients' complaints and requests for medical assistance are often not taken as seriously as those of male patients. the simultaneous positions that these officers hold as both security personnel and medical caretakers or advocates may contribute to female inmates' distrust of them. a 1999 study found that female inmates were more likely than their male counterparts to think that their access to health care was inadequate and that their quality of care was low compared to the care male prisoners were given. women in this study also visited the health care facility more often than their male counterparts and reported being healthy less often than men did. issues in correctional reproductive health care lack of resources a lack of resources, specifically of adequate staff, within facilities is largely what contributes to the substandard care of inmates. for example, although california's prison system is the largest in the country, an obstetrician/gynecologist was not hired at the california institution for women (ciw) until pregnant prisoners in california filed a class action lawsuit (harris v. mccarthy) against ciw. the valley state prison for women (vspw), another prison in california, had just two ob/gyn doctors on staff in 2000 (one of whom was indicted on four counts of sexual misconduct and eventually fired). albion, a women's prison in new york state, has 1,000 prisoners, but only one gyn doctor, who works only 16 hours per week. taconic, another facility in new york, which holds about 370 women, has no gyn doctor on site. in these cases, routine gyn care falls to the general nurse practitioner or medical director. in addition to the lack of staff, medical doctors are often not on duty on the weekends and during evening hours. this can be dangerous if medical emergencies arise during non-business hours. for example, a prisoner in ciw in 1997 went into labor over the weekend, when there was only one nurse on duty. the nurse strapped the woman into a gurney, but refused to help with her labor. when the baby was born not breathing, the nurse had to call paramedics, because she was unable to activate the breathing apparatus. by the time the newborn was transported to the hospital, he was declared brain dead. the difficulty with recruiting qualified staff can be attributed to both the physical isolation of women's prisons (often placed in areas that are considered undesirable to live in, where there are few available medical professionals), and to the relative lack of medical resources and low salaries that prisons offer to medical staff. dr. valda chijide, a former hiv doctor in an alabama prison, for instance, resigned from her position due to inadequate support. in this case, the hiv unit was rat-infested, with broken windows covered in plastic. privatization of prison health care there is also a trend towards privatizing health care by hiring outside, for-profit health care companies to provide medical care to inmates. according to a 1996 survey by the national institute of corrections (nic), forty-four state departments of corrections contract out at least some of their medical care to private vendors - in 1996 this amounted to $706 million. this can result in a lack of accountability, as proper monitoring makes a contract more expensive. oversight is often lacking. in alabama, the same official who previously held a high level position at prison health services, one of the nation's largest private vendors, now works in a position within the alabama department of corrections which requires her to oversee prison health's compliance to the contract. prison health services, which has cared for 237,000 inmates, has had to pay millions of dollars in fines and settlements due to inadequate care. in another example, according to a former supervisory nurse of a jail operated by correctional medical services (cms), a large private contractor, the jail would often release pregnant women when they went into labor, and then arrest them again after they gave birth, in order to avoid having to pay for the inmates' medical expenses. lack of accountability also results due to varying state and federal laws on private contractors' liability for medical abuse and neglect. private contractors can be challenged under the same federal civil rights law that applies to state and local governments, but these corporations cannot be sued for unconstitutional medical practices.