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Let Them Suffer: Health Care Reform And The Prison Industry

April 22, 2010

By Stephanie Jones

Healthcare reform cost, coverage and who “deserves” healthcare has been a heated debate in our country for the past several months.  Some groups are thrilled by the progress made through the recently signed bill, others devastated that we’re moving a little too close to “socialism” for their comfort.  The real question is “who pays” – that’s really what the debate is all about. Many don’t want to carry the burden for those deemed “undeserving” of medical care.

Who gets left out in this debate?  Those incarcerated individuals who are lost, forgotten and left out of ALL political debates and movements.

This past Sunday my husband, Derrick, went to the “hospital” where he is incarcerated at Clallam Bay Corrections Center.  The nurse was examining him and he started asking questions.  Questions such as, could he possibly finally have surgery for those bullets that have been left in him for years and are now starting to shift. She immediately shunned him – until he told her that it was possible to add him to my insurance policy “on the streets”. She quickly responded “Well in that case, I can look for and do more.”  He experienced first hand how the level of insurance influenced the level of care received.  The level of care he – and others who are incarcerated – have experienced has been life threatening at worst and mediocre at best.

Below is special report done by the Seattle Post Intelligencer documenting problems at McNeil Island Corrections Center from 1997 – 2001. These are just a small example from one institution and only for a few years.

Reports and investigations indicating problems at McNeil Island Correctional Center:
  • August 1997– State Health Department Investigation: Investigator found poor training and faulty medical equipment caused severe bleeding of one inmate receiving antibiotics through an IV.
  • August 1997 – Health Department Survey: Found Inadequate training, poor patient record keeping; outdated medical supplies; lack of treatment policies to guide staff .
  • October 1997 – At state’s request, a UW doctor studies McNeil health services: Found unprofessional and inefficient discord among staff for at least two years. Also, nursing medication errors, and physician’s assistants work with too little supervision.
  • December 1998 – Memo from McNeil Nurse Carol Hoke, subject: The clinic can’t meet its own standards for minimal staffing. Says nurses are being forced to take shortcuts. “This scares me, it is extremely unsafe.”
  • May 1998– Health Department Survey: Failure to provide staff with policies for care; outdated supplies and inadequately maintained equipment; poor record keeping; failure to meet standards for infection control. The inspector added, “There was evidence of many widespread systems problems.” They included: frequent incidents of multiple dosing, delays of medication administration of two to four days.
  • April 1998 – Grievance from Teamster’s Union: Due to poor management and lack of staffing, the infirmary is “a ticking time bomb.” Says it is “a dangerous place to work for staff and a dangerous place for inmates.”
  • March 1999 – Memo from Hoke to her supervisors, subject: “Frustration”: Lack of staffing and of “ridiculous” working conditions. “All of us are about at wits end at being pushed past our max.”
  • March 1999 – Philip Montgomery arrives at McNeil Island prison.
  • April 1999 – Health Department Survey: Infirmary closed down after a 46-page report listed dozens of deficiencies, many of them repeats. It said that McNeil lacked adequate staff, proper training and verification of clinician licensure. Also, it failed to document medications or lab tests, perform infection control, provide staff with standing orders and maintain working equipment.
  • May 1999 – DOC internal memo: DOC’s written plans to correct problems identified in the 1997 and 1998 were either insufficient or never actually implemented. Also, significant staffing shortfalls lead to ‘skeleton crews’ and failure to comply with nursing standards.
  • September 7, 1999 – Philip Montgomery dies.
  • December 17, 1999 – Investigation into cardiac emergency finds failure to keep accurate staffing and patient records, inadequate training, inadequately maintained equipment and failure to abide by agreement to keep the infirmary closed.
  • April 2000 – Health Department Survey: Findings include inaccurate medical records; lack of training and verification of clinician licensure; inadequate infection control; and failure to ensure a policy on emergency care.
  • March 2001 – Philip Montgomery’s family files wrongful death lawsuit
  • April 2001 – Health Department Survey: Findings include failings to keep adequate patient health records, provide staff with care policies, monitor medications, and provide infection control.

In the five years prior to 2002, the State paid over $1.2 million in settlements and judgments to families and victims of negligent healthcare that lead to death and other disabilities – all caused by lack of adequate staffing, equipment and training in our prison system. Who do you think pays for that?  Taxpayers.

The average income from a prison job is right around $55 per month. Out of that, the prison automatically takes 20% for different “taxes” and fees.  That’s $11 leaving a balance of $44.  If the individual owes child support, it’s taken from that. The average person pays about $25 per month in support. That leaves $19.  The “co-pay” to see the nurse at sick call is $2.  Seems cheap doesn’t it?  But, take into consideration the percentage of one’s income.  It’s about 11% of the individuals “take home” pay. Imagine if you had to pay about 11% of your take home pay EVERY time you got to see a nurse who was overworked, undertrained, lacked the proper equipment, or had the capacity to make a decision about your care.  And according to EVERY investigation done by the state Department of Health Services, lacks the verified licensure to even be doing the job!!! That’s right. Every prison has more than once been found to not have even verified the licensure status of their medical staff.

Let’s examine that.  The nurse that the incarcerated individual sees doesn’t have the capacity to make the decisions regarding care beyond the basics. If the person needs more than an aspirin, that care has to go through a chain of command to get approved – which may take weeks or days.  And will most likely end in denial which then has to be appealed, leading to more weeks of waiting to get care.

The absolute outrageous nature of medical neglect and the failures to put adequate, reasonable, preventative measures in place hasn’t gone undocumented.  In a 2002 report to evaluate Washington prisons, the findings (which excluded Stafford Creek and Clallam Bay) outlined it in black and white:

EVERY single prison surveyed failed to meet infection control.

EVERY single prison failed to prepare care policies.

There are no policies and there are controls for infection – – and we think they’re getting care?

My colleague pointed out earlier today that in the documentary Sicko Michael Moore made the statement that the incarcerated are getting better care than “9/11 heroes.”  (Insert swear word here.) That’s media hype to perpetuate the myth that men and women are enjoying a holiday in prison.  Three meals a day and all the healthcare one could imagine.  (The meals will be addressed at a later time – that’s a whole other story.)

What does all this mean for you?

Why should you care?

As a taxpayer, you’re paying.

As the wife of an incarcerated person, it costs me plenty.  The prison keeps half of every dollar I send in.

So that Tylenol that costs him $4 to get ($2 for 2 pills plus a $2 co pay – you have to see a nurse to get it. There’ no “over the counter” medicine available) costs me $8. For $8 you and I could drive to the local Costco and get a bottle of 500 that would last us for several months. My husband gets two pills which at 6’2” and over 200 pounds doesn’t do a damn thing for his headache.   I know, I know, I hear you saying what everyone says “You chose to get involved with a guy who’s locked up.” Yep, I did and that’s why you will never once hear me complain – I knew what I was doing.  And I know what I’m advocating for, not just for my husband, but for all incarcerated peoples, is a human right.

But you should complain. And loudly.

Do you want to keep paying millions in tax dollars in restitution for those people who die, or are gravely harmed, by the lack of care in prisons?  You should insist that the care be equal to that available on the streets. You should insist that qualified and license medical staff have policies in place and procedures that lead to healing rather than harming. It’ll save you thousands in the long run.

You should also be asking why there aren’t reports after 2002 readily available via public access.

Could it possibly be because no improvements have been made?

3 Comments leave one →
  1. Hennings permalink
    April 23, 2010 3:55 pm

    this is a very accurate account. we are with washington DOC as well and it isn’t a free ride. i wish tax payers would acknowledge that. sure, you want anyone in prison to suffer over and over…but ya know what? Judges punish…the punishemnt has been meted out. the CO’s think they get to punish as well. the public wants them all to suffer. it isn’t up to you to continue punishing. it is up to you to educate yourself and others about the cost of lack of care as well as paying for young people with life without sentences on non violent crimes…they get old, just like you do and it costs money! figure it out and we will all be better for it. maybe then you will join us in our fight…

  2. Jim Nelson permalink
    April 24, 2010 10:03 pm

    While I sympathize with the thesis of your argument, a couple things: Prison health care is vastly superior to “street level” health care, as you put it. You’re in Seattle, look into the Pike Place Medical Clinic. When their mostly uninsured clientele are lucky enough to get an appointment, the care is quick and lean, and medication is doled out very sparingly, if at all. Prison health care, however, is comprehensive, even excellent. The system is widely known for diagnosing and treating illnesses and conditions inmates had been unaware of, often for years. Among most inmates and their families, health care is the best thing about prison. In fact, the California CDC houses hundreds, even thousands of inmates who intentionally became incarcerated so that serious illnesses like cancer could be treated. Finally, $1.2 million in settlements over five years is in fact a very low number. On the other hand, I agree one-thousand percent with your outrage over the cost of OTC medications to prisoners … that plus the gouging for inmate phone services which are monopolized by the highest paying (to the state) provider … all this is nothing more than legalized piracy.

  3. James Harkness permalink
    July 3, 2012 3:59 pm

    You have to take Hoke’s “memo” with the grain of salt. This nurse worked in ICU for years before working at McNeil yet she was unable to ascertain the seriousness of one inmate’s situation. After he died, her excuse was that she “hadn’t been trained” to recognize his symptoms. What a load of baloney!

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