Healthcare in California Prisons

Higher level of healthcare for California inmates?

From three weeks to 24 hours to see a doctor, and from months of waiting to just days to see a specialist, California prisons healthcare improved dramatically.

I entered the California Department of Corrections and Rehabilitation (CDCR) in 1995 during a time when the state’s prison population was at 160,000 inmates housed in 33 prisons, way under capacity, with men housed in gymnasiums, makeshift dorms, and triple bunked. If you had a medical issue it might take 3 weeks to see a doctor, so for those with medical emergencies death was a very real outcome. Two federal court decisions – Coleman v. Wilson (mental health case) and Plata v. Brown (prison overcrowding case) – forced sweeping measures to improve the quality of healthcare provided to inmates.

In the Plata case it was noted that statewide, for decades, inmates were employed in the capacity of dental assistants working side by side with a licensed dentist. Imagine that, an inmate in blue with no training or certification whatsoever handing a dentist his tools, assisting with the hose that sucks saliva, and being responsible for sterilizing the instruments after use. It’s uncertain how many inmates may have been infected with Hepatitis C/HIV but this practice ended once officials from the Federal Receivership stepped in to enforce and monitor the new standards. Now, only a certified dental assistant is allowed to assist a dentist, and inmates can only be employed in a janitorial capacity in the dental office.

Up until recently, the CDCR did not have their prisons networked to a central computer system, and inmates’ medical files consisted of papers inside folders, where papers got lost or misplaced creating havoc with pharmacy prescription and referrals to specialists. This resulted in numerous tragedies when inmates could not get their medications on time (blood pressure, diabetes, heart meds) or see a specialist in time to start cancer treatments. Now this problem has been rectified; each prison doctor is networked into a central computer system, which contains every inmate’s medical file and can accommodate his needs faster; meds are sent to the inmate the same day and referrals to specialists are done in a timely manner.

Another recent change addresses the concern regarding correctional officers being allowed to work one shift as a prison guard and another as an MTA (Medical Trained Assistant), helping out with inmates’ medical issues and being the first person an inmate talks to before he could see a doctor, or being the first medical staff to report a medical emergency. This proved to be a serious conflict of interest, where if a guard did not like a certain inmate he could be biased and not forward a referral to see a doctor. This practice ended. Inmates now see a certified licensed RN within 24 hours of the request, and see a doctor within 48 hours for something serious (or a week for non-serious issues). Guards can only work in a security capacity, overseeing inmates.

I empathize for the daily routine of prison doctors who must make judgments on whether an inmate is faking an illness or really has an issue. Sometimes inmates complain for a variety of selfish interests. For example, an indigent inmate may complain he has a rash, which he creates himself with the intent of getting free lotions, athlete’s feet cream, or shampoo that he can later sell to another inmate. Another may complain of severe back pain, so he can get a bottom bunk and/or obtain powerful narcotic pain medications like Oxycodone or Morphine to either consume to get high or sell to other inmates for a couple of bucks a pill. 3 pills a day is $6 – not a bad prison hustle.

There are also inmates who just want attention and put in requests to see a nurse or doctor just to have someone hear them out, complaining of symptoms ultimately determined not to exits. In some cases they are eventually referred to the prison psychologist for mental health evaluation. The Coleman case addresses prisoners’ mental health. While there is a better system to identify and help mentally ill inmates, there are not enough psychologists on staff, so most cases are taken on by social workers / case managers who do not have an MD or PhD degree. As a result, many inmates are put on psychotropic medications instead of one on one or group therapy with a specialist – just not enough staff available.

I’ll close with my most recent medical experience. For years, I’ve had a belly button hernia, which started off like a dime size balloon that stuck out. Recently, I started feeling discomfort and pain, as my hernia has grown to about the size of a quarter, so I asked for medical assistance. The RN referred me to a doctor and he saw me in less than 24 hours. He determined my hernia has gotten worse and placed me on a lower bunk cell, to avoid further tearing. He also issued me an abdominal belt to use for heavy lifting, and stool softeners to use the bathroom easier.

I’m impressed, accommodated all within a 5 days period and pain has gone away. But all those are just preventive measures to avoid the obvious “medical necessity” which is surgery to fix this hernia before it gets worse. The CDCD does not approve hernia surgeries until a situation gets really bad, or a medical emergency occurs (bursting of the hernia). I feel hopeless as I see some guys around here lugging around a melon size hernia; others have experienced strangulation by the time they got into surgery, eventually losing a testicle. It seems mind-boggling that a state prisoner can request and actually be approved, as a “medical necessity”, for a transgender surgery that costs over $100,000, yet, an inmate with a hernia can’t get a surgery that may cost about $5,000.

Maybe not everything has changed at CDCR just yet, but I feel in the 20+ years I’ve been in prison, they have come a long way.

Written by anonymous while doing time in California.