Prison Health Care

The horrible reality of a failing system.

Prison doctors are almost always in a hurry to shove medical files out, like a factory worker on a conveyor line. They are also skeptical of every inmate, on the defensive, to keep inmates from pulling a con on the prison health care system, manipulating them out of lotion, shampoo, or other precious items. It’s difficult for a prison doctor to know which inmate really has a medical problem.

About twenty years ago I recalled watching a movie called “Doing Life” with Tony Danza. The humorous flick was about a prisoner’s experience serving time, touching on subjects like the arbitrary decisions made by parole boards, or the horror of seeing a prison doctor. I thought it was hilarious when a prisoner in the movie had his right leg amputated from complications caused by diabetes only to discover the prison doctor removed the wrong leg. Such “deliberate indifference” had to be fictional—or, so I thought.

I’m aware that the average American tax-paying citizen may not have affordable health care (or any health care) because of HMOs’ and insurance companies’ small print. However, any health care, even at the county hospital, beats the quality of prison health care provided to inmates housed by the California Department of Corrections. Inmates by law have a constitutional right to health care, but is it effective? In a recent ruling, a federal judge didn’t think so, ordering a federal takeover of the broken prison medical system statewide. It remains to be seen if anything will change.

“Damn Holmes, I’ve got a sharp pain in my stomach,” complained inmate Guzman to his homie nicknamed Smiley.
“Watcha homie, you’re probably constipated. Put in a request for sick call so you can get Metamucil. That shit will clean you out,” said Smiley.

Inmate Guzman, a 61 year old Mexican American, was very healthy and in shape. He exercised every day. Doing time, not facing the everyday stress of free society, preserved him.
Like the majority of inmates who face a sudden medical problem, Guzman did not seek help from the prison medical department. Stories circulate among prisoners about the hassle to see a doctor and what could happen if a problem is diagnosed. A doctor who left a Frankenstein-style scar on an inmate’s face after removing a small cancerous mole.
A “doctor” who had been prescribing medication to inmates without a California medical license. He had lost his license in another state for serious misconduct. Many inmates died under his care as a result of receiving the wrong medication, or the wrong dosage.

An inmate who died after filing an administrative grievance (Form 602) against a doctor who refused to order removal of a testicle with a tumor that had grown to the size of a cantaloupe. By the time the 602 appeal was answered, the inmate was dead.

For a time, inmate Guzman refused to seek out immediate medical care. When he did finally seek help, it was too late. He was diagnosed with stomach cancer and had lost 60 pounds. He had about four weeks to live. Prison doctors said there was nothing they could do.

“Damn man, I’m a three-striker, serving life for a petty theft. My last wish before I die is to get some pussy, but it ain’t going to happen,” he said to me with desperation.
I felt sorry for him. That would probably be any man’s last wish. He died in three weeks. I was in the infirmary the day he passed away, observing him through a small window, as he lay alone on a hospital bed, in a room designed for one person. He was left to die, like an animal. Drugged up on heavy morphine. He had lost all control of his bowel movements entirely, was wearing a diaper, fed through IVs. He had the face of death. The once-muscular man was reduced to bones; cancer had eaten all his flesh. He was talking to himself while his eyeballs rolled around like a madman. I envisioned the grim reaper above him, ready to snatch what little life remained. There was no hospice program. No chaplain or priest to pray with him. None of his family was there by his side. He did not die with dignity.

The Correctional Training Facility in Soledad, California, houses more than 7,000 Inmates. It was designed to house just over 3,000. As a result of serious overcrowding, it can take up to three weeks to see a prison doctor after an inmate signs up for sick call, and has described his problem to a nurse. The inmate will then receive a special permission slip, called a ducat, to show up at the infirmary. He will wait hours, maybe even all day, in a holding cage, until called to see a doctor.
When an inmate is called, the doctor asks the same question to “screen” the inmate. “How much time do you have left?”

Doctors ask this because inmates with less than 2, 3 years left on their sentences will likely be denied any major medical care. The reasoning is that the inmate can take care of the problem when he gets out. Doctors are also working with a limited budget so they have to conserve resources. If the inmate is serving life or a long sentence and is diagnosed with a major medical problem, the doctor will then state: “You are being put on the list to see the specialist.”

Prisons’ contracts with outside specialists range from orthopedists, urologists, to cardiologists and optometrists. Waiting lists to see the specialist can take up to one year or longer. It’s common that, after one year passes, an inmate is never even placed on the waiting list because of human error or oversight as a result of chaotic records-keeping. Nothing is computerized, and the records staff is flooded daily with paperwork and inmates’ files.

Ultimately, the most a prisoner will get from the first doctor visit will be a prescription for aspirin, a laxative, a generic alternative to Prilosec (for any complaints of stomach pain heartburn, chest pain), or told he is on the list to see a specialist. Usually, seven out of ten doctors are extremely narcissistic know-it-alls, who don’t take the time to listen to inmates’ problems. They make quick assumptions and judgments based on the inmates’ demeanor or personality, rather than focusing on the medical problem presented.
Inmates are not assigned a specific doctor, so it’s like playing Russian roulette. You hope that you get a fair doctor, not an asshole.

One day while showering, I felt a lump on my right testicle. I decided to get it checked out. Three weeks later, I was ducated to the clinic at 8:30 a.m. and sat inside a holding cage with about 30 other inmates. The holding cage is like a large dog kennel, a rectangular chain link fence. To pass time, I turned to the elderly man next to me, a 70 something Hispanic, who uses a cane to support himself.
“Hey, what are you here for?” I asked.
“I can’t piss, swollen prostate,” he replied in his heavy Cuban accent.

I sympathized with the old man, listening to his ordeal. Having to piss every 30 minutes, not being able to keep a cell partner due to getting up at night constantly to pee, he now used an empty Folgers coffee jar every night to avoid waking up his cellmate. He was on the list to see a specialist. Had been for nine months.

Like an author doing research for a book, I listened to many inmates’ stories in the holding cage, listened to their complaints about medical staff. I began to feel fear, as inmate Guzman did. Finally, at 2:30 p.m., I was called to talk to a female medical technical assistant (MTA) before seeing the doctor. A half decent looking 20 something Filipino woman asked:
“So what’s your problem?” I felt embarrassed.
“Uh, I feel a growth in my right testicle.”
“Okay, what else bother you?” she continued in a monotone voice, like the one you hear at the drive-thru speaker at a fast-food joint.
“Uh, I got toenail fungus.”
“Okay, what else?”
“Uh, I need to got a blood test to check for HIV or Hepatitis C.”
“What else?”
“I need to see the optometrist to get a new eye glasses prescription.”
“Okay, is that all?” she said, as if she had just finished taking my order.
She wrote every thing down in my medical file, then took my blood pressure, measured my weight on a scale, then said: “Go over there to the holding cage, Mr. Smith. Doctor will see you soon.”

I went back to the holding cage. A Black inmate was venting frustration to a crowd of others, while using a paper as a fan to cool off, like women do in a Baptist Church.
“That motha fucka denied me back surgery. The CAT scan MRI test came back negative. I gots to 602 him.”
“You a fool to believe a 602 will get you anywhere. You got to take it to the feds, file a lawsuit on his ass,” argued an old-time African American convict named Slim, a legendary, notorious pimp in his younger days.
“You niggas got it all wrong. You need to fall out, homie. Fall to the ground, on your back. They gots to give you immediate medical attention. You tell them you slipped on the crack on the sidewalk. They thinking you will sue. You will see a different specialists, fo’ sho,” exclaimed the young black man, who looked like a hustler.

Some of the dialog I heard was great material for a sitcom. Everyone in that cage couldn’t help but laugh. Minutes later, it was my turn.
“Mr. Smith, the doctor will see you,” said the 50 something white woman, who looked like she was a hippie back in the day.
I walked down the hall slowly, peeping into every room I passed, as if I was in the “House of Horrors” ride at a carnival, each room a torture chamber. I finally arrived at the right room.
“Mr. Smith, have a seat. Good afternoon, my name is Dr. Azadeh. Tell me, how much time do you have left?” asked the elderly Iranian doctor with a thick Persian accent.
“I’m doing life,” I said in a serious manner.
“I don’t believe you. You don’t look like career criminal or murderer. Let me see your file…Hmmm…Okay…What can I do for you?”
“I feel a lump in my right testicle.”
“Okay, take off your pants. Let me see…” Dr. Azadeh put on his latex gloves and started to feel both testicles.
“I don’t feel anything unusual. Many men come in here with the same complaint. You men have plenty of time to play with yourself, you feel things that aren’t there. You are okay, what else is wrong?”
“Uh, I got a toenail fungus, probably got it from showering with so many inmates.”
“Let me see, take off your socks and shoes. Oh yes, I see the fungus. Unfortunately, we don’t give out topical creams anymore. I recommend you urinate on your foot. Urine is very strong. Also, take off your socks when you go to sleep. Anything else?”
“I’d like to get an HIV and Hepatitis C blood test.”
“Why, are you homosexual, do you use drugs?”
“No, but I live with hundreds of inmates. I just want to be sure.”
“You can’t get either unless you have anal sex or use a syringe. If you aren’t doing either, you have nothing to worry about. But I will put you on the list to see the lab anyways.”
“Oh, I also need to see the optometrist to get a new prescription.”
“Okay, I will write down here to put you on the list to see the specialist. Mr. Smith, you are a young healthy man, only come to see us if you have serious medical problem, okay?”

I was rushed out quickly, and another inmate was just walking in. I went back to the holding cage where I awaited the officer to call my name so I could leave the clinic. The inmate who just went in to see Dr. Azadeh returned, pissed off.
“What idiots! They can’t find my medical file.” This 40 something White inmate, who looked like an accountant, showed a side of him which normally wouldn’t come out.
“Fuck, I’ve been here all day since 8 a.m.”

Four weeks later, I received a ducat for the lab. They took vials of my blood. One year later, I was still never called for the follow up results. This is common due to medical staff doing everything by hand, not by computer. Paperwork gets lost. Everything is disorganized. Eighteen months later, I was called to see the optometrist. I received my new prescription and am now sporting new eyeglasses. At present, I still have a toenail fungus. Pissing on my right foot didn’t help. I still feel a lump in my right testicle. Maybe I am playing with myself too much. I’ve got a toothache, but I’m afraid to see the dentist. Rumors say 70 percent of inmates are infected with Hepatitis C and I heard that the dentists don’t properly sterilize the medical instruments after each inmate.

The old Cuban with the prostate problem died of prostate cancer. He didn’t make it to see the specialist. He received early parole in a body bag.

Written by anonymous while doing time in California.