Amnesty Magazine
Hidden Hell: Women in Prison
Medical neglect imperils the health—and sometimes the very lives—of women doing time. A growing trend toward privatization of prison medical services fuels the problem.
BY LEAH THAYER
Leah Thayer is a Washington, D.C.-based freelance writer specializing in health and business. She previously wrote about women prisoners for The Women’s Health Activist.
Too little, too late would be a charitable description of the medical care in the three Missouri women’s prisons where Sister Fran Buschell ministers. The nun from Jefferson City has seen prisoners wait months for mammograms or biopsies after reporting breast lumps, months longer for results, and even longer for treatment. To receive medication, women must sometimes stand in line for hours. Women with hepatitis C must “jump through the hoops” of an onerous protocol to receive Interferon, she says. Ignored infections have led to gangrene and amputation; ignored meningitis to blindness; ignored headaches to brain aneurysm and death. In one particularly egregious case, a prisoner complained of chest pains for two weeks. Buschell says the prison “took her off her heart meds and gave her an antacid. She had a massive heart attack and died.” So pervasive is the reliance on over-the-counter palliatives that “there’s a joke going around” the state prison system, says Buschell: “Tylenol or Maalox?”
Stories like these are rife in U.S. prisons and jails, which now hold an estimated 181,000 women—up 750 percent since 1980. That year, not coincidentally, also marks the beginning of the prison privatization trend and the rise of colossal for-profit prison contractors such as Correctional Medical Services (CMS), which administers medical care in the three prisons where Buschell ministers. Other private contractors include Prison Health Services, Corrections Corporation of America (CCA), and the Global Expertise in Outsourcing Group (formerly Wackenhut Corrections Corporation)—with combined revenues well into the billions in 2003. The result has been the corporatization of every aspect of the prison industry, a trend that has fueled what prisoner advocates say is an epidemic of preventable illness, unnecessary suffering and premature death among women prisoners. By 2000, 34 states had some privatized health care for inmates, according to the Washington Policy Center, a conservative think tank in Seattle.
“Just because a woman has been deprived of her liberty does not mean she can be humiliated, abused, or treated inhumanely,” says a 1999 Amnesty International report on the human rights of women prisoners. “Prisoners have just as much right as everyone else to be treated humanely. But in the USA, women are often the victims of prison regimes whose practices flout human dignity and international human rights standards.”
Locked up for crimes typically related to poverty, addiction, or prolonged abuse by men, women prisoners are disproportionately unhealthy to begin with. They have higher rates of HIV infection than all prisoners, who are collectively five times more likely to have AIDS than the general U.S. population. As many as 60 percent are infected with the hepatitis C virus. In defense of prison health providers, CMS spokesman Ken Fields says treating them is no simple matter, as incarceration is often “the first regular access prisoners have had to health care.”
Incarceration, however, can “increase the risk of infection, sexual assault, and improper medical care, or contribute to post-traumatic stress, disorder,” according to the American Journal of Public Health. This statement transcends public and privately run facilities alike. Rape of women prisoners is rampant and often occurs with impunity. As many as one in four women has been raped in some facilities, according to the national organization Stop Prisoner Rape. Male prison employees routinely abuse their authority by exchanging “privileges”—such as food, basic hygiene products, or time with visiting family—for sex. Prisoner advocates report of prison employees that medicate and/or operate on women without informing them of their diagnosis or asking their consent. Women prisoners have undergone surgery, given birth, and even died while shackled to their beds. Pain management is often nonexistent because prison officials tend to believe women want the drugs to feed their addictions. When prisoners do get their medications, they often get the wrong dosage or the wrong medication entirely.
Moreover, because the prison health system is modeled on men’s needs, medical attention in women’s prisons is inadequate, indifferent, or incompetent. Gynecological care is “treated as a specialty service” and is thus “the first to go if there’s a financial problem,” says Cynthia Chandler, co-founder of Justice Now, an Oakland-based group that provides legal services to women prisoners throughout California. Women prisoners also have more and different mental health needs, often stemming from verbal, physical, or sexual abuse they have experienced. But this “is often forgotten in a correctional setting,” notes Kara Gotsch, public policy coordinator for the ACLU’s national prison project. “This is fundamental when you’re treating people; you need to understand the population.”
Clearly, it’s not that public prisons deliver sterling health care. “Quite frankly, there’s abuse in both” public and private systems, says Gotsch. “We have such a high incarceration rate, and it’s impossible for states that are so financially strapped to provide decent health care.”
But introduce the profit motive, and these challenges are exacerbated. Incarcerated women “are among the least favored people in society,” says Si Kahn, executive director of Grassroots Leadership, a community-organizing effort that resists prison privatization in the South. “Almost no one cares about a woman in prison,” so women’s health care is “not something to which the government gives large amounts of money to start with. It’s not like there’s a lot of fat to be cut.” And yet for a private company to get a prison health contract, “you’re going to have to offer to do it for less money” than the government would charge, while also keeping shareholders and top executives happy. The chief executive of CCA, the nation’s largest owner and operator of privatized prisons, made more than $1 million in 2003, not counting stock awards, according to the company’s annual report.
Lobbying, advertising, and political donations consume much of what remains. A 1996 audit by the Texas Department of Corrections found that prison contractors routinely skim taxpayer dollars to pay lobbyists and support industry-friendly politicians. The Institute on Money in State Politics reported that in the 2000 election, the private prison industry gave 830 candidates a total of $1.12 million. Even in California, where the powerful state prison guards union has kept privatization to a minimum, the industry is gaining ground. Shortly after taking office last fall, Governor Arnold Schwarzenegger accepted $58,000 from Wackenhut Corrections Corporation after rebuffing contributions from the state guards union.
Where does the money to do all these things come from, Kahn asks rhetorically. “It comes from cutting everything else.”
The impact of these tradeoffs is borne out in everyday prison life under privatization. Prison jobs are rarely easy, but there’s a lot to be said for working for the government, observes Kahn: job security, opportunities for advancement, health insurance, and a pension plan. “In a private prison, that by and large doesn’t exist.” Spending on guard training and salary are both 39 percent below those of guards in public prisons, according to The Corrections Yearbook for 2000. Annual turnover is high: 52 percent for guards in private prisons, compared to 16 percent in public prisons. As for medical staff, even those who are well trained and compassionate (and many are, according to those interviewed for this article) can’t compensate for understaffing or undo the damage done by incompetent colleagues. An investigation by a former editor of the Journal of the American Medical Association found that one in four doctors working for CMS in Missouri had been disciplined by licensing boards. The disciplinary rate of all physicians nationally is one in 40.
CMS spokesperson Fields defends the company’s staffing policies by pointing out the “nationwide nursing shortage that is affecting every element of health care.” Because state and local governments need to “focus on the security of the facility as their number-one priority,” he says, they often have a difficult time recruiting and retaining prison health care professionals who understand “the complex nature of medical conditions” among inmates.
Care delivery is the biggest casualty of privatization. CMS provided health services at 10 of South Carolina’s prison facilities between 1986 and 2000, and one registered nurse and regional manager (her name is being withheld) recalls her work on the medical team that audits nursing care. In the early years of the contract, she says, CMS “would try to transfer their sickest patients to a state facility” to avoid incurring the costs of caring for them. Once the state caught on, the company “simply wouldn’t take care of these patients, or would delay treatment as long as they could,” often by “losing” prisoners’ medical referrals, the nurse says.
Fields denies these allegations and refers to “a number of improvements” resulting from the partnership between CMS and South Carolina. In any case, that partnership ended in 2000, when CMS terminated its contract because of state monitoring that was “excessive and disruptive” and because of disputes involving payment and services.
Other private companies have equally disputed records. The Associated Press reported that Prison Health Services is defending itself against more than 1,000 lawsuits. In June, the board overseeing Nevada’s prison system voted to take over a privately run women’s prison from CCA. One of many reasons cited: DNA testing on a pregnant inmate showed that a guard was the father. In addition, women prisoners have alleged rape and similar abuses against other private prison contractors.
Even publicly run prisons bear a heavy stamp of corporate influence. Just about every state provides prisoners as a cheap labor source for companies producing items as disparate as chemicals, clothing, mattresses, and picnic tables. The “lump sum” that companies pay for prisoners is tantamount to slavery, according to Chandler. In California, for instance, nearly all prisoners work for seven to 13 cents an hour on average. Refusing to work can prolong a sentence or result in lost privileges, regardless of health status. In another example of the infiltration of for-profit business models, California prisoners must make $5 medical co-payments. That’s 50 hours of labor if you’re making 10 cents an hour—a powerful deterrent to getting any medical attention at all. Ironically, the state auditor found it costs California more to enforce the co-pay system than the system brings in.
Earlier this year, when South Carolina announced plans to resume privatization of prison health care services, the state met a response that anti-privatization forces hope may foretell a slowdown of the prison industrial complex. Memories of employment with CMS still fresh in their minds, “all of the health care workers” within the state-run prison system—nurses, doctors, dentists, pharmacists, and lab technicians—“bombarded” elected officials with demands to keep for-profit companies from returning, says the South Carolina nurse cited earlier. “We really care about the work we do,” she says. “We didn’t want to work for a company that would ask us to be unethical or compromise care.” Their efforts, coupled with a series of blisteringly anti-CMS reports by Marguerite Rosenthal for Grassroots Leadership, helped convince the state to postpone its decision until it completes a study determining whether privatized prison health services would result in better, more efficient health care than that being provided by the state. Similar acts of grassroots resistance have thwarted privatization elsewhere. Prisoners and their families are also filing a growing number of successful lawsuits that bring scrutiny and financial damage to private contractors (but also to the governments that hire them).
Finally, there is the goal of “decarceration.” With state budget crises restricting money for programs that keep people out of prison in the first place, coalitions like Education Not Incarceration are fostering opposition to new prison construction and support of decarceration for prisoners who pose little or no threat to society. This June, a report by the American Bar Association (ABA) lent significant momentum to this movement. In its Report and Recommendations on Punishment, Incarceration and Sentencing, the ABA’s Justice Kennedy Commission urged jurisdictions to invest in programs that help prisoners return to communities, provide alternatives to incarceration for individuals with mental illness or substance abuse, and help eradicate the disproportionate impact of “tough on crime” laws on people of color. The commission also called on Congress to repeal mandatory minimum sentences.
This spring, millions of Americans were horrified by the abuse of Iraqi detainees at Abu Ghraib prison, but it’s a safe assumption that women prisoners in U.S. prisons and jails were not shocked. They know that institutionalized disregard for human health and dignity is the natural consequence of putting prisoner care in the hands of poorly trained people working for a system that operates behind closed doors, accountable only to the bottom line. Why less outrage for conditions in U.S. prisons? “We don’t have the photographs,” says Sister Fran Buschell.
