- a pregnant prisoner who suffered a miscarriage at the jail waited six or seven hours before medical personnel sent her to the hospital although she was bleeding profusely;
- another pregnant prisoner suffering from serious vaginal discharge wrote to an independent jail monitor appointed by a court that she was seen by an obstetrician one month into her incarceration but a month later had still not received any treatment. She said that at sick call the jail doctor refused to see her. "I'm constantly having headaches, stomach cramps, and can't sleep," she wrote. "I'm very scared for my baby and myself....Please help me!! Help my baby!"
Virginia At the beginning of 1998, 40 women at the Virginia Correctional Center for Women signed a petition describing common delays in getting access to emergency care, doctors, medication, and treatment for chronic illnesses. The complaints included that the facility, which housed around 800 women, did not have a gynaecologist on staff and that a woman bled to death, after complaining that she was bleeding profusely from the rectum and being told by staff to elevate her feet. Linda Dennett, the mother of a prisoner, reported that her daughter's psychiatric medication had been discontinued when she was transferred from jail to prison in July 1997. Six months later, the medication had not been restored.
According to Linda Dennett, "I don't worry about trouble as much as I do about suicide."(19) Prison officials denied claims that services were inadequate.(20)
In January 1998, the Chairman of the Virginia State Crime Commission, a prison oversight body, wrote to the Department of Corrections, expressing concern that long-standing problems in health care services for female inmates appeared not to have been successfully resolved. It asked for a report on investigations into inmate health care complaints and inmate deaths during 1997. At the end of 1998, the Crime Commission had not issued a report of its review. Amnesty International has made a number of requests to the Commission for information about the review and at February 1999 had not received a response.
Perhaps the most commonly cited barrier to effective access to health services by incarcerated women is that prisons and jails employ too few medical staff. As a consequence, inmates have to wait lengthy periods to be seen initially and to receive follow-up care. Some may not be seen at all. In a recent national jail survey, fewer than half the women received a medical examination to determine their health status after they were taken into custody.(21)
Women who receive treatment also experience significant and serious delays in ongoing medical supervision and follow-up care. In a 1996 study of women in prison in California, Florida and Connecticut, 42 percent of women receiving medication for physical disorders, and 31 percent of those receiving treatment for mental health disorders reported that they were not receiving medical supervision.(22) The effects of the lack of medical supervision, the study noted, included "physical deterioration of prisoners with chronic and degenerative diseases, such as kidney disease and cancer, and over medication of prisoners with psychotropic drugs, resulting in lethargy and/or problems with speech and gait (shuffling)."
Another common barrier to medical attention is that inmates in many prisons and jails must obtain the permission of non-medical staff in order to be attended by a doctor. Prisoners and lawyers have told Amnesty International of cases where non-medical staff refused permission because they thought a prisoner was lying about her condition, or delayed calling for medical assistance because they did not think immediate attention was warranted.
In violation of international standards, many prisons and jails charge inmates for medical attention.(23) Although inmates who have no money are exempt, charges may deter poor prisoners from seeking help for what might be serious matters. Prisoners interviewed by Amnesty International in California said that the payment requirement is a significant deterrent for women who have a small amount of money, even those who have prison jobs for which the maximum rate of pay is 33 cents per hour.