PLN quoted in "Bad Medicine" re medical care at WA women's prison - The Stranger 1999

BAD MEDICINE

From the Jul 1 – Jul 7, 1999 issue

If you're an inmate at the state's only women's prison, you'd best not get sick.

BY TRISHA READY

Late in the evening on February 13, state prison inmate Dorine Crawford struck a match and used it to set her hair and clothes on fire at the Washington Correction Center for Women (WCCW). A guard foiled her suicide attempt by throwing Crawford onto the floor and rolling her in his coat to arrest the flames.

The prison had made an unsuccessful attempt to transfer Crawford--who hears voices, voices that once prompted her to try to kill her two young children--to Western State Psychiatric Hospital in Tacoma just a few months before. Though prison staff acknowledge that Crawford is suffering from a severe mental illness, the prison isn't equipped to deal with such illnesses and was unable to give her the proper treatment. After the suicide attempt, which was not her first, she was charged with a violation of Rule 712, which prohibits inmates from harming themselves and usually means a stint in an isolation cell.

In April of last year, Alissa McCune tied off her arm with a tourniquet and slashed herself after she was "sexually attacked" by another inmate. According to public records, the incident was investigated by the prison and quickly dismissed. When McCune, who was abused when she was a kid and traumatized by the incident, asked a guard for mental health attention, she says she was told "There's no one to see you." Prison officials apparently chalked the assault up to a "lover's quarrel."

McCune was sent to isolation and, without the help of her regular counselor, tried to kill herself again. And again. Her last attempt was the most severe: McCune cut the brachial artery in her arm. "I lost 75 percent of my blood," she recalls. "I was gone for 10 minutes." She was rushed to a nearby hospital for emergency surgery. When she was well enough to return to the prison, she was punished with 25 hours of work duty and a $50 fine to help pay for medical expenses.

According to WCCW Superintendent Alice Payne, four inmates, including Crawford, have tried to commit suicide since last September alone. None of them were successful. In addition, staff at the prison have counted over 100 incidents of less serious self-harm since January 1998.

The prison's treatment of McCune and Crawford, before and after their suicide attempts, seems typical of WCCW, where inmates have complained for years that medical care is either not available or woefully inadequate, and that requests for help are ignored or met with suspicion and punishment. Medical conditions have been so bad that the prison was slapped with a federal class-action lawsuit in 1994. The judge in the case ruled that WCCW had to improve the quality of its medical care, install a centralized data collection system, and submit to semi-annual reviews by outside medical experts, beginning in January 1995. The court order was supposed to have run out in January of this year, but medical conditions were still so abysmal that inmates and their attorneys took the prison administration to court again. The case, Hallett vs. Payne, went to trial in March. A decision is expected in the next few weeks.

In a way, worsening medical treatment seems to fit the times. Since the 1970s, prison rehabilitation has fallen out of style. These are tough-on-crime times of no-frills and tight control policies--budgets for programming, education, and recreational activities have been cut in Washington. But while prisons were certainly not designed to be summer camps for either gender, neither are they supposed to be so physically and emotionally damaging that people leave in worse shape than when they entered the gates.

WCCW is located in a forested area, halfway between the working-class town of Purdy and the tourist town of Gig Harbor on the southern part of the Kitsap Peninsula. Constructed in 1971 as a women's treatment center, the facility has the hollow, boxy look of a community college, only with electric fences and cyclone barbed wire.

The entrance to the prison is as remarkably ordinary as the potted silk flowers that adorn the waiting room table. The officer at the front desk is polite, but careful not to make eye contact. He listens to a tired Elvis CD with the volume turned down, the King singing, "We can't go on together with suspicious minds."

An oversensitive metal detector marks the line between inside and outside, a doorway standing in the middle of a well-waxed floor. Visitors to the prison must remove all metal, including jewelry, and leave valuables in a shoebox-sized locker. On the day I visit, a woman in a Levi's jacket has done her time and is being released. Her mother waits at a table near the front desk. She has big silver hair. A brief hug marks the ex-inmate's transition to freedom. Everyone stares. The moment seems eclipsed by the mundane weight of prison life that saturates every room, and sticks to skin.

The number of women in prisons across the country has increased by 275 percent since 1980, according to the Bureau of Justice Statistics. That's three times the increase seen in the male prison population. This same trend is visible in Washington state. In 1992, when Alice Payne started her tenure as superintendent of the state's only female prison, there were 240 women there. Currently 735 women live in WCCW's time warp atmosphere, despite the fact that it was built to house 680. As the population has grown, so has the prison. New floors have been added. According to Peggy Smith, Planning and Research Administrator for the Washington Department of Corrections (DOC), "It doesn't appear that any new construction at WCCW is in the works," although she does mention the possibility of building a new receiving center. Payne also said she hopes to add a 66-bed special-needs unit sometime in 2001 or 2002. In an emergency, according to Patricia Wachtel, who up until a few weeks ago was WCCW's media relations specialist, if the prison gets too crowded, staffers can always add a third woman to each two-bunk cell.

The prison grounds are laid out in the shape of a nesting bird, hemmed by a perimeter road, constantly circled by an armed guard in a truck. Living quarters are broken down into four main sections. Minimum security consists of three barrack-like buildings and sits closest to the service road. Medium security, called "256" for the number of women it holds, is over by the gym. And maximum security consists of a large three-tier cement building, which also serves as the intimidating entrance point for new prisoners.

Guards and staff walk between sections of the prison and spend much of their day waiting at gates. There is always a slight delay and a click before a metal gate opens. Wachtel, my guide on a tour of the prison, bows her head as she waits for the click. She seems as careful as the reception desk officer to avoid eye contact. Wachtel leads the way to the visiting room--an area with a snack bar, vending machines, and tables and chairs--located in the "control center," roughly in the middle of the prison grounds.

I'm here to interview some of the prisoners who have lodged complaints about shoddy mental health care. Wachtel, a petite woman with long, wavy, black hair, sits at the table with me as the inmates come and go. She introduces herself to them at the same time she introduces me. During the interviews she busies herself with paperwork, but interrupts when I ask something that she doesn't like.

The first woman I talk with is Neshelle Wood, who has the unassuming, cautious kindness of a rural housewife. Her dark hair flips up in some places, down in others. She wears glasses. Her nails are painted. She seems fragile, so nervous that her legs are shaking as she sits down at the table. Wood, who has three years left to serve on a 93-month sentence, calms down after a bit. She tells me that she was wary about reporting her many attempts at hurting herself to prison staff, for fear she'd be written up and placed in an observation cell. Wood has tried to commit suicide several times and has spent a lot of time in the prison's Treatment Evaluation Center (TEC), which houses inmates with severe mental troubles.

As Wood tells her story, she holds out an arm crisscrossed with welts. She explains that she has trouble crying, as she touches a scar. "When I cut myself, blood is the tears bottled up inside me."

Prisons were originally designed and are still architecturally and psychologically engineered to contain, separate, and isolate men. Male prisoners in the U.S. far outnumber women. Though the percentage of women as part of the country's total prison population is increasing dramatically (by 313 percent between 1980 and 1993), it's still at only eight percent. The mammoth prison system has been slow to accommodate women.

Men and women tend to have different reactions to imprisonment, according to psychiatrist and UC Berkeley professor Terry Kupers, M.D., author of Prison Madness (Josie Bass, 1999). Men typically respond to trauma by "acting out aggressively." Thus, male prisons are marked by hyper-vigilant observation on the part of staff, by extreme methods of separation (especially when there is a conflict), and by strict safeguards against the influence of incendiary information.
Women, on the other hand, tend to have the opposite reaction to being locked up. They are, according to Kupers, "more likely to turn their negative feeling inward and become depressed." Trying to apply the same intensive observation, isolation, and containment methods used in male prisons, asserts Kupers, only serves to enhance depression and anxiety. Women are not allowed to exchange clothes or notes, or even touch in most cases. He adds that female prisons tend to have more rules, and that, not surprisingly, women tend to receive disciplinary citations more often than men. "Women's prisons are an afterthought," Kupers asserts. "Until well into the 20th century, many women's prisons were merely partitioned-off sections of men's facilities."

Women entering prison do have some things in common with their incarcerated male counterparts--mainly their backgrounds and socio-economic status. The women at WCCW, and indeed women locked up in prisons across the country, make for a disturbing portrait of the growing population of inner-city poor in America. The rate of African American and Hispanic women prisoners has increased at four times the rate of white women. Many female inmates have low levels of education and vocational skills, and are not part of the workforce. A national survey found that 53 percent of female inmates were unemployed at the time of their arrest.

Female inmates often have histories of substance abuse, a factor that gets in the way of holding down a job. And a large number of women report histories of sexual or physical abuse. "Fifty to 75 percent of women committed to prison have been physically and sexually abused as kids," according to Dr. Cassandra F. Newkirk, a forensic psychiatrist who works for the New Jersey Department of Corrections. "Many as adults, too." She emphasizes the link between abuse and drug addiction. Reports of prior sexual and physical abuse statistics are over one-third lower for male prisoners. Because childhood and adult sexual abuse among males is often underreported, it is difficult to create an accurate comparison.

Considering the high percentage of abused women in the nation's prisons, it's especially troubling to note that male guards outnumber female guards in women's prisons by two to one. Nationwide, serious allegations of sexual misconduct by male corrections officers have been reported by the United Nations Human Rights Office. Several cases of guards raping female inmates at WCCW have made their way through the court system as well. Inmate Heather Wells was raped and impregnated by a guard in 1993. The state of Washington paid her $110,000. Another sexual violation occurred in 1998 in the TEC, where a guard forced inmate Reba Brooks to perform oral sex on him. The Washington State Legislature introduced SB5234, prohibiting sex between staff and inmates. It was signed into law in April.

Watchel reports that 85 percent of the women at WCCW are mothers, which translates into children being left behind and added depression on the part of inmates separated from their families. "Nationally, there are approximately 200,000 children under 18 who have mothers in prison," according to a March 1999 report from Amnesty International. "More than half of the children do not visit their mothers."

A typical WCCW inmate, concludes former staff psychiatrist Dr. Jan Schaeffer, is "between 25 to 35, Caucasian, a single mother, unmarried, with a history of sexual or physical abuse, and with substance abuse problems."

Because of all these factors, female inmates pose unique challenges when it comes to providing medical care. There are few female inmates overall, so costs are higher. According to Doug Hoffer, budget spokesman for the Washington DOC, WCCW operates on a budget of approximately $21 million per year. The Washington State Reformatory in Monroe, one of the state's larger men's prisons with 2,147 inmates, a population three times that of WCCW, has just over twice the budget.

The largest expense, says Hoffer, is health care. WCCW budgets $7,793 per inmate per year for dental, medical, and mental health services versus $5,369 per inmate at the Monroe prison. These numbers are linked to the fact that women seem to access health care services more than men. A 1996 report from the National Council on Crime, The Hidden Crisis: Women in Prison, cited a study where 60 percent of imprisoned men professed no health needs, as compared to 60 percent of females prisoners who needed at least minimal health care.

The current Hallett case seeks to document that these needs aren't being met. Despite all the money reportedly being spent on inmate health care, claimants are bemoaning a system in disarray. They single out inadequate dental care, dramatic staff turnover, lack of necessary mental health treatment for many women with severe mental health issues, and punishment of women who hurt themselves or attempt suicide.

Courtrooms are the main theater where the otherwise veiled world of American prisons steps briefly into the limelight. As if to stand as a symbolic link between the two worlds, a blue glass sculpture swings in precarious balance in the rotunda of the federal courthouse in Tacoma, where the two-week Hallett case opened on March 29. The sculpture consists of blue bulbous pieces fused into a larger, curved shape. The pieces appear to simultaneously cling to and explode out of an unsettled center. The whole sculpture seems capable of slipping from its wire and crashing onto the pedestal below.

"Chaotic," "unstable," "a system that has suffered dramatic staff turnover," "dental care so inadequate a prisoner had a tooth pulled without proper medication"--these are all statements used by the prosecution in its opening statement, to describe the health care at WCCW.

The defense counters that the prison's health care is excellent, fortified by a top-notch system of quality control and a staff dedicated to providing compassionate care for sometimes manipulative inmates.

The trial is a follow-up to the original 1994 case that was filed on behalf of all WCCW prisoners who had suffered from poor medical care. According to attorney David Fathi, who's representing the plaintiffs along with attorney Patricia Arthur (both of Columbia Legal Services, which provides legal representation to the poor), it would have been tougher to get the '94 settlement had it not been for an inmate named Gertrude Barrow, who died of medical neglect during the original discovery process.

Barrow had a hole in her stomach that allowed fluids to leak out. But rather than sending her to an outside hospital for what must have been incredibly severe pain, she was diagnosed by prison doctors with comparatively minor ailments: gas, constipation, and kidney stones. Barrow was even forced to clean up her own vomit hours before her death.

When she died, the state had a hard time denying points made by the plaintiffs in Hallett. The DOC agreed, as part of the 1995 court-ordered settlement, to improve its health services at least to the level afforded the state's incarcerated men. But rather than making real and lasting improvements, the prosecution claims that WCCW still has "a mental health system as badly in disarray or worse than it was in 1995." The court order would have expired in January 1999, but it was extended by a federal judge and still stands.

The current case focuses predominantly on revealing the "deliberate indifference" of the prison's administration when it comes to poor mental health care and dental treatment. Lawyers representing WCCW inmates called on mental health experts and former employees to testify that understaffing has caused an "increased use of force," and compromised the safety of inmates and others. Witnesses also claimed that the Treatment Evaluation Center lacked a mission, and that the prison operated a disorganized medical distribution system.

The dental program was criticized by one expert witness, who said that patients often suffer from "unnecessary deterioration." The expert, Michael Easely, a professor of medicine at the State University of New York at Buffalo, mentioned problems like "long waiting periods for non-emergency treatment" and "a preference for pulling teeth instead of restoring them." Throughout the trial, the judge heard horror stories from inmates about both the mental and dental health programs at the prison.

WCCW Superintendent Alice Payne, who declined to be interviewed for this story, sits in court beside the prison's new medical director and a team of lawyers from the state Attorney General's office. Payne looks more like a fashionable TV anchorwoman than a prison hard-liner. Her clothes are bright, tailored. Her hair is frosted. Inmates call her Auntie Alice. She passes notes to lawyers during the trial; her manner is light, positive; she seems nonplused by the dark stories and accusations embedded in the trial.

On the stand, Payne, who has worked for the DOC for 25 years, talks about the scope of her job: "I am responsible to protect the public because they--I--do house convicted felons. I am responsible to keep staff safe. I am responsible to keep inmates safe. I am responsible to public property." She claims to spend 85 to 90 percent of her time on mental health issues, though she admits on the stand that she has no official mental health training.

Payne talks about the complications of hiring and training staff--attracting qualified people who can do a good job in a prison setting. She discusses negotiating with Teamsters, maneuvering through the labyrinth of budget limitations, and being affected by public perceptions and misperceptions about prisons. She expresses loyalty toward staff members who have been loyal to WCCW, including prison dentist Dr. Carl Weaver, who also goes by the name "Dr. Yank." She constantly finds ways to focus on the positive effects of WCCW's quality management program, and she expresses deep concern for inmates like Dorine Crawford.

For every complaint offered by the prosecution, the defense has an answer. But the responses sometimes ring as hollow as clichés. Assistant Attorney General Daniel Judge, who is defending the DOC in the Hallett case, says high staff turnover is something that "happens in various places." He asserts that WCCW is a well-staffed, self-regulating machine. He brings up WCCW's excellent gynecological care system, and the recently implemented multi-disciplinary teams that address inmates' requests and complaints. "The health care available at WCCW exceeds what is available in the community," he claims.

Prison is a tough environment psychologically. Inmates, sealed off from the outside world, have to deal with two lives. One life occurs crammed inside a controlled space with hundreds of people of the same sex. The other consists of family and friends who are aging, having children, and moving on, and who may or may not visit often enough.
There are very few distractions in prison. At WCCW, there are 900 volunteers a week who show up to talk with inmates and hold meetings of various sorts. Most of what's offered centers around religious activities, 12-step programs, and anger management. The majority of women at WCCW go through Moral Reconation Therapy, a shame-based program that sources criminal behavior--all the way back to crying in the crib--as being motivated by the prisoner's desire to manipulate. This system seems counter-productive as a reform tool to uplift women who are already struggling to deal with gutter-level opinions of themselves.

"One foot on the outside and one on the inside is the worst way to do time," says Noreen Erlandson, who has served seven years. She has a 12-year-old son on the outside and misses him incredibly. She has no history of mental illness, yet she has become severely depressed. The prison put her on anti-depressants. She didn't seek counseling, and says none was offered until she finally wound up in the TEC. Inmates complain that meds are often administered rather than therapy at WCCW, because it's easier and requires less staff time. Pills are also tempting for inmates looking for any means to relieve stress.

Erlandson tried to kill herself in December 1998 by putting her head through a noose made of stockings and an appliance cord. She wound up in a coma, and woke up in the TEC. She's worked her way out of that unit and is now trying to start a group for inmates who have attempted or considered suicide. No such group currently exists at the prison.
The TEC is where severely mentally ill inmates or those in mental health crises live. Though it used to be run by a mental health specialist, it has recently been reorganized so it falls under the leadership of a corrections supervisor. Inmates who stay there are denied access to sharp objects like razors, as well as chocolate and coffee. According to David Kleudt, former head of the TEC, the maximum number of women who can stay in the unit is 28. He estimated its average occupancy at 15 to 18. Some women (10 to 12) never leave the unit.

The number of beds seems sorely inadequate, considering that the Bureau of Justice estimates that 10 to 20 percent of prisoners nationwide suffer from serious mental illness. Reasons for this phenomenon include the deinstitutionalization of the mentally ill in the 1980s, and the fact that there are so few resources available for public mental health services in general. Prison has become a psychiatric facility for the poor and homeless mentally ill who can't or don't access minimal services on the outside. According to a May 23 article by Michael Winerip in the New York Times Magazine, "There are now far more mentally ill in the nation's jails and prisons than in state hospitals."

Psychiatrists, ordered by the court to evaluate and make improvement suggestions for WCCW, include Dr. Jeffrey Metzner and Dr. Cassandra Newkirk. They acknowledged that there are seriously mentally ill people at WCCW, although they don't provide any numbers (one doctor, who used to work at the prison, estimates that 60 percent of inmates suffer from some sort of mental illness). Metzner says the fact that the prison's medical care is so disorganized hurts already troubled inmates. "Lack of structure can accelerate feelings of instability in patients," he says.

Both medical experts testified in court that WCCW provides inadequate mental health care because the prison has been understaffed. Overloaded workers quickly become burned out. The prison has lost at least six key staff members in recent months. There have been new hires, but the rhythm of people coming and going only adds to the clinic's instability.

Record keeping is also an issue. Metzner had trouble figuring out how many people were on psychotropic medicines by looking at prison records. Originally he was told 150, later he learned it was 215.
Neshelle Wood, the inmate interviewed under Wachtel's watchful eye, is serving time for killing her son by injecting urine into his intravenous feeding tube. Her diagnosis was Munchausen Syndrome by proxy. She has tried to cut herself 30 to 40 times using razors, cassette covers, and the metal bands around pencils. Wood makes a distinction between cutting and suicide. "When you hurt yourself you take a risk at dying," she says, "but the main purpose is to let go. Suicide is when you want to be six feet under."

Wood tells of what it's like to be placed in an isolation cell, where she's spent a fair amount of time. The room is stark, she says, furnished with nothing but a plastic mattress, a pillow, and one blanket. "An officer stares at you and writes down what you're doing. I have flashbacks when I'm in there. There's no counseling. It depresses me more." Wood says the cell brings up memories of being locked in a closet when she was a child--she's been cutting herself since she was three.

Dr. Jan Schaeffer, an expert on correctional mental health issues (and a former employee at WCCW) expressed concern that WCCW staff doesn't take self-harm and suicide attempts seriously. She recalls sarcastic comments staffers made about inmates like, "She's just trying to get out of work" and "She's just trying to get drugs."

"People hurt themselves to communicate pain, anger, and shame, and sometimes to get someone else to do something," she says. "It's a very desperate attempt."

In her deposition, Superintendent Payne divided people who cut themselves into two categories: "those who require hospitalization or require stitches or there is a loss of blood" and people "who barely scratch the surface." The latter she doesn't take seriously. The prison did not begin investigating the increasing number of self-harm incidents until February 1999. The study is ongoing, but the prison has implemented a few changes like prohibiting razors in the TEC, in segregation, and in receiving units.

Lorna Bromley was released from WCCW in January with medical woes and over $2,000 worth of hospital bills. Over a cup of strong coffee at her home in Ballard, Bromley talks about wilder days of crime and drugs. She uses the past tense.

Bromley was injured while working in a "transition to trades" program at WCCW, making $1.33 per hour as a carpenter, installing cubicle panels in government buildings. She was at the Michigan Street Employment Security Department when she stepped on a piece of conduit an electrician left out. Her head went one way and her trunk the other. Bromley stood up, leaned over, and passed out. She went to Harborview Medical Center twice after that. Besides ibuprofen, Bromley says she received no follow-up care at the prison. She can hardly walk now, and her whole right arm, from shoulder to fingertips, sometimes swells and turns red.

Under doctor's orders she can't work for the next six months. Bromley called an attorney after she was released to see if she had a case. "Juries usually look harshly on ex-prisoners," the attorney told her, and suggested she seek an out-of-court settlement. She hasn't filed a case yet, mainly because she's having trouble finding a lawyer. "I've been in prison," Bromley says, "but that doesn't mean I've lost human rights. I did my time."

WCCW's dental department is run by Dr. Weaver, who works full-time on the prison's inmates. At least up until the trial, the dental clinic had a hygienist one day per week, two other part-time contract dentists, and a contract oral surgeon. During the Hallett trial, several inmates took the stand and told horror stories about Weaver, whose license plate reads, "Dr. Yank."

They say he pulled wrong teeth, and did so roughly, or denied or unnecessarily delayed care. Weaver, a thin, pinched man, declined to be interviewed for this story, but in court he described the atmosphere in the dental office as cheery and fun. "We laugh a lot. It's a nice atmosphere with Howdy-Doody and cartoons on the wall."

Bromley claims that Weaver kicked her out of the dentist's chair for saying, "fuck, that hurts" when he shoved a Novocain needle into her mouth. She says she was sent back to her cell, and that one of the two teeth she had gone in to have pulled popped out. Although she asked to see Weaver again, she says he refused.

Cheryl Fletcher was contending with chemotherapy for non-lymphatic Hodgkin's Disease when she first went to Weaver with a sore mouth. She asked him to pull one tooth, according to her testimony in court, but he pulled the one next to it. Fletcher kept writing messages to him, telling him of her continuing pain. Weaver finally removed the right tooth, she says, but under protest.

When Fletcher brings up Weaver's license plate in court, he explains that "Some thought it was fine. I've never heard anyone but Miss Fletcher be offended by it."

But Fletcher isn't the only one who's received poor care. Mary Eastwood, who also appeared in court, wouldn't begin her testimony until Weaver left the room. Eastwood is an ex-heroin addict who entered prison needing to have most of her 16 remaining teeth removed. She says she suffered for months with a severe glandular infection after having several teeth pulled and no antibiotics prescribed.
At trial, she whispered, pointing to her mouth, "the pain, the pain that wouldn't stop. I can't chew. I can't eat anything sweet, bitter, hot, or cold." Eastwood had attempted suicide a few weeks before her appearance at the Hallett trial.

A look at Eastwood's treatment led Professor of Medicine and trial expert Easely to be very critical of the prison. In court, he discussed damaged and insufficient x-rays short of national and community standards. He analyzed mistakes made in medical decisions and record keeping, inefficient use of space (only one chair was used at a time), lack of oversight, and lack of continued staff education. Easely was critical of the fact that a dental hygienist was only available one day per week, causing some patients' appointments to be postponed for as long as a month. He stopped just short of holding Weaver responsible for Eastwood's needless suffering.

Since the Hallett case was reopened, there have been new arrivals and departures by medical staff and altered services at WCCW. Assistant Attorney General Daniel Judge says two new full-time mental health positions have been established. WCCW spokesperson David Gale confirms that the facility has added two psychiatric nurses, but says they are only funded through June 30. He says a full-time psychologist and a half-time recreational therapist have also been added on a permanent basis. The prison has extended evening and weekend mental health services, and has increased the hours worked by a dental hygienist. Judge denies that any of the changes were made in response to the lawsuit, but credits them to the prison's internal evaluation program, the Continuous Quality Improvement Process, implemented at WCCW after the 1995 court order.

Columbia Legal Services attorney Fathi challenges that claim. "The changes were implemented two months before the hearing," he says. "But the trend is toward mobilization of resources and then demobilization." Two court experts testified that until a new hire or program has been in place for six months, it doesn't constitute real change.

Paul Wright, co-editor of a prison-run newsletter called Prison Legal News, is skeptical of WCCW's shiny new face. "At WCCW they had four years," he says. "They didn't start doing anything until a month before the trial. Prisons have no intention of compliance with court orders. They never commit resources."

It remains to be seen whether improvements will remain in place long term. Governor Gary Locke just signed a new budget for the DOC that includes cuts in health care spending.

While Hallett is being ruminated in the justice chambers for a few more weeks, this brief window into the world of incarceration remains open. For the most part, legal watchdogs and prison advocates are the only ones paying attention. Otherwise prisons in the U.S. are like landlocked foreign countries, hidden in the distance of conscious public neglect. Once the trials or investigations stop, the prison returns to its bored, daily rhythm of silence.