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Is Health Care Too Much to Ask For?

By Silja J.A. Talvi

In California's State Prison System, Female Prisoners and Their Advocates Say They're Continuing to Fight an Uphill Battle, While Prison Administrators Insist They're Doing Their Job

Over the last several years, health care-related allegations emerging from women's state prisons in California have echoed notably similar scenarios: The denial of adequate medicine for chronic diseases, a lack of timely treatment for spreading cancers, and dangerous delays in care for pulmonary and cardiac problems.

At their worst, these accounts have suggested an alarming degree of health-related suffering among many prisoners, including the case of a mentally and physically ill prisoner at the Central California Women's Facility (CCWF) in Chowchilla who was confined naked to a dirty cell where, on several occasions, she ingested her own feces. According to lawyers representing prisoners at CCWF, the woman was denied access to liquid food supplements sent by her family on at least one occasion, and eventually died of untreated pancreatitis and starvation.

In response to accounts like these, legal agencies in California pursued a class-action suit in the mid-1990s, hoping to improve the quality of life for women serving sentences in the state prison systems. Prison officials have contended all along that they are doing the best they can, given a mushrooming prison population of women with diverse medical needs.

The 1995 case of Shumate vs. Wilson accused prison administrators and medical staff at both the Central California Women's Facility in Chowchilla and the California Institute for Women in Frontera with cruel and unusual punishment and charged them with "deliberate indifference" to the health needs of prisoners. [PLN, Aug. 1994]

That suit resulted in a settlement in 1997, in which the state of California agreed to improve its overall prison health care system, and allowed the state to avoid admitting any wrongdoing. The changes in the prison system are being monitored by an independent investigation team whose findings in August will determine whether the state has adequately fulfilled its obligation. If the improvements are found to be incomplete, the suit will go back to trial.

Only two years into the monitoring phase of Shumate v. Wilson, this casealong with the campaigns of prison activistscontinues to raise serious questions about the quality of health care provided to women doing time in state prison systems.

New Allegations of Medical
Ill-Treatment at World's Largest Prison Complex
for Women

Two prisons the Central California Women's Facility and the adjacent Valley State Prison for Women currently house 64 percent of California's total female prison population, or almost 7,300 prisoners, according to the most recent California Department of Corrections (CDC) statistics. Together, the two prisons constitute the largest women's prison complex in the world, and now house far more prisoners than they were designed to. Overcrowding is a constant problem, and prison activists insist that under such conditions there isn't enough let alone good enough health care to go around. San Francisco-based Legal Services for Prisoners with Children (LSPC) will file suit against Valley State later this year over alleged violations of privacy and health care needs, as well as accounts of systematic sexual abuse. According to staff attorney Cassie Pierson, the agency has received letters from women prisoners who have complained of not being able to get prescriptions on time for chronic and potentially contagious diseases.

"[The prisoners] sometimes wait three to five days, [even] two to three weeks for refills of medication, including antibiotics," Pierson says.

Pierson explains that while the lawsuit against Valley State is unlikely to focus on mental health issues (territory covered by another lawsuit, Coleman v. Wilson), the prison's Secure Housing Units, or SHUs, have still raised many such concerns. In addition to LSPC, international human rights groups including Human Rights Watch and Amnesty International have explored the psychological impact of such units to female prisoners. At any given time, dozens of women are locked in Valley State's SHUs, where they are held for 23 hours a day without access to work, family visits, or education.

"We're looking at half a dozen cases where women started out in considerably better shape than they are in now," says LSPC's founder Ellen Barry about the mental health situation facing women in Valley State's SHUs. "Women do their time differently from men. I don't ever want to imply that conditions for men are better or that conditions for women are worse because those are meaningless dichotomies ... But for women, I would argue that [isolation] takes on an even more significant dimension because of the way that gender differences play out in society. Women turn to each other for support and basic survival in ways that men don't do as often."

At the Central California Women's Facility, California Prison Focus and Women's Positive Legal Action Network have recently focused their efforts on repealing a new prison policy dealing with medication for HIV-positive patients. Previously, HIV-infected women received a monthly supply of their pills and were allowed to take their required doses in the privacy of their cells. That policy was changed last December; now prisoners and prison activists complain that these women are required to stand in line everyday sometimes as many as three times a day so health-care providers can observe them taking their HIV medications.

California Prison Focus' Judy Greenspan explains that the new policy has produced a great hardship on women who must sometimes miss meals and work and even face punishment for tardiness as a result of waiting in line. "On average, women report that they're spending two and a half hours a day outside standing in line for their medications, even if they're sick," says Greenspan.

Greenspan also notes that many medications for HIV must be taken four to six times a day in order to prevent drug resistance. The new medication policy makes it difficult, if not impossible, to keep to the recommended dosing schedule, says Greenspan. CDC representatives said they couldn't comment on the charges because of the pending lawsuit, but said claims presented by the activist group were simply "not accurate."

The continuity of necessary medicationsincluding HIV medswas one of the 57 health-related provisions that the state of California agreed to implement at CCWF and CIW. In the first independent assessment to measure how well the state was complying with the settlement agreement, the November 1998 investigator's report found that the state had complied with 46 of the 57 provisions, including a mandate to assure a continuity of necessary medications. However, in a finding of non-compliance with regard to chronic care, the investigators also reported that insufficient doses of protease inhibitors were sometimes ordered by medical staff, representing an unnecessary risk to HIV positive women.

But the ACLU's National Prison Project and LSPC have complained that certain findings of complianceincluding the finding that dealt with the timely availability of necessary medicineswere in error. In a ten-page report, the ACLU's National Prison Project cites the counsel's own interviews with prisoners as well as reviews of medical records, challenging compliance in other areas including follow-up care, dental care and on-site staff coverage.

The final assessment of how the state of California is complying with the settlement terms is due in August, at which time the case will proceed to trial if one or both prisons are found to be in non-compliance with any of the settlement provisions. Thornton explained that she could not comment on current litigation, but that health care "is a very high priority with the department."

The Ten Year Wait

Sherrie Chapman, one of the original plaintiffs in Shumate vs. Wilson, continues to wage her own battle against the prison system which she says has left her body ravaged and disfigured by breast cancer.

A 40-year-old woman serving a life sentence for murder at California Institute for Women, Chapman has been in prison since 1981. In 1985, Chapman found lumps in both her left and right breasts, and reported her concerns to medical staff. Despite her repeated requests for medical tests and despite a history of breast cancer in her family Chapman was not given a mammogram until 1994, when the lumps were actually visibly protruding from her right breast.

More than eight months later, a biopsy was finally taken, and it confirmed breast cancer. Nearly 10 years after she first reported her concerns, Chapman had a mastectomy of her right breast.

Chapman's struggle with her health and with the prison medical care system didn't end there. Throughout 1996, Chapman complained of pain and vaginal blood clots, as well as the persistent lumps in her left breast. In January 1997, surgeons finally removed Chapman's left breast, but waited until late 1997 to treat her worsening uterine pain. By that point, Chapman's diagnosis was uterine cancer, necessitating a hysterectomy.

The resulting lawsuit, Chapman vs. Maddock, alleges serious indifference to the serious medical needs of the prisoners, asserting that Chapman's current physical condition is a direct result of prison policies. This reporter's request to interview Chapman by telephone was denied as a result of a statewide ban on prison interviews by the media.

Pierson of LSPC reports that Chapman has lost more weight and is in continuous pain, and says that prison staff refuse to provide her with anything stronger than Tylenol or Motrin. Lt. Sebald, who handles media inquiries for the prison, said that he was not able to comment on her case or her current well-being.

According to Pierson, Chapman has not been given her prescription for Tamoxifen, a breast cancer treatment and prevention drug, for several months. "She's tired," says Pierson of her client. "She doesn't want the lawsuit to go away, but she's tired of the daily battles."

Compassion for the Sick?

To be sure, California is not the only state facing charges of medical abuse, neglect or indifference. A recently released Amnesty International report, Not Part of my Sentence: Violations of the Human Rights of Women in Custody, has highlighted medical ill-treatment in Florida, Virginia and Washington D.C., among other states, while the state of Washington continues to grapple with its own, ongoing legal problems at the Washington Corrections Center for Women (WCCW) in Gig Harbor, WA. (See accompanying article.)

In the aftermath of mandatory minimum drug sentencing laws that led to the explosion of incarcerated females, research findings published by national health organizations in the early 1990s began to point to concerns that the standards of health care for prisoners were becoming difficult to maintain as the number of prisoners increased.

Women, who now constitute 6.4 percent of the prison population in the U.S., often arrive in prison with serious health problems. Largely poor, often victimized by sexual, emotional or physical violence, and having had limited access to medical treatment on the outside, women sentenced to state prison sentences often manifest pressing health needs from the time that they enter the system. For some of these women, their ten and twenty-year sentences become death sentences, as chronic illnesses become terminal.

In California, a compassionate release policy designed to release women dying in prison was signed into law in October of 1997. Ironically, since becoming effective in January 1998, the numbers of compassionate releases have dwindled. According to CDC spokeswoman Thornton, eight releases were granted in 1995, while just one was granted in 1998. So far, one release has been granted this year, under what Cynthia Chandler of the Women's Positive Legal Action Network considers disturbing circumstances.

Tina Balagno, an HIV positive prisoner with a history of drug addiction, started complaining of severe leg pain in June of 1998, and shortly thereafter discovered lumps in one of her breasts. When a malignancy was found, her family urged immediate treatment. In November, Balagno was admitted into surgery for what she thought would be a lumpectomy, only to wake up to the realization that her breast had been removed. According to Chandler, Balagno received no chemotherapy or radiation treatment and got only Motrin for her pain. After falling into a coma after suffering two seizures in January, Balagno was discovered to be suffering from metastasized bone cancer, and was released to her family just one week before her death at the age of 40.

Greenspan, one of the co-authors of the compassionate release legislation, finds the current overall lack of compassion toward severely ill prisoners disheartening. "The problem is that the political climate is so anti-prisoner, and prisoners have been so demonized, that they are not even getting out [on compassionate release]," she says. "The system's refusal to release dying prisoners is both inhumane and unconscionable."

Silja J.A. Talvi is a Seattle-based freelance journalist who has written on prison issues for In These Times and Sojourner. A version of this article first appeared on MoJo Wire at

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Related legal case

Shumate v. Wilson