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Wreaking Medical Mayhem in Washington Prisons

In 1993, prisoner Gertrude Barrow crawled to the clinic at the Washington Corrections Center for Women. Her peptic ulcer ruptured, Barrow's requests for treatment had been dismissed by health care staff who diagnosed her ulcer as a bad case of gas. When Barrow vomited on the clinic floor, a nurse tossed a towel at her, and told her to clean it up. Barrow died just a few hours later. [ PLN , Oct. 1994]

Barrow's death served as the catalyst for a six-year legal struggle to upgrade WCCW's failing health care system from shameful to adequate.

For the past year, Seattle's Columbia Legal Services' Institutions Project, the ACLU and the Northwest Women's Law Center have waged a litigious battle with WCCW, in an attempt to extend judicial oversight over the institution's faltering health care system. The current litigation seeks to enforce a settlement agreement reached as a result of a class-action filed against WCCW in 1993 by prisoners. [ PLN , Apr. 1995] The 1993 suit, Hallett v. Payne (case number 93-5496), was borne out of a litany of health care horror stories: WCCW's health care staff performed bizarre procedures ( like removing a prisoner's mole with a Bic lighter and a paperclip ), a prisoner died from a common-place, treatable illness, and the prison had no coherent system of medical records.

Barrow's death occurred during discovery for the 1993 suit. Columbia Legal Services' staff attorneys David Fathi and Patricia Arthur speculate that Barrow's death led to the quick capitulation of WCCW, who settled the case immediately.

Against this backdrop of appalling medical care, a court-ordered Stipulation and Judgment was approved in 1995, setting forth requirements including oversight by outside medical investigators, improved health care services, and employment of qualified health care staff. This past March, attorneys from Columbia Legal Services went back to court, claiming that WCCW has virtually ignored the mandates of the Stipulation.

The central claims leveled at WCCW included haphazard mental and dental care, and second-rate supervision and training of staff. In the original complaint, attorneys for the plaintiffs also argued that WCCW provides substandard medical care. Because of procedural problems, Judge Magistrate David Wilson barred the medical complaints from the current suit.

Currently, only eight mental health care professionals serve a population of about 730 women. Since the suit in 1994, there are now fewer nurses at WCCW, though the population at WCCW has increased. Former Nursing Supervisor Pat Wiggins wrote in a memo in 1998: " with the increased hours and workload [for health care staff], I have seen increased numbers of errors and incidents reported. There is a need for concern." Wiggins also stated that medication errors quadrupled between April and October of 1998.

An investigation by the Department of Health (DOH) conducted in October of 1998 seconded Wiggins' concerns, finding that WCCW's failure to ensure that policies and procedures were established and implemented resulted in "errant infection control standards." The DOH found that a temporary hire, nurse Jeanette Johnston, used the same needle on two successive patients, an incident which went unreported until one of the patients filed a grievance. The investigation also found that nurses routinely recap and reuse needles, carry needles in their pockets, and improperly dispose of needles. Within the population at the prison, seven prisoners are known to beHIV positive: the risk taken by Johnston is mortifying.

The lack of staffing at WCCW has resulted in tragedies, near-misses, and overall atrocious patient care. One patient was left unattended on a gurney in a hallway overnight. During the night, she had a seizure, fell off the gurney and was rushed to a hospital in Tacoma.

Rain or shine, the women at WCCW form long lines outdoors waiting for their medication. Some prisoners refuse to take their meds because of the hassle and discomfort of the med lines, which sometimes take two hours to work through. While waiting in the med line, one frustrated prisoner sliced a 4" long cut into her arm with a razor blade, exposing the bone.

Over the past year alone, there have been over 100 acts of self-harm by prisoners. Prisoner requests for mental health consultations go unanswered; or worse, prisoners' requests are rebuffed, and then they are punished for resulting acts of self-harm. Prisoner Allissa McCune testified at the hearing that when she sought help from mental health counselor Mike Walls, he told her he was too "overwhelmed with work" to talk with her. McCune attempted suicide soon after.

Justine O'Neill requested emergency help from her mental health counselor, Levette Dearmon. When O'Neill told Dearmon that she was hearing voices and struggling with suicidal thoughts, the counselor kicked O'Neill out of the office. Ms. O'Neill sat outside Dearmon's door for forty-five minutes, crying. A prisoner passing by saw O'Neill crying and wanted to help, but was told by a counselor to "just walk by." That night O'Neill cut herself with a razor in five different places. O'Neill testified that she received no counseling following her suicide attempt, but instead was infracted with a loss of ten days "good time."

Women at WCCW are typically infracted, or punished, for their acts of self-harm. Under Washington Administrative Code Rule 712, prisoners may be infracted for self-harm. Though prisoners across the state are subject to Rule 712, women at WCCW are off the charts in numbers of infractions and correlative acts of self-harm performed. In a recent deposition, Associate Superintendent Gary Fleming stated that he's seen more acts of self-harm at WCCW than in any other prison he's worked at.

Dr. Cassandra Newkirk, an independent monitor who evaluated WCCW's mental health program, noted in trial testimony that women in prison are particularly inclined toward self- harm. Newkirk explained that women in prison typically have experienced some form of sexual, physical or emotional abuse prior to incarceration, and that restraining, punishing or secluding women who have been abused retraumatizes them. WCCW psychiatrist Dr. Jan Loeken estimates that 95% of the women she sees at the prison have suffered some form of significant abuse.

In response to punishment or isolation, women who have been abused "will engage in self-harm behavior as a way of trying to get a sense that they are actually alive," stated Newkirk. Newkirk further observed that American women have been "...acculturated not to give up." Self-harming may either be a response to a lack of meaningful attention, or because women prisoners intend to commit suicide. "If we need attention, want attention, [we] engage in many different kinds of ways to get that attention," said Newkirk.

Some women at the prison have suffered sexual abuse while at WCCW. A mentally ill prisoner was forced by former mental health counselor Robert Perry to perform oral sex on Perry. Perry, who has since been fired, threatened to kill her if she told anyone.

Infractions may result in monetary fines, loss of good time, segregation, extra work, cell confinement or loss of employment. Because of the threat of infraction, prisoners are discouraged from seeking out help from mental health staff. As one prisoner stated, "If I'm going asking for help and I'm punished for it, then I guess I won't ask for help anymore."

In February of this year, Dorine Crawford tried to set herself on fire using a match and nail polish remover. Though Crawford is severely mentally ill, her treatment plan had not been updated indicating her self-destructive tendencies, and she was allowed to keep the flammable materials she would later use to attempt a self-immolation in her cell. (Though, in a morose twist, her treatment plan did provide for the use of pepper spray against Crawford.) Crawford burned over 30% of her body. The prison responded by issuing Crawford a written reprimand under Rule 712.

Prisoners who threaten self-harm are placed in "one-on-one," or isolation cells. Prisoners confined to one-on-one receive either inadequate, or no mental health counseling at all. Neshelle Wood, a prisoner at WCCW, described one-on-one: "You get no counseling. They don't want to make it a reward process, is what Counselor Walls told me. You are locked back there twenty-four hours a day." Wood also said that one-on-one provokes flashbacks of childhood abuse and being locked in the closet by her abuser.

Prisoners with self-harming impulses may also be placed in segregation, a unit with numerous design features that could be, and have been used in suicide attempts. With "modesty walls" to hide behind, and sprinklers to hang themselves on, prisoners with self-destructive tendencies are routinely placed in this particularly dangerous environment. When Cassandra Taylor tried to hang herself in segregation, unit sergeant Hope Counts made no attempt to intervene, but instead left the unit, returning an hour later to film Taylor cutting herself.

Nineteen-year-old Naomi Riojas also attempted to hang herself in segregation. Though WCCW psychologist Michael Robbins admitted that "extended stays in seg appear to be difficult for Riojas," she nevertheless was placed in segregation, despite repeated objections by her counselor.

Most acts of self-harm at WCCW involve razors which are distributed at the prison. WCCW saw a 111% increase in self-harm incidents involving razors between 1997-1998. In response, Superintendent Payne convened a "Razor Consideration Group" to evaluate whether double-edged razors should be eliminated from the prison. Payne overruled the Group's recommendation that razors be eliminated from the institution, and has allowed razors to remain at WCCW. Payne's reasoning was that banning razors would only increase their use as contraband. In contrast, the distribution of double-edged razors was banned from men's prisons in Washington in 1995.

During the recent hearing, Superintendent Alice Payne and psychologist Michael Robbins characterized prisoners' self-harming as "manipulative," "attention-seeking" behavior. Dr. Robbins pointed to Naomi Riojas as an example of a prisoner he believes attempted suicide as a manipulative means to gain transfer out of segregation. When asked whether he realized that Ms. Riojas' suicide attempt was related to sexual harassment she suffered from a guard, Dr. Robbins responded only that he was unaware of the circumstances leading to Riojas' suicide attempt.

With the dismantling of public mental hospitals in the 1960's, and the race to incarcerate of the past two decades, prisons have become home for alarming numbers of the mentally ill. By December of 1998, 38% of the population at WCCW were on some form of psychotropic drugs, and that number appears to be on the rise. The DOC's Chuck Cummings stated that, in comparison, 8% of the men in Washington State prisons are on psychotropic drugs.

WCCW's Dr. Judith DeFelice, Dr. Jan Schaeffer and Dr. Michael Robbins, and all of the mental health experts who testified at the recent hearing concluded that staffing is inadequate to meet the needs of the population.

Despite the admission by WCCW's own staff that the prison is dangerously understaffed, and staff poorly trained or supervised, Superintendent Payne insists that WCCW offers quality health care, while alternately complaining of a lack of funds to increase psychiatric and nursing coverage.

Dental Care Courtesy of Dr. Yank

Attorneys for the women at WCCW also highlighted the prison's shoddy dental care as an example of prison's deliberate indifference to inmates' pain and suffering. Cheri Fletcher first visited WCCW's dentist Dr. Carl Weaver in October of 1998. With a vanity license plate that reads "Dr. Yank," Weaver is infamous for his fetishistic preference for extractions. When Fletcher requested a cleaning and repair of a bad enamel chip on one tooth, Weaver told her " All I do is pull them and fill them. I don't clean them; that's not my thing." Another visit to Weaver over a toothache resulted in an extraction, but of the wrong tooth. When Fletcher returned with the same toothache, Weaver constructed a bite guard for her. When Fletcher chewed through her bite guard because of the constant and continuous pain, Weaver finally pulled the tooth that Fletcher had originally indicated as the source of pain.

Mary Eastwood had 16 teeth removed in eight visits with Dr. Weaver. In trial transcripts, Eastwood stated that Weaver would ram the needle in so fast "you end up with a big sore spot worse than the tooth afterwards." And during the extractions, Dr. Weaver was "just yanking...pulling them so quickly, they are just snapping off."

After several extractions, Eastwood experienced fevers and chills. She asked if she should be taking antibiotics, but Weaver told her he didn't think it was necessary. A note written by Weaver on her chart stated, "This patient's history makes me extremely skeptical of the solidity of her complaint." When Eastwood's neck began to swell, she went to Weaver for help. Weaver told her she'd "put on a little weight." He also told her that he thought she was only visiting him because of her "drug-seeking behavior."

Months later, a visiting doctor diagnosed Eastwood's swollen neck (now with a lump as big as an orange) as the result of an infected gland due to lack of antibiotics. Eastwood now suffers from a variety of health problems related to the infection; including occasional flareups, weight loss, and the inability to eat hot and cold foods. Eastwood recently tried to commit suicide, in part because of the pain and humiliation of her experience.

With an appalling track record of medical mishaps and mayhem, it's no surprise WCCW has seen a rapid rate of turnover in its health care staff. Since 1996, there have been six different mental health supervisors, and a slew of other key mental health staff have quit--many in frustrated desperation. Dr. Linda Thomas, a former psychologist at WCCW, testified that she resigned her position because she felt "hopeless." Dr. Jan Schaeffer left WCCW after 2 ? years because of the rootlessness of mental health programming. Feeling that the program lacked a mission, Dr. Schaeffer said: "I felt I was beginning to work in a very unsafe setting."

Though health care at WCCW is undisputedly grim, the prison is by no means unique in its treatment of prisoners or staff. Columbia's staff attorney David Fathi acknowledged that--unacceptable as the health care may be at WCCW--health care at the mens' prisons in Washington is probably worse [ Editor's note: this issue of medical care in men's prisonshas been reported extensively in PLN in the past. See The Celling of America , "Dying for Attention" and accompanying side-bar. ].

The Wait

Attorneys at Columbia and the women at WCCW now wait in limbo while Magistrate Judge David Wilson ponders whether to recommend extension of judicial oversight at the prison. The plaintiffs' requests seem basic: decent health care provided with integrity. With a prison system that often runs amok if unchecked, it seems obvious that prisoners should not be dying of ulcers, their health complaints dismissed as manipulative fantasy. But behind the locked doors of American prisons, scant or non-existent oversight of prison staffs' wayward tendencies continues to provide a grim harvest of horror stories. [ Editor's note: Apparently not much. the state Department of Health recently closed the MICC infirmary due to numerous health and safety violations, we will report details in an upcoming issue of PLN .]

Tara Herival is a Seattle based free lance journalist and law student.

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Related legal case

Hallett v. Payne

The settlement and other documents from the case are in the brief bank.