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Notes From the Unrepenitentiary: CA Prisoners Denied Medical Care

By Linda Evans

Once again the Prison Litigation Reform Act (PLRA) and federal courts have prevailed in their determination to suppress prisoners' human rights. Despite startling new evidence of records tampering, falsified medical test results, and medical neglect, U.S. District Court Judge Shubb has dismissed the Shumate v. Wilson lawsuit. Shumate was a class action brought by women prisoners with chronic and serious illnesses against the California Department of corrections (CDC), documenting medical abuses at the Central California Women's Facility in Chowchilla (CCWF) and the California Institution for Women in Corona (CIW).

The story of the Shumate case is a story of many heroic women who responded to the suffering of their sisters by taking action to fight for basic medical care in California's prisons for women. Women prisoners were dying because of medical maltreatment, misdiagnoses, denial of crucial medications, and many other forms of medical abuse. In 1994, Joann Walker, an HIV+ prisoner, began documenting the abuses of HIV+ women at CCWF. She sent their statements and testimonies to prison activists outside, who alerted the ACLU National Prison Project in Washington, D.C. Charisse Shumate, Cynthia Martin, and Marcia Bunney continued the work started by Joann (who died of AIDS related complications in July 1994) by documenting conditions and fighting for decent medical care. Through the efforts of outside activist groups like the Coalition to Support Women Prisoners in Chowchilla, the HIV/AIDS in Prison Project, the California Coalition for Women Prisoners, Legal Services for Prisoners with Children and others, demonstrations were organized outside CCWF (and later Valley State Prison for Women which opened across the street in 1995), to demand better medical care.

In 1995, the National Prison Project and Legal Service for Prison with Children took the lead in filing a federal class action lawsuit in U.S. District Court. The lawsuit did not seek monetary damages, but rather a change in policies an practice: "injunctive and declaratory relief." In January of 1998, after nearly three years of litigation, a settlement was reached which provided for two 8-month periods of extensive monitoring by a court-appointed team of five medical experts. Fifty-five separate areas were outlined for observation and evalation, with specific emphasis on improving prisoner access to medical staff, appropriate follow-up care after diagnoses, preventative care, continuity of the provision of medications and respecting the confidentiality of HIV+ women. In November 1998, at the end of the first eight months, the monitoring team found the two women's prisons out of compliance in 11 key areas. After the second monitoring period, the assessment team found the prisons "basically in compliance" in its final report to the court.

Every prisoner knows that such a report could only be the result of a serious cover-up of the ongoing medical abuse we all suffer and witness. In the Shumate case, however, indisputable evidence of the abysmal medical conditions has been uncovered just in the last two months--evidence that prompted the prisoners' attorneys to file a motion to re-open discovery in the case.

First, a lab scandal dating back to the beginning of Shumate in 1995 affected 7 of California's 33 prisons, including CCWF. On July 6, 2000, the San Francisco Chronicle revealed the BCL Clinical Laboratories had been faking test results for HIV, hepatitis, cancer, and other serious diseases. BCL had "won numerous low-bid contracts to run thousands of medical tests on state prisoners and faked the results in a scam inspectors call 'dry-Tabbing. '" The California Department of Health Services sent inspectors to BCL in a surprise raid on December 10, 1996. They found a lab full of idle and dysfunctional equipment, and ample hard evidence that the lab was simply making up test results for thousands of prisoners. The lab was immediately closed; its license was suspended in January 1997, then permanently revoked in May 1997. But the damage had been done. During the six months prior to its forced closure, BCL had billed CCWF $161,000 for thousands of medical tests including pap smears to detect cervical cancer, HIV tests, biopsies, hepatitis tests and urinalyses. Federal regulators sent the seven state prisons which had contracts with BCL notices that the "lab results may not represent an accurate diagnosis of your patients' conditions and may require immediate follow-up in the area of pap smears and HIV testing." But systematic re-testing or patient notification was never conducted at any of the prisons--gross negligence and disregard for the effects a faked HIV or cancer test might have on a person's life. Although the CDC clearly knew about the BCL lab scandal as early as 1996, it was never revealed to the court, to the Shumate attorneys, nor to any of the prisons directly affected, including the approximately 3,600 women prisoners at CCWF. This was just the beginning of the cover-up.

The second area of evidence being covered up relates directly to the Shumate monitoring process. On July 17 and 18, 2000, two members of the CCWF medical staff filed declarations with the state Inspector General's office exposing extensive tampering with the audit of medical care required by the settlement agreement. These whistleblowers described a team of four CDC employees from the central Sacramento office going through hundreds (if not all) of the medical files at the institution in the weeks before court-ordered monitors arrived. The two whistleblowers observed these four people working long hours with the medical records, making inappropriate additions and generally altering the files. They also described several incidents where a medical file was hidden, and monitors were informed that the charts were "unavailable." Monitors were misinformed and kept unaware of these alternations to the medical files--yet it was on the basis of these falsified files that monitors found CCWF and its infirmary "basically in compliance" with the requirements of the Shumate settlement.

The third area of evidence was outlined by Shumate attorneys as reason to re-open discovery in the case. On February 1, 2000, the California Department of Health Services reported widespread violations at the Skilled Nursing Facility (SNF), the inpatient care facility at CCWF. In a routine visit to review compliance with licensing requirements, inspectors found that the facility failed to implement care plans, carry out doctors' orders, provide appropriate diets, keep professional records, or "ensure that residents were treated with consideration, respect, and dignity..." The report documents that mental health patients were denied utensils to eat their meals, which forced them to tear off pieces of the styrofoam cover to pick up the food and place it in their mouths. The report uncovered one woman's death due to negligence: a patient was admitted to the SSNF with signs of end-stage liver disease on October 4, 1999. Although a doctor ordered immediate ammonia level tests, the tests weren't done until seven hours later, and test results weren't reported until two days later. On October 7, this woman was rushed to the outside hospital, where an ammonia level test indicated levels 100 times higher than normal. She died that night.

Yet despite all this evidence of continuing medical abuse and cover-up, in August, 2000, Judge Shubb ordered the Shumate case dismissed. The women plaintiffs had filed their lawsuit in 1995, well before the passage of the PLRA in 1996. Judge Shubb could have retained jurisdiction to ensure the improvements in medical care so desperately needed by California's women prisoners. Instead, he imposed the legal limitations dictated by the PLRA on the Shumate class action, specifically the two-year limit on court-ordered monitoring.

Prison Legal News reports on the horrible effects of the PLRA in nearly every issue--the Shumate case is one more devastating example of the limitations of the courts as a remedy for any of the abuses we suffer in prison. But there are other lessons that Shumate offers. The deep concern and commitment that women prisoners at CCWF and CIW showed for each other in initiating the lawsuit had a tremendous impact that cannot be erased by a court order. Medical care did improve slightly during this process-- some of these changes will be permanent. The press attention drawn to prison conditions by the demonstrations and by the lawsuit itself helped to educate the public about the specific problems faced by women in prison. TV coverage has exposed other problems in the California prison system, like the sexual abuse of women prisoners by male medical staff and guards. The publicity and community mobilization probably influence the whistleblowers in their decision to step forward. The work relationship between prison activists inside and outside succeeded in winning some changes in public policy: a few prisoners have won compassionate release, and investigative hearings on conditions of confinement and medical care for women prisoners held at two women's prisons by the California legislature this October. Perhaps the most important lesson of Shumate is that it isn't necessary for prisoners to depend solely on the courts for relief. We must make alliances with activists and mobilize our families on the outside in order to force prison officials and bureaucrats to make the changes we've been fighting for.

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