Of Compassionate Release
by Silja J.A. Talvi
The deaths of eight female prisoners within a seven-week period at a California women's prison have sparked a new round of activist and legislative inquiry into the provision of adequate and timely medical care in the state's prison system.
No foul play is suspected in the deaths of the Central California Women's Facility (CCWF) prisoners. But the concentration of these deaths in November and December resulted in renewed insistence on the part of several San Francisco Bay Area-based prisoner advocate groups that the California Department of Corrections (CDC) must continue to improve its health care delivery system, and to provide compassionate release to terminally ill prisoners.
Among the deceased were Eva Vallario, 33, who died suddenly in a prison visiting room and Pamela Coffey, 46, who died on December 2 in front of her cellmates. Coffey's cellmates have complained that Medical Technical Assistants (guards who are also licensed vocational nurses) made fun of her pleas for assistance a half-hour before her death.
Some of the concerns expressed by prisoner advocate groups were echoed by Senator Richard G. Polanco (D-Los Angeles), Chairman of the Joint Legislative Committee on Prison Construction and Operations, who called for a special hearing on January 17 regarding the deaths. The hearing, dominated by testimony from the CDC, also allowed for public comment from some of the family members of the deceased prisoners.
In October, Sen. Polanco also oversaw hearings inside two California women's state prisons, which included extensive testimony from current and former prisoners alleging deficiencies in the quality of health care for serious and life-threatening medical conditions.
"I am extremely disturbed by the reports I have received about the inordinate number of prisoner deaths in the past month," wrote Sen. Polanco in a December 18 letter to CDC Acting Director Steve Cambra.
With a combined population of almost 7,000 prisoners, CCWF and the adjacent Valley State Prison for Women (VSPW) constitute the largest women's prison complex in the world. Having doubled in the last decade, the number of women in prisons is increasing at a much greater rate than male prisoners, a trend that has been linked to the implementation of mandatory minimum and three strikes legislation.
There are now slightly over 10,000 women imprisoned in the California state prison system, out of a total prisoner population of roughly 162,500. California has an incarceration rate of 479 prisoners per 100,000 population, compared to a nationwide rate of 426 per 100,000.
Since the early 1980s, California has been home to the largest ongoing prison-building program in the United States. The CDC's Master Plan currently predicts that the growing prisoner population will exceed maximum operating prison capacity of 177, 197 in April 2004.
According to the most recently available statistics, both CCWF and VSPW are respectively operating at 171% and 169% above design capacity.
Over the past several years, both CCWF and other California women's prisons have been criticized by such international human rights groups, which have pointed to what, they consider problems of substandard medical care. In December, Amnesty International renewed their concerns about the adequacy of medical care provided to female prisoners in California state prisons.
"What is particularly alarming now is that these deaths have come just weeks after state legislative hearings raised concerns about medical neglect at these facilities," the organization said in a press release.
A 1995 class action lawsuit, Shumate v. Wilson, accused prison administrators and medical staff at CCWF and Chino's California Institute for Women with cruel and unusual punishment and "deliberate indifference" to the health needs of prisoners. In 1997, the state of California agreed to institute significant changes in the health care system and submit to court-ordered monitoring, without admitting wrongdoing. In August 2000, the suit was dismissed with the agreement of all parties involved.
Following the recent deaths, the CDC launched its own, internal investigation, in addition to hiring a team of clinicians to examine medical records of three, so-called "unexpeccted deaths." The remaining deaths are being considered "expected" by the CDC, citing the terminal illnesses of the women before their deaths.
In two of the three "unexpected" deaths, the medical team found that prompt medical care might have prevented those deaths. According to the report obtained by AP, Dr. Kathleen A. Clanon, a UC San Francisco professor, "there were significant problems" with the way in which Coffey's ailments were handled by the MTAs.
Dr. Clanon also wrote that Vallario, who apparently died after choking on her own vomit, might have been saved by better medical treatment.
"Given that Ms. Vallario had a pulse when she was first seen by the medical team," wrote Dr. Clanon in the report, "there is a substantial likelihood that she could have been resuscitated if she had been ventilated earlier."
Reviews of medical records by UC Davis doctors placed no blame on the treatment given to the women by the MTAs.
Activist groups have demanded a completely independent, external investigation, complaining that group of doctors were selected and paid by the CDC.
"There are several investigations being undertaken looking at medical and custody issues [to look] at what staff did or didn't do, perhaps, in the events preceding the deaths," answered CDC spokesperson Terry Thornton. "We are just as anxious as everyone else to get answers ... if there is any evidence of staff misconduct, those will be dealt with appropriately."
Thornton also stressed that CCWF experiences higher annual death rates than any other women's state prison because prisoners requiring more intensive medical attention are transferred there from other facilities because of CCWF's Skilled Nursing Facility and other medical services. Last year, a total of 16 women died at CCWF. In 1999, nine women died there.
But all of the eight recent deaths cry out for close examination, according to Cynthia Chandler, an attorney and co-director of the Oakland-based Justice Network On Women, a non-profit law center that provides women prisoners with direct legal services and represents many terminally ill women seeking compassionate release.
Among the deaths of terminally ill women were that of Carolina Paredes and Michelle Wilson. Both of these women, said Chandler, suffered needless delays in treatment and should have been granted compassionate release once they became terminally ill.
Paredes, who died of metastasized cancer at the nearby Madera Community Hospital, started developing serious abdominal pains and complaining to staff at L.A. County Jail early in 1999. Paredes pleaded for medical attention and received none, said Chandler, who served as her lawyer in the final year of Paredes' life.
Transferred to CCWF in August 1999, Paredes continued to complain about serious pain, fainting and vomiting. Although a pelvic exam was performed shortly thereafter, she was not diagnosed with uterine cancer until October. The six cycles of chemotherapy, which was supported, to have been provided to her immediately were interrupted continually through February, explained Chandler, owing to the failure on the part of prison staff to transfer required bloodwork or chemotherapy drugs with Paredes to her chemotherapy visits. Finally, in May 2000, Paredes was given a terminal diagnosis of six months or less. Despite the efforts of her lawyer, compassionate release was never granted. Her family was not informed that Paredes was nearing death in a nearby community hospital. She died alone on December 14.
"This was very traumatic to her family," said Chandler. A similar set of errors, delays and failures of communication contributed to Wilson's death, alleged Chandler. Wilson, an HIV-positive woman serving a three year sentence for prostitution with extenuating circumstances, arrived at CCWF on February 10, 2000 complaining of debilitating headaches. That month, she was diagnosed with a brain tumor of unknown origin. A follow-up visit with a neurosurgeon for a comprehensive diagnosis was to be scheduled.
During the following six-month period, Wilson was transported out to see a neurosurgeon twice. Both times, explained Chandler, relevant medical files, tests and/or x-rays were left behind, and the examinations could not take place. In August, Wilson was finally diagnosed with benign meningioma, which had spread to her brain stem. Surgeons was successful in removing some of the tumor, but the growth in the brain stem proved inoperable.
Complications were to follow. Wilson, who already had an AIDS diagnosis, developed an abscess in the wound. "She was righteously very afraid of the quality of care she was getting and ... was planning on refusing any other surgeries. Her hope was to get out and have another operation done on the outside," said Chandler.
Chandler, who was actively working on trying to get compassionate release for Wilson, last spoke with her client on October 13. At that time, Wilson said that she had been told that she had less than six months to live and was going to be given a recommendation for compassionate release. In Wilson's last letter to her mother, she mentioned a surgery to remove her gallbladder and that her lung had been punctured while a central line (an alternative to an intravenous line for the delivery of fluids and medication) was being put in. She wrote of not being able to call anyone from a hospital, the name of which had been censored.
"Don't worry, I'm recovering slowly but surely," she wrote to her mother.
Then, on December 4, Wilson's mother, Sandra Crawley, received a telegram saying her daughter had `expired.'
"They never even let me know that she was going into a hospital," said Crawley, who explained that she would have wanted the opportunity to say goodbye to her 37-year-old daughter.
"[Wilson] was an incredibly smart, articulate woman who understood her health condition ... this is someone who knew how to advocate on her own behalf and had a lawyer advocating on her behalf, and yet this is how her life ended," noted Chandler.
According to CDC records, compassionate release was never, in fact, recommended for Wilson. Her death is clearly attributable to a "long-term diagnosis of infectious disease," said Thornton. "She received a community standard of care for her very complex and serious medical problems."
"Contrary to what other people say, we are interested in providing good health care [to prisoners], and if we can't give it to them, we will get them to a place where they can get it," Thornton added.
Improvements to prison medical care have been made since the CDC's Health Care Services Program was created in 1997. The program has received increased state funding every year since that time. For FY 2001-2002, the budget for prison health care stands at over 724 million dollars, out of a total CDC budget of nearly five billion dollars. Major budget adjustments for the current fiscal year will attempt to remedy the fact that many medical positions in the prison are underfunded and vacant, according to the California Governor's Budget Report.
But Thornton could not comment on issues surrounding the lack of notification of Wilson's mother each of the times that her daughter was hospitalized, and when she looked likely to die.
A detailed response to alleged mistakes made in the transference of medical files was not yet available. However, said Thornton, in one instance, Madera Community Hospital was responsible for transferring Wilson's files to the neurosurgeon."[But] we're willing to take part of the blame, I think, at least for the second time."
Prisoner advocate groups continue to point to these two cases as prime examples of situations in which compassionate release would have been warranted, and as examples of how difficult it is for terminally ill prisoners to receive commutations of their sentences.
"[Wilson] would have been an excellent candidate for compassionate release," said Judy Greenspan of California Prison Focus. "The prison could not decide whether she was "terminal" or not. Yet when it comes to official investigations of the deaths, the CDC is quick [to point out that women like her] were terminally ill and therefore not needing [further] investigation. But when it comes to trying to get these women compassionate release, they are not terminal enough."
In an ongoing case, Sherrie Chapman, a 43-year-old lifer at the California Institute for Women, has been diagnosed with mestastized breast cancer and has sued the CDC over the quality of medical care she has received.
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, 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. In January 1997, surgeons removed Chapman's left breast, but waited until late 1997 to treat worsening uterine pain. By that point, Chapman's diagnosis was uterine cancer, necessitating a hysterectomy.
Today, says Chapman's lawyer Cassie Pierson of Legal Services for Prisoners with Children, Chapman's cancer has spread to her neck in the form of a malignant growth.
In mid-January, Pierson _ who has urged compassionate release for Chapman _ received a letter from the Legal Affairs Division of the CDC stating that Chapman was not eligible for compassionate release because "her life expectancy, secondary to her carcinoma, presently exceeds six months."
Compassionate release cases have recently dwindled to their lowest point in a decade, despite state legislation in 1997 to help encourage and streamline the process. In 1995, a total of 102 cases for men and women were initiated by prison doctors, and 41 sentences for prisoners were effectively "recalled" by judges, with a total of eight female prisoners receiving compassionate release. In 1999, the year that Democratic Governor Gray Davis took office, only one woman had her sentence recalled.
The CDC could not offer an explanation as to why the number of compassionate releases had dropped down so significantly.
Although complete statistics are not yet available from the CDC on compassionate releases of female prisoners in 2000, it appears that two women were released, including Gina Muniz, a lifer who died less than a week after her release. And on January 10, Justice NOW co-director Cassandra Shaylor was able to secure the first compassionate release of 2001 for Cherri Lewis, a 46-year-old woman dying of terminal cancer. Lewis had been in prison since 1995 on robbery charges, and has joined her family (including a mother dying of cancer) to live out her remaining months.
While the case is being considered a victory, of sorts, for Lewis and her family, Shaylor notes that it is more the exception than the norm. "I attribute that to the timing. In the wake of all these deaths, [the CDC] doesn't want anyone else do die on their watch ... I hope that Cherri's [compassionate release] is a sign that the CDC is going to reverse their pattern of denying these kinds of requests."
"It's really important to point out that compassionate release is just one piece of an effective system of medical provision in a prison system," adds Shaylor. "It isn't the solution. If they were providing adequate medical care to women all along, we wouldn't end up in a situation where so many women are so seriously ill that they need to be considered for compassionate release."
Silja J.A Talvi is a Seattle-based journalist who writes frequently on prison-related issues. A version of this article first appeared in In These Times.
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