Greer had complained over and over that her inhaler was ineffective but her repeated pleas for help went unheeded by medical services. Twice prison guards contacted the infirmary on her behalf, but nurses said that because Greer could talk there was no medical emergency. Michelle's last minutes of life were spent sprawled on the floor of a Wisconsin prison chow hall, her hand desperately clutching an impotent inhaler. [See: Feb. 2001, PLN .]
Greer's death sparked an investigation of prison medical practices, and what the investigation found is unsettling. Wisconsin prisons fail to meet more than half of prison healthcare benchmark standards. Compared to other states with comparable populations, Wisconsin prisons have been found to be deficient in several areas.
For instance, in many Wisconsin prisons CPR-certified staff are virtually non-existent, and 24-hour health care is far below the standards of other states. Of greatest concern, however, is the huge disparity in medical staffing levels for mentally impaired prisoners throughout the system. The ratio of mentally ill prisoners to psychiatric staff at Taycheedah is 132 to 1, while at the Jackson Correctional Institution the ratio is only 14 to 1.
The Legislative Audit Bureau, created by the legislature to investigate the quality of medical care provided to prisoners, found that psychiatric patients were randomly scattered throughout the system. No coherent plan existed to distribute prisoners in a way that adequately suited their psychological needs. Furthermore, none of the Wisconsin prisons meet the standards of the American Psychological Association, which recommends at least one psychiatrist be available for every 150 patients taking psychotropic medication.
Mentally impaired prisoners are finding their way into Wisconsin prisons in ever-increasing numbers. Corrections policy that initially prohibited mentally ill prisoners from being placed in supermax prisons was surreptitiously changed. Mentally ill prisoners now make up 15 percent of the supermax population and according to the legislative report, matters are made worse by the failure of internal management "to monitor basic information about health care delivery." This lack of organization makes resource and cost control increasingly difficult. [See cover story.]
In an independent investigation, the Milwaukee Journal Sentinel documented a variety of questionable prison health practices. One prisoner who had complained of severe stomach pain for two days eventually died of a ruptured appendix. The investigation revealed that medical abuse was pervasive. The Journal Sentinel discovered an extensive list of seriously ill prisoners who had pleaded for help but were routinely ignored.
The investigation by the Legislative Audit Bureau turned up 243 unanswered prisoner requests for treatment, 105 of which were more than three weeks old. Prison officials blamed the backlog on staffing problems. Prompted by the investigation, however, the discrepancy was quickly resolved. Even so, State Auditor, Jane Mueller, verified that the state investigation "confirmed" the independent findings of the Journal Sentinel .
Among the group of legislators requesting the audit was Rep. Sheldon Wasserman (D-Milwaukee), a physician. Wasserman said that the "situation with Michelle Greer was almost bound to happen. Just having adequate health care staffing could have made a difference for her." He was concerned about the fact that Taycheedah had the lowest staffing ratios coupled with the highest number of prisoner requests for medical assistance. Wasserman did compliment prison officials on their quick response to the findings of the investigation. Specifically, 24-hour health care has since been instituted at Taycheedah. What is not mentioned is why 24-hour care was not in place to begin with.
Rep. Scott Walker (R-Wauwatosa) also tried to put a positive spin on a bad situation. He said, "The department is by no means rationalizing anything. They are trying to react and respond to the audit." Walker supposedly supports funding for 39 new health care positions, but at this point, the positions have only been given lip service. No additional funding has been provided.
The audit also found other deeply troubling issues. For one, compared to other states with similar populations and rates of growth, Wisconsin spends considerably less on health care per prisoner. Their ratio of prisoners to medical staff is also considerably lower than other states. In spite of spending more than twice as much on health care over the last five years, Wisconsin still lags far behind other states in facilities that provide 24-hour care for prisoners.
In 1997, the Wisconsin prison system spent almost one million dollars in telemedicine equipment designed to reduce prisoner's hospital trips by providing medical consultations via closed-circuit television. However, investigators found that most of the equipment has never been used.
Another cause for concern is the fact that most medication is dispensed by prison guards who have less than four hours of training. Guards are unfamiliar with the effects of the drugs they distribute and the adverse reactions that those drugs might create. Consequently, the audit "found evidence of significant underreporting" of complications caused by medication. However, under a collective bargaining agreement, guards cannot be disciplined for errors made when dispensing medication. In 1999_2000, psychiatric prescriptions rose by 60 percent, further increasing the margin for error.
The National Commission on Correctional Health Care has set 37 "essential" health care standards. Of the 37, the Wisconsin prison system meets only 14. In one case, a prisoner who had been prescribed chemotherapy was assigned to a unit where none of the medical personnel was qualified to administer the medication.
Wisconsin prisoners who are housed out of state are not faring any better. Thousands of Wisconsin prisoners are held in various facilities around the country by Corrections Corporation of America (CCA). These prisoners have also complained of medical neglect and abuse by their CCA guardians. Among the complaints raised by prisoners is a lack of adequate dental care, eye care, and treatment for prisoners with hepatitis-C. A group of diabetic prisoners claimed that they were forced to share blood-testing equipment needed to monitor their insulin levels. Yet, prison officials never bothered to determine any CCA culpability. They insist that all problems have been properly handled. The Auditors disagree. They say that at no point did health care monitors bother to determine if CCA was attempting to conform with NCCHC standards. Auditors are also seeking reimbursement from private health care vendors who have failed to maintain staffing coverage provided in their contracts.
Considering the damning nature of the Auditor's findings, changes may be on the way. However, none of these changes come in time to help Michelle Greer. Her death is a tragedy that no amount of legislation can fix. But, because of Michelle Greer, legislation has been introduced that would make the Wisconsin prison system answerable to a committee of medical professionals. In a system where one third of its population is chronically ill, this comes as a breath of fresh air.
Source: Milwaukee Journal Sentinel .
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