Most of the state’s prisoners die of an illness, with medical issues accounting for 89 percent of WDOC’s 677 prisoner deaths between 2001 and 2019. And that was before the COVID-19 pandemic came along to add to the state’s prisoner death count — 11 as of February 3, 2021.
“When a society makes a choice to lock somebody up, then you’re making a choice to provide for their basic needs,” noted Seattle attorney Ed Budge, who has represented prisoners and their families for 20 years. “And that includes basic, competent medical care.”
The U.S. Supreme Court declared in 1976 that prisoners have a constitutional right to medical care. But even as the national prison population dipped slightly between 2006 and 2016, the prisoner death toll increased 15 percent to 4,100, according to a February 2020 report by the federal Bureau of Justice Statistics. Not all of these deaths occurred among elderly prisoners, with one out of three under age 55.
“This is not how you treat human beings,” said Nick Allen, a staff attorney with Columbia Legal Services, a Seattle nonprofit law firm active in prison litigation. “A lot of this stuff has life or death implications. If you’re not taking it seriously, if you’re treating folks as ‘Other,’ that’s going to result in unnecessary and preventable death.”
Nothing could underscore that point better than the recent deaths of seven prisoners at WDOC’s central health-care facility at Monroe Correctional Complex, which have caught the attention of state investigators and lawmakers. To hear prison officials tell it, however, prisoners receive excellent health care.
“If it were myself, let’s say, going in there … I would feel pretty confident that we’re providing good healthcare,” said WDOC Deputy Secretary Julie Martin, the acting head of health services.
As rhetoric gives way to reality, however, WDOC’s priorities diverge sharply from those of its patients. Prison officials declare that they provide “medically necessary” care but fail to acknowledge that they define many common, debilitating medical conditions that could be easily repaired as not “medically necessary” by prison standards. And as those untreated conditions worsen, prisoners suffer needlessly.
“It’s par for the course, unfortunately, for those who are incarcerated,” said former WDOC prisoner Johnmoses Washington. “There is a belief that prisoners deserve and need to go through pain and anguish.”
Budge said that they are also much more likely than the general public to suffer from chronic medical conditions that prison officials classify as not “medically necessary” to treat.
“You have zero power to get your own healthcare. Zero power to see doctors. Zero power to get your own medications,” he noted. “And if the people who are running the (facility) decide that they’re not going to help you ... you’re pretty much at their mercy.”
WDOC Deputy Secretary Martin acknowledged this at least partially, saying:
“I don’t think any of us would say we’re providing the health care that we would love to provide to everybody, and there’s numerous reasons for that.”
Of course, the number one reason is cost. Like prison systems across the nation, WDOC has seen spending climb due to increasing health-care costs and a graying prison population. At the end of May 2020, with one month remaining in its fiscal year, WDOC’s prisoner health-care spending had already broken the record set the year before, hitting an all-time high of $183 million of its $1.1 billion annual budget.
Yet the money allocated for prisoner health care is significantly lower than what would be spent if they were enrolled in a public insurance program like Medicaid, which is where 86 percent of Washington prisoners get health care upon release.
“We don’t spend a comparable amount of money on the healthcare of people in jails and prisons as we would spend for those people when they’re in the community,” said Stern. “If you’re underfunded ... it’s just impossible to imagine that you can deliver constitutionally adequate care.”
In addition to denying care as not “medically necessary,” Stern notes that prison bureaucrats “downshift “from qualified personnel to those with lesser credentials. While a registered nurse (RN) generally holds a bachelor’s degree in nursing, allowing him to direct treatment, prisons often use a licensed practical nurse (LPN) who has undergone only a one-year certificate program.
“It’s done for financial reasons because LPNs are much less expensive than RNs or physicians,” he said.
Suzanne Cook, who chairs WDOC’s Family Council, dismisses the agency’s claimed financial woes as a lame excuse.
“Because they’re under this financial strain,” says Cook, the wife of a 62-year-old prisoner suffering a heart condition and diabetes, “they have to do what they have to do, even if its torturing people.”
Dr. Patricia David joined WDOC as medical director of quality and care management in August 2018. She was instrumental in creating a safety review system to examine incidents involving possible patient harm.
“Patient safety is the cornerstone of high-quality healthcare,” noted Dr. David. “The purpose of reviewing cases ... is to reduce risks, errors and harm to patients by understanding why, where and how adverse events are occurring and making changes in order to prevent them.”
But the safety committee, launched in May 2019, died a quick death seven months later due to complaints by prison medical directors, who manage the medical staff at each prison, according to Dr. David. She left WDOC to join the Office of the Corrections Ombuds (OCO) in March 2020.
Outside oversight efforts have not fared much better. While the state Department of Health (DOH) licenses prison medical workers, the agency has little interest in investigating prison practices, according to Rachael Seevers, an attorney with Disability Rights Washington. She began advising prisoners to file complaints with DOH. While those complaints frustrated prison health-care providers, they did not ultimately improve the situation, said Seevers.
WDOC Chief Medical Officer Dr. Sara Kariko claims that WDOC conducts internal reviews of “every single death that occurs, whether that is an unexpected death or an expected death.”
But such assurance offers cold comfort to lawmakers and grieving family members who are not allowed to see the findings. Administrators control the flow of information and impede efforts to investigate what happened, turning WDOC into something like a crashed plane’s unlocated “black box,” Budge said.
The lack of transparency surrounding the spate of Monroe deaths prompted Washington Senator Jeannie Darneille to introduce an oversight bill that would require WDOC to regularly report the circumstances of all prisoner deaths to the legislature, for the first time. It would also create an independent body to review prisoner deaths and near-fatalities. Yet WDOC opposed Darneille’s bill, calling it “unnecessary” and “over kill.”
During a January 2020 legislative hearing on the bill, Mary Jo Currey, then WDOC’s assistant secretary of Health Services, briefed lawmakers on both WDOC’s internal mortality review system and the patient safety committee. Yet she failed to mention that the latter had been terminated a month earlier, offering instead that “some of the things we have in place are already there and with a little bit of time, we can show some results.”
She also refused to show lawmakers any results of either internal review process, claiming the program is too new. When asked if she would object to the patient safety review process being formalized in statute, Currey told lawmakers she would “probably like to have a little further conversation about that.” No such conversation occurred, however, as she left WDOC two months later.
Unfortunately, Darnielle’s legislation did not receive a floor vote during the pandemic-shortened 2020 legislative session. But she said she is “quite certain” the bill will be reintroduced next session. The state has a responsibility “to learn from those deaths and to honor those who have died, in the sense that we don’t just go on without recognizing that our system can and should change,” Darnielle argued.
Perhaps the one bright spot is OCO. The state’s first independent oversight body monitoring the prison system, it was created in 2018 at the urging of Gov. Jay Inslee. Medical complaints are the type it most commonly hears. From a prison population that was 18,800 at the time, the WDOC faced an estimated 41,000 official health-care complaints in a single year.
Reviewing the January l, 2020, death of a prisoner who waited more than one year for cancer treatment that never came, OCO investigators faulted both of WDOC’s internal review processes, which cited “provider-to-provider miscommunication” as the sole issue. Left unaddressed were delays that led to the man’s death, OCO found in its July 2020 report.
But like many prison systems, WDOC may lack the will to address its health-care problems. If the legislature truly cares about preventing needless prisoner deaths, it could start by passing Senator Darneille’s oversight legislation.
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