by Douglas Ankney

"When mom told staff something was wrong, they said to her ‘you’re fine, you’re fine’ even though there was fluid literally coming out of her belly button,” said Evangelina Perez, describing her incarcerated mother’s condition after missing another dialysis treatment. Evangelina Perez lost count of the number of times her mother, Martha Perez, called her, gasping for breath because of missed dialysis treatments for kidney failure.

The 59-year-old Martha suffered from kidney failure, diabetes, and congestive heart failure. Incarcerated at various facilities within the Federal Bureau of Prisons (BOP) since 2005 on money laundering and drug convictions, she was sent to the Federal Medical Center Carswell (“Carswell”) in 2018.

Located in Fort Worth, Texas, Carswell is the nation’s only federal medical prison for women and houses some of the sickest women in the BOP’s custody. It is also the only female BOP facility that provides in-patient dialysis—a critical and life-sustaining treatment for kidney failure. But according to lawyers, medical experts and former BOP officials, along with court and medical records, Carswell fails to provide adequate dialysis care.

The statements and records describe missed dialysis treatments, ill-informed patients, dialysis machines that break down mid-treatment, treatments cut short, treatments lacking enough clean water and other problems. Doctors reviewing court filings and allegations have said the problems described “put dialysis patients in serious danger.” The medical records and expert court testimony “raise flags about preventable—and potentially fatal—conditions arising from substandard care.”

Martha told her daughter not only of missed dialysis treatments but also of treatments cut short. As Evangelina told The Marshall Project, “I can’t even keep track of how many times … they wouldn’t complete the dialysis on them. And that was an issue, and she would call me, panicking because she [knew] how she would get if she skipped one. She would be so short of breath that her stomach would be tight from all of the fluid she was retaining.”

Alicia Elliott was another Carswell “patient” on dialysis while incarcerated for 15 months on drug charges. Elliott revealed in court records and interviews that she was “forced to miss appointments or had her treatment cut short multiple times.” In 2022 and 2023, Elliott emailed Carswell’s associate warden three times to complain about being taken off dialysis early—including one instance in which her treatment was ended abruptly because staff wanted to leave early due to icy road conditions.

Sanjuana Garcia-Ramirez began receiving dialysis treatments at Carswell in November 2023. Serving a six-year sentence on a drug conviction, she said, “I have four kids to get back home to, and it frightens me that I may not make it out of here because of the way they run dialysis.” Compared with the dialysis Garcia-Ramirez received for two years prior to incarceration, she described treatments at Carswell as “less consistent and the machines are poorly managed.”

Dr. Charles Howard, the medical director at the Federal Detention Center-Miami, said “[a] patient has to be their own advocate, and they have to be very, very, very much aware of what they need and what they have to do to manage their condition. If they’re not able to do it or they’re not properly educated, they will not do well on dialysis.”

But Stephanie Williams, a Carswell dialysis patient for eleven months, said the women starting dialysis received no education on nutrition. She explained that these women “did not know that people with kidney problems have to monitor their potassium, sodium, fluid and phosphorus levels—or risk possibly fatal complications.”

Additionally, dialysis treatments are administered via surgically installed ports. Williams explained that the Carswell patients were not told how to keep their port clean—or the importance of doing so. “Women would shower without covering up their ports and get them wet, which increases the risk for infection,” according to Williams. Additionally, an unclean port may cause sepsis which is often fatal. “It’s a lack of education,” Williams explained. “It’s not the girls’ fault. But it’s killing them.”

Martha died in June 2023 when she was one of about 15 women at Carswell receiving dialysis. Williams said, “[s]he was bad off. The week she died, she said ‘I need to see a doctor right now.’” In the days preceding Martha’s death, the BOP failed to inform her family that her deteriorated condition had resulted in her hospitalization. Martha died—alone—at the John Peter Smith hospital where she was admitted for low blood pressure following dialysis.

While records of prisoner deaths are sparse, the BOP’s mortality reviews from 2015 to April 2020 reveal that at least three women undergoing dialysis at Carswell died within that time period. All three women were transferred to Carswell specifically for medical treatment and all three contracted sepsis prior to their deaths. Dr. Howard said, “[s]epsis is far less common if staff follow the proper contamination protocols for dialysis machines.”

When asked how many Carswell dialysis patients had died since 2020, the BOP initially responded “zero.” But when confronted with Martha’s 2023 death, BOP spokesman Scott Taylor said that no one “had passed away as a result of their condition that required dialysis,” alleging that “there was no correlation between the need for dialysis and the cause of death.” Carswell incarcerates about 1,200 people and contracts with the University of North Texas Health Science Center (HSC) to provide most of its medical care. HSC, in turn, subcontracts with U.S. Renal Care of West Fort Worth to provide dialysis. But the BOP is still held responsible for the care of its prisoners.

There aren’t any records of deaths in BOP facilities available to the public. And as of this writing, the BOP had failed to honor requests from The Marshall Project for records of mortality reviews and/or the number of dialysis patients who have died at Carswell. While U.S. Renal Care oversees the dialysis treatments, the contract requires a nephrologist (a kidney specialist) be available only four hours a month—far short of the recommended “once per week to ensure that the right amount of fluid is being pulled off during dialysis.”

During dialysis, the blood is removed through the port, cleaned and then pumped back into the patient. If done properly, there should be no cramping (which is caused by removing too much fluid too quickly). But in a compassionate release declaration from former BOP warden Jason Terris on behalf of Feliza Renteria, he stated that Renteria often experienced painful cramps during dialysis and said that he “did not know if the staff at Carswell could handle the logistical and care related challenges” presented by Renteria’s condition “due to staffing shortages and lack of resources.”

However, U.S. District Judge Anthony Battaglia of the Southern District of California denied Reneteria’s bid for compassionate release because granting her motion would imply that the BOP’s “quality of care was ineffective.” Disturbingly, the multiple outside agencies that formerly monitored the quality of dialysis care at Carswell no longer do so. The contract with the Joint Commission that provided Carswell’s accreditation as a healthcare organization expired in 2020 was not renewed. The American Correctional Association (ACA) no longer audits Carswell because the Office of Inspector General had concluded the BOP was “in effect, paying the ACA to affirm [the BOP’s] own findings.” The HSC’s contract requires quarterly reports on the dialysis treatments but HSC says U.S. Renal Care is responsible for them.  

Source: The Marshall Project

Subscribe today

Already a subscriber? Login