Litigation

Litigation is one strategy used to fight against the inhumane conditions inside prisons. Historically, large class action lawsuits served as a means for generating widespread systemic change; however in 1996 Congress passed the Prison Litigation Reform Act (PLRA) that severely limited prisoners' ability to seek relief in the courts. Specifically, class action lawsuits are now virtually impossible to file as a result of restrictive provisions in the PLRA.

A year before the PLRA passed, women prisoners filed a lawsuit that challenged the grossly inadequate medical care at two California state prisons. Shumate v. Wilson was a class action lawsuit filed in 1995 on behalf of California state women prisoners at Central California Women's Facility (CCWF) and California Institute for Women (CIW) who are being denied adequate medical care. The lawsuit was not for damages, but instead for "injunctive and declaratory relief" -- a change in policy and practice. In January 1998, a settlement was reached. The California Department of Corrections (CDC) agreed to make improvements in the quality of health care at CCWF.

A court-appointed assessment team made up of five experts was set up to monitor the CDC' s compliance. Two eight month periods of assessment were provided for in the agreement, and the assessment team was to report their findings to the court at the end of each period. The first report to the court in November, 1998 found the prisons out of compliance in eleven key areas.

The assessment team found near-compliance in its second report to the court. New evidence regarding tampering with medical files in preparation for the assessors' visits, Department of Health Services reports citing CCWF for failure to comply with regulations, and the CDC's failure to retest prisoners who had been received fraudulent lab results, prompted plaintiffs attorneys to submit a motion to the court on July 31, 2000 to re-open discovery in the case. That motion was denied by Judge Shubb, and the case was dismissed in August, 2000.

The following is a summary of the numerous violations of the agreement that have been reported to counsel team member by women prisoners. The information we present is based on over 190 interviews and over 75 medical chart reviews conducted between October 1998 and July 1999. All information has been documented by chart review unless otherwise indicated. Of course, allegations of failure to treat, or unsuccessful attempts to gain access to care are, by their nature, undocumentable. While there have been some improvements in the delivery of medical care, CCWF has not demonstrated a sustained pattern of reliable care as required by the settlement.

Diagnostic Follow-up

We have consistently encountered women who have waited months to obtain their test results, some with life-threatening diseases such as cancer or HIV. These cases are extraordinarily similar to the cases that led to the initial lawsuit in 1994. Because access to basic diagnostic services and treatment is still unreliable, women continue to die. We have also encountered the following scenario: a woman will present particular symptoms, her doctor will recommend further diagnostic work or a course of treatment, but the diagnostic work or treatment will be denied by the MAR Board (Medical Authorization Review). She will then receive no further treatment, without consideration of other alternatives to the denied treatment. Women with suspicious growths have had to wait 4-8 months for a biopsy; women who are losing their sight or who are experiencing stroke-like symptoms will wait for six months for a visit to a specialist; women with abnormal paps will wait over two years for a repeat pap instead of the recommended three to six months.

Skilled Nursing Facility (SNF)

It is clear that the SNF does not meet basic licensing requirements. Many women housed in the SNF are totally dependent on staff for basic hygiene, food and medical care. Based on numerous reports, it is clear to us that despite their desperate needs, they are denied necessary services and care in a manner suggesting staff indifference to their needs and basic human dignity. We enclose the California Department of Health Services, Fresno Division, Office of Licensing and Certification in #2567 Statement of Deficiencies and Plan of Correction which conclusively demonstrates that CCWF fails to meet essential standards for patient care.

While interviewing women confined to the SNF, plaintiff's attorneys and their representatives observed the following: an unpleasant odor emanating from C.B., indicating that she had not been bathed nor had she been issued a clean muumuu for a number of days; a thick yellow coating on her teeth, indicating that she had not had her teeth brushed daily. Other clients, R.B. and Y.H reported that they had not had clean mumus or been given a bath in several days. Oral report from S.W. states that a catheter had been removed but that she had not been given diapers to wear. As a result she had wet herself a number of times while she was visiting with her family in the visiting room. She would not go out on the "bathroom breaks" because if she had her visit would have been terminated when they learned that she was wet.

All of the patients interviewed agreed that they wait extraordinary lengths of time to have their call lights answered, sometimes as long as two to three hours and that SNF staff often exhibit a bad attitude when they do respond. This is especially true during the night. Also, many of the women interviewed reported receiving no water on a regular basis; these reports were confirmed by those of us who visited the SNF and saw that women had no water in their pitchers and had dry, parched lips.

Chronic Diseases

Diabetics wait for six months for blood work that is urgently needed to get their glucose levels under control; women with seizure disorder do not have their blood work done in a timely manner and necessary adjustment to their medication is delayed. There are an extraordinarily high number of women experiencing seizures due to mismanagement of their care at CCWF. We have received numerous accounts of women with head trauma, broken arms, and broken teeth because of the frequent and serious seizures they experience.

The first assessors' report highlighted the fact that "the HIV care program at CCWF was also problematic." Our interviews indicate that these previously cited deficiencies remain unaddressed. For example R.B., who suffers from AIDS, Hepatitis C, and Hodgkin's Lymphoma, noticed new growths where cancerous nodes had previously been removed in August, 1998. As of December, 1998, she had not yet seen an oncologist. She rarely receives her AIDS medication filled on time. Furthermore, she has not seen an Infectious Disease Specialist since June, 1998. D.R, who is HIV+ and has Hepatitis C, suffers from a pituitary tumor, which causes continuous headaches, pressure, and blurred vision. She also has milk discharging from her breasts, an important clinical sign in her case. She has had no radiographic monitoring, no neurological testing, no test of visual fields, nor any test of her prolactin levels.

Medication

There are numerous reports of disruption of medications. Pill line commonly lasts for two hours, which causes serious problems for women who are weak or ill. We hear repeated reports that women are threatened with disciplinaries for being late to work, even if they had been delayed on pill line. This results in many women skipping medication, which can have disastrous consequences for women with seizure disorder, diabetes, heart conditions, HIV, or other serious illnesses.

Of particular concern to us is the policy of DOT therapy for HIV medications, a change erroneously attributed by the CDC to a recommendation made by the Shumate assessors. The DOT policy seriously harms HIV + women by making it more difficult for women to receive their medication at the correct time and dosage, with or without food as directed by their doctors. Women with compromised immune systems are forced to wait in line for hours, two or three times a day; they report having to choose between eating and getting their meds. Moreover, the problems with scheduling make it extraordinarily difficult to comply with special dietary requirements such as medications that should be taken on an empty stomach or with a meal. If these women develop resistance due to the medication scheduling problems, they will seriously compromise the possibility that any drug regime will work. Many women miss one or two doses of medication a day due to poor health. This should be of concern to the assessment team, which stated in its first report to the court that "Several records indicated that insufficient doses of protease inhibitors were sometimes being ordered. Inadequate dosages of protease inhibitors can lead to unnecessary resistance to medication and a worsening of the disease process". Women have taken themselves off of medication in order to avoid the risks of taking poorly scheduled medications and developing immunity to the drugs.

Dental Services

The first Assessors' report found CCWF out of compliance in the area of dental care. Upon interviewing many prisoners and reviewing their medical charts, it is apparent that the dental care at CCWF has not improved. Problems include months-long waits for appointments, untreated dental abscesses, the inappropriate pulling of teeth, and the failure to provide dental prostheses as required. The following cases are but a few examples of women who have not had appropriate dental care.

A.J. had an infected wisdom tooth. In January, 1999, she went to dental sick call. She was given Motrin and penicillin. She was scheduled to have an extraction on 2/2/99, but it was not performed until 3/2/99 She sustained her self on a liquid diet for a month. She received no further pain medications while she awaited treatment. In March, 1999, her tooth was pulled, but she was left with "splinters" that caused lacerations on her tongue. As of April, 1999, she was still unable to chew solid foods and had difficulty speaking. C.S. is missing all her back teeth on both the top and bottom, she was told that she is not eligible for dentures; S.T. has no bottom teeth and needs a bottom plate. She has been waiting over 2 years for dental care.

Preventive Care

The first Assessors' report states: "To the extent that national guidelines reflect the community standards to which the defendants are committed to this provision of the settlement agreement, they have failed to deliver the level of prescribed preventative care." CCWF continues to operate well below the standard guidelines and has not, as directed in the first Assessors' report, reassessed their current approach to preventive care. While some women may receive a pap smear or mammogram on request, there are a significant number of documented cases of women not receiving mammograms or pap smears according to the standard of care.

Medical Technical Assistants (MTAs)

There are numerous reports of MTAs (Medical Technical Assistants) continuing to act outside the scope of their medical training. Since these reports often focus on the MTAs' refusal to treat certain prisoners, the reports are not easily documentable. However, reports are consistent and similar among prisoners. A few of the instances follow: P.M. was refused aid by an MTA in both August and September, 1998, despite her complaints of severe nausea and inability to eat. She subsequently had an emergency surgery at Madera Hospital on 11/6/98 for acute gall bladder. J.M. had a fifty-pound weight fall on her hand while working in the warehouse. An MTA, without consultation with a doctor, put her hand in a plastic splint causing it to heal incorrectly. Several weeks later, a doctor in B-yard had to "stretch" her hand in order to reform it for a different splint. Her hand has still not healed correctly and she currently only has movement of a few centimeters for two fingers.

Health Assessment

The first Assessors' report finds that "CCWF was not in compliance with the requirement that inmates be seen on a timely basis. National standards recommend that, in general inmates should have their non-emergency requests triaged within 24 hours and they should be seen by a qualified health professional within the next 24 hours (72 on weekend)."

It is a nearly universal complaint among women that the average wait to be seen by the medical department after submitting a request in the lock-box is two to three weeks. While this length of time may be "timely" and acceptable for some conditions, there are many conditions that are more urgent and need to be seen much sooner. Additionally, many women report submitting requests and not receiving any response or appointment time at all.

Plata Lawsuit Brief

In 2002, the state settled a huge class action lawsuit aimed at improving prison health care. Plata v. Davis was brought by the Prison Law Office (include link to their site www.prisonlaw.com ) on behalf of all California State prisoners with the exception of those incarcerated at Pelican Bay State Prison. LSPC was not a party to this lawsuit; however, in May 2002 we submitted objections to the settlement agreement on the grounds that it did not adequately address the unique health concerns of women prisoners. This was exemplified by the fact that the suit contained no named women plaintiffs and also failed to include any provisions for pregnancy women. LSPC will continued over the next few years to monitor the implementation if this lawsuit in the hopes of assuring that women prisoners received a community standard of medical care.