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Letter of Concern

Ref.: TG 251/32/01

Steve Cambra
Acting Director
California Department of Corrections
PO Box 942883
Sacramento, CA 95814
USA

22 May 2001

Dear Director Cambra,

I am writing to express Amnesty International’s concern about the adequacy of medical care provided to women prisoners in California, following the deaths of nine women in a short period last year. As you know, Amnesty International has received many reports in the past from prisoners and their representatives concerned about delays in access to health care and in the poor quality of medical attention they have received.

We understand that the Department of Corrections is conducting its own internal investigation into three of the deaths, and that it has sought outside medical expertise from two state universities. Serious concerns have been identified in all three of the cases under investigation and in at least one other case (Jodie Fitzgerald):

• Pamela Coffey, 46, had reportedly unsuccessfully sought medical treatment for a growth on her side. According to eyewitness accounts, on the evening of her death, Coffey was incoherent, vomiting and complained of severe abdominal pain and numbness in her legs but the MTA made light of the situation. Amnesty International is aware that outside medical investigators found "...significant problems with Pamela Coffey's medical care that might have contributed to her death" and that the MTA should have sought more help. The organization also notes that an autopsy report found that she had died of heart problems and that abnormal blood tests were apparently not followed up in the days prior to her death.
• Eva Vallario, 33, had a history of asthma that appeared to have been poorly managed by prison medical staff. Outside investigators concluded that she apparently died after choking on her vomit, and that "there is a substantial likelihood that she could have been resuscitated if she had been ventilated earlier".
• Investigators found that Stephanie Hardie, 34 -- who had an enlarged heart and apparently died of a heart attack -- should have received better treatment for her complaints of chest pain and shortness of breath.
• Jody Fitzgerald, 31, was reportedly very ill for weeks, complaining of extreme fatigue, loss of vision, weight loss, and inability to eat. As her health declined, cellmates repeatedly asked that she be seen by the medical department but custody and medical staff believed she was faking and instead sent her to the mental health unit. She died a week later. Amnesty International is urging that Jodie Fitzgerald’s case be also included in the investigation.

Amnesty International is aware that the full findings of the investigation are still pending, but there are serious concerns beyond these individual cases which are indicative of a wider problem in a number of areas, some of which were highlighted during the recent legislative hearings at Valley State Prison for Women (VSPW) and the California Institution for Women (CIW).

• Delays in medical treatment and neglect. Testimony by both experts and inmates in the recent hearings echoed the concerns raised by Amnesty International about adequacy of medical care during its visit to VSPW in 1999. Dr Nancy Stoller, medical sociologist of the University of California, who testified as an expert witness, maintained that state prison healthcare providers are still unable to provide full medical care. She cited as examples poor internal monitoring, slow grievance processes, and inadequate training. A lawsuit filed on 14 March 2001 alleges that the majority of the states’ prison infirmaries and hospitals do not meet state licensing standards for their healthcare.
• Role of the MTAs. Amnesty International has serious questions about the delivery of health care and the ability of the MTAs to respond adequately in crisis situations. Several of the women who died in the recent deaths had been "evaluated" by an MTA within hours of their death, but the MTA did not judge the cases to be serious. While the MTA may have a role to play in applying emergency first aid in a crisis, routine health care should not be based around them. Amnesty International’s expert delegate further observed that an MTA’s attitude to women prisoners waiting to see the doctor left something to be desired .
• Co-payment. Amnesty International is concerned that the fee inmates are required to pay for medical care is a disincentive to women who have little money. The organization believes that medical care and treatment, whenever necessary, should be provided free of charge, in accordance with Principle 24 of the Body of Principles for the Protection of All Persons Under Any Form of Detention or Imprisonment. (There is a bill to abolish the $5 fee for treatment.)
• Shumate Lawsuit. Amnesty International has received reports that two medical staff from the Central California Women’s Facility (CCWF) filed declarations with the state Inspector General’s office in July 2000 alleging extensive tampering with the audit of medical care required by the court agreement. This raises serious concern about the adequacy of the information made available to the court-appointed monitors in assessing whether or not the state was meeting the court orders to substantially improve medical care in California’s women’s prisons. We note that it was on the basis of these audits that the team had found the prisons "basically in compliance" in their final report to the court. Amnesty International is concerned that despite reports of continuing medical neglect and cover-up, the Shumate case was dismissed in August 2000.
• Need for independent audit. Amnesty International believes that an important element of the Shumate lawsuit is not present at VSPW: expert, independent monitoring of the implementation of the guidelines and the standard of health care. The organization considers that the medical standards should be periodically and independently monitored -- and reported on -- to ensure delivery of an appropriate level of health care.
• Role of male doctors. In its report on VSP, Amnesty International expressed concern that health care at the prison was provided exclusively by male doctors. We reported that prisoners (some of whom had a history of being sexually abused) told us they were disturbed by having necessary pelvic examinations and other intimate procedures conducted by male doctors. Others reported being subjected to unnecessary pelvic probes, but were too afraid to complain in case it affected their ability to receive care in an emergency. Since then, there have been further, serious allegations of sexual misconduct by male doctors at Valley State Prison -- including in testimonies given at the hearings. We have also been informed that as many as 83 complaints were made against two doctors at VSP -- ranging from soliciting sexual favours in exchange for medical attention to unnecessary and unwanted pelvic examinations and pap smears. One of the doctors, we understand, has been indicted on criminal charges of sexual assault.

In view of these very serious complaints, Amnesty International believes it is imperative that the CDC do more to recruit female doctors and to provide the prisoners with the option of being examined by a member of their own sex. The CDC should also review recruitment procedures to ensure that the department screens out medical practitioners who might be unsuitable for employment with prisoners in general or female prisoners in particular.

In view of these concerns, Amnesty International is calling for a permanent and independent audit process to ensure that medical standards are periodically and independently monitored. We also urge you to ensure that prison health care staff are competently and adequately trained, and that the women have access to specialist medical care, including transfer to outside facilities where such care is not available in the prison. We would also favour a health overview of prison medical services and have advocated for years that prison medical staff should be independent of the penal authorities. We should also be grateful to be informed of the outcome of the CDC’s internal investigation.

As you know, Amnesty International has other concerns regarding the treatment of women prisoners in California, including the role of male custody staff, which we will continue to raise with your department. While we welcome measures taken by the CDC to address the problem of sexual abuse in recent years, many complaints continue to be made. While the CDC has stated that sexual misconduct is not a "gender-specific issue", there is overwhelming evidence across states that the vast majority of sexual abuse involves female inmates and male staff, with far fewer complaints of this nature in institutions with the same gender staffing. We urge the CDC once again to review policy to ensure that female inmates are guarded only by female officers and that male staff operating in female facilities should always be accompanied by female officers, as required under international standards.

Amnesty International also remains extremely concerned by conditions in the Valley State Prison Security Housing Units (SHU). We consider that conditions in the unit, including the physical conditions in the cells, the 23-hour cellular confinement, lack of adequate exercise facilities and absence of any programming, are excessively punitive and fail to meet international standards for the humane treatment of prisoners. We are particularly disturbed by reports that a significant proportion of women suffering from mental health problems continue to be held in the SHU. We urge you once again to take steps to immediately remove women who are mentally ill or at risk of mental illness, and that immediate improvements are made to conditions for all women held in segregation.

Finally, we were disturbed by reports that some prisoners were treated punitively after the deaths last December: guards reportedly searched cells, confiscated medications and re-assigned women to different cells if they called for medical attention during the night. We urge you to ensure no prisoner is retaliated against or treated punitively for seeking medical attention.

I look forward to hearing from you regarding the above concerns.

Yours sincerely

Susan Lee
Acting Program Director
Americas Regional Program

cc: Senator Richard Polanco, Chairperson, Joint Committee on Prison Construction and Operations
    Assemblywoman Carole Migden, Chairperson, Assembly Committee on Appropriations
    Senator Sheila Kuehl
    Governor Gray Davis