When I would get sick at home, the local CVS/Pharmacy made bank. I bought NyQuil, DayQuil, ZZZQuil, Advil, Benadryl. I bought every -il in the store including Cetaphil, Massengill and Enfamil if I thought it would make me feel better. I purchased every tablet, caplet, gelcap, capsule and pellet – plus a new cherry Chapstick – each time I fell ill. It just wasn’t a cold or flu without a long, curling receipt detailing my score of home remedies, even if none of the medicines helped the virus worm its way out of me.
In hindsight, I see that it wasn’t any cold remedy or anti-congestive pills that made me feel better; it was all of the choices that the drugstore aisle afforded me. There were so many choices that I never even made one. I brought all the Robitussin’s and Coricidin’s home with me.
When that watery warning tickled the back of my throat one Saturday, I knew I was going to be illin’ without all of my –ils to soothe me. To buy any supplies in prison, an inmate must bubble in a Scan-tron order form. Then the commissary has one week to process the order and pack the purchases ready for pick-up. If my housing unit’s day for ordering commissary is Tuesday and I get sick on Wednesday and need cough syrup, I wait for the next Tuesday to order the medicine and another week to retrieve it. Whatever remedy I get my feverish little hands on today was ordered at least one week – maybe two – ago. I have no choice but to accept this system; it’s the only legitimate commerce in here.
The inmates’ Code of Penal Discipline outlaws bartering so trading something I have for something I need is, technically speaking, misconduct, so I try to stockpile medical supplies as do all Future Savers among us. The Future Spenders here at York liquidate their inmate accounts on consumables like honey buns and squeeze cheese, fuel that enables their trips to my cell door to beg for Tylenol and bacitracin to heal their nostrils after our third world toilet paper abrades them in the absence of Kleenex or Puffs. Once I saw what the toilet paper did to my nose when I was sick, I worried about what it did to our assholes; it must be killing them.
Usually after the other inmates raid me, I need the supplies I gifted out so I turn to other inmates, arrive at their cell doors to suss out some tussin cough syrup or allergy tabs. It would be nice if each inmate accumulated what she might need when cold and flu season dips in, but that’s a fantasy. Each of us gives out cold remedies to other inmates because none of us have much of a choice in controlling symptoms. Medical essentials pass around the compound, pushed on by each inmate’s individual emergencies.
For the most part, the prison health service sees patients on an emergency basis. “Sick Call” they call it, borrowing from the military but it makes it sound too much like what it is: a cattle call, permission granted to herds of women who sniffle, sneeze and sleep away their fevers to corral themselves into the outpatient medical unit and wait for the medical advice to RICE – rest, ice, constrict and elevate – everything.
“Emergency medical care is available 24 hours a day” announce signs in all housing units. Just like the words “obscene,” “reasonable” or “humorous” open themselves to a number of interpretations, emergency is in the eye of the toilet-bowl holder. Since it is what kicks in any regimen of care, everything hinges on that definition in prison.
“The difference between life and death,” a guard answers when I ask what an emergency is. But in a place with no strategy of preventive and spotty acute care, life moves closer and closer to a prisoner’s day of demise. Because inmates often don’t receive the care they need, everything is an emergency.
And even though my friend had been bleeding, spotting for months. When she sought emergency care, the guards denied her.
“Write to medical,” they ordered her, which meant to complete a “Request Form” and place it in the institutional mail system which is like sending a letter to 911. Nicole wrote and doctors told her it was nothing, probably stress. Then cancer riddled her uterus, her cervix, her ovaries; no health care provider had examined behind her ovaries where the cancer started in order to catch it in Stages One, Two or Three. When it reached Stage Four, Nicole survived total evisceration, chemotherapy, a hysterectomy and other surgeries but she eventually succumbed in the prison’s hospice on October 7, 2011.
Just a year before, another friend of mine, Deb Czarneski, dropped dead of a heart attack in the lobby of the outpatient medical unit. Her death resulted not from a lack of preventive cardiac care, but the fact that undiagnosed carcinomas in her lungs had metastasized so extensively that the metastases caused organ failure. Deb complained for months of such severe shortness of breath that she could no longer climb to her top bunk; guards threatened her with tickets for interfering with safety and security when she put her mattress on the floor to sleep. All of her written “Request Forms” had the same misdiagnoses scribbled at the bottom: asthma or walking pneumonia; no one ordered the proper scans or x-rays to reveal the tumors burgeoning in her lungs.
Nicole actually faced capital punishment for her crimes of killing jewelry store owners during robberies but the court punished Deb Czarneski for a larceny. For stealing something, she received the death penalty. When Nicole asked for “sick call” to call her for her spotting, her symptoms constituted an emergency, fitting in that spot between life and death. The same was true about Deb’s breathing; she lived in an emergency state for months.
The problems with correctional health care encompass more than woefully low funding or sub-par practitioners; ultimately, it is the lack of choice. In prison, when it comes to health care, inmates take what they get. Second opinions rarely await inmates in the Department of Correction’s examination rooms.
Incarceration must include giving up some choice because rehabilitation repays bad choices. But when punishment perverts prevention and incarceration immerses inmates in illness, we have only on choice: to expand service so as to protect all prisoners’ health. Denying options to inmates kills them.
I refused to accept the lack of choice and I was not facing a life-threatening illness. When pain in my right foot persisted for six months, APRN’s – Advanced Practice Registered Nurses, the poor man’s physicians – advised me that, as arthritis, it was untreatable and something I just needed to accept. When my walking suffered, I filed a health Services Review form which is a grievance against medical treatment and/or diagnoses. Because I grieved the fact that I needed treatment for something more than arthritis, the Health Services Review was my attempt to forge my own choice, to create options where they did not appear to exist.
The Health Services Review Coordinator nurse, a model of preventive and public health who cannot work for 30 minutes without a smoke break, met with me and said “We don’t do this,” not referring to some procedure I requested but to the fact that few people in the medical unit questioned others’ medical conclusions. She confirmed my suspicion that employees in the medical unit align themselves very tightly, at least in the face of questions and complaints from inmates and guards. I think she believed that her four words would make me go away, to limp out of her office defeated.
“Well, there’s a form and a procedure for me to question the adequacy of my treatment, so I think that you do,” I retorted to a stunned expression. I don’t speak like the other inmates. So much of what I say stuns the people who work here.
Eventually, I saw two physicians who diagnosed a neuroma in my foot which was treated with cortisone and alcohol injections. It took eight months for me to get those shots. If my foot’s neuroma squeezed into the emergency space between life and death, a toe-tag would have decorated my future.
The lack of choice for inmates’ medical care causes more than just physical distress; it also creates rancor between medical personnel and “custody staff” – guards, lieutenants, captains and the wardens. When custody staff wants to send an inmate for emergency care, nurses sometimes send her back, deciding that symptoms are not serious enough, maybe even faked. Other times, inmates appear in the medical unit with conditions so advanced that nurses pick up the phone and yell at a member of the custody corps for not dispatching the prisoner over for treatment sooner. The internal power struggle leaves medical needs unexamined and inmates like me have no choice but to stand as silent witnesses to the duels.
“I can’t believe they let her die!” cried one female guard after Deb died, a clear accusation that it was the medical staff’s fault, not the guards who might not have referred her properly or with enough priority for effective care.
“I don’t know what’s happening in that unit, but you waited too long to send her here,” a nurse was telling a C/O over the phone in a conspicious way – on the phone in the lobby of the medical unit. It makes me think it;s more theatre than concern when one of us croaks.
When that watery warning developed into a full flu crisis, I thought of asking a guard to call the medical unit for me, if only to collect another bottle of Tylenol for my fever, something it would take two weeks for me to receive from the commissary, but I didn’t. The nurses advice would do as much as all of those over-the-counter pills I used to buy, which was close to nothing. I decided I had no choice but to ride it out if it isn’t serious.
THREE IDEAS in JUSTICE REFORM FROM NOVEMBER 23-30, 2015
From Fluvanna Review: Lawsuit Spotlights Inadequate Health Care At Fluvanna Prison
“Capitated compensation” – a contract between a private healthcare provider and a correctional system whereby the provider is paid a fee for each resident of the facility and no more – can be the unofficial cause of death for prisoners.
All the fixin’s. And food in people’s pants.
From the Chicago Sun-Times: Prison “Reform” Can’t Be Revolving Door
The State of Illinois spent $69 million in fiscal year 2014, $67 million in fiscal year 2015 on prisoner re-entry services. Since July 1 of this year, the state has spent only $418,000 on services. Is Illinois headed toward more recidivism?