Medical Mayhem in Washington Prisons

by Tara Herivel, Free Press Contributor

In 1993, prisoner Gertrude Barrow crawled to the clinic at the Washington Corrections Center for Women (WCCW). Barrow's requests for treatment had been dismissed by health care staff, who diagnosed her ruptured peptic ulcer as a bad case of gas. When Barrow vomited on the clinic floor, a nurse tossed a towel at her, and told her to clean it up. Barrow died a few hours later.

Barrow's death served as the catalyst for a six-year legal struggle to upgrade WCCW's failing health care system from shameful to adequate.

For the past year, Seattle's Columbia Legal Services' Institutions Project, the ACLU and the Northwest Women's Law Center have waged a litigious battle with WCCW, in an attempt to extend judicial oversight over the institution's faltering health care system. The current litigation seeks to enforce a settlement agreement reached as a result of a class-action filed against WCCW in 1993 by prisoners. The '93 suit, Hallett v. Payne, sprang from a litany of health care horror stories, such as health care staff removing a prisoner's mole with a Bic lighter and a paperclip.

Barrow's death occurred during discovery for the '93 suit. Columbia Legal Services' staff attorneys David Fathi and Patricia Arthur speculate that Barrow's death led to the quick capitulation of WCCW, who settled the case immediately.

Against this backdrop of appalling medical care, a court-ordered Stipulation and Judgment was approved in '95, requiring oversight by outside medical investigators, improved health care services, and employment of qualified health care staff. This past March, attorneys from Columbia Legal Services went back to court, claiming that WCCW has virtually ignored the mandates of the Stipulation.

The central claims leveled at WCCW included haphazard mental and dental care, and second-rate supervision and training of staff. In the original complaint, attorneys for the plaintiffs also argued that WCCW provides substandard medical care. Because of procedural problems, Judge Magistrate David Wilson barred the medical complaints from the current suit.

Only eight mental health care professionals serve a population of about 730 women. Former Nursing Supervisor Pat Wiggins wrote in a memo in 1998: "with the increased hours and workload [for health care staff], I have seen increased numbers of errors and incidents reported. There is a need for concern." Wiggins also stated that medication errors quadrupled between April and October of 1998.

An investigation by the Department of Health (DOH) conducted in October of 1998 found that WCCW's failure to ensure that policies and procedures were established and implemented resulted in "errant infection control standards." For example, a temporary hire, nurse Jeanette Johnston, used the same needle on two successive patients, an incident which went unreported until one of the patients filed a grievance. The investigation also found that nurses routinely recap and reuse needles, carry needles in their pockets, and improperly dispose of needles. Within the population at the prison, seven prisoners are HIV positive: the risk taken by Johnston is mortifying.

Self-harm

Over the past year alone, there have been over 100 acts of self-harm by prisoners. Prisoner requests for mental health consultations go unanswered; or worse, prisoners' requests are rebuffed, and then they are punished for resulting acts of self-harm. Prisoner Allissa McCune testified at the hearing that when she sought help from mental health counselor Mike Walls, he told her he was too "overwhelmed with work" to talk with her. McCune attempted suicide soon after.

Justine O'Neill requested emergency help from her mental health counselor, Levette Dearmon. When O'Neill told Dearmon that she was hearing voices and struggling with suicidal thoughts, the counselor kicked O'Neill out of the office. Ms. O'Neill sat outside Dearmon's door for forty-five minutes, crying. A prisoner passing by saw O'Neill crying and wanted to help, but was told by a counselor to "just walk by." That night O'Neill cut herself with a razor in five different places. O'Neill testified that she received no counseling following her suicide attempt, but instead was slapped with a loss of ten days "good time."

Dr. Cassandra Newkirk, an independent monitor who evaluated WCCW's mental health program, noted in trial testimony that women in prison are particularly inclined toward self-harm. Newkirk explained that women in prison typically have experienced some form of sexual, physical or emotional abuse prior to incarceration, and that restraining, punishing or secluding women who have been abused retraumatizes them. WCCW psychiatrist Dr. Jan Loeken estimates that 95 percent of the women she sees at the prison have suffered some form of significant abuse.

In response to punishment or isolation, women who have been abused "will engage in self-harm behavior as a way of trying to get a sense that they are actually alive," stated Newkirk. Newkirk further observed that American women have been "...acculturated not to give up." Self-harming may either be a response to a lack of meaningful attention, or because women prisoners intend to commit suicide. "If we need attention, want attention, [we] engage in many different kinds of ways to get that attention," said Newkirk.

Some women at the prison have suffered sexual abuse while at WCCW. A mentally ill prisoner was forced by a former mental health counselor to perform oral sex. The counselor, who has since been fired, threatened to kill her if she told anyone.

Women at WCCW are typically punished for their acts of self-harm. Infractions may result in monetary fines, loss of good time, segregation, extra work, cell confinement or loss of employment. The threat of punishment discourages prisoners from seeking out help from mental health staff. As one prisoner stated, "If I'm going asking for help and I'm punished for it, then I guess I won't ask for help anymore."

In February of this year, Dorine Crawford tried to set herself on fire using a match and nail polish remover. Though Crawford is severely mentally ill, her treatment plan had not been updated indicating her self-destructive tendencies, and she was allowed to keep the flammable materials she would later use to attempt a self-immolation in her cell. Crawford burned over 30 percent of her body. The prison issued Crawford a written reprimand.

Prisoners who threaten self-harm are placed in "one-on-one," or isolation cells and receive little or no mental health counseling. Neshelle Wood, a prisoner at WCCW, described one-on-one: "You get no counseling. They don't want to make it a reward process... You are locked back there twenty-four hours a day."

Prisoners with self-harming impulses may also be placed in segregation, a unit with numerous design features that have been used in suicide attempts. With "modesty walls" to hide behind and sprinklers to hang themselves on, prisoners with self-destructive tendencies are routinely placed in this dangerous environment. When Cassandra Taylor tried to hang herself in segregation, the unit sergeant made no attempt to intervene, but instead left the unit, returning an hour later to find Taylor cutting herself.

Most acts of self-harm at WCCW involve razors which are distributed at the prison. WCCW saw a 111 percent increase in self-harm incidents involving razors between 1997-1998. In response, Superintendent Payne convened a "Razor Consideration Group" to evaluate whether double-edged razors should be eliminated from the prison. Payne overruled the Group's recommendation that razors be eliminated from the institution, and has allowed razors to remain at WCCW. Payne's reasoning was that banning razors would only increase their use as contraband. The distribution of double-edged razors was banned from men's prisons in Washington in 1995.

During the recent hearing, Superintendent Alice Payne and psychologist Michael Robbins characterized prisoners' self-harming as "manipulative," "attention-seeking" behavior. Dr. Robbins pointed to Naomi Riojas as an example of a prisoner he believes attempted suicide as a manipulative means to gain transfer out of segregation. When asked whether he realized that Ms. Riojas' suicide attempt was related to sexual harassment she suffered from a guard, Dr. Robbins responded only that he was unaware of the circumstances leading to Riojas' suicide attempt.

With the dismantling of public mental hospitals in the 1960's, and increasing incarceration in the past two decades, prisons have become home for alarming numbers of the mentally ill. Within the population at WCCW, over 60 percent of the inmates suffer from serious mental illness. 40 percent of the women at WCCW are on some form of psychotropic drugs, and that number appears to be on the rise. The Department of Corrections' Chuck Cummings stated that, in comparison, 9 percent of the men in Washington State prisons are on psychotropic drugs.

Despite the admission by WCCW's own staff that the prison is dangerously understaffed, and staff poorly trained or supervised, Superintendent Payne insists that WCCW offers quality health care, while alternately complaining of a lack of funds to increase psychiatric and nursing coverage.

Dental Care by Dr. Yank

Attorneys for the women at WCCW also highlighted the prison's shoddy dental care as an example of prison's deliberate indifference to inmates' pain and suffering. Cheri Fletcher first visited WCCW's dentist Dr. Carl Weaver in October of 1998. With a vanity plate that reads "Dr. Yank," Weaver is infamous for his extractions. When Fletcher requested a cleaning and repair of a bad enamel chip on one tooth, Weaver told her " All I do is pull them and fill them. I don't clean them; that's not my thing."

Mary Eastwood had 16 teeth removed in eight visits with Dr. Weaver. In trial transcripts, Eastwood stated that Weaver would ram the needle in so fast " you end up with a big sore spot worse than the tooth afterwards." And during the extractions, Dr. Weaver was "just yanking...pulling them so quickly, they are just snapping off."

Eastwood experienced fevers and chills. She asked if she should be taking antibiotics, but Weaver told her he didn't think it was necessary. Weaver wrote on her chart, "This patient's history makes me extremely skeptical of the solidity of her complaint." When Eastwood's neck began to swell, Weaver told her she'd "put on a little weight," and that he thought she was only visiting him because of her "drug-seeking behavior."

Months later, a visiting doctor diagnosed Eastwood's swollen neck (now with a lump as big as an orange) as the result of an infected gland due to lack of antibiotics. Eastwood now suffers from a variety of health problems related to the infection, and recently she tried to commit suicide.

With a track record of mishaps and mayhem, it's no surprise WCCW has seen a rapid rate of turnover in its health care staff. Since 1996, there have been six different mental health supervisors, and a slew of other key mental health staff have quit -- many in frustrated desperation. Dr. Linda Thomas, a former psychologist at WCCW, testified that she resigned her position because she felt "hopeless." Dr. Jan Schaeffer left WCCW after two years because of the rootlessness of mental health programming. Feeling that the program lacked a mission, Dr. Schaeffer said: "I felt I was beginning to work in a very unsafe setting."

Though health care at WCCW is awful, the prison is by no means unique in its treatment of prisoners or staff. Columbia's staff attorney David Fathi acknowledged that -- unacceptable as the health care may be at WCCW -- health care at the mens' prisons in Washington is probably worse.

Attorneys at Columbia and the women at WCCW now wait in limbo while Magistrate Judge David Wilson ponders whether to recommend extension of judicial oversight at the prison. The plaintiffs' requests seem basic: decent health care provided with integrity. With a prison system that often runs amok if unchecked, it seems obvious that prisoners should not be dying of ulcers, their health complaints dismissed as manipulative fantasy. But behind the locked doors of American prisons, scant or non-existent oversight of the prison staff's wayward tendencies continues to provide a grim harvest of horror stories.

A longer version of this article appears in Prison Legal News.