When prison illness becomes a death sentence

From The Guardian, on Feb. 16th 2012, this gruelling story about a private prison from CCA in Colorado, Bent County CF. May people outside wake up to the fact that people in prisons are Human Beings! Stop the privatising of prisons. Health care for everyone, INCLUDING people in prisons.

Two in every five inmates in US prisons have a chronic medical condition. Terrell Griswold, due for release last year, was one.

On 28 October 2010, Lagalia Afola received a phone call from the Bent County Correctional Facility, a private prison operated by the Correctional Corporation of America (CCA), informing her that her 26-year-old son, Terrell Griswold, was dead. Terrell was serving a three-year sentence for burglary and was due to be released in early 2011. Sadly for him, and for his grieving family, he never made it home.

The autopsy report stated that Terrell died as a result of “hypertensive cardiovascular disease” and that he had a clinical history of hypertension, for which he refused to take medication. His mother found this conclusion hard to accept and, after months of persistent enquiry, was finally
provided with at least some of her son’s medical records. Upon reviewing the records, she discovered that her son had been suffering from a blockage in his prostate that prevented him from urinating properly, causing chronic kidney damage, and which, she believes, ultimately
contributed to his abrupt demise.

This blockage in Terrell’s prostate was discovered on 3 December 2009 by Dr David Oba, an attending physician at the CCA prison. The doctor noted at the time that inmate Griswold reported having had problems passing urine for the past two months:

“He has the urge to void but sometimes is unable to void at all, other times he has a very weak stream but is able to void.”

The doctor also noted that he had discussed with the patient that “he may have a chronic sub-acute prostatitis”, which he planned to treat with a 30-day cycle of ciprofloxacin (Cipro). If there was no improvement he wrote that “he may need an eval [sic] with cystoscope with urology.”

According to the records seen (pdf), Terrell was never treated by an urologist during his entire stay at the CCA facility, and it appears he did not receive the Cipro for almost six months. On 27 January 2010, Terrell had a follow-up visit with a nurse. The nurse’s report of the visit reads as follows:

“I/M (inmate) to medical to discuss non-compliance re: HCTZ & Lisinopril. (Both drugs were to treat hypertension and high blood pressure). Per I/M he has the meds in cell but states he forgets to take meds. I/M agrees to take meds as ordered.”

She goes on to write:

“I/M also reports he never received Cipro for his urinary problem.” She reviews his charts and confirms that the Cipro was never ordered. Following this visit, there are several “Refusal of Treatment Medical Release Forms” dated 5, 13 and 24 February, 10 and 15 March, which appear to have been completed on Inmate Griswold’s behalf but which he “refused to sign”.

There appears to be no record of any visits with the medical team regarding his urinary complaint for several months. His next visit with a nurse (other than to deal with an issue regarding a swollen knee), according to the records I reviewed (pdf), was on 16 August 2010. The nurse notes again that “I/M non-compliant re: medication regimen. Last pick up 5/14/10.” This note is somewhat at odds with Terrell’s monthly medication records, which list all the medications he is taking each month. In May, June and July, the listed medications include HCTZ, Lisinopril and Cipro. If what the nurse stated on 16 August 2010 was true, that Griswold had not picked up his medications since 14 May 2010, then why did the records list all these medications (including Cipro) for the intervening months?

Whatever the explanation, it is clear from what followed is that Terrell Griswold’s urinary complaint never went away.

Close to midnight on 22 October 2010, Terrell declared a medical self-emergency (pdf) and was taken from his cell to the prison clinic. He complained of “diarrhea, dizziness, tingling in his fingers and feet, has an odd smell in nose like bleach or ammonia, feels like his throat is closing up, has acid reflux when awake and pain in epigrastic area.” He did not see a doctor because the doctor was not there; but the doctor did prescribe Bactrim, an antibiotic used to treat infections, over the phone. The nurse noted on her report that inmate Griswold was instructed to take his meds as ordered, told to follow up in 24-48 hours if no better, and was sent back to his cell. She ticked the box that said “no acute distress”.

On 24 October 2010, Griswold got to see the doctor. But according to the records, the doctor performed no tests, did not take a blood pressure reading, and simply wrote the words “UTI” (urinary tract infection) in the assessment section. During this period, Terrell’s cellmate later reported that he was making frequent attempts to urinate.

Three days later, on 27 October 2010, Griswold began vomiting in his cell and was sent to the nurse at 7.30pm. The nurse informed her patient that his antibiotic was making him sick. She ordered him to return to his cell and wrote: “He did not show any outward signs of distress that would have warranted he needed emergency treatment.”

Eleven hours later, at 6.30am, Terrell Griswold was found slumped over his toilet bowl, lifeless. His condition finally warranted emergency treatment (pdf) and the full capacity of the CCA’s medical team kicked in; CPR was administered, the patient was rushed to hospital, where he was pronounced dead at 7.24am. It was noted on his death certificate that his bladder was full of urine.

When a prisoner is deprived of their liberty by the state, they cannot provide themselves with food, water or medical care. For this reason, the state has to assume the responsibility for meeting those basic needs. A private prison that is run for profit has the same obligation to meet these basic needs; otherwise, the prisoner would be deprived of life, a violation of their most basic constitutional rights.

I asked Steve Owen, the senior director of public affairs for the CCA, if he felt that Terrell Griswold had been provided with adequate medical care.
He would not comment on Griswold’s specific case, citing privacy reasons, but he sent a fact sheet (pdf), which, he said, “summarizes both the scope and commitment to quality inmate healthcare services that our company provide and to which our government partners hold us
accountable.”

The fact sheet claims, among other things, that every CCA facility is equipped with a fully-staffed, state-of-the-art medical clinic, which is available for inmate access 24/7; that all care-related decisions are made solely on a medical basis, entirely independent of impact on CCA profits. It also states that CCA facilities utilize an innovative computer program that automates medical records, pill call and pharmacy services, which reduces paperwork and wait times.

Lagalia Afola wrote to Dr Leon Kelly, the coroner who performed her son’s autopsy, detailing her objection to his initial conclusion that her son had died of “hypertensive cardiovascular disease”. When he reviewed the new information, the coroner issued a revised autopsy (pdf), listing obstructive uropathy as one of the causes of death. Dr Kelly told me that he believed the successive urinary episodes led to kidney failure, which “certainly contributed to [Terrell’s] sudden cardiac death”.

At this point, however, the cause of death is of less concern to Mrs Afola than the fact of it. “My son was sentenced to three years for burglary,” she said. “It was not supposed to be a death sentence.”

According to bureau of justice statistics (pdf), around 4,000 inmates died in prison and jails (both public and private) in 2009; and over half of those deaths were illness-related. A comprehensive nationwide survey on the health and healthcare of US prisoners carried out by Harvard Medical School researchers (pdf) found that over 40% of US inmates were suffering from a chronic medical condition, a far higher rate than other Americans of similar age. Of these sick inmates, over 20% in state prisons, 68% in jails and 13.9% in federal prisons had not seen a doctor or nurse since incarceration.

One of the authors of the study, Dr Andrew Wilper, told me they did not include private prisons in their study because, to the best of his knowledge,there was no data available. In his view, he added, “the private prisons like it that way.”

Interested parties can write to:

Sadhbh Walshe
PO box 1466
New York, NY 10150
Or send an email to: sadhbh@ymail.com

http://www.guardian.co.uk/commentisfree/cifamerica/2012/feb/16/when-prison-illness-becomes-death-sentence

Colorado prisons moving 321 inmates out of lockdown

A little bit of hopeful news from a Lockdown State, already from Jan. 21st, but anyway.

By Kirk Mitchell
The Denver Post, Jan 21 2012

The Colorado Department of Corrections is transferring 321 inmates out of administrative segregation following a new directive by the department’s executive director.

Executive director Tom Clements acknowledged that the state’s prisons relied too heavily on administrative segregation. He said one of the reasons the practice should be reduced is because 97 percent of all offenders will someday be released.

Read more: Colorado prisons moving 321 inmates out of lockdown – The Denver Post http://www.denverpost.com/news/ci_19787816#ixzz1lGRg7I25

New Study: Solitary Confinement Overused in Colorado

From: SolitaryWatch:
November 18, 2011
by Jean Casella and James Ridgeway

A new report on solitary confinement in Colorado’s state prisons concluded that there are far too many inmates in round-the-clock lockdown. A series of relatively modest changes in its classification, review, and mental health treatment practices would “significantly reduce” the number of prisoners in administrative segregation, the report found. The report was funded by the National Institute of Corrections, and its authors, James Austin and Emmitt Sparkman, were involved in the dramatic reduction of solitary confinement in Mississippi’s prisons.

Alan Prendergast, who has spent more than a decade reporting on Colorado prisons for Denver’s weekly Westword, reviewed the report and provided the following summary:

A study by researchers at the National Institute of Corrections has found that Colorado’s approach to locking down its most unruly prisoners in 23-hour-a-day isolation is “basically sound” — but could be used a lot less. Instead, even as the state’s prison population is declining slightly, the use of “administrative segregation,” or solitary confinement, continues to increase.

The Colorado Department of Corrections houses close to 1,500 prisoners in “ad-seg,” about 7 percent of the entire state prison population. That’s significantly above the national average of 2 percent or less — and if you factor in the additional 670 prisoners who are in “punitive segregation” as a result of disciplinary actions, the CDOC figure is closer to 10 percent. And four out of ten of the prisoners in solitary have a diagnosed mental illness, roughly double the proportion in 1999. The state’s heavy reliance on ad-seg, including building a second supermax prison to house the overload, has put Colorado in the center of a growing national controversy over whether isolating prisoners creates more problems in the long run.

NIC researchers James Austin and Emmitt Sparkman were invited by DOC to prepare an external review of its ad-seg policies and classification system. Among other points, the pair found that the decision to send prisoners to lockdown has little review by headquarters; that “there is considerable confusion in the operational memorandums and regulations on how the administrative segregation units are to function;” that the average length of stay in isolation is about two years; and that 40 percent of the ad-seg prisoners are released directly to the community from lockdown, with no time spent in general population first.

Austin and Sparkman urge the DOC to require a mental health review before a prisoner is placed in ad-seg and to simplify the programs and phases inmates are required to complete before returning to a less restrictive prison. Even modest administrative changes would “significantly reduce” the state’s lockdown population, they claim, freeing up cells for other uses and saving the state money, since supermax prisons are more costly to operate than lower-security facilities.

For more on solitary confinement in Colorado, read our article Fortresses of Solitude.

Denver: Anarchist Black Cross Conference Organizing Underway

From: People of Color Organize

anarchist black cross Denver: Anarchist Black Cross Conference Organizing Underway
The Denver Anarchist Black Cross would like to formally invite you to a conference for North American Anarchist Black Cross chapters from August 12-14, 2011 in Denver. This is an invitation to attend this conference. Also seeking proposals for workshops, skill shares, or other activities that chapters would like to see at the conference.

The Conference is open to all ABC chapters active in North America, regardless of greater organizational affiliation.

The intention of this conference is not to create any new broader organization, but instead to have North American ABC chapters share our experiences and skills. We hope to build and strengthen social and political networks with each other to grow and strengthen the movement defense capabilities for those of us struggling in North America.

In order to create a cohesive and productive conference atmosphere, we are only inviting those actively engaged in ABC Chapters or interested in starting an ABC Chapter. The following principles of unity will work as a guiding document for who should or should not attend this conference:

1. We are anarchists. We believe in an anti-capitalist, anti-authoritarian movement to replace all predatory social, economic, and political systems with a society based upon voluntary cooperation, mutual aid, and self determination for all peoples.

2. We believe in active revolutionary struggle against the state, capitalism, and social oppression. We support actions that target those that perpetuate oppression. We believe in broad based social movements that are capable of confronting those that benefit from exploitation.

3. We are engaged in supporting members of liberation movements who have been captured by the state. We support the right of all peoples to fight against oppression and for self determination. We actively work to support those that have been captured while struggling for liberation, whether or not their politics exactly align with ours or not.

4. We wish to contribute to the greater defense of social movements. We are engaged in political prisoner or prisoner of war support, but understand this is but one facet of movement defense.

5. We will not allow infighting to further cripple our work. We will not allow past feuds, infighting, or divisions to stop us from moving forward as a movement, and figuring out ways to support each other and our joint struggles. We will not allow power struggles, internalized sexism, racism and classism to dominate and threaten our organizations and our struggles.

Registration Information – Deadline is June 1st.

Bill to Limit Solitary Confinement Introduced in Colorado Legislature

From: SolitaryWatch:

Feb. 22nd, 2011
By James Ridgeway and Jean Casella

A bill just introduced in the Colorado state legislature would place curbs on the use of solitary confinement in state prisons, especially on prisoners with mental illness. As we’ve written before, Colorado makes liberal use of solitary confinement. The practice has spurred public debate over the opening of an second costly supermax prison in the midst of a budget crisis, and over a controversial study of prisoners in the all-solitary Colorado State Penitentiary.
The new bill emphasizes the economic costs of solitary confinement as well as its human costs. The following is from a press release issued this morning by the ACLU:

A bill introduced last night in the Colorado state legislature will end the all-too-common practice of warehousing prisoners with serious mental illness in solitary confinement. The bill would require a mental health evaluation for prisoners before they are placed in solitary and permit long term isolation only in extreme situations. It also would support mental and behavioral health alternatives to solitary confinement through cost-saving mechanisms and ensure that prisoners are reintegrated into the general prison population before their community release.

The bill is the first to be introduced anywhere in the nation since the beginning of economic crisis that takes a serious look at the extraordinary cost to taxpayers of overusing solitary confinement.
“Using solitary confinement is enormously expensive, jeopardizes our public safety and is fundamentally inhumane,” said David Fathi, Director of the ACLU National Prison Project. “The vast majority of prisoners who are forced into solitary confinement eventually are released back into the community, making it imperative that we invest in proven alternatives that lead to greater rehabilitation and pave the way for successful re-entry.”

S.B. 176, introduced by Sen. Morgan Carroll (D-Aurora) and Rep. Claire Levy (D-Boulder), is a response to the growing number of inmates in Colorado prisons who have been diagnosed as mentally ill or developmentally disabled, and the staggering cost of using solitary confinement, rather than mental or behavioral health alternatives, as the default placement without regard to medical needs, institutional security or prisoner and public safety.

In Colorado, 37 percent of those in solitary confinement are prisoners with mental illness or developmental disabilities – up from 15 percent just a decade ago. The more than 1,400 Colorado inmates in solitary confinement spend 23 hours a day in isolation, for 16 months on average, at an increased additional cost of up to $21,485 per year, per inmate…

“By undermining the innate human need for social interaction, solitary confinement works against our goals as a society,” said Jessie Ulibarri, Public Policy Director for the ACLU of Colorado. “Releasing inmates directly from solitary confinement to the streets without any time to readjust to human interaction is a dangerous practice. What we want are people ready to fully integrate back into their communities, not people who are released from solitary confinement and led directly to the
prison gate, only to return again.”

A copy of the bill is available online at the following link: http://www.leg.state.co.us/CLICS/CLICS2011A/csl.nsf/fsbillcont3/A88F4FFC795C5C79872578080080E624?Open&file=176_01.pdf

And here is an editorial supporting the bill from the Boulder Daily Camera: http://www.dailycamera.com/ci_17395457?source=rss

CO: Jail Drops Postcard-Only Policy Following ACLU Lawsuit El Paso County Sheriff Agrees To Stop Suppressing Prisoners’ First Amendment Rights

Jail Drops Postcard-Only Policy Following ACLU Lawsuit
El Paso County Sheriff Agrees To Stop Suppressing Prisoners’ First Amendment Rights
December 20, 2010
(ACLU Press Release, thanks to the Real Cost of Prisons)

DENVER – The El Paso County Jail today dropped its policy of restricting prisoners’ outgoing mail to postcards. Faced with defending an unconstitutional policy before a judge at a hearing scheduled for Wednesday, county officials agreed to a preliminary injunction ending the postcard-only policy following a lawsuit by the American Civil Liberties Union and the ACLU of Colorado. Chief Judge Wiley Y. Daniel of the U.S. District Court in Denver signed the order today.

Just in time for the Christmas holiday, prisoners at El Paso County Jail – most of whom are awaiting trial and have not been convicted of any crime – will once again be permitted to send letters in sealed envelopes to their children, family members, friends and loved ones.

“Today we celebrate a victory not only for the First Amendment, but for hundreds of Colorado families,” said Mark Silverstein, ACLU of Colorado Legal Director. “The El Paso County Jail’s ‘postcard-only’ policy violated the rights of both prisoners and their correspondents. Incarcerated individuals will no longer be forced to avoid personal topics such as medical, financial or relationship issues simply because their words were in plain sight for anyone to read.”

Callie Gonzales, whose son Damian is currently in El Paso County Jail awaiting trial, looks forward to once again receiving letters from her eldest child. Ms. Gonzales, who used to receive three to four long letters a week from her son, says their correspondence has been significantly cut down under the “postcard-only” policy.

“Since the policy went into effect…our communications have been dramatically stifled,” said Ms. Gonzalez in a recent court filing. “These postcards provide only a tiny fraction of the space he was once able to fill…It is impossible for Damian and I to remain as close we were when he was able to send letters…Damian no longer sends handmade cards or drawings to his…youngest siblings who cannot read, and for whom these drawings and cards were their most direct and loving form of communication with him.”

“It shouldn’t take a federal lawsuit to allow a prisoner to write a letter to his mother,” said David Fathi, Director of the ACLU’s National Prison Project. “The El Paso County Jail did the right thing by abandoning this unconstitutional practice; we hope that other jails with ‘postcard-only’ policies will do the same without waiting for litigation.”

In recent months a number of jails around the United States, including one other jail in Colorado, have adopted “postcard-only” policies for prisoner mail. Today’s ruling is the first in a case challenging a jail “postcard-only” policy in which the prisoners were represented by counsel throughout the lawsuit.
“Beyond their clear constitutional violations, these policies are simply counter-productive,” said Rebecca Wallace, staff attorney with the ACLU of Colorado. “Letters clearly allow prisoners to maintain relationships with friends and family that will aid in their return to life after incarceration. If jail officials are serious about lowering recidivism and increasing public safety, they would do well to recognize that preserving prisoners’ rights to send letters actually protects us all.”

Today’s court order is available online at: http://aclu-co.org/case/martinez-v-maketa

ACLU and Experts Slam Findings of Colorado DOC Report On Solitary Confinement

December 4, 2010
by James Ridgeway and Jean Casella
SolitaryWatch
This press release, issued by the ACLU of Colorado this week under the headline used for this post, speaks for itself.

The ACLU of Colorado and leading forensic psychology experts are questioning the findings of a report released by the Colorado Department of Corrections (DOC) on the psychological effects of solitary confinement.  The report, titled “One Year Longitudinal Study of the Psychological Effects of Administrative Segregation,” concludes that solitary confinement does not cause mentally ill prisoners to get worse.  The ACLU noted that this conclusion, which contradicts considerable previous research and prevailing expert opinion, also poses a danger of rationalizing the continued warehousing of seriously mentally ill prisoners in “supermax” conditions that impede treatment and improvement.

Dr. Terry Kupers, one of the world’s leading experts on the psychological effects of solitary confinement, notes that “the methodology of the study is so deeply flawed that I would consider the conclusions almost entirely erroneous.  I fear that this seemingly scientific study will be used to justify the use of solitary confinement with mentally ill prisoners in the future.”  He continued, “the researchers did not even spend time talking to the subjects about their experience in supermax.  And far from finding ‘no harm,’ there were many episodes of psychosis and suicidal behavior during the course of the study – the researchers merely minimize the emotional pain and suffering because they judge the prisoners to have been already damaged before they arrived at supermax.  Further, the tests in this study are designed as accompaniments to record reviews and clinical interviews, and are not valid as stand-alone self-reports, which is how this study utilized them.  By only including prisoners who volunteered for the study and who can read at an 8th grade level or better, the researchers excluded two of the groups most likely to be adversely affected by solitary confinement: those who refuse to participate in social interaction and those unable to pass time by reading and writing.”

Dr. Stuart Grassian, a Board-Certified forensic psychiatrist and former faculty member at Harvard Medical School, was invited by the study’s authors to review their research.
“Prior to publication, I informed the researchers that their report contains several fatal flaws in methodology, particularly their decision not to analyze to data that contradicted their conclusions. DOC files record incidents of emergency psychiatric contacts (e.g. incidents of suicidal or self-destructive behavior).  Among the prisoners in solitary confinement, there were almost two incidents for every three inmates (63%), as compared to less than one incident for every ten inmates (9%) in the general population. This objective data squarely contradicts the authors’ conclusion that solitary confinement does not produce significantly more psychiatric difficulties than does general prison housing.  The authors simply declined to perform this straightforward statistical analysis, even after the oversight was explicitly pointed out.
As Dr. Grassian notes, while the study is flawed, there are some useful pieces of data. For example, it confirms that a shockingly high number of inmates in solitary confinement are suffering from serious mental illness.

“The DOC’s study confirms a scandalous and unacceptable reality: there are hundreds of seriously mentally ill prisoners who are essentially warehoused in solitary confinement under conditions that prevent them from receiving adequate treatment for their illness,” said Ray Drew, ACLU Executive Director, who recently toured seven solitary confinement units at various Colorado prisons.  “Even if the study were reliable, a proposition many experts contest, it concludes only that solitary isn’t causing further deterioration.  But that’s a far cry from meeting the DOC’s legal obligation to provide the treatment the prisoners need.”

The decision to base many of its findings upon inmates’ self-reported information is the report’s most obvious weakness. Prisoners have every incentive to downplay symptoms of mental illness and deny their suffering in order to present themselves as healthy enough to be released from solitary. Yet instead of acknowledging this basic truth, the DOC tries to turn it on its head, noting that prisoners “may have reason to exaggerate their symptoms.”

The report concludes that there was “improvement in psychological well-being across all study groups,” while at the same time noting that the official prison records—a major component of the data—were “inconsistent and incomplete.”

The report’s troubling conclusions create the very real danger that it will be used to justify the current system of solitary confinement, allowing it to operate without regard to its ineffective nature, dubious constitutionality, or cost to the taxpayer. Ultimately, well over 90% of prisoners held in solitary confinement will be released to the community. 41% are released directly from solitary confinement to the streets, after years of total isolation from human contact. They don’t last long. 68% return to prison within three years, as compared to a 50% recidivism rate in the overall prison population.

“We must address this from a public safety perspective, as well as a policy issue,” said Drew. “Furthermore, the practice of releasing prisoners directly to the streets after years of solitary confinement simply cannot continue. It is a danger to the public and an almost surefire way to guarantee that a prisoner will be returning to prison.”

EXPERT BIOS
Dr. Terry Kupers is a Board-certified psychiatrist, Institute Professor at The Wright Institute and author of Prison Madness: The Mental Health Crisis Behind Bars and What We Must Do About It.  He has served as an expert witness and monitor in class action litigation about conditions of confinement such as supermax isolation, the quality of correctional mental health care and the ramifications of sexual abuse of prisoners.  He was named “Exemplary Psychiatrist” by NAMI (National Alliance on Mental Illness) in 2005.

Dr. Stuart Grassian is a Board-certified psychiatrist and former faculty member of the Harvard Medical Schools. He has served as an expert witness in numerous lawsuits addressing solitary confinement, and his conclusions have been cited in a number of federal court decisions.  He has provided invited testimony before legislative hearings in New York State, Maine and Massachusetts.