When I hear of people on the outside saying prison inmates have it made with a free place to sleep, free food and free quality medical care, I know they have never experienced the reality of what prisoners are faced with every day. It is not of my opinion that prison inmates deserve luxury, but they do deserve common decency, basic medical care and intervention as protected by the 8th Amendment under the Constitution. I would like to set the record straight.
I have been fortunate in my 17 years of wrongful incarceration that I have required very little care from the California Department of Corrections medical. In 2014, when I had a hernia, knowing the lack of quality care provided by CDCR, I dreaded the ordeal I anticipated was about to begin. I assumed it would take multiple medical appointments and about a year to have my hernia repaired, which was accurate, but I was completely unprepared for the initial obstacle I received in obtaining treatment.
“I do not feel anything” is what the Nurse Practitioner told me while examining my lower abdomen. At the time this was the Primary Care Provider for Facility 3C at California State Prison Corcoran. “If I do not see or feel your alleged hernia, I cannot refer you to be seen by the surgeon.” I was aghast. Someone who is not even a doctor or trained in medical specialty to diagnose hernias was denying me access to be seen by the medical specialist, a surgeon. The exam I had received was hostile and accusatory, as if I was lying about having a hernia and the subsequent pain.
I wake up each morning tired and sore from laying on the 1.5 inch-thick matress pad which does not fully cover the solid metal bunk I have been forced to sleep on for 17 plus years. Each night my sleep is interrupted multiple times by guards loudly passing by to conduct count at regular intervals as well as to allow the early shift workers to be let out at 4:30 am. I do not eat the food served in the dining hall. Partly because of the incredibly low nutritional value and quality of the food served, but also because of the unsanitary conditions with which it is prepared and served. The dining hall and kitchen constantly flood out from leaks in the roof, which CDCR has attempted to patch and “fix” for the past four years. The leaks continuously cause black mold to be discovered. The ceiling has open holes from which debris falls onto the dining tables and trays below, even as men are eating. The food trays are often crusted with uncleaned food remaining from previous meals. No restaurant in the US would be allowed to operate under the same conditions as a California Department of Corrections dining hall and kitchen. If the local health inspector were allowed to inspect the unsanitary conditions, which has been requested and denied, they would be shut down immediately.
As for the ‘free quality medical care’ provided to prisoners within CDCR, the truth is that California tax payers are billed for the level of quality health care that no prison inmate ever benefits from. California pays around $81,200 per inmate annually. At the same time, CDCR medical staff attempt in every way to limit or deny the treatment and care provided. Pleading with a Primary Care Provider in CDCR is akin to someone on the outside seeking approval from their insurance provider to cover the cost of cosmetic or elective surgery. Despite CDCR’s obligation to care for the human beings in their custody, they fail to do so.
One male inmate I spoke to, J.M., said “I live in constant fear of my doctor not being honest with me. I am not allowed to ask for or seek any kind of a second opinion. I am not even allowed to Google what my doctor tells me to find out if it is legit.”
J.M. also filled me in on the details of another inmate, H., whose story the occurred in 2018 adds to J.M’s fear. For nearly two years H. complained of stomach pain and had several appointments with CDCR medical staff. When H was seen by CDCR medical staff they gave him ibuprofen for his stomach pain without ever diagnosing the cause. When the pain finally became too much for H to bear, he went “man-down” which is essentially calling for emergency medical care. H. was taken by ambulance to a hospital not operated by CDCR and finally saw a non-CDCR doctor. This doctor discovered that his pancreas had failed and diagnosed him with stage-4 pancreatic cancer. I remember hearing about H’s cancer diagnosis at the time but he was transferred to a high-risk medical facility within CDCR before I was able to interview him myself. I do not know his current status, but stories of this nature and many others plague CDCR due to the lack of basic medical care provided.
Many prisoner inmates feel that CDCR medical staff do not believe them when they seek care and report symptoms. In my own experience seeking care for my hernia, this was true. Some CDCR staff will even admit they believe most prisoner inmates are attempting to ‘game the system’ and lie in order to obtain medications. If an inmate is only seeking medication instead of treatment, perhaps suspicion is justified in those cases, however this should not be the criteria in which to follow for all medical exams.
But all inmates are openly treated with hostility and distrust by their CDCR care providers. When an inmate patient is seeking treatment, not medication, what is there to distrust? The underlying truth is that CDCR does not want to pay for the necessary treatment to provide inmates with basic levels of medical care.
A clear example of an inmate-patient being denied required treatment is S.D. who has severe nerve damage in his neck and left shoulder caused by degenerative disc disease. S.D. has compressed 2,3,4 and 5 vertebras with mild compression of his spinal cord. This man lives in constant pain with his head tilted far to the left as if her is looking at everyone sideways. For the past 22 months S.D. has sought treatment from CDCR with no results.
During this time S.D was sent for various medical evaluations and appointments This began with 8 weeks of physical therapy concluding with the physical therapist stating there is nothing physical therapy can do to help him. D.S. was finally sent to see a neurosurgeon to evaluate his neck. The neurosurgeon determined that if S.D’s shoulder was repaired first, it would alleviate stress on his neck and minimize the amount of corrective neurosurgery needed. S.D. was then sent to an orthopedic surgeon on May 23, 2019 to evaluate his shoulder. The orthopedic surgeon recommended “The only surgical treatment for the shoulder would be total shoulder replacement.” This surgeon then referred him back to the neurosurgeon to have his “cervical spine issues addressed first” On July 18, 2019 S.D was back before the neurosurgeon who asked him why he was back without his shoulder being fixed. The neurosurgeon told S.D. that he would not operate on his neck without the orthopedic surgeon first repairing his shoulder. The neurosurgeon noted his recommendation “Patient in my opinion should have his left shoulder arthroplasty addressed first”. Continuing “Once his left shoulder arthroplasty has been performed we suggest that the patient follow up with neurosurgery if symptoms persist.”
Despite these recommendations that surgery clearly needed to be conducted to treat S.D., he has received no actual treatment to correct his “cervical spine issues” nor his “shoulder arthroplasty”. This man living in constant pain has simply been passed around within the bureaucracy of CDCR medical. Recently S.D. filed a medical appeal attempting to force CDCR medical to provide the necessary care and treatment he needs. This man is the responsibility of the State of California and deserves basic medical treatment while in CDCR’s custody. If this man’s pain were caused by CDCR’s officers it would be considered cruel and usual punishment. When CDCR fails to provide the basic levels of care to alleviate this man’s pain, that too constitutes cruel and unusual punishment.
This cycle of being constantly passed around within the CDCR medical system is not uncommon; the reason is that the CDCR medical system is not bound by the medical recommendations of outside specialists or surgeons. Seeking second, third, fourth or more recommendations looking for a cheaper treatment recommendations and passing the responsibility onto someone else is unfortunately cheaper than providing necessary treatment. And being passed from one specialist to the next is reliant on if an inmate can even get through the first hurdle of going through CDCR medical. In many instances, the overwhelming burden of persistently seeking needed care is too much for most incarcerated individuals to handle. The vast majority of prison inmates lack proper formal education and are unable to effectively navigate the bureaucracy and appeal procedures within CDCR. CDCR counts on the lack of legal understanding amongst the population, knowing that most are unable to effectively advocate for themselves.
In seeking treatment for my hernia, I was unwilling to take no for an answer. I did not care that the Nurse Practitioner had been unable to diagnose my condition or if she did not believe me. I knew I could prove to her visually the validity of my hernia. I challenged her that if my hernia would bulge out, would she refer me to the surgeon? She said she would and I told her I could go out to the yard and do pull-ups and push-ups to cause physical strain on my body, forcing the hernia to protrude out. She responded that she could not “advise” me to do that, but she would be in the clinic for another hour. I told her that she may not be advising me to do so, but she was giving me no other option. I returned to the clinic 20 minutes later with my hernia visibly bulging from my lower abdomen. With complete indifference she said “Oh, so you do actually have a hernia. I will refer you to the surgeon.”
I feared a similar experience when I saw the surgeon. My hernia was not protruding during my appointment and in an attempt to be helpful I began explaining to the surgeon that I could do push-ups to make the hernia bulge out if he needed proof. The surgeon, an outside medical professional, seemed shocked by my suggestion and said it would be completely unnecessary. I felt anxious that the surgeon would not be able to confirm my hernia and I would have to start the whole process over. Or worse, to wait for my hernia to become worse. Thankfully, my fear was unwarranted. The surgeon had me lay back on the exam table and within 10 seconds located and diagnosed my inguinal hernia. From start to finish I waited nearly a year to have my hernia repaired. And I was one of the lucky ones, my hernia experience was by far one of the better outcomes possible under the care of CDCR.
My own determination and willingness to sacrifice my body forced CDCR medical staff to acknowledge my need for treatment. Without standing up for myself and pushing beyond the limits of what anyone should be required to endure in order to receive basic medical care, CDCR would have refused me the medical treatment I legitimately needed. The surgery to repair my hernia may have been free of financial cost to me, but it was not truly free.
The unrecognized cost of inmate-patients receiving substandard care from California Department of Corrections medical comes in the form of physical deterioration to the inmate’s health by being denied necessary basic medical care while in the custody of California and CDCR. Recent studies determined that for every year a person spends incarcerated, their life expectancy is shortened by two years. This cost is far too high.
Written by Sean O’Brien
Artwork and editing by Emelia O’Brien, January 2020
*Inmate names abbreviated for confidentiality purposes