CI: Prison Health Care as Punishment

Criminal InJustice is a weekly series devoted to taking action against inequities in the U.S. criminal justice system. Nancy A. Heitzeg, Professor of Sociology and Race/Ethnicity, is the Editor of CI. Criminal InJustice is published every Wednesday at 6 pm CST.

Prison Health Care as Punishment
by Kay Whitlock with introduction by nancy a heitzeg

Misrepresentations of the realities of prison life abound. These are a constant staple of media and public conversation, including unfounded claims that inmates are leading some sort of life of luxury, lifting weights, watching plasma TVs, dining finely and seeking college educations at the expense of taxpayers.

And this -- California Inmates Get Better Health Care than Ordinary Citizens: Thanks to Justice Anthony Kennedy, California prisoners have easier access to health care than ordinary citizens.

Those convicted of “non-non-non crimes”–non-serious, non-violent, non-sex related–are liable to get early release as a result of the Supreme Court’s 2010 ruling that the state must reduce prison overcrowding in order to provide adequate medical, mental and dental health care.

Petty thieves and the like can get freed and have no more claim to health care than an honest citizen.

Killers, rapists, and armed robbers, on the other hand, are free of health-care worries until they make parole, if they ever do.

The court ruled 5-4 that the absence of adequate care for prisoners violates the Eighth Amendment’s prohibition against cruel and unusual punishment. The majority decision was written by Kennedy.

In an added twist, J. Clark Kelso, the overseer of California’s effort to comply with the order was a law clerk to Kennedy in the early 1980’s. He says that he gets the same question wherever he goes: “How come we’re giving felons better health care than I get?”

Well, we aren't. California has yet to dramatically reduce over-crowding, often shuffling inmates out of state-run prisons to county jails, and despite some efforts to comply with the Supreme Court order, questions still remain as to what standards California is using to define "adequate care". In addition, the intolerable conditions of SHU confinement recently lead to a series of on-going prisoner hunger strikes and related deaths at Pelican Bay and elsewhere.

Hardly a "health care" paradise.

The reality of prison health care - throughout the nation -- is one of neglect, denial f treatment and untimely death.

In response to the false picture presented by The Daily Beast and others, CI is re-publishing a piece which outlines the on-going limitations of the oxymoron called "prison health care".

Prison Health Care as Punishment

Let’s put a human face on the issue. Her name: Victoria Arellano, a transgender woman and undocumented immigrant from Mexico who had AIDS, but was doing well on medication. Stopped on a traffic charge in 2007, she was sent to the male facility of the U.S. immigration detention center in San Pedro, California where, two months later, she died in custody at 23 years of age.

Despite repeated and increasingly desperate pleas for her life-saving medications, officials simply ignored Arellano's requests. She suffered rapid weight loss, nausea and vomiting, diarrhea, high fever and other symptoms as fellow detainees struggled to care for her with nothing more than makeshift measures and their own considerable compassion. Finally, they went on strike to demand that she receive medical care.

She was at last admitted to the infirmary where, two days later, shackled to the bed, Victoria Arellano died of an AIDS-related infection.

Later, 20 key detainee witnesses who had direct knowledge of these events were transferred out of the facility and area less than a day before a Human Rights Watch investigator arrived. A number of AIDS-related and human and civil rights organizations spoke out, demanding an investigation and Immigration and Customs Enforcement (ICE) compliance with basic standards of decent health care.

"The treatment Arellano received in San Pedro, unfortunately, is typical of what passes for healthcare at about 400 immigrant detention centers across the U.S. . .immigrant detention centers, many of which are run by private contractors, are not legally mandated to abide by any healthcare standards when it comes to treating sick immigrants."

Source: Sandra Hernandez, "A Lethal Limbo," LA Times, 6/1/08

For more information, see "Careless Detention: Medical Care in Immigrant Prisons," The Washington Post.

See also "DHS Announces 11 Previously Unreported Deaths in Immigrant Detention," 8/17/2009.

Victoria Arellano's story illustrates, in tragic detail, how the provision of "health care" in U.S. prisons, jails, juvenile "correction" facilities, and immigrant detention centers transmutes, in unspoken and unacknowledged ways, into an additional form of dehumanization and punishment for prisoners – the vast majority of whom are people of color (Native peoples, immigrants, and U.S. born) – and many of whom have some form of physical or mental disability. Because prisoners are overwhelmingly low-income and poor, and have had little or no access to adequate health care throughout their lives, many are incarcerated with already-existing problems. The longer sentences that are part and parcel of the bogus "get tough on crime" crusade from the 1970s through the 1990s is also producing an aging prisoner population (For an excellent introduction to the realities of mass incarceration in the United States, see Incarceration Nation )

In truth, prison health care represents a singular distillation of several forms of structural violence that permeate the larger society – racism, poverty, misogyny, heterosexism. Locked away out of sight and out of mind, usually in overcrowded facilities inadequately staffed and equipped to handle medical needs, prisoners bear the harshest brunt of that violence.

Throughout this discussion, I urge you to keep in mind the 8th Amendment to the U.S. Constitution: "Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted." Litigation concerning prison health care often focuses on legal debates over whether inadequate, indifferent, and incompetent health does, in fact, constitute "cruel and unusual punishment." But perhaps more to the point is the simple question of human decency, and whether any person should ever be subjected to the systemic neglect and violence described here. Unfortunately, the demonizing of "criminals" – and whole groups of people presumptively considered "criminal," such as young people of color, black men, immigrants of color – by politicians and mass media is so pervasive that many are willing to buy the idea that any brutality inflicted on prisoners is not only justifiable but desirable. The problems are further complicated by the relative lack of any effective systemic efforts to enforce such standards as do exist within the countless jurisdictions that oversee the operation of prisons, jails and other detention facilities. For example, U.S. Bureau of Prisons standards are critiqued here(caution: pdf download of academic paper), and the hedged language of the U.S. Marshals Service can be found here. An ACLU pdf download for prisoners on 8th Amendment issues is here.

The inhumanity so often embedded in prison/jail health care comes in many forms, and there are many contributing factors that produce it. Here are some snapshots.


In order to contain rapidly rising medical costs necessitated by an ever-increasing incarcerated population, a growing number of local, state, and federal governments have turned to private, for-profit “managed care” corporations to provide prisoner health services, in whole or in part. Not coincidentally, mass incarceration is essential to the profit-making potential of these companies.

Just two of the major corporations, Prison Health Services and Correctional Medical Services, provide services to a variety of facilities in (according to their websites) 41 states. Other corporations, such as The GEO Group, offer health care as part of their overall mission to design, construct, and manage jails, prisons, and other detention facilities. Despite years of lawsuits, investigative reports exposing horrific problems in South Carolina (scroll down publications page at this link to access Prescription for Disaster: Commercializing Prison Health Care in South Carolina publication), New York, Texas, Vermont, and other states, and an occasional lost contract, these companies continue to flourish.

Snapshots of Expendable Lives

Jesus Manuel Galindo, 32, died in 2008 in Reeves County complex, a large, private prison in Texas operated by The Geo Group. In custody, he requested anticonvulsant medication to address epileptic seizures. Instead, officials placed him in solitary confinement. A month later, having never seen a doctor, he was dead.

Seven young offenders at the GEO-run Coke County Juvenile Justice Center in West Texas alleged in a lawsuit that the living conditions were unfit for human habitation. An investigation by the Texas Youth Commission found vermin-infested food, filthy bedding, and feces smeared on the floor and walls. The TYC “subsequently pulled all of its nearly 200 juvenile detainees” from the Center. Source for both of the above items: Peter Gorman, “Private Prisons, Public Pain,” Fort Worth Weekly, 3/10/10

Ashley Ellis, 23, died in the Northwest State Correctional Facility in Vermont, less than two days after arriving to serve a 30-day misdemeanor sentence for a traffic accident. She had a serious eating disorder and required potassium supplements to keep her heart working. Prison Health Services personnel did not give her the prescribed medication. The autopsy listed cause of death as heart failure due to denial of access to medication. Source: Terry J. Allen, “Death by Privatization: For-profit healthcare system implicated in death of inmate,” In These Times, 12/8/09

Brian Tetrault, 44, had Parkinson’s disease and was on medication to control tremors when he was arrested for taking items from his ex-wife’s home and jailed in upstate New York in 2001. He immediately became ill and within 10 days “fell into a stupor, soaked in his own sweat and urine,” but nurses from Prison Health Services regarded him as “a faker.” His heart stopped, and jail officials doctored records to make it appear that he'd already been released when he died. Investigators discovered that the jail’s medical director had denied Tetrault most of his daily medications. Source: Paul von Zielbauer, “Harsh Medicine: As Health Care in Jails Goes Private, 10 Days Can Be a Death Sentence,” The New York Times, 2/27/10

Criminalizing & Incarcerating People with Mental Illness

In 2005, the PBS/WGBH series Frontline broadcast a program called "The New Asylums," examining the incarceration of people with mental illness in U.S. prisons and jails. The documentary confirmed what Human Rights Watch and the National Alliance on Mental Illness (NAMI) already knew: that with closure of treatment centers, hospitals, and residential facilities designed to care for people with mental illness, prisons and jails have become the primary institutions housing them – and within those institutions, the care is abysmal. The facilities and staffing are in no way appropriate or adequate to provide therapeutic or even responsible custodial care.

The program reported that "[f]ewer than 55,000 Americans currently receive treatment in psychiatric hospitals. Meanwhile, almost 10 times that number -- nearly 500,000 -- mentally ill men and women are serving time in U.S. jails and prisons." This includes people with such serious conditions as schizophrenia, clinical depression, and bipolar disorder, in addition to other illnesses. Human Rights Watch estimates that about 70,000 are psychotic on any given day; many suffer delusions and hallucinations, debilitating fears, extreme and uncontrollable mood swings. "They beat their heads against cell walls, smear themselves with feces, self-mutilate, and commit suicide."

"Conditions in jails and prisons are often terrifying for people with severe mental illnesses. These settings are not conducive to effectively treating people with these brain disorders. Many correctional facilities do not have qualified mental health professionals on staff to recognize and respond to the needs of inmates experiencing severe psychiatric symptoms. Correctional facilities frequently respond to psychotic inmates by punishing them or placing them in physical restraints or administrative segregation (isolation), responses that may exacerbate rather than alleviate their symptoms. Inmates with severe mental illnesses usually do not have access to newer, state-of-the-art, atypical antipsychotic drugs because of the costs of these medications. Federal and state prisons generally do not have adequate rehabilitative services available for inmates with severe mental illnesses to aid them in their transition back into communities.

"These alarming trends are directly related to the inadequacies of community mental health systems and services."

Source: National Alliance on Mental Illness (NAMI)

G.M.: A History of Chronic Mental Illness

G.M., a homeless man incarcerated in Los Angeles County Jail, had a long history of chronic mental illness and also had cerebral palsy, which made him wheelchair-bound. He expressed hunger when he was admitted into the jail; an employee gave him a sandwich, which another officer decided to take away.

When G.M., in his wheelchair, struggled to hold onto his food, several officers interpreted his action as hostile and resistant; they moved to physically subdue him. He was taken to a room, aggressively manhandled, taken out of his wheelchair, and forcibly placed in four-point restraints; minutes later, he died.

The medical examiner's report confirmed that G.M.'s airways were restricted by the weight of guards atop his body, and that he suffocated due to "positional asphyxia." Later, mental health professionals confirmed that the restraints were inappropriate for someone in G.M.'s condition.

Source: Ill-Equipped: U.S. Prisons and Offenders with Mental Illness, Human Rights Watch, 2003

Criminalizing Childbirth: Shackling Pregnant Women

In 2008, as the result of relentless advocacy and activism, the federal Bureau of Prisons announced a policy change barring the shackling of pregnant inmates in federal prisons in all but the most extreme circumstances.

But despite the fact that the American College of Obstetricians and Gynecologists and the American Medical Association (AMA) oppose the shackling of pregnant women in detention, the practice remains widespread.

43 states still permit the shackling of pregnant women in jails and prison during childbirth; in late March of this year, Gov. Chris Gregoire signed a bill making Washington the 7th state to restrict the shackling of pregnant prisoners. The Washington bill also prohibits the shackling of nearly all female inmates who are recovering from labor and bans the use of waist chains and leg irons at any point in pregnancy and limits restraints on pregnant prisoners who are being transported in their third trimester.

Tina Torres' Experience

In Pennsylvania, Tina Torres reports that her experience as a pregnant incarcerated woman at Riverside Correctional Facility was nightmarish - from pregancy through the 17-hour delivery and postpartum isolation. During labor, her legs were shackled together, with her left wrist handcuffed to the gurney. She needed a C-section, and the doctor at the hospital to which she was transferred insisted that the shackles from her severely swollen ankles be removed during the procedure; shackles were reapplied moments after birth. Said Torres, “I just had surgery...and I’m shackled to the bottom of the bed. When they took off my stockings, my ankles were bleeding. They were cut through..." Later, she found herself - with other new mothers – placed in a crowded unit for inmates with mental illness.

Source: Daniel Denvir, "Giving Birth in PA Prisons: A State Senator Moves to Unshackle Pregnant Inmates, Philadelphia Weekly, 1/19/10 The ACLU also publishes a summary of state standards regarding pregnancy and abortion for pregnant women.

† © Copyright 2010-2012, Nancy A. Heitzeg, Kay Whitlock, and Seeta Persaud of CMP. All rights reserved. All articles and posts published by Criminal Injustice may not be distributed, re-published or cross-posted in any format, including print or electronic format, without express and explicit written permission from the copyright holders, including CI editors (Nancy Heitzeg and Kay Whitlock) and

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