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Prisons:3 8/23/07 8:54 AM Page 12 The revelations were less surprising to Nikki and Pat, who lived inside the California prison system for a combined total of 48 years. Because Nikki and Pat live in a small community and of the stigma attached to having served prison time, they asked that their last names remain anonymous. In an interview from their home in California's Central Valley a summer ago, Pat described how in 1995 she nearly lost her life at Central California Women's Facility (CCWF) in Chowchilla when a doctor who was giving her a cortisone shot for back pain punctured her lung. "I was walking back to my unit and I knew I felt funny. My heart was pumping," Pat said. Pat had never had a cortisone shot before. She thought the discomfort she felt was a side effect of the drug. But soon after she received the shot, she told one of the guards that she thought something was wrong. "He said, 'Cortisone shot? People would kill for one of those,' because they're so hard to get [in prison]," Pat said. Soon, she was in serious pain, and reported the situation to the officer on her cellblock who told her that if it got worse, they'd take care of it. But Pat continued to have trouble breathing. She described gasping and holding her chest. She continued to talk to medical and other personnel to get some response to her condition. Afraid for her life, she called her sister-in-law and told her to contact her lawyer. For six days Pat's condition deteriorated. She continued to ask for help from officers, doctors, and counselors. Twice, when she was taken to the prison ER, the doctor never came. When Pat told the Medical Technical Assistant (MTA)—a hybrid position of a licensed vocational nurse and a correctional officer that's being phased out of the system—that she was seeing bursts of light, the MTA said, "Oh, are you seeing angels now?" Pat was then returned to the general population. Later she learned the bursts were likely caused by lack of oxygen. Finally, a doctor admitted Pat to the prison infirmary because the doctor said Pat was making "everyone nervous." By the time she reached the infirmary, Pat said she was turning grey from lack of oxygen. On the seventh day after her first complaint, the doctor took an x-ray, and on the eighth day a man showed up with a gurney and an oxygen mask to take Pat into town. "I asked him why," Pat said, "And he said, 'Don't you know? Your left lung is completely collapsed.'" Pat was taken to a hospital outside the prison where a doctor inflated her collapsed lung and wondered how her condition was allowed to go untreated for so long. "They didn't believe me," Pat told the doctor. At the time of her lung puncture, Pat's previous experiences with the prison medical system already gave her great cause for alarm. In the early 1990s she'd been a plaintiff in the Shumate vs. Wilson class action case. The Shumate lawsuit charged that the medical staff at Central California Women's Facility in Chowchilla and the California Institute for Women in Frontera displayed a "deliberate indifference" to the health concerns of prisoners to a degree that constituted cruel and unusual punishment. The suit was settled in 1997 and the state was exculpated from any wrongdoing in exchange for agreeing to upgrade the prison healthcare system. The case was named after lead plaintiff Charisse Shumate, an ardent activist for women prisoners, who in 2001 died in prison from complications of cancer, Hepatitis C, and sickle-cell anemia despite pleas from advocacy groups and her family for her compassionate 12 REGISTERED NURSE release. Shumate's case addressed the issue of medical neglect in California's prisons head on. Despite the settlement, organizations monitoring the outcome of the case, such as Legal Services to Prisoners with Children and other prisoner advocacy groups, reported in 2002 that investigations into promised improvements showed few healthcare reforms had been implemented. The Shumate case set the stage for the Plata case, the largest prison class action lawsuit in history that publicly revealed the healthcare crisis in California prisons and led to Sillen's receivership. Pat and Nikki say that prisoners who have repeatedly been denied care are forced to file lawsuits in order to survive. It can take up to two years to receive a decision from the prison internal appeals system. According to prisoners' rights organizations, many inmates suffering from debilitating or life-threatening illnesses are unable to wait for the prison's verdict regarding their complaints. Even when inmates file and win a lawsuit, Pat said, the rulings don't last for long. Despite court rulings that conditions must change, Pat and Nikki said they witnessed prison officials complying with orders for a few months or a year before conditions reverted back to the way they were before the lawsuit. According to Heidi Strupp, advocacy and litigation coordinator at Legal Services for Prisoners with Children and a member of CNA/NNOC's Statewide Correctional Nursing Advocacy Group, prisoners file lawsuits as a last resort. They also file because they're hoping for some public acknowledgement of the atrocities they've endured. "In doing this work, I find that people file lawsuits because they want validation about what happened to them," Strupp said, but she noted that the process isn't easy. "People don't get peace, justice, or validation. I've seen people go into lawsuits with so much hope. But it is incredibly difficult to file lawsuits let alone win. There is a prejudice against people in prison." Medical neglect within the closed, often defensive environment of prison, where what Strupp calls a "code of silence" thrives, is often difficult to prove. As a result, many prisoners suffer for years before they receive help. Some never receive assistance. One of the most disturbing examples of medical neglect Pat witnessed was the death of her roommate in 1996 while she was housed at CCWF in Chowchilla. The roommate's name was Minerva. She had heard that Pat's room was peaceful. "She wanted to be in our room because she needed to rest," said Pat. "She had AIDS. None of us knew it at the time." The memory was an uncomfortable one for Pat. She wished she could have saved Minerva. Though Pat was known in prison as someone who helped the new girls, and helped refer women in dire need of medical attention to attorneys whose intervention might save their lives, she couldn't shake the feeling that there was something more she could have done. "You know, when it's your roommate…" Pat began before her voice trailed off. Pat said Minerva died a slow death in Chowchilla. As Minerva grew progressively weaker, Pat and the six other women in the cell told medical officials that their roommate was desperately ill. Medical personnel told Pat to send Minerva to the clinic, but Minerva was unable to walk. One of the girls risked going into an off-limits area to another unit to get her a wheelchair, Pat said. "When we got her to medical they told us to come back at one W W W. C A L N U R S E S . O R G J U LY | A U G U S T 2 0 0 7