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C A L I F O R N I A N U R S E S E P T E M B E R 2 0 0 5 25 Emergency Response: Emergency response time is extremely slow, often putting the patient's life at risk. MTA/LVNs often function as first responders to urgent care calls, and many make medical judg- ments beyond their scope of practice, leading to dire consequences. Additional- ly, there is no 24-hour on-site physician. Specialty Care: Women often experi- ence problems simply accessing primary care, thus specialty care is often even harder to obtain. Many women wait months or even years to see a specialist for diagnostic evaluation and follow-up treatment. Prisoners must navigate a long and bureaucratic evaluation process in order to obtain a specialty referral. Even if approved for specialty care, many pris- oners are put on long waiting lists to see specialists that only make weekly visits to the prison or must wait to be transported to an outside contract specialist. These delays are significant for women with time-sensitive health problems. For exam- ple, one woman waited two and a half years to see a specialist regarding lumps in her breast. Also, according to Califor- nia law, the prison health system is not required to follow any specialist's recom- mendations. Follow-up Treatment: Even if a woman succeeds in getting an appointment with a doctor, she may have to wait for weeks or months to receive follow-up testing and treatment, whether this means getting a certain type of medication, physical ther- apy, or surgical procedure. Patient Healthcare Education: The prison health system fails to empower women about health and wellness and rarely provides prevention education serv- ices and materials. Women in custody are not given any education about the side effects of the medications they take and often are not well informed of their health status. The prison has extremely limited educational materials about health con- ditions and many medical staff hold the attitude that women in custody aren't interested in their health. Treatment of Terminally Ill Women: Many terminally ill women receive terri- ble treatment, and some of these women could have avoided their terminal status had they received adequate medical care from the prison earlier. Terminally ill women are often housed in prison med- ical units where they remain isolated from other prisoners and often are denied access to their families. Women prisoners confined to these units regularly suffer abuse and mistreatment at the hands of the prison medical staff. Additionally, many women's request for compassionate release are denied by the prison system, even when they clearly meet the qualifi- cations. Reproductive Healthcare: The over- whelming majority of prisoners are men, and correctional facilities are designed around a male military model. Conse- quently, many health issues unique to women are often not addressed. Many women report that they are not receiving regular pap smears and mammograms. The California prison system does not current- ly have a policy regarding the need to employ female OB/GYNs, which forces many women to have no choice but to be seen by a male doctor. This often presents a problem because many women in prison have histories of physical and sexual abuse, and feel uncomfortable with male OB/ GYNs. Additionally, there is no policy requiring OB/GYNs to participate in Post Traumatic Stress Disorder (PTSD) training. Treatment of women with HIV/Hepati- tis C: HIV-positive women prisoners are forced to stand in long "pill lines" every day to receive their medications. Often they must stand in the scorching Central Valley summer heat or freezing winter weather, which deters them from adher- ing to their HIV medication schedules. Additionally, these women risk a poten- tial breach of confidentiality about their HIV status because they are the only pris- oners who walk away from the pill line with a small baggy of medications. For HIV-positive people, missing medication doses is very dangerous because it could make them resistant towards the medica- tions. Also, many women who are tested for Hepatitis C are not told that they are being tested, or are not informed of their test results. If they are informed of their status, they are not educated about the disease. Additionally, many Hepatitis C- positive women do not receive regular monitoring of their liver function. Those that might benefit from treatment often don't receive it. Stories from the Inside: There are numerous stories from incarcerated women who suffered because of lack of healthcare, and many other stories from surviving families about their loved ones who died as a result of denial of health- care. Grace Ortega made a special presen- tation to the Correctional Nursing Task Force about her daughter Gina Muniz. In September 1998, 27-year-old Gina Muniz, while being incarcerated at a Los Angeles County jail called Twin Towers Correctional Facility, noticed spotting between periods. When she reported the bleeding to doctors in the correctional facility, she was told it was "nerves" and was given Motrin. This went on for months, undiagnosed and untreated, resulting in her daughter collapsing on the In this environment, RNs are thwarted in their ability to act as effective patient advocates. Mostly in the state prison systems and in environments void of effective union representation, RNs themselves lack strong advocates. RNs need protection from the control of custody, medical, and nursing management and also predatory, violent, or mentally ill prisoners. These entities are quick to sacrifice the RN role as patient advocate, including the RN role in providing effective inmate/patient care that is competent and equal to current standards of nursing care in the community.