National Nurses United

26 S E P T E M B E R 2 0 0 5 C A L I F O R N I A N U R S E floor as a result of severe bleeding. She was taken by ambulance to an outside hospital where she finally under- went testing and was eventually told she had cervical cancer stage IIB. She was diagnosed six months after her first symp- toms. She underwent preliminary chemo- therapy and radiation and was told she needed a hysterectomy. Before the sur- gery was scheduled, she was transferred to Central California Women's Facility (CCWF) in Chowchilla. Requests to have the surgery performed prior to the trans- fer were denied. After her transfer, Gina's condition deteriorated so much that she was unable to walk or eat and was in con- tinuous, excruciating pain. And, despite promises that the surgery would be sched- uled soon, she still did not receive approval to see a specialist about the can- cer. She was not treated for the pain but was given Metamucil to treat other symp- toms. Gina Muniz never got the hysterec- tomy. Instead she was granted compassionate release in November 2000, and died 15 days later, at home, from untreated cervical cancer. Grace Ortega continues to be a pow- erful advocate for healthcare rights for women, in memory and honor of her daughter Gina. There is a saying that, "When you put a woman in prison and deny her basic care, you may wind up punishing a minor offense with a death penalty." LACK OF ACCESS TO QUALIFIED MEDICAL SPECIALTY CARE In addition to encountering problems obtaining primary healthcare, prisoners often experience significant difficulties accessing specialty care. Many prisoners wait months to see a specialist for diag- nostic evaluation and follow-up treatment. Prisoners must navigate a long and bureaucratic evaluation process in order to obtain a specialty referral. Medical providers must make due with an anti- quated referral system which fails to uti- lize a computerized monitoring and tracking mechanism. Even if approved for specialty care by the prison primary care provider, many prisoners are put on long waiting lists to see specialists who only make weekly visits to the prison, or expe- rience lengthy delays awaiting transport to outside specialists. There are additional concerns regard- ing physician credentials and qualifica- tions. The CDC admits that, "Based on review of several facilities, there appears to be an emerging pattern of inadequate and seriously deficient physician quality in CDC facilities." Examples: Physicians trained in obstetrics managing the care of HIV patients; neurosurgeons seeing patients for internal medicine problems; and the hiring of physicians with prior criminal charges, mental health disorders, alcoholism, substance abuse problems, loss of privileges, or a prior record of incompetence. Case Study No. 2 Access to Psychiatric Care In 1995, a federal court in Coleman v Wil- son found that the entire mental health system operated by the California Depart- ment of Correction was unconstitutional and that prison officials were deliberate- ly indifferent to the needs of mentally ill inmates. All 33 institutions in the CDC are presently being monitored by a court- appointed special master to evaluate the CDC's compliance with the court's order. The most cogent description of the mental health crisis in today's correctional system—for all prisoners—is captured in the book Prison Madness: The Mental Health Crisis Behind Bars and What We Must Do About It. Written by Terry Kupers, MD, a forensic psychiatrist and psychology professor, the book delivers a disturbing and shocking exposé of the state of mental health. In the book, Kupers offers powerful and constructive criticism of the attitudes prison professionals hold toward inmates, the way the mentally dis- turbed are physically handled, and the woefully inadequate inpatient psychiatric or counseling services which contribute to increasing individual dysfunction. Authorities say there are two key rea- sons that more mentally ill patients are incarcerated: less tolerance for quality-of- life crimes such as aggressive panhandling and public drunkenness at the same time as many county mental health treatment centers have closed, leaving jails as the only alternative. There has also been a dramat- ic increase of suicides in county jails, pos- sibly because more mentally ill individuals are incarcerated instead of hospitalized. In November 2000, the California Lit- tle Hoover Commission issued a scathing report on mental health deficiencies in California. The report, entitled "Being There—Making a Commitment to Mental Health," recognized that as a result of poor mental health services in the community, jails have become the safety net for the mentally ill and their families at a time of crisis. The report recommended focused efforts to ensure that no one ends up in jail or prison due to inadequate mental healthcare. To improve conditions for mentally ill prisoners, the report recom- mended the establishment of a council on offenders with special needs. This coun- cil would work to identify the best treat- ment strategies for the difficult task of providing treatment in a penal institution, and to improve the transition from incar- ceration into the community. In 2001, several bills were introduced in response to the Hoover Commission's report. AB 1422 (Thomson), which would have created a state mental health advo- cacy commission and was recommended by the report as the first step towards assuring that "no one who needs care is denied access to high quality, tailored mental health services," was vetoed by the governor. SB 1059 (Perata) was signed into law. This bill established a Council on Mentally Ill Offenders, to promote cost- effective approaches to meeting the long- term needs of mental health clients in the criminal justice system. Meanwhile, more counties have hired outside contractors, the largest being Mon- terey-based California Forensic Medical Group (CFMG). The company provides inmate healthcare in 24 counties in Cali- fornia (Workers in only one of the counties CFMG operates are unionized.). CFMG estimates that 10 to 15 percent of the jail- house population has what is described as an "Axis One" diagnosis, which includes serious conditions such as major depres- sion, schizophrenia, and bipolar disorder. Anywhere from 10 to 35 percent of inmates are on psychotropic medication. The California Department of Mental Health has seven state hospitals where they treat mentally ill inmates from the CDC, a population which includes patients found Not Guilty by Reason of Insanity; patients found to be Sexually Violent Predators (SVPs); or patients who have been certified as Mentally Disordered Offenders (MDOs). They are located in Atascadero, Coalinga, Norwalk, Napa, Pat- ton, Vacaville, and Salinas. LACK OF ACCESS DURING MEDICAL EMERGENCIES AND LACK OF CONTINUITY OF CARE Additional barriers to care for the Cali- fornia state prisoner include difficulty CE Home Study Course

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