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Healthcare As Punishment: Seeking Medical Care In Washington Prisons

This article was funded by the Marvel Cooke Fellowship. Read more about this reporting project and make a contribution to fund our fellowship budget.

About one year after the COVID-19 pandemic hit Washington State prisons, sick prisoners at Stafford Creek Correctional Center found themselves huddled into the gym to isolate from the rest of the population. 

The events that took place in that gym, organized by medical and corrections staff, provide a window into medical care in a carceral environment.

“A couple of weeks ago, I had got diagnosed with COVID,” Robert Hampton recounted from a prison phone in June 2022. “Now when I first got diagnosed, I didn’t believe I had COVID. I was telling everyone like, yo, I don’t got COVID, they’re tripping. But then they put us in the gym.”

“We get to the gym and you got all these people up in there, and they’re coughing, just hacking up and everything. And the next day I found out I did have COVID, and I could barely walk and whatnot.”

Hampton recovered in the gym, but soon more people arrived. He realized prison officials were mixing people from different housing units—raising the risk of transmitting infection between buildings in the midst of an outbreak of a highly contagious airborne virus. 

“As I started getting well, they started bringing other people in,” Hampton explained. “They bring in a couple of brothers and I know that they’re from a different unit. We’re all hanging out. We’re making prayers and everything together.”

“And then one night, they come in there about nine o’clock and they turn the field lights off,” he said. This was a surprise because typically the lights were turned off around 11pm.

“I’m just thinking like damn what the hell they doing? Then [staff] go over to one of my bros—actually they went to two of them—but they went to one of my bros. He came and told me before he left.”

“He came up and said, ‘Rob, man, they’re moving me over…. They said I got [tuberculosis].’”

This was the start of a massive and deadly tuberculosis (TB) outbreak at Stafford Creek, which would continue for months and eventually see the WADOC fined $84,400 for “reportedly failing to follow safety rules meant to stop the spread of disease” at the prison.

“He’s been in here with us for three days. We’re not even wearing a mask in there, you know—we all got COVID so we’re not wearing a mask in there—but he’s been there with us for three days. And then he comes and tells me on his way out the door that they’re moving them guys out and that he has TB.”

Hampton told the others in the gym what had just happened, but by then it was too late. Over 300 people who had been quarantining in that space had been exposed to the disease. Many had already returned to their housing units.

“They turned the gym into like a sick hall and a TB testing place,” he said, “but I don’t know… I don’t know what they do… I don’t know what they do for it. But I know this. We didn’t have it in our [housing] unit. (Well, so they said, right?) But then it started showing up in all these different places.”

“This has been going on now with this TB for months,” Hampton said with frustration. “So it’s like, yo, how did we even get to a point where we got TB and we don’t even have that under control here? How are we… how are we getting to this? You know what I mean? So they don’t care. They don’t care.”

The administration’s response to the outbreak was not one of regret and remediation but one of obfuscation.

“When they were on the news and the news media got wind of it, then they blame it all on COVID. ‘Oh, well, you know, it’s hard for us to tell…’ You know what I mean? Like we’re in a cold catch-22 up in here.”

“We have this lady named Cheryl Strange that was on TV denying a lot of stuff the other day,” Hampton said, referring to the State Secretary of Corrections who had recently been appointed to the position by Democratic Governor Jay Inslee. Strange was promoted to the position after running the Department of Social and Health Services. 

“That’s supposed to be the head of medical,” Hampton said. “That’s supposed to make these things better. And it’s like, how can you make things better if you can’t even come in here and meet with us? You got authorization to slide up in here and talk to the people, not the staff, come talk to the people, but you’re not doing that you know.”

Hampton eventually recovered in the gym and returned to his housing unit, but he said they “changed the rules up.”

“Now they be testing cats and, if a cat has COVID, they’re not even gonna tell you,” he said. “They’ll just retest you later, and then your results will come, and you’ll be like, ‘Oh the whole time I had COVID.’ So what happens to the guy that didn’t have COVID, you got COVID, and then they don’t tell you?”

“Then they had these guys sign waivers that said that, if they get COVID, they’re gonna shelter in place, whatever whatever. But they’re not even telling you if you got COVID now. See what I’m saying? So I was like, man, this is all, it’s all bad.”

Deliberate Indifference

Hampton’s story demonstrates how prison health care is designed to avoid or withhold care for as long as possible, often to the point of causing serious harm. 

Legally, prisoners are the only people in the United States who have a constitutional right to state-sponsored medical care. The Eighth Amendment is supposed to shield prisoners from cruel and unusual punishment, which includes protection against “deliberate indifference to serious medical needs.” But as Hampton’s experience indicates, such rights mean little in a system that is designed to punish instead of care.

Prisoners’ “right” to healthcare was established in a 1976 Supreme Court decision Estelle v. Gamble, which held that “deliberate indifference by prison personnel to a prisoner’s serious illness or injury constitutes cruel and unusual punishment contravening the Eighth Amendment.” At first glance, this ruling may seem capable of protecting a prisoner’s right to medical care. However, it only legislates over its absence.

Prisoners point out a number of issues with this arrangement. First, there is an enormous burden of proof placed on incarcerated people to prove “deliberate indifference.” It is easier to prove that something happened—that injury or an act of harm has taken place—than it is to prove neglect.

The second issue concerns the standard necessitated by “deliberate.” The protection presumes a degree of contact between prisoners and those for whom a standard of “deliberate indifference” would even apply. However, the prohibitive bureaucratic processes and perverse incentives inherent to the prison healthcare system ensure that there is as little contact as possible between prisoners and the healthcare system. Prisoners feel they are abandoned to either muddle through costly and complicated bureaucratic processes, or to cope with or address their medical issues collectively or on their own.

The irony of having to meet the standard of “deliberate indifference” is that to actually experience and understand the reality of prison health care is to know that there is nothing indifferent about it. Incarcerated people and their loved ones see correctional health care as intentionally callous and cruel, a system designed to make people suffer through illness, infections, chronic pain, and mental health crises in which they must plead for care with little hope of relief. 

Seeking Medical Care 

In an Inside Olympia interview shortly after the TB outbreak, Secretary of Corrections Cheryl Strange said healthcare reform is her administration’s top priority. She described the prison’s current health care model as “treatment on demand” and said that her team is working towards a “preventative care” model.

Washington prisoners take issue with Strange’s characterization of the existing system for a number of reasons. They will tell you that, because the system is so quick to deny them care and will often charge them exorbitant costs regardless of treatment, there is nothing “on demand” about it. Even if state prisoners pay the $4 copay for medical visits and are permitted to see a doctor, more often than not they are denied additional testing or a referral to a specialist. While $4 may not seem like a steep price to those on the outside, for prisoners who are indigent and supporting themselves on wages that range from $0.70 to $1.70 per hour, medical copays are often prohibitive. 

In other words, prisoners without significant outside financial support have to choose between purchasing basic food and hygiene items or seeing the doctor. For this reason, they often decide to cope with medical conditions such as high blood pressure, low blood sugar, nerve pain, bloody stools, and breaking or rotting teeth. If they see a doctor without adequate funds, they incur institutional debt. And whenever money is added to their commissary accounts, it is automatically garnished to pay off that debt.

As long as the DOC denies that these problems produce severe illness and mass death, no health care reform program will improve these conditions.

Want to get involved in the fight for health care in Washington State prisons?
Contact Lawrence Jenkins via Securus:

ID#: 306665
Stafford Creek Corrections Center (WA)

When people enter prison, they lose any prior health care coverage and are automatically enrolled in the state’s prison health care plan. In Washington, for example, prisoners are enrolled in the WA DOC Health Plan. The plan’s language makes evident that the system is designed to withhold rather than provide care while insulating the institution from lawsuits as much as possible. The first page of the plan states that the “WA DOC Health Plan is not a contract or a guarantee of services to incarcerated individuals.” In order to receive medical services, the prison must identify the issue as “medically necessary” for the patient or general health of the prison population.

Each step in the process of obtaining medical care is increasingly prohibitive. Prisoners first file a medical “kite,” on which they detail their medical, dental, or mental health needs. Of course, for many ailments, it is extremely difficult for the patient to pinpoint exactly where the pain is or describe exactly what it feels like in as much detail as a doctor needs to proceed. Nonetheless, when prisoners are later called for “sick-call,” they are only evaluated for exactly what they describe on their kite.

Prisoners can expect to be called up two-to-three days after submitting a kite. For optometry, dental, and mental health-related issues, it can take much longer. These long time horizons leave prisoners at risk not only for severe pain and discomfort, but also an increased likelihood that their conditions worsen and become harder to treat. 

When prisoners are finally summoned to sick-call, medical personnel will categorize the issue with a “level” of one, two, or three. As WA prisoner Frank Brunner describes, the level essentially determines how long somebody will have to suffer, not the amount of attention or care they will receive.

“Medical level one is emergent, necessary, life-sustaining care—a broken bone, or you’re bleeding or you’re having a heart attack,” he said. “They have to give you immediate emergent care, regardless of cost. Level two care is like a person with cancer—stage three cancer or diabetes—they know that you’re dying, but it hasn’t reached the level of number one care for it to be considered emergent. Yeah, so it’s slowly killing you is the difference.”

“And then level three care is the stuff you can’t get, like anything cosmetic,” he said. “You should see all the stuff that they just deny, you know acne, and stuff like that—cysts and tumors.”

Many prisoners do not even bother seeking care when they think the doctor will deem the issue level three. They make the assessment that the $4 copay isn’t worth being told to take Ibuprofen and drink water before being sent back to one’s cell.

Of course, any “minor” issue can become quite serious without adequate attention and care. One WA prisoner, Darrin Maiden, suffered ankle pain for over three years and racked up a bill of over $900 in an effort to get medical care. Each time he sought treatment for his pain, he paid $4 and was told to rest and take Ibuprofen. The medical staff never documented the progression of his pain, nor did they schedule follow up appointments. 

“Eventually three years go by and it’s to the point where I can’t even walk, I have to use a cane and I’m missing meals,” he said. “So I decided to go up there and look at my medical records because I wanted to know what was my medical provider putting in my medical records to explain why they wasn’t doing nothing to help me.”

“That’s when I realized he wasn’t documenting everything that I was telling him. When I told him how much pain I was in or the level of swelling… he didn’t document any of that. That’s how they’re able to get away with not doing anything for you.”

Maiden’s story demonstrates how difficult self-advocacy is, even if you can afford to rack up medical bills and bear the mental burden of seeking care in this environment. When he was able to get the X-ray needed to properly diagnose his condition, he found out that the cartilage in his ankle joint had completely deteriorated and his bones were scraping together with every step. At that point, the pain was excruciating.

For conditions deemed “level two,” WA DOC has a Care Review Committee composed of DOC medical staff from across the state. It meets weekly and decides whether care is necessary and cost-effective. If they decide it is not, it becomes nearly impossible for prisoners to get care and for families to advocate for them.

This leads to another issue toward which WA prisoners consistently point: the lack of alternatives if they are denied care or believe they are misdiagnosed.

“There is no access to a second opinion whatsoever. If you have money to pay for it yourself, maybe you can get it, but it has to be approved by the DOC,” said Brunner.

As one would expect, obtaining DOC approval is nearly impossible. However, practically speaking, there is no reason a prisoner should be denied access to a second opinion if outside family members and loved ones can organize and pay for it. Here we start to see the punitive nature of these denials. 

Hampton has suffered from chronic migraines for 20 years in prison. While the medical staff prescribed him a migraine medication, he went to sick-call a number of times in an effort to understand the underlying issue. Each time his requests for a CT scan were deemed unnecessary. 

If prisoners want to appeal a decision by the Care Review Committee, their only route is to file a grievance. Prior to President Bill Clinton’s enactment of the Prison Litigation Reform Act (PLRA) in 1996, prisoners could directly file lawsuits in federal court. Under the PLRA, they are required to exhaust all other administrative remedies before filing a lawsuit. The grievance is the first step.

Grievances go through an intra-administrative process in which prisoners file formal complaints. When a prisoner submits a grievance, the prison’s grievance coordinator—an administrator with no medical training or experience—will deem the issue grievable or non-grievable. Prisoners have the option of appealing the decision, but the cycle of appeal and denial can continue for months until the grievance is reviewed by WA DOC headquarters. 

In the unlikely best case scenario, when a prisoner files a grievance for an issue that is deemed grievable, DOC policy permits 120 days for the department to remedy the issue. When it comes to medical issues, a four-month waiting period can become a death sentence. 

Even worse is the apathy and negligence around emergent medical issues. For emergencies, prisoners are at the complete mercy of prison guards, who lack medical training yet are given the responsibility of being first to determine whether a medical issue is emergent or not.

Hampton explained that prisoners are often forced to resort to extreme measures to get the help they need. In one instance, an elder prisoner was continuously denied a hospital visit and forced himself to pass out so he could get the prison staff’s attention. He was only taken to the hospital after passing out a second time.

“When he got back from the hospital he was like, ‘Man, you’re not gonna believe this. I got stage 4 liver cancer.’ We were all just stunned.” Hampton said. “When they finally took him serious, he’s gone. He passed away.”

In the absence of medical care, WA prisoners pointed out that they do whatever they can to care for each other. They check in on each other regularly, inquiring about the state of their physical and mental health. They cook together and pool resources to meet the dietary needs of people with chronic illnesses such as diabetes. They also act as physical therapy aides. In the event that someone’s medical issue is becoming life-threatening, they collectively organize campaigns with outside support to pressure the prison administration to attend to their needs. While prisoners risk getting an infraction for caring for one another, they see these measures as necessary to ensure their collective survival.

Each Crisis Amplifies The Next

As the COVID-19 pandemic raged in prisons, blatant disregard for pandemic safety protocols led to many deaths in WA facilities. Stafford Creek Correctional Center was recently fined $60,000 for skirting COVID-prevention measures. On top of this, the pandemic strained the already understaffed prison health care system and led to even further denial of care for non-COVID related medical issues. As Brunner explained, prisoners were locked down in their units and could not access medical care if they needed it.

“Because they were short on medical staff, there was no sick call. There were no kites going out. We had no access to medical care,” Brunner said. “If you had an infection or something, by the time they picked up a kite, it’s already been days or weeks even and you still haven’t been seen. Routine care was totally set aside.”

When prisoners and their families thought the medical situation in WA prisons could not get any worse, the tuberculosis outbreak at Stafford Creek in May instigated the largest outbreak that the state has seen in two decades. From the perspective of Stafford Creek prisoners, prison officials did nothing to curb the outbreak and acted with intentional disregard for their safety, even after dozens of prisoners were infected. 

When you unearth the violence underneath any facet of the prison industrial complex, it’s extremely difficult to believe in any outcome short of abolition. But there are life-saving measures that prisoners need now. 

WA prisoners compiled a few important measures they hope advocates will help fight for:

  1. Elimination of medical copays. Medical copays force prisoners into institutional debt, making it extremely difficult for all prisoners, but especially indigent ones, to access medical care. Health care services should be accessible to all prisoners without financial obligation.
  1. Establish first aid training classes for prisoners. WADOC should remove rules and regulations that prevent prisoners from helping other prisoners in the case of a medical emergency. Currently, if prisoners assist each other in a medical emergency, they risk catching a write-up because the prison doesn’t want to risk legal liability if something goes wrong.
  1. Establish health education courses for prisoners. When prisoners are sick, experiencing pain, or coping with chronic illness, they don’t have the ability to Google their symptoms and help themselves through common illnesses. In this information void, prisoners need access to education that teaches them about how to manage common illnesses and diseases commonly experienced by prisoners, such as diabetes, asthma, high blood pressure, etc.
  1. Allow prisoners and their families to access medical information. While the barriers to getting a second opinion on medical diagnoses are significant, one important step would be to remove institutional barriers that prevent prisoners from accessing their medical records. Currently, it can take months to receive records once a request is made. This prevents prisoners from effectively advocating for themselves and families from advocating on behalf of their loved ones.
  1. Allow alternatives to prison medical coverage. Currently, WADOC does not allow prisoners’ loved ones to pay for procedures or necessary medication or medical equipment, such as an insulin pump. These senseless restrictions have led to preventable deaths in WADOC.
  1. Expand healthcare coverage through medicaid and medicare. Currently, prisoners are not covered by Medicare or Medicaid while incarcerated, even if they are eligible. While recent reforms have introduced Medicaid access for prisoners who are set to be released, these programs should be expanded to cover currently incarcerated people and therefore remove health care from state DOC budgets altogether. This would hopefully provide strong coverage as well as more stringent oversight provisions for care.

It’s undeniable that prisons are death-making institutions, but the contradiction of the prison health care system specifically is that it is a system designed around withholding care – it actually hastens death. Whether or not the law recognizes it, routine medical neglect in prison is cruel and unusual punishment.

Want to get involved in the fight for health care in Washington State prisons?
Contact Lawrence Jenkins via Securus:

ID#: 306665
Stafford Creek Corrections Center (WA)

Lawrence Jenkins and Minali Aggarwal

Lawrence Jenkins and Minali Aggarwal

Lawrence Jenkins is a Black Political Prisoner, agroecologist, educator, writer, artist, and organizer. He is a co-founder and director of Liberation Media Northwest, a collective and organizing platform to support and advocate for incarcerated people in the Pacific Northwest.

Minali Aggarwal is a PhD student, organizer, and mixed media artist. In her research she focuses on racial politics, incarceration, and labor.