Women's health in prison: Breast Cancer Behind Bars

The following article was just published on Truthout by Vikki Law, author of "Resistance Behind Bars: The struggles of incarcerated women," and editor of Tenacious, a national zine written by and for women in prison.

In light of some of the distressed correspondence I've been receiving lately from women at Perryville prison complaining of serious medical neglect, I'll be making a point of researching and posting more on women's health in prison here in coming weeks.

In the meantime, for a first-person account on women's health care in Arizona state prisons, see Sue Ellen Allen's book "The slumber party from hell."

Thank you for this, Vikki. Can't wait for this state to finally be sued. What they've done to our people is criminal.

----from Truthout---

Breast Cancer Behind Bars: How a Prison Sentence Can Become a Death Sentence

Wednesday 25 January 2012

by: Victoria Law, Truthout

  .

Imagine finding a lump in your breast. Imagine that your efforts to schedule a medical check-up are stymied and you have to wait weeks, if not months, for that initial exam. In the meantime, the lump continues to grow. Imagine that, when you finally do see a doctor, you are told that you have breast cancer. When you walk out of the office, you are locked into your prison cell with no more information or sympathy than when you walked in. This is the daily reality for women in prison

In 2006, a Department of Justice (DOJ) study found that women in prison are at significantly greater risk for cancer than their male counterparts. Out of every 10,000 incarcerated women, 831 had cancer, compared to 108 per 10,000 men. Of those, 91 of every 10,000 women behind bars reported having had or currently having breast cancer. Given that 114,979 women were behind bars at the end of 2009, this would mean that over 1,000 women have had or currently have breast cancer. 

Despite these numbers, prevention, screening, diagnosis, care, pain alleviation and rehabilitation for breast cancer remain virtually nonexistent in prisons. In 1998, a study at an unnamed Southern prison found that, although many were at high risk because of family histories, women were not provided with a clinical breast exam, information or basic education on self-examination upon admittance. Seventy percent of women who should have had mammograms under standard medical procedure had never been tested. [Williams, Roma D, Terry D. Mahoney, and R. M. Williams, Jr, "Breast Cancer Detection Among Women Prisoners in the Southern United States," Family & Community Health 21.3 (1998): 32.]  Even women who enter prison already diagnosed with cancer must fight to receive lifesaving medical care.

Fifty-two-year-old Margaret DeLuca had already been diagnosed with stage 3A breast cancer and undergone a left-breast mastectomy before arriving at Clinton Correctional Facility in New Jersey. "She knew exactly what she needed, but was unable to get it," stated Bonnie Kerness, a human rights advocate and coordinator of the American Friends Service Committee's (AFSC) Prison Watch Project, who helped DeLuca fight for proper medical care. Their advocacy resulted in incremental improvements in DeLuca's medical care but did not change the prison's health care system. [Interview with Bonnie Kerness, December 28, 2011]

Like DeLuca, 57-year-old Sue Ellen Allen entered Arizona's Estrella Jail with a diagnosis of breast cancer (hers was Stage 3B). She had also undergone six sessions of chemotherapy and was awaiting a mastectomy. Two and a half months later, she was awoken at midnight, then handcuffed, shackled and transported to another jail. At 9 AM, she was moved to the hospital for the mastectomy.

"I am locked in a room alone, freezing. I ask for a blanket. No, they snarl. Why is everyone so nasty?" she recounted. "I haven't eaten in twenty hours, I haven't slept, I'm freezing and facing surgery alone." After the mastectomy, Allen should have begun chemotherapy, but the jail delayed it to avoid shouldering the costs. Allen did not receive chemotherapy until she was transferred to the Perryville prison three months later.

The chemotherapy made Allen sick.

"On my way back to my yard, I collapse, vomiting. A guard comes and asks if I can walk the three blocks to medical. There are no wheelchairs." Allen collapsed and vomited twice while walking to the medical unit. Staff watched her, but the only acknowledgment she received about her condition was when a sergeant asked, "What's the issue, Allen?" 

Allen made it to the medical unit, where she continued to vomit into a wastebasket. The prison's doctor was not available to administer the shot that would stop Allen's vomiting. Allen continued to vomit for an hour. "Even the nurse is frustrated. She says there is no other emergency. He's doing paperwork." When the doctor arrived an hour later, Allen recounts, he was obviously irritated. "He acts like I'm faking and reluctantly administers the shot. Eventually, I am sent back to my room alone. I am dismissed."

Allen underwent three more chemo treatments. "Despite the rigid schedule, never is the medication ready on time, nor is the newly discovered chemo diet ready. I have to spend my sickest days walking to Medical, begging for what I'm missing. When I'm supposed to be healing, I'm worn out battling for proper treatment."

Allen is one of the more fortunate; she survived the ordeal. When 36-year-old Christina found a lump in her breast in April 2002, Perryville's medical staff ignored her concerns. By the time she was taken to the hospital in September, the lump had grown so large that the hospital skipped the chemotherapy and performed an immediate mastectomy. By then, however, the cancer had already spread to her other breast. Christina died the next year, three months after being released from prison. "If her cancer had been diagnosed and treated when she discovered her lump, maybe she'd still be alive," Allen wrote.

While breast cancer survivors and advocates outside prison would be horrified at these obstacles and delays, Allen received relatively prompt treatment under what passes as current standards for prison health care. Sherrie Chapman, a woman incarcerated in California, waited much longer.

In 1985, Chapman, who had a family history of breast cancer, found a lump in her right breast. She alerted the prison's doctor, who dismissed her concerns. Chapman persisted in demanding that the lump be further examined. In 1994, when the lumps were visibly protruding from her right breast, she finally received a mammogram. The radiologist at the outside hospital found "extremely dense breast parenchyma" and recommended a follow-up mammogram within one year. Chapman was unable to convince the prison's medical department that she needed the follow-up mammogram until late 1994. This time, the radiologist recommended immediate follow-up tests. The prison's doctor, however, refused to order a biopsy, ultrasound or fine needle aspiration. The prison labeled her a "drug seeker" for her repeated requests for something stronger than Motrin for the pain in her breast.

In 1995, Chapman was examined by a different prison doctor, who immediately ordered a biopsy. By that time, the cancer had spread to both breasts and metastasized in her neck, forcing her to undergo two mastectomies. Post surgery, guards signed her out against medical advice to return her to the prison. Staff ignored chemotherapy appointments. In addition, her uterus began to hemorrhage. Medical staff allowed her to bleed for 18 months before performing a hysterectomy. In 2000 and 2001, Chapman discovered other growths in her neck and shoulder areas. The prison doctor's response? "You've just got swollen glands. Don't worry; they're not cancerous." 

Chapman appeared before the parole board in June 2002. The board rejected her and admonished her to use the self-help available in the prison, ignoring the fact that, by then, she was too ill to participate in groups that required regular attendance. She died on December 12, 2002, at the age of 45, under the custody of the California Department of Corrections and Rehabilitation (CDCR), with a prison guard posted in her room.

Women have not quietly accepted this gross medical neglect and failure. They have attempted to advocate for themselves and draw attention to the issue. In California, Chapman testified before the legislature about the dangerous medical care in the state's women's prisons. She also filed a lawsuit against the CDCR and the prison doctor for ignoring her initial complaints about painful breast lumps. Chapman won and was awarded a $350,000 settlement. Her efforts also led to several magazine articles exploring the failures of the prison health care system to address the needs of those battling cancer. [See: "A Cancer Grows," in The Nation, and A. Clay Thompson, "Cancer in the Cells," San Francisco Bay Guardian February 24, 1999 (not available online)]

Breast cancer survivors imprisoned in other states have had less success in finding advocates and attorneys to help them push for change. Allen wrote letters to numerous lawyers, all of whom declined to file suit. "Most firms don't have the resources to fight the state," she noted.

Allen did not allow the lack of legal support to deter her from trying to change the culture of prison indifference and isolation. Recognizing that each woman battled both breast cancer and the prison's life-threatening and indifferent medical care, Allen began a cancer support group. The process of starting such a group would be simple enough on the outside, but behind bars, nothing is ever straightforward. "It took me a year of begging," Allen recounted, "but I finally got permission." The group, which quickly grew to include 14 other women, met once a month with an outside volunteer from the American Cancer Society.

Allen remembered that women were initially reluctant to attend: "They didn't expect anyone to help them or care. They didn't know how to talk about their fears." The support group provided them with a space to talk - and to vent. "There is no place in prison to vent," said Allen. The volunteer also brought information about cancer, enabling the women to understand the protocols and procedures of cancer treatment and to know what questions to ask. Given that women are told nearly nothing about their illnesses, treatments and recuperation, such information is invaluable. [Interview with Sue Ellen Allen, December 27, 2011]

Looking back, she notes that, with the exception of Christina, all of the support group members were white. Although white women are more likely to get breast cancer (125 per every 100,000), African-American women are not far behind, with 116 per 100,000 diagnosed. Latinas, who make up the largest proportion of Arizona's women's prison population, have a rate of 91 per 100,000. Given these statistics, Allen wonders how many women of color remain undiagnosed.

Although Allen was unable to find an attorney or legal group to help file suit against the Arizona Department of Corrections, other prisoners' attempts to change the prison's medical care system over the years finally sparked outside action. In October 2011, Prison Law Office, a legal advocacy group for prisoners nationwide, sent a letter to Arizona Corrections Director Charles Ryan. The letter listed dozens of specific allegations of deliberate indifference to prisoners' health needs and asked Ryan to agree to a court injunction to address problems as a way to avoid a lawsuit in federal court. On November 17, 2011, Arizona's Department of Corrections signed an agreement to investigate the medical claims. Prison Law Office and the American Civil Liberties Union (ACLU) of Arizona agreed to delay any lawsuit for three months.

In New Jersey, DeLuca reached out to the AFSC to help her advocate for the care she needed. "It was a partnership between inside and out, which is often the most effective way to obtain change," Kerness remembered. Although their efforts did not improve the overall quality of prison medical care, it did have a ripple effect within the circle of women around DeLuca. Through her example, other women became aware of the power of advocacy and their ability to help outside supporters advocate on their behalf. [Interview with Bonnie Kerness, December 28, 2011] Sadly, many women battling breast cancer and other serious medical issues lack outside support. Breast cancer survivors and advocates need to recognize that, for women with breast cancer and other life-threatening illnesses, a prison sentence may mean a sentence to death by neglect. Then they need to speak out and take action to help women inside successfully fight for their lives.

WSJ Review: The Collapse of American Criminal Justice

Crimes, Courts And Cures

Why the justice system does a bad job of separating defendants who deserve punishment from those who don't.

Wall Street Journal

OCTOBER 26, 2011

By PAUL G. CASSELL

How has the American criminal-justice system become one of the most punitive in the world without providing a corresponding level of public safety? In "The Collapse of American Criminal Justice," William J. Stuntz—a revered Harvard law professor who died of colon cancer earlier this year at the age of 52—offers a provocative big-picture answer.

Perhaps aware that "collapse" in the book's title requires justification, Mr. Stuntz begins by reviewing some statistics. As he shows, in the 1950s, 1960s and early 1970s, amid the largest crime wave in American history, the U.S. prison population declined. Imprisonment rates plummeted to some of the lowest ever seen in the modern Western world. High-crime neighborhoods, as Mr. Stuntz puts it, were "abandoned to their fate."

The backlash to this crime wave was equally striking. Since the mid-1970s, America has punished crime more and more severely. New York's imprisonment rate, for example, has sextupled. In a span of a little more than 30 years, "America first embraced punishment levels lower than Sweden's, then built a justice system more punitive than Russia's."

Mr. Stuntz readily acknowledges what many legal scholars do not: America's current lock-'em-up philosophy has dramatically helped to reduce urban crime. Since 1991, violent-crime rates have declined roughly a third nationwide and as much as two-thirds in a few cities (New York among them). Even so, Mr. Stuntz counts these declines as a pyrrhic victory, given that violence per capita in the U.S. today remains significantly higher than in 1950. And he is unwilling simply to assign all the credit for recent crime drops to increased punishment. He wonders, for example, why crime rates began falling only around 1991—two decades after prison populations started steeply rising.

To unravel such complexities, Mr. Stuntz tries to place America's contemporary criminal-justice problems in their historical legal context. He first looks at the 14th Amendment's effort in 1868 to ensure that newly freed slaves received "the equal protection of the laws"—a promise that fell apart a few years later when the Supreme Court eviscerated the equal-protection guarantee and left generations of Southern blacks to be victimized by Klan violence. Mr. Stuntz argues that narrow equal-protection jurisprudence helps to explain why, nearly a century later, Chief Justice Earl Warren began spinning constitutional restrictions from the 14th Amendment's other important provision, the Due Process Clause.

Justice Warren faced a Southern criminal-justice system that treated blacks unequally. More generally, he was dealing with an American system that did little for indigent defendants. But rather than address racism and poverty head-on as equal-protection matters, the Supreme Court let old precedents divert its attention to due-process claims. The court ended up dealing with such problems indirectly through an array of new procedural requirements. For example, the Warren Court tried to rein in questionable police evidence-seizure tactics by imposing an exclusionary rule on the states (in Mapp v. Ohio). The court likewise responded to unequal treatment during police questioning by creating its famous warning and waiver requirements (in Miranda v. Arizona).

This web of new procedures had an important effect: Defense attorneys, embracing the new rights, did not bring forward evidence of their clients' innocence but instead sought to suppress evidence of their guilt. Whatever the other merits of the procedures, they were bound to make the justice system do a worse job of separating defendants who deserve punishment from those who don't.

Mr. Stuntz powerfully argues that such decisions have perversely worsened inequality in the criminal-justice system. The Miranda rule, for example, gives sophisticated suspects—mainly recidivists and white-collar defendants—the ability to "lawyer up" and avoid questioning altogether. Many other suspects—including the innocent but poor—waive their rights and receive less protection than they did before Miranda.

These excessive procedures contributed to a new punitiveness in criminal sentencing, Mr. Stuntz says. With fewer violent criminals successfully prosecuted under Warren-court restrictions, those who are convicted are incarcerated longer. And because of the difficulty of finding witnesses willing to testify against gang members and other violent criminals, easily proven "surrogate" crimes (namely, drug possession) are punished more harshly.

"The Collapse of American Criminal Justice" concludes that our system suffers "from the rule of too much law and the wrong kind of politics." Mr. Stuntz recommends a host of reforms, including decentralization that would encourage local control responsive to local crime. He also argues for expanding city police forces—because the increased police presence would discourage the commission of crimes.

But he seems to back away from his argument that excessive proceduralism is part of the problem. While critiquing decisions such as Mapp and Miranda, Mr. Stuntz never urges that they be overturned or restructured, even though such changes could lead to the decentralized decision-making that he supports. Instead, he singles out for overruling Supreme Court precedents limiting equal-protection argument by defendants. He targets United States v. Armstrong, for example, which barred drug dealers from arguing that prosecutors must be racially discriminating when statistics indicate disparities in charges being brought. But overturning the law would lead to precisely the kind of procedural litigation that Mr. Stuntz deplores.

Nonetheless, the overarching themes of "The Collapse of American Criminal Justice" deserve wide discussion, and the book as a whole can be rightly seen as the capstone to a distinguished legal career. Americans may debate whether our criminal-justice system has truly collapsed, but few would argue that it can't be improved.

Mr. Cassell is a professor of criminal law at the S.J. Quinney College of Law at the University of Utah.