Saturday, July 11, 2009
On the Investigation into Marcia Powell's Death, the Continued use of Outdoor Cages, and "Constitutionally Mandated" Prison Health Care.
I met with the Arizona Department of Corrections Director Charles Ryan as planned yesterday morning, as well as Deputy Director Charles Flanagan and the ADC General Counsel Karyn Klausner. We covered a number of issues, and while I ended up feeling better informed about the director's positions on them, I certainly didn't move him much on anything. Not that I expected to: he was accommodating me into his schedule to set me straight, not the other way around. He already knew well what I thought from the five page letter I'd sent him, and had summed up my numerous concerns as "misperceptions", which he hoped a meeting might clarify for me.
I broke the ice as our meeting began by apologizing for the tenor of that particular letter. The terms "perpetrator of injustice" and "sadistic character" came to mind - along with my question about what would compel someone to make their career out of imprisoning tens of thousands of people, too many of whom are probably either innocent or no danger to society. Such references were raised not as accusations, however, but as speculation. I honestly didn't know what to make of the man. Still, I did feel an apology was in order for my antagonism, and was perhaps even necessary for us to move on; the director had not been unaffected by the tone of my letter and was frank in his response that I was in no position to pass judgment on his department, which I knew little about, or on him, about whom I knew even less.
I didn't argue that point with him. I wanted to establish dialogue, not alienate him further. Besides, I don't necessarily think that he's just another heartless bureaucrat; I do believe he was deeply troubled by what happened to Marcia Powell. We just don't seem to agree on why it may have happened and how to prevent it from happening again. But, there are things about the case I just don't know.
Anyway, once I apologized and explained what I meant by prison abolition, we got into some of the main issues I covered in the letter I referenced. I questioned the status of the investigation into Marcia's death, raised concerns about the quality of health care services, challenged the continued use of outdoor cages (albeit under a modified policy), and explored his relationship with the legislature in light of the effects of overcrowding and budget issues.
Beyond those matters I found his discussion of privatization, department reorganization, and the effects on the prison system of determinate sentencing fascinating. I suppose you could say we had an interesting dialogue - tempered by his staff's presence and efforts to defuse conflict. Although I certainly learned a few things, I think we parted shaking hands in a stalemate, with him inviting me to email again - albeit, I suspect, with a silent hope that I won't. That, in fact, is why I think I ended up with the business cards of three of his top staff.
The most positive thing to come out of the meeting, I believe, was to have connected with Counselor Klausner and Deputy Director Flanagan, who urged me to contact one of them with any other concerns, and who gave me the card for Betty Cassiano, the Constituent Services Officer, who handles issues that prisoners' friends and families have which aren't satisfactorily addressed at the unit or prison complex level.
This was in response to my expressed concern that many families and prisoners don't come forward with allegations of mistreatment or complaints about the environment for fear of guard or administrative retaliation. Without denying or acknowledging the legitimacy of that concern, Counselor Klausner advised that contacting Betty Cassiano directly in such cases might be best, as an inquiry into a specific case or prison conditions from the Director's office is likely to be handled, well, differently than if it went through the standard grievance process. Ms. Cassiano's number is (602- 364-3945). The office email address is IFFLiaison@azcorrections.gov ; if you email instead of call, make it to her attention.
Director Ryan was unable to discuss much about the investigation into Marcia's death, except to repeat what he has publicly stated: that it was a tragedy and a failure on the part of the ADC, and he is determined to prevent it from happening again. He believes that modifying the cages (water, shade, benches, misters) and instituting new procedures for monitoring the prisoners being kept in them are adequate policy changes, and expects that the individuals directly involved in Marcia's death will be held accountable. The Department of Public Safety is reviewing the ADC's internal investigation, which the director feels is sufficient for assuring that the investigation is thorough and fair. He does not believe additional outside investigations of the incident are necessary.
Somewhere early on in our conversation Director Ryan made it clear that certain discussions involving privileged inmate information would be off limits - an allusion, I suspected, to the fate of the three women who set their mattresses on fire at Lumley. I decided that I might try to bring the conversation back to them later, but never got there. Nor did I discuss mechanisms to improve department transparency, which I felt were in the same general category. I am, as I write, slowly building a list of things left uncovered which I may soon address with Deputy Director Flanagan. Perhaps he will even arrange the visit to a prison that Director Ryan proposed.
When I questioned the use of the cages again, Director Ryan remained adamant that his new departmental policies and procedures regarding the outdoor cages are sufficient to protect prisoners from heat-related illness or other temperature extremes. I suggested that the staff's reliance on these cages as temporary holding pens despite extreme temperatures were symptomatic of overcrowding, and that despite policy they were often used precisely for "punishment".
While Ryan conceded that the prisons are indeed over-crowded, he saw that as completely unrelated to the use of outdoor enclosures, or "sallyports", which are considered as necessary holding cells when prisoners are being transferred from one location to another. These are in common use "everywhere", he assured me. Having read how Arizona is the only state in the country that still uses such cages (which I kept to myself), I wondered why they couldn't do without them if space could be made available indoors - especially for things like treatment waiting areas - by relieving overcrowding. I again expressed concern that particularly those prisoners who are already ill remain at risk under his new policy, but he would not bend on it; that issue we just couldn't find common ground on.
The director had a visceral response to my negative characterization of prison health services (I used the term "atrocious", which I mistakenly believed was a common sentiment, having heard it so often among family and ex-prisoners). Director Ryan, Deputy Director Flanagan and General Counsel Karyn Klausner all responded in defense of prisoner health services, asserting that they meet or exceed federal standards, they've been fully accredited by national bodies, and that the Department of Justice even gave them high marks for their compliance with the Americans with Disabilities Act.
The director was rather insistent that health care in Arizona's prisons is better than a lot of prisoners get on the outside (where many have no insurance coverage and/ or are so into their addictions that they lack concern about getting medical care when they need it). He also noted that the prison population is already high-risk medically because so many have histories of alcoholism, addiction, and poor self-care. This I was well-aware of, and is one reason why I believe that health care needs to be even better for the chronically ill in prison than what they may have access to on the outside. I believe we agreed that because prisoners often arrive in such poor health their life spans tend to be shorter than the general population's. I would have also argued that their life spans are considerably shortened by the poor medical care and the general conditions of prison life, but was not prepared enough with evidence to do so.
The term I repeatedly heard describing the quality of medical care received by
As far as I know, prisoners are the only people in
Proving that a medical provider or prison has fallen short of the "constitutionally mandated" standard of care appears to be a difficult task - I believe the prisoner has to prove "deliberate indifference" to a prisoner's illness or suffering on the part of the health care provider, and that the prisoner experienced lasting physical harm as a result of the lack or inadequacy of health care. Proving all that is nearly impossible when seeking relief from negligent or harmful mental health treatment.
So, despite the resounding defense of the ADC's health care services, I'm not convinced that offering "constitutionally mandated" care for prisoners is the same as offering adequate or necessary or timely care, or meets the standards of "usual and customary care", which is a standard applied to non-prison health care settings.
This could explain why a prisoner at Perryville received chemotherapy for her colon cancer - which I would expect to be "constitutionally mandated" - but not the expensive post-chemo blood-building treatment that the "usual and customary" standard would dictate.
It also avoids the question of why treatment for prisoners with HIV/AIDS is constitutionally mandated while screening for HIV among this population is not. Routine life-saving tests for women (pap smears, mammograms) weren't constitutionally mandated until an aggressive legal and PR campaign made it so. And even though it was the women's litigation that resulted in the determination that prisoners have a constitutional right to health care in the first place, prison health care for women across the country is notoriously lacking compared to that available to men.
This discussion (or lack thereof) in the director's office about the real problems with health care accessibility and quality in Arizona's prisons may shed light on this year's legislative attempt to write a caveat into the budget bill which would prohibit any medical provider working or contracting for the ADC from providing a standard of care to an inmate that is higher than the minimum standards required by the federal government. I don't know whose idea that was, but it was clearly in the interest of the state, not health care for prisoners. Such a provision would seem to derail any grievances or state-level lawsuits arguing for medical treatment - potentially even life-saving - that simply hasn't yet been proscribed as constitutionally mandated by the feds.
This concerns me particularly in light of care for neglected populations like women, people of color, older adults, and prisoners with illnesses like Hepatitis C for which there are more affordable, less toxic medical breakthroughs in treatment all the time. Hepatitis C - which is prevalent in prison populations and can actually be treated before it causes life-threatening organ damage, is not only not routinely screened for, but is often left untreated until symptoms of liver failure emerge, by which time many patients are too ill to handle the treatment that may have actually destroyed the virus' ability to damage the body further.
Although our discussion about quality of and access to medical treatment was quickly shut down by the insistence that it met "constitutional mandates" and that the ADC's medical services were fully-accredited, Karyn Klausner and Deputy Director Flanagan did invite me to give them details about the specific cases I was referencing or that might come to my attention in the future, offering that they would follow up on them. I took that opportunity to pass on the name and info for Leanne's friend for Counselor Klausner to look into. She is the woman who had to wait seven months from the time she reported her symptoms to the prison medical staff to get a colonoscopy done (by which time she had stage III colon cancer) - the same woman I mention earlier whose diagnosis and treatment were inexplicably delayed.
I'll finish up my account and subjective impressions of the visit in my next blog entry. In the meantime, I'm open to hearing if my information or perceptions are wrong - or if I've left out a crucial case reference or point. I'm only just beginning to learn about the state of health care in prison - especially for women - and find it mind-blowing, for lack of a better term. You can post a correction or critique at the end of this entry, or email me privately, and if you convince me that I'm mistaken I'll be sure to correct myself. At the very least it will compel me to better research and substantiate with documentation my own claims.
Finally, for those of you actually following this blog, you'll notice that I've edited and posted it numerous times now, trying to decide what belongs here - where I'd like to focus on this meeting - and what I should hold for an entry specifically about women's health care in prison. I think this is the final, final version of this post. Thanks for bearing with me.
