What if I Need Medical Treatment in Federal Prison?

All prisons employ teams of medical staff for people in need of healthcare. They include at least one physician, nurse practitioners or physician assistants, nurses, dentists, hygienists, and technicians. Like anywhere else in society, some people are in need of more healthcare services than others. Authorities designate people with chronic healthcare needs to prisons that operate as medical centers.

In an effort to minimize malingering and the wasteful use of medical resources, policies require people to make payments if they ask to see someone from healthcare. At less than $10 per visit, those costs seem negligible by society’s standards. To put those costs in perspective, remember that some prison jobs result in less than $10 per month in earnings. If a person doesn’t keep money in the account, he may not have to pay for healthcare costs.

Each prison will have its own policy for how to access healthcare procedures. What follows is a summary of what to expect—broadly speaking. These are descriptions from a typical prison, rather than from a designated federal medical center. We also offer commentary from people in prison that we’ve interviewed.

We offer insight into four different aspects of medical treatment in federal prison:

• sick call,
• emergency medical problems,
• illnesses requiring regular monitoring, and
• special surgery.

Sick Call in Federal Prison: The term “sick call” refers to the initiation of medical treatment. Either a staff member or a person in prison may start the sick call process. In other words, staff members may want to call upon a person for a routine examination. The staff member may put the person on sick call. Likewise, a person may not feel well and want to see a doctor or a nurse. The prisoner would submit a request to go to sick call.

Except in emergencies, a person will only be able to request a visit to sick call on specific days. As an example, a prison may make sick call available four days each week—Sunday, Monday, Wednesday, and Thursday, between 6:15 p.m. and 6:45 p.m. In this example, the door for sick call would open at 6:30 in the evening.

A staff member from Health Services would collect prisoner ID cards and issue forms for the men to fill out describing the reason that they’re requesting medical attention. People who are not waiting at the door when it is open to receive their forms miss out. By 6:45 a staff member would close the door.

If a person misses sick call, he will need to wait until the next available Sick Call opening. Since prisons typically hold several hundred people, anyone going to sick call should anticipate a long line of others waiting to schedule their own appointments. When a prisoner’s name comes up, he will have an opportunity to talk briefly with a staff member to describe the illness. The sick call procedure is simply for screening, not medical treatment.

Except in emergencies, a person may wait between one and three weeks before he is able to meet with a physician. Emergency care is said to be available 24-hours each day. In practice, people in a typical USP, FCI, or prison camp get a different experience.

Tom’s Story:

Tom said that he did not have any previous experience with Health Services. While confined in a low-security prison, he said that he began to feel ill on a Monday evening. He had a high fever during the night and felt nauseated when he woke on Tuesday morning.

Tom reported his illness to the officer on duty and requested permission to remain in the unit for rest. The officer didn’t authorize Tom to remain in the unit. Instead, the officer quoted policy, mandating him to report to the assigned work detail as scheduled or face disciplinary procedures. In prison, policies frequently trump human interactions.

Tom said he walked the 200 yards that separated his housing unit from his work detail so that he could report on time for duty at 7:30 a.m. He told his supervisor that he felt sick, as if he had the flu, or some type of virus. Tom requested permission to rest in the housing unit. The supervisor told Tom to stay on the job for a few hours to see how he felt. Ninety minutes later, the supervisor allowed Tom to leave.

Since it was a Tuesday, Sick Call wasn’t available until the following Wednesday evening. Tom returned to his unit and went to bed. A couple of hours later he had to vomit. After vomiting, Tom went to see the officer in his unit and asked for permission to see a doctor. The officer called Health Services. Rather than agreeing to see Tom, the person at Health Services told the officer to instruct Tom to take some aspirin and report to Sick Call the next Wednesday evening.

Health Services saw only emergency cases on days when Sick Call was not available. In prison, staff members define an emergency as being life threatening.

Tom suffered through that day and the next. At 6:10 on Wednesday evening, he walked the 300 yards between his housing unit and the Health Services building. More than 30 people were waiting in line. Since there weren’t any seats, he stood waiting for his turn. It was his first visit to Health Services and he didn’t know what to expect.

The officer opened the door to collect ID cards and issue forms each person could complete to describe the illness or symptoms. Tom wrote that he been vomiting and feeling weak for two days. When the PA called him, Tom handed his form to the PA.

The PA read Tom’s form but didn’t ask any questions. He didn’t offer advice or prescribe medicine. Instead, the PA gave Tom an appointment to return to Health Services the following Monday morning.

Over the next few days, Tom’s illness began to pass. By Monday, the day of his scheduled appointment, Tom felt completely better. He skipped his appointment without seeing anyone from Health Services.

Later that evening, the Lieutenant’s office summoned Tom to cite him with a disciplinary infraction. The report accused Tom of being out of bounds because he missed an appointment. When the lieutenant asked Tom why he didn’t go to the medical appointment, Tom told him that he felt better and didn’t need to see the doctor. When he needed to medical attention, Tom said no one would treat him or give him medicine. The lieutenant told Tom he still had a responsibility to go to the call out.

After his unit team members convicted Tom of the disciplinary infraction, they sanctioned him with the loss of telephone and visiting privileges for 30 days.

Emergency Medical Problems:

Emergency medical problems are different. If there’s a sudden and abrupt change in a person’s health, staff may send him for emergency care.

Austin’s Story: Austin was 59 when a staff member determined that he needed emergency medical care.

It was winter in the Northeast prison where he was held. After completing his shift working in the kitchen, he walked back to the housing unit. Snow and ice made the ground slippery. While walking, he slipped and fell down, face first. He broke his nose, two of his teeth, cut his face, and he hurt his legs. Austin needed immediate medical attention. The guard on duty outside the cafeteria saw him fall.

Since Austin fell after regular hospital hours, the guard had to call the hospital for emergency medical attention. Two of Austin’s friends picked him up and walked him over to the Health Services Department.

A PA was on duty, but no doctor was available. Austin said the PA provided several Ibuprofen pills and instructed Austin to take the medication. The PA told Austin that the pills would help him with his blood pressure problem. “I don’t have a problem with blood pressure,” Austin said. “I fell down and hurt my nose, cracked my teeth.”

The PA didn’t look at Austin’s medical file, didn’t examine his nose or the pain in his mouth from the broken teeth. The PA sent him back to his housing unit with the Ibuprofen. Austin learned that emergency medical care in prison differed from what he expected.

After the fall, Austin said he never got over the pain. He had to walk with a cane, usually with the assistance of another prisoner. Swelling in his left ankle began soon after his fall, but Austin said Health Services would not treat the problem. They told him that since the ankle swelling wasn’t life threatening, Health Services wouldn’t treat it.

Patient Requiring Regular Medical Monitoring:

Peter was 66 and he suffered from severe arthritis and diabetes. As a result of his medical condition, Peter said it was hard for him to walk. He’d been incarcerated for a decade, and while at a previous BOP facility, the Health Services Department authorized him to purchase a special pair of boots made for patients who suffered from orthopedic disorders.

Peter paid approximately $350 for his orthopedic boots and he used them for a year. They made walking easier for him. When Peter transferred to a lower-security prison, the Health Services Department at the new prison refused to grant Peter permission to keep his boots. They told him to either donate the boots or send them home.

Despite records showing that he purchased the boots through Health Services at a separate BOP facility, and despite Peter’s never having left the BOP’s control, staff members said the boots would threaten security of the institution. Instead of the boots, Health Services provided him with orthopedic pads and told him to insert the pads into his prison-issue shoes.

The shoes and pads made walking difficult. Peter said he had to walk with a cane at times, but even that didn’t help. His diabetic condition required him to walk several hundred yards each day to the Health Services building for treatment. He also suffered whenever he walked to the cafeteria. Without the orthopedic shoes he needed, Peter said he suffered needlessly. Staff members were indifferent to his pain, he complained.

Peter described a problem he encountered during one of his regular checkups for his arthritic and diabetic condition. About a year ago, when Peter first arrived at his institution, he met with a doctor who completely reviewed Peter’s medical file and spoke with him about his illnesses and the treatment Peter had been receiving. Other than the loss of his orthopedic shoes, Peter said he didn’t have any complaints. The doctor prescribed the same medication that Peter had been taking for the past several years. The doctor also prescribed some knee braces to lessen the pain while he walked. Peter saw the same doctor on his next regularly scheduled quarterly visit. The doctor continued the same treatment plan.

At Peter’s next quarterly visit, however, a different doctor saw him. The new doctor didn’t review Peter’s file in front of him and didn’t ask about the treatment. Instead, without consultation or explanation, the doctor changed Peter’s prescription. He also told Peter that since he’d been using the knee braces for longer than six months, he should turn them in.

Before going to the pharmacy window to pick up his new medication, Peter went to the library to read the Physician’s Desk Reference (PDR) about the new medicine he was supposed to take. Peter learned that the new medication was for people that suffered from heart problems and hypertension. Peter didn’t think he had those symptoms. Peter also learned from his research in the PDR that the new medication might be problematic for those suffering from diabetes.

With this new information, Peter went to the pharmacy window and explained that the doctor must have prescribed the wrong medication because Peter didn’t suffer from heart problems. The pharmacist told Peter he either had to sign up for Sick Call to address those concerns or wait for his next quarterly check-up. The doctor’s prescription was final unless another doctor changed it.

Special Surgeries in Federal Prison:

Many of the prisoners confined are older and suffer from poor health. Some use Sick Call procedures regularly. They may have to go through emergency care treatment for ongoing illnesses. Some, like Hugh, even proceed through special, major surgeries during their period of incarceration.

Hugh’s Story:

Hugh is a 73-year old prisoner who had to go through open-heart surgery. Hugh said he was sick when he came into the system and he believed that he should have been confined in one of the BOP’s special facilities for prisoners in need of constant medical attention. Hugh couldn’t walk 200 feet without stopping for rest. Since reporting to prison, he’s been treated on four separate occasions at outside hospitals for pneumonia.

Tests revealed that Hugh’s heart was in bad shape. His left main artery was blocked completely, and the right was 99-percent blocked. As a result of the closed arteries, Hugh’s heart didn’t receive sufficient blood flow. After tests revealed his condition, guards took him to a community hospital for open-heart surgery. He remained in the hospital for 13 days.

While he was in the hospital, guards shackled both of his ankles to the bed rail. It was particularly painful for Hugh, because the doctors removed veins from Hugh’s lower legs in order to replace the blocked arteries. The removal of veins from Hugh’s legs left delicate, unhealed wounds. Despite the scars that were developing on Hugh’s legs, the cold, steel cuffs were fastened around his ankles every minute of his stay in the hospital. The guards said that policy required the shackles.

The doctors had Hugh breathing through oxygen tanks and argued with the BOP that Hugh needed to remain in the hospital for aftercare and recuperation. It didn’t happen. Despite protests, the guards transported Hugh from the hospital back to prison. Hugh spent his first night back in one of the prison’s Health Services rooms.

The PA on duty that evening didn’t know of Hugh’s condition. He refused to provide Hugh with his medication. The officers that transferred Hugh from the hospital back to the prison, apparently, had neglected to provide the changing shift with Hugh’s medical paperwork. Hugh tried to explain to the PA that he had just returned from the hospital after having undergone open-heart surgery and that he needed medication because he was in such pain. The PA said he didn’t want to hear about it and disconnected the bell that allowed Hugh to call the PA from his room.

The air conditioning in the room blew cold air on Hugh. In response to the cold air, Hugh lifted himself off the bed and went to lie on the floor with his blankets, out of the direction of the cold air that blew on him.

Another officer walked by Hugh’s room and saw Hugh lying on the floor. He called a superior to check on him. Hugh explained that he was ill, that the PA was unresponsive to his needs, and that he couldn’t return to the bed because it placed his unhealed wounds directly in the path of the cold air. The supervisor located Hugh’s medical file, learned of the surgery that he had recently undergone, and made adjustments to Hugh’s treatment that evening.

The following day, Hugh returned to his cell in his housing unit. A few hours after Hugh returned to his room, his condition deteriorated. He couldn’t control his bowels, became dehydrated, and finally collapsed on the floor.

Hugh’s roommate, John, ran to the hospital to notify the staff that Hugh had collapsed and was lying on the floor, unable to move. The PA instructed John to tell Hugh that he should report to Health Services. John stated again that Hugh had collapsed and wasn’t able to move by himself. The PA instructed John to bring Hugh over. When John asked for a wheelchair, the PA said Health Services didn’t have any wheelchairs. John grabbed a stretcher, located a few other prisoners, and carried Hugh back to Health Services.

A doctor examined Hugh. The doctor determined that Hugh needed to return to the community hospital and summoned an ambulance. Guards chained up Hugh and they drove him back to the hospital. They placed him in the same bed he had been in fewer than 48 hours before. His scarred ankles were again chained to the bed. Hugh remained in the hospital for five more days, during which time the doctors tried to stabilize his condition, feeding him intravenously at first, and then with solid foods.

In general, people going to prison have a better experience if they can toughen up their mindset. They should not have any expectations of a kind, bedside manner or compassion when it comes to health care (or anything else). Instead, they would be wise to expect staff members, in general, to be cynical and to doubt anything a prisoner says.

The Eighth Amendment of the U.S. Constitution requires the government to provide health care services to people in prison. That said, prisoners shouldn’t expect to receive the level of care they may be used to receiving outside.

The Health Care department in some prisons will be better than others, depending on resources and the competence of administrators. Some prisons will have different Sick Call procedures than the one described above.

All Health Care departments are challenged to meet the needs of an ever-growing and aging prisoner population. Although the BOP operates seven Federal Medical Centers across the United States, in Butner, NC; Carswell, TX; Devens, MA; Fort Worth, TX; Lexington, KY; Rochester, MN; and Springfield, MO, it struggles to keep up with the medical needs of its swelling and aging population.

The FMCs provide psychiatric treatment and long-term care for the seriously or chronically ill. Apparently, there is not enough space in those facilities to accommodate all the people that need constant medical attention.

Doctors in prison are likely to be overwhelmed by their massive caseloads. As with all staff members, medical doctors in prison “are correctional officers first.” Policy will require them to consider security first when treating medical needs.

People in prison would be wise to keep their weight under control, to exercise regularly, and avoid activities that could hurt their medical condition.

Justin Paperny

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