CI: Prison Health Care as Punishment

April 11, 2012 at 7:00 pm by: nancy a heitzeg Category: Anti-Racism, Civil Rights, Criminal Defense, Criminal Injustice Series, Intersectionality, LGBTQ, Prison Industrial Complex, Prisoner Rights

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Criminal InJustice is a weekly series devoted to taking action against inequities in the U.S. criminal justice system. Nancy A. Heitzeg, Professor of Sociology and Race/Ethnicity, is the Editor of CI. Criminal InJustice is published every Wednesday at 6 pm CST.

Prison Health Care as Punishment
by Kay Whitlock with introduction by nancy a heitzeg

Misrepresentations of the realities of prison life abound. These are a constant staple of media and public conversation, including unfounded claims that inmates are leading some sort of life of luxury, lifting weights, watching plasma TVs, dining finely and seeking college educations at the expense of taxpayers.

And this — California Inmates Get Better Health Care than Ordinary Citizens: Thanks to Justice Anthony Kennedy, California prisoners have easier access to health care than ordinary citizens.

Those convicted of “non-non-non crimes”–non-serious, non-violent, non-sex related–are liable to get early release as a result of the Supreme Court’s 2010 ruling that the state must reduce prison overcrowding in order to provide adequate medical, mental and dental health care.

Petty thieves and the like can get freed and have no more claim to health care than an honest citizen.

Killers, rapists, and armed robbers, on the other hand, are free of health-care worries until they make parole, if they ever do.

The court ruled 5-4 that the absence of adequate care for prisoners violates the Eighth Amendment’s prohibition against cruel and unusual punishment. The majority decision was written by Kennedy.

In an added twist, J. Clark Kelso, the overseer of California’s effort to comply with the order was a law clerk to Kennedy in the early 1980’s. He says that he gets the same question wherever he goes: “How come we’re giving felons better health care than I get?”

Well, we aren’t. California has yet to dramatically reduce over-crowding, often shuffling inmates out of state-run prisons to county jails, and despite some efforts to comply with the Supreme Court order, questions still remain as to what standards California is using to define “adequate care”. In addition, the intolerable conditions of SHU confinement recently lead to a series of on-going prisoner hunger strikes and related deaths at Pelican Bay and elsewhere.

Hardly a “health care” paradise.

The reality of prison health care – throughout the nation — is one of neglect, denial f treatment and untimely death.

In response to the false picture presented by The Daily Beast and others, CI is re-publishing a piece which outlines the on-going limitations of the oxymoron called “prison health care”.

Prison Health Care as Punishment

Let’s put a human face on the issue. Her name: Victoria Arellano, a transgender woman and undocumented immigrant from Mexico who had AIDS, but was doing well on medication. Stopped on a traffic charge in 2007, she was sent to the male facility of the U.S. immigration detention center in San Pedro, California where, two months later, she died in custody at 23 years of age.

Despite repeated and increasingly desperate pleas for her life-saving medications, officials simply ignored Arellano’s requests. She suffered rapid weight loss, nausea and vomiting, diarrhea, high fever and other symptoms as fellow detainees struggled to care for her with nothing more than makeshift measures and their own considerable compassion. Finally, they went on strike to demand that she receive medical care.

She was at last admitted to the infirmary where, two days later, shackled to the bed, Victoria Arellano died of an AIDS-related infection.

Later, 20 key detainee witnesses who had direct knowledge of these events were transferred out of the facility and area less than a day before a Human Rights Watch investigator arrived. A number of AIDS-related and human and civil rights organizations spoke out, demanding an investigation and Immigration and Customs Enforcement (ICE) compliance with basic standards of decent health care.

“The treatment Arellano received in San Pedro, unfortunately, is typical of what passes for healthcare at about 400 immigrant detention centers across the U.S. . .immigrant detention centers, many of which are run by private contractors, are not legally mandated to abide by any healthcare standards when it comes to treating sick immigrants.”

Source: Sandra Hernandez, “A Lethal Limbo,” LA Times, 6/1/08

For more information, see “Careless Detention: Medical Care in Immigrant Prisons,” The Washington Post.

See also “DHS Announces 11 Previously Unreported Deaths in Immigrant Detention,” 8/17/2009.

Victoria Arellano’s story illustrates, in tragic detail, how the provision of “health care” in U.S. prisons, jails, juvenile “correction” facilities, and immigrant detention centers transmutes, in unspoken and unacknowledged ways, into an additional form of dehumanization and punishment for prisoners – the vast majority of whom are people of color (Native peoples, immigrants, and U.S. born) – and many of whom have some form of physical or mental disability. Because prisoners are overwhelmingly low-income and poor, and have had little or no access to adequate health care throughout their lives, many are incarcerated with already-existing problems. The longer sentences that are part and parcel of the bogus “get tough on crime” crusade from the 1970s through the 1990s is also producing an aging prisoner population (For an excellent introduction to the realities of mass incarceration in the United States, see Incarceration Nation )

In truth, prison health care represents a singular distillation of several forms of structural violence that permeate the larger society – racism, poverty, misogyny, heterosexism. Locked away out of sight and out of mind, usually in overcrowded facilities inadequately staffed and equipped to handle medical needs, prisoners bear the harshest brunt of that violence.

Throughout this discussion, I urge you to keep in mind the 8th Amendment to the U.S. Constitution: “Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted.” Litigation concerning prison health care often focuses on legal debates over whether inadequate, indifferent, and incompetent health does, in fact, constitute “cruel and unusual punishment.” But perhaps more to the point is the simple question of human decency, and whether any person should ever be subjected to the systemic neglect and violence described here. Unfortunately, the demonizing of “criminals” – and whole groups of people presumptively considered “criminal,” such as young people of color, black men, immigrants of color – by politicians and mass media is so pervasive that many are willing to buy the idea that any brutality inflicted on prisoners is not only justifiable but desirable. The problems are further complicated by the relative lack of any effective systemic efforts to enforce such standards as do exist within the countless jurisdictions that oversee the operation of prisons, jails and other detention facilities. For example, U.S. Bureau of Prisons standards are critiqued here(caution: pdf download of academic paper), and the hedged language of the U.S. Marshals Service can be found here. An ACLU pdf download for prisoners on 8th Amendment issues is here.

The inhumanity so often embedded in prison/jail health care comes in many forms, and there are many contributing factors that produce it. Here are some snapshots.


In order to contain rapidly rising medical costs necessitated by an ever-increasing incarcerated population, a growing number of local, state, and federal governments have turned to private, for-profit “managed care” corporations to provide prisoner health services, in whole or in part. Not coincidentally, mass incarceration is essential to the profit-making potential of these companies.

Just two of the major corporations, Prison Health Services and Correctional Medical Services, provide services to a variety of facilities in (according to their websites) 41 states. Other corporations, such as The GEO Group, offer health care as part of their overall mission to design, construct, and manage jails, prisons, and other detention facilities. Despite years of lawsuits, investigative reports exposing horrific problems in South Carolina (scroll down publications page at this link to access Prescription for Disaster: Commercializing Prison Health Care in South Carolina publication), New York, Texas, Vermont, and other states, and an occasional lost contract, these companies continue to flourish.

Snapshots of Expendable Lives

Jesus Manuel Galindo, 32, died in 2008 in Reeves County complex, a large, private prison in Texas operated by The Geo Group. In custody, he requested anticonvulsant medication to address epileptic seizures. Instead, officials placed him in solitary confinement. A month later, having never seen a doctor, he was dead.

Seven young offenders at the GEO-run Coke County Juvenile Justice Center in West Texas alleged in a lawsuit that the living conditions were unfit for human habitation. An investigation by the Texas Youth Commission found vermin-infested food, filthy bedding, and feces smeared on the floor and walls. The TYC “subsequently pulled all of its nearly 200 juvenile detainees” from the Center. Source for both of the above items: Peter Gorman, “Private Prisons, Public Pain,” Fort Worth Weekly, 3/10/10

Ashley Ellis, 23, died in the Northwest State Correctional Facility in Vermont, less than two days after arriving to serve a 30-day misdemeanor sentence for a traffic accident. She had a serious eating disorder and required potassium supplements to keep her heart working. Prison Health Services personnel did not give her the prescribed medication. The autopsy listed cause of death as heart failure due to denial of access to medication. Source: Terry J. Allen, “Death by Privatization: For-profit healthcare system implicated in death of inmate,” In These Times, 12/8/09

Brian Tetrault, 44, had Parkinson’s disease and was on medication to control tremors when he was arrested for taking items from his ex-wife’s home and jailed in upstate New York in 2001. He immediately became ill and within 10 days “fell into a stupor, soaked in his own sweat and urine,” but nurses from Prison Health Services regarded him as “a faker.” His heart stopped, and jail officials doctored records to make it appear that he’d already been released when he died. Investigators discovered that the jail’s medical director had denied Tetrault most of his daily medications. Source: Paul von Zielbauer, “Harsh Medicine: As Health Care in Jails Goes Private, 10 Days Can Be a Death Sentence,” The New York Times, 2/27/10

Criminalizing & Incarcerating People with Mental Illness

In 2005, the PBS/WGBH series Frontline broadcast a program called “The New Asylums,” examining the incarceration of people with mental illness in U.S. prisons and jails. The documentary confirmed what Human Rights Watch and the National Alliance on Mental Illness (NAMI) already knew: that with closure of treatment centers, hospitals, and residential facilities designed to care for people with mental illness, prisons and jails have become the primary institutions housing them – and within those institutions, the care is abysmal. The facilities and staffing are in no way appropriate or adequate to provide therapeutic or even responsible custodial care.

The program reported that “[f]ewer than 55,000 Americans currently receive treatment in psychiatric hospitals. Meanwhile, almost 10 times that number — nearly 500,000 — mentally ill men and women are serving time in U.S. jails and prisons.” This includes people with such serious conditions as schizophrenia, clinical depression, and bipolar disorder, in addition to other illnesses. Human Rights Watch estimates that about 70,000 are psychotic on any given day; many suffer delusions and hallucinations, debilitating fears, extreme and uncontrollable mood swings. “They beat their heads against cell walls, smear themselves with feces, self-mutilate, and commit suicide.”

“Conditions in jails and prisons are often terrifying for people with severe mental illnesses. These settings are not conducive to effectively treating people with these brain disorders. Many correctional facilities do not have qualified mental health professionals on staff to recognize and respond to the needs of inmates experiencing severe psychiatric symptoms. Correctional facilities frequently respond to psychotic inmates by punishing them or placing them in physical restraints or administrative segregation (isolation), responses that may exacerbate rather than alleviate their symptoms. Inmates with severe mental illnesses usually do not have access to newer, state-of-the-art, atypical antipsychotic drugs because of the costs of these medications. Federal and state prisons generally do not have adequate rehabilitative services available for inmates with severe mental illnesses to aid them in their transition back into communities.

“These alarming trends are directly related to the inadequacies of community mental health systems and services.”

Source: National Alliance on Mental Illness (NAMI)

G.M.: A History of Chronic Mental Illness

G.M., a homeless man incarcerated in Los Angeles County Jail, had a long history of chronic mental illness and also had cerebral palsy, which made him wheelchair-bound. He expressed hunger when he was admitted into the jail; an employee gave him a sandwich, which another officer decided to take away.

When G.M., in his wheelchair, struggled to hold onto his food, several officers interpreted his action as hostile and resistant; they moved to physically subdue him. He was taken to a room, aggressively manhandled, taken out of his wheelchair, and forcibly placed in four-point restraints; minutes later, he died.

The medical examiner’s report confirmed that G.M.’s airways were restricted by the weight of guards atop his body, and that he suffocated due to “positional asphyxia.” Later, mental health professionals confirmed that the restraints were inappropriate for someone in G.M.’s condition.

Source: Ill-Equipped: U.S. Prisons and Offenders with Mental Illness, Human Rights Watch, 2003

Criminalizing Childbirth: Shackling Pregnant Women

In 2008, as the result of relentless advocacy and activism, the federal Bureau of Prisons announced a policy change barring the shackling of pregnant inmates in federal prisons in all but the most extreme circumstances.

But despite the fact that the American College of Obstetricians and Gynecologists and the American Medical Association (AMA) oppose the shackling of pregnant women in detention, the practice remains widespread.

43 states still permit the shackling of pregnant women in jails and prison during childbirth; in late March of this year, Gov. Chris Gregoire signed a bill making Washington the 7th state to restrict the shackling of pregnant prisoners. The Washington bill also prohibits the shackling of nearly all female inmates who are recovering from labor and bans the use of waist chains and leg irons at any point in pregnancy and limits restraints on pregnant prisoners who are being transported in their third trimester.

Tina Torres’ Experience

In Pennsylvania, Tina Torres reports that her experience as a pregnant incarcerated woman at Riverside Correctional Facility was nightmarish – from pregancy through the 17-hour delivery and postpartum isolation. During labor, her legs were shackled together, with her left wrist handcuffed to the gurney. She needed a C-section, and the doctor at the hospital to which she was transferred insisted that the shackles from her severely swollen ankles be removed during the procedure; shackles were reapplied moments after birth. Said Torres, “I just had surgery…and I’m shackled to the bottom of the bed. When they took off my stockings, my ankles were bleeding. They were cut through…” Later, she found herself – with other new mothers – placed in a crowded unit for inmates with mental illness.

Source: Daniel Denvir, “Giving Birth in PA Prisons: A State Senator Moves to Unshackle Pregnant Inmates, Philadelphia Weekly, 1/19/10 The ACLU also publishes a summary of state standards regarding pregnancy and abortion for pregnant women.

pmlarsonmiller 2 Like

People who struggle with mental health have a difficult time on the outside - afraid to leave their homes due to anxiety, unable to function due to depression, consumed by their OCD, bipolar and eating disorders, etc. I have been privileged enough to have access to treatment for issues in the past, and I can say that even in an adequately staffed hospital setting with access to necessary treatment, it can be a traumatizing experience in and of itself. The lack of respect for human life and the stripping of dignity within prisons is absolutely abhorrent; money means more than life, and this is what society has become. Criminalizing and murdering people (in more ways than one) for profit.


People on the outside, if they ever think of prison at all, are disillusioned to believe that inmates are getting better healthcare than those who are not incarcerated. People jump to complaining before they take the step to educate themselves - how about they read something, research these issues, put faces to the failed health "care" system within prisons - read any number of memoirs from prison, news stories, reports. If one cannot find compassion and be moved to do something about the violation of human rights that occurs every day then they choose denial over humanity. 


Additionally, there needs to be a critique of the greater social structure that targets specific populations to endure these inhumanities and brutalities, in addition to confronting issues with health care even on the outside of the prison walls - those who are poor, if they have not yet been criminalized and swept into the criminal justice system, have a difficult time gaining adequate access to health care simply due to lack of funds. 


Unfortunately, healthcare is not treated as a basic human right in our country; many cannot afford it and suffer from various ailments without treatment - those who are privileged: have jobs with benefits, have the money to pay out of pocket, have adequate insurance, etc., can truly feel secure and confident that they will be taken care of no matter what their condition or situation. 

Panyia 2 Like

"Unfortunately, the demonizing of “criminals” – and whole groups of people presumptively considered “criminal,” such as young people of color, black men, immigrants of color – by politicians and mass media is so pervasive that many are willing to buy the idea that any brutality inflicted on prisoners is not only justifiable but desirable." 


- Sadly, too many of us buy into what these powerful people tells us to believe in.  So many times I want to blame the whole capitalist system and I want it changed. Maybe have the poor people be powerful (even thought they are poor) and have the rich people be powerless?  I really don't know but some how make some changes?  But many times I do wonder how it would be like if that is to happen.

nancy a heitzeg
nancy a heitzeg 1 Like

 @Panyia Capitalism is indeed a major piece of this problem -- people become disposanble in pursuit of profit


Sad indeed

McKenzieDaul 3 Like

To begin with, information like this always strikes me as simply fascinating. I only hope this information gets out to the entire society soon! Because with this awareness and insight I believe change will be mandatory. The mental health piece of the criminal justice system always interests me.. I wonder how many inmates truly do have some sort of mental illness. I mean most have to struggle with depression and anxiety sitting in a concrete blocks for hours, days, months, and years at a time. It seems to me nothing is taken seriously within the walls of prisons, whereas on the outside these are seen as serious problems that need immediate treatment to prevent any harm to oneself or others. How come it's any different for inmates. I do not necessarily think medication is always the cure but at least acknowledgement and not always an assumption that the inmate is resisting or acting out.. Or maybe the acting out and resisting comes from the understandable anxiety. I had so many emotions when I read about the women being shackled while pregnant or in labor. If that is not cruel and unusual I do not know what is. Amazing article, I am hoping more and more people start understanding these prison realities because we are talking about human life being totally taken advantage of, tortured, and relied upon for profit. 

KayWhitlock 1 Like

 @McKenzieDaul Hi, McKenzie.  Thanks for such a thoughtful and excellent comment.


          One thing, however:  you say, "It seems to me nothing is taken seriously within the walls of prisons, whereas on the outside these are seen as serious problems that need immediate treatment to prevent any harm to oneself or others."


          In reality, since "decarceration" - deinstitutionalization of many thousands of people with severe mental illness in the 1970s and defunding of many community outpatient mental health centers in the ensuing decades, I'm afraid that affordable, appropriate, safe treatment that respects the rights of people with mental illness is not available for most who would benefit.  With respect, I do not believe that mental illness is seen as a serious problem that needs to be dealt with compassionately by society within our own communities.  Rather, "the problem" has just been relocated to jails and prisons, with inhumane and brutal results. 



Vikki 4 Like

Thank you so much Kay & Nancy!


WORTH (Women on the Rise Telling Herstory, an amazing organization of formerly and currently incarcerated women in New York State) is developing its Birthing Behind Bars project to address the myriad issues of reproductive injustices behind bars, including the shackling of incarcerated women while in labor. Through the project, we will not only collect and compile stories from women across the country who have experienced pregnancy while incarcerated, but we will also strengthen their capacity and ability to share their stories. Too often, issues of reproductive justice are separated from issues of incarceration. Birthing Behind Bars will tie women's individual experiences to the broader issues reproductive justice (or injustice) behind prison walls. These stories can be used to help push a state-by-state analysis of the intersections of reproductive justice and incarceration.


WORTH was instrumental in ending shackling of pregnant women in New York State. In 2009, members of WORTH, other formerly incarcerated mothers and their allies took up the fight to outlaw the shackling of women in labor in New York State. Formerly incarcerated women spoke about being pregnant while in jail and prison, being handcuffed and shackled while in labor, being separated from their newborn babies almost immediately. Their stories drew public attention to the issue and put human faces to the pending legislation. New York became the seventh state to limit the shackling of incarcerated women during birth and delivery.


On March 21, 2012, Arizona became the 15th state to have any sort of legislation restricting or banning the shackling of women in labor. Florida's legislature passed an anti-shackling bill on March 8, 2012 (International Women's Day), but it has yet to be signed by the governor. Why is it 2012 and 35 states still allow this atrocity to occur?

nancy a heitzeg
nancy a heitzeg 2 Like

 @Vikki ps I know that Schwartenegger vetoed the CA bill and i expect that Florida;s will face th same fate :(

nancy a heitzeg
nancy a heitzeg 3 Like

 @Vikki Excllent vikki -- thank you so much for that update


Kudos to Birthing Behind Bars!


and great to see you as always :)

Heather Ellis
Heather Ellis 4 Like

I truly believe that if more of the public was aware of these atrocities than more people would speak out on behalf of the inmates. I know it's hard when many people in the public can't afford it themselves they feel angry when they hear falsified stories of the lavish treatment prisoner get, but if they knew the truth they could put their anger in the right places. As a future health care worker I am just appalled by stories like these. It's especially sickening to think that the only reason she was in jail was because of being undocumented, and because of that, and I'm sure her status of being transgender she was deemed criminal.

McKenzieDaul 3 Like

 @Heather Ellis So true! If society took it upon themselves to view this information instead of popular culture news and gossip we would have a lot more people questioning and challenging this flawed system, which affects all the others! 

Susan Pashkoff
Susan Pashkoff 3 Like

An excellent discussion, thank you Kay. This is simply appalling and I swear every time I read something on the human rights violations of prisoners, I am shocked that the US is not treated as an international pariah. In the face of the European Union Centre on Human Rights allowing people accused of terrorism offenses to be extradited to the US where of course they are ignoring documented repeated violations of civil and human rights of prisoners, I am horrified. I am sorry to divert the discussion, but the judgement came out yesterday and it is on my mind as I already have written asking them to be tried in the UK if there is any evidence of guilt (which they have not done and have kept people both incarcerated and then tagged in violation of due process and UK civil law). Sorry to distract the discussion, but one of them is missing an eye and both arms and they will be sentenced certainly to maximum security prisons in the states and then I read this and the EU says that their human rights will not be violated. They spend a lot of time covering up each other's human rights violations, don't they? Am disgusted and furious.

nancy a heitzeg
nancy a heitzeg 2 Like

 @Susan Pashkoff Not a distraction at all Susan..


The EU is wrong -- the USA cjs is an endless series of human rights violations


thanks for that update

JaimieBeavers 4 Like

This is so upsetting. Nobody should be treated the way these prisoners were treated. It is unjust and unfair. The shackling of pregnant women in prisons still exists in 43 states! This is just heartbreaking. Nobody, especially pregnant women, should be treated so poorly. Pregnant women need special care and treatment - not shackled and chained up. 


 @JaimieBeavers So true.  What permits this to go on is the criminalizing of women of color and poor women, so that giving birth is seen as the production of more criminals.  This is obscene and inhumane beyond words.

nancy a heitzeg
nancy a heitzeg 2 Like

 @JaimieBeavers the shackling is especially horrific..


 and yes -- all over including federal ICE Detention Centers.. There has been some movement to abolish this practice but not a lot of legislative success

rubyr 4 Like

This is just sickening. What a world!!


Thanks for another very important diary.

nancy a heitzeg
nancy a heitzeg 3 Like

 @rubyr hey ruby


yes sickening and so frustrating that the false memes re what prison is like persist..everywhere

nancy a heitzeg
nancy a heitzeg 4 Like

kay unfortunately can't be tonight -- but as always much gratitude to her for this piece..


Te contrast between the "myths" of the criminal injustice system and the realities are always stunning


Seeta moderator 3 Like

 @nancy a heitzeg A heartbreaking expose on the prison health care system, Nancy.  Thanks to you and Kay for tackling these issues week after week and debunking all the propaganda and mythologies that prop up this sickening system.

nancy a heitzeg
nancy a heitzeg 3 Like

 @Seeta it is heart-breaking...


and thank you seeta for hosting -- indebted...


Concerned btw as to what "justice " for Zimmerman may or may not look like... Sigh..

Seeta moderator 3 Like

 @nancy a heitzeg me too.... I think Zimmerman should be ordered to pay restitution in the form of service to the black communities he so despises.


  1. […] An average of one inmate per week died as a result of malpractice or neglect. (Please see Prison Health Care as Punishment for an overview and Shumate v. Wilson for a specific look at health care issues for women in […]