Medical Privacy Is Still Our Right in Prison, Unless It Involves Psych Meds

June 15, 2023

Just before the pandemic hit, when my Washington Corrections Center (WCC) job assignment was Maintenance crew, I fell off a ladder and landed on my back. Washington State Department of Corrections (WDOC) does prescribe opioid painkillers when it decides a prisoner’s pain level warrants it, but did not decide so for mine.

I never pursued them because I knew there was no point. I spent the next two years requesting an alternative, and then one day a WDOC provider offered to prescribe amitriptyline. They said that certain doses were used to manage pain.

Amitriptyline (brand-name Elavil) is used for chronic nerve pain, but whether it would have helped I’ll never know. Everyone here knows that unless you can’t live without it, the harms of being prescribed psychiatric medication here are going to outweigh any benefits. I declined the offer.

Amitriptyline is an old-school tricyclic antidepressant that’s often used as a sedative. In prison culture, at WCC and other facilities around the country, this means it’s considered an antipsychotic like quetiapine (better known by brand-name Seroquel), regardless of its actual classification.

Countless prisoners have had similar talks with similarly well-meaning but uninformed medical staff.

Psychiatric medications are a risk factor in Washington Offender Needs Evaluation, the classification assessment that determines a prisoner’s “likelihood of reoffending.” I told the provider that I didn’t know whether having amitriptyline on my file could jeopardize my clemency hearing, so I couldn’t take the risk.

The provider explained to me that privacy laws protect disclosure of any prescriptions or diagnoses in my file, and so I didn’t need to worry. I explained to the provider that while the Washington State Clemency & Pardons Board isn’t handed my psychiatric file directly, it can access anything documented by WDOC security officers, which can prompt a request to see my file. If requested, the file will be sent.

Countless WDOC prisoners have had similar talks with similarly well-meaning but uninformed medical staff. This is partly because Psych is part of WDOC’s job-screening process—prisoners fear that, one way or another, psychiatric medication will prevent them from getting the assignments that would allow them to save money or be near their families. WDOC did not answer Filter‘s request for comment.

A psychiatrist signs off on your fitness for all work assignments, and the notes they leave on your file are not redacted. These notes won’t specify a diagnosis or medication, but will often include some statement like, Patient is stable. A job supervisor will later read this and wonder, As opposed to what?

The supervisor will start asking around about whether you should be considered dangerous. Dangerous prisoners are a security threat, so anyone they ask for information is going to give it to them. A lot of it will come from other prisoners.

Why would so many people around you know your medical history—or think they know it? Because  psychiatrist notes aren’t the only weak point in the privacy protections we’re supposed to have. For many, the even more harmful thing is Pill Line.

Twice a day, guards call over the intercom “Pill Line; Pill Line.” Everyone sees who gets up to go.

WDOC prescribes medications one of two ways: Keep On Person (KOP) or Pill Line (PLN). KOP is the less controlled of the two, and includes most selective serotonin reuptake inhibitor (SSRI) antidepressants like Prozac, plus everyday medications like Aspirin or Tylenol. (Most people can’t afford to buy those over the counter from commissary.) Medical typically fills KOP prescriptions one month at a time, like pharmacies do with many medications on the outside.

PLN is for medications that are highly stigmatized, associated with “diversion” or both. This includes almost all antipsychotics, mood stabilizers, opioid analgesics—including Suboxone—and hormones taken orally. Amitriptyline is usually PLN, but sometimes KOP depending on the parties involved. If WDOC doesn’t want you to keep a medication on your person, to get it you have to report to Pill Line.

Pill Line is a sort of ongoing HIPAA violation in physical form. Twice a day, before breakfast and usually after dinner, guards call over the intercom “Pill Line; Pill Line.” Everyone sees who gets up to go.  Everyone who goes at some point sees which pills the other people in line are there for, since all of this happens out in the open.

For insulin, the callout over the intercom is “Diabetic Line.” Pill Line is the catch-all for everything else that isn’t KOP, but anyone who reports daily is presumed to be on antipsychotics or mood stabilizers. It does not matter what they’re actually there for.

I’ve known hundreds of people on psychiatric medication go to medical and report that they’re “cured.”

Fear of being associated with psychiatric illness is a determining factor in which medications are prescribed. Someone prescribed a 10-day regimen on a muscle relaxer might benefit, but getting it would mean being seen standing in Pill Line. That alone keeps people from seeking care, even for serious injuries.

The stigma of Pill Line is what keeps prisoners who aren’t prescribed psychiatric medication from accessing other kinds of medications when they need them. But there’s a different access barrier powerful enough to make many who are prescribed psychiatric medications discontinue them, even ones they’d been taking for most of their lives.

I’ve been incarcerated in WDOC for 28 years, and it’s not an exaggeration to say that I’ve known hundreds of people who’ve gone to medical reporting that they’re “cured,” so they no longer need their prescription. Nothing had changed for them medically; what changed was they became eligible for camp.


Read Part 2 of this story here

Photograph via City of Philadelphia

Jonathan Kirkpatrick

Jonathan covers harm reduction and re-entry. He's incarcerated at Washington Corrections Center, where he's a Teacher’s Assistant for re-entry workshops and trains peer educators in HIV and hepatitis C harm reduction. His writing has been published by the AppealTruthoutJewish Currents and the Seattle Journal of Social Justice. His Washington State Department of Corrections ID is #716850, and until WDOC corrects a 29-year-old paperwork error his name in Securus is “Jonathon.”

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