Let’s say you’re incarcerated and have a heart condition. You’re supposed to be see a cardiologist every six months, but haven’t since you were transferred to a private prison a few years ago. Unless you’re literally dying, they’re not going to transport you to see an outside specialist and it’s more trouble than it’s worth to try.
You’re always in pain, but the past few weeks you’ve been in a lot of pain. You can’t see how you’re going to make it through another week at your Maintenance job, even though you need the 22 cents per hour. So you get a Sick Call form, write a brief description of your condition and symptoms, and submit it to staff to get on the list allowing you to go to medical. Theoretically, once you submit the form you can see someone the next weekday.
Once you’re at medical, a nurse weighs you and takes your vitals, then asks what brings you in. They tell you that before you can see a cardiologist they’ll need to run some tests in-house, like a chest X-ray and an echocardiogram, so you’ll need to come back next week. The ultrasound technician comes on Mondays, the X-ray technician comes in on Wednesdays, and so forth.
After the test results come back, medical agrees you should see a cardiologist. The appointment request moves up to the senior staff. They approve it the next day, and send it up to the warden who approves it a few days later. So within about three weeks, you’re cleared to see a doctor as far as the prison is concerned. Except that everyone up to this point works for the private contractor the state is paying to run the facility instead of the department of corrections (DOC), which now has to approve it too.
The warden sends the request to the DOC liaison, who sends it to the DOC commissioner. The commissioner approves it and sends it back to the prison. So within four or five weeks, you’re cleared to see a doctor as far as the prison and DOC are concerned. Except now the request goes to the different private company that’s been contracted to do the scheduling. The schedule they propose has to go back to the prison and DOC for approval. So anywhere from one to eight months after you filled out the Sick Call, you’ll be approved for an appointment the following year.
The issue is not bureaucracy; it’s cost.
That’s been my experience in the facility where I’m currently incarcerated, but everyone here has a story like that. Sure, requests can be designated as “urgent,” but that doesn’t mean they’re treated as such; it can take weeks or months for broken bones to be set.
“Medical put me off for four years, denying I needed open heart surgery,” Jim*, in his mid-60s, told Filter. “When they finally sent me out … I needed a quadruple bypass. And then waited another three years before [DOC] approved a procedure that expensive. So … that tells you pretty much everything you need to know about health care here.”
Fundamentally, the issue is not bureaucracy. It’s cost. When you’re paid per prisoner no matter what happens to them, and your goal is to maximize profits for shareholders, what reason is there to keep us healthy?
The Federal Bureau of Prisons is phasing out its use of private prisons, though it’s taking longer than it was supposed to. Twenty-seven states contract with private prison operators, mostly in the South and the West. Some of those facilities use a different private contractor for health care. But state-run facilities are also increasingly outsourcing health care to private contractors, and in many of them the experience of trying to access care isn’t likely to be less miserable than at a privately run prison.
They disagreed with the doctors about what constituted “life-saving treatment.”
Frenchie* has been incarcerated for 15 years, most of them in this facility. In 2019 he kept passing out, until the problem forced him to fill out a Sick Call. His fainting spells were dismissed as panic attacks, his hypertension as nothing that required medication, and he waited almost a year to be transported out to the hospital where he was diagnosed with a blood disorder.
“They tried to refuse paying for the blood transfusion because they deemed it unnecessary. They put me on two medications I’d told them I was allergic to, because they were cheaper. I’d been told I needed surgery sometime [in] 2020,” Frenchie told Filter. He didn’t get it until 2023. “According to the hospital I was sent out to, I was on the door of death. I had to receive several emergency transfusions that the facility again tried to deny payment on.”
They disagreed with the doctors about what constituted “life-saving treatment.” After they were forced to pay, they next tried to deny his post-surgery check-up.
“Whatever problem you have,” Frenchie said, “they will deny it is a problem.”
One man here, in his mid-30s with life-threatening haemochromatosis—too much iron building up in your blood—was for a time able to access the expensive treatment. But when he didn’t show signs of responding to it, he was cut off.
I remember a man with Stage IV cancer who was told there was nothing more that could be done. So they stopped his chemotherapy and refused him any further treatment. Why throw money away?
*Names have been changed to protect sources
Image via Centers for Disease Control and Prevention