Prison Health Care A Nightmare

I have been a political activist since the 1960s and a community physician for 20 years. I became interested in prison health care at the time of the Attica Rebellion in 1971 and was a prison doctor in 1972-73.

In 1982, I was arrested for allegedly treating a member of an underground revolutionary group wounded in a shoot-out with police, the first doctor so charged since Dr. Mudd was jailed for treating John Wilkes Booth. After release on bail, I failed to appear for trial. I was arrested in 1985 and ultimately convicted of a number of politically-motivated crimes. I have been incarcerated since then, mostly in high security units, including Manon Penitentiary, the notorious highest security federal prison.

I developed cancer in 1985 and again in 1990, and had to fight the Bureau of Prisons (BOP) to get medical care. In 1990 I survived eight grueling months of chemotherapy, the first four months in a hospital lock ward and the second four shackled to a bed in an isolation room in an oncology unit. I was largely paralyzed from my neck down during that period.

I was supported by many activists and groups like Amnesty International and Physicians for Human Rights, and was featured on a "60 Minutes" segment on prison health care. Now I am undergoing rehabilitation at the federal prison unit connected with the Mayo Clinic in Rochester, Minnesota, and am scheduled for release in July 1992.

I survived two bouts of lymphatic cancer because I am a doctor (both times I found the enlarged lymph nodes that prison doctors did not) and because I have outside supporters. Supporters kept me out of the basement of the Springfield prison hospital, where I would have died, an end that the BOP wanted.

My situation is interesting, but to speak only of that would be to shirk a responsibility that we political prisoners have to fellow prisoners. A substantial part of our society' s poor and people of color will receive health care - or will be denied it - in prison. The prisoner/patient is a growing phenomenon. The U.S. has the highest incarceration rate of any industrialized nation. A high and growing percentage of prisoners are people of color, with the women's prison population growing faster than the men's. HIV and tuberculosis epidemics which are devastating inner cities are swamping already inadequate prison health care facilities. Long sentences from the "war on drugs" are "graying" the prison population, so prison doctors see more heart disease, cancer and strokes to which older people are prone. Like other institutions that serve the poor, prison health care is collapsing, or, more accurately, has already collapsed. The disaster is measured in increasing unnecessary suffering and death.

A congressional committee investigating prison health care heard that 154 men died at Springfield in 1990. I was called to testify, but the BOP objected and the subpoena was withdrawn. This is part of my statement to the committee, describing my brief stay at Springfield in 1987:

I was kept in the "hole" at Springfield. I was allowed out of my cell five hours per week: two hours in a dog cage outside and three hours in a cage inside. My doctor was the Chief of Medicine, Dr. Nelson. He was one of the most hostile, least competent, and least compassionate doctors I've ever met. Our encounters were limited, but I witnessed his interactions with other prisoners as well.

Jonathan, for example, was a 23-year-old who lived on one side of me. He had an overactive thyroid due to Grave's disease. That condition can be treated with drugs, radioactive iodine, or surgery. In previously untreated young people, drugs are almost always tried first. Dr. Nelson never told Jon about the three options. Instead, he told him he had to take the radioactive iodine. He did not inform him of the side effects.

Terry's cell was on the other side of me. He was sent to Springfield from Marion Penitentiary because of recurring bouts of hepatitis. Dr. Nelson informed him that the liver abnormalities were due to winter weather and depression - a ludicrous explanation. The treatment was to return him to the notorious Marion control unit.

For part of my stay, Pablo was in the cell across from me. He was sent there to have a bullet removed from his buttocks. A nurse carne to have him sign a release form. He couldn't read or speak English; the nurse knew no Spanish. Pablo asked me to translate. The release was for the removal of a lymph node, not a bullet. No one had told him that the doctor suspected he had cancer.

Carlos was in that cell after Pablo. He was a Connecticut state prisoner who had been held at Marion for years. He went on a hunger strike to protest his long years in 23-hour-a-day lockdown. Pursuant to BOP policy, he was sent to Springfield for forced feeding. Forced feeding has been widely condemned by human rights groups. The World Health Organization has called on physicians to refuse to particípate in it. Forced feeding at Springfield is particularly brutal. After a pro forma psychological evaluation to establish that a hunger striker is, by definition, suicidal, the prisoner is strapped down. A large rubber feeding tube is forced down his or her gullet, and a liquid meal is administered. The tube is then removed and reinserted for every feeding, subjecting the patient to incredible pain and the risk of aspiration pneumonia.

There was another prisoner in my unit who was restrained. I don't know what brought him to Springfield. He spent a fair percentage of his time verbally harassing the staff. He sounded confused to me. The guards got permission to restrain him, even though he was never physically violent. He was strapped spread-eagle to the bed and left there to urinate and defecate on himself. I believe regulations state that such restraints can only be used for 24 hours. He was in restraints from Friday until Monday - 72 hours of total immobility, covered with his own waste.

That brings me to one last example from 21 East, Pedro. He was in his late 30s and dying from inoperable lung cancer. As he grew weaker, he could no longer come out for his occasional hour of recreation. His hacking cough and labored respirations echoed down the tier at night. He lay in his bunk, staring at the ceiling, a blank wall, or a barred window. When one of the rest of us went to recreation or a shower, we'd kick his door and yell "Hi!" It was his only human contact.

When my cancer recurred in 1990, I avoided being shipped back to Springfield. Dr. Nelson would have been my primary physician. The consulting "cancer specialist" at Springfield has never even qualified to take the specialty boards and is not a member of either of the two medical societies for cancer specialists. Springfield has close to 700 patients but has no doctor on the premises after 4 pm on weekdays or on weekends. The lab and x-ray facilities don't function after 4 pm or on weekends. Yet the BOP considers this a full-service hospital. It's frightening. What's more frightening is that many state systems and county jails have worse medical facilities. In 1990, some one million people were in prisons and two million passed through county jails. Black men in certain sections of New York City have a death rate comparable to that in Bangladesh, but Black men in prison die at an even higher rate. At what point do we call the policy of stuffing people of color into prisons and neglecting their health genocide?

Mail brightens any prisoner's day, or any patient's day. Write to Alan Berkman as folïows: Dr. Alan Berkman, #35049-066, P.O. Box 4600, Rochester, MN 55903-4600.