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Indybay Feature

Texas Prisons: A Place To Die

by Oread Daily
Long, but worth the read

When a federal judge acting under pressure from an appeals court recently released the Texas prison system from the federal oversight which it has been under for years, many concluded that things must be "okay." However, that is far from the truth.

Brenda has liver disease and is so swollen she looks like her stomach is going to burst open. She can't breathe because of the fluid in her body from the disease. She is always nauseated She bleeds from the rectum and from the mouth. She calls for help and prison staff ignore her. Some days she can get up and move around and other days she is just too sick. She is at the end of her disease and in a lot of pain. The other inmates try to help her but there is not much they can do. She has been refused medicine many times. She has been placed in what is called a medical dorm, but it is only called that because it is where they warehouse sick inmates. No one there is qualified to care for someone as sick as Brenda. She needs to be in a hospital. Of Brenda’s situation, another prisoner wrote, "She is swollen with fluid, her stomach is so far distended it appears it may bust. She vomits blood, runs a fever and must now sleep siting up, because the fluid in her body is suffocating her. When she lays down she chokes continuously and although she saw Dr. West on Tuesday July 2,02 and he told her she would be hospitalized soon... we can all see this effort will be made much to late to help Brenda. I can't even describe what we are seeing happen to her, while medical ignores it."

Chad is a twenty eight year old prisoner with Lyme Disease. Despite six years of pleas for some kind of treatment, nothing happens. Even if his Lyme Disease cannot be cured, Chad’s joint swelling, and pain can be treated, his seizures can be controlled with modern medicine. His psychiatric condition has deteriorated significantly. While he has been previously assigned diagnoses of Bipolar Disorder and Hyperactivity Disorder and treated with appropriate medications for both those conditions, he is not currently being treated with psychiatric medications. An outside psychiatrist says that it also seems quite likely he is suffering from a seizure disorder. The temperature in the segregation unit where he is incarcerated exceeds 110 degrees Fahrenheit at times in the summer. An outside physician decries his treatment as "barbaric."

These are real people suffering real pain. Unfortunately, they find themselves in the prison system of the state of Texas where such "barbaric" treatment is the norm, not the exception. Prisoners have been left to die in their cells. They've starved in infirmaries, languished in their own feces before dying. Care in the prisons is so bad, inmates say, that they join experimental drug trials at a university hospital in Galveston to avoid the care offered in jailhouse infirmaries. Prison system doctors, relegated by then to administrative functions, took notice of criticism and began an emergency audit in 1996 of the medical charts of the inmates who had died that year. The doctors reviewed 24 charts and concluded that 16 dead inmates had received improper care. A couple of examples. Alexander Oris, "starved to death in infirmary," according to the Texas Department of Criminal Justice's internal review. Michael Anderson vomited for three days and had no bowel movements for six days before he died and "appeared to have been neglected in his cell." The system administration afterwards said they had made improvements. Yet two years later an attorney representing Texas convicts in a long-running federal lawsuit over prison conditions hired corrections system doctors from other states to conduct another review of prison deaths. These doctors came to conclusions strikingly similar to those in the prison system's own study two years earlier at Stiles. They examined 59 deaths from across the state and found that 20 of the inmates received poor or very poor care. Sixteen of those 20 deaths were either "preventable" or "possibly preventable." Care for diabetes and hypertension was "strikingly poor," the doctors testified. Dr. John Robertson, who at the time headed the prison health-care system in New Mexico, said he found that inmates would arrive at prison clinics with "what by most any reasonable expectation would be close to a medical emergency, and very little would be done about it." A federal judge wrote in 1999 that he had heard evidence of "significant, even deadly, inadequacies" in the medicine practiced on inmates. Two examples. Ophelia Rangel was left "lying in feces, menstrual fluid and urine" until she died of "severe dehydration," the doctors concluded. Robert Lee Brown died of a stroke and a heart attack after prison health officials ordered medicine to treat hypertension that caused a "precipitous lowering of blood pressure." The federal Food and Drug Administration had warned against this method of treating hypertension in 1985. Did the state know about these problems? "I don't think it's possible they could be unaware of it unless there's no coordination or no looking at the data we looked at," Robertson testified. "It would be impossible not to know that there were serious problems in the system and problems that, really, again, transcended all units and locations." In the year 2000, prisoners at the Stiles Unit where many of the sickest prisoners were housed began filing large numbers of complaints about medical care at the facility.

A few years back Texas put its prisoners in everybody’s favorite money saving scheme - an HMO. In that system the University of Texas Medical Branch treats 80 percent of the inmates in 71 prison clinics and a hospital in Galveston. Texas Tech University in Lubbock takes care of the remaining inmates, using prison clinics and community hospitals to provide care in West Texas. One of the goals of an HMO is to limit care in order to save money, and that can leave prison inmates, who tend to be sicker than the general population because of their poverty and their drug and alcohol abuse, in a particularly vulnerable position. Any number of people can deny them care, from a poorly trained health care aid to a physician's assistant at a pill window. Doctors at prison units can override the recommendations of Galveston specialists and take away medications, work restrictions and even crutches, walkers and back braces. Among the problems which have resulted since implementation of the HMO plan:
*Inmates have been discouraged from getting medication.
*Doctors at local units have ignored what specialists said about inmates' conditions.
*Infectious diseases such as hepatitis, tuberculosis and drug-resistant staph have soared.
*An internal medical audit revealed serious lapses in treatment for HIV and AIDS.
*The Huntsville facility kidney dialysis unit lost its accreditation.
*At least eight prison unit physicians have had their licenses restricted by state medical boards.
With the advent of managed care in 1994, all medication had to be taken at pill windows, and no one was allowed what were called "KOP," or Keep On Person, pill packs. In most units, the pill window is open only twice a day, once from 3 to 5 in the morning, and once in the evening, usually from 4 to 6 p.m., which tends to fall during mealtime. There is a water fountain at the pill station where the inmates must take their medicine under the eye of a guard. If 70 to 80 inmates require medication, the wait for a pill can be onerous and long, especially if an inmate is disabled or ill. And if the line is too long and all the patients are not served by closing time, the window is simply shut, and those who didn't get their medication have to come back later. In some cases, inmates have to choose between eating dinner or getting their pills. Chronically ill patients, such as those infected with TB, sometimes simply give up hope and don't bother to take their medication. For many inmates, it's not worth the hassle of going to the infirmary and waiting three days to see a doctor for something like the flu, a cold or a headache. As a result, drug costs drop. Prisoner complaints not surprisingly have skyrocketed. Said a nurse who worked in this system, "… from the beginning you are taught to treat them mean…There was never anything wrong with an inmate. Anybody that treats them nice is called an inmate lover…A nurse is supposed to look at an inmate," she says, "but sometimes they'll turn down a request if they judge the inmate has already been seen. They'll write a 'no-show' on appointments because the inmate can't get out for security reasons. A guard might fail to get them out for various reasons, or there might be a lockdown. A lot of focus is on getting rid of the sick-call requests." Most measures of health-care quality in Texas prisons are secret, according to state law and rulings by state Attorney General’s Office. Databases of inmates' medical grievances, findings of doctors who review the deaths of inmates, inspection reports of dialysis facilities, correspondence among prison health-care administrators and inspections of prison health-care facilities are all private in Texas.

As mentioned above, since 1993 University of Texas Medical Branch (UTMB) has operated both, the prison hospital and most of the prison clinics. But the care in the clinics, in the prison was not the same at the hospital in Galveston. Inmates knew it, and they also knew there was one sure-fire way to get to Galveston: Join an experimental drug trial. Become a biomedical research "guinea pig" for UTMB. Until late 2000, UTMB conducted dozens and possibly hundreds of trials without telling state prison officials what it was doing — violating a long-standing prison system rule. Inmates knew about the trials, however, and as they came to understand the failures of the prison health-care system, they agreed to join the drug tests. Their decisions weren't so much willing as they were fatalistic. The voluntary consent of the human subject is absolutely essential," reads the Nuremberg Code of 1947, which was drafted in direct response to the sheer barbarity of Nazi-era medical experiments on Jews and other captive groups. "[The] person involved should have legal capacity to give consent; should be so situated as to be able to exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, over-reaching or other ulterior form of constraint or coercion. " Because little in prison is done without any element of force, the Nuremberg Code should have ended most research on prisoners. It didn't. However, following many exposes and investigations by the early 1980s, such practices had been greatly diminished. Texas, however, was at the forefront of the few states continuing this notorious tradition. Federal officials found "scant evidence" in a July 2000 inspection that the University of Texas Medical Branch had followed regulations for protecting prisoners enrolled in medical research trials. Convicts had not been fully informed of the risks in some tests. In one study, the federal regulators alleged, prisoners with ovarian cancer were asked to sign a consent form that vastly overstated the benefits of participation. In more than half the 25 UTMB research projects it reviewed, the federal Office of Human Research Protections (OHRP) found problems. According to federal regulations, research in prisons must fit into one of four permissible categories: studies of the possible causes and effects of incarceration and criminal behavior; studies of prisons as institutional structures or of prisoners as incarcerated persons; research on conditions affecting prisoners as a group; and research involving a therapy likely to benefit the inmate involved. In all cases, studies are required to present no more than a "minimal" risk to the prisoner. Yet in many of the clinical trials reported to OHRP, those regulations were clearly violated. A September 14, 2000 letter from the feds to UTMB listed numerous research projects that did not fall into any of the categories of permissible research on prisoners, finding "scant evidence" that the university’s institutional review board followed federal regulations when it reviewed and approved the studies. Documents obtained through a Freedom of Information Act request offer insight into the types of studies conducted on prisoners at UTMB. Listed studies included those on induction of labor among pregnant inmates; a study of different methods of obtaining biopsies from inmates; a Phase I clinical trial (used to test a new drug or treatment for the first time in a small group) involving an experimental HIV vaccine; and another using a new experimental therapy of the intrahepatic (directly into the liver) delivery of a powerful chemotherapy drug. Perhaps most shocking was a Phase I study, ongoing since 1997, that used prisoners to test a radically experimental approach to treating lung cancer. In that study, the prisoner was anesthetized and then connected to a machine called the BioLogic-HT System. According to the consent form, the test subject would agree to be heavily sedated and then to have tubes inserted into veins in the leg and neck to obtain blood. The blood removed from the volunteer would then be heated by the machine and returned to the body, inducing a dangerously high body temperature of 108.5 degrees and resulting in a sustained "hyperthermia" for two hours. The consent form for the study cites a long list of serious potential side effects, including brain and spinal cord damage, loss of limbs, heart attack, hallucination, memory loss, burns at body pressure points, congestive heart failure, internal bleeding, seizures and death. While consent forms for experimental studies typically do list a wide array of possible complications, this form carried the additionally disturbing warning that the university would not compensate a research subject in case of injury. Participants in the study signed a form that read: " I understand that I cannot ... receive financial remuneration for any injuries resulting from my participation in this project." Federal regulations specifically prohibit any language in informed consent documents whereby a subject is made to release, or appear to release, the investigator or the institution from liability for negligence. Yet while UTMB was given specific guidance on how to improve its reporting, reviewing and informed consent procedures, at no point, confirms the OHRP, were any of the prisoners in these studies interviewed about their experiences as test subjects. Paperwork was submitted by the university in response to concerns raised by the OHRP. On the basis of that paperwork—although no further site visits were made—the researchers were given the go-ahead by the OHRP in mid-January 2001 to resume their work, although it is unclear which of the objectionable studies were allowed to continue.

Keith Curry, a Washington-based psychologist issued damning findings in a report he prepared for prisoners' attorneys in the Ruiz prison reform lawsuit. Curry, who works for Applied Forensics LLP, is an expert witness who has worked on prison mental-health cases in several other states. Curry reviewed the records of 68 convicts who had been in segregation from one month to 17 years. The average was 5.2 years. In all, prison officials say, a little more than 6,700 mentally ill inmates are in administrative segregation statewide. Curry reported finding mentally ill convicts whose medication had been improperly halted and were too disoriented to appeal. A shortage of trained staff meant that mentally ill inmates weren't properly monitored by prison medical personnel. Routine blood tests weren't taken or logged into medical records, despite a requirement that tests be given with certain drugs. Inmates suffered painful and debilitating side effects from their drug treatment, but received no proper treatment in response. He says, "The provision of mental health care in Texas prisons is abysmal." Curry adds, "People who are coming out of this system are infinitely worse than when they went in. A system like this is not good for (inmates) and not good for Texas."

Some folks are benefiting though with public money being sent to UTMB to provide health services to Texas prisoners. Some $668,000, for example, went right into the pockets of 60 UTMB physicians as bonuses, despite the protests of the prison board. Some Texas tax money appears to have been spent helping UTMB bid on providing health services for jails in New York City and for prison systems in other states. And a quarter of a million dollars goes to two highly paid -- and apparently underworked -- administrators who were once employed by the prison system.

On and on, I could go and this is only medical conditions. You can imagine what other conditions are like. And this is only Texas. The end of federal oversight does not mean conditions are now acceptable. As the letter below (as well as the first two stories above) show, all is far from well. If you know anyone who can look into the situation of medical care in Texas prisons, get them to do it. If you are a healthcare worker of any kind, get your union, your professional organization, whatever, to take a stand on prison healthcare and the brutality of Texas prisons. One other action you might consider. Send an Email to the "Joint Commission on Accreditation of Healthcare Organizations" at complaint [at] and ask them to look into the services provided by University of Texas Medical Branch to Texas prisons.


Letter from Mary Vallier
My name is Mary Vallier TDCJ #762401, I have been in the system for two years, and one other stretch. I was diagnosed with cirrhosis of the liver and hepatitis C.
I was released in April of 99 and returned on a violation in December of 2000. Since my incarceration here my health has seriously declined due to lack of proper medical care.
I am in the end stages of cirrhosis now, and all they tell me is that there is nothing they can do for me, well thetas what they have told me since I was diagnosed. There are things they could do for me ,but don't.
I applied for special needs parole and was denied. I had to take it upon myself to apply for that.
All medical ever tells me is that I am dying and I have to accept that, well I've always been a fighter, but the fight is getting harder. These people over medical here, in my opinion, would not make good animal doctors.
You just cannot imagine the mental anguish I go through daily knowing that my life is in the hands of a bunch of un professionals. I fully intend to fight until I draw my last breath, to try and help others in the same situation and see justice done for all of the ones that have suffered due to the neglect of medical care here.
The only medication I have been on for years are vitamins and water pills. I have only had one ultra sound on my liver, no biopsy. They only speculate on the serious aspects of my condition, due to my critical labs and symptoms. I have taken so many water pills that my kidneys don't work on their own.
If there is anyone out there that reads this letter. I am not asking for sympathy, only empathy, Just because a person makes mistakes in their life don't mean they deserve to die in the process. Hopefully there will be an attorney or even a judge that will look into these matters, everyone in the system can't be telling a lie. I really do think that these accusations against the State prison Medical Facilities and U.T.M.B. should be looked into. Ask yourselves if you had a loved one in the system would you want then to be neglected this way? Take a chance on us, we are only women trying to survive on the inside.
Thank you for taking the time to read this letter. If there is anyone out there that may be willing to help, please contact me. I go home August 23rd address upon release has been provided
Update: Mary was rushed by ambulance to hospital and she was sent home as she is dying.. they denied her special needs parole when she had asked and made her spend her last days in mental anguish, neglected and without decent medical care.
Mary Vallier #762401
1401 State School Road
Gatesville Texas 76599
Interested Attorneys:
910 Chance St.
Wichita Falls, Texas 76306

Sources: Family members of prisoners, Houston Press, Texas Prison Labor Union, Austin American Statesman, In These Times, Cox News Service, Austin Chronicle

(Please See Update Below)

Update: The following information came in today. This is in regards to Brenda mentioned above.

From James West, M.D.
Cluster Medical director
Gatesville Cluster
Re: Offender Brenda Doss
TDCJ-ID #1013935
Brenda Doss is a 43y/o cirrhotic with a history of bleeding esophageal varices. For the last 4 weeks she has been having shortness of breath and nocturnal dyspnea secondary to ascites, possible early failure and consuming 3 liters of fluid a day. I have put her on a fluid restriction and increasing doses of Lasix and Enalapril to mobilize her fluid. To date she has lost 8 pounds. Today I added Spironolactone to her medications. I will see her weekly until she is no longer dyspneic. Record review shows no complaints of vomiting blood in the last 6 months or more. I never told her she would be hospitalized soon. She has a G.I. clinic follow- up scheduled. She is being seen on a weekly basis now because of her complaints of shortness of breath, not because of any pressure put on the medical staff. She was seen in Galveston 8 times last year and she has been seen in our clinic 10 times by a primary care provider this year. I hardly think that this represents her being "left to die" or "ignoring" her
condition. Chart search shows no recorded fever in the last 6 months.
Dr. James West MD

From Brenda to an outside advocate:
I just wanted to drop a line to say a few things about me and my illness. I may not spell some of the things that good, but you'll know what it is.
These are the illnesses I have
1)I am a diabetic
2)I have hepatitis b and c
3)Amonia in my blood
4)Cirrossis of the liver(liver failure)
6)My stomach is so full of fluid look like I have 2 babies
7)Gall stones
8)I get so weak, some mornings I can't even get up unless I feel like
throwing up. The doctor gave me some finagrin for it.
9)High blood pressure
10)High colesterol
11)Nuropthy in my legs and feet
12)My feet are cracking, which is not good for a diabetic. I tried to tell the doctor, she didn't do anything for me, she just brushed me away every time I complained about it... My eye is bloodshot really bad and I told the nurse today when I went to get my insulin. She wouldn't examine me, she told me to drop a sick call. One thing is I am scared to write this letter, will you make sure you won't let the people do anything to retaliate. But also I am so scared to die in here. Please help me. I am so sick my eyes are black underneath. I am laying down as I write because every time I sit up I get dizzy. Please help me. I don't want to die in here. They say that there is nothing else they can do for me…. I was throwing up blood and a nurse came in to check me. Well guess what she brought me..2 antacids and for me to drop a sick call. I signed the papers for you to get my medical records…Thanks Brenda

Dr. West does not choose to acknowledge many of Brenda’s complaints. In regards to those complaints he does acknowledge ("…shortness of breath and nocturnal dyspnea secondary to ascites, possible early failure…), he says he will "… see her weekly…" Remember this is a person who has diabetes, liver failure, hepatitis B and C. A once a week visit is totally inadequate care. Even taking Dr. West at his word does a prison cell sound like the place for Brenda to be?

The Oread Daily provides daily (Monday-Friday) progressive, left, anti-racist, anarchist, commie, activist, environmental, Marxist, revolutionary, etc. news and information from around the US and around the world. The Oread Daily was a mimeographed sheet that came out first in the summer of 1970 in Lawrence, Kansas. It was irreverent, radical, spicy, revolutionary et. al. Now, three decades later it returns. To view the entire Oread Daily, please visit:
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