Are the Prisoners’ Complaints of Health Services at Fort Dix Valid?

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Several prisoners describe their experiences as patients of the Health Services Department at Fort Dix East, a federal prison In New Jersey.

November 20, 2000

People in prison are chronic complainers. They’re upset about being apart from their families and communities, about having lost a degree of control over their lives, about being incarcerated.

Since 1987, I’ve been a prisoner myself, and during my sentence I’ve been designated to serve my term in four separate Bureau of Prisons (BOP) facilities. I’ve met thousands of other prisoners and listened to thousands of complaints about the way prisoners perceive their mistreatment. Many of the complaints seem unwarranted, a product of disgruntled lives. One category of complaint, however, pervades every prison: prisoners deplore the treatment they receive from Health Services.

Health Services is the department in every prison that is responsible for responding to the medical needs of the inmate population. At Fort Dix East, the prison where I currently am confined, the Health Services Department employs two full-time physicians and several physician assistants (PA).

Because Fort Dix East holds approximately 2,000 prisoners, and the Health Services Department employs so few medical professionals, prisoners have a difficult time seeing someone from Health Services when they are in need of medical attention. Health Services, perhaps, is the most understaffed department at this facility. It certainly is the department that I hear prisoners complain about most.

Like everything else in a large bureaucracy, the Health Services Department is governed by strict procedures outlined in the Fort Dix Policy Statements. The Policy Statement for Health Services, though, is not available in the prison law library, so it is beyond the reach of most prisoners; only the most legally astute prisoners understand their rights to treatment.

In the fourteen years that I’ve been confined, I’ve been fortunate in that I’ve rarely had to use the Health Services Department. Yet, because it’s a topic among prisoners that generates regular complaints, I wanted to learn more abut it. Why does the Health Services Department at Fort Dix East generate such vitriol?

In order to answer my question I sought out prisoners whom I knew had used the Health Services Department and asked them to describe their experiences. I spoke with several different people, each of whom complained not only about their lack of access to prompt medical attention, but also the indifference and sometimes open contempt with which they perceive they are treated. A pleasant “bedside manner,” apparently, is not a prerequisite for employment at the Fort Dix East Health Services Department.

Although my conversations with other prisoners were not conducted with any pretense of scientific methods, listening to them describe their personal experiences with Health Services helped me understand why they resent the department. I do not discount their ordeals simply because they are prisoners.

Readers can make their own determinations of what weight they want to give to the veracity of these men’s descriptions. My experience of living behind these fences leads me to conclude that the prisoners’ descriptions are genuine, but I can appreciate a reader’s concern about “biased prisoners.” Nevertheless, the health-care episodes described here will help readers understand why prisoners at Fort Dix East take umbrage at what they perceive as a lack of access to acceptable medical care.

The people with whom I spoke described four different aspects of medical treatment: sick call, emergency medical problems, illnesses requiring regular monitoring, and special surgeries.

SICK CALL

Sick call is the procedure one must endure if he wants to initiate medical treatment at Fort Dix East. It is available to prisoners four days each week, Sunday, Monday, Wednesday, and Thursday, between 6:15 p.m. and 6:45 p.m. The door generally opens for sick call at 6:30, at which time a staff member from Health Services will collect prisoner ID cards and issues forms for the men to fill out describing their medical needs. Prisoners who are not waiting at the door when it is open to receive their forms miss out, as by 6:45, the door is closed.

If a prisoner feels nauseous, develops a rash, or suffers from pain, he must wait until the next available Sick Call opening and proceed to Health Services. He usually will encounter a long line of other prisoners waiting to schedule their own appointments. Once a prisoner’s name comes up, he will have an opportunity to talk briefly with a PA; no treatment is available during the Sick Call procedure.

The PA will listen to the prisoner’s description of his medical problem, then issue an appointment for anywhere from one to three weeks later for the prisoner to return for treatment. On Tuesdays, Fridays and Saturdays no Sick Call procedure is available; if a prisoner feels ill on those days he must wait until the following Sick Call day to see someone from Health Services. Emergency care is said to be available 24-hours each day, but the prisoners with whom I spoke to in order to obtain information about Health Services had nothing positive to say about the treatment one can expect to receive.

TOM

For example, I spoke with Tom, a 50-year old African-American prisoner who is in his first year of confinement here at Fort Dix. He had no previous experience with Health Services, but began to feel ill on a Monday evening. He had a high fever during the night and felt nauseous when he woke on Tuesday morning.

Tom reported his illness to the correctional officer assigned to his housing unit that morning and requested permission to remain in the unit for rest. The officer instructed Tom that he was not authorized to allow him to remain in the unit; policy required Tom to report to his assigned work detail.

Tom works in the Education Department. He walked the two hundred yards that separate his housing unit from his work detail and reported on time for duty at 7:30 a.m. He explained to his supervisor that he felt like he was suffering from influenza or some type of virus. Tom requested permission to return to his unit for rest. His supervisor told Tom to remain on duty until 9:00 a.m., then to check back.

This was unconscionable to Tom. He had only been in prison for a short time. If he felt ill while working at his job in the community, he would simply call in his illness and not report to work. As a prisoner, he found that he would not be given this “luxury.” Instead, he would have to remain at his post for at least 90 minutes. At 9:00 a.m., his supervisor allowed him to return to his unit.

It being a Tuesday, Sick Call was not available until the following Wednesday evening. Tom reported back to his unit and went to bed. A couple of hours later he had to vomit. After vomiting, Tom went to see his unit officer and asked for permission to see a doctor. The officer called Health Services, but whomever he spoke to told the office to instruct Tom to take some aspirin and report to Sick Call on Wednesday evening; Health Services saw only “emergency” cases on days when Sick Call was not available. “Emergency” prisoners have come to learn, is synonymous with life threatening.

Tom suffered through his illness that day, remaining in his bed and trying to sleep. Later that evening he vomited again and suffered through the night with a high fever. The next morning, however, policy required Tom to attend work. He did. Again, he asked his supervisor for permission to return to his unit. This time, the supervisor recognized Tom’s pallor and allowed him to return to his unit for rest. Tom walked back to his unit and got into bed. He remained there until 6:10 p.m. at which time he walked back outside and crossed the approximately 300 yards between his housing unit and the Health Services building

When Tom got to Health Services he found a line of over 30 prisoners. There were no seats available so he stood waiting for his turn. It was his first visit to Health Services so he didn’t know what to expect.

When the officer opened the door, he collected each prisoner’s ID card and issued a form the inmate was required to complete to describe his illness. Tom wrote that he was suffering from influenza for two days and that he had vomited twice. When the PA called him, Tom handed him his form. The PA read it, but didn’t ask Tom any questions about how he was feeling then or make any inquiries about his medical history to determine whether Tom’s illness presented any other health risks. Neither treatment nor medication was dispensed. Instead, The PA gave Tom an appointment to return to Health Services the following Monday morning. He then dismissed Tom and instructed him to return to his living unit.

Over the next few days Tom’s illness began to pass. By Monday, the day of his scheduled appointment, Tom felt completely better. He skipped his appointment without seeing anyone from Health Services.

Frustrated with the procedures at Health Services, Tom sought out the warden to ask why Sick Call was not available three days out of the week. Tom tried to explain that people don’t get sick according to a schedule and they suffer without access to medical attention on Tuesdays, Fridays, and Saturdays. The warden told Tom that those days are closed according to policy, but inmates with emergency health needs may see a doctor. Tom said he realized that regardless of what he said further to the warden, nothing was going to change and he was better off just moving on rather then challenging the warden on the logic of her own policies.

Later, Tom said he inquired among some of the longer-term prisoners and learned that had he been persistent on the day of his illness, either his work-detail supervisor or his unit officer could have declared Tom’s case a “medical emergency.”

If the staff member would have called the hospital and sent Tom over, Tom says he would have been diagnosed, given a prescription for medicine, and perhaps would have been given a “lay-in,” which would have allowed Tom to stay in bed instead of having to report to work. But without the policy that governs Health Services being available, Tom says he had no way of knowing these rules prior to his illness, and that even now he is unable to verify whether the information he’s given is valid.

JAMES

Another prisoner, James, who is 58, told me about his experience with Sick Call. After having his hair cut in the prison’s barbershop, he noticed a fungus spreading on the top of his scalp. He went to Sick Call with hopes that he could receive a cream to help him treat the fungus. Instead, he was given an appointment for nine days later. James has been incarcerated in four other facilities over the past eight years, and each facility that he’s been confined in saw sick-call patients on the same day of their reported illness. At Fort Dix East, though, both James and Tom have learned that regardless of what type of medical attention one needs, time will pass before a doctor becomes available.

EMERGENCY MEDICAL PROBLEMS

Emergency medical problems differ from the types of illnesses one would treat during regular sick call procedures. This category of treatment requires a sudden and abrupt change in a prisoner’s state of health.

AUSTIN

Austin, a 59-year old prisoner describes his need for emergency medical care. He tells me that he had just arrived at Fort Dix in January of 2000. The ground was covered with snow and a thick coating of ice was beneath the snow. While walking to the cafeteria for dinner, Austin slipped and fell to the ground, face first. Austin broke his nose, two of his teeth, cut his face, and he hurt his legs. He needed immediate medical attention.

The guard who was on duty outside the cafeteria saw what happened. Because the accident occurred after regular hospital hours, the guard had to notify the hospital that Austin had fallen down and needed emergency medical attention. Two of Austin’s friends picked him up and walked him over to the Health Services Department.

A PA was on duty, but no doctor was available. Austin says the PA provided him with several Ibuprofen pills and instructed him to take the medication. He told Austin that the pills would help him with his blood pressure problem.” I don’t have a problem with blood pressure,” Austin said. “I fell down and hurt my nose, cracked my teeth.” The PA did not look at Austin’s medical file. Austin says the PA made no inquiries about his nose or the pain in his mouth. The PA simply provided him with the Ibuprofen and sent him back to his housing unit. That was the extent of Austin’s emergency medical care.

Ten months have passed since Austin’s fall. He now walks with a cane and usually with the assistance of another prisoner. Austin showed me his left ankle, which is visibly swollen. The swelling began soon after his fall, but he says his efforts to have Health Services treat the problem have been unsuccessful. “It is not life threatening,” he’s told, and so he can’t get treatment. Also, Austin says that he cannot breathe out of his left nostril, and he pushes it from side to side to demonstrate that it moves like a rubber ever since he suffered the fall.

FRANCIS

Francis, another prisoner who has required emergency medical treatment, contrasts the treatment he received at Fort Dix East Health Services with the medical treatment he received a few years prior when he was a prisoner at Fairton, another federal prison. Francis is a 60-year old white male. He stands about six-feet tall and is overweight at about 255 pounds. He’s been incarcerated for approximately ten years and has twelve years remaining to serve.

Francis suffers from what the Health Services Department describes as uncontrollable high blood pressure. Prior to his incarceration, Francis says that he met with a blood pressure specialist who regularly monitored his blood pressure problem and that it was controllable then. He was taking medication regularly, but that medication was discontinued when he came to prison because it was too expensive. Francis says that he offered to use his insurance coverage in order to obtain the medication he needed, but was told that policy prohibited inmates from contributing to their own medical needs; the BOP was responsible.

Francis explained to me that a person with average blood pressure would receive a reading of 120 over 80 when tested. One time, while he was at Fairton, Francis said his blood pressure shot up to 200 over 130, a dangerously high level.

With his blood pressure that high, Francis said he could feel his hands become so tight that he couldn’t close them into a fist; his face, too, was swollen and red. Francis walked to Health Services, without an appointment, and explained his change in condition. The staff at Fairton’s Health Services immediately took him inside, tested his blood pressure, gave him medication, and instructed him to lie down in a health-services room. A PA remained with him for a while, then checked his progress every 30 minutes or so. Francis was told that he had been in the heart-attack range.

After Francis’ problem at Fairton, his medication was modified. His blood pressure remained high, but at manageable levels. He was taking medication regularly, and every three months someone from Health Services called him in for a check up.

These three-month check ups were continued after Francis’ transfer to Fort Dix. But a few months after his arrival, one of the doctors at Fort Dix changed the medication that Francis had been taking without explanation. Not long after the medication was changed, Francis said he began to feel worse. He attended the regular Sick Call procedures to explain that the change in medication was having a bad effect on him, but the PA refused to reinstate the prior prescription or grant Francis an appointment with a doctor. He was told he would need to wait for his regular three-month check up, at which time he would be reevaluated. Francis was left with no alternative but to continue taking his new medication.

Within the next few weeks, Francis said he began to encounter the same symptoms from which he suffered at Fairton. His face became swollen and red, his vision became blurry, his hands became swollen and tight. He walked to Health Services in search of emergency care; he said he could feel his blood pressure had again shot up to the same levels he once suffered from at his previous prison. The door to the Health Services building was locked and so Francis had to bang on it for several minutes. An officer finally opened up, but told Francis he needed a staff member to call at that time if he wanted to see someone from medical. Francis explained he could feel his blood pressure had risen to a dangerously high level and he needed immediate treatment. The officer acquiesced and brought Francis to a doctor’s office.

The doctor was on the phone when the officer and Francis appeared. After a few minutes, he put the phone down and Francis tried to explain his problem. Before Francis could finish, the doctor flew into a rage and began venting that he was too busy, that he was overworked and couldn’t take the pressure any more. He said he was going to quit. The officer quickly escorted Francis out and instructed him that no one was available to treat him; Francis was told to return to his unit and get some rest.

Later, Francis said he was able to have his medication changed again, and since then he’s been feeling better. But he says the people in Health Services are simply way overworked. “There are only two regular medical doctors for 2,000 prisoners,” he says, “and I’ve never seen more then three PA’s working on a single shift.”

Francis explains the level of stress rises as the prison becomes more overcrowded. Most people at Fort Dix are assigned to twelve-man rooms; the absence of privacy coupled with living among strangers and the pains of confinement is harder on some prisoners. He says these factors can contribute to a high rate of heart attacks, and as a victim of high blood pressure, he worries about the health care available at Fort Dix East.

REQUIRING REGULAR MEDICAL MONITORING

PETER

Peter, a 66-year old white male suffers from severe arthritis and diabetes. His medical condition makes walking difficult. Peter has been incarcerated for about a decade and has served time in several facilities. While he was confined at a different BOP facility in Pennsylvania, the Health Services Department there authorized Peter to purchase a special pair of boots made for patients who suffer from orthopedic disorders.

Peter paid approximately $350 of his own money for his orthopedic boots and he used them for about a year while confined at his previous institution; they made walking easier. When Peter transferred to Fort Dix, however, the Health Services Department refused to grant Peter permission to keep his boots. He was required to send the boots home.

Despite Peter’s having purchased his boots through Health Services at a separate BOP faculty, and despite Peter’s never having left the BOP’s control, personnel at Fort Dix stated that it would be a “breach of security” to admit his orthopedic boots into the prison because there was no way to check them for contraband. Nor would Health Services authorize Peter to purchase a new set of orthopedic boots. Instead, Health Services provided him with orthopedic pads that he is supposed to insert in his shoes.

Peter is upset. The shoes he has been provided, even with the pads, make walking difficult. He uses a cane at times, but even that doesn’t help. The building in which he is confined is several hundred yards away from the Health Services building, and his diabetic condition requires him regularly to make the long walk to Health Services for treatment. He also suffers whenever he walks to the cafeteria, and consequently frequently eats food he buys from the commissary in his room.

Because he doesn’t have the orthopedic shoes he needs, Peter says he suffers needlessly. And personnel at Health Services are indifferent to this added aggravation Peter must endure while serving his sentence.

Peter also describes a problem he encountered during one of his regular check ups for his arthritic and diabetic condition. About a year ago, when Peter first arrived at Fort Dix, he met with one doctor who completely reviewed Peter’s medical file and talked with him about his illnesses and the treatment Peter had been receiving. Other than the loss of his orthopedic shoes, Peter said he had no complaints.

The doctor then prescribed the same medication for Peter’s illnesses that he had been taking for the past several years; he also prescribed some knee braces to compensate for the loss of the orthopedic shoes and to help Peter walk easier. Peter saw the same doctor on his next regularly scheduled quarterly visit, and the doctor continued the same treatment plan. At his next quarterly visit, however, Peter was met by a different doctor, one whom he had never met previously. The new doctor did not review Peter’s file with him or discuss the treatment. Instead, without consultation or explanation, the doctor changed Peter’s prescription; he also discontinued Peter’s use of the knee braces.

After Peter received the new prescription, but prior to his going to the pharmacy window to pick up his new medication, Peter went to the library to read about the medicine in the Physician’s Desk Reference (PDR). Peter learned the new medication that had been prescribed to him is designed for people who suffer from heart problems and hypertension, neither of which Peter suffers from. Peter also learned from his research in the PDR the medication that had been prescribed to him may be problematic for those who suffer from diabetes.

Armed with this new information, Peter went to the pharmacy window and explained that the doctor must have prescribed the wrong medication because Peter does not suffer from heart problems. Peter said he was concerned the doctor may have issued something that could be harmful when taken together with the medicine he already was taking for his diabetes. The pharmacist told Peter he would have to sign up for sick call to address these concerns, or wait for his next quarterly check up; the doctor’s prescription was final unless another doctor changed it. Peter currently is in the process of rectifying his problem through the BOP’s administrative remedy procedure.

CRAIG

Craig, another prisoner who is upset with the medical treatment he has received while incarcerated, explains how his medical problems began. Within a week after having arrived at a BOP facility in upstate New York, Craig began to suffer from rashes that were breaking out on his hands. He went to Health Services and was prescribed some creams. Instead of improving, however, the rash grew more severe and spread to other parts of his body.

Craig showed me pictures of his hands. The skin was cracking like a dried out leaf. His hands were swollen, red, and dripping with blood. Instead of taking Craig to a specialist, Health Services continued to prescribe creams for him to apply to his rash and told him not to worry so much about it.

Craig’s skin was so sensitive that he said he couldn’t open a door or even wash his hands without causing them to bleed. When taking a shower, he had to wear plastic bags around his hands so that the skin wouldn’t break; he washed his hair with a scrub brush, or else his hands would begin to bleed from the scrubbing.

Craig wrote to the manufacturer of the cream he was being prescribed to learn more about the medication. When he received the information, he read that the cream was not to be applied excessively, that prolonged use could lead to several side effects, including vision loss, Cushings Syndrome (bone softening), toxicity and death.

Craig knew he was allergic to something at that institution, but he didn’t know what. It upset him that instead of treating his illness, the Health Services Department continued to prescribe the same creams that were not succeeding. No effort was being made to determine what was causing Craig’s rash. No one in Health Services really cared, and as a prisoner, Craig was unable to retain competent medical advice on what he could do to resolve the problem.

Health Services issued Craig “work idles” that permitted him to convalesce in his room and not report to work, but Craig was an otherwise healthy young man in his mid 20s; he was too young to be sitting in his room for years at a time without a cure for his severe allergic reaction to something unknown at the institution. Despite Craig’s suffering with this rash for over a year, a doctor in Health Services told Craig the allergy was in his mind and that the best advice she could give him was to “picture yourself on a nice warm beach.”

Clearly Craig was allergic to something in that facility, because he was transferred to Fort Dix in August of 1999. Within two days of arriving at Fort Dix his allergies had healed completely. He no longer applied cream and his hands and skin returned to normal. But Craig had noticed another medical problem: he felt a knot on his left testicle.

About a month after Craig’s arrival at Fort Dix, a doctor from Health Services called him over to take a look at Craig’s allergic condition. Craig told him that his rash had cleared but that he noticed a new problem with the recently developed knot on his testicle. The doctor said he would order some blood tests to see what they revealed.

Two more months passed and Craig had not been called for the blood test that the doctor had said he was going to order. Craig then went to Sick Call and was given an appointment for about two weeks later. When he appeared for his appointment, Craig reminded the doctor that he was concerned about the lump that had been growing on his testicle and that he was supposed to have a blood test. The doctor told Craig there must have been a problem in the scheduling; he would order another one.

Craig finally was called back to Health Services and a PA drew his blood. A few more months passed, but Craig was not given any information about what the blood tests had revealed. Because the knot remained in Craig’s testicle, he was concerned that perhaps the cream prescribed to him at his previous facility was overused and was in some way related to this knot. Craig returned to sick call to inquire about his blood test results. He was given an appointment for about two weeks later.

When Craig appeared for his appointment, he reminded the doctor that he was concerned about the knot and wanted to know the results of the blood test. After much shuffling around, the doctor realized the blood test results must have been misplaced; he ordered another blood test and told Craig this time he would stay on top of it. By this time, Craig had been at Fort Dix for over seven months; he still knew nothing about his condition.

About two weeks later, Craig was woken by a guard at 4:00 a.m. He was told that he had to report to Health Services for an outside medical treatment. Craig dressed and headed over to the Health Services building. He was locked in a room, without explanation, and told to wait. He waited.

About 8:00 a.m., the doctor showed up and spoke with Craig. He explained that three blood tests had been performed on the blood that was drawn. Two of the tests came back normal. The other, an Alpha Feta Protein (AFP) test came back abnormal and could indicate cancer. The doctor said further tests needed to be performed.

A normal reading on the AFB test, Craig was told, is between zero and 8.5, Craig’s reading was 91.5, which raised concerns. The doctor said that after he learned about Craig’s results on the AFB test, he called a urologist specialist who works on a contract basis with the BOP. The urologist told the doctor that he wanted to see Craig immediately, and hence Craig’s sudden trip into town for a special examination.

At about 9:00 a.m. Craig’s ankles were chained together, another chain was wrapped around his waist and his wrists were handcuffed to that chain. Two officers then escorted Craig to their automobile and drove him into town to meet the urologist.

The doctor had his staff perform an ultrasound test on Craig, and then began to explain to Craig why he was concerned. He told Craig that the AFP test came back abnormal and required further testing to determine whether the knot was the beginning of a cancerous growth. He told Craig not to be too alarmed, as further tests needed to be performed before a determination could be made or treatment could begin. He patiently explained to Craig that he would be told about his diagnosis and treatment as more information became available. Craig was then returned to Fort Dix.

I asked Craig whether there was any difference between the treatment he received from the community doctor and the treatment he received from the BOP doctors. Craig responded “Are you crazy? The community doctor treated me with respect and compassion for my condition. To BOP doctors I’m not even a person. In fact, the BOP is the only place with a prerequisite that its doctors simultaneously work for the devil.”

Several more months passed and Craig had not heard back about the results from the ultra sound test. But the growth remained on his testicle, and he has begun to suffer from regular pains in his stomach. And whenever he walks for too long, he vomits blood. Not knowing what is wrong with his health, Craig is frustrated.

Craig remained in limbo, without information from Health Services. Although he believed he was suffering from a serious medical problem, he was receiving neither treatment nor guidance on what he could expect.

His next development came about 4:30 a.m. one morning when he rose to urinate. While using the bathroom, he began to bleed profusely from his rectum. Seeing the blood, Craig panicked. He placed his bloody underwear in a plastic bag and brought it to the unit officer to verify that he needed to see someone from Health Services immediately.

The officer called Health Services and the PA told him that Craig would be permitted to walk over, but not until the BOP’s 5:00 a.m. census count cleared. Craig said this treatment was typical. “A census count takes precedence over a human being who suffers from a bleeding rectum.”

Craig finally made it to Health Services, bringing the bag containing his underwear. He thought the PA could use it to help with the diagnosis. Instead, without looking at the bag, the PA disposed of it in the trash. He took Craig’s blood pressure, which measured 162 over 114, and without examination or medication, saying, “ok, you let us know if this happens again.”

Craig, who is 29-years old, has been left without explanation about what is happening to his body. All he knows is that he suffers from a knot in is testicle, that he vomits regularly and suffers from stomach pains. A blood test suggests that he could be suffering from cancer, but the Health Services Department misplaces test results and chooses not to treat his medical problems with the serious attention they deserve. Although health Service representatives tell Craig that his illness is being monitored, Craig is left in the dark about what is going on.

SPECIAL SURGERIES

Many of the prisoners confined at Fort Dix East are older and suffer from poor health. Some use Sick Call procedures regularly, and undergo emergency care treatment for ongoing illnesses. Some, like Hugh, even proceed through special, major surgeries during their period of incarceration.

Hugh is a 73-year old prisoner who recently went through open-heart surgery. He has been confined for about five years. Prior to his incarceration, when he was 68, Hugh said that he attempted to take his own life. “I didn’t think I had too much longer to live and wasn’t thrilled about spending my remaining years in prison.” Hugh said he brought his tractor inside his closed garage started the motor along with the motors of some of his other machinery in an attempt to kill himself through asphyxia. His wife found him unconscious and rushed him to the hospital, where he was stabilized. He lived.

Hugh says he never completely recovered from his suicide attempt and that his body has been weak throughout his incarceration. He maintains that he should have been confined in one of the BOP’s special facilities for prisoners in need of constant medical attention. Hugh couldn’t walk 200 feet without stopping for rest when he began his term in confinement; he’s been treated on four separate occasions at outside hospitals for pneumonia during the years he’s been confined.

Several months ago, some tests revealed that Hugh’s arteries and ventricles were in bad shape. His left ventricle had closed completely, and his right ventricle was ninety-percent closed. His heart was not receiving enough blood. Hugh was taken to a community hospital for open-heart surgery and remained in the hospital for 13 days.

While Hugh was in the hospital, both of his ankles were chained to the bed at all times. It was particularly painful for Hugh, because the doctors had removed veins from Hugh’s lower legs in order to replace badly collapsed veins near his heart during surgery. The removal of veins from Hugh’s legs left delicate, unhealed wounds; despite the scars that were developing on Hugh’s legs, though, the cold, steel cuffs were fastened around his ankles every minute of his stay away from Fort Dix.

The doctors had Hugh breathing through oxygen tanks and argued with the BOP that Hugh needed to remain in the hospital for aftercare and recuperation. It didn’t happen. Despite protests, Hugh was removed from the hospital and returned to Fort Dix.

Hugh spent his first night back at Fort Dix in a Health-Services room. The PA who was on duty that evening was not informed of Hugh’s condition and refused to provide him with his medication. The officers who had transferred Hugh from the hospital back to Fort Dix, apparently, had neglected to provide the changing shift with Hugh’s medical paperwork.

Hugh tried to explain to the PA that he had just returned from the hospital after having recently gone through open-heart surgery and that he needed medication because he was in such pain. The PA said he didn’t want to hear about it; he disconnected the bell that allowed Hugh to call the PA from his room.

The air conditioning in the room was blowing cold air on Hugh, which exacerbated his pain. In response to the cold air, Hugh lifted himself off the bed and went to lie on the floor with his blankets, out of the direction of the cold air that was blowing on him.

Another officer who happened to be walking by Hugh’s room saw Hugh lying on the floor and called a superior to check on him. Hugh explained that he was ill, that the PA was unresponsive to his needs, and that he couldn’t return to the bed because it placed his unhealed wounds directly in the path of the cold air. The supervisor then located Hugh’s medical file, learned of the surgery that he had recently undergone, and made adjustments to Hugh’s treatment that evening.

The following day Hugh was released from the Health Services room and returned to his two-man cell in his housing unit. A few hours after Hugh returned to his room, his condition deteriorated. He couldn’t control his bowels, he became dehydrated, and he finally collapsed on the floor.

Hugh’s roommate, John, ran to the hospital to notify the staff that Hugh had collapsed and was lying on the floor, unable to move. The PA instructed John to tell Hugh that he should report to health Services. John stated again that Hugh had collapsed and wasn’t able to move by himself. The PA instructed John to bring Hugh over. When John asked for a wheelchair, though, the PA said Health Services didn’t have any. John grabbed a stretcher, located a few other prisoners, and carried Hugh back to Health Services.

Hugh was examined by a doctor, and the doctor determined that Hugh needed to return to the hospital. Accordingly, an ambulance was summoned, Hugh was chained up, and he was transported back. They placed Hugh in the same bed he had left less than 48 hours before, and his scarred ankles were again chained to the bed. He remained in the hospital for five more days, during which time the doctors tried to stabilize his condition, feeding him intravenously at first, and then with solid foods. When it was time to return to Fort Dix, Hugh just wanted to die.

Hugh has since recovered and is now able to walk around a bit. He tells me that his release date will come in less than a month and that he’s looking forward to returning home, where he will receive better care.

While he was in the hospital, Hugh said, he couldn’t really rest. His ankles hurt from the chains, and it was difficult to sleep because the guards who were watching him, 24 - hours each day, left the lights and television on. Rest was not really an option. Further, despite Hugh’s critical condition, the prison did not allow Hugh’s family to visit him. Recuperating in prison isn’t easy, either, because prisoners have to abide by the prison regulations: stand-up counts, long walks in the open air to the dining room, poor medical attention, and an inablility to receive support from loved ones.

The Health Services department provided no aftercare, Hugh said, and this is a problem that several prisoners who went through major surgeries complained about. Hugh heard the doctors at the hospital instruct the BOP doctors to perform x-rays and follow-up work within six weeks of Hugh’s release and no follow-up work had been performed on him. He just couldn’t get any attention from the Health Services department at For Dix East.

But at least Hugh is alive. Other prisoners who went through major surgeries while in custody of Fort Dix East aren’t so lucky.

TORTY

Torty, a former prisoner at Fort Dix East, was about 60 and had recently begun serving his ten-year sentence. Blind in one eye, Torty was a sick man.

Torty went to the doctor complaining about pains in his abdominal area. Doctors performed a biopsy, and he was diagnosed with an abdominal cyst; Torty suffered with pain in his stomach for approximately nine weeks after the biopsy before the BOP scheduled his surgery to remove the cyst.

Within a week after the surgery was performed, Torty was back in his room at Fort Dix East. After he returned, the Health Services Department neglected to call him back for aftercare. Indeed, his roommate reports that the doctors even forgot to call him back to remove the staples the surgeons had used to close Torty’s wounds. After about six weeks, one of the people who resided near Torty walked him back to Health Services so someone could remove the staples; skin already had begun to grow over the staples.

The people who were around Torty say that he couldn’t get anyone to perform the aftercare that the surgeons who operated on him said Torty needed. And a few months after the surgery was performed, Torty began to complain about new pains in his abdomen; he felt another lump beginning to grow.

When doctors finally did look at the new lump Torty was complaining about, they transferred him to a BOP medical facility. A few weeks later, word came back to Fort Dix East that Torty had died. His many friends at For Dix East wonder whether his death could have been prevented with better health care.

JOHN

John is another prisoner who complains about a lack of aftercare following a major surgery. He fought for fourteen months to have his knee replaced. Had it not been for his good relationship with two influential staff members, he says, he never would have had the knee-replacement surgery.

The Health Services department kept telling John that at 60-years old, he was too young to have his knee replaced, his pain and the knee’s swelling notwithstanding.

John worked in a clerical position that put him in frequent contact with two associate wardens. Because they had taken a liking to John, he says, they used their influence to transfer John to a BOP medical facility so that he could receive his knee-replacement surgery.

John is grateful to have received the surgery, but complains about the aftercare and rehabilitation that he did not receive. “A proper knee-replacement surgery,” John says, “Would have been followed up with x-rays to record the knee’s heeling, to monitor the growth of the stretched muscle.” John received no follow up. Indeed, soon after his surgery was performed, he was returned to Fort Dix East and has not been seen by Health Services since.

MARK

Although John did not receive any aftercare or rehabilitation services for his knee-replacement surgery, at least he was able to have the operation. As a result, John finds it much easier to walk around the prison; he doesn’t need crutches or a cane anymore. Another prisoner, Mark, does not have the influential relationship with high-ranking staff members and has not been so successful in persuading the Health Services department to arrange a simple operation to treat an inguinal hernia from which he’s been suffering for the past several years.

Mark has been incarcerated for nearly five years. Not long after he was incarcerated, the medical staff at another BOP facility had to arrange a surgery to treat a hernia from which Mark suffered on the right side of his groin.

A couple of years later, though, Mark began to experience severe pain on the left side of his groin, and it became clear that he now suffered from a hernia on the left side of his groin. A surgeon at his previous facility explained that surgery was the only solution to the hernia and was going to schedule Mark to have the operation. Unfortunately, Mark was transferred to Fort Dix before he was scheduled for the hernia operation.

When Mark first arrived at Fort Dix, he explained to a Health Services PA that he was suffering from a hernia and that a doctor from his previous facility had recommended him for surgery. The PA informed Mark that Fort Dix does not operate on hernias because they are not life-threatening illnesses.

For the first two years of Mark’s incarceration at Fort Dix, he endured the pain caused by the hernia. He could not exercise, and after he ate he would always have to lie down and wait for his food to digest, otherwise the hernia would begin to protrude and cause him severe pain; only by lying down could Mark push his hernia back into place.

When Mark couldn’t stand the pain anymore, he returned to Health Services and began pleading for treatment. Finally, health Services scheduled Mark for an appointment with a surgeon. The surgeon examined Mark and concluded that only surgery would cure his condition. Mark assumed this meant he would be scheduled for an operation. After all, this was the second BOP surgeon who recognized Mark’s need for surgery; he felt some relief that his pain would be cured.

Two months later, Mark’s suffering continued as no surgery had been performed. Mark returned to Health Services to inquire about the delay. The doctor told him that the delay in his surgery was an administrative decision, not a medical decision. Mark was left with no choice but to begin filing a grievance through the BOP’s administrative remedy procedure. He initiated his complaint on a formal form that was sent Fort Dix’s warden.

The warden responded to Mark’s complaint saying that hernia operations are not approved by the BOP and provided a page reference in the BOP Health Services Manual, which she said would verify her position. Mark examined the manual and learned that the contrary was true: hernia surgeries could be performed by the BOP.

Mark proceeded to the next level of administrative remedy by filing the appropriate form with the BOP regional office. The region disregarded Mark’s observation in the Health Services Manual, which indicated that hernia’s qualify for surgery, and instead responded that Mark “was being treated appropriately” for his condition.

Finally, Mark submitted his final request for administrative remedy appeal with BOP headquarters, where it looked as if he would receive some relief.

After Mark filed his grievance with headquarters, the clinical director of Fort Dix East’s Health Services department called Mark in for appointment. Mark explained to him that two surgeons had looked at his hernia and stated that the only cure would be to undergo an operation. He told the director that he was in regular and severe pain and that he needed to have the have the hernia repaired-at his own expense if necessary.

The clinical director finally said he agreed and that he was going to schedule Mark for surgery to repair his inguinial hernia. That meeting with the clinical director occurred over five months ago, however, and Mark has received neither his operation nor information about when it will take place.

AUGUSTIN

All of the medical complaints described thus far originated with health problems prisoners contracted during their confinement. Augustin, though, explains that his medical problems began outside, and that prior to his incarceration, he had made arrangements to resolve them. Representative of the BOP, however, assured Augustin and his sentencing judge that the BOP facilities were fully prepared to handle Augustin’s medical needs.

Augustin initially was arrested in 1998, but being a nonviolent offender and not deemed a threat to the community, he was released on bond pending the outcome of his case. Legal issues kept him in the community until the summer of 2000, by which time he finally was convicted and sentenced to serve 18 months in prison.

At the time of his arrest, Augustin had been suffering from some type of infection in his jaw. His doctor recommended a two-part surgery, explaining the first surgery could take place immediately, but that he would have to wait for some healing to occur (approximately twelve to fifteen months) before the final surgery could be performed. Knowing that he was facing legal problems, Augustin agreed to begin the surgery soon after he was released on bond. As a manager of a large hotel, Augustin was fully insured for the complete operation.

The first part of the surgery was successful, and the doctor scheduled the second part of the surgery for July of 2000. The hospital, though, could not admit Augustin for surgery until July 26; he had been ordered to report to prison on July 14.

Through his lawyer, Augustin appealed to his sentencing judge to delay his reporting date to prison so that Augustin could undergo the surgery. Seeing that the surgery date was only two weeks after Augustin’s reporting date, the judge said he would give Augustine a choice: either he could delay the date he would report to prison so that the surgery could be performed at his expense, or, he could report to prison as planned and have the BOP doctors perform the surgery.

The judge had made some inquiries and been assured by the BOP that it was capable of operating on Augustin. After being assured that BOP doctors would tend to his medical needs, Augustin agreed to commence the service of his sentence and undergo his surgery while serving his time.

Soon after that last court hearing, a representative from the BOP’s central office called Augustin and explained to him that the BOP was aware of Augustin’s medical needs. The representative told Augustin that he had been designated to Fort Dix, which had a hospital capable of performing the surgery; she told Augustin that Fort Dix had a “state of the art” Health Services department and that he should bring all of his medical records with him.

Augustin arrived at Fort Dix as instructed on July 14, 2000. The following day he reported to the health Services department with his medical records and attempted to secure an appointment with a doctor. When he was able to meet with the doctor, Augustin explained that he was suffering from pains in his mouth, that he could not open his mouth wide enough to chew his food. Augustin showed the doctor his medical records which verified he was scheduled for surgery to correct the problem together with paperwork from his court proceedings which verified the BOP’s confirmation to Augustin’s sentencing judge that the surgery would be performed.

The doctor conducted his examination and looked at Augustin’s paperwork, agreeing that the surgery was necessary. The problem, the doctor said, was that Fort Dix health Services was not equipped to perform the surgery. The doctor said he would write to the BOP regional office for guidance.

Augustine heard nothing back from the doctor over the next two weeks of July. He heard nothing back in August. Augustin then complained to an associate warden about his need for surgery. The administrator told Augustin that she would “look in to it.”

When nothing happened, Augustine explained his problem to his attorney. He told his attorney that he wasn’t receiving medical attention and that the pain from his jaw problem was growing more severe. The attorney wrote a letter to the warden of Fort Dix, stating that if Augustin did not receive medical attention, he would initiate legal action.

Soon after the warden received the letter from Augustin’s attorney, Augustin was called to the Health Services department. He was taken to a community medical center where he was examined by a doctor. The doctor agreed that surgery was necessary, but he said that his medical facility was not equipped to perform the surgery; he told Augustin that he would recommend the surgery be performed in a hospital in order to minimize the possibility of nerve damage.

Augustin received no further information by the end of September. Again he approached the associate warden seeking assistance. She told Augustin that she was going to be away from the prison on holiday, but that she would “look into it” when she returned.

In early October, Augustin met with his Unit Team, the people who are responsible for monitoring Augustin’s progress in prison. Augustin explained to them about his illness and the difficulties he encountered while trying to receive medical attention. During the meeting, Augustin’s counselor told him that at 18 months, his sentence was too short and that the BOP would not perform the surgery; he’d have to wait until his release.

Since that meeting, Augustin initiated the steps necessary to begin legal action against the BOP. He recognizes, however, that his sentence may expire before his is able to obtain any relief. In the meantime, he will continue to suffer terrible pain in his mouth and will survive on soups, salads, rice, beans, and foods that do not require him to chew.

Besides the pain that Augustin endures, he says his is bothered most because he could have had the corrective surgery performed outside by competent medical professionals, and that he would have had it performed if the BOP had not assured him and his sentencing judge that his medical needs would be met. Now, Augustin is no longer employed by the large hotel and no longer has insurance. So, assuming the BOP does not perform Augustin’s surgery by the time of his release, he will have to scrape together money in order to pay for the surgery himself.

CONCLUSION

As a long-term prisoner, I’ve learned to take each day as it comes and to live my life as independently as possible. Now, after speaking with so many prisoners and listening to them describe their experience with Health Services, I realize how fortunate I have been to have served these first fourteen years of my sentence without any health problems. I’m hoping to avoid health problems during the remaining time I have to serve.

Without exception, every prisoner with whom I spoke about Health Services complained that he did not receive the medical treatment he deserved. Each prisoner complained of the hassles he received at Sick Call, that it is available only four days each week and at specific times of the day only.

What is worse, the prisoners say, is that when one goes to report an illness during the sick-call procedure, the prisoner may not receive an appointment to speak with medical professionals until up to three weeks later.

At least two prisoners complained about doctors with whom they had not consulted previously changing their medication, and of receiving no explanation as to the reasons for the change. Indeed, being kept in the dark about their medical conditions is a huge complaint from the people who suffer from medical problems at Fort Dix. Craig continues to wonder whether he is suffering from cancer.

Prisoners who do receive surgery criticize the Health Services department for rushing them out of the hospital. When the prisoners return to Fort Dix, they say, they’re put back in their rooms without support. They cannot receive visits from family members, regardless of how close they are to death. Also, they say, the BOP is remiss in refusing aftercare or rehabilitative work that should follow a serious operation.

Some of the prisoners noted that it is the policy of Fort Dix to delay health care until the last possible minute. Perhaps it is not “official,” they say, but a tacit policy exists to ignore health problems or delay treatment with hopes that the prisoner will either die, be transferred to another facility, or be released before medical attention is dispensed. No preventative medicine exists at Fort Dix East, the prisoners say.

As a prisoner, obtaining “the other side of the story” is not an option. The career bureaucrats would not explain themselves, their actions, or their policies to a prisoner. As Tom found out when he approached the warden with complaints about Sick Call, the only answer a prisoner can expect is “That’s the policy.”

Certainly, the prison system is growing in geometric proportions: more people are being locked in prison, fewer people are being released, and all prisoners are serving longer sentences. This massive growth of the prison population is resulting in a thin supply of medical resources being administered to a much larger group of people. The result is that medical staff are overworked, and prisoners are underserved.

Every prisoner recognizes that he was sentenced by a court of law to serve his sentence. But now that prisoners are serving these sentences is very crowded prisons, they are exposed to potential viruses and disease from the thousands of other prisoners around them. And with the long sentences that prisoners are serving, frequently spanning multiple decades, there is no question that the demands on Health Services will grow even more.

Perhaps the time has come to contemplate alternatives to this system, maybe even one that would allow prisoners the opportunity to provide for their own health treatment. Something needs to be done, because after listening to so many complaints, I am convinced that prisoners’ complaints about Health Services are valid.