Behind the Walls: A Guide for Families and Friends of Texas Prison Inmates

7. Medical and Dental Facilities

39 Because the medical care received in prison is such an important issue, this chapter is broken into two parts. The second, Appendix B, is taken word-for-word from the TDCD-ID Comprehensive Health Manual, and it outlines what services are available to Texas inmates. As you will see, they are impressive and are an enormously welcome improvement from the shockingly negligent system in place before Ruiz. However, there is a huge gulf between what services are available and what services are actually provided. Many factors influence the quality of prison medicine, and the single biggest is the attitude I referred to in chapter one—the system cares little for inmates’ welfare except when it is possible that staff negligence may result in an inmate’s injury and death, and the system will then be held liable. In this chapter I will again refer to Judge Justice’s March 1, 1999 order in Ruiz v. Johnson, 37 F. Supp 2d and 55 (S. D. Tex. 1999.) While Judge Justice did not find the medical practices unconstitutional, the testimony of expert and inmate witnesses, and the admissions of medical personnel and TDCJ officials, will help illustrate some of the problems I will point out. medical and dental facilities Chapter seven 40 Chapter Seven In 1994, the Legislature created the six-member Correctional Managed Health CareAdvisory Committee (currently nine members) to take over management of TDCJ’s health care delivery system. Through this process, the day-to-day operations of the medical system are assumed by the University of Texas Medical Branch (UTMB) at Galveston and the Texas Tech Health Science Center. What this means is that TDCJ is merely a conduit between the health care providers and the inmates themselves . From an inmate’s point of view, the medical system is simple. An inmate who is sick or has a medical or dental problem requests to be seen by filling out a sick call slip. The nursing staff will evaluate the nature and severity of the complaint and schedule the inmate to be seen. He will come in, his vital signs taken and recorded (weight, temperature , and blood pressure,) and he will explain the exact nature of his problem to the nurse. She or he will then decide what is needed, and if a doctor’s opinion is believed necessary, she will schedule an appointment . There are many inmates who undoubtedly abuse the medical procedures . They wish to miss work and thus they exaggerate their problems. They may want to be reassigned to another job, or to another unit. They may be attempting to be prescribed certain drugs to feed a habit. They may simply want to sit in the air-conditioned waiting room and ogle the nurses. Inevitably, the nursing staff will begin to think of inmates as malingering liars instead of patients. This view is worsened by the fact that actual access to any unit infirmary is controlled by TDCJ officers, who open the doors, lock the doors, lock inmates into the waiting rooms, and sit with them, and by their presence ensure that the often unruly inmates maintain a respectful attitude toward the nurses. However, unless an inmate is bleeding or has some outward sign of illness, most officers will believe the sickness is faked. This attitude pervades every step of TDCJ medical care. It afflicts the nursing staff and security, and since no inmate moves in prison without security’s blessing, minor ailments are ignored and become major, at which point the inmate’s health has deteriorated and thousands of dollars must be spent attacking what was preventable if not for someone’s assumption that the inmate was lying. Medical/Dental 41 A complete compendium of the problems bedeviling the TDCJ healthcare system would take chapters. I will merely quote some of the more relevant passages in Ruiz v. Johnson. John M. Robertson, M.D., M.P.H., is the Health Services Bureau Chief and Medical Director for the New Mexico Corrections Department . He is a full faculty member at the University of New Mexico in the department of medicine. Dr. Robertson was one of the primary expert witnesses in Ruiz v. Johnson, and he spent more than three hundred hours “evaluating the quality of medical care in TDCJ by analyzing the data culled from death charts of 59 inmates who died in 1998.” (page 894, Ruiz v. Johnson.) In his summary “Summary Findings...