August 2, 1999

Sociologist examines health care conditions for women prisoners

By Jennifer McNulty

There is a crisis in health care for women prisoners in California, where inmates are routinely denied access to trained medical providers, receive inadequate diagnostic and follow-up care, and suffer interruptions in the delivery of prescription medications, according to Nancy Stoller, a professor of community studies at UCSC.

Stoller, a sociologist who began studying the health care of women in prison more than 25 years ago, recently received a $45,000 grant from the California Policy Seminar (CPS) to examine health care conditions for women in California state prisons.

"When I started studying the health issues of women in prison, I was moved by their situation even then, and by their inability to get the smallest things taken care of," said Stoller. "Since then, the prison system has grown enormously, and the general attitude toward prisoners, both women and men, has become much more punitive. I wanted to go back and see how conditions in prisons had changed."

The grant was funded by CPS's California Program on Access to Care, a subsection dedicated to studying whether the state's poor, rural, and immigrant populations are losing access to health care. The vast majority of women prisoners, who make up 8 percent of the state's prison population, are poor and from minority and immigrant backgrounds, said Stoller.

Recent legal cases indicate that the Department of Corrections has failed to comply with major portions of the settlement of a lawsuit that challenged the quality of health care at two women's prisons in 1997, and the state now faces a separate impending lawsuit regarding conditions at its largest facility for women, Valley State Prison in Chowchilla. In addition, Amnesty International recently accused the state of being abusive to women prisoners and failing to provide adequate health care, in violation of United Nations standards.

"Women have unique health care needs, and they are having problems getting adequate care," said Stoller. "We know that from a public health viewpoint, a little prevention saves a lot of dollars later, and the Department of Corrections can benefit, as well as other state agencies that end up taking care of many of these women after they are released."

Among the areas that Stoller will investigate are the provision of preventive health care like pap smears, mammography, and HIV education, which she said "can reduce the economic, social, and health care burden for parolees, their families, and the state."

There is currently no routine call-up of prisoners for age-related procedures like pap smears and mammograms, said Stoller, and non-emergency care requires inmates to make a $5 copayment for each medical visit, a fee that is beyond the reach of many women prisoners.

The length of the average sentence has increased in recent years, said Stoller. In 1975, fewer than 25 women statewide had been sentenced to more than three years. Today, at least 700 women are facing sentences of more than 12 years. The trend toward longer-term incarceration has contributed greatly to the aging of the prison population and a correspondingly higher need for medical care, said Stoller.

The grant will enable Stoller to assess the scope of the problem in the state's three largest prisons for women: Valley State Prison and the Central California Women's Facility, both in Chowchilla, and the California Institute for Women, which is about 40 miles east of Los Angeles.

During the study, Stoller will analyze a large database of interviews, medical records, letters, and legal documents from 1,100 women prisoners, and judicial reports that were assembled in conjunction with inmate complaints during the past four years.

"For example, it is common for women on prescription HIV medicines to have an interruption (of treatment) when they enter the system initially and when they are transferred to one institution or another," said Stoller.

She will also compare the model of health care offered in California with services that are provided for women prisoners in other states. In California, the Department of Corrections provides routine health care directly and contracts with local hospitals and specialists for inpatient care and surgery. Other states hire private companies, public health departments, and medical schools to provide prison medical care, said Stoller.

"As legislators and policy makers consider their options, it's important to have a solid foundation of contemporary information," said Stoller, who expects to spend six to eight months on the project, which began this summer. "Part of fixing the problem is identifying the unmet needs of women inmates, and that means looking at the inadequacies of the current system."

The California Policy Seminar is a joint project of the University of California and the state legislature. Managed by the university's Office of the President, it enables UC researchers to investigate areas of interest to state policy makers and lawmakers.

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