Present at meeting 6/21/00 held at CMF Vacaville Prison
in the Warden Ana Ramirez Palmer's chambers from l:30
p.m. to 6:30 p.m. five hours without a break.
 

Nadim K. Khoury, M.D. , Asst. Deputy Director, Health
Care Services Directoro

Don Livingston, M.D. Chief Deputy Clinical Services

CMF Chaplain, Reverend Knauf

CMF Vacaville Warden, Ana Ramirez

Larry Witek, Acting Regional Director (also Warden at Chino)

Dave Tristan, Director of Instutions

Ken Hurdle, Senior Ombudsman

Gwynnae Byrd, Attorney for Senator Polanco, Prison Operations
 

Representatives, United for No Injustice, Oppression or Neglect
U.N.I.O.N.

John Videen, M.D.

Margie Jump, Mother of James Diesso

Lucinda Gunn, whose loved one is in the CMF Hospice

B. Cayenne Bird, Journalist
Director of the U.N.I.O.N.

Not present:
Dr. Suzanne Steinberg, Chief, Health Care Services Division
Michael Kastner, UNION member (who is suffering pneumonia)

    Somber UNION members were greeted with a response to the agenda we submitted to State Officials last week which included a 2" thick stack of reports and documents.  It was clear that State Officials had invested a considerable quantity of time in answering the concerns of the UNION regarding inmate medical and custodial care issues.
 

     No tape recorders or cameras, or other journalists besides myself were allowed to attend the meeting.  The reason for exclusion of the press given by CDC is that they "wanted this to be an educational meeting and without confrontation and did not want any of the participants to feel they had to be careful about
what they said because the press was there per Director Cal Terhune." This statement was printed on the agenda which was slightly revised just before the meeting.

We were "processed" and "scanned"  through the visitors' center but we were allowed our notebooks.  All UNION representatives were taking notes to accurately document this historic meeting.  My notes are
in shorthand, very detailed for approximately 60% of the meeting, Dr.Videen and Lucinda Gunn also took notes so that we could compare our facts after the meeting.  With the combination of information given to us by State Officials from various departments and our own notes, there are some 100 pages of documents to review and study.

     Each agenda item was carefully discussed by several administrators while UNION members fired the questions being careful not to mention names of specific inmate cases that are now in court and litigation.  It was an intense, often tedious and often emotional interaction which seemed to bring a number of
issues around existing policies into the light.

         Dr. Suzanne Steinberg sent Dr. Nadim K. Khoury, M.D., Asst. Deputy Director of Health Care Services Division as her representative.  He answered the majority of our questions and complaints and expressed that he is sincerely concerned in our back up documentation and other evidence around abuses.  The five hours of dialogue was the proverbial "tip of the iceberg" of the complexity and
knowledge of systemic dysfunction.  Dr. Dr. Videen and myself were unbending and relentless in the pursuit of an acceptable answer to each individual question but the State Officials were patient and
held up under our drilling.

      Margie Jump held up under this intensely emotional interchange although at times she had to leave the table and broke down crying when the responses from State Officials seemed to be either untruths or lack of knowledge of how certain policies are actually implemented versus what administration thinks is happening.

A confusion exists among state employees about where the line is drawn to determine which inmates are behavior problems and which are mentally ill.  This correlates with the confusion over what should be prioritized first...medical care or custody (retribution-style responses).  In theory, "acting out" of inmates
that are part of the Mental Health Delivery System is supposed to be handled by
trained psychiatric staff.  From the numerous complaints the UNION has received, there is no doubt in my mind that the mentally ill are frequently punished just for being mentally ill and acting out their disease.  In response to this, there was unanimous agreement amongst State Officials that any deviations
from policy would be approached with harsh personnel action, i.e. termination of employment.  They appeared to be unaware of the problems and are receptive to addressing specifics of our complaints.

          Our proposal that MTA's (Medical Technical Assistants) not be nurses AND guards (members of CCPOA) due to the professional violation of ethics for nurses (Footnote 1) was met with agreement from all medical doctors present.

Cost of health care, staff shortages, and a burgeoning strain on too large a prison population are the root of the majority of the problems we discussed on the agenda.

    There was a great deal of bureaucratic-style "passing the buck" happening during the meeting.  Some of our most serious concerns were blamed on the Department of Mental Health Services, especially around the use of restraints.  State officials clearly voiced that multiple point restraints are only used for the protection of the inmate's own health in the setting of accepted mental health care and monitored by non-custodial staff "for a few days at a time."  They said that restraints should be never used for punitive reasons.

       We have considerable follow up to do after the meeting for questions which were inadequately answered due to the time constraints such as "who is responsible for failed double-celling decisions, especially those which result in death?" I was dissatisfied with the answers on inmate's access to
medical professionals and  the Warden.  Our complaints  contradict statements that a physician or nurse is always available for inmate care.   The theory of what top brass believes is in place is not what is actually happening in many prisons statewide, but they wish to be enlightened and seek remedy according to the dialogue.

In summary of this initial reaction to yesterday's meeting before all documents are fully reviewed:

  There were concerns amongst State Officials regarding access to health care as well.  Insufficient staffing, funding at all positions was identified as the most significant problem.    The Department of Finance and legislative budget allocations driven by citizen's groups is the reason why dental care is not a high priority.  The lawmakers simply will not appropriate adequate money for the necessary care and feeding of prisoners.  They say there is insufficient pressure from  voting lobbies for them to do so and plenty of pressure the opposite direction for funds not to be spent.

       Dr. Khoury seemed capable and more than willing to implement appropriate changes in all aspects of health care delivery, but was limited by funds provided to his division by the legislature.

      I found this group of professionals to be far less callous than all of the legislators we have dealt with over these same issues to date.  Even the good legislators have been insensitive to these serious matters of life and death, perhaps because they know that without money, the crisis can't be fixed.

       I harped that no one in the room should consider these problems as "business as usual" and continue to operate in accepting hundreds and thousands of more prisoners from the courts.  CDC's position is that they must accept whomever the courts send to prison, regardless of whether appropriate housing, dental or medical care can be provided.  CDC has not alerted the public that the burden is too
extreme.
 

None of them doubted that we know exactly what is going on inside the prisons, except that Dr. Khoury was either unaware or ashamed of  certain practices such as chaining  dying prisoners to their beds in secure rooms/wards until they draw their last breath.  He said the practice isn't occurring and that he will  take action if he finds out that it is, so this meeting opened multiple cans of worms, which have yet to be sorted out.

     Dr. Khoury spoke of a large shortage of psychiatrists and had historical data for efforts he had made to improve the delivery of health care which were denied by the legislators.  This denial was most likely due to the pressure of CCPOA, Crime Victims and other Citizen's Groups and very little resistance from pro-prisoner organizations (because there isn't anything available outside our UNION) in the mainstream.  He was uncomfortable with a fact that many legislators know very well, that prisoners are returning to the communities sicker than when they   were admitted. Given the present circumstances and budget limitations, the medical doctors present appeared to support compassionate  treatment of the incarcerated mentally ill.  They expressed shock at our reports of atrocities   and requested details.  Communication between inmates, inmate representatives and the mental/medical staff was a stated consistent
priority.
 

    Everyone is hoping that  communication established through the Prison Ombudsmen Program is the most facile and appropriate route to effect change.

    I could see he invested a great deal of time in preparing responses to our questions which fall under his jurisdiction.

    I felt a rapport with Dr. Don Livingston, CMF's new Chief Medical Officer, not just because he agreed with me that padded cells would be a more humane way to treat the mentally ill than the present practice of "cold rooms" where an inmate is placed naked without a mattress or blanket often for days at a time to protect themselves and others, but because he is an African American who had/has a loved one inside prison.  I could see that he needed the support of a citizen's group for a number of his ideas for reform,
in the same manner as the legislators, who cannot make the noise for prisoner families who must do this part themselves.

    I cannot judge success of this meeting on anything but the eventual outcome to our specific complaints and we are still at the stage of furnishing documentation and evidence to prove the practices do exist.  My heart aches for all those inmates without family to sponsor their UNION complaints but I do not see how we can as volunteers with no funding cover every individual  crisis.  I can only emphasize to our
members and the public that for every  inmate who endured the suffering of  the Jimmy Diesso family that  there are probably thousands of others.

    18,500 inmates are thought to suffer mental illness and the majority of these inmates are double-celled throughout the system.
 

My closing remark was:

    "The UNION is grateful for the opportunity for this dialogue.  It is clear that due to inadequate funding and staffing we have a moral obligation to alert the taxpayers that the number of prisoners is too large for humane treatment to be given to any inmate.  We give animals in the zoo excellent medical, dental and nutritional care and if we can't do this adequately, then the citizens must force the courts to stop the conveyor belt that is bringing more and more people into an out of control system.  For starters, we must
end the Three Strikes Law and immediately find ways of alternative sentencing and compassionate release.  We need to place those prisoners who are dying out into community hospices or send them home on compassionate release.

    Non-violent prisoners and addicts must be taken out of the prison system immediately to free up resources for violent prisoners, and above all, prevention through education and rehabilitation must be our highest priority.  We cannot ignore this crisis through inaction or allow politics to be more important than the care of people."
 

*Footnote 1
The Nurse's Role in the Care of Detainees and Prisoners, first adopted in 1975, reaffirms ICN support for the Geneva Conventions, endorses the Universal Declaration of Human Rights and “condemns the use of all [interrogation] procedures harmful to the mental and physical health of prisoners and detainees”. The statement goes on to say that “nurses having knowledge of physical or mental ill-treatment of detainees and prisoners must take appropriate action including reporting the matter to appropriate national and/or international bodies”. It also rejects demands for nurses to play the role of security personnel by, for example, carrying out body searches for security reasons.

Nurses and Torture. This statement, adopted in 1989, notes that nurses may be called on to carry out a number of functions which assist torturers. It commits the nurse to giving care to people seeking it, prohibits the nurse from assisting in any way in torture and urges national nurses associations to provide a mechanism to support nurses in difficult situations.

Nurses and the Death Penalty. This statement, adopted in 1989, concludes that “participation by nurses...in the immediate preparation for and the carrying out of state authorized executions [is] a violation of nursing's ethical code. ICN thus calls on national nurses' associations to work for the
abolishment of the death penalty...”

In addition to these ICN statements, the United Nations Principles of Medical Ethics, adopted in 1982 enjoin health professionals to act ethically and specify that participation in, or tolerance of, torture is unethical (principle 2) and that the only ethical role for a health professional working with prisoners or detainees is to “evaluate, protect or improve their physical or mental health”See footnote 5.

Some national nurses associations have also taken initiatives to enshrine human rights principles in their codes of ethics. For example, the Canadian Nurses Association adopted a position statement on human rights in 1991. It endorses the Universal Declaration of Human Rights and states that “nurses have an individual and universal responsibility to protect [human rights]”See footnote 6. The Association created a volunteer Human Rights Officer post to bridge the potential gap between principle and action. Among the duties of the officer is urgent action letter writing. One Canadian nurse has suggested an amendment to the ICN policy to permit their action on behalf of nurses who have been abused for a wider scope of reasons such as their race, religion, politics, or ethnicitySee footnote 7. In 1983 the American Nurses Association stated their view that participation in an execution was in breach of nursing ethicsSee footnote 8, and in 1991, adopted a position statement on ethics and human rights which notes, inter alia, that “the principle of justice is one point at which issues of ethics and human rights intersect”See footnote 9.  The British Royal College of Nursing (the professional body of nurses in the United Kingdom) published in 1994 a paper on female genital mutilation “to raise nurses' awareness of the issue and give them a greater understanding of the issues involved”See footnote 10.