Surgery in Shackles

The Health Care I Received In Prison Was Horrible, So I Started Reporting On It

By Carla Simmons

Art By Huanhuan Wang

Hands pulling apart the strings on a woman's orange hospital gown

I arrived at the hospital in shackles. I’ve always been very proud of my slender ankles, but that morning, I cursed them. Before leaving the prison, the transport officers fitted me in handcuffs with a long chain around my waist attached to the manacles around my feet. I couldn’t feel them seated in the van on the way from the prison. It was only with the weight of my body that the pain began, step-by-step. When the two escorting guards walked briskly towards the fluorescent glow of the hospital entrance in the early morning darkness, I felt the manacles clamp down with every flex of my foot. I lifted the chain like a skirt as I struggled to keep up, not wanting one of them to turn and admonish me. As we passed through the automatic doors, some patients and employees watched me clank by. Others looked away.

The health care system at Lee Arrendale State Prison, where I’ve been incarcerated, uses Wellpath, one of the largest for-profit health care companies for incarcerated people. Wellpath has had over 1,400 federal lawsuits filed against it for allegations such as medical malpractice, patient injury, and wrongful death. It’s a managed care organization (MCO), a type of health care provider that charges a flat price to the prison to provide care. Currently, most health care providers in America employ aspects of managed care. But in the carceral system, these models encourage dangerous cost-cutting measures. MCOs compete with each other for contracts with the state by offering the lowest monthly fees. As a result, their policies reduce both the cost and amount of care, with devastating consequences. Atlanta News First reported that in Cobb County, Georgia, an inmate in the county jail died less than 24 hours after he entered without receiving medical attention — despite jail medical staff, contractors provided by Wellpath, being aware of his medical issues. Wellpath declined to comment on the case.

Inadequate medical care is a crisis for the incarcerated population.

Inadequate medical care is a crisis for the incarcerated population, who suffer from high stress, poor nutrition, little to no physical exercise, and exposure to infectious disease, mycotoxins, and violence. Inside, we cannot use any alternatives to what the state provides and are generally non-paying customers. As such, there is little incentive for MCOs to provide quality care to the incarcerated population. Providers like Wellpath contract with corrections departments for a fixed per-patient, or per-incident fee, and the MCO assumes the financial risk if costs exceed the fixed amount. Managed care models appear to be incentivized to minimize high cost treatments, like those that require hospitalization or specialist care. Providers employed by an MCO must get approval for tests and surgical procedures and these are often delayed, or denied. Courts have firmly established that a lack of funds does not justify constitutionally inadequate treatment of prisoners, particularly when it comes to health care. Yet, such delays or denials of treatment have persisted.  

I had been experiencing abdominal pain for over a year. The ever-changing providers at the institution had passed me around, lost the X-rays, and prescribed me daily laxatives for gas. The first provider wanted to try an OTC medication for several weeks and order a blood test as a first approach to determining the problem. Before the trial meds were complete and the lab results were recorded, the ball had been dropped. I waited weeks for a follow up that never came, put in another request to be seen, waited again for weeks to be seen, until I was assigned a new provider who agreed to try another OTC medication and ordered another blood test. After many complaints, pleas, and worsening symptoms, I was finally sent to an outside gastroenterologist, who ordered a colonoscopy. 

A woman's broken face held together by bars behind which is another woman's face

Three days before the procedure, I was moved to a bed in the infirmary so that I could be administered the pre-op medication. I was also to be put on a fasting watch so I couldn’t ingest anything but water and medicine for 72 hours. (Previously it was a 24-hour process, but too many scans were canceled due to the impacted bowels of our residents. So to save money on hospital trips, the 72-hour lockdown is the current procedure.) The infirmary consists of two bed cells with glass windows facing a central area for nurses and security. I was housed with an elderly woman who had just had a hip replacement. She was surrounded by Styrofoam trays and several days’ worth of half-eaten meals because she couldn’t move and no one had come to collect her trash. She had been sponge-bathing with one of her socks because basic toiletries or cleaning tools hadn’t been provided. When I pulled back the blanket of my assigned bed, there were stains and loose hair left by the person before me. I tried to raise the issue, but there was no replacement linen. 

The next morning, I was given a citric sulfate drink and an oral laxative and, by the afternoon, I was forced to use the toilet in front of not just my roommate, but also anyone in the infirmary that could see through the glass, including a group of maintenance men who were working on an electrical outlet in the cell next to ours. Over the course of three days, a parade of people, male and female, resident and personnel, flowed past our cell while the nurses fed me only laxatives until I sweated and shook. 

Incarcerated people do not forfeit all of our rights during incarceration. The First Amendment, for example, gives us the right to speak freely, including in regards to the poor treatment we endure in the carceral system. We also retain our Eighth and Fourteenth Amendment rights that prevent cruel and unusual punishment and guarantee equal protection. Yet, after an overwhelming number of complaints from prisoners began to flood the courts beginning in the 1970s with the rise of mass incarceration, the courts responded with acts to curb prisoners’ legal action. 

The Civil Rights for Institutional Persons Act (CRIPA) is a federal law enacted in 1980 that allows the Department of Justice to intervene on the behalf of incarcerated people whose rights are being violated. It requires that incarcerated individuals first enter a 90-day grievance process within the institution. But in-house grievance processes work without oversight from any outside entity, so complaints are often dismissed or even outright ignored, leaving the plaintiff with no legal ground to move forward. There’s also the Prison Litigation Reform Act (PLRA), a federal law passed in 1996 to make it more difficult for incarcerated people to file lawsuits in federal court. PLRA means that in the unlikely event a prisoner’s complaint is elevated to a judicial level, the incarcerated person will incur the court fees — a cost many of us cannot afford. And if they lose the case, their complaints could be classified as a waste of court time and result in criminal charges. Both of these acts have effectively crippled the ever-increasing incarcerated population’s ability to seek justice while the cost saving measures of the state torture, dehumanize, and sometimes ultimately kill people whom have no ability to care for themselves.

There wasn’t time to explain the law in Georgia around felony murder.

After three days in the prison infirmary I arrived at the hospital for the colonoscopy. I signed the admissions paperwork with shackled hands. I didn’t provide contact information, knowing I couldn’t be contacted here at the institution. I acknowledged that I do not have a living will. I was led to a waiting room where other patients sat with their families. When the nurse came for me, the guards followed as I was taken to the pre-op area. The female officer stood by me behind the curtain and the male officer stood just outside as I stripped naked. I put on the hospital gown, which opened at the back, and got onto the gurney. The female officer then shackled my feet together while the nurse brought me a blanket and opened the curtain. The anesthesiologist came to introduce himself, explained that I would be put to sleep, made sure I didn’t have any loose teeth, and said he would take care of me. After a short wait, I was rolled down the hall into a dark room and the guards were asked to leave. The nurse explained that I needed to lie on my side, with my butt exposed and my feet in shackles. They put a mask for oxygen on my face. At that moment, I turned to the shield that I have long used to protect myself from shame or embarrassment: I disconnected from my body. I hid myself down inside, trying to find comfort in the fact that these are strangers who’ve never known me. It’s a tactic that came to me in an operating room just as it had over the past 20 years when I have been held captive, stripped naked, and forced to share private spaces with crowds of strangers.

Just when I had tucked myself in, prepared for the discomfort, loneliness, and vulnerability in the operating room, the anesthesiologist reemerged. He leaned down to my masked face, not close enough to whisper so the others couldn’t hear, but close enough that I could hear him over the whirring of machines. He said, “Carla, if you don’t mind me asking, why are you incarcerated?” The look on my face must have indicated that I didn’t know how to answer, so he clarified, “I mean, what are you charged with?” His question swiftly brought me back into my body, along with a mix of horror and shame. I murmured through my mask, “Felony murder.” In retrospect, I wonder if I should have told him to go fuck himself or to look me up on Google, hoping that he would read my case and perhaps even see the other sides of me through my published work. But I have learned to accept myself and my reality, and knowing the work it has taken to own my story, there just wasn’t time to tell it there, chained on a table. The anesthesiologist couldn’t hear me through the mask and over the machines, so he leaned a little closer and asked me to say it again. I indicated that I needed to take off the mask to explain myself properly. The nurse nodded. So with my butt exposed and my feet in chains, I pulled the mask off my face. I tried to explain that 20 years ago I was arrested with three male codefendants. But I stopped myself, noticing his face twist with disgust. 

A woman bending down to lift up her gown made up of jail cell-like iron bars

There wasn’t time to explain the law in Georgia around felony murder (under which you can be prosecuted if you committed a felony that resulted in a murder, even if you did not commit the actual murder). There wasn’t an opportunity to enlighten him on the nature of addiction, poverty, and racial discrimination. I was asked to define myself out of context while naked and in chains. This did not elicit his compassion or kindness. Without a response and with the disgusted look still lingering on his face, he began to inject a milky-white substance into my IV, which I watched coil through the dark room and into my body. I remember moving my unshackled hands to my throat in panic just before the room went black, with my attempt to explain my incarceration still hanging in the air. I knew a woman who was executed by the state of Georgia in 2015 and a glimpse of her was the last thought I had. 

This is the second way prisoners are deterred from the care (poor quality though it may be) that is available: the humiliation and paternalism that they experience. In my case, and in many experiences shared with me in my community, first-time concerns tend to be treated as frivolous by the provider, who talks to the patient as if they are incompetent, attention-seeking, and a waste of their time. There is little bedside manner offered to incarcerated people like me. As a result, many residents will avoid medical care as much as possible and suffer serious pain, discomfort, and chronic illness. Factor in the additional deterrent of the co-pays imposed on most visits and medications to the mostly indigent population. A co-pay in a Georgia prison is often around $5, but for prisoners who are not guaranteed any sort of minimum wage, this fee is exorbitant. The culmination of  all of these factors — neglectful MCOs, uncaring providers, and high fees — results in such traumatizing experiences that once a person has experienced them they are reluctant to subject themselves to it again.

“You know, you people don’t have any modesty anyway.”

I woke up in the recovery area, a row of beds surrounded by curtains, and the nurse instructed me to push air from my body — to make myself fart. My curtain was open to the bright lights and people hustling back and forth. Half asleep, I did as I was told, and then abruptly asked the female officer, sitting by my bed, where the male officer had gone. Somehow she understood that I would be more comfortable farting loudly in front of her than him. She told me he was standing just over there, but exclaimed, “You know, you people don’t have any modesty anyway.” I made a half-coherent statement trying to convince her that I did, to which she chuckled lightly. A moment later, another nurse arrived who explained to me that I really needed to eat more fresh fruits and vegetables. I tried to explain to her that there were no fresh fruits and vegetables available to me. She said in a distrustful tone, “Oh, come on, you have to have fruit.” With some authority I raised myself up and tried to argue that it was indeed rare. She rolled her eyes, removed my IV, and handed my bag of clothes to the guard. The guard unshackled my feet so I could put my white underclothes on, which looked dingy in the bright hospital light. I then put on my uniform before the handcuffs and waist chains were reapplied and I was escorted back to the prison van. 

After outside appointments, the prison medical staff do a follow up to write any prescriptions requested by the specialist, update the files, and schedule the next outside appointment. It has been six months since the colonoscopy and I haven’t seen a provider here at the prison and, therefore, have not been back to see the gastroenterologist to discuss the results. Several hours after I eat anything, a wave of pain moves across my upper torso like a rainbow from right to left. My bowels are obstructed, and my skin breaks out in itchy sores when waste builds up in my body. Sharp pains wake me up at night and I can often feel my heartbeat throbbing in my lower body. There is a record of these complaints in my medical chart that go back now for over two years, along with useless advice: drink water and exercise. Over the last decade I’ve been incarcerated at Lee Arrendale State Prison, my community has witnessed the suffering and untimely deaths of many of our neighbors and friends — we need more and better care, not less. The managed care model is working to save money for the state instead of the lives of those in custody. With nowhere to turn for help, I am left to hope I can get some answers and some relief, before it’s too late.

Carla J. Simmons has been incarcerated in the state of Georgia since 2004. She holds an associate degree in Positive Human Development and Social Change from Life University and is a member of the Justice Arts Coalition. A survivor of state and domestic violence, she is now a member of a very small and supportive family, and a believer in the significance of the here and now, as well as hope for a better future for all. Publication of this story was supported by Empowerment Avenue, an organization that supports incarcerated writers and artists.