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Death on the Installment Plan

Medical neglect, chronic disease, a hepatitis epidemic. Some Colorado prisoners pay for their crimes with their lives.

Bleeding from his behind, Fidel Ramos had this crazy notion that he should be taken to a hospital. Not a prison infirmary, but a real hospital, with an emergency room and doctors and such.

His keepers at the Denver Reception and Diagnostic Center, a maximum security prison on Smith Road, thought otherwise.

Ramos complained that the bleeding was getting worse. No response. He asked for an ambulance. The guards chuckled. He demanded to make a call to his lawyer. That got someone's attention. Finally, after days of blood and negotiation, he was slung into the back of a van like a side of beef and taken to the emergency room at Denver Health.

At the hospital, Ramos lost consciousness. When he came to, a doctor explained that he'd performed surgery on a ruptured artery, a complication resulting from two prior surgeries to remove a peri-rectal cyst. If he hadn't sought medical attention when he did, the doctor told him, he could have bled to death.

It was around that time that Ramos decided he'd had enough. Maybe he was just a lowly prisoner, serving 24 years for bank robbery in the Colorado Department of Corrections. But you don't treat even a caged dog that way -- especially a dog whose complaints have already cost the state in excess of $100 million.

At 55, Ramos knows his way around the state prison system. He's been behind bars for close to half of his life. During that time, he's picked up a little knowledge of constitutional law, including the Eighth Amendment, the one about cruel and unusual punishment. (The Founding Fathers were against it.) Early in his prison career, he even made law.

In 1977, acting as his own attorney, Ramos filed a lawsuit against Colorado's antiquated maximum-security prison, known as "Old Max." The case soon became a class-action lawsuit championed by the American Civil Liberties Union, with Ramos named as lead plaintiff. A sprawling indictment of a violent, poorly managed corrections agency, Ramos v. Lamm was the most effective -- and costly -- attack on prison conditions the state had ever seen. It led to the closure of Old Max, a building boom that has modernized prisons across the state and a revolution in the way the DOC deals with safety issues and medical care for inmates ("Safely Behind Bars," July 3, 1997).

The Ramos case served as a judicial watchdog over the DOC until it was finally settled in 1994. By then, Ramos himself had moved on to federal prison. Three years ago he returned to the DOC to serve state time for his last robbery -- and discovered that medical care under the "new" system wasn't all that different from what he'd experienced previously. Although technologically the services were much more advanced, getting access to care wasn't easy.

For almost twenty years, Fidel Ramos had been the biggest pain in the ass the DOC had ever known. Now it was his turn to feel the pain.

According to Ramos, he had to battle the department's medical bureaucracy every step of the way -- to get his cyst diagnosed and operated upon, to get a second operation after the area became reinfected, and to get treatment for the ruptured artery in early 2001. Months later, he discovered in his medical records a doctor's recommendation that he not be forced to sit for prolonged periods of time, in order to avoid putting pressure on the incision. The recommendation had been routinely ignored as he was transported back and forth among half a dozen prisons between surgeries and afterward. Nearly two years after the last operation, he's still having trouble with chronic infections and bleeding -- and still being shifted from prison to prison.

"I'm tired of messing around with medical," he says. "There's professional concern and then there's professional neglect. They treat us like we don't deserve any kind of medical assistance at all."

Bouncing around the system for months, Ramos became convinced that his concerns were hardly isolated ones. He saw prisoners collapse or go into seizures while corrections officers with minimal medical training stood by, watching idly or putting in a leisurely call to medical staff for instructions. He saw jaundiced inmates, in advanced stages of hepatitis, dying slowly of liver disease while waiting for admission to the DOC's highly restricted drug-therapy program.

He saw Charles Renfro, an old con he'd known since the 1970s, confined to a wheelchair after suffering a stroke. One day Renfro complained of chest pains. He was told to put in a "kite" -- a formal request for administrative action -- so he could be examined by a physician's assistant the following day. That night, Renfro died in his cell.

Ramos saw plenty. Then he began drafting a new lawsuit, one he expects to be filed in federal court before Christmas.


If any enterprise in Colorado can be considered recession-proof, it's the corrections business. During the turbocharged 1990s, as newcomers flocked to the state and housing prices soared, the DOC's inmate population doubled and its annual budget nearly tripled. Now the local economy is sputtering, but the prisons are busier than ever.

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