Death on the Installment Plan

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

"The DOC knows much more about the health of its patients than any HMO in the state," McGarry says. "We suffer the burden of our vigilance. We do a good job of detecting these diseases and treating them."

Yet there are crucial drawbacks to the kind of health care a prison can offer. Pundits who express outrage at the notion that prisoners are entitled to any kind of medical attention rarely grasp how limited the care really is. Routine complaints are usually seen by a nurse or physician's assistant rather than a doctor, and security considerations severely restrict access to outside care. Some rural prisons are located hours away from the nearest fully equipped trauma center. For obvious reasons, powerful painkillers are almost never prescribed, and all but the most indigent inmates are expected to purchase ibuprofen and other over-the-counter medicines at the canteen, paying for their pills out of prison wages that average less than eight dollars a month.

Depending on staff attitudes and training, a prisoner complaining of chest pains -- or labor pains -- may receive immediate treatment or be told to sit tight until tomorrow. Recently, the state paid $50,000 to one female inmate whose pregnancy ended in a miscarriage, the result of medical care that McGarry described as "below any minimal level of competency."

Mark Andresen
Roderic Gottula devised the DOC's first hepatitis treatment policies a decade ago.
Brett Amole
Roderic Gottula devised the DOC's first hepatitis treatment policies a decade ago.

"In the real world, you can call 911 for a medical emergency," says one nurse-practitioner who's worked in Colorado's prisons. "But in there, you're at the mercy of the medical staff."

"The general medical services are poor," says Dennis Hartley, a Colorado Springs attorney who is currently suing the state over its hepatitis C treatment policies on behalf of several inmates. "But I don't think the DOC is completely at fault for that. Some inmates don't get treatment because they don't want to give blood tests that show they're getting drugs smuggled in. Some people arrive in pretty miserable condition to start with. But the general attitude on the medical staff is that the inmates are trying to manipulate them, and these guys have to make several complaints before they get the attention they need."

Sometimes they don't get it. Hartley once represented the family of a DOC inmate who was stabbed by another prisoner. "When the guards finally come to get him, they walk him to the infirmary," Hartley recalls. "Once he's there, they put him on a gurney -- and he's bled to death by that time. The pathologist said a simple pressure bandage could have prevented this."

Officially, the death was entered in the books as a homicide, but Hartley believes that medical care, or lack of it, played a part, too. The same might be said of death from an asthma attack -- a rare occurrence on the outside, but the DOC has had at least two such deaths in recent years.

Other cases are more ambiguous. Last December, 24-year-old Henry Whatley collapsed and died on a basketball court at the Buena Vista Correctional Facility. Whatley had a congenital heart defect; given his condition, it was an oversight for the DOC to place him at Buena Vista, a high-altitude setting that would put further strain on his heart. But then, Whatley probably shouldn't have been playing basketball, either.

In the spring of 2001, David Alonzo, 42, slipped and fell in his cell at Limon. Three days later he was dead.

Alonzo went to the infirmary the day after his fall, complaining of swelling in his left arm. He was moved to a local hospital, then to University Hospital in Denver, as the doctors who examined him began to recognize the seriousness of the infection he had developed. At University, Alonzo was diagnosed with upper-extremity compartment syndrome -- basically, his left arm had become necrotic and required immediate surgery. He died a few hours later.

It's impossible to say if Alonzo's bumped elbow would have proved just as fatal if he hadn't been in prison. He was diabetic and weighed 340 pounds; he had a history of health problems, and surgeons had previously amputated one leg below the knee. But when dealing with a condition as dangerous as compartment syndrome, every minute counts, and the long journey from infirmary to major hospital is, as McGarry puts it, part of the "downside" of prison life.

Bryan Bush never made it to the hospital. A 43-year-old inmate at Arkansas Valley, Bush was found unconscious in a bathroom in the summer of 2001 by another inmate. He was taken to the infirmary, where he revived. The medical staff could find nothing wrong with him and sent him back to his unit. He was found dead in his cell later that day.

Bush had a long history of seizures, and it was probably a seizure that killed him. That, at least, was the opinion of the forensic pathologist who conducted the autopsy and "found no evidence of traumatic injury or medical disease sufficient to explain his death." But among prisoners who knew Bush, a former minister and notorious child molester, rumors persist that he was murdered -- if not by another inmate (his cellmate was questioned and cleared), then by the contempt of his keepers.

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