Treatment Behind Bars

> In a prison in Alabama, an elderly inmate who had suffered a stroke was forced to sit on a wooden bench so that he would not soil his bed.

Injuries suffered in repeated falls from the bench, combined with circulatory problems, forced amputation of one leg.

He died the day after his operation.

> A t Cermak Memorial Hospital, a 111-bed facility serving the Cook County correctional system in Illinois, a prisoner with a policeman's bullet in his buttock waited three hours for treatment.

He was finally removed to another hospital because no surgeon was available.

> At Boston's decrepit, 122-yearold Charles Street jail, a man brought in on charges arising out of an automobile accident complained of back pains. Only when his mother bailed him out three days later and took him across the street to Massachusetts General Hospital did he learn that his spine was fractured.

Such flagrant examples of medical negligence are not everyday occurrences in U.S. prisons and jails. But neither are they unusual. There are at least 360,000 men, women and youngsters behind bars in the U.S. today, and before the year ends, perhaps as many as a thousand will die there, many of conditions that would be considered both treatable and curable outside the walls. Thousands more will suffer from illness and discomfort so needless that they amount to cruel and unusual punishment. With few exceptions, inmates of the nation's correctional institutions must either go without medical care entirely or make do with treatment that is far below accepted standards.

A 1972 A.M.A. survey found that two-thirds of all U.S. jails have only first-aid capabilities, while one in six had no medical facilities at all. County-run institutions designed to hold either short-term prisoners or those awaiting trial do the least to preserve their inmates' life and health. Many are staffed by personnel unable and unwilling to recognize illness in an inmate; some are so lacking in sanitary facilities that they are virtual breeding grounds for such diseases as hepatitis and gastroenteritis.

State prisons are little better. Alabama's correctional system, which has 7,000 inmates, currently has only one doctor. Chicago's Cermak Memorial, which lost its hospital accreditation this month, depends almost entirely on part-time physicians. Even federal prisons, which tend to be better run and better financed, are short staffed. Three of the four doctors at the federal prison at Fort Leavenworth, Kans., which has 2,100 inmates, plan to leave at the end of the month. Many prisons must rely on untrained inmates to screen patients or perform medical services. In Alabama, unsupervised prisoners have been drafted into service to pull teeth and perform minor surgery.

Nor are those prisons that have full medical staffs always able to provide proper care; some simply lack the necessary equipment. At the Minnesota State Prison in Stillwater, considered by many cons a "good place to do time," surgeons must scrub for operations in a converted urinal; proctoscopic examinations are performed in a lavatory on a dilapidated operating-room table.

In most prisons, doctors' attitudes are little better than the facilities. "Medical care is dispensed with a different standard in prisons than it is in the community," says Jerry Haleva, a consultant for a legislative committee investigating prison conditions in California. "Inmates are thought of as prisoners first and patients second." Low salaries drive many good doctors out of prison work; cynicism destroys the effectiveness of many of those who stay. Thus many prison doctors ignore the complaints of their patients, suspecting that they are malingering, while some hand out tranquilizers or other drugs indiscriminately to keep prisoners under control. Says Frank Schneiger, director of Prison Health Services for New York City's Health Services Administration: "There's an inbuilt corruption of the doctor-patient relationship in the prison setting. Clearly the patient doesn't want to be there."

Getting Better. No one has yet figured out a way to keep people out of prison. But some action is being taken to ensure that those who are behind bars get proper medical care. The bloody 1971 riot that claimed 43 lives at New York's Attica prison called attention to the inadequate medical facilities there among other abuses. That has led to the establishment of a medical review board within the state department of corrections and increased salaries to attract qualified physicians to the institution. Massachusetts has renovated and improved hospital facilities at its Norfolk correctional institution. California is continuing an ambitious program to upgrade medical care in its twelve major institutions and 18 conservation camps. The system, with 20,000 prisoners, employs 58 full-time physicians, 51 psychiatrists and 35 psychologists, as well as nurses and medical technical assistants. San Quentin even runs a program to train prisoners to become licensed vocational nurses.

The greatest strides have been taken by New York City's correctional system, which has 9,700 prisoners in its ten institutions. All incoming prisoners are given thorough medical checkups, and a 24-hour screening program run by specially trained nurses and physicians' assistants is being set up on each prison tier to ensure prompt attention to all medical complaints. To supplement the expanded medical facilities, the city's Prison Health Services is contracting with major medical centers to provide high quality care for inmates. The arrangement has already increased the care provided to prisoners in city institutions. A year ago, when patients were brought to city hospitals by the busload without appointments, only 10% actually received treatment. Now that the P.H.S. has set up an appointment system with its affiliated hospitals, all the prisoners receive medical attention.

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