Why Doesn’t the Hippocratic Oath Apply to the Nation’s Prisons?

UPDATE: Washington State: Class-action Alleges DOC Policy of Denying Medical Care

Original date: Nov 2015 Washington:

Many inmates will do anything to avoid seeking medical assistance if they can help it. A recent lawsuit in Washington State explains why.

The Hippocratic Oath has long embodied all that is good in the medical profession. Those who swear by it vow to act “for the benefit of the sick” and to prevent “harm and injustice” from befalling their patients.

But in the correctional system, the Oath is often undermined or, at best, ignored.

The Washington Department of Corrections (WDOC) is an unfortunate example. Medical professionals within the WDOC acknowledge in depositions that its medical staff are required to use “a different standard to evaluate patients than is used [ ] in the community,” and some medical personnel in WDOC concede there is nothing “science-based or humane” about the policies that govern their decision-making.

These claims are currently the subject of a lawsuit, in U.S. District Court for the Western District of Washington, brought against WDOC by the non-profit Columbia Legal Services (CLS) on behalf of prisoners throughout the State of Washington. [See, Daniel Haldane, et al. v. G. Stephen Hammond, M.D., et al., No. 2:15-cv-01810-RAJ]

CLS is seeking to end WDOC’s use of “a healthcare pre-approval process to restrict medical costs at the expense of necessary prisoner healthcare” and maintains this practice poses “an ongoing, serious risk of harm to all 16,000 prisoners under DOC’s care,” according to the Plaintiffs’ Motion for Class Certification.

The medical conditions complained of include: commonly withholding opioid treatment even when a prisoner’s chronic and substantial pain is unresponsive to other therapies; and refusing to authorize surgery even when, as a result, prisoners must struggle to wipe themselves after toileting.

While the efforts of CLS should be applauded, prisoners should nevertheless resist the temptation to believe this litigation will lead to better medical treatment throughout WDOC.

Even enlightened, well-meaning policies can degenerate into arbitrary and unsound decision-making. Having suffered the brunt of such decisions over the last quarter century during my confinement, I have come to believe a correctional system’s shortcomings are often rooted in the negative views of the employees.

Views that developed in an era of mass incarceration.

One of the consequences of mass incarceration is the adoption of a military mindset by many correctional employees as the paramount goal within prisons came to be maintaining order and security. When this becomes the ultimate objective, staff members can easily begin to perceive the prison as hostile territory and prisoners as the enemy—especially when the level of violence within a facility makes the working conditions quite dangerous (relatively speaking).

Once this prisoner-as-enemy mentality takes hold of correctional staff, the idea that they should show care or humanity to those who are confined seems to be frowned upon and rejected.

Harm and injustice at first is tolerated, then becomes accepted.

The prison infirmary is no exception. I have seen and felt the iciness that medical providers evince when they have this mindset . Trust me, it would impress the most cold-hearted convict.
Even in prisons with relatively safe working conditions, there is a general lack of sympathy for prisoners with medical problems.

Furthermore, to expect proper diagnosis and treatment to be advanced by people with these attitudes is to ignore common sense and human nature.

Yet even in prisons with relatively safe working conditions, there is a general lack of sympathy for prisoners with medical problems. Their health needs are rarely taken seriously.

Indeed, I have long resorted to toughing it out or trying every home remedy that a convict can conceive before heading to medical to find relief.

Like other medical departments in WDOC, prisoners must be ready for war when they enter the medical facility at Stafford Creek Corrections Center. While the inside is nice and clean, physician assistants and nurses face off with prisoners as adversaries.

When I explain what ails me, I know, without a doubt, that every attempt will be made to dismiss my symptoms as if I am malingering or exaggerating; and I will likely be sent away with, at best, ibuprofen or amitriptyline—WDOC’s cure-alls for damn near everything.

If I complained, it is almost certain that I would be ordered to leave unceremoniously; and, were I to hesitate because the pain I was enduring was all-consuming, I will be handcuffed and escorted to segregation—like the enemy.

The message is: We are unworthy.

We are degenerates.

We should be grateful to get any medical treatment by the DOC.

These ubiquitous views explain why a correctional system might see fit to establish “a practice of withholding necessary medical care from patients with serious and painful medical conditions,” as CLS claims to be the case with WDOC. Such practices only develop when correctional employees do not believe the welfare of prisoners is a priority.

That said, my jaundiced eye has not left me without empathy, so I urge readers not to judge correctional medical personnel too harshly.

With all due respect to Hippocrates, it is easy to tolerate harm and injustice when both have been perpetrated by one’s patients.

Jeremiah Bourgeois is a regular contributor to TCR, and an inmate in Washington State, where he is currently serving 25 years to life for a crime committed when he was 14. He will be eligible to go before the parole board in 2017. He welcomes comments from readers. ..Source.. by an inmate (reprint from: https://thecrimereport.org)