Saving Your Mind: Mental Health in the Age of COVID

November 1, 2020
By Leo Cardez
Illinois Department of Corrections

“This is some crazy ass shit; and I thought I’d seen it all after twenty years in the joint.”  Murder*, my COVID wing co-worker, lamented while shaking his head.  We were dragging yet another fellow inmate to the hospital wing of our prison.  Murder is a seasoned con from the streets of Chicago’s South side, but I swear I saw a tear in his eye.

            There were four of us glorified janitors working in the makeshift quarantine wing of our prison.  Besides cleaning, we were tasked with moving and caring for sick (even dead) inmates.  At the peak of our coronavirus outbreak, we worked seven days a week double shifts, sweating through our full PPE—too busy to even stop and eat.  It was only at the end of the day, during my shower, that I would finally have a moment to catch my breath.  Sometimes I would break down, hiding my tears as the warm water washed over me.  My co-workers and I suffered everything from nightmares to migraines.  We lost and gained weight at an alarming rate.  We slept sporadically and were often depressed or angry.  Double D, my morning co-worker, said it best, “We are never going to be the same after this… you cannot unsee or undo this type of damage.”

Continue reading “Saving Your Mind: Mental Health in the Age of COVID”

Ask PHN: Reducing Your Risk of Diabetes in Prison

By Lisa Horwitz and Seth Lamming

Question:

Dear Prison Health News,

How do I avoid diabetes when the meals usually consist of white bread, white rice, cake, cornbread, fruit served in syrup, and white noodles? I would appreciate any

information you can provide. Thank you.

—Colin Broughton, South Carolina

Answer:

Thanks for this great question! Type 2 diabetes, also known as adult onset diabetes (high blood sugar), is a common long-term health problem that affects 1 out of every 10 Americans. It can cause many physical complications, and of course we would all like to prevent getting it if at all possible (If you have diabetes, PHN has written a “Diabetes Self-education Guidebook” that we will send you on request).

The cause of diabetes is not really known—so guaranteed prevention is not possible for any of us. It is thought that a combination of environment, genetics, and health choices like diet and exercise cause some people to develop diabetes. Risk factors for diabetes are: smoking, having other family members who have diabetes, being overweight (especially if the extra fat is mostly in the belly), getting little or no exercise, high blood pressure, high cholesterol, diets high in sugars and saturated fats, being of Black, Hispanic, Native American, or Asian/Pacific Island ethnicity, being female, and being over 40 years old. Being low income increases risk, both because of increased stress and lack of access to fresh whole food. But anyone can get diabetes, even if they have none of these risk factors.

Preventing diabetes is about doing what you can to make your body and mind as healthy as possible. Ways to take care of your body include getting enough sleep (more than 7 hours every night), eating a balanced diet, drinking plenty of water, managing health problems like high blood pressure, quitting smoking, and moving your body regularly. Washing your hands regularly and making sure you are up to date on all your vaccines is important to prevent getting sick.

Doing things to lower stress and improve mental health are also important for preventing diabetes. Over time, stress hormones in the body can contribute to high blood sugars. Proven ways to reduce stress are aerobic exercise and slow, deep breathing. Even ten minutes a day of slow, focused breathing has been shown to reduce blood pressure and improve sleep. Box breathing is one technique: Breathe in, counting to four slowly. Feel the air enter your lungs. Hold your breath for 4 seconds. Try to avoid inhaling or exhaling for 4 seconds. Slowly exhale

through your mouth for 4 seconds. Hold again for 4 seconds. 12 Carbohydrates, or carbs, are in most things we eat. When you eat carbs, they get broken down into glucose (a type of sugar) for energy. Carbs are made out of sugars, but they are not all bad. A little more than half of the food you eat should be carbs. Where you get your carbs from is important though. Carbs are in fruit, vegetables, grains, and other things like white bread, cake, and soda. Eating foods that will not cause your blood sugar to be high is harder in prison, where you don’t have much choice over what you eat. It is helpful to learn which kinds of foods are less likely to cause blood sugars to spike, so you can make the best decisions possible. Foods with a lot of fiber and low-fat proteins do not cause blood sugars to spike. Avoiding foods that are highly processed and with lots of added sugar (like factory-made cakes) is a good rule of thumb. In some facilities, medical can order special low-carb diets for people with diabetes.

Foods that raise blood sugarFoods to try instead
White bread, potatoes, pasta, white riceWhole-wheat bread/pasta/tortillas, brown rice, a variety of green vege- tables
SugarSugar-free sugar substitutes like Equal or Sweet’N Low
Flavored oatmeal packetsPlain oatmeal with sugar substitute
Sugary breakfast cerealsPlain cereals with a lot of fiber like Cheerios or Raisin Bran
Chips, candy, snacksPeanut butter and crackers, dried fruit, whole fruits
Soda, juiceWater, tea without sugar, sugar-free or diet drinks
Red meatsLean proteins like chicken, turkey, fish, eggs, beans, or nuts

Regular exercise is helpful for lowering blood sugar, reducing stress, and improving overall health. In general, adults should try to get 150 minutes of aerobic activity per week and strength-training exercises twice per week. Aerobic exercise is anything that gets your heart rate up, like walking fast, jogging, or doing jumping jacks. Exercises like push-ups and squats that target muscles in specific parts of your body are “strengthening” exercises. There are lots of creative ways to exercise, like dancing or yoga. Doing chores like mopping that require endurance can also give you an excuse to get active. Even just getting up and moving around every couple of hours is good for your body if you have limited mobility.

High Blood Pressure (Hypertension) And What You Can Do About It

By Lucy Gleysteen and Seth Lamming

Whenever your heart beats, it pushes blood through your body to nourish tissues and organs. The heart has to beat with enough force to reach every part of the body. However, many people have blood pressure that is too high. When blood vessels are narrowed by conditions such as high cholesterol, the heart has to work harder to supply blood to the rest of the body, increasing pressure. High blood pressure, also known as hypertension, over time causes less blood flow to the kidneys, which causes the body to retain more water and salts. With more water and salts in the body, the heart has to beat harder to manage all the fluid, causing an increase in blood pressure.

What is blood pressure, and what do the numbers mean?

Blood pressure is the measurement of how much pressure or force there is of blood pushing up against the walls of your arteries. Arteries are what carry blood from your heart to other parts of your body.

Blood pressure readings have two numbers. Systolic, the number on top, represents the pressure on blood vessel walls when your heart is beating or contracting. Diastolic is the number below, and it represents the pressure on your blood vessels between beats when your heart is relaxing. It is normal for blood pressure to fluctuate over the day.

What is high blood pressure (hypertension)?

A normal blood pressure is below 120 (systolic) over 80 (diastolic), or 120/80. High blood pressure, also known as hypertension, is when a person has a blood pressure consistently above 130/80. Sometimes blood pressure readings can be impacted by things like stress, caffeine, sleep, and nicotine.

Systolic and Diastolic Readings
Normalsystolic: less than 120 mm Hg diastolic: less than 80 mm Hg
Elevatedsystolic: 120-129 mm Hg diastolic: more than 80 mm Hg
High Blood Pressuresystolic: 130 mm Hg or higher diastolic: 80 mm Hg or higher

Who is at risk for hypertension?

The exact cause of hypertension is not known. However, many people believe that a combination of genetic, environmental, and lifestyle factors cause high blood pressure. Hypertension is more common as you get older. Hypertension also tends to be more aggressive and occur earlier in Black people in the United States, due to intense stress and less access to preventative health care. Higher levels of hypertension is a clear

example of how anti-Black racism can impact health. You are more likely to have high blood pressure if people in your family have it. Other risk factors include diets high in salt, excessive alcohol, some medications, not exercising, and smoking.

Does hypertension have signs and symptoms?

Often hypertension does not have warning signs or symptoms. Getting a high blood pressure measurement on two separate occasions is the only way to confirm a hypertension diagnosis.

If there are no symptoms, what’s the issue?

Managing hypertension is important, even if there are no symptoms. Over time, high blood pressure damages the blood vessels in your body, causing them to narrow and harden. As a result, hypertension can lead to heart failure, chronic kidney disease, vision loss, dementia, and many other problems. It is also a common cause of heart attack and stroke.

How can I prevent it?

It takes time to develop high blood pressure. Sometimes it is genetic. If it is difficult to get physical activity or eat healthily, a person might be at higher risk of hypertension. Some people do not have access to healthy food, or time and space to exercise, so while there are recommendations about lifestyle in preventing hypertension, it is also important to acknowledge that not maintaining healthy blood pressure is not something that someone should be blamed for. Things that can help with preventing or reducing high blood pressure include getting regular physical activity, not smoking, and limiting sodium intake.

How can I take care of high blood pressure in prison?

Although managing hypertension in prison comes with many challenges, there are some things you can do to lower your blood pressure. Eating more fruits, vegetables, and whole grains and limiting saturated fats and red meats can help. Trying to eat less than 2,300 mg of sodium per day is recommended. Try to get regular physical activity, at least 20-30 minutes per day. If you smoke or drink alcohol, try to cut back or quit.

Medication is an effective method for managing hypertension. Blood pressure medication only works well if it is taken as prescribed. Even after your blood pressure gets lowered, it is necessary to continue these medications for life. People usually start with either an ACE/ARB, or calcium channel blocker. Diuretics are usually added second if blood pressure is not well controlled. These are medications that are used to treat hypertension:

Angiotensin-converting enzyme (ACE) inhibitors cause blood vessels to relax and open up, which lowers blood pressure. It also helps your kidneys get rid of extra sodium and water. Examples include lisinopril or enalapril.
Angiotensin II receptor blockers (ARBs) work in a similar way to ACE inhibitors. They cause blood vessels to relax and open up, which allows for lower blood pressure. It also helps your kidneys get rid of extra salts and water. Examples include losartan or valsartan.
Calcium channel blockers cause smooth muscles in the blood vessels around the heart and throughout the body to relax, causing blood pressure to lower. Examples include amlodipine or nifedipine.
Diuretics, sometimes called water pills, help remove sodium (salt) and water from your body through urination. There are many different types of diuretics,
but thiazide-type diuretics like hydrochlorothiazide (HCTZ) are usually used
to treat hypertension.

What You Need to Know About Your Rights of Consent Regarding Medical Care

By C. Nunley, GRCC, KY

Do you know what “consent” means? Maybe you think that you might, or perhaps you know what the dictionary defines it as, but did you know that legally, as far as the healthcare system goes, there are two basic types of consent?

The first type of consent is known as “implied consent.” This type of consent is typically based on actions rather than words. One example of implied consent is in emergencies. If you are found unconscious and not breathing, the law basically says that a reasonable person would assume you want them to save your life, so consent is implied without you having to say anything.

The second and most overlooked, but perhaps the most important, is “informed consent.” It is the type of consent that I would like to discuss in this article. I could bore you with a textbook definition using a lot of big words that you may or may not care to read, but let’s just use plain English. Essentially, this means that when you go see a healthcare professional, they are supposed to sit down and explain what your diagnosis is, what happens if you don’t get treatment, what treatments are available, and what bad things can happen to you if you decide to take the treatment. In many states, providers are required by law to get informed consent. If it isn’t illegal to neglect this duty, it’s at least a violation of the ethical codes that doctors and nurses are held to.

The best personal example that I can give is what happened in my own case. After my initial sentencing, I sought help from the psychologist in the medical department. She referred me to the psychiatrist, who diagnosed me with clinical depression, complicated by long-term insomnia. That doctor proceeded to prescribe a series of medications that were not what I needed. These included a “cocktail” of Zoloft (sertraline), Risperdal (risperidone), Haldol (haloperidol), Remeron (mirtazapine), and Desyrel (trazodone). Every time that I had an appointment and could think to explain that the meds weren’t working as I thought they should, the telehealth doctor would simply increase the dosages.

Not one time did the doctor explain anything about the medication regimen or any possible adverse effects. So, for ten years, I was given this “cocktail” the whole time without knowing that the adverse effects would be permanent. As a result, I now have a permanent neuromuscular condition called tardive dyskinesia. While this condition has been known about for decades, pharmaceutical companies have only recently released treatments for it in the past few years.

The vendors/contractors charged with providing us healthcare seem to think that they can just prescribe whatever because in many cases, when one of us presents with signs and symptoms of long-term adverse effects, it’s too late for us to seek any sort of legal remedy in most jurisdictions.

The only treatment for tardive dyskinesia is a daily dose of even more medication, so the cycle continues. In my case, after five years of discontinuing the medications, the condition has eased up. But it will never go away, and I will continue to have issues with it for the rest of my life. Had the doctor taken 15 minutes to explain and discuss the well-documented adverse effects of the medications with me, I would have looked for another way. EVERYONE NEEDS TO KNOW THIS!!

The problem with healthcare today in here, as well as the outside world, is that entirely too many doctors are too fast on the draw with that prescription pad. Nobody takes the time to do a patient history interview anymore, so they don’t know or seem to care that maybe their patient has been self-medicating with a substance that might be incompatible with whatever pill they want to cram down our throats.

Even as inmates, we do retain some basic constitutional rights (albeit a scaled- down version). However, as HUMAN BEINGS, we do have the unalienable right to consent, in any form, and we certainly have the right to know what we are putting into our bodies and what it can do for us or to us.

How many of us would not be in here had Purdue Pharmaceuticals not lied to everyone about how addictive their products were?

“Turn It Up” magazine recently published an article that really deserves attention! And with it, they published a “Patient’s Bill of Rights for Incarcerated Persons.” This proposed Bill of Rights was created by the men behind the walls of Sing-Sing and Green Haven prisons in New York. It is well thought out and should be implemented across the corrections systems in all 50 states immediately.

I present it here, in this forum, for your review.

  • Ensure the use of gloves by healthcare providers, including when dispensing medication.
  • Prompt responses to all medical emergencies.
  • Staff to maintain confidentiality, limiting access to medical files and requiringofficers to stand away from exam rooms.
  • Clinicians to keep instruments sterile and inside packaging until in front ofpatient.
  • Clinicians to notify patients of the medications being prescribed. [Note fromwriter: I take this to mean informed consent and what the medications will do.]
  • Presence of emergency alarms in porter cells for quick responses to medicalemergencies.
  • AEDs [automated external defibrillators] accessible in program areas anddormitory areas.I would like to add the following: Refer to us as “patients” and not “offenders” because no matter what the crime that brought us here was, no matter how seemingly insignificant or heinous, we are all human, and we all deserve a chance at redemption.

Permission to reprint or cite this article is given by the author with the provision that credit is given to the publisher and the author.

MDOC Covid-19 ‘Quarantine’ Reaps Financial Windfall for Corizon Health’s Investors

By Rand. W Gould, October 2021

Reprinted with permission from San Francisco Bay View National Black Newspaper

In early March 2020, the Michigan Department of Corrections (MDOC) declared a so-called “medical quarantine” for influenza, i.e., the flu, that quickly morphed into the COVID-19 “quarantine” still in effect to this day. Just as quickly, MDOC health care provider Corizon Health, Inc., took full advantage of this quarantine to deny prisoners constitutionally mandated health care across the board, including dental, optical, hepatitis B and other vaccines, with all previously scheduled 2020 medical consults and surgeries canceled.

Accordingly, health care requests were answered with such stock phrases as “no treatment until we return to normal operations” or “you are on the waiting list,” with many of us on this “list” for two years or longer. Shockingly, this is true for almost all medical issues requiring urgent, and even emergent, health care for over 17 months and counting, as confirmed by the Petitions for Health Care recently signed by prisoners at Central Michigan Correctional Facility (CMCF). The MDOC’s so-called COVID-19 “quarantine” at CMCF, and likely at all its prisons, at no time was in compliance with the Centers for Disease Control (CDC) guidelines and protocols for controlling COVID-19 in correctional settings, as mandated by PD 03, 04, 110, the MDOC policy directive for “Control of Communicable Diseases.” This constitutes willful neglect to perform a public duty in violation of MCL 750-478, a misdemeanor carrying a sentence of up to one year, and malfeasance in violation of MCL 750.505, a felony carrying up to five years.

There was no isolation of infected and close-contact prisoners and, immediately following the identification of COVID-19 infected prisoners at CMCF, over 500 prisoners were moved from the east side of the prison to the west, and vice versa, due to programming. To this day, there is no way to practice 6-foot social distancing, with men sleeping within inches of each other—eight men crammed into a four-man cubicle.

Moreover, the lack of a legitimate medical quarantine explains why CMCF had a nearly 100 percent COVID-19 infection rate in November-December 2020, the highest in the country, as previously reported by this writer. [See “Gov.

Whitmer hosts COVID-19 super-spreader events in Michigan,” San Francisco Bay View, January 2021, pages 3 and 16.]

Corizon is one of the largest, if not the largest, prison health care corporations in the country and is paid hundreds of millions of taxpayer dollars each year to provide health care to prisoners. The MDOC’s gross appropriation for health care for FY 2021 was $310,399,380. Corizon is a wholly-owned subsidiary of Valitas Health Services, Inc., a privately held corporation owned by Blue Mountain investment group, a hedge fund, and Beecken, Petty, O’Keafe & Co., a Chicago-based private equity management firm.

Its sole purpose is to fatten its owners’ bottom line by not providing health care at every opportunity, which is known within Corizon as “the Corizon Way.” The MDOC’s COVID-19 “quarantine” was one hella-opportunity to deny health care to prisoners, resulting in Corizon’s investors raking in a huge financial windfall for the past 17 months. State taxpayers and prisoners’ health be damned!

The Power of Hundreds of Prisoners’ Signatures

The willingness of these men to sign these petitions comes at a risk for themselves, as nearly every one of them is five years or less from possible parole—their ERD or Earliest Release Date—and MDOC can be vindictive. The men on Petition No. 1, which was lost or confiscated and replaced with No. 19, are the ones who helped push this endeavor to fruition. And every group on the compound participated to some extent.

Health care in Michigan prisons is abominable. I went almost six years to get hernia surgery, and I haven’t seen a dentist in over two years. The last column on each petition, headed “Health Care Denied,” gives the signers a place to specify their complaints.

Public outcry over Corizon’s medical abuse and neglect, generated by this story, could drive Corizon out of Michigan.

Covid-19 Updates: April 2022

By Lily H-A

The most recent wave of COVID-19 cases, driven by the omicron variant of the coronavirus, peaked in January in the US. The rate of COVID-19 cases at that point was by far the highest in the US to date. Cases dropped rapidly over the next couple months. However, as of April 2022, cases have begun to rise again in many parts of the country, though less steeply than before. This is likely due to a “sub-variant” or slightly different version of the omicron variant called BA.2 (the version of omicron that caused the earlier, larger wave was called BA.1). BA.2 seems to be slightly more contagious than BA.1, but does not seem to be more severe.

The Centers for Disease Control and Prevention (CDC) released data in April 2022 estimating that 58% of Americans now have antibodies showing that they have been previously infected with the coronavirus. This number is even higher in children. Your immune system makes antibodies specifically targeted to the coronavirus when you get infected, and these antibodies remain in your body for a period of time. It is likely that these antibodies provide some protection for people who have them, but unclear how much protection or for how long. Antibodies from prior infection seem to be less effective than vaccination in preventing future illness. The strongest protection seems to be from “hybrid immunity,” when people have antibodies both from vaccination and from prior infection.

It is difficult at this point to predict the course that the coronavirus will take in the future. New variants of the coronavirus are certain to evolve over time. How they affect the population will depend on how much immunity there is (from vaccination and from prior infection), how much that immunity protects against the new variant, how contagious the new variant is, and other factors.

In April 2022, the CDC released data showing that COVID-19 was the third leading cause of death in the US in 2021 (the same as in 2020). As of April 2022, over 990,000 people have died from COVID-19 in the US. By the time you receive this issue, it may have passed 1 million.

Mask Policies

On April 18, 2022, a federal judge in Florida struck down the CDC order requiring masks on public transportation and airplanes, after a lawsuit from multiple states. The justice department has appealed this decision.

The CDC still requires masks to be worn in congregate settings like shelters, jails and prisons, as well as in health care facilities. These policies were not affected by the recent court decision. Mask policies are changing fast, though, so this may change. Many states and cities that still had mask mandates for indoor settings like stores and restaurants have recently rolled them back. Data still show that masks are very helpful for preventing coronavirus infection and preventing

spreading it to others, especially N95 and KN95 masks.

Vaccination Updates

Some people are now eligible to get a second booster dose, as of April 2022. Booster doses can only be Pfizer or Moderna vaccines. The people currently eligible are:

  • People 50 or older who got their first booster at least 4 months ago
  • People who are moderately or severely immunocompromised, over 12years old, and got their first booster at least 4 months ago
  • People who got 2 doses of the Johnson & Johnson vaccine at least 4 months agoThe data showing benefit from a second booster dose (compared to just one booster dose) are still limited, so at this point it is only recommended for people in those higher-risk categories. Data continue to show that the vaccines are very safe and that being vaccinated (especially with a booster dose) provides good protection against serious illness and death.Vaccines are still not available for children under 5 as of April 2022. Both Moderna and Pfizer have asked the FDA to approve their vaccines for children under 5, and the FDA will likely make a decision within the next few months.TreatmentsSome of the treatments previously approved by the FDA for COVID-19 are no longer approved, because data showed they were not effective against the omicron variant. As of April 2022, there are several targeted treatments for COVID-19 that are currently approved, but many of these drugs still have limited supply and availability in the US. These treatments include:
  • Paxlovid (antiviral): This drug is recommended for people outside of the hospital at high risk for severe disease who were recently diagnosed with COVID-19.
  • Remdesivir (antiviral): This drug was originally only approved for hospitalized COVID-19 patients, but is now approved for patients outside of the hospital who are at high risk for severe disease. The National Institutes of Health (NIH) recommends remdesivir if paxlovid is not available.
  • Molnupiravir (antiviral): This drug is less effective than paxlovid and remdesivir but is recommended for high-risk patients if other antivirals are not available.
  • Bebtelovimab (monoclonal antibodies): This is a newer monoclonal antibody recommended for non-hospitalized patients at a high risk of developing severe disease when other approved drugs are not available or not clinically appropriate.
  • Evusheld (monoclonal antibodies): The NIH recommends this treatment as a preventative measure (like vaccination) for people who are immunocompromised and cannot produce a strong immune system reaction to the vaccine, or who cannot be vaccinated due to severe adverse reactions to the vaccine. It is not recommended for people who are currently infected with the coronavirus.

Convict Chronicles: Tip #21: Breathe Easy

By Leo Cardez

Adapted from Yoga Magazine 2020, Pam O’Brien

There is a medical term called heart rate variability, or HRV, which stands for the variability of time between heartbeats. There’s significant research demonstrating a correlation between better HRV (more variety in the length of time from one heartbeat to the next) and improved mood, enhanced focus, better sleep, boosted energy, and more resilience overall. Anyone would benefit from better HRV—and fortunately, anyone can … with a little practice.

Here’s the secret habit to a better HRV:
Take two minutes (the average commercial break in your favorite show) and start by inhaling through your nose for four seconds—mentally count while focusing on the sensation of the air flowing in through your nostrils. Now, without pausing, exhale for six seconds through your pursed lips—as if you are blowing on hot food. Again, count mentally as you focus on feeling the air through your mouth.

You may notice an immediate feeling of both relaxation and alertness. Work your way up to 20 minutes a day, twice a day. I have been adding one minute a week and am up to 10 minutes twice a day. The biggest and most immediate result I have noticed is my ability to fall asleep faster, sleep deeper, and wake up more refreshed. I have always had sleep issues, especially since my incarceration—this is the first thing that’s actually worked.

Beyond the aforementioned benefits, there are additional perks to a stronger, lower baseline heartbeat. For example, for workout junkies, they may note less effort exerted to achieve the same results. Also, there’s a second wind effect, which means they may be able to go longer and stronger.

Also, as the breathing exercises push more blood to our muscles, our biggest “muscle” benefits the most. More blood flow to the brain can mean greater clarity, concentration, and focus. The reduced stress will also help us make better, more rational decisions. Some researchers are studying the seeming reduction of degenerative cognition as we age in some study participants.

So there you have it: This brain hack is a no-brainer, but you have to stick to it. From my experience, I recommend gradually adding time to how long you practice breath exercises each day. I have found more benefits the more time I am able to commit to it daily; I think it’s the best return on investment we can ask for in prison.

Indiana Begins to Allow Hormone Therapy Treatment for Transgender Inmates

By Tonie. N Loveday

I would like to relay my story of how I, a transgender woman and inmate doing time at the Indiana State Prison in Michigan City, took on the Indiana Department of Correction (IDOC).

Not being on hormone treatment prior to incarceration, the IDOC would not allow transgender inmates to begin them. I was not diagnosed with gender dysphoria until June 2015, seven years into my sentence. Gender dysphoria is the medical diagnosis for experiences of distress and discomfort connected to a difference between one’s gender identity and their sex assigned at birth. Diagnosis by a psychologist, psychiatrist, or doctor is often required to receive gender-affirming care, such as hormone therapy and gender-affirming surgeries. A diagnosis of gender dysphoria is not needed to identify as transgender or be a part of the community. However, it is often needed to access treatment.

After over a year of talk therapy, the lead psychologist at the time, Dr. Renaldo Matias, suggested I request hormone treatments, even knowing the state’s position on the matter.

The American Civil Liberties Union (ACLU) of Indiana could not intervene until l had fully exhausted my grievance remedies within the prison. The following is the procedure I followed, along with the responses I was given. Hopefully, this may be a guide for others in the same fight:

1. Beginning with a request for healthcare form, I wrote: “I have been diagnosed with gender dysphoria, and I want to begin taking hormone treatments.” Response from the health care staff stated:
“We have reviewed your request with the Regional Mental Health Team, and it was determined that hormone treatment is not appropriate for your situation.”

2. I followed up with an informal grievance but received no response.

3. After filing a formal grievance, the state issued the following response:

“Dr. Matias advised; Wexford medical staff and the Indiana Department of Correction has an informal policy (it is informal as far as he is aware) that if an offender did not enter the IDOC already on hormones, neither the contracted medical staff nor IDOC are under any obligation to provide hormone therapy for offenders who discover they are transgender while incarcerated. Grievance Addressed.”

4. Not agreeing with the state’s resolution, I wrote the following lengthy appeal:
“The response to my grievance stated due to an ‘informal policy’ my diagnosis of gender dysphoria will not be treated with hormone therapy because I was not receiving treatment prior to incarceration.

The American Medical and American Psychological Associations have each officially recognized gender transition treatments like hormone therapy as medically necessary treatments for gender dysphoria.

Also, in response to a federal lawsuit filed in February 2015, the U.S. Department of Justice intervened, declaring the state prison’s continued denial of the complainants hormone therapy a violation of the Eighth Amendment to the U.S. Constitution. Also mandating individualized assessment and care for gender dysphoria in all trans prisoners, suggesting that trans inmates who were not undergoing hormone therapy prior to incarceration should also be eligible for access.

By taking action, the Justice Department is reminding the Department of Corrections (of each state) that prison officials have an obligation to assess and treat gender dysphoria, just as they would any other medical or mental health condition. Acting Assistant Attorney General Vanita Gupta explained in the DOJ’s statement: ‘Prisoners with gender dysphoria should not be forced to suffer needlessly during their incarceration simply because they were not receiving care or could not prove they were receiving care in the community.’

I do suffer anxiety, depression, and suicidal ideation due to my gender dysphoria, and not being afforded the proper treatment for my diagnosis is truly a violation of my Eighth Amendment right prohibiting cruel and unusual punishment.”
The grievance appeal was denied, stating that the initial response was appropriate.

5. I contacted ACLU of Indiana on November 7, 2017. The ACLU of Indiana filed Complaint for Injunctive and Declaratory Relief, No. 1:17-cv-04123 in The United States District Court; Southern District of Indiana: Indianapolis Division, Against the Commissioner of the Indiana Department of Correction in his official capacity; Defendant.

Two weeks later, ACLU of Indiana attorney Jan Mensz informed me that the IDOC was amenable to resolve the issue of my complaint without going through the courts.

I was prescribed testosterone blockers on January 25, 2018 after a physical, blood work, and signing a consent and counseling form. Thirty days later, I was finally allowed to begin taking estrogen.

6. Due to my efforts and ACLU of Indiana’s filings, the IDOC has adopted a written policy regarding transgender inmates: Decisions about prescribing hormone therapy for gender dysphoria are now reviewed by a team from IDOC staff and contracted medical staff and psychologists. If the criteria for gender dysphoria has been sufficiently documented, the inmate can be prescribed hormones.

Since winning the fight for access to hormone therapy, IDOC is now allowing gender-appropriate undergarments and clothing as of late 2020. Additionally, in the past year, I have been allowed to purchase the same cosmetics available at Indiana women’s prisons.

I have also successfully scheduled gender-affirming surgery for later this year, with the support of the ACLU of Indiana. After filing for gender affirmation surgery in the 7th U.S. District Court, the IDOC and health care providers have settled and will agree to my surgery.

I am determined to continue the fight in Indiana for all transgender inmates and to assist in any way all transgender women and men, incarcerated or free. Thank you for allowing me to share, and perhaps this may be a guide for other trans inmates nationwide who are hoping to become their true selves.

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Prison Decarceration in the Context of the COVID-19 Pandemic  

Protesters in Philadelphia demand decarceration during the COVID-19 pandemic. Photo by Joe Piette, shared under Creative Commons https://creativecommons.org/licenses/by-nc-sa/2.0/

by Yosef Robele

Editor’s note: With this thoroughly researched academic article, Prison Health News has the rare privilege of offering scientific data—in addition to our continuing testimonies from people in prison—about how the COVID-19 pandemic has impacted incarcerated people. We agree with the author, Yosef Robele, that decarceration is the winning strategy we all must fight for.  

Yosef is a 2nd year masters student in the Environmental Health Science & Policy Track at George Washington University School of Public Health. He was born and raised in Denver, Colorado. He went to undergrad at the University of Pennsylvania, where he majored in Environmental Science and minored in Physics. He hopes to have a career tackling environmental justice issues from a scientifically informed background.

Abstract

The COVID-19 pandemic has done much to reveal structural inequalities in American society. Throughout the pandemic, the Prison Industrial Complex has been shown to be wholly inadequate in protecting incarcerated persons, prison staff and the surrounding communities. As both the incarcerated persons and the staffs have higher rates of chronic disease than the general population (Wildeman & Wang, 2017), this places them at higher risk of an adverse outcome from contracting COVID-19. While the prison population has actually decreased by about 10% for various reasons during the pandemic, (Franco-Paredes et al., 2021) prison reform advocates have called for more radical slashes. This paper will advocate not only for these radical slashes but also for other forms of support for formerly incarcerated people. Over summer 2020 alone, over 500,000 cases of COVID-19 can be attributed to the carceral state (Hooks & Sawyer, 2020). In order to prevent further cases and deaths, it’s imperative that incarcerated people are not only released but released with enough health care and housing to support themselves during the pandemic.

Continue reading Prison Decarceration in the Context of the COVID-19 Pandemic  

Prison Health News Advisory Board Member Under Threat for Health Activism in Oregon Prison

April 28, 2022

One of our beloved Advisory Board members for Prison Health News, Aaron Maxwell Hanna, filed a lawsuit last year against the Oregon Department of Corrections for not enforcing its own rule that prison employees must wear a face mask to protect those inside the prisons from COVID-19. It’s widely known that prison guards are the most common way COVID gets into prisons from the community. After filing the lawsuit, Max got COVID earlier this year. At his facility, Two Rivers Correctional Institution, 1,287 others have contracted COVID; across the state, 45 people in prison have died of it.

Due to his tireless advocacy, Max won a preliminary injunction on March 21 in federal court that requires the prison authorities to enforce their own mandate for staff to wear face masks. After Max won the injunction, guards allegedly pressured a gang member to take Max’s life, but Max was able to use the support he has from other prisoners to reach this gang member, who is now testifying for Max. We are awaiting the next court hearing, which will be May 10 and cover the alleged retaliation by prison guards against Max and others.

Max requested that we share this note from him on our website, along with a copy of the preliminary injunction:

I am fighting the good fight and standing up against an entire prison staffed with right-wing Republicans who don’t care about me or anyone serving a sentence behind these walls. You have no idea how big, how red and bright this target is on my back, but I don’t care because I am doing the right thing for everyone! This is what matters to me, and how I want to be remembered.

With what I am writing to you, I hope to encourage all of you who are prison activists, who want to protect the lives of those that can’t or won’t stand up for themselves. Please keep all of us in your thoughts and prayers. If you want to email me with words of encouragement, please do so at: MaxwellH7019@gmail.com and I’ll get those from you. I’ll even respond to you if you let me know that you want me to do so.

Stay strong, brothers and sisters!
Max

You can read the preliminary injunction here: https://prisonhealthnews.files.wordpress.com/2022/04/max-hanna-mask-injunction-2022.pdf

Medical neglect of elders: Ivan Schweitzer in Pennsylvania

July and November, 2021
Ivan Schweitzer
incarcerated in Pennsylvania

To whoever can help,

I would like to know if I can sue Wellpath or the prison for medical negligence. If so, how and can you find me a lawyer? I have been waiting for 2 years to get my teeth fixed. Meanwhile, a couple months ago 2 teeth broke off and I lost a filling. I have put in sick calls but no response. I have ended up with infected lymph nodes. They gave me antibiotics and said I would get X-rays. 15 days later, no word from dental. With the lymph nodes, I got double and blurred vision. Continue reading “Medical neglect of elders: Ivan Schweitzer in Pennsylvania”