The Controversy Over Inmate Pregnancy : Officials Deny Inadequate Care Claim in Frontera Prisoners’ Suit

Brenda Jackson, five months pregnant, said she was not allowed to see an obstetrician for a month while she experienced heavy bleeding. When she finally did, the doctor found the placenta had separated from her uterine wall. Her baby was stillborn a month later.

Linda Hampton said she was already in advanced labor when she was shackled and strapped to a bench while riding to a hospital in a security van. Her baby suffered oxygen loss during delivery and will allegedly suffer mild disability.

Marla Klemmer said she had a uterine problem that doctors diagnosed three months after she gave birth, but failed to treat the disorder for an additional two months. Physicians later said they had no choice but to perform a hysterectomy on Klemmer.

During their pregnancies and afterward, all three women were prisoners at the California Institution for Women at Frontera in San Bernardino County. Now, a class-action lawsuit has been filed against prison officials on behalf of these and other inmates, alleging that the women have been denied proper care.

Complaint Filed Last Month

The allegations are included in a complaint filed last month in U.S. District Court in Los Angeles, one of four lawsuits filed in the last eight months over conditions and care in the state’s only prison exclusively for women.

The suit charges that the 1,850 prisoners at the Frontera facility “are being deprived of adequate prenatal and postpartum medical care,” resulting in infant deaths and defects, stillbirths, miscarriages and unnecessary hysterectomies.

A key argument made by plaintiffs is that the prison does not have a gynecologist, according to Ellen M. Barry, director of Legal Services for Prisoners With Children, a San Francisco-based group that filed the suit in conjunction with the American Civil Liberties Union Foundation of Southern California and a private San Francisco law firm.

‘It’s Just Foolhardy’

“It is inconceivable that a prison could provide appropriate gynecological care without the services of a gynecologist. . . . With high-risk pregnancies that need attending, it’s just foolhardy,” Barry said.

Named as defendants in the suit are Daniel J. McCarthy, director of corrections; Annie Alexander, superintendent of the California Institution for Women, and Dr. K. K. Srivastava--known to inmates and prison staff members as “Dr. Kris”--the prison’s chief medical officer.

Prison officials referred questions about health care at the facility to Dr. Nadim Khoury, chief of health services for the California Department of Corrections.

“I believe that the prenatal care delivered at (the prison) is the standard delivered in the community outside,” Khoury said. “I am satisfied that in all the cases (described in the lawsuit), the proper treatment and prenatal care was given.”

The lawsuit charges that the prison’s medical staff has dispensed drugs that are inappropriate for pregnant women, disregarded doctors’ instructions for bed rest and special diets, ignored prisoners’ medical needs and failed to take them to the hospital for prescribed examinations.

Some pregnant inmates, who asked not to be identified, said the prison staff lacks expertise in dealing with their medical needs. Staff members do not know how to monitor a fetal heartbeat or measure cervical dilation, one pregnant prisoner said, adding that “the nurses that don’t know obstetrics need that training.”

The California Institution for Women has advertised its need for a part-time obstetrician-gynecologist, but has received no applications, according to Hal Tanner, deputy superintendent of the prison. Officials are directly soliciting applications from doctors in the area to work at the prison about one day a week, he said.

‘No Evidence of Negligence’

Inmates now receive obstetric and gynecologic care--in addition to other medical services that the prison infirmary cannot provide--at Riverside General Hospital, Tanner said.

Dr. Wilbert Gonzalez-Angulo, chief of obstetrics and gynecology at the hospital, said he investigated two of the cases cited in the lawsuit and “found no evidence of any negligence” on the part of prison officials.

Gonzalez-Angulo also said he does not believe prison medical personnel have changed his clinic’s prescriptions or dietary orders for pregnant prisoners.

Plaintiff Marla Klemmer’s medical problem--her uterus had fallen out of its normal position--”is not an emergency,” Gonzalez-Angulo said. “People can have a prolapsed uterus for many months, or even years. . . . The surgery doesn’t have to be done right away.”

However, Klemmer had a severe case, Gonzalez-Angulo said, and “in the majority of those cases, the patient has a hysterectomy.”

Condition Progressed Too Far

Doctors found no specific cause for the problems with Brenda Jackson’s placenta, he said, but the condition is often caused by trauma or hypertension. Once the problem begins, Gonzalez-Angulo said, “there is nothing a physician can do to prevent it.” In Jackson’s case, the condition had progressed too far before the baby could survive outside the womb, he said.

Yet Jackson believes that prison officials were at fault, saying they refused to believe her bleeding revealed a serious condition and disregarded medical orders from Riverside General.

“I was having a lot of problems with my pregnancy,” Jackson said in an interview at the prison. “I kept bleeding and I’d come to the infirmary and they’d tell me it was normal. . . . Dr. Kris said that if I came back (to the infirmary) again, he was going to refuse (to see) me because it was normal.” Despite the orders of a Riverside General doctor that she get bed rest, Jackson said, she “was pushing (floor) buffers and mopping when I was five-months pregnant.”

Gonzalez-Angulo conceded that hospital staff and prison medical personnel had suffered “a breakdown in communications,” beginning about three years ago, when the prison lost the services of its own obstetrician.

Regular Communication

Representatives of the prison and the hospital have met twice this year to resolve the problem, he said, adding: “We have established very good rapport and we communicate very regularly.”

Prison officials have also provided separate housing for pregnant prisoners in a wing of the infirmary, a program that began two weeks ago. The move has improved inmates’ access to the medical staff and helped strengthen the support network among pregnant prisoners, according to Dorothy Burnett, a pregnant inmate at the facility.

Other inmates complained, however, that they still cannot get to the hospital when necessary. “I haven’t been in four weeks,” said Elizabeth Vasquez, “and I’m supposed to go every two.”

Plaintiff Linda Billington said she lost a baby in 1980, while she was a prisoner at the California Institution for Women. This year, she returned to the prison on a parole violation. “Believe me,” she said, “I was scared to be pregnant here again, after what happened to my first baby.”

‘High-Risk’ Inmate Pregnancy

Billington agreed to take part in the lawsuit “to ensure the care for this baby,” she said. Her baby girl, Lindsay, was born Sept. 17.

Inmates, doctors and prison officials agree that prison pregnancies generally require more attention than those outside the fences. “Because a lot of (pregnant prisoners) have used drugs . . . and don’t live what you might call a normal life style, many of them are high-risk,” Billington said.

“The patients that we see from the institution are, by and large, high-risk patients,” Gonzalez-Angulo said. The prisoners have a higher incidence of post-term pregnancies, premature births and babies that are small for their gestational age than do other mothers, he noted. Another obstacle to providing prenatal care is the prisoners’ reluctance to talk about their medical problems, said prison Deputy Superintendent Tanner.

Daily Sick Call

“By and large, I think the women’s perspective of the level of care and the level of services is that (the care and service) are not good, that you can’t get decent care and can’t get to see a doctor,” he said.

The prison has daily sick call in each of its housing units, Tanner said, and keeps medical personnel on duty and and a physician on call 24 hours a day. “We transfer a lot of people out (to Riverside General) on nights and weekends,” he said.

Physicians at Riverside General Hospital set the rules for prenatal care at the prison, Tanner said. “If the doctors say a prisoner needs a return visit, we do it,” he said.