For Women Behind Bars, "Health Care" Can Be Deadly

Why a book about women in prison?

Readers of Women Behind Bars might ask the logical question of why an entire book should be focused on female incarceration while men are still, by far, the majority of people getting arrested and locked up. To many criminologists and writers who cover prison issues, the percentage of women in prison is so small as to warrant little, if any, attention or analysis. (Indeed, at many of the prison-related conferences that I have attended over the years, prisoners are referred to by the male pronoun almost exclusively.)

This question is entirely valid, and deserves a response. Men do face unique issues and hardships in prison, and the overrepresentation of men of color (especially African Americans), the mentally ill, and poor people in general has been more of an overall focus in my work than women's issues in prison until this point.

The deeper I began to delve into the underlying reasons for the rapid growth of girls and women in lock-up, the more insight I gained into a world that few outsiders see, much less understand. Once I began to pay particularly close attention to the ways in which females in the criminal justice system were portrayed in the media, it became clear to me that stereotypes and judgments about "fallen women" from centuries ago were still holding fast.

There's much more to all of this, of course, from the overt medical neglect of women's chronic health needs; to the prevalence of sexual coercion and abuse in women's detention facilities (primarily at the hands of correctional officers, as opposed to other inmates); to the fact that girls and women enter the criminal justice system with far higher rates of drug abuse, sexual violence, childhood abuse, mental illness, and experiences with homelessness. Women are also being punished heavily with undeserved federal "conspiracy charges" for their general unwillingness (or inability) to "snitch" on their loved ones or friends in drug cases -- to the point that this has began to be known as the "girlfriend problem" in the criminal justice system.

Today, the number of girls and women doing time is utterly unprecedented in U.S. history. In 1977, there were just slightly more than 11,000 women in state or federal prison. By 2004, the number of women in prisons had increased by a breathtaking 757 percent. At the end of 2006, there were 203,100 women in jails, state and federal prisons, plus another 1,094,000 women on probation or parole, for a total of 1.3 million females under some form of correctional supervision. (Another 15,000-20,000 girls are being held in juvenile detention.) While Euro-American women still outnumber any other demographic group in jails and prisons, African American women are four times more likely to be locked up than their Euro-American counterparts. (Collectively, African American women and Latinas represent more than 60 percent of women doing time.)

The following excerpt provides just one woman's story from Women Behind Bars. She did not live to tell it, but I am able to share it with you here.

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I was already several months into the process of writing Women Behind Bars when I received an e-mail from a woman by the name of Grace Ortega. Grace had heard about the book project, and wanted to know if she could tell me what happened to her daughter, Gina Muniz, after she was incarcerated for the first (and last) time in her life. In truth, I already had enough women's stories to fill the pages of a few books -- if anything, I was overwhelmed trying to figure out which stories not to include -- but there was something about Grace's letter, the sheer urgency of it, that made me want to talk to her.

In our first conversation, Grace and I talked for two hours -- or, to be more precise, I listened for those two hours. It actually didn't click until a few days after that conversation that something sounded very familiar about what Grace had been telling me in great detail. Sure enough, I had once actually written about Gina, albeit briefly, in an article about the allegations and emerging evidence surrounding shoddy, abusive, and sometimes life-threatening medical "care" in two adjacent women's prisons: Valley State Prison for Women (VSPW) and the Central California Women's Facility (CCWF) in Chowchilla.

Grace and I stayed in touch, and I made it known that I would be interested in researching the details of her case for Women Behind Bars. I asked her to send me court documents, medical records, prison memos, grievances, or anything else she might have that would enable me to grasp the chronology of events in Gina's life, and to look more deeply into her situation. A few weeks later, a cardboard box the size of an orange crate arrived at my home. Grace had taken my request seriously and literally; from what I could tell, she had sent me absolutely everything she possessed pertaining to her daughter's case.

I didn't actually examine the contents of the box closely until I was already well into a few chapters of this book. When I did finally start to sort through the material, I saw that Grace had included four 8" x 11" color photos of her daughter. I set them down on my kitchen table and just stood there, staring at them. I don't know how much time passed, but I know it was long enough that the images were actually seared into my mind.

When I mentioned earlier that I was haunted by Gina's story, I meant that I have also been haunted by these images. For a time, I actually buried the photos under piles of paper in a strange attempt to block out my emotional reaction to them. It didn't matter; my mind couldn't erase any of it.

As I write this, these pictures are out of hiding, because I can finally give Gina's story a voice. The photograph that I have placed next to me is of her emaciated body, shackled to a bed in a community hospital near CCWF. Another of Gina's photos, which was taken just two months before her arrest on August 8, 1998, is on top of my desk. This is a snapshot of a naturally, strikingly beautiful woman with thick, dark curls framing her wide smile. Gina's warmth and kindness radiate from that picture, just as the one taken just a few weeks before her death conveys the agony of living in a body taken over by cervical cancer, which had started out as an entirely treatable, early-stage illness.

Gina's face in the hospital picture is that of a much, much older woman. The only parts of her that still look young are her hands and long fingers, which resemble a pianist's. Her left arm is shackled to the bed, per the requirement of the California Department of Corrections and Rehabilitation that even terminally ill prisoners be shackled to their beds and guarded twenty-four hours a day, seven days a week. Her right arm tenderly cups the head of her then-eight-year-old daughter, Amanda.

Her eyes give away the intensity of her suffering, which started out as horribly as it ended. When she was first taken to the LA County Jail, Gina began to bleed so profusely that she would go through many sanitary pads in the space of a few minutes; most of the time, she was just left to bleed all over herself and her cell. When her cries got loud enough, jail guards would typically come over and look at her with disgust, and then throw toilet paper rolls into her cell.

All of this went on until Gina passed out while talking to her mother on the phone after nearly eight months of nonstop bleeding in jail. Gina's collapse was apparently what it took for her pleas for medical assistance to be heard. Even then, it would be months before she was examined properly and diagnosed with Stage IIB cervical cancer, which has a high success rate of being treated and stopped in its tracks if it is treated aggressively and consistently.

Gina's pleas for justice, however, were not heeded. She received a life sentence in state prison, with an additional seven years tacked on. A life sentence would seem to indicate that she had committed a heinous crime, and most certainly a crime of violence. But Gina had actually committed a nonviolent act, although even she thought she should be punished for stealing $200 from a fifty-one-year- old Vietnamese American woman. Gina did not have a gun, knife, or any other weapon with her, but she admitted that she "strong-armed" the woman into going to a nearby ATM and giving her the money. Even the victim herself, when the police arrived on the scene, stated that Gina had not hurt her in any manner. Gina hadn't been a career criminal by any stretch of the imagination.

Her only violations were for car-related misdemeanors, including a June 30, 1998 charge for driving without a permit. (Gina did not do jail time, although the incident did go on her record.) What happened that pushed this twenty-seven-year-old, with no history of criminal behavior, to the point of rob- bing someone?

Grace explained to me that Gina's father's death on April 22, 1998, triggered a serious, debilitating spiral of depression in her daughter's life. Although Gina's father had periodically been a heavy cocaine and heroin user, and Grace had left him when Gina was just a child, Gina still adored him and tried to see him as much as possible.

By all accounts, cocaine hadn't even been a part of Gina's life until after her father died. Although she had gotten involved with men who hadn't exactly done right by her, Gina had set her sights on becoming a nurse and paving the way for a good life for Amanda.

Seeing her grief, a much older, married male family member offered his "support" to Gina, and then gave her a taste of a drug that he promised would help her get through the pain. His encouragement of her cocaine use was obviously far from being in Gina's best interest. When her use turned into dependency, he started demanding sexual favors, which she provided to him for a time in exchange for money to buy more drugs.

The "exchange" went on for a few months, until a day when she asked for $200 and this relative demanded another sexual favor. As Gina later admitted to her mother, she was suddenly consumed by hatred and disgust -- toward him and toward herself. She refused his advances, and he in turn refused the money. But Gina's desire for more cocaine overtook her ability to think clearly. As her mom put it, "Gina did something that she would have considered unthinkable" in the not-so-distant past.

A mere surface examination reveals that Gina's poor attempt at a crime was obviously a fumbling act of desperation by a woman addicted to drugs. But that's not how the court saw it. Gina's own defense attorney took Grace's hard-earned money (which he was eventually forced to return when Grace filed a complaint with the California Bar Association), did nothing to argue her case, and then urged Gina to plead guilty in exchange for a short sentence. While the judge was announcing the terms of her sentence, Gina heard the words "life" and "seven years," and anxiously asked her lawyer what was happening.

As a bailiff would later testify, Gina's lawyer had lied to her, telling her that entering a guilty plea would get her only a seven-year sentence, not life in prison. Gina did not find out until she was sent to CCWF that she was going to spend the rest of her life in prison. Medical "decisions" made at some level in the process ensured that she was denied the necessary hysterectomy, radiation, and chemotherapy that would have saved her life. In essence, her already cruel and unwarranted life sentence was hastened into a death sentence over just a few horrible months of pain and suffering, during which she and her mother pleaded constantly for medical intervention and urgent treatment.

It took many months of letter writing, and the volunteer assistance of the San Francisco-based advocacy group Legal Services for Prisoners with Children, for Grace to get her daughter out of a depressing community hospital room under the constant watch of prison guards. Gina wanted to die at home, and so she did. On September 29, 2000, Gina Muniz slipped away in silence, surrounded by her immediate family, just two days after her mother took her home.

Where is the healing or hope in a story like this? Gina was certainly not given the chance to experience either.

Instead, they have manifested themselves in Grace's ability to turn her own grief into advocacy on the part of other women in prison. Grace has traveled across California, testifying before legislators and advocating for compassionate release for terminally ill women in prison so that they do not have to endure anything akin to the needless and slow death that Gina suffered.

Grace still looks at the pictures of her daughter every day, and she worries that her daughter's life will be forgotten entirely or, worse yet, dismissed as the plight of a criminal whose life and death were of no particular significance. "Please," she asked me again at the end of our last conversation, "Please make sure that Gina isn't forgotten."