Article excerpt

Feeling a lump in her breast, Sherrie Chapman, an inmate at the California Institution for Women, in Frontera, first raised an alarm to her assigned doctor in 1991, explaining her family history of breast cancer. The doctor belittled her complaints. Persisting, Chapman managed to score a mammogram two years later. The recommended follow-up took place in 1995, after another two and a half years. Outside doctors ordered an immediate radical right-breast mastectomy and the removal of four lymph nodes.

Shackled in a hospital holding room, Chapman curled up on a bench. "I tried to focus, not cry, not feel bad, not hurt--so many emotions running at one time, and nobody there to make you feel better at all," she says.

More troubles ensued. Postsurgery, guards signed her out against medical advice and confiscated her pain medication. Correctional officers ignored chemotherapy appointments. "There was a lack of care, concern, compassion, sympathy, anything," says Chapman. The cancer spread, and in 1997 Chapman had a left-breast mastectomy. Now 44, she says she can feel lumps on her neck.

"Whether [out of] willful disregard or [because] they just blew it off, her doctors did not follow rather standard practice," explains Yuri Parisky, director of breast imaging services at Norris Comprehensive Cancer Center of the University of Southern California. Chapman achieved one rare victory: She won a settlement from the state.

"It's hard not to feel outrage," says Ellen Barry, founder of Legal Services for Prisoners with Children, in San Francisco, which represented Chapman. "People would see this in another country and think it's a human rights violation. This is our own backyard."

Although the silent and insidious killers of women--breast, ovarian and cervical cancer--are finally commanding pink-ribbon attention and activism in the outside world, inside prisons, women might as well be living in the dark ages. Healthcare for prisoners, male as well as female, is decidedly subpar, but women face exceptional hardships in a system based on a military design, with young and healthy men as the treatment model.

The number of women in prison has risen rapidly because of mandatory drug-related sentencing, doubling the female population in ten years, to 162,000 in 2000. Yet women are easily forgotten in corrections, where they are only 8.4 percent of 1.93 million prisoners. Few women get the death penalty; many get damaging, even deadly, medical treatment. In the area of reproductive and breast cancers, prisons fail in prevention, screening, diagnosis, treatment, continuity of care, alleviation of pain, rehabilitation, recovery--and concern.

Across the continent from Chapman, in the Danbury Federal Correctional Institution in Connecticut, Susan Rosenberg faced the opposite dilemma in March 2000. A mammogram showed changes in breast calcifications. Rosenberg, a prisoner for sixteen years until she was released in January 2001, underwent a biopsy in chains, shackles and with four armed guards in the operating room. Afterward, the prison doctor verbally reported the results. "For a week, I thought I had breast cancer and was almost ready to have a mastectomy," said Rosenberg. A health advocate in prison and a political activist, Rosenberg demanded the pathology report, contacted lawyers and got a Congressional Representative to intervene. She discovered that she had "lobular carcinoma in situ"--a condition that requires close monitoring but not breast excision. After a second opinion (something rarely granted to a prisoner), the mastectomy was rejected. "I almost went and had a breast cut off unnecessarily," says Rosenberg. But most prisoners, she says, cannot round up the same resources.

"All other issues pale before the issue of physical and psychological health of women in prison. If women are dying, what does it matter what other programs there are? …