Experts in autocracies have pointed out that it is, unfortunately, easy to slip into normalizing the tyrant, hence it is important to hang on to outrage. These incidents which seem to call for the efforts of the Greek Furies (Erinyes) to come and deal with them will, I hope, help with that. As a reminder, though no one really knows how many there were supposed to be, the three names we have are Alecto, Megaera, and Tisiphone. These roughly translate as “unceasing,” “grudging,” and “vengeful destruction.”

I would bet cash money that TomCat already knows every word I will write this week (although he won’t have seen it in Truthout, since he doesn’t go there. I do; I just don’t read the opinion articles most of the time.) But from his volunteer work and some other life experiences, he will know.

 When Taylor Lytle began fainting every morning when she stood up, she had to make a decision: Should she seek medical care or should she save her hard-earned wages to buy soap, shampoo, deodorant and feminine hygiene products?

Victoria Law

Taylor was incarcerated. Technically, she had a constitutionally guaranteed right (under the Eighth Amendment) to health care – this was litigated in Estelle v Gamble, which was decided in the Supreme court in 1976. But that doesn’t mean the prison can’t require a “co-pay,” and in 41 states, they do. Victoria Law, the author of my primary source, researched around, and found co-pays as low as $3.00 and as high as $8.00. Taylor Lytle was in California, which required a $5.00 co-pay. She had a job in the prison kitchen, which paid $0.08 per hour. You can do the math. I come up with more than a week and a half, even assuming she had an eight-hour work day, which I doubt.

Taylor might have been better off if she didn’t have a job.

 [In California, t]he fee is waived for people who are considered indigent, or who have $1 or less in their prison account for 30 consecutive days. If the person received funds — say, money from a family member or loved one — within the following 30 days, the $5 co-pay would automatically be deducted. (In 2018, the amount for indigent status was raised to $25. That exemption now affects nearly 61,000 of the state’s 131,000 prisoners.)

There aren’t enough prison jobs to go around, for one thing, and some that there are require some skills and/or mental abilities, while others require physical abilities. Not everyone is qualified to do a prison job. But, if you don’t have either a job or family and friends sending you money (or both), then you have nothing – no money, and nothing to barter with (of course there’s always contraband, but I really don’t want to go there, and in any case it wouldn’t pay co-pays.)

California is not the worst state in which to have a medical issue while in prison. Seven states – Alabama, Arkansas, Florida, Georgia, Mississippi, South Carolina and Texas – have jobs for inmates, but they pay nothing. Zip. Zilch. Zero. And, yes, that is Constitutional under the Fourteenth Amendment as it stands, since it contains an exception for prison labor. And Texas –

 In 2012, Texas lawmakers changed the prison co-pay system from $2 per visit to a flat yearly fee of $100. The new law allows exceptions for emergencies, chronic care or follow-up services for an initial treatment. But the initial treatment still requires that $100 co-pay. Those who do not seek medical care can avoid that cost altogether — and it seems like that’s what they’ve been doing. In 2014, two years after the co-pay system changed, only 15,000 of the more than 150,000 state prisoners paid the $100 fee. 

Another former prisoner whom Law spoke with is Romarilyn Ralston, whose experience brings up additional issues. She was first incarcerated in 1988, before there were co-pays.

But that didn’t mean that people had ready access to health care or their concerns were taken seriously. Ralston recalls long medical lines, frequent misdiagnoses and many stories of people’s complaints not being taken seriously by medical staff. 

When prisoners put off seeking medical care for any reason, there are consequences.

For Ralston, the co-pay meant putting off medical care, which led to disastrous consequences. For months, she endured a tickle in her throat, which grew into a cough. “I probably should have gone months before,” she reflected, but each month she was faced with the choice of spending her paltry prison wages on hygiene items or a doctor visit. When she finally did seek medical attention, the doctor ordered a chest x-ray. The x-ray revealed spots on her lungs. Ralston was taken to the hospital where she underwent a lung biopsy, which revealed that she had sarcoidosis, a growth of inflammatory cells on her lungs. Untreated, sarcoidosis can lead to pulmonary fibrosis (permanent scarring of the lungs) and problems in other organs…. [H]aving sarcoidosis led to inflammation not only in her lungs, but also in her eyes. She contracted a cataract and later, had a small stroke. “Could they have caught it sooner? Probably yes,” she said. But she would have had to visit the doctor months earlier, which would have meant forgoing buying soap and deodorant or other needed items. 

In fact, co-pays – and, to be fair, other issues with health care in prisons – constitute a serious public health issue.

These co-pays not only deter people from seeking medical care for illnesses and injuries, but, in several instances, they have contributed to a mass outbreak that could have been prevented had jails and prisons not instituted this costly barrier. In 2003, the Centers for Disease Control identified co-pays as one of the factors that contributed to mass outbreaks of MRSA [Methicillin-resistant Staphylococcus aureus] in Georgia and Texas prisons, as well as the Los Angeles county jails. 

Ralston is an organizer with the California Coalition for Wome Prisoners, and has worked on serveral legislative goals involving prisoners (of all genders). She is now working on a measure called “AB 45” which if passed will eliminate co-pays legislatively. Lytle is also now an organizer for the group, and testified in committee on AB 45. She was understandably upset with, and rebutted in her testimony, a statement from the Riverside Sheriffs Association:

 [W]hile the association supports efforts to help people in custody remain healthy, “our members also recognize that if any inmate at any time can request medical attention for any reason, there would never be enough staff to handle the inmate transfers from cell to medical.” 

(If there was smoke coming out of her ears when she read that, I wouldn’t be surprised. I know there was out of mine when I did.) But she kept her cool and merely said:

 “We’ve seen in California and across the country what happens when incarcerated people are denied medical help because of this stigma. People die. Please do not allow this false idea about incarcerated people to direct your policy choices. AB 45 will save lives.”

Well, the Public Safety Committee agreed and sent the bill to the Appropriations Committee, where it is now. So there will be more testimony ahead for advocates. They will need to convince this committee that it can do without (or somehow replace)

QQ up to $1.68 million each year from co-pays. In fiscal year 2017-2018, it received approximately $460,178 in co-pays for medical and dental visits. QQ

Alecto, Megaera, and Tisiphone, after last week, this one is simple (I did not say easy, just simple.) You need to convince the Appropriations Committee of the California legislature that the benefits of this measure outweigh the revenue loss … and then convince the full Assembly of the same. Best of luck. At least there are some dedicated volunteers out there who will help.

The Furies and I will be back.

Cross posted to Care2 HERE.