On a sweltering day in July of 2014, a van departed from the Fluvanna Correctional Center for Women and headed toward the University of Virginia Medical Center in nearby Charlottesville. The van carried an inmate named Debbie Daley, who was midway through her three-year sentence. The sun bore down on the pavement, but Debbie, a blond-haired, blue-eyed 49-year-old, was feverishly cold. Her blood pressure had plummeted, her heart rate was spiking. As the prison van lumbered ahead, the tumor on her backside caused immense pain, propelling her forward in her seat.
Fluvanna is the largest women's prison in the state. Its modern medical building has long been considered advanced, though inmates requiring specialist appointments sometimes are transported to local hospitals. A year beforehand, after her arrest in suburban Richmond for distributing prescription pain pills, Debbie was diagnosed with Stage 2 rectal cancer. Her ensuing radiation treatment, administered by a UVA clinical team, did not work. In the next several months, as Debbie awaited chemotherapy in prison, Fluvanna officials twice failed to take her to scheduled hospital appointments.
During that time, the area around Debbie's tumor became infected. A Fluvanna doctor declined to treat it with antibiotics, instead offering to lance near the grapefruit-sized bulge protruding below her spine. Debbie refused the treatment; she remembered her UVA oncologist telling her it was the wrong approach. For weeks she lay on her side in her prison infirmary bed, feeling as though hot coals were pressing against her bottom. "I have been real sick the past few days 
," she wrote to her sister, Glenda Pleasants. "The sweat rolls down my face, this is all night & most of the day.... It's times like this I need to see a MD!"
When Debbie showed up to her next appointment—this time at a different hospital in Richmond—she was met by a surprised doctor, who had not received her full medical records. And so, nearly two weeks later, on that scorching July day, an ailing Debbie sat hunched over in the prison van as it shuttled her to her original UVA oncologist. It had been nine months since her radiation ended.
Prison health care is a costly business. Incarcerated Americans are disproportionally prone to sickness, with around 40 percent battling a chronic condition. States spent around $8 billion a year on prison health care in 2011, per the most recent national estimates—likely a fifth of all correctional spending. That's partly due to an aging inmate population: Between 1993 and 2013, the number of state prisoners 55 and older sentenced to more than one year spiked an estimated 400 percent. The situation has become a growing concern to state corrections departments, who have responded by farming out health care to private contractors in an attempt to cut costs. This contracting trend has alarmed some critics, who believe for-profit companies are more loyal to shareholders than to the inmates entrusted to their care.
Fluvanna contracts out its care, and allegations of inadequate standards at the facility led to a lawsuit against the Virginia Department of Corrections, citing the experiences of Debbie and more than a dozen other inmates. A Pacific Standard review of court filings, as well as interviews with Debbie's legal representation, physicians, and relatives, revealed a pattern of neglect in her care at Fluvanna.
[For more of this story, written by John H. Tucker, go to https://psmag.com/social-justi...profit-prison-health]
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