In the April, 1994, issue of PLN we reported Hallet v. Payne, No. 93-5496(T)D, the class action suit by women prisoners in federal court in Tacoma against prison officials at the Washington Corrections Center for Women, also known as Purdy. The suit alleged that medical care for prisoners at Purdy was inadequate to meet the prisoners' serious medical needs. These contentions were reinforced and indeed proven by the death of Gertrude Barrow in May, 1994, [See PLN, Vol. 5. No. 7 and 10]. Barrow died due to the willful neglect of her captors who failed to provide her with adequate medical care.

The settlement agreement was signed on November 28, 1994, and affects all prisoners at Purdy. Among the DOC's obligations are to develop, adopt and implement a set of health care standards consistent with the Washington State Department of Health Standards. The standards will comply with previous court orders entered in the case and will consider four sets of National Standards that have been used to govern prison health care in the U. S. These are those of the American Correctional Association (ACA), American Public Health Commission (APHA); Joint Commission on Accreditation of Health Care Organizations (JCAHO) and the National Commission of Correctional Health Care (NCCHC) The deadline to develop the policies is September 1, 1995, and they must be fully implemented by April 1, 1996. By no later than December 1, 1994, the DOC must develop a health care services delivery plan for WCCW prisoners. This plan must specify the implementation and completion dates of all tasks in the plan.

By April, 1995, WCCW shall install and begin using a DOC medical services database. The database will contain information on: details of medical care encounters, services provided such as provider name, date of service, primary diagnosis, treatment, referrals for lab, X-ray, appointments with specialists, medication prescribed and other follow up actions; scheduling of medical care appointments and follow ups as well as referrals for diagnostic tests, specialty care, etc.; medical care provided off site in the community, including hospitalizations and referrals to community specialists. A dental services and mental health services database will track comparable information in those areas.

Health care records must be legible and contain the necessary signatures in accordance with professional standards. The DOC will date and time all health record entries. At a minimum WCCW health care records will include: records of written and oral requests for health care; identifying information such as the patient's name, DOC number, etc.; treatment plan; problem list which will include the receiving screening health assessment, all findings, diagnoses, treatment and dispositions; medications prescribed and their use; reports of lab, x-ray and diagnostic studies; progress notes; consent and refusal forms; release of information forms; results of consultations and off site referrals for treatment; discharge summary of hospitalizations; special needs treatment plan, if any; immunization records; date, time and place of each medical encounter and the signature and title of each documenter. The DOC must ensure that all records are complete and completed in # timely manner. Pharmaceutical records must be kept with patient records.

By no later than November 1, 1994, the DOC should have implemented a system to track the dispensing and administration of medications. The standards governing this area must be consistent with correctional health care standards. WCCW will institute a self-medication program defining the circumstances under which prisoners may carry and administer their own medication. The DOC agreed to comply with all applicable state and federal laws and regulations and their own policies regarding the prescription, dispensing, administering and procuring of pharmaceuticals.

The DOC agreed to provide adequate staffing of qualified health care providers at WCCW. By October 1, 1994, the DOC was to come up with a plan to ensure that WCCW prisoners were provided with necessary follow up health care. The system must ensure that prisoners are provided access to the results of any medical tests or assessments performed as soon as the results of the medical tests are known: Medical tests and assessments done at WCCW or off site must be obtained, and follow up care done, in a timely manner. The decree requires the DOC, together with an independent monitor and consultants, to randomly review the health care records of WCCW prisoners to determine if all necessary and recommended tests, assessments and treatment were performed. The independent monitor must be one mutually agreed upon by the parties. If the parties can't agree on a monitor one shall be appointed by the court. The DOC will pay the monitor's expenses.

The DOC will ensure that physician's orders are signed and mid-level provider's orders are reviewed and signed in a timely manner complying with professional standards and state law. The DOC must also develop a protocol to coordinate prisoner health care among multiple providers to ensure continuity of care. The DOC must provide a written, problem oriented individual health care plan, with necessary follow up, for all WCCW prisoners with high risk medical conditions such as asthma, AIDS/HIV, diabetes, seizure disorders, ulcers, gynecological problems, etc. The defendants must also prepare a plan to provide routine gynecological care for all WCCW prisoners, including PAP smears and mammograms.

The defendants must train their medical staff to "ensure that they maintain a professional attitude at all times while providing health care services and that staff treat prisoners as individuals with consideration or their privacy, dignity and feelings."

By October 1, 1994, the DOC was required to develop a Continuous Quality Improvement program (CQI) that will monitor the quality of health care services at WCC W. The program will monitor all major aspects of health care including: access to health care, nursing services, physician services, mental health services, pharmacy services, dental services, environmental services, infectious control procedures, health care records, sick call services, admission screening and evaluations, chronic disease services, infirmary care, diagnostic services and all adverse patient occurrences including all deaths. The DOC must establish a multi disciplinary committee that involves the use of qualified health care professionals with the appropriate specialties and includes persons not regularly employed by the DOC. The committee must perform at least quarterly reviews and identify staff training needs and deficiencies as well as any deficiencies in the services provided to prisoners. It will also prepare corrective plans to address all recommended improvements and then assess the effectiveness of corrective action. The independent monitor will review all reports and findings made by the CQI and determine if the CQI process is working effectively.

The DOC must employ a qualified health care manager responsible for the administration of health care services. The manager will be responsible for arranging all levels of health care and ensuring the quality and accessibility of all health services provided to WCCW prisoners. All medical judgments must be made by a licensed physician or qualified health care provider under a physician's supervision. The DOC must also employ a licensed physician as medical director for the prison. In addition to providing timely care the medical director will supervise all health care judgments regarding health care provided to WCCW prisoners.

WCCW prisoners will receive mental health services comparable to those given to male prisoners. The DOC will employ sufficient qualified mental health staff to provide prisoners with adequate evaluation and treatment at least five business days a week with emergency coverage for other periods, consistent with professional standards of care.

The DOC also agreed to develop a policy which would allow prisoners to obtain their own health care at their own expense or through private insurance coverage, provided that prisoners using such care bear the cost of security, transportation to and from personal providers and all other related expenses. Interpreters must be provided to prisoners seeking health care who do not understand English and illiterate prisoners must be given oral information. Special diets must be given to prisoners with medical need for such. Prisoners will not be housed in housing units designated especially for housing mentally ill prisoners for reasons other than those related to mental health.

The consent decree gives the federal court continuing jurisdiction over the case for four years after it is entered by the court. The defendants can motion to end the court's jurisdiction- before that period if they can show by a preponderance of the evidence that they have complied with the decree's terms. The plaintiffs can motion to extend the court's jurisdiction over the case if they can show that the decree has not been complied with. The decree does not resolve the plaintiff s claims for money damages nor the use of restraints and seclusion.

Among the changes already made at Purdy are that the on call physician who, was on duty when Barrow died has resigned. A doctor who burned a mole off a prisoner's thigh with a paper clip no longer works at Purdy (perhaps he was transferred to another prison?). Given the overall abysmal state of prison health care across the country it remains to be seen if the decree will have the desired effect of improving health care services for WCC W prisoners. The prisoners were represented by Patricia Arthur at Evergreen Legal, Services, Katrin Frank, cooperating attorney with the Northwest Women's Law Center and Megan McLemore, cooperating attorney with the ACLU.

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