A REVIEW OF TIIE QUALITY OF H£ALTH CARE
ATTIIE
LACKAWANNA COUNTY PRISON

Project completed by:
PAX CHRISTI
OF
NORTIIEASTERN PENNSYLVANIA

Project Committee:
Joseph Rogun. EdD.
Sr. Barbara Craig, RSM
Ann Marie Crowley, R.N., R.S.N.

Joan Holmes, MS, MA, LPC
Fr. Williom Piekord, M Div.

Submitted to:
WARDEN JEANINE DONATE
and the
MEMBERS OF TIIE
LACKAWANNA COUNTY PRISON BOARD

January 29,2008

Copy to:

Bishop Joseph Martino

1

REVIEW OF THE QUALITY OF REALm CARE
AT THE
LACKAWANNA COUNTY PRISON

I. INTRODUCTION
BACKGROUND
Partially because of the incident during the SWJllllel' of 2007 when an inmate of the l.acbwanna
County Prison gave birth unattended to a child in her cell, but also because of other concerns raised before
and after that incident, Pax Cbristi ofNortheastern Pennsylvania' decided to see whether we could (at least
informally) determine the quality ofhealtb. care at the prison. At the onset. we understood that we did not
have the means or the access to conduct a formal evaluation. Even so, given our and others' concerns, we
determined that we would rather do something than nothing.
We were also motivated by the fact Ihat despiteaills b such by variousmembers oftbe
community, including County Commissioner Michael Wasbo, no formal investigation of the summer
incident has yet been conducted by an impartial third party. Instead, wha1 happened, why and bow has
been inconsistently chronicled in news releases and reports which, we believe, collectively provide
incomplete and. incorrect Information.

PROCESS
1. In the fall, we fanned a commiltee of several area professionals to discuss the idea and to consider bow
we might proceed. We determined that we would develop a questionnaire that would structure our
interviews; we intended to ask each interviewee exactly the same questions.
2. We attempted to publicize our plan and invite participation by placing an announcement in the Scranton
TimesfTribune. Despite several submissions over several Weeks, the IlCWllpBpel" did not prier our
announcemenl We therefore resorted. to a Jetter-to-the editor, which the newspaper did prinL After the
letter, it printed OUT announcement; however, by that time we were well behind our self-imposed schedule.
In addition, we placed fliers around the community and asked participants in the Diocese of
Scranton's Prison Ministry Program to mention the project during their visits.
Our announcements told former and current inmates who wanted to be interviewed for the project
to submit their names., addresses, and phone numbers to our post office box. We did not ask for leners, but
got several - which we did not use.
3. We received thirty-eight responses, Because most were from current inmates, we asked the warden for
permission to interview in the jail. She denied our request.
4. During late December2007, our teams interviewed ftxme'f" inmalcs in the community. During late
Decembe.-2007 and early January 2008, pan;cipants in !he OK=< of Scranton's Prison Minislry Program
who volunteered to help, interviewed current inmates during the course of their regular visits to the prison.
5. Within the time line we set for the project, we were able to complete only sixteen interviews. For
logistical reasons (c.g., distance), we were not able to interact with a few former inmates who volunteered
Because our access was restricted, we were also not able to interview all the current inmates who
volunteered.
6. Our original team ofprofessionals reviewed the information we collected; we summarize it here.

I Pax Christi is WI international organization of CatholicaIt and its national and regional offices
advocate for peace end justice, globally, nationally, and locally.

2

INTENT
We decided to submit Ibis report to the prison's warden with copies to the members of the
I..ackawanna County Prison Board. in doing so, even though we only sampled a portion of'the prison's
population. we hope that the warden and the Board would give serious consideration UI our findings and
recommendations. For informational purposes, we also submitted a copy to Bishop Joseph Martino.

ILPROTOCOL
INTERVIEW FORMAT
All interviews were with individuals and face-to-face; we conducted no small or large group
interviews. With all, we used om twenty-question questionnaire (seven additional questions for women who
were pregnant while in prison).
We read an introduction in which we staledthat we were members of Pax Christi ofNor1beastem
Pennsylvania and that we were conducting interviews to determine the interviewees' views of the quality of
the medical care at the Lackawaona County Prison.. We told them that we would ask twenty questions (and
seven additional for women who were pregnant while in prison). We promised that their individual reports
would remain anonymous,but noted that we intended to summarize our findings to the prison's officials.
We noted that we were interestedonly in their personal experiences;even so, several told us about the
experiences of other imnaIes. 2
After the interviews, we askedthe interviewees to review our notes to verify lbat we correctly
captured then- views. We thankedthem for volunteering to be interviewed.
We collected information such as gender, date uf'bfrth/age, place ofbirth, and occupation prior to
incarceration, as well as dates of incarceration and release. Those data did not relate to our project; we did
not summarize them other than to determine that eight of our interviewees were female and eight were
male. We did not ask why they were incarcerated. All interviewees spoke English. Given the incident this
summer, we were especially interested in the women's accounts.

Ill. FINDINGS
FINDINGS RELATED TO INTAKE
Most of the people we interviewed reported that they were given only a cursory medical check at
intake. They answered some questions asked by a nurse or nurse practitioner (or once by a secretary) and
bad their temperatures and blood I"""""" taken. Some reported being tested fur TIl. Preexisting conditions
were not addressed. Rased on the intake reviews, none reported that they were given any medical
recommendations, except to drink water and exercise.
Several of the interviewees said they presented challenging information. For example, a female
informed the prison's reviewer that she was rom-months rwegnant; she was given a pregnancy test that
confirmed her claim and also a TB test. However, there were 00 adjustments made for her condition andno
follow up.
Several had conditions or injuries at entry, such as broken ribs, pneumonia, the complications of
back surgery, heart problems, and stomach problems. Most felt their current medical problems were
ignored.
Mootbs after entJy> one inmatewho reported heart probJems at intake had received DO treaunent
and badno tnoney fuo-....mcano.... One reported 1ha1 _
three weeks, the medical staff cbanged the
inmate's heart medieenons, then failed to give any for three additional weeks.

2 Although we did seek second-hand accounts of other inmates' experiences, several such reports.
concerned us and we intend to follow up. For example, we received reports that after the summer 2007
incident, women who were pregnant (including one with an Rh-condition and who had oot received
adequate ClII"e while incarcerated despite requests) were transferred out of LCP. Additionally. we
determined that there probably are a half dozen women currently incarcerated who are now pregnant (and
we assume receiving the same care, or lack thereof, that we report here).

3

One, because of a growth on his spine needed surgery - his personal doctor was available to
explain the situation but the prison did not follow through. He maintains he was not evaluated or monitored,
received no medications, and was told by a nurse that "we're all going to die sooner or later."
Based on their experiences with the intake reviews, none felt as though there was a planned follow
up program in place, regardless oftheir conditions at intake. Medications they were supposed to take were
often changed or discontinued (understendebfy in cases where inmates were addicts). Often medications
needed were unavailable for long periods.

INTAKE WHEN SUBSTANCE ABUSIl. WAS INVOLVED.
Half of the inmates we interviewed reported that they had overused/abused drugs/alcohol and/or
were dependent at time of entry. At entry, they had the typical detox/withdrawal symptoms (Le., tremors,
sweats, cramps, pains). None thought they were evaluated for their situations; instead they were asked a
series of questions by a nurse or an intake guanI. One saw a doctor, None were given prescriptions or
recommendations for medical treatment. All were placed in the prison's special until their symptoms
subsidedor were manageable. None thought they were medicallymonitored while in thai unit.

MEDICAL CARE WHILE INCARCERATED
Several of tile interviewees needed medical care after entry. A few reported that they asked for and
received appropriate treatment. Most, however, had bad experiences.
One had hepatitis C, broken nUs.,sleep problems, etc. and was happy when sent to a counselor to
get treatment for depression. However, the inmate did not receive prescribed medications until two months
later.
The inmate who had back surgery prior to entry was not further evaluated and received no special
treatment.
One had prescribed medications Slopped at entry and was told to see the doctor who might resume
the medications. The inmate frequently requested to see the doctor (Le., "submitted slips") but has not seen
a doctor yet and is thus without medications.
One interviewee who claimed to have been beaten by poficc and as a result bad brain, neck, spinal,
and nerve damage was on eight medications, most of which were discontinued.
One woman who was pregnant at entry experienced a nose bleed once incarcerated. She saw the
on-eall doctor in the prison. She asked for access to prenatal care, but none was provided. Later, she had a
fever. .Because she W2IS pregnant, sbewas told she couldnot take Tylenol. She reported tha1 medical staff
promised to check back to see bow she was doing, but never returned- no one ever checked her even to
monitor her temperature. A month later, after her fiuniIy complained, she was taken to an external medical
facility which prescribed and scheduled an ultrasound, They rescheduled it with the jail twice; even so, it
never took place. The female reminded the nurses WIdofficers many times to no avail.
Both women who were pregnant at entry were taking prenatal vitamins. The prison ran out of
medications at times leaving the women without medications for weeks.

REQUESTS FOR MEDICAL CARE
Most of the people we interviewed requested medical attention while in the prison [i.e., "submitted
slips"). In fact, the reason they offered to participate in our project was because they were so unsatisfied
with the response:>.
A few did getlhe care !hey reqeested, One who experienced menial h<al1h sympIOmS reponed he
was seen immediately by a doctor. One said staff responded very quickly wbeo he was ill; he was having a
heart attack.
Most, however, reported that their requests were ignored, or, if addressed at all, only very slowly.
When they did get attention, in many cases no treatments were prescribed. One was told ther he was just
getting old.
While in prison, one experieoced severe GI problems and reported them to a prison nurse, who
responded that the inmatejust neededa bowelmovement. On furlough, the inmate went to an area hospital
emergency room and was immediately transferred to an out-of-area hospital where doctors removed a 1arge
cyst.
One who had back surgery before entry was not allowed to go 00 a prearranged follow up visit to
his doctor, despite multiple written requests. A guard eventually intervened to get help.

4

One ton: a teodoo. in a fall and could not walk. A IRII'Se looked at it and said tbe inmate was OK.
The inmale put in five medical"slips" but never saw a doctor.
One bad an accident in the prison gym and suffered head lnlurtes. The inmate now reports
recurring headaches and loss of memory, but cannot afford to see a doctor. Prisoners are charged for
medications and to see a nurse or doctor.
One developed a rash; the prescribed medication did not arrive for two weeks.
One woman who was pregnant 011 at ,-""lry put a "slip" in every week asking for prenatal care. It
took a month to get a response; she wailed two months to see a doctor. When she did see a doctor, he
turned out to be a psychiatrist.
A pregnant inmate developed abscessed teeth; as the infection spread. her face swelled. After
seven days, a nurse finally interceded; she was taken to dentist where several teeth had to be extracted She
was most worried about the infection affecting her baby. The dentist gave her Tylenol. After return, staff
would not allow her TyIeooJ because of her pregnancy. Other imnates pretended to be ill to get Tylenol
wbiclt d1ey sIwed with her.
Those who were provided with medicines reported that, except f(H" distribution routines (i.e., "the
cart came by"), they were not monitored.

ACCESS TO REVIEW
Several of the palients who claimed to receive no medical care or polR" care did oot complain to
prison officials, jn part because d1ey thougbtd1ey would not listen. Oshers filed frequent "slips" to complain
or reached out to nurses and guards. Most got no or very slow results.
The prison has a grievance procedure. The people we interviewed never actually filed any
grievances. Several said they would be ignored ifLhey did, or the grievances would be "torn up" in their
faces.
Two independently reported that when one inmate they knew filed a grievance, their
inmate's entire unit was locked down while a guard read the details of the inmate's complete medical
history over the intercom for all to hear.

PREGNANT INMATES
Because of the incident in the summer of2007, we were especially concerned about care for
pregnant women. AlLhough we did not interview them (but might in the future), wc understand that some
female prisoners who were pregnant dming the summer were transferred out of tile prison. We also
understand that severaJ women currently incarcera1ed are pregnant.
We spoke to two former inmates who were pregnant while in prison. Both were given a pregnancy
test at entry, but no other check ups. Both reported that they received inconsistent prenatal vitamins and got
no prenatal care. Neither was provided with a special diet- each received the same tray as all inmates. They
both reported that "everything was soy," even though they needed and asked for milk. As did many other
inmates, these two reported that the food in the prison is temble.l When possible, the pregnant women ate
only vegetables whenever they could get them. BoIh were "always hungry," One lost eight pounds while
pregnant,

ADDITIONAL INFORMATION
A few of the former and current inmates complimented some nurses and guards; however, for the
most part, most view the staff at the prison, whom they knnw have difficult jobs, as being uncaring. They
reserved their major coostemation, however, for the jail's medical director. That the penon best positioned
to provide im:nates with care was the one they most disrespected was telling.
On inmate who seemed to have followed the swnmer incident closely opined that there is a basic
conflict of interest at the prison- the county contracted with a firm to provide medical care at the facility;
the doctor who serves as the prison's medical director is a principal in the company. The doctor, therefore,
"owns" the company tor which he works. The inmate we interviewed suggested that money the doctor does
not spend on the inmatesreverts to his company as profit. Therefore, according this inmate, there is a
tendency to short medical services - the Jess care, the more profit.

:I Although we did not ask questions about food (except for the pregnant women), many inmates
mentioned that it was awful.

5

An inmate told us that medicines are routinely replaced or unavailable to save the linn money.
Many medicines come in generic wrappers. not even labeled ~ they are placed in haggles and identified
with magic markers. Based on one inmate·s experience, most of the prison's medications do not come from
US sources. When inmates leave, the staff reuse remaining pills, and bills a second time, one explained.
One inmate felt sorry for the nurses who need to keep their jobs but are worried about malpractice.
An inmate informed us that the baby born this summer was delivered in a cell that was filthy. The
woman received no care prior to or during the delivery. 'rbe baby dropped into vomit and feces.
One told us of another who had multiple sclerosis and could only take a few smaU steps. His
medications usually wore off in the middle of the night and he had to eodme till the morning. By then, he
could not make it to the medical cart Another had. dystonia, a condition that causes massive muscle cramps.
After the medical staff cut his medications, he would curl up and had trouble breathing. At one point, a
nurse who came by with medications suggested the inmate was "faking it." He was laid on the floor; by
6:30 AM he was dad blue and curled up in a ball. He stammered lI1ai he could not breathe. Later, a narse
visited - with coffee and donut in hand stating,. "'[ do not have time fur this."
One inmate was very concerned abmrt another who was described as probably mentally retarded.
The latter gets agitated very easily and, when he does, slams his face to the point of drawing blood. The
reporting inmate argued thai people like that should not be in prison.
One inmate had major bowel control problems, making the whole medical unit unhealthy. The
inmate was moved back to the general population!
One inmate told ofanother who was kept in a cell fur two months straight; was not aljowed to exit
for any reason. He filed requests to see medical staff. but the slips were thrown in the trash. The inmate we
interviewed took them from the trash and mailed them to his own family for safekeeping.
One noted that inmates are tested for TB. if the preliminary test is positive, they are isolated and a
second test is prescribed. The problem with that is that the wickets (openings in the cell doors) are left open
and inmates can interact.
An imnate who bad been incarcerated elsewhere wondered why LCP charges for medical care; the
inmate's previous experiences suggested thar the federal government coven federal prisoners.
We wondered to some how this summer's review team was able to give the prison such a glowing
rating. An inmate told us that the medical block was locked down, the visitors passed by but did not talk to
anyone. The day before they arrived, the prison got rid of some challenging inmates; the day they left, those
inm81es returned.
w

RECOMMENDATIONS
We received about three dozen requests from former and current inmates who wanted to be
interviewed, While we were not able to interview them all, we sincerely respect that each took a risk in
sharing with us; we hope there will be no retribution.
Clearly, we tapped only a small number offormer and current inmates.. Even so, we see several
basic themes in our data. Oe- assumption is that a more significant review ofthe medical services at the
prison would substantiate and maybe amplify the themes.
RECOMMENDATION 1
To confirm our findings ~ or to reject them we recommend that the Lackawanna County Prison Hoard
immediately contract with an objective outside party, possibly an accrediting group ofsome sort, to
tborougbly evaluate the LCP's medical services.
w

RECOMMENDATION 2
Thai the prison's medical director is a principal in the finn that provides care to the prison is a concern,
possibly a conflict of interest. We recommend that the Lackawanna County Prison Board immediately
review the arrangement.
RECOMMENDATION 3
Inmates told us lha1 when they entered the jail, they received only cunory medical evaluations. We
recommend ther the Lackawanna County Prison Board immediately review the prison's intake procedures,
especially related to medical evaluations. The Board should pay special attention to the fact that female
inmates might be pregnant at entry and thus should have a thorough review of their conditions.

6

RECOMMENDATION 4
We recognize that at least some of dIe reports provided by our interviewees. especially those who needed
medical services while incarcerated, might have been colored by personal motives. Ahnost all of the former
and CUITent inmates we interviewed stated that when they asked for services they were largely ignored, or at
least put off, and tbat the services they eventually received were vel)' poor. Regardless, we recommend that
the Lackawanna County Prison Board immediately review the prison's response procedures (e.g., logs of
requests for care v. responses).

RECOMMENDATION 5
It is clear frum the information we gathered that at least a few current inmates - those with serious mental
health and/or medical problems - should not be housed in the LCP. We recommend that the Lackawanna
County Prlson Board immediately review this possibility and determine where these inmates, and those
who present in tbe future, would be beuer placed.

RECOMMENDATION 6
It seems to us that a large Dumber of former and current inmates were placed in the LCP for crimes directly
related to alcohol/drug abuse. We observe that maybe these people need treatment and education, rather
than punishment; maybe they need the services available through Drug Court and its affiliates.
Accordingly. we recommend that. the Lackawanna County Prison Board immediately review current
literature, which is voluminous, to detennine the views of experts in the field relative to the differing effects
oftreatment v. punishment. Possibly theBoard migbt challenge the local colleges and universities to get
their professors and students involved in such a project The Board should share the findings ofthat project
with the members of the criminal justice system which feeds the jail.

RECOMMENDATION 7
Based on wbaI: we know of the incident this summer andbased on the responses of females who arelwere
pregnant while in jail, we recommend that the Lackawanna County Prison Boord immediately review the
prison's policies and procedures related to how women who are pregnant should be addressed. At the very
least, we believe, they must receive appropriate and ongoing evaluations oftheir conditions, should not
have to beg to receive medications and vitamins that are necessary to support prenatal development of their
babies, and, as soon as their pregnancies are detennined, they should be placed on !he rich diets they need
to enhance the development of their babies. AdditiooaJly, with a small window for error, it is not difficuLt to
detennine likely delivery dates. As women approach these dates, their medical care should be adjusted to
reflect their needs and the medical staff should initiate protocols that ensure that the women deliver their
babies in a hospitaL

RECOMMENDATION 8
We did not set out to determine the quality oflhe food at the prison. but clearly those we interviewed found
it almost unfit for consumption. Inmates with means have the option to purchase better food in the prison's
commissary (at high prices); those without means do not have this option. Because nutrition directly affects
health, we recommend that the Lackawanna County Prison Board immediately review the prison's food
service system to determine whether the inmates are being properly fed and whether they receive proper
nutrition.

7