Reclaiming Health Worthiness

When we interviewed Sputnik, who has spent thirty-six years inside a California women’s prison, she shared the following memories with us of friends who had died from medical neglect. Her voice was full of emotion; she was crying, and we could hear her anger and anguish as she remembered and relived the experiences. Death is a part of life. Sputnik had seen people she cared for die before. But these deaths were different.

I watched my friend have an asthma attack right in the middle of the fucking sidewalk. And her best friend carried her over to the clinic. When she got her there, she laid her on the floor, and she died right there because the motherfuckers acted like they didn’t know she was having an asthma attack. Marva Hines was her name.

Patty Searles was standing in the med line because they didn’t have an awning over it. It took us fifteen years to fight for an awning over the med line because you are standing in the middle of the fucking sun at twelve o’clock in the afternoon trying to get your meds because the bitch too fucking lazy to come and open it up on time. So, she comes at one o’clock. Patty passes out from a fucking heart attack. Guess what? She dies right there on the fucking sidewalk in front of us. Her name was Patty Searles.

Marge Tanner. Her pussy literally fell out of her body, but instead of them fixing her the correct way, you know what they did? They pulled it back up through her body, attached it to her spine, sent her back to her room, and she died in the hallway. Her name was Marge Tanner.

Candace Bennett. She got an ear infection. Something happened, but the shit went through her stomach. You think they knew what the fuck was going on? She died in the hallway at MTA. At seven o’clock at night. Her name was Candace Bennett.

Cheryl Morales, she was at VSP. Her stomach kept swelling and swelling and swelling. Oh well, you’ve got problems with your liver, so we are going to check you out. She sat in the motherfucking clinic on B yard and died on the bench because she was waiting for them to come and do something for her. I had just talked to her fifteen minutes before that.

These were my friends. These people were my family. They don’t give a fuck. It’s all about the fucking money. And you want to charge me a $5 copay to be seen and I ain’t got $5? So you won’t see me? Or I got to wait thirty days? Bullshit. Why I got to wait thirty days to be seen? I wasn’t sick when I came in here. You motherfuckers didn’t take care of me. Feed me bullshit, let mice and everything else run around, shit in the food, shit’s all in the kitchen. Roaches. All this shit. You think they give a fuck? They don’t care. We took better care of each other than the medical department did. We took better care of each other. If they did anything. And they got the taxpayers out here thinking that they are taking care of us. They ain’t doing a motherfucking thing. That’s it.

Is this what you wanted to know?

Sputnik understood that these deaths were caused by state violence. They were the result of medical neglect, correctional officers’ contempt, and systems designed to punish rather than care. What Sputnik was describing went beyond loss; she was describing ongoing trauma following decades of enduring and witnessing violence inflicted by agents of the state.

Much of the discourse surrounding police and state violence has focused on overt acts of physical violence perpetrated against individuals. While it is critically important to shed light on the abuse inflicted by agents of the state, the everyday, insidious reality of systemic medical violence often remains hidden behind prison bars and barbed wire. In 2018 more than 4,500 people died in U.S. prisons; these numbers are only growing, with more than 2,600 deaths behind bars due to COVID-19 alone in 2020 and 2021. While some attention is focused on deaths due to suicide, homicide, and drug overdose, less is focused on fatalities occurring at the hands of the state that result from subpar medical care, inadequate nutrition, unsanitary living conditions, and other harmful conditions of confinement. In addition to the lives lost to carceral medical violence, the punitive conditions of care lead many incarcerated people to experience fear and lack of trust in the medical system. Many people incarcerated in women’s prisons report refusing or delaying care because of the poor quality of care and negative interactions with health-care providers, leading to worsened health outcomes among an already marginalized population.

In 1976 Estelle v. Gamble established the right of people who are incarcerated to receive health care under the Eighth Amendment, yet there is a long history of medical neglect, experimentation, and exploitation in U.S. correctional institutions. In California, there has been repeated court oversight of health care administered by the California Department of Corrections and Rehabilitation (CDCR). In 2001 plaintiffs in Plata v. Davis, heard in the Ninth Circuit Court of Appeals, claimed that inadequate medical care in California state prisons violated the Eighth Amendment prohibition against cruel and unusual punishment. In 2006, after failing to improve prison health care as ordered, the California state prison system was put under federal receivership. Despite this history and the eightfold increase in the number of incarcerated women in the United States over the late twentieth century, correctional institutions have struggled to provide adequate health-care services for people incarcerated in women’s prisons.

While people of all genders who are incarcerated are more likely to suffer from serious mental illnesses and infectious and chronic diseases than the general population, women—who are more likely to enter incarceration with histories of trauma and abuse—have higher rates of medical and psychiatric conditions than incarcerated men. Further, reproductive health care is compromised by the very nature of mass incarceration, which, as public health researchers Crystal Hayes, Carolyn Sufrin, and Jamila Perritt write, “undermines bodily autonomy and the capacity for incarcerated people to make decisions about their reproductive well-being and bodies . . . [violating] the most basic tenets of reproductive justice—the right to have a child, not to have a child, and to parent the children you have with dignity and in safety.” Prison itself is a critical form of gender-based violence as it limits freedom and causes bodily and psychological harm while perpetuating hegemonic power and control. Prison health care lies at the intersection of two forms of structural violence and oppression: the criminal legal system and the health-care system, which, in the words of Beth Richie and Erin Eife, serve to “mutually create and reinforce each other.”

Dismissal and inadequate treatment of symptoms are common in the prison context. In prison health care, many women described being treated as an “inmate” first and a “patient” second. They are seen as criminal, deceitful, and manipulative, and their reports of symptoms or requests for intervention are viewed with skepticism. Katie described this phenomenon and her journey seeking care for what could have been a minor issue. It started very simply with a spider bite, but the cascade of neglect and poor care led to years of medical trauma. She told us:

I got a spider bite. They didn’t want to take care of it, and so it got really bad and got staph infection. They finally were willing to see me and do something about it, but the antibiotics, because they had waited so long, the antibiotics didn’t work. I got a tiny little nick on my stomach. A little scratch that turned into the second infection.

She was working at a job site that was dirty when she got the second infection. She was concerned that the infection wasn’t healing properly or could worsen, but she was expected to show up for work each day. She went on to describe her care:

This second site was on my stomach, and so they tried the third antibiotic. It wasn’t working. They suggested taking me out to do an IV or something, but then changed their mind after discussing my sentence, in front of me. The doctor and the chief medical officer, who basically is the one that decides who can go out of the institution and all that, they discussed it together, saying like, is there any way we can do something else before taking me back out? It’s just at a quarter size, the size of a quarter. But it was deep. Still the infection didn’t go away.

Katie was serving a “life without the possibility of parole” sentence, or LWOP. Because of this sentence, taking her to an outside hospital would require multiple correctional officer escorts and a chase car to follow behind her transport—it would be expensive and pull staff away from other work at the facility. Concerns about security and cost played a role in decisions about her care. In this case, they outweighed the concerns about her health. Katie continued her story:

I ended up getting a tiny pimple on the corner of my lip, and that’s where the infection landed last. My lip swelled up extremely huge. I could barely eat. And it went to my tonsil. They finally took me out then because I could barely talk. Took me out to an ear, nose, and throat [doctor], and they said, like, the tonsil is caving down my throat.

The doctor said she needed surgery immediately, but again security concerns overruled the recommendation. She was sent back to her cell to sleep, despite the surgeon cautioning that her airway could become obstructed at any time. Katie finally had her surgery, but security concerns continued to disrupt her care. An officer came in and woke her up in recovery to tell her it was time to go back to the prison. As Katie described it, “The nurse got really upset at the officer because [the officer] wanted to force me to do the squat and cough. She’s like, ‘She has stitches in her throat, she can’t do that.’ [The officer’s] like, ‘She has to.’ So I basically ended up throwing up all over [the] officer.”

Care and healing in prisons often occur within the community of incarcerated people formed inside—women who didn’t trust the system, but who come to trust each other deeply. This care work is another key form of resistance taken up by many women inside. In the absence of both a safe medical system and family support, the community formed inside assumes the roles of both health-care provider and caregiver. Loved ones inside care for each other, providing support, nourishment, help with activities of daily living, medications, and advice, all of which is an affront to the carceral system. Some activities, like bringing food to a sick friend—so normal in free society—are expressly forbidden in prison. In general, finding ways to care within a violent environment is a tremendous act of resistance. These acts of love and humanity are radical acts of standing up to a violent system to care for one another. The families and community formed inside are unrecognized, unsupported, and at times unallowed. Individuals can be isolated or removed from their families with no reason or notice. And yet, the system in many ways depends on these networks of care to fill its own gaps.

Sputnik described how incarcerated people often wait in line to receive medical care for hours when they are sick. Some of this is structural, the result of our culture of mass incarceration. But, for Sputnik, it often also felt like the people working inside didn’t care or couldn’t provide care, and it was up to the community to care for themselves and each other:

We did more self-medicating and taking care of each other when shit happens than anybody else did. You know what I mean? You go over there for a triage; the nurse will give you a look. ‘You know what? We’ve got a lot of people out here to see.’ I was like, just give me what I need to take care of my damn self and let me go back to my room.

People with any medical training or background are often relied upon for advice and care. One woman who had been a nurse prior to incarceration described, “The number of times women would come to me with some pill in their hand and say, ‘Birdy, what is this? Do you think I should take it? I have an ear infection.’ And I would say, ‘No, you shouldn’t take it. And don’t take someone else’s antibiotics. Two or three doses is just going to create a resistant strain, don’t do that.’ But people would still come and ask.” People incarcerated in women’s prisons continually find ways to build a culture of caring in a violent system that attempts to strip away health, community, and love.

Building a community of care within a system designed for punishment is in and of itself a form of resistance to state-sanctioned violence. Sputnik described how much she missed many of the people she came to know and love during her decades in prison and shared her pain and anguish remembering the loved ones she lost inside. She described the impact that her family inside had on her life:

I miss them. This is what you need to understand. I miss them. I wouldn’t be the person that I changed to be if it wasn’t for a lot of those ladies that’s in there. Some of us made it out; some of us are still trying to get out; some of them ain’t going to never get out. And then some of them died protecting us and teaching us and, you know, building a foundation for us in a prison. Who would’ve thought that people in prison could build a foundation where you can eventually come home and function as a human being?

Sputnik found healing—from the abuse and violence faced both before and during her incarceration—through the relationships she built inside. It was the community formed with other people who were incarcerated, not the health-care system, that allowed for her healing from trauma.

The punishment and structural violence embedded in the prison doesn’t stop at the clinic or hospital doors. It is present in the dismissal of symptoms. It is pervasive in the assumptions of ulterior motives for seeking care. It is allowed to flourish through the prioritization of “security” over the health and well-being of the patients seeking care. Incarcerated patients are expected to avail themselves of medicine; to be vulnerable and trusting in a system that continually abuses them.

For the women we interviewed, reclaiming health worthiness came in many shapes and forms. As with trauma healing, it was a choice they made on their own terms and by reconnecting to the sacredness of their bodies—from using their voice (in the form of self-advocacy) to giving themselves permission to rest, rather than “just pounding through.” For most, reclaiming health worthiness took them on a journey of providing care and healing in community with other system-impacted women, sharing resources—including power and privilege—with each other. By holding space for each other and deepening the relationship with self, these women are on a path of liberation from the prison–industrial (health) complex.

Prison is not and can never be the solution to trauma. Violent systems perpetuate harm and cannot promote healing. Instead, healing comes through community. Our findings call into question whether the idea of trauma-informed care is or can be truly possible in the prison system, though we would urge steps to be taken to prioritize models of patient-centered care. This is not a problem of bad-apple doctors but rather one of systemic violence. Routine medical care offered under the constant threat of punishment and violence will always be punitive in nature. We must invest in community-based, trauma-informed care and disinvest in prisons. Abolition medicine provides an antidote by questioning the systems that enable violence and create racial health inequities and reimagining medicine as an anti-racist practice. As carceral health researcher Andrea Pitts writes, “By building models for healthcare that eliminate structural oppressions, cycles of medicalized violence, and forms of criminalization, we can aim to effectively render prisons and correctional healthcare obsolete.”

From All This Safety Is Killing Us by Ronica Mukerjee and Carlos Martinez, published by North Atlantic Books, copyright © 2025 by Ronica Mukerjee and Carlos Martinez. Reprinted by permission of North Atlantic Books.

_{Image: Roxanne / Unsplash}

Contributors

Aminah Elster Aminah Elster is the cofounder and executive director of Unapologetically HERS (Healing Experiences through Research Solutions) and a coorganizer with the California Coalition for Women Prisoners and Survived & Punished.

Jennifer James Jennifer James is an associate professor at the University of California, San Francisco. She is a sociologist, ethicist, and Black feminist scholar who conducts community-engaged qualitative research on health, racism, and structural violence.

Giselle Pérez-Aguilar Giselle Pérez-Aguilar, LCSW, is a first-generation Mexicana Indigena doctoral student at the University of California, San Francisco.

Leslie Riddle Leslie Riddle, MPH, is a staff research associate in the Department of Humanities and Social Sciences at the University of California, San Francisco.

Topics

• Institutions & Practices

Tags

• abolition
• conditions of confinement
• deaths in custody
• health care