GOOCHLAND- At first, Tina Smith was relieved when she left the hospital after ear surgery, even though she looked like a mummy with a large bandage wrapped around her head.
Doctors at Virginia Commonwealth University's medical center in Richmond had removed a growth from her right ear in November, her medical records show, and Smith returned the same day to the Virginia Correctional Center for Women, where she is incarcerated.
But about a week later, she woke up with no feeling on the right side of her face. She said her doctor had ordered that her bandage be changed daily and drops be put in her ears. Neither happened, she said. Now she was being sent to the hospital fearing she'd suffered a stroke.
It turned out to be Bell's palsy, a rare condition where muscles on one side of the face become weak or paralyzed. The paralysis typically clears within a few months. Smith's was likely a reaction to a viral infection.
More than three months later, on a recent morning in a room at the prison's administrative building, Smith pressed a hand to her right cheek, which still has no feeling, as her lip curled involuntarily to the left side. She's losing vision in her right eye and has to tape it shut to sleep.
"I have to hold my face to talk," said Smith, 38.
When her youngest children, ages 8 and 10, visited her for the first time after her surgery, they cried.
"My little guy was just looking at me like, 'Mommy, are you OK?' " she recalled. "They knew something was wrong."
About a year ago, Smith's fellow inmate Julie Payne had waited for days as a warm, swollen lump on her breast oozed after an emergency request to be seen was denied. It would take her more than a week and several more requests — all documented — before she was taken into emergency surgery and diagnosed with a bacterial MRSA infection.
Smith, Payne and several other women imprisoned at Goochland told The Virginian-Pilot they are not receiving adequate medical care. They're scared that getting sick could become a death sentence, especially after Jennifer Addison, a fellow inmate, died a year ago of the flu and MRSA. One inmate said many women have been afraid to even get a flu shot for fear of getting sick. Another has waited a year and half for hepatitis C treatment as it progresses to stage 4.
The Virginia Department of Corrections, which oversees the state's prisons, declined or did not respond to multiple interview requests to discuss medical care at Goochland. The governor's office, to which Smith's husband had previously reached out for help, declined to comment and directed inquiries back to the corrections department.
A federal judge in January told the department it was not upholding its Eighth Amendment obligations to provide basic medical care at the Fluvanna Correctional Center for Women, which is about 40 minutes west of Goochland. The corrections department is now fighting the judge's order to make changes.
"It's absolutely the same range of issues," said Shannon Ellis, an attorney for the Fluvanna plaintiffs with the Charlottesville-based Legal Aid Justice Center. "If the return address says Goochland instead of Fluvanna, I wouldn't know because it's so similar. The overarching problems are the same: failures in funding, failures in staffing and underlying disregard for prisoner patients."
Smith has two years to serve out on an old drug conviction after she violated her parole, but she could be released as early as next year after a behavioral program. She said the Goochland medical department is "at a standstill with me."
"They don't know how, at this point, to help me get better. I'm really worried I'm going to be like this for the rest of my life."
An old photo of Smith shows her with a slight smile, blond face-length hair pulled back by sunglasses on top of her head.
Now, Smith said, the Bell's palsy has destroyed any self-esteem she once had.
"I am miserable. I hold my head down a lot," she said. "I don't really give much eye contact anymore."
It's impossible to link her condition to the alleged lack of care at the prison. But she feels that the department has given up on helping her.
"It seems like I'm pulling tooth and nail trying to get" medical attention, she said.
A corrections department spokeswoman said in an email officials could not discuss Smith's medical circumstances but that her case "has been reviewed and she's receiving proper medical care from care providers."
Smith has had problems with her ears draining ever since she was young but never had a growth like last year's. It was discovered while she was at the Brunswick Work Center, and a surgery was planned shortly after she arrived at Goochland last fall.
When she returned from the procedure Nov. 13, she came with an envelope from the hospital detailing instructions for her post-surgery care. When she went to see a prison doctor weeks later, she said, the brown envelope was sitting unopened with her chart.
"They didn't even look at it when I came back from the hospital," she said.
She filed an emergency grievance Nov. 23 requesting care.
"I just had drastic ear surgery in my right ear and I'm not receiving the proper after care through the medical department," she wrote. "They are inconsistant (sic) on giving me my meds when needed. I'm swollen, I'm in a lot of pain, I can't feel the right side of my face and I'm having a hard time eating. I feel I'm not going to heal properly if they can't take the time to help me when they are suppose (sic) to."
The form indicates that a nurse denied her request for emergency care and directed her to submit an informal complaint — though the prison had already received one four days earlier.
On that complaint, someone with the prison wrote a description of the situation: "Health Services received an email from offender's family. She has recently had surgery on her ear and the local ENT doctor that performed the procedure had ordered that her dressing be changed twice daily by him and not the facility. That didnt (sic) and her fear is that the ear will get infected. … She has told me that her complaints have been ignored and that your medical department told her they couldn't do anything for her and that they were done?"
A response from another prison official, whose name is unclear from the form, said 10 days later "the recommendations provided by the outside provider were followed" and there'd been no documentation of a request for medical services.
On average, Bell's palsy starts to get better on its own within a few weeks of initial symptoms and returns to normal within three to six months, according to the National Institute of Neurological Disorders and Stroke. In rare cases, symptoms never completely clear up or return.
Smith is afraid she'll be in the latter category. She said her doctor at VCU is concerned and has discussed possible reconstructive surgery.
The VCU Health System declined a Pilot request to speak with Smith's doctor about her situation.
Smith said she's been back to the hospital several times and was prescribed medication to help the viral infection, but she had trouble getting it back in prison.
"It was like back at square one," she said. "It's just very inconsistent."
One nurse gave her steroids to take for a month, she said. When she returned to the department with side effects, including severe joint pain and trouble sleeping, she said a doctor told her she should have weaned herself off the medication already.
Prisoners at Goochland are often first seen by a licensed practical nurse. On at least one of Smith's emergency grievances, it was a practical nurse who deemed the situation not an emergency.
"Very seldom do I actually see a doctor," Smith said.
Ellis said that system is no longer permitted at Fluvanna. Because of issues brought to light in court, the prison now requires inmates be seen by someone with more training, such as a nurse practitioner.
The doctor charged with overseeing Fluvanna's court agreement wrote last year that the practice of licensed practical nurses or correctional officers determining whether symptoms constitute an emergency was "unsafe and unacceptable." ___
Working in the dark
Earlier this year, federal Judge Norman K. Moon said the state was not meeting its constitutional obligation to provide basic care at Fluvanna. He ordered changes, and fast.
They include training nurses to maintain a continuous supply of medications, recognize patient vital signs and respond to a medical emergency; studying how medical care could have been improved in cases where an inmate dies; developing protocol "ensuring unimpeded access to timely medical care"; and requiring "meaningful responses" to emergency medical grievance requests filed by inmates.
Ellis, the plaintiffs' attorney, said a compliance monitor will visit the prison soon to assess whether appropriate changes have been made. Meanwhile, the corrections department has filed a motion arguing it should not have to make the changes. Their attorneys argue that the court improperly rewrote the terms of the settlement agreement. A spokesman for the attorney general's office, which represents the state in court, declined to comment for this article.
"From our perspective, given all of the evidence … to be objecting to even the limited reliefs the court ordered seems pretty cynical," Ellis said. "That's disheartening."
When asked whether the changes might impact care at other state prisons such as Goochland, a corrections department spokeswoman said in an email that "the Fluvanna agreement is specific to Fluvanna; it doesn't affect any other facility."
At a committee hearing in January, department director Harold Clarke told legislators that the issues are linked to the lack of an electronic health-care record.
None of the state's prisons has an electronic records system, which means doctors unfamiliar with inmates — who often switch between providers onsite and offsite — often do not have immediate access to the patients' records.
"This has been a known problem for a long time," Ellis said. "Doctors on both sides (of the prison) are working in the dark. And patients are in the dark. There's great anxiety that comes with that."
Clarke told lawmakers that the department is "vulnerable to additional litigation." He said it's "difficult to defend" the Fluvanna lawsuit because the poor data storage makes it hard to show whether the state is providing adequate care. It's also hard "to analyze and contain offender healthcare costs" and retain staff, he added.
The department plans to roll out an electronic health-care record at all women's facilities next year, starting with Fluvanna. Men's prisons would follow. It'll cost at least $11.8 million for the women's prisons and an estimated $32.5 million for the men's, according to his January presentation.
Prisoners tend to have more health problems than the general population, and the medical needs of women offenders are generally almost double that of men, according to Clarke's presentation.
The corrections department spent $1.1 million on medical services at Goochland last year, up from $741,812 in 2017, according to online financial data.
Dr. Robert Cohen, a correctional health expert who's now a member of the New York City Board of Correction, said specialty care is some of the toughest to provide in jails and prisons because it requires transporting people for treatment, which adds staff effort and money.
Medical care, he added, shouldn't be based around emergency grievances.
"Legitimate grievances shouldn't be filed because (those issues) should've been taken care of in the first place."
A few months ago, a legislative commission that evaluates state policy and oversight wrote that Virginia's corrections department does not adequately monitor health care at the prisons it manages and that when problems are identified, there is often no required followup or plan to correct them. ___
"They seem to ignore it"
Last February, Julie Payne noticed a red spot on her breast that was sore, warm and swelling. She notified medical staff with an emergency grievance form, noting she felt "like I'm also running low grade fever."
"I knew it probably had an infection. I didn't know what it was," said Payne, 54.
Her request was denied. She was seen by a nurse three days later, who told her he'd refer her to a doctor. Another few days went by and "I was in so much pain and was so sick it wasn't even funny," Payne said. "I was in tears. I said, 'I have to be seen.' "
She filed another grievance form, noting that her bra was rubbing and irritating the spot more. "If medical don't have the time to cover it I will do it myself if they will provide me with a large bandaid," she wrote.
Another few days later, still in severe pain with stomach and headaches, Payne was taken to the emergency room at the VCU hospital. She'd had a cyst that became infected into an abscess. She'd also contracted MRSA. Payne says a worker told her she should've been seen a lot sooner, and she was taken into emergency surgery.
Since returning to Goochland, she has had two more cysts that turned into abscesses. One was in her nose.
Then in October, an abscess developed on her cheek, which swelled. She again submitted an emergency grievance, noting she had a history of abscesses and MRSA. "Can I please be seen. Thank you," she wrote. Instead, she was told to put in a sick call and sent back to her hall with ointment.
"I had to beg once again to have treatment," Payne said. A few days later, she was sent back to the ER and put on antibiotics for two weeks. But on her return to Goochland, the prescriptions weren't filled until several days later, while her face was infected and swollen.
"It looked like she was wearing a Halloween mask," Payne's daughter, Brittany Cooksey, said after visiting her in the fall. "My mom's worried she's going to die in there."
Payne is serving for drug possession and distribution and is scheduled to be released early next year. Five months after it appeared, the infection on her face has faded but she is waiting for follow-up appointments and unsure of what to do next.
"They seem to ignore it. Like we're dumb or don't know what we're talking about (with) our own health," she said. "It feels like (the women) are being seen and not heard at all."