Death Sentence

Why are prisoners with AIDS dying for release?

Thankless doesn't even begin to describe the work of Judy Greenspan.
For the past eight years, Greenspan, 43-year-old director of the Oakland-based HIV/AIDS in Prison Project, has been fighting for the compassionate treatment -- and for those near death's door, the compassionate release -- of one of the most stigmatized segments of society: prisoners dying of AIDS.

To say the work is difficult, amid rampant homophobia and a political climate that has led to the imprisonment of a record 1.5 million Americans, is to say the sun is hot. But Greenspan, who works under the auspices of Catholic Charities of the East Bay, expects the difficulties. She expects the raised eyebrows when she mentions caring and criminals in the same breath.

What she doesn't expect, she says, is what she believes is the stubborn illogic -- and questionable practices -- of prison officials and politicians, particularly when it comes to the 3,200 inmates at the California Medical Facility (CMF) in Vacaville.

More than 500 CMF inmates are HIV-positive. One of four prison hospitals in the state, CMF is the only such facility with a special AIDS hospice, a 17-bed unit that is typically considered a bright spot in the otherwise grim universe of jailhouse medical care.

But in the past few months, Greenspan says, the situation at CMF -- where every four days or so a man dies of an HIV-related illness -- has grown increasingly disheartening. Her concerns about Vacaville prisoners include everything from the health information they receive while alive to the autopsies they receive when they die. The troubles at CMF, she says, highlight a complex, often subtle set of realities that keep dying prisoners behind bars, deny them help, and turn convictions for even minor crimes into death sentences.

On Nov. 1, for reasons under dispute, Dr. Joe Bick, chief medical officer at CMF, shut down an internationally acclaimed HIV peer education program, in which prisoners counseled other prisoners on health matters and how to avoid HIV. The social worker who created and supervised the program, Scott Cozza, has been reassigned to a different prison job, says Greenspan.

Cozza declined to comment on the matter. But according to Greenspan and other prisoner advocates -- who were contacted by upset inmates and other sources -- the peer program was suspended after the prison scheduled flu shots for HIV-positive prisoners, and Cozza, in response, distributed fliers providing information about how those shots can sometimes be dangerous for people with weakened immune systems.

"What he handed out was a fact sheet that didn't recommend anything," says Ryan Clary of Project Inform, the AIDS treatment advocacy group that provided Cozza with the fliers. "All we do is present the information, and it's up to the individual and doctors to make choices," Clary says. "That's why we were kind of shocked that [Bick] would shut down the program."

"This is a cutting-edge program," adds Tish Levee, co-chair of the HIV/AIDS Commission for the Episcopal Diocese of Northern California. Cozza's work is so well-regarded, and his material in such demand, he's been invited to speak at AIDS and prison conferences in Israel and Japan, and at the upcoming "AIDS in Africa" conference in Uganda, Levee says. "Frankly, I don't understand why the prison isn't going around tooting their horn about him," she says.

Bick, meanwhile, says the program was not shut down because of the flu shot flier, but because "we had some breaches in security." The doctor declined to say what the breaches were, but likened them to "bringing in medical cutlery, or leaving outside phone lines unattended." Bick says the program will be reorganized and restarted, but apparently sans Cozza.

"Anything we can do to prevent HIV infection in prison, we want to do," Bick says. "But it has to be done in a way that security risks aren't created."

"There was no security risk," counters Greenspan, rarely one to back down. Before coming to the Bay Area four years ago, she worked for the American Civil Liberties Union National Prison Project in Washington, D.C. It's a time-honored excuse in prisons, she says, to declare something a security risk. "What this is about is control versus care," she declares.

The point/counterpoint, Greenspan vs. Bick, is nothing new. For years, Greenspan has fought Bick and prison officials in general for the compassionate release of prisoners whose terminal illnesses render them unlikely security risks. Allowing such prisoners to die at home not only makes moral sense, says Greenspan, but could save the state millions.

California, home of the largest prison population in the country, spends at least $372 million annually on inmate health care -- more money than the entire prison budgets of 36 other states combined. According to the state Department of Corrections, medical bills for prisoners sick enough to need outside hospitalization -- and, along with it, 24-hour guards -- can reach $4,000 per day. Even at CMF, with its hospital behind bars, sick inmates run up tabs of $75,000 a year.

The cost, which will only increase as prison populations both grow, and gray, led Assemblyman Antonio Villaraigosa, a Los Angeles Democrat, to sponsor a bill this year that would have streamlined the compassionate release process and allowed more inmates to die at home. The bill was vetoed by Gov. Wilson in October.

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