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Credit: Photo courtesy of Washington State Department of Corrections

Not a death sentence: Female inmate serving 35-year sentence fights for life-saving health care

For the last four years, inmate Cynthia Miller’s health condition has only gotten worse.

Transvaginal mesh was implanted inside the 60-year-old woman in 2005, to help with incontinence issues caused by her bladder, before she was incarcerated.

In the 10 years since the surgery, complications from the procedure have compounded with her Lupus and high blood pressure, her husband Dean Rhodes said.

Miller has stage three kidney failure. Her colon is collapsed. Her bladder has prolapsed through the mesh device and drooped down into her vaginal wall. To urinate, Miller inserts her fingers into her vagina, and pushes on her bladder, which is protruding down.

Miller is one of many female inmates in Washington state who report that their medical needs go unmet. In an incarcerated women survey published by the Office of the Corrections Ombuds in February, about half of the 772 female inmates said their healthcare needs were not met.

An inmate at the Washington Corrections Center for Women in Purdy, Rhodes said Miller has been denied a medical furlough and hasn't received the surgery to remove the mesh implant.

The Food and Drug Administration banned sales of all transvaginal mesh products for pelvic organ prolapse in April 2019, because they couldn’t “assure women that these devices were safe and effective long term.”

A medical furlough means Miller could leave the prison to get surgery, and return to serve the rest of her 35-year sentence after she recovered. In 2016, Miller was found guilty of torturing and starving her grandchild, a 9-year-old girl, who was described in court records as having been deprived of food and being beaten relentlessly, sometimes with a bamboo stick. One of the other children in the home said that the 9-year-old girl had a demon inside her and that because of this, she had to stand in a corner with a bible over her head while they shouted “Jehovah” at her.

Miller has also been denied an extraordinary medical placement, which is similar to a medical furlough. It allows an inmate to be released to get medical treatment outside prison, while also removing the burden of medical costs from the state.

"Any outside doctor that she's seen, that knows her condition, has said she will need extensive-post recovery treatment, and the prison does not have the facility or experienced medical personnel to address that," Rhodes said.

In 2018, 28 inmates were under consideration for extraordinary medical placement in Washington state, according to data collected by the Department of Corrections. Two of these inmates were approved and eight inmates died before they were relocated or a decision was reached.

A spokesperson with the Department of Corrections said Miller was denied an extraordinary medical placement because she didn't meet the requirements.

"We understand her husband’s concerns and want to reassure him Corrections continues to follow health and safety guidelines to protect the women housed at the Washington Corrections Center for Women," the spokesperson wrote by email.

In addition to her bladder problems, Miller has been confined to a wheelchair since July because of knee issues and lower back pain, Rhodes said. A shoulder injury she sustained last November, after she fell unconscious as she was being transported from Washington Corrections to Yakima Department of Corrections, means she’s reliant on others to wheel her to get medications and food. During a fire drill last week, Miller was left behind, her husband said.

Rhodes said both Department of Corrections health workers and an outside bone specialist have confirmed that Miller needs a shoulder replacement — as of today, nearly 10 months after the fall, she hasn’t received it.

Similar to Miller, other women inside Washington state prison facilities have reported they felt that their health complaints were not believed or downplayed — even when symptoms were serious, according to a Corrections Ombuds report.

Twenty-nine women reported that during follow-up appointments, which can take months to get, were told to “take ibuprofen and drink more water as a generic remedy to all kinds of specialized medical problems.”

And both specialized and preventative medical care were denied to inmates serving both short-term and lifelong sentences, the Ombuds report states.

“I feel they will let you die because we are property of (the) state,” one female inmate said in the survey. Inmates of all genders also said they felt discarded by society after being incarcerated.

Prisoner advocates say that no matter the crime, prisoners are entitled to health care. The prison and the time are the sentence — not medical neglect.

“These are human beings who deserve to be dignified,” said attorney and community organizer Nikkita Oliver. “The state has an obligation to take care of these people … We shouldn’t be allowing people to suffer, not to mention that a failure to provide healthcare for some people is a death sentence, and that’s just unacceptable.”

Oliver said sometimes inmates keep their pain to themselves, and struggle in silence, due to fears that they will be punished instead of treated. The coronavirus pandemic, she said, exemplified this – some inmates won’t disclose that they’re feeling ill because they don’t want to be put in solitary confinement.

“I ask people to consider, if it was their loved one incarcerated, how would they want their loved one to be cared for?” Oliver said.

Zishan Lokhandwala, attorney for Cynthia Miller, faxed an application for an emergency medical furlough for Miller to Superintendent Jo Wofford in July 2018.

In the application he noted that Miller needed to have her bladder and colon reattached to the inside of her body, and that if this could not be done by a doctor, she instead would need to have these organs removed and a colostomy bag attached.

Miller’s husband, Rhodes, said the mesh implant has fused into the tissue of her bladder and colon, and that when her bladder fills, and she pushes on her bladder to urinate, it pulls on the colon, resulting in a tearing of the tissue. A large enough tear would cause internal bleeding.

“Doctors have explained that it's like removing chewing gum from hair and not breaking a single strand,” Rhodes said, quoting Miller's urologist.

The complications that can arise from these mesh devices were noted by Attorney General Bob Ferguson, in a May 2016 lawsuit against Johnson & Johnson. He said the pharmaceutical giant knowingly hid the risks of using the surgical mesh to treat pelvic floor conditions in women. The company never told women that the mesh could cause infections and “move and protrude into an organ or through the vaginal wall” causing pain.

Quoting an internal company document, the lawsuit states “Mesh retraction ("shrinkage") . . . can cause vaginal anatomic distortion, which may eventually have a negative impact on sexual function. Its treatment is difficult.”

In July 2018, Mary Colter, facility medical director for the prison, denied Miller’s application after she examined Miller.

“It is my medical opinion that Ms. Miller does not have a life-threatening illness and she is not seriously ill. Her medical condition can certainly be treated while she is housed at WCCW if it is determined to meet medical necessity criteria under the Offender Health Plan,” Colter wrote.

This criteria includes: procedures that would save a life, and prevent severe bodily damage; reduce intractable pain; and prevent significant deterioration of activities of daily living.

The Department of Corrections recently approved an outside cardiologist visit for Miller, after news reports about her condition. The cardiologist visit is needed to determine if Miller's heart is strong enough for non-cardiac surgery.

“It's taken four and a half years of neglect and abuse and the need to go public on the news to get some form of treatment lined up,” Rhodes said.

Miller’s lawyer reapplied for her medical furlough on her behalf in August 2019. But so far, they haven't heard back.