California Medical Facility, or CMF, is touted as the flagship medical institution of the California Department of Corrections and Rehabilitation, or CDCR, but some with inside knowledge of its alleged treatment of incarcerated patients call that reputation into question.

According to multiple sources, including those incarcerated at the facility and lawyers representing them, the building lacks any heating or air conditioning and has poor ventilation despite being a medical facility that warehouses vulnerable people. During the 2020 fire season, the windows that were broken or unable to shut allowed smoke to flood the building.

Last year’s Vacaville fire came within miles of the facility, but despite initially being included in the fire department’s evacuation zone map, corrections officials deemed evacuation unnecessary for the prison and its neighboring facility, California State Prison Solano, according to a KQED article and multiple other news reports. When pressed by reporters, CDCR representatives were unwilling to disclose any evacuation plan for the prison, leading some to question if there was ever a contingency plan for evacuating the two facilities. During the Vacaville fire, a Mercury News article reported insufficient N-95 masks for the incarcerated population.

Additionally, throughout the duration of the pandemic, there have been reported instances of corrections officers, or COs, refusing to wear masks. In one report, a prisoner, who requested anonymity out of fear for her safety, alleged that she was walked to the shower by an officer who was not wearing a mask. That CO reportedly tested positive for COVID-19 the next day. It is not known if the prisoner was infected as a result of this exposure.

“We take the proper use of Personal Protective Equipment, including facial coverings very seriously,” a spokesperson from the medical care provider for CDCR prisons, California Correctional Health Care Services, or CCHCS, said in a statement to The Daily Californian. “CMF as well as other institutions have notified staff in a multitude of venues, including policy memos, the requirement of wearing a mask. This policy is continuously monitored. If there are deficiencies noted then actions are taken via the disciplinary process.” In addition, the spokesperson added, “policy adherence audits are evaluated by the OIG to assure we are taking appropriate action.”

Fire season and the pandemic are far from the only stressors placing health and lives at risk in CMF. The prison has a long history of substandard medical care, documented in part through the Office of the Inspector General, or OIG, periodic medical reports on all CDCR facilities. In both its 2016 and 2017 medical inspections of CMF (the last year’s inspections were conducted before the currently unpublished 2020 inspection), the OIG rated the facility “inadequate” in its overall assessment and in areas including preventive services, quality of provider performance and quality of nursing performance to evaluate the facility overall. Between the two inspections, the OIG found that “the institution’s leadership failed to address serious provider performance deficiencies” as well as other deficiencies found in the 2016 inspection, even though inadequate care by specific medical providers had been identified at the prison. The findings of the office include a range of substandard practices, including failure to follow proper hand sanitization procedures by nursing staff, lack of timely and proper medication administration and follow-up tests for potential tuberculosis cases, failure to adequately take action by nursing staff in response to injuries and medical provider assessments and multiple failures to perform face-to-face assessments on sick call requests or attempt to administer necessary medication ordered by a provider.

The history of sick calls going insufficiently answered is a problem only being amplified by the coronavirus pandemic.

“The Office of the Inspector General has not done a medical inspection of CMF in three years, even though (they) were under scrutiny for a while for the state of (their) medical services,” prisoner support advocate Olivia Campbell said.

When asked about CMF’s response to “inadequacies” found in the OIG reports, a CCHCS spokesperson stated, “California Medical Facility (CMF) and our entire organization are continually focused on quality improvement, including areas identified in OIG reports.”

The history of sick calls going insufficiently answered is a problem only being amplified by the coronavirus pandemic. In one alleged instance, a patient inside the COVID-19 wing was so ill that he lost consciousness and defecated on himself, according to Campbell. After this, other prisoners in the wing reportedly had to clean the area and the patient and transport him to bed because nursing staff refused to enter or respond to their earlier calls for assistance. According to multiple reports from friends and family of people in CMF, the dorm inside the prison where people who test positive for COVD-19 are being housed is D-Dorm, a wing previously used to house the dogs for the prison’s Paws for Life program that they say has not been sanitized after the rehousing of the dogs.

According to the CCHCS statement, CMF has “designated units for isolation of positive patients according to their specific bed needs” and that they also “quarantine units or specific incarcerated individuals, should they be deemed a potential exposure.”

The ramifications for prisoners who test positive for COVID-19 is largely responsible for the explosive outbreak at the facility. There is a widespread fear at the facility of COVID-19 testing, as the tests are rumored to be highly inaccurate, and a positive test means removal to one of the quarantine wings, which are overcrowded and either badly ventilated inside or located in tents on the prison grounds. A frequent refrain from people inside and their loved ones is that people who test positive at the facility do not believe they have COVID-19 or present symptoms until they are moved to the quarantine areas, after which they quickly fall ill. This has led to prisoners allegedly not requesting medical care if they are feeling ill and not in a quarantine wing, as they are more afraid of what a positive COVID-19 test would mean for their health than whatever illness they suffer on their own, according to the anonymous source within the prison. According to Jasmine Jones, who currently works in prisoner support and was previously incarcerated at CMF, this trend toward hiding COVID-19 symptoms to avoid dangerous quarantine conditions in prison is not limited to CMF, as other CDCR prisons have similar or even more overcrowded quarantine situations.

Even the potential of a vaccine does not seem promising to many of those on the inside: A large concern of advocates for the incarcerated is that not enough people within facilities such as CMF will opt to receive the vaccine once it is an option since little beyond basic information and a request for them to take it has been offered to those inside, according to sources within the prison. Decades of medical experimentation on prisoners in institutions across the country have seriously degraded the trust of medical professionals among the incarcerated. Especially in CMF, where many people have various preexisting conditions and are on other medications, this lack of information flow is concerning, since they do not feel confident that they will not suffer an adverse, unexpected reaction from the vaccine. A CCHCS spokesperson stated information about the vaccine “is provided in handouts, via the institution television system and through one-on-one education.”

Despite the documented history of insufficient medical care at the facility, complaints of medical neglect filed at CMF allegedly face a quick dismissal. Martha Pulizzano provided The Daily Californian with a statement alleging medical neglect on behalf of her husband, James “Julz” Pulizzano, who is currently incarcerated at CMF. Julz is physically disabled: He is an amputee and uses a prosthetic leg with an articulated knee to walk, and he has little strength and problems moving his arms as a result of surgery on both limbs. His prosthetic leg has been broken since 2018, leaving him with severely limited mobility. Rather than sending his prosthetic to be repaired or even letting his wife replace it, his complaint, which detailed the many medical issues caused by his inoperative and ill-fitting prosthetic was rejected by all three levels of internal CDCR appeals for failure to “separate your medical issues (disagreement with treatment for a rash, prosthetic leg and associated symptoms, and an early release due to COVID-19) and your mental health issues (EOP programming and depression/anxiety medications) as medical and mental health are two different health care disciplines.”

In another complaint Julz filed, he requested a single-occupancy cell because he alleged that “with the last 7 cellmates I’ve had including the one now since coming to CMF 11/2019 all make the look or talk under their breath that they want to harm me.” Despite having a documented set of disabilities that make him “incapable of protecting myself from another,” Julz’s request was denied because CMF claimed that its status as a facility that caters to medically vulnerable populations means he “does not have a higher risk of victimization than other inmates currently housed at CMF.”

“He just wanted to survive”

Jeenha Huh’s family has been speaking to anyone who will listen, trying desperately to bring attention to the situation of John Huh, Jeenha’s brother, who is currently inside CMF. Jeenha said John Huh was sentenced at age 18 to a 28-year sentence, and he is currently age 41.

Jeenha Huh spoke about her brother’s experiences and his current situation.

“He’s trying to survive,” Jeenha Huh said. “He knows he’s coming out soon.”

Despite the promise of release in a year and a half, John Huh maintains that to get there, he will need to survive not just the pandemic sweeping the prison but also multiple threats on his life since transferring to CMF a little more than a year ago.

“One day my brother called me, crying for help, because he just wanted to survive,” Jeenha Huh said. Referring to CMF’s reputation as a low-security medical facility, she said, “He was actually happy he was going to go there, and it’s just been dreadful for him.”

Despite the promise of release in a year and a half, John Huh maintains that to get there, he will need to survive not just the pandemic sweeping the prison but also multiple threats on his life since transferring to CMF a little more than a year ago.

This is a familiar theme when it comes to CMF; its reputation as a medical institution leads many to expect it will be an improvement in comparison to the horror stories that surround more high-profile CDCR prisons, but it sometimes proves even more dangerous than the alternatives for two very critical reasons:

First, the licensed Acute Care Psychiatric Hospital that was the shining star of CDCR mental health care no longer exists. While CMF still provides acute psychiatric care, that particular unit was operated directly by the California Department of Mental Health until its dissolution in 2012, at which point it was taken over by the derivative California Department of State Hospitals, or DSH. The DSH contract with CMF, however, was not renewed in 2017, and the prison’s medical care is now run through CDCR and CCHCS. This means that the standard of care and medical (particularly mental health) expertise at CDCR has shifted dramatically over the last four years, according to Jen Orthwein, a lawyer who has argued multiple cases against CDCR prisons for abuse and retaliation.

Second, CMF is part of a large push at CDCR to integrate “Sensitive Needs Yards,” or SNY, into the “mainline” General Population yards at the majority of its prisons as part of Proposition 57. These prisons are now called “Non-Designated Programming Facilities.” SNY was established to protect prisoners who were at increased risk of harm from other inmates. Thus a large percentage of the SNY population is composed of transgender, nonbinary and gender-nonconforming people in prison. The CDCR website frames merging the yards as a progressive move stemming from recent pushes toward criminal justice reform, claiming that the targeted facilities “are intended to provide an environment focused on positive rehabilitative programming for inmates who abstain from violence.”

However, CDCR is not making this yard integration optional, and that leaves many people with a tough dilemma: risking their life on the mainline, or getting into ad-seg. Ad-seg, short for “administrative segregation,” is a euphemism for solitary confinement – 23 hours in a cell alone and one hour outside a day. Solitary confinement can have excruciating psychological effects and is a life-threatening situation itself, as studies have shown people in prison are up to five times more likely to commit suicide while being subjected to solitary.

A source, who asked to remain anonymous out of fear of retaliation toward his partner in the prison, told me that his partner, a transgender woman currently incarcerated in CMF, has been in ad-seg ever since a suicide attempt she made last August after being forced to share a cell with a man who made threats against her. In letters he provided me, his incarcerated partner describes how even in ad-seg, another prisoner managed to get ahold of one of the envelopes containing their correspondence and made threats to stalk and attack her partner.

He explained that his partner’s troubles don’t end with other prisoners. In her letters, she details one incident in which a doctor allegedly came to her hall to inform her that the medicine he planned to prescribe her would interact negatively with her HIV medication, revealing to her whole hall her HIV-positive status in the process. The harassment and attacks against her by other prisoners redoubled in intensity as a result, and her partner informed me that she later filed a violation complaint — that is in the appeals process — against the doctor that violated the federal law restricting the release of medical information, but the damage was already done.

Fear of retaliation

According to the anonymous source, his partner’s medical information being publicly disclosed wasn’t an isolated experience. In an incident that resulted in filing another privacy law complaint, she alleged that her doctor refused to speak with her privately about the results of a medical test, ignoring her requests for the CO accompanying her to step outside before discussing private medical information. She also claimed a doctor violated her rights granted by the Prison Rape Elimination Act, or PREA, by demanding that she remove her shirt when alone with him during a standard checkup.

The anonymous source has already had her PREA violation complaint rejected at all levels of appeal. Though the privacy law violation complaints are still in the appeals process, she is not optimistic about her chances of having any of these incidents resolved through CDCR’s reporting system. After the PREA violation complaint that his partner in CMF filed was rejected, the anonymous source said he sought legal support from the Transgender Gender-variant and Intersex Justice Project, or TGIJP, an organization that provides legal advice and advocacy for transgender and intersex people in prison. Because their case is ongoing, the partner in prison is still open to retaliation; TGIJP declined to discuss these specific allegations or details of any other cases they are currently involved in due to fear of retaliation against its incarcerated clients.

When written complaints about prison staff are subject to the internal review, Jones said, “you have to be careful because the COs will strip you out or turn your cell out, and find a weapon when you don’t have one.”

“There’s an evil law — the Prison Litigation Reform Act,” said legal director at TGIJP Alex Binsfeld. The Prison Litigation Reform Act, Binsfeld explained, requires people in prison to exhaust all internal appeals in a very short period of time before they are allowed to file suit for maltreatment. This opens prisoners up to retaliation, requiring them to jump through legal hoops such as filing a writ of habeas corpus — which orders that a person in custody be brought before a court — or mandamus to gain legal acknowledgment of the danger they may be facing. Additionally, prisoners cannot file lawsuits against CDCR or a specific prison but rather can only sue individuals, such as guards and medical personnel. The fact that one is required to single out defendants by name can increase the likelihood of retaliation.

“The process is so hard to understand, and for folks on the inside it can be a huge barrier,” Binsfeld said. For further explanation, Binsfeld referred me to Jasmine Jones, who works as a legal aide at TGIJP.

“They don’t make the forms available,” Jones said when asked about the process for someone in CMF filing a complaint. “Half the time they’re not turned in appropriately or they just vanish.” When written complaints about prison staff are subject to the internal review, Jones said, “you have to be careful because the COs will strip you out or turn your cell out, and find a weapon when you don’t have one.”

The anonymous source said his partner experienced this form of retaliation firsthand. He alleged that after he reached out to both the warden and the public information officer at CMF, a unit sergeant came to her cell to do a wellness check, during which the officer told her to get her partner to back off if she wanted to stay safe.

A spokesperson for CCHCS stated, “If there are complaints of retaliation made by an incarcerated individual, they are fully investigated and appropriate action is taken.” However, no further detail was provided as to specific measures that exist to prevent retaliation in the first place beyond it being against CDCR policy.

This story is a common one across CDCR prisons. Jen Orthwein referred me to a case their firm filed in federal court for CJay Smith, currently incarcerated in CMF. After she filed a complaint about sexual assaults she had suffered while in San Quentin State Prison, she alleged that she faced retaliatory measures, including a search of her cell that resulted in a “fabricated ‘Possession of a Deadly Weapon’ charge,” according to Smith’s legal complaint, which is still pending.

For vulnerable people in particular, Orthwein said, “When they raise their needs they get retaliated against and that leads to more horror and higher levels of security.”

“It’s the system itself”

“Every prison has these issues, it’s the system itself that causes these to arise,” Binsfeld said.

California does have one office, the OIG, which has the power to monitor and conduct investigations into CDCR, and it consistently produces illuminating reports on the quality of life and endemic problems within California’s prisons. While its commitment to transparency is admirable, the office seems to have secured little material change in the institutions it oversees.

That is because the OIG “can’t compel any changes and don’t have enforcement authority” over recommendations from its inspections and assessments, according to OIG public information officer Shaun Spillane.

The recommendations they do issue tend to be targeted, single-issue fixes with concrete steps the prisons can take such as recommending a different process for scanning in radiology forms to prevent miscommunications but offering no specific recommendations to remedy inadequate standards of preventive care they identified. Despite the overwhelmingly negative medical inspection results in its 2016 and 2017 reports on CMF, the number of clear recommendations issued by the OIG in those reports was minimal.

Orthwein also noted that recourse against CDCR through the courts is difficult, as CDCR is explicitly removed from tort claim action.

“Even federal judges are exhausted and have limited ability to hold CDCR accountable,” Orthwein said.

The legislature and the governor are the only two institutions independent of CDCR with the power to implement systemic changes to California’s prisons. Despite both having access to the OIG’s reports and the frequent news reports of crises in prisons (especially during the pandemic), neither has made a significant intervention on the behalf of the people locked inside institutions such as CMF.

“I just want people to understand that CMF is not what they think it is, these issues extend so long before the pandemic; the pandemic is horrific and it’s being mishandled,” Campbell said. “But it’s not just that.”

“People are never going to be safe inside,” Binsfeld concluded. “We just need our folks outside and into community care.”