Locked out of Care: The Hidden Human Cost of Prison Health Care in California
As federal oversight of the state prison system ends, the incarcerated worry health care will worsen
By Denis Akbari
Inside her cell, time moves slowly for Sonya Bullette. It’s marked not by clocks but by calls to her kids and grandkids and the taste of the 6:30 a.m. cracked wheat served at the chow hall.
Bullette, 53, currently incarcerated at the Central California Women’s Facility has not received appropriate health care for the last 13 years, she says.
She’s been in a wheelchair since 2012 because she needs a hip replacement that she has never received.
Interviews with over 30 incarcerated people at seven different state prisons along with a review of medical lawsuits and medical grievances show that, like Bullette, incarcerated individuals have repeatedly told the state that their basic needs aren’t being met. Their fear now is that it will become worse once a judge’s order for federal oversight to address the prisons’ shortcomings expires. More than a decade ago, a court ordered the prison system to fix its health care services: Today CDCR is still failing, incarcerated individuals and lawyers say.
Those in state prisons allege that California’s prison system, the California Department of Corrections and Rehabilitation, or CDCR, and the California Correctional Health Care Services, or CCHCS, are failing to keep people who are incarcerated healthy — neglecting to provide them with adequate care by making patients wait months before they are seen for serious conditions, dismissing patients’ concerns and physical pains and not providing any type of medical literacy, according to several accounts of incarcerated individuals, prison advocacy organizations and attorneys.
In an email, the prison system did not respond to questions about the alleged lack of care the incarcerated described, but stated that it follows the industry standard of care.
Waiting for Care
It took two weeks before Jambri Johnson, 47, received surgery after breaking his jaw.
“It sucked, it was difficult because of the pain I was in,” he said. “I was trying to stay cooped up in my cell, just trying to be real cautious and just stay in bed so nothing would hurt it even more. It was really stressful.”
Before the surgery, he waited in a hospital for four hours. The nurse told him he fractured his jaw in two places, but at the time, there wasn’t a doctor to consult with Johnson. He would need to visit another hospital, the nurse told him.
But he was sent back to San Quentin Rehabilitation Center and doctors prescribed him morphine three times a day for 90 days.
Johnson had a huge visible gap between his teeth.
“It was like a split in the gum. I had this open wound in my mouth, I couldn't even brush my teeth,” he said.
Sleeping for Johnson was out of the question.
“Sleep was almost impossible,” Johnson said. “I had to sleep on my back in an upright position, and when I woke up in the morning, that's when the pain was at its worst.”
Two weeks later he had his jaw surgery.
Elizabeth “Leesa” Nomura, who is the membership organizer for California Coalition for Women Prisoners says that wait times are often compounded by the dismissal of medical complaints.
“There are many ways for staff to retaliate against a confined group of individuals,” she said. “And one of those is withholding medical treatment.”
That was true for Scott Behnke.
Behnke, 42, suffered a severe skin breakout at Valley State Prison in Chowchilla because of a SaniGuard chemical exposure when working in the kitchen.
“My arm broke into hives and then the hives turned into an open wound and I was bleeding. I kept going to medical for days and they were not seeing me,” Behnke said. “I was nearly crying, I couldn’t even sleep.”
Behnke called his family and asked his mom to help. It wasn’t until his family called the institution and threatened to file a lawsuit that the medical officials finally decided to see Behnke and treat him.
“Am I not good enough? Do my complaints not count?” he said.
Behnke said he didn’t file any medical grievances or lawsuits because of how time consuming and ineffective they are in holding CDCR accountable. However, long wait times are not just painful but they make medical conditions worse over time.
Bullette echoed that sentiment.
Bullette has been waiting for a hip replacement for a little more than a decade, which is what put her in a wheelchair.
“If they had just done something when it first started to happen, I would have never gotten in the wheelchair and endured years of pain,” she said.
A Federal Mandate
Since 2006, California’s prison medical system has been under direct management of a federal court-appointed receiver or regulator, who took over the administration of prison health care service because the state was found to be providing unconstitutional levels of care.
Appointing a receivership is a rare step taken when federal judges feel they have exhausted other options.
That case is now known as Plata v. Newsom.
Despite the changes and new level of oversight, health care in the prisons still needs improvement, according to civil rights attorney Eric Sapp.
“There's a constitutional right not to be subjected to deliberate indifference to health and safety, as a component of the prohibition on cruel and unusual punishment,” he said.
Sapp said that under the California penal code, for instance, it is a misdemeanor to block care that would injure or impair the health of the prisoner.
However, he said that this is unenforced.
Doctors and nurses at the California Correctional Institution in Tehachapi act like police officers but with scrubs, says Roland Cardiel, 45.
Cardiel has been suffering from various medical complications such as type-2 diabetes and bone spurs in his heels for which he needs special medical shoes. He has been waiting for the shoes for over a year and has been denied access to them.
This causes him pain in his lower back and knees and makes it more challenging for him to get through his daily programs. Cardiel has filed medical grievances but is still waiting to hear back.
There are very few successful lawsuits filed from incarcerated people, according to Alissa Moore, re-entry coordinator at Legal Services for Prisoners with Children, or LSPC.
“You need a law firm behind you to be able to do that or you are limited as an incarcerated individual. Many times people are unable to follow through with the financial obligation, even when it’s a small fee,” Moore said. “Their choice would be to either have soup, soap and toothpaste for the month or send an appeal.”
Back in the Central California Women’s Facility Bullette explains that the wait times and neglect take a toll, but not only physically.
“This is mental, emotional, psychological, psychological. Because it's like you can't function in pain 24/7. Being a lifer, they don’t care about us,” Bullette said. “This is not a system that's made for us. Once you start getting sick and your body starts breaking down here, it just slides all the way down the hill. They do not care.”
A friend of Bullette, Chantell Gosztyla, 39, has had acute rib pain since 2008 because of a popped rib caused by a car accident while she was in the free world. In 2019 when she got to the Central California Women's Facility in Chowchilla, her regular chiropractor appointments stopped.
Since then she has been seeking the help of a specialist and her doctor finally referred her to a chiropractor in November 2024. However, she received a denial from the prison system in February 2025 to see a chiropractor.
“Women are an oppressed minority. Incarcerated women are even more oppressed,” Gosztyla said. “Most women here have had a violent abuser and lots of trauma. It’s harder for women to speak for themselves in these circumstances.”
Gosztyla has filed many medical grievances and she is currently fighting the prison system in a lawsuit.
“I wake up in the middle of the night with so much pain,” she said. “What I have resulted in is wrapping a sheet around my blanket, tucking it underneath my bed and making it like a sleeping bag. I can cool myself inside my bed to try to keep me in a neutral position and to keep my arms below.”
Wearing the bras that the prison provided was not just uncomfortable for her, it was painful. Something as simple as getting dressed turned into an emotional and physical battle because of the tightness intensifying her rib pain.
“Why is an incarcerated person’s health, regardless of sex and gender, not as essential as everything else? Why can’t nurses and doctors run when there is a medical alarm too? They should be running as cops do when there is an alarm for a fight.” Frank Wells, 61, said about his daily life - Mule Creek State Prison
“They literally told me to not worry about it because I’ll be dead before I get to stage five. People think you're in prison, you deserve that or whatever. My only concern is getting out of here alive.” Stanley Miller, 57, has to wait about 90 days between multiple appointments to be able to see a specialist for his stage three kidney failure and possible Crohn's disease - California State Prison Solano
Understaffed Care
Recent evaluations from the California Legislative Analyst’s Office show the high vacancy rate of medical staff. The vacancy rate varies by department, by occupation and by facility and it is 32%, which is a lot higher than it was in 2006 — before the federal oversight. This has contributed to the gap in understanding between medical officials and the incarcerated.
Many incarcerated individuals might not know medical jargon and this takes away their opportunity to understand what is going on with their bodies and take action, according to LSPC re-entry coordinator Moore.
Brian Thames, 56, has been hospitalized three times for kidney stones while incarcerated at California State Prison Solano. Initially he was unaware of what that entailed and the reasoning behind it, but he made it a point to figure it out.
“I think that the medical professionals within these prisons can help improve a lot by actively helping and growing the health literacy of patients, even during visits,” Thames said. “Know that you're not talking to your medical peer, know that you're talking to a patient and that that patient is also a human being.”
Thames adds that health literacy and clearing up language barriers is very important and if doctors must write in medical jargon when writing notes, at least they can try to explain and communicate better when they are face-to-face with the patient.
Many people are uneducated but whatever their degree is or is not, the medical system is very complacent in dismissing the incarcerated population, according to CCWP membership organizer Nomura.
Like Thames, Gosztyla is also her own lawyer.
“Unless you as a patient very diligently advocate for yourself, you will not get your medical needs met, especially in this institution,” Gosztyla said, referring to the Central California Women's Facility. “You have to push it, fight for it. You have to order your medical records and you have to stay on top of absolutely everything.”
The federal oversight that was mandated in 2006 to oversee health care is coming to an end. Despite years of federal intervention, California State Assembly reports show that CDCR continues to face a number of long standing and still heavily litigated class action lawsuits for a number of constitutional violations and other policies that endanger the lives of incarcerated people.
And addressing the litigation has cost the state billions.
But the prison system has come a long way since being placed under federal oversight as a result of the Plata v. Newsom's case.
The Plata parties stipulated to injunctive relief in June 2002, requiring the CDCR to implement a series of health care improvements and subjecting the CDCR to a series of audits to determine compliance.
Judge Henderson, assigned to this case, elaborated on October 3, 2002, that the state’s prison medical system was “broken beyond repair” and that future harm was “virtually guaranteed in the absence of drastic action.”
As of March 2025, the receiver has delegated oversight of health care of 26 out of 31 institutions back to CDCR. The remaining five institutions are California Health Care Facility, Stockton, High Desert State Prison, California State Prison, Sacramento, Substance Abuse Treatment Facility and Salinas Valley State Prison.
Byron Fairbanks, 64, is at the Stockton facility which will remain under court oversight. He continues having issues with doctors getting his medications on time, he says.
“The doctor just couldn’t give me a reason why my supplies were not available and he suggested I self-catheterize,” Fairbanks said. “I had an infection before from them self catheterizing me and I didn’t want to do that again.”
For someone on dialysis, a delay in supplies could be life threatening.
The Prison Law Office has been the only legal representation for Fairbanks because “there is an undersupply of legal service provision for incarcerated persons,” as LSPC attorney Sapp stated.
So CDCR has once again failed the incarcerated population, while medical care is almost fully restored back in its hands, according to Moore.
The prison system responded to the claims by saying that CDCR and the CCHCS follow the industry-standard Complete Care Model for patient care, which is focused on providing continuous, comprehensive and coordinated care based around the individual patient’s needs.
In response to that, Moore thinks that there are some serious issues with respect to incarcerated life and how much it's valued.
“We need to at least demand a minimum of care for these individuals because they have no dignity, and we have stripped that from them as human beings in the state of California,” she said. “I'm not even going to say this is about human rights, because they have none. But I do believe that we can hold legislators accountable to at least treat them as humans and make sure that we are not making them sick.”
Meanwhile — Bullette continues to count the days and seasons until she can receive appropriate care.
But until then, she’ll keep going to the chow hall in her wheelchair.
“Here you have time,” Bullette said. “You have nothing but time.”