After spending 20 years in the Georgia prison system, Melodie Rosser said she’s lucky to have made it out alive.
The community organizer nearly died while incarcerated when she developed an infection from a procedure meant to detect if she had breast cancer. Over time, she said, her breast began to turn black.
At age 12, doctors told Rosser there was a mass in her breast. She was advised to have it examined annually. If by the time she turned 18 the lump was still present, doctors recommended she get a biopsy.
When Rosser turned 18 not only had her mother passed away from breast cancer, but she went to prison. Rosser, now 40, said during her incarceration it was incredibly difficult to receive medical care, even with a family history of breast cancer.
It wasn’t until six years into her prison sentence that Rosser was transported to a hospital to have a biopsy performed.
After the surgery, she said the prison misplaced her medical records and as a result they did not have the accurate information about her aftercare. The incision site ended up reopening, bleeding, and eventually becoming infected.
“Once it got infected … the nurses didn’t even want to deal with it anymore because they didn’t know what to do themselves. No one had the common sense to take me back to the hospital. And so, finally, if my aunt hadn’t came down there, I probably wouldn’t be alive,” Rosser said.
Further risking her health, she said, she was not given annual mammograms after the procedure. She said she was told she was too young to get screenings.
Rosser, who now works for an Atlanta nonprofit called Women on the Rise that helps women coming out of jail and prison, said that her harrowing health journey isn’t unique for formerly incarcerated women.
Cancer is a leading cause of death for individuals incarcerated in the U.S. For Black women, who are disproportionately impacted by both breast cancer and incarceration, the stakes are even higher.
According to the American Cancer Society, Black women face the lowest survival rate for every known stage of breast cancer across racial demographics. On top of that, according to the Prison Policy Institute, Black people make up 13% of the U.S. population but are 37% of the people incarcerated in the country.
Physicians, advocates, and formerly incarcerated women told Capital B Atlanta various barriers such as delays in medical care, difficulties obtaining medical test results and records impact care. The dehumanization of individuals in the prison system have also caused incarcerated women to receive inadequate preventative and chronic medical treatment to help detect and treat breast cancer.
Policy versus practice
In a statement to Capital B Atlanta, Lori Benoit, the deputy director of communications for the Georgia Department of Corrections, said that GDC provides a “full range of treatment services needed to meet contemporary community standards.”
“In addition to routine diagnostic tests received upon admission to the GDC, female offenders will receive a full health screening and review of systems as well as a comprehensive female exam including gynecological and breast exam and baseline mammogram for women greater than forty (40) years of age or with a family history of breast cancer or as clinically indicated,” Benoit said.
Advocates said that GDC policy doesn’t always align with what happens in practice.
Dr. Mark Spencer is an internal medicine physician and the executive director of Stop Criminalizing Of Our Patients, a group of medical and public health professionals working to address healthcare issues inside the criminal legal system and advocates for alternatives to incarceration.
Spencer said that in the U.S. prison system, security runs everything — including medical care. He said if security lacks adequate staffing the day that a health screening is supposed to take place, the screening will be delayed.
“One thing we know about jails, prisons across the whole country, is that staffing is critically poor, and in Georgia sometimes they have vacancies of 50% or 60%. If you don’t have security staff, then nothing functions, including medical,” he said.
Christy Perez, co-founder and director of public affairs for Georgia Prisoners’ Speak, echoed Spencer’s sentiments. She saw staffing issues play out in real time as she was previously incarcerated in the state’s prison system.
“I have been to no less than 14 facilities in my decade. I was what they called a problem inmate because I was a litigator and I won, and so I would get transferred a lot,” Perez said. “Every institution more or less suffers with the same issues. When I first came to prison in 2010, 2011 … it was better in terms of staffing. Around 2018, that began to pitch down sharply. Once COVID hit, it was completely obliterated.”
She said another layer of the problem is how prison staff treat incarcerated individuals in GDC’s system.
“When a nurse or a new guard comes in, they go through their training, and their training tells them things like, ‘You can’t trust incarcerated people. Don’t turn your back on incarcerated people. They’re liars. They’re here because they did something terrible,’” she said.
“As a result, what it does to those nurses and those new officers is it makes them apathetic and not able to tap into their empathy, and they see you as different, and they see you as trying to game the system. So even those that show up with good intentions that want to do something good, they usually don’t last long, or they end up becoming part of the problem,” Perez said.
Spencer said breakdowns in medical care and delays occur due to the need to outsource certain equipment, like mammogram scanners, or needing to arrange transportation to take someone to see a specialist.
“This is extremely burdensome, time-consuming, takes a lot of staff, takes a lot of money and time. So this is why it doesn’t happen. So one anecdote I’ll use was from a gentleman who had urologic cancer. He was supposed to get chemotherapy once a month, but the prison couldn’t even figure out a way to coordinate him getting it once a month,” he said. “So over the course of about 12 months, he probably got about six infusions out of 12, and … the issue for him was purely based around transportation logistics.”
Spencer said delays can drastically change someone’s health outcome, especially for a disease like cancer.
“[Timing] could be the difference between having a … mastectomy or even just having one medication versus needing radiation, chemo, bilateral radical mastectomy, and having a life expectancy less than five years versus having a curative procedure,” he said.
Perez said GDC’s health policies are “only as good as the paper it’s written on.”
“When it comes down to what their policy says and what they’re doing, their policy … on its face it looks to be medically comprehensive and commensurate with standards of care. The breakdown is the reality,” Perez said. “There are delays of weeks and months just to speak to somebody and be able to give them a report of what’s wrong with you, and then there are so many fumbles in that handling of the treatment and handling of the patient, and there’s so many impediments that are structurally built into the agency and into the environments that it maintains.”
Consequences to delayed care
Robyn Hasan-Simpson, the executive director of Women on the Rise, got the news this year that doctors discovered a large lump in her breast. She immediately recalled all the times she was not provided mammogram screenings while incarcerated in Georgia’s prison system.
Hasan-Simpson concluded her 10-year sentence when she was 44. She said she had only one mammogram in that time and was never provided with her results. Now 50, she said she believes that if she had been ordered to get annual mammograms while incarcerated, the lump may have been found earlier.
“My doctor was telling me this is something that has grown over years and definitely could have been detected. So in June of this year I had to go in and have surgery to have it removed,” she said.
While the mass was found to be benign, her doctors say she must get a mammogram every three months moving forward.
Keisha Dickerson, a staff member at Women on the Rise, said that she recalls having a mammogram delayed by nearly half a year due to security issues while she was incarcerated.
Dickerson, 53, said she had to become her own health advocate throughout her 15 years in the state’s prison system. With Women on the Rise, she now works to provide information on health insurance and access to medical care to those coming out of the carceral system.
Before being incarcerated, Dickerson said she was getting mammograms in her 30s because breast cancer runs in her family. In prison, she had to continuously advocate to get screenings as she was told she had to wait until she was 40 to get one.
Multiple mammogram test results showed cysts in her breasts, but doctors told her no treatment was needed.
Upon her release, she underwent a procedure to drain a large cyst found in her left breast. A similar procedure must be done on the right breast in the future.
While she believes her issues may have been downplayed by doctors in prison, she said had she not pushed for screenings, they likely wouldn’t have happened.
“You really have to put the pen to the paper in order for you to get a lot of things done. If you’re not writing your grievances … you’re not going to get anything done. They really don’t see you,” she said.
Rosser, Dickerson, and Hasan-Simpson said they all use their experiences to highlight the issues of healthcare in the prison system and to advocate for those who are currently incarcerated. A large part of their work is getting the public and policymakers to see the humanity of those who are incarcerated.
“So when you look into the policies, the policies are in place for them to do what they’re supposed to do, but it’s the culture of the staff and the culture of [GDC],” Rosser said. “If they don’t see us as human, then of course they’re not going to do the things that they’re supposed to do to ensure our safety and our humanity and to make sure that we have the medical care that we need.”
“And that’s from prisons all the way to county jails. If we don’t change the culture, then of course they’re not going to look at the policies that are in place because they feel that security overrides everything.”
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