Pamela Clifton isn't the ideal mother. With an arrest record that includes larceny, burglary, criminally negligent homicide, and a couple of drug busts, she's been in prison before.
But Clifton, 39, says she loves her kids. Her two surviving children -- a son and a daughter aged 11 and 7 -- are in foster care as she serves a six-year sentence in Cañon City on a drug charge. The third died in prison -- in Clifton's womb.
Clifton has filed a civil suit against four prison workers in U.S. District Court alleging that negligence and lack of training on the part of prison personnel is to blame for her baby's stillbirth.
Her story raises questions about the general health of Colorado's 1,200 female inmates, who are served by less than one full-time equivalent physician.
David Lane, Clifton's attorney, said medical care in Colorado's Department of Corrections is so lacking that it at times violates the Eighth Amendment, which protects prisoners from cruel and unusual punishment.
Christmas in Cañon City
Clifton was sentenced to prison when she was two months pregnant, one of about a dozen pregnant women put behind bars in the state each year.
When Clifton began feeling regular contractions early on Christmas Day 1998, she was alarmed. She was a month short of her due date. Clifton says she approached Officer Dawn Anaya, a guard, and told Anaya she was in labor and needed medical help.
Rather than calling for medical staff, Anaya allegedly ordered her to go back to her unit.
Surprised by the indifference, Clifton says she then approached another guard -- Iria Wilkes -- who also ordered her back to her unit, allegedly telling Clifton there were "plenty of women back there who could birth a baby."
Clifton's contractions, timed by another inmate, were coming three minutes apart, and she was in significant pain. "I felt completely powerless at that point."
She went back to her unit, and with the help of the other inmate, continued to work through the contractions. By evening they had become erratic. The pain, says Clifton, was different from that she'd endured during her previous labors. She started to worry.
At the change of shifts, she and the other inmate approached another guard, who immediately sent her to the infirmary.
Nurse Iona Eubank, not a regular DOC employee, checked Clifton and told her that because her water hadn't broken, the labor was likely a false alarm.
"I asked her to check with the fetal heart monitor because I felt something was wrong," Clifton said. "It didn't feel right."
Eubank allegedly told Clifton she didn't know how to use the monitor and sent her back to her unit.
Clifton said the contractions continued through the night. Increasingly afraid, Clifton got the attention of another guard early the next morning.
By then she had a new worry. Her "very kicky" baby had stopped moving.
Grief behind bars
By morning Clifton could feel nothing.
Nurse Eubank was on duty again. This time, however, Eubank called a doctor, who hooked Clifton up to the fetal heart monitor.
The machine could not detect a fetal heartbeat.
"I was scared," Clifton said. "I knew something had gone wrong."
Clifton clung to that hope as she was transported to a nearby hospital. There, tests showed the fetus' heart had stopped beating.
Clifton was crushed.
Because her labor had stalled, the medical staff decided to send her back to prison.
On Dec. 28, she was taken back to the hospital, where she delivered a 5-pound, 3-ounce stillborn girl. Clifton was allowed to hold her baby briefly.
A social worker was sent in to comfort her, but Clifton says she felt alone.
Then a DOC representative arrived to tell her she'd need to cover the cost of disposing of the baby's remains, a new worry as Clifton is indigent.
After frantic collect calls to friends and relatives to raise $3,000 to cover the cost of a funeral, the baby was buried in Greeley. Clifton, in jail, was unable to attend. Although more than two years have passed, she says she hasn't yet been able to grieve.
"I have to put that aside until I get out," Clifton said. "There's no way to heal it in here."
Disregard for dignity
Clifton believes that if she had been taken seriously -- and if the guards and the nurse had taken her to the hospital when she'd first approached them -- doctors would have been able to save the baby.
Although her past might suggest otherwise, Clifton insists drugs had nothing to do with the stillbirth.
"I have never taken drugs in prison," she said.
Prison officials conduct random urine tests on prisoners -- about 17,000 tests last year, according to the DOC.
Lane says no one can be sure why the baby died since no autopsy was performed. But of one thing he is certain.
"Department of Corrections medical care is so lacking as to be shocking," Lane says. "We get complaints every day."
Anaya, Wilkes, and Eubank are named in the lawsuit, as is Dr. Joseph McGarry, whose job it was to supervise prison medical staff.
Citing privacy concerns and pending litigation, DOC officials would not comment on Clifton's claims. However, in a document filed with the court, the defendants deny Clifton's allegations and have demanded a jury trial.
The DOC by law has to provide the community standard of medical care, said spokeswoman Heidi Hayes. Medical personnel are required to meet community standards as well, she said.
Inmates who believe they've been mistreated can avail themselves of the DOC's grievance process by first making an informal complaint, then a formal written complaint, which is reviewed by another doctor on the medical staff. If they're still unhappy, inmates can call for a review by the central DOC office.
Hayes said she could not say how many internal medical grievances have been filed by female inmates, nor could she reveal the outcome of grievances because the information is not public.
Clifton said she has exhausted her options within the DOC.
"The DOC needs to address the fact that women have some special needs," she said. "Just because we're inmates doesn't mean we should be discounted or treated as less."
A double whammy
The U.S. Department of Justice has defined women as a "special needs" prison population, but most facilities have taken few steps to address those needs, in part because women constitute a small minority of inmates.
In Colorado, only 7.9 percent of the inmate population of more than 16,000 are female, accounting for about 1,200 women. Those women share a medical staff of less than one full-time physician and the equivalent of 17 other support staff positions.
Lynda Monsey, a women's health nurse practitioner with the Boulder Valley Women's Health Center, said those figures seem low. Incarcerated women, she said, typically present a greater array of health problems than the general population.
"These women come in with every problem in the book," Monsey said.
Many haven't received regular medical care for most of their lives. Lack of care combined with poor choices, physical and sexual abuse, poor nutrition and hard living contribute to overall poor health.
Women in prison face another obstacle as well.
"They've done something wrong, so they're considered 'bad women' by society," Monsey said. "And they're women. Women aren't believed."
Clifton will soon be eligible for parole. She may make it out in time to press her court case as a free woman.
But the civil trial isn't foremost on her mind. When she gets out, the first thing she wants to do is visit that quiet grave in Greeley.
If she hadn't been in prison, Clifton says, her baby would have lived.
"I need to see her, and I need to apologize," she said. "I feel guilty because I'm her mother and I didn't take care of her."
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