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Q&A with KPCC's Julie Small: Investigating Prison Health Care

Q&A with KPCC's Julie Small: Investigating Prison Health Care

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Prison health care in California costs about $2.5 billion per year, but the quality of that care has been so abysmal over the years that a federal judge in 2002 forced California to give up control of its prison health services to a federal receiver. Eight years later, few journalists have bothered to follow up on this once headline-grabbing topic. The prison health story, like so many other complex policy topics, became a casualty of the state capitol press corps' thinning ranks.

Julie Small/SCPR

These days, few journalists have the time, resources or interest to dive deep into the state of prison health care. Julie Small, state capitol reporter for Southern California Public Radio and a California Endowment Health Journalism Fellow, is the exception. Her investigative series, Prison Affliction: Medical Care Inside California's State Prisons, started airing Monday on KPCC and will continue through Friday. Below, you'll find our conversation, which has been edited for clarity and length.

But first: this week, Small will participate in an Internet radio show hosted by ReportingonHealth to discuss the story behind her prison health care investigation, moderated by ReportingonHealth editor-in-chief Michelle Levander. Small will talk about the challenges of reporting on prison health, including secrecy at the prisons, fear of reprisals against her sources, and the challenge of verifying allegations.

Join our interactive chat Thursday at 11:00 a.m. - just click here to listen!

Q: Can you give us a brief overview of what you found in your reporting?

A: What I found was a lot of pressure, because of California's state budget cuts, to say that prison medical care is all better now. California's been under a court order since 2002 to improve its prison medical care - because a lack of care was leading to inmates dying and unnecessarily suffering. There's been a lot of progress, but there's a lot further to go.

Q: Why did you decide to focus on prison health?

A: I was very affected by the first prison I visited. I went with the first federal receiver. The idea that people could die in prison because they couldn't get a basic asthma inhaler medicine – was unacceptable and disturbing to me. As I've watched the California capitol press corps dismantled - I'm one of the last people standing on this issue - I feel I'm more committed to covering it now.

Q: What challenges did you face in reporting this series?

A: How much time do you have? A big part of the challenge is that there's no real good measurement of what's going on with prison medical care. All parties involved (in the lawsuit) agree that the way they're trying to measure improvement isn't that accurate. The number of people dying went down but the number of people who may have lived longer with better medical care has risen. It's very confusing. The attorneys who brought this class action lawsuit also have trouble keeping track of progress. There's a lack of a concrete way to say "yes, it's succeeding" or "no, it's not."

Q: How did you deal with issues of patient and prisoner confidentiality?

A: There's an extra layer of (confidentiality) in that you can't request to speak to a particular inmate - you'll only get someone who's random. I tried to get the names of inmates who died. I thought I could contact their families and get medical records from them. But that information is confidential. There are a lot of other ways I tried to gain access. I went to the courts and looked for lawsuits from inmates. . We went to the Prison Law Office (which filed the landmark lawsuit). They couldn't give me information but they gave my information to inmates. We reached out to people online.

Q: What was the most surprising aspect of reporting the series?

A: I was surprised by how unwilling people are to talk about what goes on in prisons. People who work there don't want to lose their jobs. It was amazing that there was no whistleblower. No one was willing to go on record. A lot of people expressed fear about retribution. A lot of people say that the prison guard union is very, very powerful. It can affect politicians but also family members worried about retribution against inmates. Former guards who might have wanted to talk didn't want anyone coming after them.

Q: What turned out to be easier than you expected in your reporting, and what turned out to be harder than you expected?

A: Getting inside prisons was easier than I thought it would be. Finding inmates was harder than I expected. If anyone dies in prison, it's investigated and noted on a death certificate. But there is no way to identify which people were prisoners (on the death certificates). You have to have a name.

Q: You had a lot of news to cover while you reported this series. How did you balance breaking news with long-term enterprise reporting? 

A: I tried to follow the recommendation that I keep (the investigation) in my back pocket until it's halfway there. I did an hour here and there, and then presented that to my editor. I tried to do the daily news first and get something on the air early in the day.

Q: Did this project make you a better reporter?

A: One of the great things about being reporter - I may start out with one set of beliefs and that set of beliefs changes. That's a sign that I'm open to what I find out to be true. If you hear enough people say the same thing, who have different vested interests, you can glean that that's probably true. I wanted to go further with this series, but what I ended up is more nuanced because that's the truth.


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If a family member wants to have access to a prisoners medical records how do you do this?

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It appears that inmates can only release medical records to their attorneys.

But double check with your prison's inmt family council. Somebody must have tried to get these records. And let me know what you find out.


Julie Small

3370. Case Records File and Unit Health Records

Material—Access and Release.

(a) Unit health records means a patient's health record that includes all records of care and treatment rendered to an inmatepatient.

(b) Except by means of a valid authorization, subpoena, or court order, no inmate or parolee shall have access to another’s case records file, unit health records, or component thereof.

(c) Inmates or parolees may review their own case records file and unit health records, subject to applicable federal and state law. This review shall be conducted in the presence of staff, and may necessitate the use of a computer.

(d) No inmate or parolee shall access information designated confidential pursuant to section 3321 which is in or from their own case records file.

(e) No case records file, unit health records, or component thereof shall be released to any agency or person outside the department, except for private attorneys hired to represent the department, the office of the attorney general, the Board of Parole Hearings, the Inspector General, and as provided by applicable federal and state law. Any outside person or entity that receives case records files or unit health records is subject to all legal and departmental standards for the integrity and confidentiality of those documents.

NOTE: Authority cited: Section 5058, Penal Code. Reference: Sections 2081.5, 5054 and 6126.5, Penal Code; Sections 56.10, 1798.24 and 1798.40, Civil Code; and Code of Federal Regulations, Title 45, Sections 164.512 and 164.524.


1. New section filed 12-20-91 as an emergency; operative 12-20-91 (Register 92, No. 4). A Certificate of Compliance must be transmitted to OAL 4-20-92 or emergency language will be repealed by operation of law on the following day.

2. Certificate of Compliance as to 12-20-91 order transmitted to OAL 4-15-92 and filed 5-27-92 (Register 92, No. 24).

3. New subsection (b) and subsection relettering filed 3-24-99; operative 4-23-99 (Register 99, No. 13).

4. Amendment of section heading, section and Note filed 1-19-2006; operative 2-18-2006 (Register 2006, No. 3).

5. Amendment of subsection (e) filed 12-9-2008; operative 1-8-2009 (Register 2008, No. 50).

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