Sister Antonia Maguire, a Catholic nun who works in a New York state prison, told a story about an inmate named Cathy who complained every day for a week that she felt sick. At the prison clinic, she was given medicine for a cold, and hot tea.
Refused permission to see a doctor, she grew worse. She begged her mother to contact the superintendent, Maguire said, but died before the call could be made. A post-mortem showed congestive heart failure. She was 32.
"Not once did she see a doctor," Maguire said. "Not once did anyone put a stethoscope to her chest. Not once did anyone take her blood pressure."
Maguire was speaking last week to the Commission on Safety and Abuse in America's Prisons as it pursued a year-long effort to illuminate life behind bars for 2.2 million inmates and the 750,000 men and women who staff the facilities. The idea behind the 21-member group is to identify problems and find salable ways to address them.
The nation's prisons and jails have hardly been a source of innovation or good news in recent years, despite the estimated $60 billion spent annually on corrections. But some experts see a shift in perception and politics that could create openings for creativity in sentencing, incarceration and parole.
Michael Jacobson, former director of New York City's corrections department, says state budget crunches and dropping crime rates are creating a "historical moment." He pointed to crime's declining rank among issues Americans care most about and the trend toward flexibility in handling nonviolent offenses, especially drug cases, in such states as Arizona, Kansas and Michigan.
"We're in a period now where we can do some pretty interesting reform," said Jacobson, director of the Vera Institute of Justice, a New York-based nonprofit that is the prison commission's principal sponsor.
The climate has "changed substantially," agreed Marc Mauer, assistant director of the Sentencing Project, based in Washington. He sees a fresh opening for what he calls "rational discussion of policy and different choices."
"There's a growing liberal-conservative consensus that it's in everyone's interest that we provide resources in prison that decrease the chances of recidivism," Mauer said, also noting an added emphasis on programs to help inmates reenter society. "Ten years ago, there was what we can only characterize as hysteria around crime."
In a three-year stretch ending in 1996, legislatures in about half the states in the country passed "three strikes" laws that imposed stiff penalties for repeat offenders, Mauer said. Prosecutors tried more juveniles as adults and judges sentenced accordingly, their hands often tied by mandatory minimum sentences.
States and the federal government built prisons in the 1990s at an unprecedented pace, farming out inmates they had no space to keep. Highly fortified "supermax" facilities rose from farmland, providing jobs and a sense of security to people outside the walls, if little hope to most on the inside.
On any given day, more than 2 million Americans are living behind bars, an increase of more than 500,000 since 1995, said Allen J. Beck, the Justice Department's top authority on the corrections system. Five million more people are on probation or parole.
The likelihood that someone will serve state prison time for a conviction has grown, except for drug crimes. Crowding remains severe, straining inmates and officers alike, and services behind bars are few. Beck said an estimated 150,000 state inmates released in 2000 needed drug treatment but did not receive it.
The commission, co-chaired by former attorney general Nicholas de B. Katzenbach and former federal appellate judge John J. Gibbons, chose urban Newark for the second of four scheduled hearings. Members include former FBI director William Sessions, Southern Center for Human Rights director Stephen B. Bright and California Senate Majority Leader Gloria Romero.
"I hope this is not just another commission . . . ," James Bruton, who once directed the supermaximum Oak Park Heights prison in Stillwater, Minn., told the group. "This country is in sad shape when it comes to prisons."
Pearl Beale's son was stabbed to death in the D.C. jail in December 2002. She told the commission through her tears that prisoners "might be out of sight, but they're not out of our concern." She said later that she does not understand how the killer stabbed her son nine times without the guards seeing.
"I would like to see some improvement. There's a need," Beale said. "What is it going to take to bring attention to what needs to be done?"
Yet what needs doing is itself a point of considerable debate.
Corrections officers and prison officials point to low salaries, high turnover and often miserable morale. In Louisiana, starting pay is $18,000 and family health insurance costs a worker $3,600 off the top. Turnover is 30 percent a year.
Vocational and educational programs in state prisons have fallen victim to budget cuts and complaints about coddling prisoners. When Gary Harkins started work for the Oregon Department of Corrections in 1980, an inmate could learn a vocation or study all the way to a PhD. These days, he said, the 2,000-inmate Oregon State Penitentiary has no teachers on staff, no graduate-equivalent degree program.
Mental health experts said prisons and jails are woefully short of trained professionals able to diagnose and treat the large number of inmates who have psychiatric problems. The longtime trend toward closing mental hospitals and returning the patients to communities unable to support them means more are ending up behind bars.
Unable to handle mentally ill prisoners, who can be unpredictable and violent, some prisons resort to confining such inmates to disciplinary segregation or isolation cells for periods that can stretch into years.
Solitary confinement, where inmates are typically confined for 23 hours a day with virtually no contact with others, is "psychologically toxic," said Massachusetts psychiatrist Stuart Grassian, who has studied the results. He said some prisoners find themselves "literally mentally rotting."
"With the huge influx of the mentally ill into our institutions, and staff not properly trained to work with these individuals, the stated purpose of our institutions is being challenged," Harkins told the commission. "Are we a correctional institution or are we a mental health treatment facility? I am not sure those two areas are truly compatible with each other."
Thomas Farrow murdered a New Jersey grocer and had his sentence commuted 16 years later for good works while incarcerated. He said he was diagnosed as bipolar and later spent eight more years behind bars for violating parole.
There was "no meaningful treatment" for himself or many other inmates, said Farrow, who concluded that time behind bars leaves mentally ill prisoners "in no shape to fight for the help they need on the outside."
"Prison," he said, "is a hostile environment that uses your illness against you."
Daud Tulam spent 24 years in prison for armed robbery, his second felony conviction. Eighteen of those years were in the isolation section of the Management Control Unit, where inmates live in single cells measuring about 9 by 13 feet. He kept his head by regimenting his day but felt poorly prepared to leave prison behind a year ago.
"My motto is, 'If you're not building, you're BS-ing,' " Tulam said in an interview. "It is a struggle for you in society. If you don't have nothing to anchor your sanity to, it definitely gets at you."