Cruel and Unusual Health Care

How Mississippi prisoner Jamie Scott’s life sentence could turn into a death sentence.

<a href="">Free the Scott Sisters!</a>

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On February 25, a small crowd gathered outside the state capitol in Jackson, Mississippi, to push for the release of sisters Jamie and Gladys Scott, who are serving two consecutive life sentences apiece for a 1993 armed robbery in which no one was injured and the take was about $11. Supporters of the Scott sisters have long tried to draw attention to their case as an extreme example of the distorted justice and draconian sentencing laws that have overloaded prisons, crippled state budgets, and torn families apart across the United States. But in recent months, their cause has taken on a new urgency, because Jamie Scott’s unwarranted life sentence may soon become a death sentence.

Jamie, 38, is suffering from kidney failure. In order to stave off further complications, she needs either a kidney transplant or regular sessions of dialysis, a procedure in which blood is drained from the patient through a cleansing filter and then returned to the body. But at the Central Mississippi Correctional Facility (CMCF) in Pearl, where Jamie and Gladys are incarcerated, medical services are provided by a private contractor called Wexford, which has been the target of lawsuits and legislative investigations in several states over inadequate treatment of the inmates in its care. According to Jamie’s family, in the eight weeks since her condition became life-threatening, she has endured faulty or missed dialysis sessions, infections, and other complications. She has received no indication that prison doctors are considering a kidney transplant as an option, though her sister is a willing donor.

Jamie’s family and legal advisors believe the poor health care she is receiving in prison places her life at risk. The Mississippi Department of Corrections (MDOC) has a provision for what it calls “conditional medical release”—but Jamie is not a candidate, department spokesperson Suzanne Garbo Singletary said in an email, because “MDOC policy provides that an inmate must have a condition that is ‘incapacitating, totally disabling and/or terminal in nature’ in order to qualify.” So Jamie appears to be caught in a deadly catch-22. In order to be released from prison, she must convince the MDOC that her illness is terminal or “totally disabling”—and it seems the authorities won’t be persuaded of that unless she dies in prison.  

Since Jamie became critically ill, her supporters have also appealed to Mississippi Gov. Haley Barbour to consider early compassionate release. They have received no response—and the prospects don’t look good: Barbour has a record of being extremely stingy when it comes to issuing pardons. He is also currently engaged in a budget battle with his state legislature to prevent cuts to Mississippi’s prison spending, and the early releases such cuts would demand. According to a local television station that reported on the rally at the capitol, a spokesperson for Barbour said that “Jamie Scott was tried, convicted and incarcerated, and she is receiving her care with the Department of Corrections.”

A Sick System

In telephone interviews, the Scott sisters’ mother, Evelyn Rasco, described the treatment Jamie has received at Central Mississippi Correctional Facility (CMCF), based on her own observations and information provided by her two daughters. Jamie, who has diabetes and bouts of high blood pressure, said that prison medical staff told her in 1997 that she had high protein levels in her urine, indicating possible kidney problems.

Until recently, however, she received minimal treatment beyond the insulin prescribed for her diabetes. Jamie’s physical and mental health suffered last fall when she spent 23 days in solitary confinement (for being found in an “unauthorized area” in the prison gym) and was cut off from her routine of work, classes, church, and occasional visits with her sister. Then, in mid-January, Jamie became seriously ill when both her kidneys began shutting down. She was sent to the prison infirmary and, after a week’s delay, was taken to hospital. There, doctors inserted a shunt in Jamie’s neck to allow her to receive dialysis through a catheter, and she was promptly returned to prison.

Rather than letting Jamie leave the prison regularly for treatment, prison authorities chose to truck in dialysis machines. About three times a week, Jamie has received hemodialysis in a trailer on the prison grounds—if the machines are working properly, which she reports isn’t always the case. At one session, Jamie told her mother, the blood was flowing out of her through a catheter into the dialysis machine—but it wasn’t flowing back in, so the treatment had to be stopped. At the end of January, another inmate looked in on Jamie, who was locked up alone in her cell, and found her unconscious. She was rushed to the hospital, where doctors told her there were problems with the shunt inserted into her neck. They made adjustments, and she was again returned to prison.

Rasco lives in Pensacola, Florida, where she cares for her daughters’ five children while they are behind bars. Since Jamie and Gladys went to prison, Rasco’s husband of 30 years died of a heart attack; another daughter died of congestive heart failure; and her oldest son was away for several years serving with the Army in Iraq. In a letter to supporters last year, Jamie wrote: “When I think of the word ‘strongest,’ I think of my mother. She is 4 feet 9 inches tall and has the strength of Job in the Bible.”

Rasco lacks the time and financial resources to visit her daughters often, but in mid-February, she managed to make the trip to Mississippi. When she visited the prison, along with Jamie’s 18-year-old son, Jamie was feeling sick but was able to make it to the visiting room. When Rasco returned two days later, she found Jamie in a cell attached to the infirmary. “She was real weak,” Rasco said. “She couldn’t walk.”  An infection appeared to have developed at the site of Jamie’s catheter, which had filled with blood and pus. Nurses reportedly told Rasco that Jamie should be in the hospital, but the paperwork hadn’t been done.

Rasco said that when she entered her daughter’s cell, Jamie was sitting on the edge of a hospital bed with dirty linens, near a toilet and wash bowl that had not been cleaned. Prison staff arrived with a plate of food—a hamburger swimming in grease, rice, squash, a piece of cornbread, and a cookie—but Jamie said it looked so bad she couldn’t eat it. The doctors at the hospital had given her a list of foods she should eat, including meat, fish, and vegetables, but they were not available, and she did not have permission to purchase food at the prison commissary. (That permission has since been granted.) So Jamie sat on her grimy bed eating a Snickers bar. “She sat right there with me,” Rasco said, “and tried to give me a piece.” Knowing it was the only nourishment her daughter was likely to have, her mother declined.

Since Rasco’s visit, Jamie was back in the hospital for a day after experiencing chest pains following dialysis. Last week, she collapsed and was rushed to hospital, where doctors told the family an infection from an improperly placed shunt had spread through her body. At that point, according to the family, a hospital doctor stepped in and barred the prison from taking Jamie back into her cell, noting that she could die if denied hospital care. As of Wednesday, Jamie is back in prison. Her mother visited her there recently, and according to a person familiar with the case, reported Jamie was very weak and could scarcely walk due to an emergency catheter placed in her groin. She is scheduled to return to the hospital in the next few days, where doctors will prepare her for an operation next week that will attach a permanent fistula or shunt into her body to make kidney dialysis possible. Requests by Mother Jones last week to interview Christopher Epps, the state commissioner of corrections, were denied.

The best medical option for Jamie would be a kidney transplant. Studies show that patients in their thirties who receive successful transplants live considerably longer than those who remain on dialysis. Rasco said that when Gladys Scott, 34, learned of her sister’s kidney failure, she immediately offered to give Jamie a kidney. Gladys says that CMCF staff told her that state prisoners don’t qualify as donors, and that a transplant would be too expensive, though there is no indication that their statements reflect official MDOC policy. Rasco said that she was hoping the prison would at least let Gladys care for Jamie—feed her and bathe her—as inmates are sometimes allowed to do for ailing relatives. When Rasco last spoke to her, Gladys had not received the necessary permission.

Chokwe Lumumba, a longtime activist and attorney who also serves on the Jackson City Council, is representing the family in the medical matter. In an interview, Lumumba said, “Our first idea is to get some medical attention into the jail. Asking for a private doctor to go in there and see her.” But what Jamie really needs, he told me, is “to be in hospital until a kidney transplant.”

Singletary, the MDOC’s spokesperson, replied to several email inquiries regarding Jamie’s care. In one email, she wrote that “MDOC cannot comment on any specific medical condition or treatment for an inmate.” In another, she referred to patient privacy laws when asked whether a kidney transplant was being considered for Jamie Scott. Regarding transplants for state prisoners in general, Singletary said that “the state would pay for a needed and necessary transplant” and would do so “when evaluated the Dr. as needed [sic].” Singletary added in another message: “Dialysis units are fully operational with no malfunctions documented in the past several years.” She restated the MDOC’s policy that “chronic, but stable, medical conditions are not eligible for conditional medical release consideration.”

Jamie’s care is in the hands of Wexford Health Sources, a Pittsburgh-based private company that provides prison medical services. Wexford’s record includes lawsuits by prisoners and current or former employees in at least six states, as well as allegations involving racial discrimination and improper gifts to public officials. In 2006, the Santa Fe Reporter investigated Wexford, which supplied health care to some 6,000 New Mexico prisoners, and discovered widespread complaints, among them that Wexford “refuses to grant off-site visits for seriously ill inmates.” The story concluded that “the company’s insistence on the bottom line over the care of its charges causes inmates to suffer, sometimes with lasting, even fatal, results. The investigation prompted hearings on prison health care in the New Mexico state legislature, and in December 2006, Governor Bill Richardson ordered the New Mexico Corrections Department to find a new health care provider.

Wexford’s reported resistance to allowing inmates access to offsite treatment is particularly relevant to Jamie’s case and the potentially dangerous delays she has experienced before being sent to the hospital. The same issue surfaced in a 2002 case in Pennsylvania, where a 26-year-old prisoner named Erin Finley suffered a fatal asthma attack in prison while under Wexford’s care. According to the Wilkes Barre Times Herald, Finley’s family eventually received a $2.15 million settlement after their lawyer presented evidence showing that “Finley desperately sought medical care for severe asthma she had had since she was a child, but she was repeatedly rejected based on a prison doctor’s belief that she was ‘faking’ her symptoms.” On the day of her death, Finley was taken to the prison infirmary several hours after complaining that she was having trouble breathing. A physician’s assistant examined her and told the doctor she needed to go to a hospital, “but he refused to see her and left the prison at 2:40 p.m. Twenty minutes later, Finley lost consciousness and stopped breathing,” according to the Times Herald. She was finally sent to the hospital—only to be pronounced dead.

In Mississippi, where Wexford took over health care for the majority of the state’s prisoners in 2006 under a three-year, $95 million contract, the Jackson Clarion Ledger reported in November 2008 that “a search of the federal court system found more than a dozen open lawsuits filed by inmates against MDOC on medical issues.” At Central Mississippi Correctional Facility—the prison where the Scott sisters are housed—the sister of a dead inmate said she watched her brother waste away for months from inadequately treated Crohn’s Disease, an inflammation of the digestive tract. “He literally starved,” Charlotte Boyd said of her brother William Byrd, who died in November 2008. “We watched him turn into a skeleton.” Boyd told the Clarion Ledger that people might lack sympathy for prisoners like her brother, a convicted rapist, but “even a dog needs medical attention.” She said she believes that “if they are doing him that way, they are going to let somebody else die, too.”

In fact, Mississippi has one of the highest prisoner death rates in the nation, according to a review of prison statistics carried out by the Jackson Clarion Ledger‘s Chris Joyner. The death rate in 2007 was 34 percent higher than in 2006—the year Wexford took over the MDOC’s medical care. A December 2007 report conducted by the Mississippi Legislature’s Joint Committee on Performance Evaluation and Expenditure Review (PEER) concluded that inmates were not receiving timely and adequate medical treatment from Wexford. Among other things, the report found that Wexford “did not meet medical care standards set forth under its contract with the state” and “did not adhere to its own standards in following up on inmates with chronic health problems.” When questioned about the report and the high prisoner death rates, the Clarion Ledger reported, corrections commissioner Epps “said he is satisfied with the contractor’s performance.” The budget presented by Epps for the coming fiscal year, which begins on July 1, shows a request of $37.4 million to Wexford for medical services.

In response to questions about care provided by Wexford, MDOC spokesperson Singletary wrote: “Jamie Scott is receiving quality medical care for her condition. Wexford provides basic medical care for all inmates at MDOC prisons. Inmates are sent to hospitals if the need for hospital care arises.” Singletary stated that such decisions are made by the attending doctor at the prison, a Wexford employee. Wexford did not respond to requests for comment.

Unpardonable Offenses

On December 23, 1993, Jamie and Gladys Scott, then 22 and 19, were both young mothers with no criminal records. They were at the local mini-mart buying heating fuel when they ran into two young men they knew, who offered to give them a ride. Sometime later that evening, the two young men were robbed by a group of three boys, ages 14 to 18, who arrived in another car, armed with a shotgun.

Jamie and Gladys say that they had already left the scene to walk home when the robbery took place. The state insisted they were an integral part of the crime, and in fact had set up the victims to be robbed. Wherever the truth lies, trial transcripts clearly reveal a case based entirely on the testimony of the victims and two of the teenaged co-defendants—who had turned state’s evidence against the Scott sisters in return for eight-year sentences—and a prosecutor who appears determined to demonize the two young women.

Jamie and Gladys were not initially arrested for the crime. But ten months later, the 14-year-old co-defendant—who had been in jail on remand during that time—signed a statement implicating them. When questioned by the Scotts’ attorney, the boy confirmed that he had been “told that before you would be allowed to plead guilty” to a lesser charge, “you would have to testify against Jamie Scott and Gladys Scott.” The boy also testified that he had neither written nor read the statement before signing it. It had been written for him by someone at the county sheriff’s office, he said, and he “didn’t know what it was.” But he had been told that if he signed it “they would let me out of jail the next morning, and that if I didn’t participate with them, that they would send me to Parchman [state penitentiary] and make me out a female”—which he took to mean he would be raped. The 18-year-old co-defendant who testified against the Scott sisters also said he was testifying against the Scotts as a condition of his guilty plea to a lesser charge.

But the prosecutor succeeded in depicting Jamie and Gladys not only as participants in the crime robbery, but as its masterminds—two older women who had lured three impressionable boys into the robbing the victims at gunpoint. (This despite the fact that the oldest of the co-defendants was just a year younger than Gladys.) In his summation, he told the jury:

They thought it up. They came up with the plan. They duped three young teenage boys into going along and doing something stupid that is going to cost them the next eight years of their lives in the penitentiary.

That probably makes me, at least, as mad about this case, simply at least as much, as the fact that two people got robbed. That three young boys were duped into doing the dirty work.

The prosecutor also reminded jurors that while Jamie and Gladys admittedly did not have a weapon, the judge’s instructions “tell you that if they encourage someone else or counsel them or aid them in any way in committing this robbery they are equally guilty.”

It took the jury just 36 minutes to convict the Scott sisters.  And while there was a range of possible sentences for the crime of armed robbery, the state asked for—and received—two consecutive life sentences for each sister. In contrast, Edgar Ray Killen, the man convicted in 2005 of manslaughter in the 1964 deaths of civil rights workers Schwerner, Cheney, and Goodman, received a sentence of 60 years—meted out by the same judge who presided over the trial of Jamie and Gladys.

A direct appeal, carried out by the same lawyers who defended them at trial, failed to overturn the Scotts’ conviction, because they were tried for a crime committed before October 1994, when even harsher sentencing rules had been introduced.

During her recent visit to Mississippi, Rasco had the opportunity to confront Epps, the state’s corrections commissioner, when she attended a meeting at the state capitol on prison budget cuts. She spotted Epps, whom she recognized from a photograph, walked up to him, and told him about her daughter’s poor health and the problems with her medical treatment. According to Rasco, Epps said that he was getting a lot of messages about Jamie, and that he would do what he could obtain a pardon or clemency for the Scott sisters. He told her that he was “giving his word on this,” although he had no power to actually make it happen himself.

The person who could make it happen is Governor Haley Barbour, whose past record on pardons does not bode well for Jamie and Gladys. Barbour, who took office in 2004, was initially known for refusing to grant any pardons. In his second term he changed course—but only for a particular set of offenders. A 2008 investigation by the Jackson Free Press found that Barbour had pardoned or suspended the sentences of five murderers, four of whom had killed their former or current wives or girlfriends.  All five men were part of a prison program under which they did odd jobs at the governor’s mansion. Writing in Slate, Radley Balko, summarized Haley Barbour’s pardon policy as “show[ing] mercy only to murderers who work on his house.”

Jamie’s health crisis has also coincided with a protracted struggle between the governor and state legislators over how to handle budget shortfalls. Throughout, the ambitious Barbour, who is talked about as a possible 2012 presidential candidate, has appeared determined to polish his reputation for being both fiscally conservative and tough on crime. With revenue down due to the recession, Barbour implemented a series of deep, across-the-board cuts to state spending in the current fiscal year. He recently vetoed a bill that would have restored some of that funding, primarily to education. At the same time, he asked the legislature to put $16 million back into the Department of Corrections budget. “We have the resources to restore funding to our priorities this year,” the governor said in a statement, “including law enforcement and corrections.”

Against opponents who argued that Mississippi already spends more on prisoners than it does on schoolchildren, Barbour held up the specter of what could happen if prison spending was cut: 3,000 to 4,000 inmates would have to be released early. “The threat of convicted criminals on the streets,” the Jackson Free Press wrote in February, “has provided Barbour a rhetorical trump card in budget negotiations.” Even in light of such rhetoric, it would be difficult to see the Scott sisters as dangerous or violent offenders, although the state of Mississippi has certainly gone to great lengths to depict them as such.

Nancy Lockhart, a legal investigator and analyst based in South Carolina, has been working with Rasco for several years, organizing a grassroots campaign to secure decent treatment for the Scotts and either a review of their case or some provision for their early release. In interviews last week, Lockhart said that she had helped Rasco appeal to the Justice Department, which informed her that the statute of limitations was up for civil rights claims. They plan to try again, offering proof of earlier letters to the DOJ. They have also organized letter writing and email campaigns to numerous state and MDOC officials, and set up a website. The sisters’ group of supporters is growing, but they have received few responses to their pleas.

The Scott sisters will be eligible for parole in 2014, after they have served 20 years—though there is no guarantee they will receive it. In the meantime, Evelyn Rasco is praying for mercy, for a good lawyer—and for her daughter Jamie to live that long.

Updates about the Scott sisters’ case can be found on Solitary Watch, where an earlier version of this story appeared.


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