Dr. Alison Pachynski started at SQ as a primary care provider in 2007, after a UCSF colleague saw her potential for community medicine and suggested she give the job a try.
“At the time, there was a lot of cleanup work going on as far as healthcare inside CDCR (California Department of Corrections and Rehabilitation) because of ongoing Plata litigation,” she recalls.
(Brown v. Plata was a U.S. Supreme Court decision holding that a court-mandated population limit was necessary to remedy a violation of prisoners’ Eighth Amendment constitutional rights.)
“There were still doctors in the system with restricted licenses, and they were in the midst of eliminating those providers.”
Pachynski’s detour into SQ turned into a career choice. “I didn’t see working here as permanent back then, but I found my patients so compelling — so resilient,” said Pachynski. “There’s a humanity and heart that’s still alive in here. You guys are amazing.”
When she accepted the position as SQ’s Acting Chief Medical Executive in 2019, COVID-19 lurked just beyond the horizon. Dr. Pachynski would soon find herself front and center inside one of the worst viral outbreaks in prison history.
CDCR just recently awarded Dr. Pachynski a 2021 Medal of Valor and named her Health Care Professional of the Year for maintaining “a positive approach and an uplifting leadership style” throughout SQ’s COVID emergency.
Known for taking time to stop and talk freely with incarcerated community members — all of whom she considers her patients, Dr. P. agreed to sit down for a Q&A with SQNews and discuss the current state inside San Quentin.
JG: With flu season approaching and all these different variants popping up, how do you feel about where SQ’s at in terms of COVID safety right now?
Dr. P: I worry most about our unvaccinated patients. They probably had COVID already, but that doesn’t mean their natural immunity’s as powerful as the vaccine. We’re still learning about those kinds of factors.
Delta’s been the worst as far as being infectious, and we seem to have made it through that wave fairly well. I don’t know what’s around the corner — nobody does.
That last small outbreak had me worried. But you guys have been great — with testing and vaccination. We have tools we didn’t have back then. Availability of tests and vaccines are at the top of the list.
JG: You surprised a lot of us when you came into Alpine unit during that small outbreak in August. Why’d you go around to every cell answering questions and pushing to get folks vaccinated?
Dr. P: I just felt compelled to be there. I know if I were in your situation, with a potential new outbreak about to blow up, I’d be anxious.
It was scary. We didn’t know what delta would look like. The people who aren’t vaccinated — it weighs on me. Even early vaccination starts protecting them right away.
JG: You think everyone who was here during the 2020 outbreak had COVID-19 regardless of whether they ever tested positive?
Dr. P: I don’t know how anybody could’ve escaped it, given these housing units. In our dorms, that was a completely different story. We only had three cases.
But in the “closed” dorms— Did you know that’s what the buildings with all the open bar-front cells are technically called? Think about that. “Closed dorms.” From that starting point, you see how that changes the way of looking at things.
JG: Some of us avoid testing because of false positives and the threat of being housed in the AC (Adjustment Center) for 14-21 days. That last outbreak in August, I know guys that were woken up and moved to the AC at 2 a.m. Why did it have to happen like that?
Dr. P: I wish I had a better solution, but we have to move people as quickly as possible into a closed-in space with solid doors.
As soon as those test results hit the electronic health record, public health alerts custody. I’m always on-call, so half the time I’ll get woken up, too.
JG: Have you ever sat in one of those AC cells and thought about the solitary confinement?
Dr. P: Yeah, I’ve done that, but I never had the door closed. I can see how the feelings of isolation set in — day to day, and hour to hour
You should have the same privileges, within the confines of isolation. You’re supposed to have the same privileges. Testing positive for COVID-19 shouldn’t change your level of custody.
But I don’t oversee custody.
JG: At some point, there’ll be an event inside SQ in recognition of the 28 people in blue who died from COVID-19.
You’ve been asked to speak, and you said yes. Why is that important to you?
Dr. P: COVID impacted the entire institution — no matter who you are here. No one has ever been through this before. There are things I think need to be acknowledged — mainly the strength and endurance of our community.
But it’s still so painful. How do you put that into words?
JG: Knowing what you know now, what would you have done differently?
Dr. P: Oh heavens — I would have physically stood at the gates and figured out a way to block entry.
JG: You’re talking about blocking the buses that brought COVID into SQ?
Dr. P: Yeah, of course.
JG: What about the policy of allowing staff to work and move from unit to unit?
Dr. P: Cohorting staff? That’s exceptionally complicated. I’ve had so many higher-level discussions about it. It boils down to a labor issue, how a place actually runs.
I’ve thought about this a fair amount with my staff—cohorting. It would greatly limit our ability to provide coverage everywhere.
That’s where proper use of PPE (personal protective equipment) comes in. My team, my doctors, we know the importance of taking precautions to keep our patients safe from us.
JG: What’s your opinion on this place going all single cell?
Dr. P: From a public health perspective, it certainly makes everything easier. But I understand corrections is also a business, right?
I’ve taken new medical staff into the buildings and had them climb onto an upper bunk. They need to understand.
Lower bunk/upper bunk — that makes a difference in a patient’s everyday quality of life.
I’m 5’4’’, and there wasn’t much room in there for me. I can’t imagine how two people function in a cell that size, day in and day out
JG: Given the standards for habitable living space set by the American Correctional Association, why isn’t San Quentin single-celled completely across the board for all residents?
Dr. P: I don’t make those decisions. My understanding is that SQ’s population numbers are determined at headquarters (in Sacramento.) As far as who, exactly, ultimately controls that decision, I don’t know.
JG: When the incarcerated community criticizes SQ’s COVID response last year, both you and Warden Broomfield get vilified — especially in regards to your testimony during the Marin County hearings. Your thoughts on that?
Dr. P: That actually kinda hurts me to hear that. But I also understand it.
As far as medical goes, we’re very nose-to-the-grindstone. We just take care of our patients the best way we can while everything else is going on.
JG: How do you feel about being named Health Care Professional of the Year?
Dr. P: I appreciate the recognition, but it really was a team effort. We have a devoted team of doctors who all stepped up — working around the clock 24/7 during that terrible time.
I hope our patients realize how much our providers care about them.
JG: You seem genuinely invested in our community. What’s your vision of SQ’s future?
Dr. P: I’m totally all in, 100%. We braced for impact as best we could. COVID did a real number on us. It’s gonna take a lot to recover as a community.
People are sicker — from the whole situation, the shut-down, the lack of physical activity. They gained weight and generally became less healthy all the way around.
But I see SQ as that phoenix rising from the fire. What do we do from here? I just feel the potential of this place.
We can lead the way.