Sal Dagnone is serving 36 years to life for killing a man during a drunken bar fight 19 years ago. A lot has happened in his life since then. When he entered prison at 18, Dagnone couldn't read or write. He's since earned a GED, two years of college credit and paralegal training, and has gotten married. Dagnone is now being held in Great Meadow Correctional Facility in Comstock, New York, but his stint behind bars has taken him through almost every maximum security prison in the Empire State: Attica, Sing-Sing, Downstate, Shawangunk, Southport, Clinton, Coxsackie, Sullivan, Elmira.

In Elmira, Dagnone tried to escape. He used a rope and hook to scale the roof, and stolen wire cutters to get through a fence before a guard dog nabbed him. The foiled breakout earned him five years in disciplinary confinement at Upstate Correctional Facility in Malone.

After nearly two decades in prison, Dagnone is still haunted by an incident he witnessed at Upstate a little over a year ago. For two days and nights in December 2004, he listened helplessly as a 19-year-old inmate named Christopher Campos suffered repeated seizures in a nearby cell. Campos later died in the infirmary because the prison's medical staff assumed he was faking it.

When Vermonters gaze across Lake Champlain at the snow-covered Adirondacks, most never realize they're also looking at the heart of New York State's prison country. Clinton, Essex and Franklin counties, collectively known as the North Country, are home to 10 prisons that employ more than 3900 people. The annual payroll exceeds $177 million.

The small town of Malone, northwest of Plattsburgh, is the site of three prisons. Together, Bare Hill, Franklin and Upstate correctional facilities account for more than one-third of the town's 14,800 residents. Upstate Correctional Facility is New York's newest and largest super-max prison. It's a sprawling complex of 23 buildings on 70 acres about 10 minutes by car from the Canadian border.

Upstate is unique among the 70 prisons operated by the New York State Department of Correctional Services (DOCS). Hailed at its opening in July 1999 as a "new concept in disciplinary housing," it was designed to hold the worst of the worst. It has a capacity of 1500 inmates -- 300 to work in the prison's mess hall, laundry and other services, and 1200 in disciplinary confinement known as the "Special Housing Unit," or SHU.

Prisoners get "SHU time" for a variety of offenses -- possession of contraband, failed drug tests or "dirty urines," fighting with other inmates or assaulting staff. SHU prisoners are locked down 23 hours a day, with just one hour of legally mandated "recreation" time in an empty outdoor cage attached to each cell. There are no phones, no clocks, no programs, no religious congregations and no physical interaction with other inmates. Except for a limited amount of reading material, headphones that play staff-selected radio stations, and one allowable visit per week, inmates in SHU have virtually no contact with the outside world.

A 10-by-10-foot cell can house one or two inmates. The cell has no bars, just a concrete floor and three walls, a thick metal door and a vent that allows in filtered light. Nearly all an inmate's activities take place inside his cell, minimizing his contact with staff and other prisoners. Each cell has a stainless steel sink and toilet; staff operate a shower externally. All meals are served through a "feed-up" slot in the door. On the rare occasions when an inmate leaves his cell -- for court hearings, meetings with visitors or emergency infirmary calls -- he is typically shackled in leg irons and handcuffed at the waist.

New York leads the nation in both the number and percentage of inmates who live in disciplinary confinement, according to the prison watchdog group Correctional Association of New York. DOCS credits this approach for its steep decline in inmate offenses. Between 1993 and 2002, DOCS reported a 38 percent drop in inmate-on-staff assaults. Inmate-on-inmate violence declined 44 percent, contraband offenses 39 percent. The correctional department's newsletter, DOCS Today, summed it up in April 2003: "Upstate is doing exactly what officials had hoped it would do."

But critics of Upstate and similar SHU facilities point to disturbing problems associated with life "in the box" -- notably, the inmates' extraordinary amount of idleness, isolation and neglect. With virtually nothing to do for weeks, months and sometimes years at a stretch, inmates are essentially warehoused and rarely receive any treatment or counseling. Many "max out" their sentences at Upstate and are released directly back into society with no transitional period following their time in solitary confinement.

"It's essentially a human kennel," says Stacy Graczyk, an attorney with Prisoners' Legal Services of New York in Plattsburgh. "It does things to people being in there. In the military, people get special psychological training in case they become a prisoner of war, to help them tolerate this kind of isolation. And these are people who already have trouble fitting into society."

Graczyk, who provides legal aid to inmates in 16 prisons in northern New York, first learned of the Campos case in a letter from Dagnone. The letter, which she found deeply disturbing, echoed many of the complaints she commonly hears about inmate medical care. At Upstate, she says, prisoners can find it "extremely difficult" to get anyone to take their ailments seriously.

"We see that in the medical and mental health records all the time, that they're malingering, they're faking it, they're always complaining," Graczyk says. "I think it blinds [the medical staff] to the serious issues that might be there."

For example, according to Graczyk, it's standard procedure at Upstate for medical exams to be conducted through the door, with nurses handing out medications, making patient assessments, even drawing blood and giving shots through the feed-up slot. Not only does this compromise an inmate's privacy, she says, but it also raises serious questions about how medical personnel can evaluate a patient they can't see or touch. Graczyk believes it was this "hands-off" approach to medical care that cost Campos his life.

Christopher Campos was born in Mexico and came to the United States when he was 13, according to his 18-year-old half-brother, Hilario Campos Jr. Campos spoke very little English, his brother says, so he often skipped school and fell in with gang members who lived near their home in Queens.

The New York State Commission of Correction, the independent state agency that investigates all inmate deaths, released a report on Campos' death in late September. It notes that Campos' criminal record began at age 16, when he and several others tried to rob a man. When the victim attempted to flee, he was stabbed several times and hit with a baseball bat. Campos was convicted of second-degree assault, menacing behavior and possession of a weapon. He was sentenced to one to three years in prison.

Campos entered the correctional system with a known medical history. During his intake in February 2003, he reported that he suffered from a seizure disorder that had begun when he was 6, as well as asthma and tachycardia, for which he was taking medication. His last reported seizure occurred three days before he entered prison.

Campos was sent to Lakeview, a minimum-security prison in Brockton, then to Washington Correctional Facility in Comstock. There, according to the Commission report, he "experienced frequent seizures regularly witnessed by officers." Although Campos occasionally refused to take his meds, the report states, he began undergoing treatment and observation in the neurology department at Albany Medical Center, where he was a frequent patient for the next year and a half.

On July 26, 2004, Campos attacked another inmate with a weapon and was sentenced to 10 months in SHU at Upstate. He was assigned to 8 Building, B Block, Cell 26 -- two cells away from Dagnone. Campos was alone in his cell.

Dagnone, who has seen his share of correctional facilities, says of Upstate, "I ain't gonna lie to you," he says. "That's the worst prison I ever been in." A clean-cut man with a boyish face, a friendly demeanor and no-bullshit Brooklyn charm, Dagnone relates his account of what happened to Campos during a conversation in the visitors' hall at the Great Meadow Correctional Facility in Comstock.

Dagnone remembers when Campos arrived, he says. He and Campos talked occasionally -- though Campos was two cells away and didn't speak English well, he recalls. A Latino inmate named Julio Perez in the cell between them spoke Spanish. Perez sometimes translated for Campos when the nurses came around on sick calls, Dagnone says. Perez wasn't allowed out of the cell to translate -- he had to shout through the door.

On September 21, 2004, Campos was taken to Albany Medical Center, where it was determined that his seizures were still not controlled and he needed "long-term" monitoring, according to the Commission report. On November 20, he was admitted to Albany Medical Center's Epilepsy Monitoring Unit and kept under constant observation until his discharge on December 6. Campos had no seizures during this time, the report states. However, the attending neurologist noted in his medical history, "The patient wakes up multiple times in the night with injury, sometimes tongue biting, sometimes abrasions all over his head." Campos' discharge diagnosis read "pseudoseizures."

Pseudoseizures, as the Commission report explains, are a real and dangerous condition. Also known as Psychogenic Nonepileptic Seizures, pseudoseizures are not phony seizures. Rather, they are believed to be "a psychological defense mechanism induced by stress or episodes of severe emotional trauma." Pseudoseizures often accompany other types of seizures, and are commonly treated with anticonvulsive drugs.

Campos was returned to Upstate on December 6 without his prescribed medication of Carbatrol, an anti-seizure drug, and was admitted to the prison infirmary for 24 hours of observation. The physician assistant (identified in the Commission report only as "L.T.") noted on his chart that Campos had "missed one dose already so he may not get today. Will just discontinue." When she was later interviewed by state investigators, the physician assistant "said that she 'assumed' that pseudoseizures were 'fake seizures.'"

On December 8 and 9, according to the report, Campos refused his meal trays at breakfast, lunch and dinner and was visited by a nurse and a social worker. At one point on December 9, a corrections officer reported that Campos was lying "half under his bed" and "refused to respond when [the officer] arrived at the cell." The report states that the inmate "keeps asking for meds," but wasn't given any. His medical examination was conducted through the cell window.

Dagnone, who has never seen the Commission report and wasn't interviewed by state investigators, remembers how for two days before Campos died, he complained about his stomach, called for his meds and asked that his family be called. Inmates often play games with guards and medical staff to get attention, Dagnone admits. But he knew something must be seriously wrong for Campos to refuse all three meals for two days in a row.

On December 9, Dagnone says, a guard called the nurse because Campos appeared to be in serious trouble. "I gotta give credit where credit is due," Dagnone says. "[The guards] tried to get him help."

Dagnone remembers that the medical staff showed up at Campos' cell but didn't enter. "They kept yelling at him, 'Get off the floor, Campos! Get off the floor! We know you're faking it!'"

Campos was left alone. Dagnone claims he didn't sleep much that night because of what was going on two cells away. "We could all hear him banging around and flapping on the concrete . . . If you're looking for attention, why do it when no one's watching?"

The Commission report confirms Dagnone's account. The staff physician on duty, identified in the report only as "Dr. E.W.," claimed that Campos was "difficult to evaluate." However, the report also states, "Other medical and correctional staff in the area did not corroborate Dr. E.W.'s interpretation of the event. They stated that the physician concluded that Campos was 'faking and acting like a child holding his breath.'"

On the morning of December 10, 2004, Campos was found lying unconscious on the floor of his cell. He was brought by stretcher to the prison infirmary, where he was pronounced dead later that day.

"If the nurses would have did their job, this never would've happened," says Dagnone. "He was a young kid with his whole life ahead of him. And the fucking guy choked to death. That's a horrible way to die! You wonder, God forbid I get sick, these are the people I gotta go to?"

The Commission's conclusions about the incident are sharply critical of the medical care Campos received. The report states that the staff physician on duty "failed to provide appropriate intervention, diagnosis and treatment of a gravely ill inmate." The physician assistant "arbitrarily discontinued Campos' medication," and the nurse assigned to the infirmary "failed to provide proper nursing intervention." Investigators also criticized the practice of conducting patient evaluations through the window of a cell or infirmary room. All three medical staff were recommended for "administrative action."

The superintendent's office at Upstate does not release the names of staff and refers all media inquiries to the DOCS press office in Albany. DOCS spokesperson Mike Fraser says he cannot comment on the specifics of the Campos case but only on department policies and practices as a whole.

"The incident being raised is certainly a tragedy," Fraser says. "But it's important to know that it's not representative of the care that our inmates receive, and it certainly doesn't represent the efforts around the state to provide the best possible care we can to more than 63,000 inmates statewide."

Fraser points out that New York State has made tremendous strides in addressing some of the most serious medical issues in the inmate population, including a 95 percent drop in AIDS deaths since 1995, and a 78 percent decline in tuberculosis. "We actually have a lower TB rate than New York City," he notes.

Fraser adds that the Campos incident, while tragic and unfortunate, gives the correctional system an opportunity to "take a long, hard look" at its policies to learn from and improve care. Recommendations made by the Commission on Correction are not legally binding. However, Fraser insists that DOCS takes them "very seriously."

Fraser couldn't say how many members of the Upstate medical staff speak Spanish. Although an estimated 8 percent of New York inmates are Spanish-dominant speakers, there's no requirement in New York that prisons have Spanish-speaking doctors or nurses on staff.

When asked what "administrative action" was taken against the individuals involved in this case, Fraser explains, "Our response is to counsel our physicians and staff who were involved and also to educate them." None was terminated.

Robert Gangi is executive director of the Correctional Association of New York. The prison-watchdog group has unique authority under state law to inspect prisons and interview inmates. Over the years, it's issued a number of scathing assessments of inmate health care.

In February 2000, the Correctional Association identified a host of systemic problems plaguing New York prisons, including the high number of underqualified medical staff, the lack of quality assurance, and no external government oversight -- which means that prison health-care workers are accountable only to prison authorities.

The 2000 report also noted the serious shortage of Spanish-speaking medical personnel. "Spanish-speaking inmates were given medical information they did not understand, drug prescriptions they could not read and substandard health care due to the lack of Spanish-speaking medical staff," the report states.

During an inspection of Upstate in January 2001, one inmate told interviewers that he'd entered the prison with serious medical ailments and had filed 47 requests to see a doctor but hadn't received any treatment. On another visit in August 2002, CA inspectors found a disabled prisoner who had been transferred from the wheelchair unit in another prison. At Upstate, his wheelchair was confiscated for "security reasons."

"He was in extreme distress and said that he could barely hoist himself onto the toilet," the report reads. "Because of his disability, he had trouble moving his hands and could not write a grievance to medical staff. He had spent several weeks at Upstate living on the floor."

When interviewed by phone last week, Gangi said he'd just returned from a visit to Upstate a day earlier and had heard "a lot of complaints about medical care." Gangi wasn't familiar with the Campos case, but he said many of the events described to him from the Commission report are symptomatic of problems his group has been complaining about for years.

Graczyk at Prisoners' Legal Services hears comparable stories from Upstate. She refutes the DOCS' assertion that the Campos case was an isolated incident. Recently, her office worked with an inmate there who'd arrived at Upstate with a heart condition. He had been prescribed self-carry nitroglycerin pills, which were taken away from him upon arrival. According to Graczyk, the inmate was told that if he experienced chest pains, he should "bang on his cell door." Only after Prisoners' Legal Services got involved were the pills returned to him.

"You hear it all the time. 'Lock the door and throw away the key. Who gives a fuck what happens to them?'" Graczyk says. "People think that everyone in prison is a Ted Bundy. But what about this kid? He's in there for one to three for assault second. Did he deserve a death sentence for that? Obviously not."

When Graczyk requested a copy of the videotape of Campos' cell from December 9 and 10, 2004, under New York's Freedom of Information Law, she was told it wasn't available. The tape hadn't been preserved.

Hilario Campos Jr. says he learned of his brother's death when he arrived home from school on Friday, December 10, 2004. He says someone from the prison had called and left a message with his parents -- in English. Since they couldn't understand it well, Hilario had to call the prison back.

When reached last week at their home in Camden, New Jersey, Hilario said he and his parents didn't know the Commission of Correction had issued a report on Christopher's death. No one had informed them that the state was conducting an investigation.

"As a matter of fact," Hilario says, "they haven't even sent us the autopsy results. They only give us the death certificate."

Campos would have turned 21 on January 17, and would have been released from prison this week.