The Health of Our Prisons

In December 2003, Robert Treadway awoke in the middle of the night and knew something was terribly, perhaps even fatally, wrong. He awoke to a terrible smell and his bed was soaked with blood.

Frightened, he did what any concerned person would do—he called for help. But for people in Treadway’s condition, help is hard to come by. He is one of 2 million adults imprisoned in the US. Treadway is serving time at the Federal Correctional Institution in Yazoo City, MS.

“They took me to the medical center, where the prison doctor, Dr. Anthony Chambers, took a scalpel and cut my navel open,” Treadway says. “There was no anesthetic, and it hurt real bad. Then they sent me back to my cell.”

Just a week before, Treadway had been sent to a hospital in nearby Vicksburg, MS, where surgeons operated on a hernia that had been bothering him since July. He was sent back to prison the same day of the operation.

Treadway spent the following week in horrible pain, but received no care from the prison medical staff. Internal medical records indicate that Yazoo’s physicians recommended that he get a new wound dressing on December 14, but there is no record of him actually receiving any postsurgical care.

By all accounts, he was left to fend for himself after major surgery. To receive his pain medication, he was forced to walk to the “pill line” three times a day. Meanwhile, the pain continued to worsen, until the fateful night of December 17, when it first occurred to him that he might not live through this experience.

If prison officials were worried about his condition, there is no evidence of it. After treating him that night, they again sent him back to his cell. Later the next day, Treadway was once again forced to walk to the pill line under his own power.

Finally, someone took mercy on him. A prison nurse, T. Clarkson, saw his condition and told him to go sit in the medical center. According to Treadway, she immediately recognized the smell on him as gangrene, a potentially fatal infection of wounded flesh.

“She said, ‘You’ve got to go to the hospital,’” Treadway recalls. “I really believe she saved my life.”

Once again, Treadway was taken to the Vicksburg hospital, where doctors removed a four-inch section of his abdomen, including his navel.

The Exception or the Rule?
Treadway’s case is tragic yet unremarkable. With news of prisoner abuse in Iraq dominating the headlines, the President himself proclaimed “that is not the America I know.” The abusers are described as “a few bad apples” or rogue MPs acting outside their legal authority. Our government officials congratulate themselves on running our domestic prisons with the highest standards of moral integrity.

Unfortunately, their claims do not stand up under close scrutiny. According to insider accounts, national experts, lawyers, and numerous recent investigations, prison conditions in this country are little better than at Abu Ghraib. Prisoners are regularly beaten, both by guards and other inmates, in crowded wards. Sexual predators, both guards and inmates, are given free rein to terrorize other prisoners. Moreover, the health care system is often horrifically inadequate.

None of this is legal. The Eighth Amendment to the US Constitution states:

“Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted.”

The courts have specifically interpreted the Eighth Amendment to mean that prisoners are entitled to adequate medical care.

Yet the Constitution has fallen by the wayside. According to accounts from inside our federal prisons, inmates regularly are forced to wait for health care. When they do receive care, it is often woefully inadequate. Too often, prison medical centers are not equipped to handle trauma and emergency medicine—and doctors are loath to send anybody outside the prison walls for health care.

The result is substandard health care for a segment of the population that desperately needs help. According to the American Civil Liberties Union (ACLU) and its National Prison Project, which fights for the human rights of prisoners, the inmate population tends to suffer from greater levels of chronic diseases, such as heart disease and cancer, and infectious diseases, including hepatitis C and AIDS, than the general population. This is in addition to the hardships imposed by prison life itself, where a culture of unchecked violence and physical abuse creates a stream of injured and terrorized inmates.

Problems Traced to Cost Containment
Tragically, the cause of these conditions is not a mystery. Everybody seems to have the same answer: providing adequate medical care costs money, and as long as the general population is willing to turn a blind eye to conditions inside our own prisons, the system will provide nothing more than the bare minimum. Sometimes even less.

“It’s budgetary,” says David Singleton, executive director of the Prison Reform Advocacy Center in Cincinnati, OH. “It’s all related to cost containment, because you get crappy doctors if you can’t afford to pay for them.”

Singleton cites hepatitis C as an example. This disease runs rampant through the US prison system. By some estimates, as much as 40% of the prison population has hepatitis C. The disease is deadly because symptoms are frequently delayed for years while often irreversible damage is inflicted to the liver.1

Unfortunately, however, hepatitis C is also very expensive to treat. The standard treatment, a ribaviran-interferon cocktail, can cost as much as $25,000 a year.

Rather than pay, prison officials overlook hepatitis C and other diseases as long as possible, frequently discharging infected prisoners without treating or sometimes even telling them. According to a study sponsored by the National Institute for Justice, inmates released from prison or jail account for 35% of the US population infected with tuberculosis and 17% of those infected with AIDS. In 1996 alone, nearly 1.4 million people infected with hepatitis C were released from prison—untreated.2

“You have to have advanced liver disease to get the treatment,” Singleton says. “It’s a huge topic. There needs to be more coverage of it.”

The public needs to know. In 2004, a Human Rights Watch publication wished for Abu Ghraib-style photos to emerge from US prisons, if only to shock people into caring. The paper concluded, “Absent such graphic and unavoidable evidence, it is all too likely that abuse will continue to be a part of many prison sentences.”3

Indeed, until there is a major overhaul of the US prison system, the medical neglect is almost certain to continue. After having a chunk of abdomen the size of his fist removed, Robert Treadway had some simple questions: Why was a patient with a hernia allowed to suffer for five months before getting outside care? Why was a surgical wound allowed to fester into a gangrenous mess before proper medical care was sought?

“Even the nurses said, ‘I don’t know why they didn’t send you to the hospital sooner,’” Treadway says.

Seeking relief, Treadway filed a formal Request for Administrative Remedy with the prison warden. He accused the prison medical staff of “deliberate medical indifference” and requested $10 million and home confinement for the three years remaining of his nine-year sentence.4

In a one-page letter, the warden, M. Pettiford, flatly denied Treadway’s request: “You must let the Health Service care providers know when any medical problems arise, in order to receive the medical attention you need. There is no evidence to support your allegation of deliberate indifference to your medical needs . . . Based on our findings, your Request for Administrative Remedy is DENIED.”

Denial, however, is not an option when it comes to health care for prisoners. The courts have determined that under the Eighth Amendment of the US Consti-tution, officials are obligated to provide prisoners with adequate medical care.5 This is known as the “community standard” of health care, meaning that prisoners are constitutionally entitled to the same level of health care the community provides for itself.

In today’s prison systems—federal, state, and local—the community standard of health care has been eroded by budget pressures, a huge increase in the number of people imprisoned, and a staggering national indifference to the fate of our prisoners. The result is a national disgrace of lawlessness, disease, and abuse:

• According to a 2001 Human Rights Watch study, 21% of male prisoners in America are raped during their incarceration.3 Beatings and abuse by guards and other inmates are disturbingly common.
• According to experts, 20-40% of the prison population has hepatitis C, yet “some state prisons . . . have gone so far as to adopt a ‘don’t ask, don’t tell’ policy as a way of avoiding costs affiliated with the treatment of hepatitis C.”1 Indeed, until late 2002, the state of New Jersey refused to treat prisoners for hepatitis C. It changed its policy only because of pressure from the Philadelphia Inquirer.6
• One of the fastest-growing industries in America is incarceration. America’s war on drugs has flooded our prisons with new inmates; up to 57% of the federal prison population consists of nonviolent drug offenders.3

Privatization: Part of the Problem
Prisons everywhere are bursting to capacity, and prisoners of different security levels are regularly “mixed,” often to the detriment of minimum-security prisoners. To help ease the crunch, states and the federal government have turned to private companies. Today, we contract out to private companies the building, maintenance, and guarding of prisons, as well as the provision of health care within them.

The two largest private health care providers inside prisons are Correctional Medical Services (CMS) and Physician Health Services (PHS). Industry leader CMS operates in 27 states, providing health care for 225,000 inmates on a contract basis. In turn, it contracts with 450 health care providers, including physicians, dentists, and optometrists.

Although CMS claims that about two-thirds of its facilities are “accredited” by “independent reviewing organizations,” it remains very difficult to get an accurate picture of the health care system in prisons. The world inside those walls is closed, and it usually takes a lawsuit to be noticed. Oversight is internal, private, and, in too many cases, nonexistent.

Whether or not privatization works is almost beside the point. Privatization itself is an experiment. The fact is, in the 1990s, the US began incarcerating people at an alarming rate that could not be sustained. By 2002, one of every 146 US adults was incarcerated.3 Yazoo City, where Treadway is housed, was designed for 1,400 inmates and currently houses more than 1,900.7

By putting this many people behind bars, the government has taken responsibility for their welfare. They need to be housed, fed, and otherwise cared for. But there has been no corresponding increase in prison budgets.

“Privatization is a big part of the problem,” said Kara Gotsch, public policy coordinator with the ACLU’s National Prison Project in Washington, DC. “But I think the problem is over-incarceration. There’s just too many people in prison, and it’s expensive to provide health care to 2 million people.

“The reason private companies became so prevalent is because they said, ‘We can save money.’ But you can’t take blood from a stone. You have to wonder how a private corporation can make money, and we believe they’re cutting corners.”

One obvious corner to cut is sending sick patients to an outside hospital. This is a corner that any prison medical center might cut, private or not. Unfortunately, it is virtually impossible to prove specific instances of neglect. Medical records are sealed. Prisoners are automatically branded as liars. And prison authorities are reluctant or unwilling to discuss conditions in their facilities.

Not until someone is hurt badly and files a lawsuit is his story usually told. Tragically, the ones who die are never heard.

For this story, Yazoo City prison officials denied requests to interview prisoners regarding their firsthand experience with the prison’s health care system. Instead, inquir-ies were routed to the Bureau of Prison’s public affairs office in Washington, DC.

Nevertheless, through prisoners’ family members, attorneys, and the prisoners themselves, accounts of life on the inside leak out. According to prisoner accounts at Yazoo City, during a lockdown over Easter 2004, prisoners were denied medication for chronic illnesses such as diabetes. When one prisoner’s wife followed up on it, a federal bureaucrat told her “health care is a privilege.”

Not according to the Constitu-tion, but that venerable document holds little sway when it comes to prisoners.

Documenting Medical Neglect
One inmate, Jay Kimball, has made it his mission to compile firsthand accounts of medical neglect. These accounts are forwarded to the new Civil Liberties Coalition, which plans to post the results of Kimball’s investigation on the Internet at its website (www.discovery-experimental.com). The site will be dedicated to helping prisoners secure their constitutional rights to healthier, more humane treatment.

Jay Kimball’s accounts, gathered from prisoners, are chilling. They include stories of prisoners nearly beaten to death, who instead of receiving medical care are put “in the hole” as punishment, as well as stories of prison officials ignoring diabetic prisoners who were too ill to walk and therefore could not receive their insulin shots. Then there is Kimball’s own story.

Kimball received his initiation shortly after entering the federal prison system to serve a 13-year sentence for selling for what he believed to be a dietary supplement, liquid deprenyl. While awaiting transfer, Kimball spent time at a county jail in Belle Glade, FL, that was contracted by the US Marshals Service to hold federal prisoners. Kimball received numerous shoulder injuries in a Marshals Service vehicle that drove at speeds topping 100 miles per hour during his transport to Belle Glade. While he was at Belle Glade, prison officials refused to treat his shoulder injuries. In fact, the jail warden gave Kimball a message for Mrs. Kimball, which was to keep her mouth shut. This was in response to her refusal to stand by and allow the jail and the Feds to continue to abuse her husband. While at Belle Glade, he contracted a respiratory bacterial infection.

Instead of receiving immediate treatment, he was transferred to another federally contracted county facility, this time in Tampa. By the time he arrived in the Tampa jail, he had lost his voice. He was treated, and then transferred yet again to another federally contracted jail in Hernando County, north of Tampa. He was there for just a short time before being transferred to the Federal Correctional Institution in Coleman, FL.

At Coleman, Kimball was told it would be three months before he could see a physician. Kimball, who had owned and operated a business before being convicted, swung into action. His own doctor traveled hundreds of miles to see him and promptly prescribed antibiotics for his patient.

The prison medical center at Coleman, however, refused the antibiotics and instead gave Kimball an inhaler to keep him breathing.

Kimball next filed a restraining order in Ocala in an attempt to get medical attention. The restraining order was denied, and in retaliation, the prison seized Kimball’s inhaler and put him “in the hole” for 15 days.

After this experience, Kimball educated himself on how the medical system in prison is supposed to work. The federal Bureau of Prisons Health Services Manual is a comprehensive document of 340 pages. It covers everything from contract agreements with outside physicians to chronic disease management.

According to the guidelines, all inmates are supposed to receive an initial screening by a competent medical professional when they first enter a facility. Inmates with chronic conditions are referred to the medical center for treatment.

Without examining prison medical records—which are, of course, sealed—it would be impossible to confirm that any prison or jail, whether federal, state, or local, lives up to this standard. But if the Santa Fe County (New Mexico) Adult Detention Center is any indication, major problems are the norm.

This facility was investigated in early 2003 by the state attorney general’s office, acting under the authority of the 1997 Civil Rights of Institutionalized Persons Act (CRIPA). Investigators interviewed prison personnel and reviewed documents, policies, and procedures, including medical and mental health records.

The results were a broad and damning indictment of nearly every single aspect of the prison’s health care operation. Doctors’ orders were ignored. Prescriptions were withheld. Chronic conditions were never diagnosed, or if they were, they were never treated. Acute care was nonexistent. Prisoners were denied outside medical care. Suicidal prisoners who literally begged for help were dismissed by guards only to kill themselves within hours.

“We find that persons confined suffer harm or the risk of serious harm from deficiencies in the facility’s provision of medical and mental health care, suicide prevention, protection of inmates from harm, fire safety, and sanitation,” the investigators concluded. “In addition, the facility fails to provide inmates sufficient access to the courts and opportunity to seek redress of grievances.”8

This flawed system was a clear violation of the prisoners’ constitutional rights, according to the investigation. And the blame lay squarely on Physicians Network Associates, a private company that had been contracted to deliver health care services to the prison.

The investigation provides a chilling glimpse into the world of modern prisons. According to the report, only 37% of prisoners received a full health screening. Among that minority, prisoners who were identified with “serious medical needs” were not referred for health care services. Amazingly, not a single prisoner was referred to health services for a chronic health condition.8

Finally, as with Robert Treadway at Yazoo City, the investigation found that physicians did not send prisoners for outside care quickly enough. And just as bad, outside doctors’ orders were routinely ignored once inmates were back in their cells.

The report called for a sweeping, 53-point overhaul in the way the prison was operated. The attorney general’s office threatened to file a lawsuit if the conditions were not met in 49 days.8

Increasingly, lawsuits are the only way for prisoners to assert the basic human rights guaranteed to them under the Constitution. So far, successful class-action lawsuits alleging medical neglect have been filed in California, Michigan, and Utah. Groups in other states are preparing to file. Even in Yazoo City, a local attorney is preparing a lawsuit on behalf of a prisoner.

Rather than forcing change, however, these lawsuits have had the opposite effect. Instead of providing the rights that decency and the Constitution demand, the federal government passed the 1996 Prison Litigation Reform Act. This legislation made it harder for federal courts to guarantee constitutional conditions in federal prisons. According to the ACLU, now “many states are following the

federal government’s example and enacting laws that create similar obstacles for prisoners in the state court system.”

If the prisoners cannot protect themselves, and the public refuses to be shocked by the grim statistics and images pouring from America’s prisons, there can be only one end to this story: a national disaster.

One possible scenario is depressingly easy to imagine. Under the current system, millions of people will continue to be convicted for nonviolent crimes, especially drug offenses. They will be given long sentences in prisons that are literally bursting at the cell doors. They will be subjected to crowded conditions, sexual and criminal predators, and infection with the deadly diseases that run rampant through our prisons. Then, with inadequate medical care, they will be released onto our streets, sick and corrupted.

Unless something is done, our prisons will continue act as incubators of violence and disease, and before long, we will all pay a price for our neglect.

EDITOR'S COMMENTS

The purpose of this article is to report on what is wrong with American prisons. We interviewed dozens of former prison inmates and received different opinions about the quality of health care afforded in prisons. In some instances, former inmates rated the health care as very good. Sadly, however, this was not the typical response. Life Extension members are keenly aware of the importance of good health care, including both prevention and treatment. Various agencies of the federal government publish reports on what Americans should be doing to avoid the infirmities of aging, yet these standards are ignored in most federal prisons. In today’s world, it is easy to document the life-span-shortening effects of poor medical care. Failure to deliver quality health care to those convicted of political crimes represents punishment that extends well beyond the deprivation of individual liberty that imprisonment is supposed to exemplify. Do not think that you are immune to being incarcerated. If you drive a car, operate a business, or work for a living, you are especially vulnerable. Overzealous prosecutors today no longer need to show that you had “intent” to commit a crime. If you exceed the speed limit and are involved in a wreck that kills someone, you could be indicted for vehicular manslaughter, even though you had no intent to harm anyone. The fact that you broke the law by speeding is enough to put you away in a nasty state prison for many decades. In an unprecedented case, a drunken passenger was convicted of vehicular manslaughter because he gave his car keys to his drunken brother to drive. The state argued that the inebriated passenger and drunken driver were equally at fault for the accident. Since two people were killed in this tragedy, the passenger is facing up to 30 years in jail. Prosecutors said they wanted to “test” this new legal “theory” that a drunken passenger is as guilty as a drunken driver. Do not even consider driving drunk—you could get life in prison in some states, even if you did not cause the accident. There are now so many regulations that business owners fear being arrested for all kinds of imaginary crimes. The government has criminalized normal human behavior to the point that making the proper business decision could easily cause you to wind up in jail, even though you may not have even known that your actions broke the “law.”