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At Angola Prison, ‘People Are Suffering. People Are Dying’

Trial begins in class action suit alleging medical neglect by Louisiana State Penitentiary.

msppmoore/Flickr (CC BY-SA 2.0)

At Angola Prison, ‘People Are Suffering. People Are Dying’

Trial begins in class action suit alleging medical neglect by Louisiana State Penitentiary.

“[T]he Louisiana State Penitentiary’s delivery of medical care is one of the worst we have ever reviewed.” That’s what two doctors and a nurse practitioner concluded in a report prepared for a trial that started this week stemming from a 2015 class action lawsuit.

Dr. Michael Puisis, an expert in correctional medicine, argued on the stand Wednesday that Louisiana State Penitentiary, known colloquially as Angola, had long neglected its duty to keep prisoners safe. A large part of that, he testified, was the failure of the Louisiana Department of Corrections to implement a system to review prisoner deaths or physician errors. “If you don’t look for problems, you don’t find them,” Puisis said.

A group of individually named prisoners, along with the Southern Poverty Law Center, the ACLU of Louisiana, the Advocacy Center of Louisiana, Cohen Milstein Sellers & Toll PLLC, and the Promise of Justice Initiative, brought the class action suit against the prison and the Louisiana Department of Public Safety. It alleges that, for a quarter of a century, they have run an unconstitutional healthcare system for the 6,000 people incarcerated in Angola.

“People are suffering. People are dying,” said Mercedes Montagnes, executive director of the Promise of Justice Initiative and lead counsel on the case. “It is our sincerest hope that this suit will ensure that the state of Louisiana treats all its people with basic decency and in accordance with the Constitution.”

The 90-page medical report discussed in court Wednesday describes delays, denials of treatment, inadequate care, and a lack of accountability for physicians, violating rights guaranteed by the Eighth Amendment’s prohibition on “cruel and unusual” punishment. In one case involving a prisoner who was a double-amputee suffering from necrosis, for instance, Puisis told the court he had “never seen that extent of dead tissue in a patient.” Another patient, since deceased, went 16 months without a biopsy for a mass in his lung that turned out to be cancer.

Puisis also pointed to the near doubling of mortality rates in Louisiana state prisons, from 361 per 100,000 prisoners in 2001 to 628 in 2013 (the last year data is available), which is the highest death rate of prisoners in the country. The number, the experts explained, could not be attributed solely to the prison’s aging population. The state’s Department of Public Safety and Corrections declined to comment on the trial, noting that it does not “comment on pending litigation.”

An exhibit in the case.
Courtesy of the Southern Poverty Law Center

At Angola, the average prisoner age is just over 40, and the average sentence is in excess of 90 years, far beyond the prisoners’ expected life spans. The vast majority of prisoners are assigned to “hard labor,” working the 18,000 acres of crops, bending and toiling outside all day in all weather. The plaintiffs say these conditions all contribute to the current healthcare crisis. Puisis said the fact that the mortality rate nearly doubled over ten years suggests “something is happening in Louisiana that is really amiss.”

Puisis said the problems start with the process of evaluating prisoners for health issues. He said EMTs make the initial evaluation for “sick calls,” which often occur in the middle of the night when prisoners who want to see a physician for any reason are required to present themselves for a preliminary exam. Prisoners with chronic and painful health problems are also frequently denied narcotics, he noted, because of misdiagnosis or because staff don’t believe the prisoners are in pain.

Puisis and his colleagues also called into question the quality of the staff. Louisiana guidelines permit the Department of Corrections to hire physicians with restricted licenses and, according to the report and publicly available information, the Louisiana State Board of Medical Examiners had at some point suspended or restricted the licenses of all the physicians at Angola when the report was written.

The current director of medical services, Dr. Randy Lavespere, had his license suspended from 2006 to 2014 based on his felony conviction for possession with intent to distribute meth. According to the medical examiners board and as noted in the expert report, he was diagnosed with an unspecified personality disorder and has testified previously that he thinks half of his patients are faking their symptoms. As the report documents, other doctors on staff had their licenses suspended or restricted for concerns like sexual misconduct, drug and alcohol dependency, and a federal conviction for selling human growth hormone. Lavespere is in charge of monitoring all of the other doctors, which Puisis argued presents an inherent risk to patient safety.

Puisis also blasted the prison for an official policy allowing prisoners to be punished for “aggravated malingering,” a label applied to people who are deemed by staff to have requested unnecessary healthcare. “Medical staff shouldn’t be assigning punishment,” Puisis testified, because it violates agreed-upon standards for correctional health care. “It’s inappropriate, unprofessional and perverse,” he elaborated under cross-examination.

Earlier in his testimony Wednesday, Puisis raised concerns over the prison’s funding. From 2001-13, Angola spent less than half as much on healthcare per prisoner than the average for prisons nationwide. Puisis said administrators at Angola were unable to provide a line-item budget on its spending.

Puisis’s report provides context that could bolster the case brought by the named plaintiffs, who represent some of the most egregious cases of medical neglect. Otto Barrera, who lost most of his lower jaw in a 2012 shooting before arriving at Angola, appeared in the courtroom in shackles on Wednesday. Barrera was referred for reconstructive surgery in 2014 on his missing bottom lip and tongue, but Angola’s administration denied the procedure. Because he cannot chew his food, he is supposed to be on a soft diet. But, according to the complaint, he continues to receive the same meals as other prisoners, which he must tear into small pieces and painfully chew.

Advocates say the lawsuit highlights a problem plaguing Louisiana’s prisons overall: too many prisoners who are aging during their extremely long sentences. “This lawsuit should remind legislators that Louisiana is at a crossroads,” Norris Henderson, executive director of Voice of the Experienced, and a member of Louisianans for Prison Alternatives, later told The Appeal. “The state can either spend more money to provide adequate healthcare or it can incarcerate fewer people.”

Cash Bail Yields A New Casualty

A Texas jail suicide involving a woman who couldn’t make bail in a shoplifting case highlights of the plight of pretrial detainees with mental illness.

An empty prison cell.
Photo illustration by Anagraph / Photo by Darrin Klimek/Getty Images

Cash Bail Yields A New Casualty

A Texas jail suicide involving a woman who couldn’t make bail in a shoplifting case highlights of the plight of pretrial detainees with mental illness.

On July 21, Debora Ann Lyons walked into a Walmart in Houston and headed to the deli counter. There, she stuffed food into a beach bag and proceeded to the self-checkout register. But did not pay for the items; instead, she walked to a nearby McDonald’s and ate them. When she was finished, she placed food scraps back into her beach bag and then returned to the Walmart. In the store’s pharmacy section, she picked out a walking cane. In the men’s area, she grabbed some clothing. She then left the Walmart, again without paying for the items. Outside the store, she was arrested by Houston police; later, a Harris County magistrate judge set her bail at $1,500 and she was remanded to the county jail.

Like the nearly 500,000 people nationwide who are held in local jails because they cannot afford bail, Lyons could not purchase her release from the Harris County jail. At around 6:45 p.m. on Aug. 14, the 58-year-old Lyons, who, according to the Houston Chronicle, suffered from schizophrenia and bipolar disorder, hanged herself in the jail’s common room.

Lyons was then taken to a nearby hospital for treatment; her attorney, meanwhile, requested a personal recognizance bond so that she would not have to return to the jail if she had survived. The judge granted the bond but Lyons died soon afterward.

Lyons’s death was the second suicide in a month at the jail. And It was the fourth time in two years that the jail—Texas’s largest, which holds around 9,000 inmates and houses more mentally ill patients than all of the state’s mental hospitals combined—was deemed to be noncompliant by the Texas Commission on Jail Standards after guards had not properly monitored inmates. Lyons’s death also came as Harris County is fighting litigation in federal court that would ensure that poor defendants like her are not detained pretrial. Last month, a federal judge ruled that a wrongful death lawsuit brought by the family of Kenneth Christopher Lucas, who died in the jail in 2014 after he went into cardiac arrest when a deputy sat on his back, can move to trial. Lucas died the same day his bail was set at $5,000 for violating a child custody order; he was accused of keeping his children too long during a scheduled visit. The lawsuit filed by his family noted that between 2001 and 2007, most of the 101 detainees who died at the Harris County jail were there pretrial.

Even though the items Lyons stole from Walmart totaled just $155, she was charged with felony theft by the Harris County district attorney’s office because it was the latest in a string of low-level thefts. Lyons had been arrested six times for stealing dating back to 2009; in two of those incidents, she had stolen items ranging from $50 to $500. “It doesn’t appear she was a lifelong thief,” Jay Jenkins, an attorney with Texas Criminal Justice Coalition, told The Appeal. “She appears to be stealing out of necessity. If she would have had enough money to make bail, she probably wouldn’t have been stealing in the first place.”

Under Texas law, prosecutors can enhance misdemeanor charges if there are prior convictions but the district attorney has the ultimate authority to decide whether that’s appropropriate. Harris County District Attorney Kim Ogg, who ran as a reformer, should have used her discretion in Lyons’s case, Jenkins says.  “It certainly doesn’t fit the mold of someone who wants criminal justice reform to be nibbling around the edges on some issues and still handling cases like Ms. Lyons in this way,” he said. “As long as low-level theft defendants are facing years in prison we’re not going to be able to fix things.”

But Anthony Robinson, the chief of the district attorney’s mental health division, said prosecutors never had the chance to make a recommendation on Lyons’ bond because she did not appear at the probable cause hearing for health reasons. Because Lyons was not present, the prosecutors didn’t make a recommendation and the sole authority in making a bond determination fell onto the magistrate judge, he said. “In a situation like this there’s not really anything we can do,” Robinson told The Appeal.

Lyons’s $1,500 bail was set on July 22 by a magistrate judge after she missed a probable cause hearing for an unknown medical reason. It was less than the $5,000 bail she was given in her previous two theft cases, in March 2018 and June 2017, but one she was still unable to make.

At the Harris County jail, where roughly a quarter of the inmates have a mental illness, Lyons was housed in a mental health step-down unit, which is where detainees are placed while they stabilize from a mental health crisis yet still require daily care. Jail officials use a system of colored wristbands to help them monitor mentally ill prisoners and they were aware of Lyons’s mental health issues, a source close to the case told The Appeal. But according to another source briefed on the case, jail officials mixed up the color of her wristband and she was ultimately left alone for a prolonged period of time during which she was able to hang herself. According to the Houston Chronicle, she had threatened suicide in the days before her death.

The Harris County sheriff’s office declined to comment on the claim, citing a pending investigation.

An investigation by the Texas Commission on Jail Standards, charged with overseeing the state’s jails, found that Lyons was not checked on every 30 minutes, which is required for prisoners known to be suicidal, mentally, ill, or “who have demonstrated bizarre behavior.” According to the commission’s report, which was released in late August, Lyons had left her cell to take her medicine just before she hanged herself. Brandon Wood, the commission’s executive director, told The Appeal that lax monitoring of prisoners with mental health issues is a “concern” within the Harris County jail. Because it has been an ongoing problem, the commission is examining how to address it once the jail is back in compliance, he said.

Now, the jail must devise a plan to remedy its problems with monitoring prisoners with mental health issues. The commission will then review the plan and continue to monitor the jail to ensure that it is being put into action. Wood said he has information regarding how Lyons was able to hang herself in the common room, but declined to provide specifics because of a pending investigation by the Texas Rangers, a division within the Texas Department of Public Safety with lead criminal investigative responsibility in areas such as major incident crime and public integrity investigations. The Texas Rangers did not respond to a request for comment.

Since Lyons’s death, the jail has also set up a suicide hotline for prisoners as part of a 60-day pilot program that sends their calls to a center that is in charge of mental health services.

Lyons’s suicide came months after the Fifth Circuit Court of Appeals upheld a federal judge’s 2017 ruling that Harris County’s bail system violates the equal protection clause of the Constitution. “The wealthy arrestee is less likely to plead guilty, more likely to receive a shorter sentence or be acquitted, and less likely to bear the social cost of incarceration,” court wrote in its February opinion. “The poor arrestee, by contrast, must bear the brunt of all of these, simply because he has less money than his wealthy counterpart.”

But in August, after Harris County argued that a defendant waiting for 48 hours in jail for an “individualized (bail) hearing” is not a violation of the equal protection clause or due process, the Fifth Circuit issued a stay on the 2017 ruling, effectively granting the county the ability to detain people regardless of their ability to their pay bail. Even when the injunction was in place, Lyons was not eligible for release because she was charged with a felony; but she was the sort of person who the legal challenge to wealth-based detention was meant to protect.

“It’s a tragedy,” said Elizabeth Rossi, an attorney with Civil Rights Corps, the legal nonprofit organization that filed the class action lawsuit in federal court against Harris County in 2016 that led to the landmark 2017 decision declaring its bail system to be unconstitutional. “Nobody should lose their life because they can’t make a monetary payment. I think it just goes to show how senseless, heartless, and inhumane the system is.”

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Prisons Crack Down On An Opioid Treatment Drug, Endangering Lives

Few of the prisons trying to stem flow of contraband Suboxone offer substantial opioid treatment programs.

Spencer Platt/Getty Images

Prisons Crack Down On An Opioid Treatment Drug, Endangering Lives

Few of the prisons trying to stem flow of contraband Suboxone offer substantial opioid treatment programs.

Maryland banned prisoners from holding or cuddling family members. Pennsylvania is restricting prisoners’ access to book donations. Colorado prisons have forbidden greeting cards and any mail containing drawings. All of these measures were taken in the name of stemming the flow of contraband Suboxone, an opioid treatment drug that helps lessen withdrawal symptoms.

Yet few of these prisons offer substantial rehabilitative programs for prisoners in need of treatment for substance use disorders.

Medical professionals endorse medication-assisted treatment programs, which use a combination of mental health counseling and medication (such as methadone, Suboxone, buprenorphine, or naltrexone) to prevent opiate overdose. Though studies have shown this approach reduces overdose deaths in prisons, prisons have been slow to adopt substantial medication-assisted treatment programs. While some prison systems refuse to offer any such treatment programs, others have limited their program to only one medication.

Denying treatment has proved fatal in jails and prisons across the country. “People who re-enter the community after a period of incarceration are 50 to 120 times more likely to overdose and die than the general population. This is because they go through detoxification and withdrawal, diminishing their tolerance,” Leo Beletsky, a professor of law and of health sciences at Northeastern University, told The Appeal.

Forced, sudden withdrawal is also deadly. In May, Kentrell Hurst died in the Orleans Justice Center jail while detoxing from opiates and alcohol. In January, Frederick Adami died because of opiate withdrawal complications at Bucks County Correctional facility in Pennsylvania. In Colorado, 25-year-old Tyler Tabor died of dehydration at Adams County jail outside Denver after experiencing painful opiate withdrawal symptoms for three days in 2015. And in Utah, Madison Jensen died in 2016 of cardiac arrhythmia due to opiate withdrawal and dehydration. Nearly all withdrawal deaths, especially those due to dehydration, are preventable.

If he had not reached a settlement with the Maine Department of Corrections last month, Zachary Smith could have been one of the casualties. Smith, who has been in recovery for five years, is preparing to start a nine-month stint in the Aroostook County Jail, which has a ban on medication-assisted treatment.When he entered the prison system, Smith would have been cut off from buprenorphine, the medication that has helped him manage his chronic illness. The ACLU of Maine argued on Smith’s behalf that the lack of medication-assisted treatment programs violated Smith’s rights under the Americans with Disabilities Act, which lists drug and alcohol addiction as a disability. Additionally, they alleged that the painful withdrawal symptoms he would undergo would constitute cruel and unusual punishment, a violation of the Eighth Amendment.

“He was going to go from being a person with an addiction problem who is in recovery to somebody who is taken off their medication and left to try to manage their problem on their own—which is incredibly hard to do and not the way that doctors and the medical community think this should be treated,” said Zachary Heiden, legal director of ACLU of Maine. “To go from being on medication-assisted treatment to being cut off from that treatment, as prisons and jails frequently do, is incredibly painful and potentially life-threatening.”

Smith will continue taking buprenorphine when he goes to prison. But, the lawsuit settlement doesn’t extend to the other 2,500 people incarcerated in the Maine prison system. The state’s Department of Corrections commissioner, Joseph Fitzpatrick, said the agency had no plans to provide medication-assisted treatment to the rest of its prisoners and called Smith’s situation a “unique case.”

Last year, Suboxone was the most common contraband found in the Maine prison system.

Prison officials justify the crackdowns by arguing that Suboxone, which is prescribed by a doctor, can be abused in large doses to produce a high similar to other opioids like heroin. But contraband is far more likely to be smuggled in through correction officers, who are less scrutinized than prisoners’ families and visitors. States have busted ring after ring of corrections officers who trade contraband drugs, alcohol, phones, and other banned items in exchange for bribes.

And while multiple prison and jail systems—such as in Virginia, Maine, and Pennsylvania—have come down hard on prisoners in the name of restricting contraband drugs, these same states fail to offer meaningful channels for the majority of their prisoners to access necessary medications.

To justify ending book donation programs and moving to an electronic book system, the Pennsylvania Department of Corrections posted a photo on Twitter last month of a book sent to the prison from a bookseller that had strips of Suboxone in it. Pennsylvania offers only naltrexone to most of its prisoners for its medication-assisted treatment program (pregnant people receive methadone). Amy Worden, a spokesperson for the agency, said it will begin offering buprenorphine (both Suboxone and Sublocade) as a pilot program next month in two or three of its 24 prisons.

Similarly, the Virginia Department of Corrections posted a photo on Twitter showing orange Suboxone strips. The tweet alleged that a visitor had attempted to smuggle in Suboxone strips by hiding it in her genitals. Days earlier, the agency banned female visitors from wearing tampons or menstrual cups; however, Brian Moran, the state’s secretary of public safety and homeland security, suspended the policy on Sept. 25 “until a more thorough review of its implementation and potential consequences are considered.”

In July, Virginia prisons began a pilot medication-assisted treatment program that offers one drug: naltrexone. Naltrexone does not treat withdrawal symptoms. Prisoners in the program will receive an injection of the drug right before being released and are required to participate in post-release drug treatment services. However, for the majority of those incarcerated in Virginia Department of Corrections, the pilot medication-assisted treatment program will not be accessible. Indian Creek Correctional Center and Virginia Correctional Center for Women are the only two of the state’s 38 prisons that have the program. (People incarcerated at three out of five of the Community Corrections Alternative Programs are also eligible.) Since 2015, at least 12 people have died of overdoses in Virginia prisons, making opiate treatment programs in the state an even more pressing concern.

Meaningful intervention, according to Beletsky, requires making medication treatment programs accessible to all prisoners upon entry into prison. Because of the subtle differences in medication treatments and possible side effects, it’s important that prison and jail systems offer as many options as possible.

“Ideally prisons and jails will continue the treatment that somebody is already receiving. … Because anytime you change somebody’s medication, there’s potential problems,” Heiden said. “Each of these drugs works on the brain in slightly different ways, and the medical standard of care is not to simply swap one for another—just as you would not simply swap Celexa for Zoloft. One medication may be less effective than another, or it may cause different side effects.”

Prisons that have committed to the medication-assisted treatment approach have seen promising results. Rhode Island’s Department of Corrections, which started making three opioid treatment drugs available in mid-2016, quickly found that fewer prisoners died from overdoses after being released.

The Maine ACLU and other legal experts argue that states that do not to provide medication-assisted treatment programs in their jails and prisons are violating the Eighth Amendment, as they say denying necessary medication amounts to cruel and unusual punishment. “Prisons and jails are obligated to provide medical treatment for people in their custody and medication-assisted treatment is medical care,” Heiden said.

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