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How jails harm, and the challenge for healers
Being jailed can have dire consequences for one’s health. Even though incarcerated people are entitled to access to adequate medical care, the culture of punishment can override even dedicated healthcare professionals. Jennifer Gonnerman writes about medical care at Rikers Island in a recent New Yorker article titled “Do Jails Kill People?” [Jennifer Gonnerman / New Yorker]
Jennifer Gonnerman’s piece looks at “Life and Death in Rikers Island,” the newly published book by Dr. Homer Venters, former chief medical officer of Correctional Health Services in New York City. Venters was the head doctor overseeing medical care at Rikers and other city jails until 2017. Gonnerman describes how, in his 10 years working at Rikers, Venters made his mark in a setting completely inhospitable to patient care: “On an island known for abuse and violence, Venters became a legendary figure; he often spoke about human rights and was known for his persistent advocacy” on behalf of those incarcerated there. She captures the tension between the principles and vision that Venters brought to work and the hard limits on protecting people’s health in a place like Rikers. [Jennifer Gonnerman / New Yorker]
There are at least three big issues with ensuring the well-being of people in jail. (This is leaving aside the pressing question of how to ensure post-release access to care for people who receive treatment while in jail.) The first is that the people who are jailed are, on average, sicker than those who are not. Rates of mental illness and substance use disorders are high, and these factors are major contributors to who is jailed. In the decades-long absence of sturdy and sufficient community treatment, the legal system has criminalized people because of their mental illness and substance dependence and use. People with these conditions are now jailed in staggering numbers. The treatment that they need is either not provided or often inadequate in jails. [Steve Coll / New Yorker]
The second issue is that in many jails, the incentives for healthcare providers run contrary to providing the best care. People are seen as “inmates,” not “patients.” In another recent article for the New Yorker, Steve Coll documents the ways in which privatized healthcare companies in jails and prisons routinely fail to provide care to people in dire need of it. Coll first notes the poor health and the medical crises of the people who are being sent to jails, where “nearly half the people … suffer from some kind of mental illness, and more than a quarter have a severe condition, such as bipolar disorder.” Data from 2007-09 showed that two-thirds of people in jail who had been sentenced had substance use disorders, and this was before the onset of the opioid epidemic. [Steve Coll / New Yorker]
Faced with a group in desperate need of quality care, private healthcare companies fall staggeringly short. David Fathi of the ACLU told Coll that although prison healthcare directly run by local government was “often appallingly deficient,” there is at least “some measure of oversight…some measure of democratic control.” With private companies “you don’t have that.” And the lawsuits that have exposed some of the most wrenching instances of neglect by private healthcare providers in jails and prisons—1,500 against the two largest providers in the past five years—chronicle an unwillingness by medical staff to take genuine concerns seriously and to provide appropriate care as needed. [Steve Coll / New Yorker]
Finally, the mission of jails, and the culture that pervades them, is the opposite of providing care. In contrast to the private companies that ignore patient distress, there are many principled healthcare professionals who work in jails, including at Rikers. But the commitment to punitiveness and indifference to suffering can frustrate the efforts of even the most dedicated medical staff.
The indifference of corrections staff can even translate into a lack of access to specialized care outside the jail. According to the New York City Board of Corrections, the city’s independent oversight body, people held in city jails in 2018 missed over 30,000 appointment for specialized medical care. The main reasons were the failure of jail staff to take them to appointments. One man who was jailed at the Manhattan Detention Center is suing the city for $90 million over their failure to manage his rare medical condition, even after he alerted jail staff to it and repeatedly sought care. [Reuven Blau / New York Magazine and CITY NY]
What Venters’s book also illuminates, Gonnerman says, is that the security staff’s unwillingness to facilitate treatment is not just coincidental. Guards inflict violence on incarcerated people in high numbers and in stomach-turning ways. Many will suffer injuries, often debilitating ones, at the hands of corrections officers. In his book, Venters wrote about patients frequently describing the cause of their injuries as “slip-and-falls.” Yet many of the injuries he saw did not match what patients said had happened. He realized it also coincided with corrections officers insisting on escorting patients to the clinic for all appointments. Patients who had been beaten by officers lied about what happened. The pressures on principled and dedicated clinicians can thwart the best intentions. They include lack of cooperation, blatant interference, even explicit threats. [Jennifer Gonnerman / New Yorker]
(A study co-authored by Venters and published last year chronicled the astonishingly high incidence of traumatic brain injuries among people held in jails. These injuries, to a degree that is still far from fully understood, can shorten life spans, affect cognitive functioning, and contribute to recidivism. A sizeable fraction—23 percent—of the head injuries came at the hands of corrections officers. Another significant contributor? “Slipping and falling.” [Maya Miller / Gotham Gazette])
Medical and all other nonsecurity staff are expected to avert their eyes and shut their mouths. The cost of trying to treat people attacked by COs, let alone speaking out about the attacks, can be high. One doctor’s tires were slashed, and dead flowers were delivered to her desk. [Jennifer Gonnerman / New Yorker]
Many healthcare professionals in jails do heroic work. Too many others succumb to what Venters describes as “dual loyalty”—the tension between the commitment to care for patients and the pressures to conform to the culture of security staff and comply with their directives. In doing so, they end up complicit in violence. In some instances, as in the case of clearing people for placement in solitary confinement, it is explicit. In others, it is through inaction, as in the example of a doctor who, hearing a man being beaten by COs outside his door, stayed at his desk, trying to “finish my paperwork.” [Jennifer Gonnerman / New Yorker]
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