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How jails harm, and the challenge for healers


What you’ll read today

  • Spotlight: How jails harm, and the challenge for healers

  • Confession throws prison uprising trials into chaos

  • 15 infants released from ICE detention in Texas; at least one remains

  • Idaho could bring transparency to risk assessment

  • Unabated violence in Alabama prisons

In the Spotlight

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]

Stories From The Appeal

 

Photo Illustration by Anagraph / Image via Delaware Correction Center

Confession Throws Prison Uprising Trials Into Chaos. A judge excluded a confession that exonerated defendants in one trial related to a Delaware prison uprising, but a pair of defendants were nonetheless acquitted, promising further problems for prosecutors. [Ella Fassler]

Stories From Around the Country

15 infants released from ICE detention in Texas; at least one remains: Last week, immigrant advocacy groups filed a formal complaint to the Department of Homeland Security warning “that the number of infants under the age of one detained in Dilley had increased over the last month,” according to Pacific Standard. ICE confirmed that on March 1, there were 17 infants and their mothers held at a facility Dilley, Texas, as well as one infant in another facility. At least 15 infants under the age of 1 have now been released in Dilley, with their mothers. As of yesterday, at least one infant was still detained. Children’s health experts “have warned that there is no safe way to hold children in detention without risking serious short- and long-term health issues.” [Jack Herrera / Pacific Standard] See also JPMorgan Chase announces it will “no longer bank” the private prison industry, including CoreCivic and the GEO Group. Protesters have urged the bank to sever its ties with the industry, and last month Representative Alexandria Ocasio-Cortez said she would seek oversight hearings to make banks accountable for “investing in and making money off of the detention of immigrants.”

Idaho could bring transparency to risk assessment: One house of the Idaho legislature approved a bill this week that requires that “all pretrial risk assessment tools shall be transparent” and all records of their use be “open to public inspection, auditing, and testing.” The bill would also do away with the  “trade secret” exemption that makes it nearly impossible for anyone challenging the validity of the assessments to obtain the details of the algorithms used. While the use of risk assessment tools has been a part of many bail reform efforts, there are concerns, as MuckRock reports, that “computational models, like those used in the risk assessments, have a substantial downside and could automate and reinforce prejudices against groups that have long been subject to discrimination. Thirty-three of Idaho’s 41 counties use some form of pretrial risk assessment. [Beryl Lipton / MuckRock]

Unabated violence in Alabama prisons: Alabama prison officials confirmed yesterday that Steven Mullins was stabbed to death at the St. Clair Correctional Facility. According to the Equal Justice Initiative, Mullins was the fourth person killed at St. Clair in the past six months and the 24th in Alabama prisons in the past two years. In 2014, EJI filed a lawsuit against St. Clair, alleging dangerous conditions amid a spate of violent deaths in the preceding three years. A 2017 settlement agreement mandated the reforms to improve the safety of officers and people in prison, but in June 2018, EJI notified the federal court that the corrections department has failed to implement the changes. [Equal Justice Initiative] See also EJI has calculated that the homicide rate in Alabama prisons is 600 percent higher than the national average. In January, Think Progress reported that people in prison allege officers permit, and even fuel, the violence.

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