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Report Details ‘Cruel’ and ‘Unconscionable’ Treatment of Patients in Illinois Prisons

A federal monitor says substandard healthcare persists—with horrific consequences—more than a decade after a lawsuit was supposed to compel changes.

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Report Details ‘Cruel’ and ‘Unconscionable’ Treatment of Patients in Illinois Prisons

A federal monitor says substandard healthcare persists—with horrific consequences—more than a decade after a lawsuit was supposed to compel changes.


Last year, on the day before Christmas, a 45-year-old man with cancer was lying on a mattress on the floor of an Illinois prison, with feces on his hands, according to a report filed in federal court last week.

A nurse at the prison gave the patient sanitary wipes to clean himself. “Pt refuses to get up off floor to be assisted with cleaning,” she wrote in her notes, according to the report. “Says I’m fine down here you can go on now. Educated on sanitary hygiene. Will [continue] to encourage hygiene and sanitation practices.”

Later that day, the man was dead.

In the months before his death, the man often complained of severe pain, had lost more than 20 pounds, and was incontinent, but medical providers took little action, according to the report.

His death is one of more than two dozen contained in the latest report filed by a court-appointed monitor tasked with overseeing long standing issues of inadequate health care in Illinois state prisons. More than a decade ago, Uptown People’s Law Center, a Chicago-based civil rights firm, and others filed a class action lawsuit against the Illinois Department of Corrections (IDOC), alleging that healthcare in the state’s prisons was so poor that it violated the constitutional rights of incarcerated people. In 2019, the plaintiffs and IDOC entered into a settlement agreement, which mandated that correctional officials implement a number of reforms.

But incarcerated patients are still waiting for many of those changes to materialize. Earlier this month, federal District Court Judge Jorge L. Alonso found IDOC in contempt of the court’s order to complete a valid implementation plan to improve healthcare services. Shortly thereafter, the court-appointed monitor, Dr. John Raba, filed his fifth report—a damning condemnation of the substandard care that Illinois prisons continue to provide.

People in IDOC custody, Raba wrote, “died from dehydration and malnutrition …. or were allowed to deteriorate without intervention.” Their care was “unacceptable.”

The most vulnerable patients—people with life-threatening illnesses and elderly patients with dementia—face particularly poor treatment, according to Raba’s report. More than 1,000 people age 65 or older were incarcerated in Illinois prisons as of last December.

People with dementia, the monitor found, signed living wills or “do not resuscitate” orders when “they clearly were not of sound mind and could not willfully and voluntarily do so.” In several cases, they “appeared mistreated, neglected, or abused.”

IDOC has pushed back against the monitor’s findings. In a statement sent to The Appeal, IDOC said that the monitor “has advocated that the Department create a healthcare system that far exceeds community standards.” The department maintained that it “takes the physical and mental healthcare of incarcerated individuals very seriously.”

To help comply with the consent decree, IDOC said it hired Dr. Jane Leonardson, “a nationally recognized correctional healthcare expert.” After conducting her own review of the same records provided to the monitor, Leonardson concluded that Raba’s report “included extensive inflammatory and inaccurate statements which are unsupported and are meant to cast unfair doubts on the entire IDOC healthcare system,” according to an IDOC statement.

When The Appeal asked to review Leonardson’s version of the report, an IDOC spokesperson clarified in an email that she had not drafted her own version, and had only “assisted the department in responding to the Monitor’s report.”

In March, IDOC entered into a three-year contract with Leonardson for an estimated $1.95 million, according to a copy of the contract IDOC provided to The Appeal. Over the course of three years, she’ll be compensated for an estimated 3900 hours of work—around 25 hours a week—at a rate of $500 an hour. As a consultant for IDOC, Leonardson is tasked with, among other duties, assessing departmental policies, assisting with developing a quality assurance program and, when necessary, providing expert testimony.

An IDOC spokesperson declined a request for an interview with Leondardson on the doctor’s behalf.


As part of the court-appointed monitor assessment, Raba examined the records of 25 people who died in IDOC custody or who had been in custody shortly before their death. He found that medical providers repeatedly ignored patients’ symptoms, delayed necessary diagnostic testing, and, in effect, left people to waste away until their death. The monitor called one doctor’s care of a 70-year-old cancer patient “incompetent and cruel.”

For six months, another prisoner, a 49-year-old man, repeatedly complained of back pain. Medical staff told him to drink more fluids, cut down on sugar, and stretch, according to the monitor’s report. When he was finally sent to the hospital, he was diagnosed with brain and bone cancer, and respiratory failure.

When the patient was returned to prison, he “complained of pain consistently on most days,” but the nurses often withheld his prescribed pain medication. He died last August, about a month after being released from prison.

In what the monitor described as “unconscionable” treatment by medical staff, an elderly man with dementia was housed in “what appeared to be the equivalent of solitary confinement.”

The man had been admitted to the infirmary not as an official “patient,” but as a “security hold,” a term used to describe individuals who cannot live in general population for any number of reasons, including an inability to care for themselves. Because medical staff never considered him a patient, he was expected to care for his own daily needs, such as drinking, eating, and bathing.

Between March and August of last year, he lost almost 60 pounds. He fell multiple times and often refused food, according to the monitor’s report. But even as his condition worsened—including a brief hospitalization for a possible seizure—medical staff did not admit him as a patient and rarely examined him.

Last September, the man was found unresponsive in his cell and was taken to the hospital. His temperature was in the 70s. Because of his malnourishment, he had developed severe hypothermia and gone into cardiac arrest, according to the monitor’s report. He died later that month.

The medical staff’s treatment of the man constituted elder abuse and should be investigated, the monitor wrote.

If the people described in the report were housed in a nursing home and not a prison, their inadequate care would “trigger a state investigation, and the home would immediately be shut down,” Alan Mills, executive director of the Uptown People’s Law Center, wrote in an email to The Appeal.

“IDOC clearly wants to continue their misconduct with impunity, hidden behind prison walls,” he wrote. “Their complete disregard for the health and safety of people in prison should disgust every taxpayer in Illinois.”

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