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The Appeal Podcast: Neglect and Abuse in Our Prison Healthcare System

With Mercedes Montagnes of the Promise of Justice Initiative.

msppmoore/Flickr (CC BY-SA 2.0)msppmoore/Flickr (CC BY-SA 2.0)

Most people know that the healthcare situation in the United States is one of most precarious in the world, but what’s rarely discussed is the quality of healthcare for America’s 2.2 million incarcerated people––which is lightyears worse. One prison in particular, Angola in Louisiana, rates at the very bottom of even this group, with mortality rates almost double the national average for prisons. Our guest, Mercedes Montagnes of the Promise of Justice Initiative, is a lawyer helping people incarcerated at Angola sue the state for rampant abuse, neglect, and injury.

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Adam Johnson: Welcome to The Appeal. I’m your host Adam Johnson. This is a podcast on criminal justice reform, abolition and everything in between. Remember, you can always follow us on Twitter @TheAppealPod, you can like us on Facebook at The Appeal magazine’s main Facebook page and as always you can subscribe to us on iTunes. Most people know that the healthcare situation in the United States is awful, but what’s never talked about is the status of healthcare for America’s 2.2 million incarcerated persons, which is light years worse. One prison in particular, Angola in Louisiana, is the worst of the worst with mortality rates almost double the national average. Our guest today, Mercedes Montagnes of the Promise of Justice Initiative, is a lawyer helping prisons in Angola sue the state for rapid abuse, neglect and injury.

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Mercedes Montagnes: At Angola the most common healthcare provider that people encounter is an EMT and, you know, there are three levels of EMTs, but the basic EMT essentially has a high school degree or equivalent and four months of training and they have become the gatekeepers to healthcare at Angola such that very often they’re making the medical decisions that a doctor should be making. And that’s why we see cancer progressed to really advanced stages when it shouldn’t be.

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Adam: Thank you so much for joining us on The Appeal.

Mercedes Montagnes: Thank you for having me.

Adam: So you are involved in a class action lawsuit along with the Southern Poverty Law Center, the ACLU, the Advocacy Center for Louisiana and several others that is suing specifically about the negligent healthcare at Angola prison in Louisiana, also known as the Louisiana State Penitentiary. This has been going on for some time. Can you set the table for our listeners by explaining what the impetus for this lawsuit was and what are the kind of broad charges being made?

Mercedes Montagnes: Sure, so Angola is a prison that is about an hour and a half away from our states’ capital of Baton Rouge. It was formerly a slave plantation and then it was converted into a prison. It has 6,000 people there. It’s maximum security and essentially the folks who are incarcerated there, our patients, our plaintiffs in this case, work in the fields, they work in various factories. It’s sort of a small town that exists in an isolated part of our state and a few years ago I began to receive a number of complaints about the quality of healthcare that they were receiving in addition to a lot of lawyers around the state and so I convened a sort of small working group of people to talk about the trends that we were noticing and did we think that this was a situation and we launched an investigation. That investigation lasted a couple of years and then we filed suit in May of 2015 alleging constitutional violations as it relates to the provision of medical care as well as several claims under the Americans with Disabilities Act relating to access to the facility and medical care for folks with disabilities.

Adam: Okay. That’s very exhaustive. So let’s kind of go down here because I want to establish the stakes. There’s a general ethos in American culture and I think specifically probably more so in Louisiana, at least if it’s anything like Texas where I’m from, of lock them up, throw away the key, screw ’em, they did their time. That prisons in general are the last thing that we want to fund, we being the sort of proverbial, you know, Joe Sixpack and healthcare within prisons is maybe right behind education as the absolute last thing we want to fund. How difficult has it been in your experience when doing publicity or talking to people or doing anything involving this case, how do you convey to people that this actually matters as a sort of baseline human rights issue?

Mercedes Montagnes: Well you know I always think that the stories help, you know, so one of the stories I like to tell is about my client Shannon Hurd. He actually died in the pendency of this action, but he was a named plaintiff and he complained for years and years. He was losing weight. He had flu like symptoms and it took them three years to properly diagnose him with renal cancer. By the time they diagnosed him with it it had metastasized all over his body and he died at 42. Shannon was serving time for stealing $14 out of an uninhabited dwelling. He was convicted by a non unanimous jury and maintained his innocence and it was under a really perverse three strikes law and he ended up getting a life sentence. So sometimes I think telling stories like Shannon’s, how people understand what we’re really talking about and shed some light on why this suit is important. But I also think that we have to recognize that when we lock someone up, they have no ability to go to their own doctor or go to their own pharmacy or help themselves in any way. They are at the complete mercy of the prison system. And finally, I think that there is always going to be a public health argument. Prisons become breeding grounds for infectious disease and they spill over into the community inevitably and those are public health issues as well.

Adam: Right. So let’s start with some numbers here. Uh, some pretty startling statistics coming out of Angola as Appeal writer Jessica Pishko noted, which are that the prison mortality rate has increased quite a bit over the last few years. In 2001, it was 361 deaths per 100,000 prisoners, as of 2013, the last date where data is available it’s 623, so it’s almost doubled. There are several theories as to why this is. One of them is that the hard labor, the use of hard labor is increasing and they are effectively working people to death. Can you talk about the extent to which hard prison labor is used as both a sort of punishment and a means of overworking, especially the the elderly prisoners?

Mercedes Montagnes: So I definitely think that there’s been a massive increase in the number of people dying within the system. I think that’s absolutely accurate. I also think that we ask folks to participate in sometimes dangerous labor and we actually had a client, Charles Butler, testify to that this week, where he had a duty status restricting the kind of labor he could do and he was forced to do drywalling. I would be skeptical if that rise in the death rate was related to the kind of labor that we are requiring from the patients and the plaintiffs in the lawsuit, only because I would really link it to the decline in the quality of medical care.

Adam: Right. To what do you attribute the lack of medical care?

Mercedes Montagnes: I really think it’s about funding. I think it’s about reliance on outdated medical techniques. I think it’s about, so for example, at Angola the most common healthcare provider that people encounter is an EMT and, you know, there are three levels of EMTs, but the basic EMT essentially has a high school degree or equivalent and four months of training and they have become the gatekeepers to healthcare at Angola such that very often they’re making the medical decisions that a doctor should be making. And that’s why we see cancer progressed to really advanced stages when it shouldn’t be. And we actually had two doctors who treat patients at the University Medical Center here in New Orleans who regularly see patients from Angola testify that the patients show up from Angola, their disease progression very far along. So what’s happening is they’re just not catching diseases when they’re still treatable. For that reason our experts in their report found that many of the deaths that they saw were preventable deaths, meaning if the patients had received proper medical care, they would likely not have died from the diseases that were there.

Adam: And the gentleman who runs the medical services at Angola, Dr. Randy Lavespere, had his license suspended from 2006 to 2014 after a felony conviction for the distribution of meth. Now we don’t want to, you know, necessarily stigmatize people who’ve been subject to arbitrary drug laws, but it seems like it seems like the people they’re picking to work there are not the highest quality care and that has obviously gotten worse over time.

Mercedes Montagnes: Yeah. I think it’s important, right? We believe in redemption and we don’t want to be punitive, but I also think it’s important that when you have a doctor, particularly doctors who have been convicted of crimes and have a limited licensure, you want them to be practicing in an environment where they’re around other doctors who don’t have limited licensures. What you have at Angola is a concentration. All the doctors at Angola have a history of restrictions on their licenses. Many of them have restrictions on their licenses because of the way that they provided care to their patients, either be it sexual abuse, be it over prescribing pain medication, and various other things, and then you take our patients, the most vulnerable patients and you put them with those doctors it’s just not a safe recipe.

Adam: And one element of this, which I was shocked to learn and I’m curious how common it is, is that there’s something called aggravated malingering, uh, which is a label applied to people who are deemed to have requested medical attention gratuitously or without merit, that they actually get punished for it at Angola prison. That if you ask for medical assistance and they somehow diem, again, I’m not sure based on what theory of mind, but they deemed that you did so fraudulently, that you get punished through the mechanisms that prisons punish people. Can you talk about that and how that has a deleterious effect on healthcare?

Mercedes Montagnes: Absolutely. So every healthcare request form that Angola has at the bottom is a warning that if you’re asking for healthcare and you’re deemed not to want it, that we’re going to punish you with this punishment called aggravated malingering. So with every healthcare requested a patient puts in, not only are they charged $4 to $6 per healthcare request when they only make four to twenty cents an hour for their work, but they have to fear that they could take disciplinary action against them. And actually just in October we had one of our experts testify about  a patient where they thought he was making up his symptoms and in fact he had lymphoma and they sent him to mental health and mental health was speculating about why he was exaggerating and in fact he died from that lymphoma. And so it’s very hard in the medical profession to say that someone is lying and not telling the truth and usually, as our expert testifies, if you can’t figure out what’s wrong, it just means you have to keep looking, not that the patient is lying.

Adam: Yeah. Again, having seen the dichotomy in healthcare personally, um, I know the difference between a small county hospital and a, an appointment at Northwestern or um, or MD Anderson is night and day. I imagine that it’s, you know, a whole different universe, not to mix metaphors. Especially in terms of cancer. I mean, cancer is a very involved process. It’s a very, you have to have many expertise. I can’t even imagine what it’s like getting cancer in prison, much less Angola. Is the lack of early detection and the lack of early treatment is something that’s, it’s something that’s systemic, correct?

Mercedes Montagnes: Absolutely. Um, whenever I visit Angola, I hear more and more stories and our case is named after Joe Lewis. Joe Lewis also died in the pendency of this action from throat cancer. He complained again for years about feeling like his, he had a sore throat, something was wrong, Laryngitis and sure enough he also had throat cancer and by the time they caught it, it was too late. So we see that quite often. And as a result, we see people, you know, what I believe is a very high death rate as a result of missed diagnosis.

Adam: Now  according to data Angola spends about half as much in healthcare per prisoner than the national average and that there seems to be a mindless cost cutting ethos. You talked about the importance of personal stories. Let’s talk about the case of Otto Barrera, who was shot in the jaw, the lower jaw in 2012 and had most of it removed and then he was referred for reconstructive surgery in 2014 for a missing bottom lip and tongue. But Angola denied this. He can’t chew food and he has to be on a soft diet, but they refuse to give him a soft diet and they gave him regular prison food which he had to cut up and apparently it’s excruciatingly painful for him to chew. Can you talk to us about that case and what? I mean I, I assume at some point in the, in these proceedings, somebody representing the state will get in front of a judge and defend these actions. What are the kind of apologetics here like how do people justify this dehumanizing healthcare?

Mercedes Montagnes: Well, in Mr. Barrera’s case, he testified at trial in October and he spoke eloquently about the difficulties he had encountered. Um, he has subsequently many years too late, began having some of his reconstructive surgery so it’s slightly better, but he still has significant trouble and the defendants essentially went after him because they noted that he had purchased some food from the commissary that suggested that he could in fact chew. They didn’t believe him that he couldn’t chew even though it was plainly obvious to anyone who saw him. And, you know, in the end he is, he simply said, ‘Yes, I did buy food because I was living in the infirmary with many men who had no family support. I was lucky enough to have family support. And so I bought food for other people.’ Essentially the argument appears to be that these individuals, you know, might have one time refused care because their family was visiting or they had an attorney visit or something like that and because they did that it’s okay that we didn’t give him surgery for three years. It appears to be that that’s the kind of explanation that we get.

Adam: Now, obviously certain states are better than others in terms of healthcare. In your knowledge, both in terms of Louisiana and other states, is there any sort of coordinated movement that’s a little more high level to really bring to attention these conditions? Healthcare in general in prisons, obviously you have a lot of talk about prison reform. Oftentimes labor conditions are centered in that, but I think rarely would we talk about healthcare in prisons. Can you talk to us about any organizations or groups or, or, or kind of high level stuff that’s going on, uh, that tries to raise public awareness about this?

Mercedes Montagnes: Well. One thing that is exciting is that they’re Vera Institute has begun to take individuals on trips to places in Europe where they really approach incarceration from a very different level. And in fact the secretary of the Department of Corrections in Louisiana. I was scheduled to attend that trip in October and he had to cancel. But I think exposing our, especially our corrections, high up high level corrections officials to a different way of doing things. So in Europe, often there’s a much stronger focus on rehabilitation. There’s a much stronger emphasis on reintegrating people into society slowly and helping them get back on their feet with a real emphasis away from punishing people for mistakes, but rather thinking about innovative and new ways that we can help people recover from incarceration. So I’m really grateful for that work. Um, I’m grateful for the existence of things like The Appeal which are really focusing on criminal justice issues and raising awareness. I think that’s essential if we’re going to move this conversation forward. Um, and then, you know, I think all about chipping away at a system that you know has been allowed, I think especially since the nineties, to go a little bit under dark. I tell everyone this, but when the Prison Litigation Reform Act passed, it made it much, much harder for attorneys to go in and expose these kinds of conditions. It made it more expensive. It made the likelihood that they would prevail much, much harder. And because it raised the bar so high, you really see as sort of curtain withdrawn over a lot of these prisons in the nineties and I think that’s changing now. And I think a lot more exposure about these issues is happening.

Adam: Yeah. We discussed this on a, on a prior episode with Raven Rakia about the prison strikes, the law that was passed in the nineties under Clinton that basically made tort very, very difficult, which of course is going to, you know, in any case where you don’t have any kind of compensatory or punitive alternative you’re going to just have people treating you like garbage. I mean that’s the, that’s the logical endpoint of that on a systemic level. So I mean that, that to me seems to be a major factor in both the healthcare and the and the, uh, labor abuses that you see. So before you go, can you tell us the status of the lawsuit and where people can read about it or check out or follow up dates if there’s any place that can do that?

Mercedes Montagnes: So the lawsuit is wrapping up October 26th. And then once it’s wrapped up, they’ll probably be somewhat of a lag between when the trial ends and when the judge renders her opinion. We certainly are in the media, but um, you can follow, our website, and we’ll have updates there as things progress along. Can you follow us on Twitter @JusticesPromise and we will definitely be updating it as things progress. You know, one thing to bear in mind with these kinds lawsuits is it’s a marathon not a sprint and change is a slow process. And so we’re hoping that we will be able to convince the judge in this first step of approving the constitutional violation and then we can move into deciding how we fix it.

Adam: Well, thank you so much. I appreciate you coming on.

Mercedes Montagnes: Well thank you so much for having me.

Adam: Thanks to our guest, Mercedes Montagnes of the Promise of Justice Initiative. This has been The Appeal podcast. Remember, you can follow us on Twitter @TheAppealPod or subscribe to us on iTunes and follow us on Facebook at The Appeal magazine’s main Facebook page. I’m your host Adam Johnson. The show is produced by Florence Barrau-Adams. The production assistant is Trendel Lightburn and executive producer Sarah Leonard. Thank you so much for joining us. We’ll see you next week.