The Appeal Podcast: Substandard Healthcare in American Prisons

The only people in the United States that the government is required by law to provide healthcare for are the incarcerated. But what constitutes a baseline standard of care is very much in doubt and many human rights activists and legal experts argue the healthcare, namely in states like Illinois and Louisiana, is far below any moral or constitutional standard. Today, Taylor Elizabeth Eldridge, a Type Investigations Ida B. Wells Fellow and Appeal contributor,  joins us to discuss how we are long overdue for a national conversation on healthcare neglect in America’s sprawling prison complex.

Adam Johnson: Hi 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 at The Appeal magazine’s main Facebook and Twitter page and as always you can rate and subscribe to us on Apple Podcast. 

The only people in the United States the government is required by law to provide healthcare for are the incarcerated. But what constitutes a baseline standard of care is very much in doubt and many human rights activists and legal experts argue the healthcare, namely in states like Illinois and Louisiana, is far below any moral or constitutional standard. Today Type Investigations Ida B. Wells Fellow and Appeal contributor Taylor Elizabeth Eldridge joins us to discuss how we are long overdue for a national conversation on healthcare neglect in America’s sprawling prison complex.

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Taylor Elizabeth Eldridge: You know their medical board, there are disciplinary actions that are, you are only allowed to work in prison. You know, they can restrict whether they’re allowed to have a private practice. And so it does, I think, you know, self filter for physicians who have no other option but to try to work in a correctional setting.

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Adam: Before we begin our interview with Taylor, we wanted to play some audio testimony from one of the affected parties that she recorded. A gentleman by the name of Gerry Armbruster, a former prisoner at Southwestern Illinois State Correctional Facility, a 763 bed prison in East St. Louis, who was neglected by prison doctors for months while suffering from an undiagnosed condition called Spinal Cord Compression. Armbruster spent the final five months of his sentence begging for medical treatment that he never received until after his release. Here’s Gerry describing in an interview with our guest Taylor how his symptoms began.

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Gerry Armbruster: It started with my hands. My fingertips were always numb. My wrist was hurting, my elbows was hurting. I could barely walk. I knew something was wrong, but I couldn’t pinpoint it. I didn’t know what it was and it just kept getting worse and worse and worse and worse.

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Adam: In the same interview, Gerry talks about the pain he continues to feel to this day from the condition he developed while incarcerated.

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Gerry Armbruster: Every day I still have it. My wrists hurt, my knuckles hurt, all this hurts, but I have to deal with it. I’ve learned to deal with it and I know it’s not going to get better.

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Adam: Lastly, Gerry talks about what it felt like going to the doctor over and over again, but not feeling like his concerns were being taken seriously.

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Gerry Armbruster: I think about it and it pisses me off. No one cared. It was supposed to be at a place where they want you to change and be real and be honest and couldn’t be no more damn honest than what I was and they didn’t care.

[End Clip]

Adam: Taylor, thank you so much for joining us. 

Taylor Elizabeth Eldridge: Thanks for having me.

Adam: So you wrote an excellent long form piece that was a partnership with The Appeal and Type Investigations entitled “Why Prisoners Get The Doctors No One Else Wants. Even after a major class action suit required Illinois to revamp its prison healthcare system, doctors whose alleged neglect resulted in major injury or death still remain on the prison system payroll.” So we had touched this earlier, we did an episode specifically on Angola in Louisiana. We didn’t really extrapolate it out too much. This is an even more robust look at this problem, which is apparently a major nexus point of criminal justice reform. Can you orient our listeners as to what your investigation found in general, specifically in Illinois, but also what that says about the country in these practices in general?

Taylor Elizabeth Eldridge: Yeah, so generally this investigation, just to give you some context of what prompted me to look into this, I was working on another story about dental care for prisoners and I noticed a prisoner claiming that he was not the first patient that his dentist had made this particular error with and he submitted these documents that showed discipline in two different states. And that just kind of stuck with me. And I started doing more research into the kind of doctors that get hired to work in prisons. And so what I found generally, I mean I found many, many doctors across the country who have histories of discipline by medical boards and numerous lawsuits, yet they continue to work in prisons. But Illinois in particular had, as you know, reflected in the story, the most damning explicit evidence about the performance of those doctors.

Adam: Right. Illinois and Louisiana are usually competing to see who, how many government officials can go to jail. I assume there’s a correlation between that and neglect in the medical system. So you start off by telling us the case about Gerry Armbruster who went to a doctor in May of 2014 complaining about what you describe as tingling and numbness in his arm. Can you tell us about his case and use it as an entry point into what the more systemic issues are?

Taylor Elizabeth Eldridge: Yeah, so you know, I got to spend a lot of time talking with Gerry about his experience and it was really, what he told me it was in that May of 2014, you know, he was just months away from getting out of prison. He had been in and out of prison for most of his life and he had gotten sober. He was, you know, looking forward to moving on with his life. And then this numbness and tingling started and he just, it was a constant, it’s difficult to describe, but he, you know, to the point where he couldn’t hold a pencil, he couldn’t open doors, he was walking, in his words, “like the Hunchback of Notre Dame.” He was just in constant pain and he, you know, listening to him talk about going to the doctor over and over and over and over again, and then telling him, ‘It’s all in your head, you’re fine. Just drink some water. Nothing’s wrong with you.’ And then, you know, the story of his, the day he got out and what it was like to have to crawl to the car to go home with his parents. And then two weeks later he’s getting emergency spinal surgery. I mean, he’s just one prisoner of the hundreds of thousands across the country. So Gerry is a guy who, his ability to reenter society and restart his life after being incarcerated has been really impacted by the care that he got while he was incarcerated. You know, he hasn’t been able to work since he got out. So it’s, it’s been very difficult for him.

Adam: Let’s talk about the recourse here. I think the natural thing people would respond to in hearing this, especially a lot of our listeners are in fact lawyers and those not familiar would say, ‘Well why don’t they sue?’ That one of the sort of main checks against malpractice is lawsuits. There’s a dispute about whether or not that’s excessive or whatever, but generally speaking, there’s some checking mechanism. Now I know that a lot of prisoners don’t really have that option. Can we talk about the sort of barriers to accountability both in a criminal and civic arena?

Taylor Elizabeth Eldridge: Yeah, absolutely. I think prisoners face lots of barriers when they’re trying to get accountability for any mistreatment when it comes to healthcare. A major barrier to accountability for prisoners who’ve been harmed by doctors is the fact that many doctors can see a prisoner over their time in prison. So it’s hard to say like this one doctor on this day made a mistake that harmed me. You have to really prove that that doctor knew all the relevant details and you know that’s really difficult when you see a different doctor every month. But then there’s also, you know, the ability to file a lawsuit, which is available to people who are not incarcerated, getting that second opinion from another doctor that you’ve been mistreated, that your claim is valid is enormously difficult for people who are incarcerated. Like there’s, one of the examples we give in the piece of Derrick Echols, who was also a prisoner in Illinois, how is he going to get a doctor to say that the care that was provided by their colleague was inadequate? And then there’s also the requirement that prisoners have to go through the grievance process within the prison, which I think is probably the most efficient barrier that’s erected to preventing accountability for these things. Because if you don’t hit these grievance deadlines, then you are literally out of luck. You cannot restart the grievance process for an incident.

Adam: Wow. So yeah, cause I know we talk about the Prison Litigation Act of 1997 a lot. It comes up in pretty much every case about prison abuse where they’re like, ‘Oh well there’s no mechanism of accountability because in the nineties we decided that prisoners were subhuman’ and which of course we did before, but we sort of extra did it in the nineties and that was during the tort reform panic too. So. So you write that the Illinois Department of Corrections healthcare program, quote “hired ‘under-qualified’ physicians, failed to provide appropriate supervision and oversight, and did not have adequate electronic resources for physicians to manage care. These conditions resulted in at least 36 deaths between January 2013 and June 2014 and two deaths in 2010 that the team deemed ‘problematic.’” Can we give a sense of the scope here? Cause I know that for example in Louisiana the mortality rate of Louisiana was twice the rate of every other state in their state prisons. Can we give some context as to like when we’re talking about Illinois, like how bad it is? How does one sort of measure systemic healthcare neglect? I know that your findings, and there’s a ton of original research in this, by the way, and original reporting, you have to go check it out. What did your findings sort of show that puts it in context to how kind of urgent this really is?

Taylor Elizabeth Eldridge: Yeah, so these deaths, I mean the expert teams did not even have the time or the bandwidth to review every facility in the Illinois Department of Corrections. These are the deaths just from eight facilities that are supposed to provide-

Adam: Right. Sorry, I should’ve been clear. Yeah. This is not a totalizing study they did.

Taylor Elizabeth Eldridge: Right. But, the expert teams, you know, kind of extrapolated those findings to say, ‘If we’re finding these significant issues and this disturbing number of preventable deaths at these facilities, we’re concluding that this is a systemic issue.’ Illinois’s issues with healthcare, with its healthcare program, are largely connected to budget issues. You know, I write that they did not have adequate electronic resources for physicians. You know, this is a prison agency that is still using paper medical records for people who are incarcerated for years and years and years and they’ve just become this, I mean you can imagine that that’s not a great way to manage lengthy medical histories. And Illinois is among, you know, the lowest, they spend the least on prisoner healthcare, not the least, but they’re, you know, the bottom ten of inmates healthcare spending. But their death rate, I mean I don’t, I can’t actually speak to how their death rate compares to a place like Louisiana.

Adam: Yeah. It’s sort of like when you try to measure the deaths of immigrants at the border or trans people and they realize that no one’s actually keeping track of any of these things and that, that’s kind of the issue.

Taylor Elizabeth Eldridge: Right. Cause many of these deaths that I looked at in my story were categorized as natural deaths in the general death reports by the agency. So that’s also, it makes it very difficult to know.

Adam: Because the line between neglect and organic problems is not very clear all the time. Is that a fair? 

Taylor Elizabeth Eldridge: Right. I would agree with that. 

Adam: Okay. So you also do write about the state of Louisiana. You say that quote, “nearly a third of the prison doctors in the state had a record of misconduct, its corrections agency said ‘sometimes it’s so desperate a situation, you just need a body in the job.’” Now the problem here is that a lot of the times that, and correct me if I’m wrong, but from previous reporting I’ve read and what you wrote is that doctors who get fired from everywhere end up in prison, doctors who exhibit a sort of streak of incompetence or negligence or malice even, end up in the bottom rung. The bottom rung is the prison system. So by definition you’ve filtered out a certain level of aloofness. How much is this about standards and is there any effort to like re-examine what standards we maintain or is it just if we have too high of standards we literally just won’t have doctors because nobody wants this job?

Taylor Elizabeth Eldridge: Yeah, I think it’s a combination of the second one and also just correctional healthcare is a difficult job. You know their medical board, there are disciplinary actions that are, you are only allowed to work in prison. You know, they can restrict whether they’re allowed to have a private practice and so it does, I think, you know, self filter for physicians who have no other option but to try to work in a correctional setting. I think to the question of standards though, what the class action lawsuit in Illinois was about was about whether the healthcare program in that state met the minimum constitutional standard and the constitutional standard is well below what the community standard would be. So you, it would not be acceptable for you or I or any other non incarcerated person to go to a doctor and get the minimally, constitutionally adequate care. That’s basically saying ‘you are not being tortured,’ but that doesn’t mean that you’re getting quality medical care. And so the fact that these agencies, Illinois is struggling to meet that minimum that is not even acceptable, you know, in the community is in my mind, pretty damning. If we can’t hit the level of, we’re not violating someone’s civil rights by causing prolonged pain and suffering, then that’s, I think that is a standard that we need to maintain. But yeah, it’s a, I think the self filtering is a real factor here.

Adam: What are the sticking points with these things? Whenever you talk about problems in prisons, one of the things people say is, or even with public defenders offices is a lack of funding. Now, the general abolitionist ethos is that you never give money to prisons ever, for any reason ever. And that if they need, if they’re neglecting prisoners’ healthcare, you need to redirect funds from something else because there’s a risk that of course you could say, ‘Oh well prisons are neglecting people’ and then some budget allocation process of the state and they give more money to the prison and that money actually ends up going to other things. To take your reporter hat off a little bit, maybe pontificate with me a bit, but is the issue that maybe many of these people really shouldn’t be in prison in the first place? Should there be some conditional medical criteria for being in prison where if we’re going to have the lowest rung of healthcare, that if you have a certain degree of physical or mental injury that you really ought not be behind a cage to begin with? What’s a good way to look at this, I guess is what I’m asking?

Taylor Elizabeth Eldridge: I think that’s a great question and not to put my reporter hat back on, but from talking to the advocates that I spoke with for this story, you know, the thing that they really emphasize was that yes, this is a story about poor healthcare, but it also, the larger question is why do we have so many people in prison to begin with? What is going on that we are incarcerating people at this rate? You know, there are people who are in prison who have significant health needs that the prisons can’t handle, and I think there are some, some of the people, some of the prisoners that I spoke to for this story were obviously incarcerated for a variety of charges and convictions. But yeah, I think that to take my reporter hat off, I would agree that I think there are many, many people in prison who are either ill enough or who just don’t necessarily need to be incarcerated and I, I just don’t think you can provide for some of the deaths that I reviewed and some of the prisoners that I spoke with, some of these health conditions, you just, you know, the idea of trying to manage those in a carceral setting just doesn’t make sense. I think it only can result in harm.

Adam: You write that there’s a group called the Wexford Health Services Incorporated that provides physician and medical staff to the Illinois Department of Corrections. Can we talk about briefly the degree to which private companies sort of race to the bottom and private companies and combined with a lack of public oversight and legislative oversight has made this worse? Can we talk about the element of privatization here?

Taylor Elizabeth Eldridge: The involvement of private companies in any aspect of corrections is an opportunity for exploitation. In my experience, I did my reporting involving a private company to provide care to an incarcerated population, monetizes the level of care that is provided. So private companies like Wexford are given a lump sum by the state and any expenditure out of that is a loss for the company. And so it creates, you know, the setup can create a kind of perverse incentive to provide little to no care in order to maximize profits. But I really found in this class action case is that the private company’s relationship with the state is such that the company has final say over the physicians, even though the state is the one that’s legally responsible for the physicians’ conduct. So these doctors that I mention in my piece, they are on Wexford radar. They are aware of the issues with them, but the company decides not to terminate them or just to move them around. And the state has no recourse for that. There’s literally nothing the state can do because these people are employed by Wexford and not the state. And so it creates this dynamic of, you know, you can bring a lawsuit against the state, but the company is the one making these final decisions and bringing in these under-qualified doctors.

Adam: Yeah. This is, you see there’s a lot with privatization, you kind of launder, you kind of launder responsibility so no one’s actually held accountable cause everyone can sort of blame the other party. 

Taylor Elizabeth Eldridge: Yes, exactly. 

Adam: Which is sort of the point of the design, right? Public-private partnerships is a really great way of saying no one’s responsible.

Taylor Elizabeth Eldridge: Right. Yeah. And I think when they work they are probably great. But I feel like Illinois is a state that has struggled with its budget for a while and it is difficult to provide correctional healthcare. And I think this is a shortcut that agencies take to outsource it. But then all of these other consequences come with it. And, you know, there were many lawsuits against Wexford as a company.

Adam: What is the current effort to try to overhaul this? Is this being brought to the attention of lawmakers and the media more and more? I, you know, unfortunately I don’t see a lot of it. What is kind of the plan in the next five, ten years to really kind of revamp this and get rid of these cruel conditions.

Taylor Elizabeth Eldridge: I think the sticking point for any progress on this particular issue going forward is the involvement of these private companies with state duties. And until we have a way of holding private companies accountable, I’m not sure that we can progress in the way that would be beneficial to people who are incarcerated. And so I think in Illinois in particular, there is a push to have some kind of public oversight of the interactions between private companies like Wexford that are providing public duties, you know, acting in the name of the public of Illinois, allowing Illinois citizens to really weigh in and hold that company accountable. I don’t know what that would look like, but I think that is to me, the glaring kind of gap in accountability here.

Adam: Okay. Taylor Elizabeth Eldridge, an Ida B. Wells Fellow at Type Investigations. Thank you so much for coming on. I really appreciate it. 

Taylor Elizabeth Eldridge: Thanks for having me.

Adam: Thank you to our guest, Taylor Elizabeth Eldridge. This has been The Appeal podcast. Remember, you can always follow us at The Appeal magazine’s main Facebook and Twitter page, and as always, you can rate and subscribe to us on Apple Podcast. The show is produced by Florence Barrau-Adams. The production assistant is Trendel Lightburn. Executive producer Craig Hunter. I’m your host Adam Johnson. Thank you so much. We’ll see you next week.