Illness in the System

photo by Valery Titievsky on Flickr
Benjamin Fleury-Steiner is Associate Professor of Sociology and Criminal Justice at the University of Delaware.  His most recent book is Dying Inside: The HIV/AIDS Ward at Limestone Prison.

 

The overwhelming majority of two-million plus offenders locked away in the nation’s jails and prisons are poor, non-violent drug offenders.  Indeed, only a fraction represents America’s so called “worst of the worst” violent offenders. This observation is not controversial and has been well documented in an imposing empirical literature.
 

Another observation, however, of what exactly locking up so many  human beings means is rarely addressed by academics and the public alike:  Most of the people swept up in the prison boom of the last three-plus decades lack health insurance and disproportionately suffer from a host of serious-if-untreated illnesses such as Diabetes, HIV/AIDS and Hepatitis C.  
 

When we consider gross carceral overcrowding and dwindling budgets for medical resources, it is not surprising that the federal government and the states have been forced to contract out health services with a focus on cost-cutting.   In this way, even the most well intentioned health care workers and wardens simply cannot address and therefore must learn to live with increasing numbers of sick prisoners that needlessly die in their midst.
 

It is very easy place blame on politicians, prison officials, or doctors for this disturbing state of affairs.  But playing such a blame game is counter-productive. The bottom line is this:  Nearly four decades of locking up an unprecedented number of the chronically ill uninsured poor is institutionally unsustainable and, most importantly, inhumane and immoral.  

 


Let us consider just a tiny accounting of the facts from across America’s penal landscape in recent years:

  • 43 HIV-infected prisoners were virtually left to die with minimal care in an old, decrepit warehouse in Alabama’s Limestone prison.  Individual mortality reviews conducted by a leading prison health expert concluded that the treatment of these men preceding death was “appalling,” “unacceptable,” and “completely inappropriate.”      
     
  • Dozens of Wisconsin inmates have died under questionable circumstances during the last decade in a flawed Corrections health care system that keeps internal reviews of prison deaths secret.  If not for a lawsuit and subsequent investigation of every prisoner death in the state between 1994 and 2000 conducted by The Milwaukee Journal Sentinel, the scandal would have remained the system’s dirty       secret. Grossly understaffed medical care teams rarely administered CPR on dying prisoners. Additionally, emergent care was often dangerously delayed resulting in preventable deaths and medical evaluations were often “sloppily done” and “frequently don’t even list the cause of death.
     
  • An investigative report of health care in all 33 of Ohio’s prisons conducted by the Columbus Dispatch revealed catastrophic failures to provide care.  In a review of thousands of pages of Ohio Department of Corrections records and dozens of  interviews with prison medical officials, dangerously ill prisoners were found to  be routinely abandoned. 
  • A recent account by court appointed medical monitor in California, Dr. Robert Sillen, attests not only to the lack of adequate health services but, indeed, the persistence of preventable deaths in California’s jails and prisons:

I have run hospitals, clinics and public health facilities for the past 40 years, and medical care in California prisons is unlike anything I’ve ever seen.  Inhumane is the nice term for the conditions. . . .Needless deaths occur weekly in our prisons, either from lack of access to care, or worse, from access to it.           
 

 

Ben Fleury Steiner

Ben Fleury Steiner

If these disturbing snapshots teach us anything at all, it is that our conventional wisdom of “prisoners” that drove more than three decades of mass incarceration policies has been corrosive to American Democracy.  The ideology of “us and them” that drove the recent punishment wave creates not only a phony separation between chronically ill prisoners and poor, often racially aggrieved populations living outside prison walls, but it drives a wedge between “them” and “us”—that is, the overwhelming majority of Americans who are presently not incarcerated and live far away from the prisons of educational inequality, joblessness, and lack of health insurance (although, those numbers are frighteningly on the rise). 

 

 

One can only hope that as courageous policy makers such as Senator James Webb of Virginia—who has called for a sweeping investigation of the nation’s carceral institutions including, specifically, as he stated in a Senate floor speech of March 26, 2009, the need to “see what happens inside” America’s jails and prisons— will do more than confront the crisis as simply the result of bad criminal justice policy decisions. 

 

While that is certainly a welcomed beginning, the broader need is for policy makers to consider the deeper structural conditions that have created these massive houses of poverty and grossly inadequate health care in the first place.  Being “tough” on the long neglected crimes of racial segregation, deepening wealth and income inequality, and, indeed, woefully under resourced systems of health care, need to be a high priority as we approach the second decade of the new millennium.

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8 Comments on “Illness in the System”

  1. bob says:

    Yes, Ben, incarceration and illness both seem to raise a similar question in this context–Do we dare to cross that invisible ( and wrong-headed) boundary that separates the healthy from the sick, the saint from the sinner? Can the powerful recognize the powerless? Can those who are warm understand those who are cold? It is a courageous act to step into that “other country” and confront our vulnerable self. But that is what we often seem to do. We hide from that vulnerability and, refuse to see.

  2. bob says:

    Yes, Ben, incarceration and illness both seem to raise a similar question in this context–Do we dare to cross that invisible ( and wrong-headed) boundary that separates the healthy from the sick, the saint from the sinner? Can the powerful recognize the powerless? Can those who are warm understand those who are cold? It is a courageous act to step into that “other country” and confront our vulnerable self. But that is something we rarely do. Instead, we too often hide from our vulnerability, and refuse to see.

  3. Stefan says:

    The crisis of how to manage illness extends far beyond the reach of our criminal justice system. As is being shown today with our debate over a new healthcare plan, our nation is in dire need of a solution, fast! While it may be inhumane for the government to allow prisoners to die of their illnesses without proper medical attention, is it not more inhumane to allow the same practice to occur to citizens who have not committed crimes? I believe that while some improvements must be made to ensure prisoners have proper treatment, we need to focus more on improving the healthcare system outside of prisons. The statistics about how many prisoners have died without being given any hope for survival is disturbing, I admit. We have to remember, however, that these prisoners have been stripped of their rights. As cruel as it may sound, we have a duty to fulfill the rights of those who have not harmed society. Prisons are becoming increasingly expensive already; putting a reliable, tax-funded healthcare system in tact is only going to add to our problems. Let’s get our priorities straight and ensure that those who have not infringed upon the rights of others are given proper treatment and then worry about the ones who given up their rights when they decided to commit crime.

  4. Evan says:

    It is terrible to see what is happening and something definitely needs to be done with it. We can not forget that prisoners are still people. They have been stripped of their rights but that does not distinguish who they are, just because a person was convicted of possession should not deter them away from getting help. Besides most of these people will be getting out anyways, we still have a duty to take care of the sick and the needy despite who they are and what they have done. As for money the situation is also problem since most of it is poorly used which should be identified as well. There is no panacea that can fix this problem quickly and efficiently with little time and money. We as people need to stop looking at the prisoners with a us vs. them viewpoint and start realizing they are still people. If we do not then this problem will never get fixed.

  5. Connie says:

    As health care seems to be an on-going issue in this country it seems particularly problematic in prisons and jails. As the article pointed out, there are several poor, non-violent and chronically ill prisoners in the U.S. prison system. This seems to support the radical criminology approach as to problems existing within the system or society that need to be fixed. These people were probably poor and ill before they entered the criminal justice system. If these people did not live in poverty already, perhaps they would not be forced to commit crimes. Maybe if they had educational benefits, opportunities for jobs, and provided health care benefits, they would not be going to prison in the first place. As people who live in extreme poverty are forced to commit more crimes, these same people will likely be the ones who will be caught and incarcerated. The inhumane treatment of prisoners that the article talks about is very disturbing. However, and as others have pointed out, the United States does not do a very good job of providing health care coverage for all of its citizens. I think health care is administered by doctors and hospitals based on how patients (or their insurance companies) can pay. Unfortunately, patients with good health care plans and ample money to pay for procedures receive the best health care services.
    This would then follow that prisoners who are typically poor anyway would receive poor health care services. However, I don’t think treating prisoners in inhumane ways is the answer. Perhaps if we focused on keeping all Americans more healthy and productive, it would cut down on reasons for people committing crimes in the first place therefore reducing the number of people incarcerated. If we had less prisoners in the United States, we might be able to provide better health care for those that are incarcerated.
    I’m not proposing that prisoners should be treated the same or better than other citizens who have not committed crimes. However, withholding medical treatment for anyone or administering medical treatment that could kill them should not be allowed in the United States as we are one of the most developed, modern countries in the world. By withholding health care services to the poor (both inside and outside the prison walls) this helps to promote the “them vs. us” mentality.

  6. Jeehoon Lee says:

    It is my first time to read this kind of article and I did not realize what it happen in the prison. I never had thought about this topic which is really interesting and controversy. This is really bad situation to prisoner. I absolutely agree with Evan said that we cannot forget that prisoners are still people. They have been stripped of their rights but that does not distinguish who they are, just because a person was convicted of possession should not deter them away from getting help. I think that in the prison, people still have their own right and their right have to be respected by others even prisoner under the sin. This happens because of economic problem and inequality. From other view point by economically, as other person reply that there are several poor, non-violent and chronically ill prisoners in the U.S. prison system. This seems to support the radical criminology approach as to problems existing within the system or society that need to be fixed. These people were probably poor and ill before they entered the criminal justice system. If these people did not live in poverty already, perhaps they would not be forced to commit crimes. Maybe if they had educational benefits, opportunities for jobs, and provided health care benefits, they would not be going to prison in the first place. As people who live in extreme poverty are forced to commit more crimes, these same people will likely be the ones who will be caught and incarcerated. I do not think that prisoners should be cared the same or better than other people who are not in the prison but, the medical treatment for prisoner should not trear them by death and it has to help them at least guaranteed their live in the prison.

  7. Sarah says:

    Prisons are the place where the “bad people” go to be placed far away from society. However, when these people go to prisons they do not expect to be treated as if they belong to a third world country. Have these people committed crimes? Yes. Do they deserve to be in Prison? According to our criminal justice system, yes. For this, I do believe that many of the rights and privileges of the prisoners should be taken from them. Prisoners do not deserve cable and free education to receive the degrees that I have paid thousands of dollars for but they do deserve to be treated like humans. The healthcare workers in the prison system are being paid to provide services to prisoners. Many are being paid very well. For this reason, they should do their jobs to the best of their ability and not at sub par. These workers are not completely to blame. The prison system itself in the United States is inefficient and sub par. It is evident by the millions of people that we have incarcerated and will continue to incarcerate. Laws need to change and lawmakers need to stand up for what is right. Prison is not a place to lock up deviant people and throw away the key. There needs to be better options.

  8. Matt D. says:

    We a person is incarcerated they give up their rights a citizen. Crime and punishment go hand in hand but the treatment of criminals inside the justice system is a problem itself. A lot of tax payer dollars go into the system to help with the costs. I think the prisoners should have to work inside the prison to “earn a living” to pay for their own ways. They should not be given a easier life. Healthcare is a problem outside of the prison system in our own communities. Why should be give prisoners benefits when we have children who are dealing with health issues? Incarcerated prisoners chose to do the things that they do with their lives. They should not get benefits that upstanding citizens still do not get. Health care workers should do their job but they only have so much power and the kind of treatments that inmates get is based on the amount of money that the prison gets. With overcrowding, money is being used to pay for meals and other things. If you are going to start offering health care for inmates think of our nations youth first as they are our future and deserve the health care before a man who has harmed another.


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