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.
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.