Dying Inside: The HIV/AIDS Ward at Limestone Prison

Chapter 6. Normalizing Catastrophic Loss of Life

Chapter 6 Normalizing Catastrophic Loss of Life Seeing so many guys were passing away, you talk to them today and tomorrow they going to the HCU and never come back. It had a tremendous effect in a negative way on all of us, because we had no classes or support groups. So it affected a lot of guys in a negative way, where they would ‹ght all the time with the nurses and doctors, you know, and get write-ups—unnecessary write ups-and stuff. We were able to go up and sit with the guys in the Health Care Unit (HCU). And when they were on their last stage, almost about to die, you know, we could go read the Bible, talk to them, try to encourage them to hold on or whatever. But again that didn’t last a year; they done away with that program. And now, for the last four or ‹ve years, none of our inmates have been able to go up there and take care of these guys when they go up there. So when they go to HCU they just up there. —wilson rogers, former limestone prisoner1 As discussion in the preceding chapters has shown, the privatization of prison health has largely been inadequate in addressing the varied, often complex needs of chronically ill prisoners. At the time leading up to the Leatherwood litigation, attorney Josh Lipman and investigator Lisa Zahren, both of the Southern Center for Human Rights (SCHR), described in graphic detail just how compromised the system of health care at Limestone was. But most of the details concerning the prisoners’ suffering and deaths came to SCHR in the form of letters and postevent interviews. Indeed, the PLRA had blocked 113 SCHR from responding to these prisoners’urgent pleas in the time of their most desperate need. To expand on Lipman and Zahren’s accounts, particularly as they pertain to what was happening inside the Health Care Unit (HCU) at Limestone between late 1999 and 2003, I draw on Dr. Stephen Tabet’s expert witness report and his mortality reviews conducted in February 2003 and February 2004. Dr. Tabet’s report was extensively covered in the media and is widely available online.2 However, to preserve con‹dentiality of the deceased, all names and factual details from the report that might compromise con‹dentiality have here been changed. Likewise changed to protect con‹dentiality are names of the deceased and family members mentioned in newspaper articles and presented in interviews conducted by Birmingham News investigative journalist Carla Crowder, my primary collaborator on this project. Limits of Dr. Tabet’s Report The popular media have reported on Dr. Tabet’s report in extensive detail. However, one of the limitations of this coverage has been its focus on the details of prisoner deaths in the absence of a closer look at the broader institutional failures that precipitated them.3 Although several articles go further than the “prison horror story” that characterized the reporting of “Thunderdorm” throughout the 1980s and 1990s, they do not investigate, at any length, the dynamics of institutional failure that is captured by Dr. Tabet’s report, which is comprised of more than two hundred pages of detailed mortality reviews and personal impressions. Dr. Tabet’s report provides a window into the dynamics of institutional failure that has come to characterize health care in most U.S. penal institutions more broadly. As a kind of ideal type, the Limestone case sheds important light not only on how preventable suffering and death of prisoners with dangerous illnesses are increasingly commonplace in U.S. penal institutions but on how such catastrophes persist at the institutional level (see also appendix B). Yet Dr. Tabet’s reviews are limited in terms of what they reveal about other important details that may not have been directly implicated in prisoner deaths. To ‹ll in this gap as much as possible, I draw on interviews that 114 dying inside Carla Crowder conducted with former prisoners and prisoners’family members (see appendix A for more details about research methods).4 I begin by shedding additional light on why the decision of the Alabama Department of Corrections (ADOC) to hire Naphcare is important for understanding how such catastrophic failures took place. Naphcare Takes Over When Naphcare took over the administration of health care at Limestone in early 2000, the segregated HIV unit was in a state of...