Dying Inside: The HIV/AIDS Ward at Limestone Prison

Chapter 2. The Conflicting Imperatives of Mass Incarceration and Prisoner Health

CHAPTER 2 The Conflicting Imperatives of Mass Incarceration and Prisoner Health It may be tempting to write off the Limestone case as a problem typical only to infamous penal institutions in the southern United States. Given the historical record of brutal, inhumane conditions in prisons and jails in this region of the country—perhaps most notably the deplorable treatment of prisoners incarcerated at Louisiana’s notorious Angola prison or Mississippi’s Parchman Farm, the latter an institution that historian David Oshinsky famously described as “worse than slavery”1 —one might conclude that the number of preventable deaths occurring among Limestone’s HIV-infected population represents a disturbing regional anomaly. However, writing about the University of Pennsylvania Law School’s Health Law Project of the early 1970s, public health scholar Douglas McDonald observed that serious de‹ciencies in the treatment of sick prisoners has by no means been restricted to the American South. The Project identi‹ed a number of de‹ciencies in Pennsylvania’s prisons. Newly committed prisoners were given only cursory medical examinations , with no provision for ongoing medical surveillance. Access to “sick call,” the only point of entry to medical care, was often barred by guards 29 who lacked training in medical triage. Special diets were virtually nonexistent ; diabetics were simply told to select their food from regular meals, without instruction or assistance.2 Most recently, one need only take a cursory look at cases concerning health care for chronically ill prisoners in states from every region in the United States to realize that the nation is littered with penal health care systems that often fail to provide even remotely adequate access to treatment. • In 2000, the Milwaukee Journal Sentinel reported that “dozens of Wisconsin inmates have died under questionable circumstances during the last decade in a ›awed Corrections health care system that keeps internal reviews of prison deaths secret.”3 If not for a lawsuit and the newspaper’s subsequent investigation of every prisoner death in the state between 1994 and 2000, the scandal would have remained the system’s dirty secret. The investigation revealed that grossly understaffed medical care teams rarely administered CPR on dying prisoners; that emergent care was often dangerously delayed, resulting in preventable deaths; and that medical evaluations were often “sloppily done” and frequently did not even list the cause of death.4 • An investigative report of health care in all thirty-three of Ohio’s prisons, conducted by the Columbus Dispatch, revealed catastrophic failures to provide care. A review of thousands of pages of records from the Ohio Department of Corrections and of dozens of interviews with prison medical of‹cials uncovered that dangerously ill prisoners were routinely abandoned “after waiting nearly an hour for ambulances” and that “prisoners with chest pains died of heart attacks within minutes of being seen and released from clinics.”5 Additionally, dangerously ill prisoners at Lima Correctional Facility routinely went ‹ve or more days without receiving their prescription medication. In the most extreme instance, the prison’s pharmacy contractor, Prima Care, left the prison’s pharmacy completely unstaffed for two weeks. • A yearlong investigation of health care practices in California 30 dying inside prisons, conducted by the San Francisco Chronicle, revealed “hundreds of cases in which sick inmates received care that was incompetent , negligent or punitive.” The Chronicle reported: “Some inmates declined into critical illness before they recovered . Some were permanently disabled.”6 For example, despite repeated pleas to the of‹cials at California’s Avenal State Prison, HIV-infected prisoner Bruce Rizotto was called a “crybaby” by guards and left to die of an untreated respiratory infection.7 • As of 2006, the state of health care in California’s prisons was so poor that U.S. district court judge Thelton E. Henderson placed the state’s system under federal receivership.8 A recent account by a court-appointed medical monitor, Dr. Robert Sillen, attests not only to the lack of adequate service but, indeed, to 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.”9 • A 2006 investigative report of Michigan’s substandard jail and prison...