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Is the American Health Profession Ignoring a Human Rights Issue Hiding in Plain Sight?

James Ridgeway, from Solitary Watch, asks whether the health needs of American prisoners are being neglected.

Image credit: Jumilla at Flickr
Image credit: Jumilla at Flickr

There are 2.3 million people in US prisons in conditions that are often inhumane and at worst life threatening. An estimated 80,000 of US prisoners are locked up in solitary confinement, which means in a 6 ft x 9 ft cell containing little more than a bunk bed, toilet, sink, shelf, and unmovable stool. Prisoners in solitary confinement are let out in leg irons, handcuffs and belly chains for ‘exercise’ two or three times a week in dog kennel-type runs. Bathing is sporadic and the food often miserable and insufficient. One third of prisoners in solitary confinement are thought to be mentally ill and half are placed in solitary for nonviolent crimes.

Recently, the press has begun suggesting the situation in US prisons might be improving slightly. In part, this may be due to reforms pushed by the American Civil Liberties Union in Mississippi that forced reduction in numbers of men held in solitary and because of the hunger strikes in California which have brought small reforms there. Under steady pressure from citizen groups, Maine has reduced the numbers of men in solitary. Furthermore, reforms proposed by US Attorney General Eric Holder aim to reduce overall crowding in prisons by releasing the old and sick, and by loosening the hitherto mandatory drug laws. These laws have sent untold thousands into prisons on lengthy sentences for minor drug offenses.

As states cut costs, there is some pressure to shut down certain prisons, but the real story is business as usual. Cost cutting may shutdown prisons but also means that corrections officials double cell the inmates, that is, put two people in already cramped cells.  Individuals serving sentences in solitary confinement live under these cramped conditions, not for weeks or months, but for years and decades. Two men have been in solitary at Louisiana’s Angola prison for 41 years. I write to a man in New York State who has been in solitary for 26 years. In Colorado a man in solitary confinement has not seen the sun in 10 years.

The most striking aspect of this scene is the lack of decent medical care for prisoners in the US whether in solitary confinement or in the general prison population. Over the last two years I have corresponded with prisoners who have been waiting for years to have dental work, and end up pulling their own teeth. Women line up at 4 am in Alabama to receive aspirin. People with hearing impairments are thrown into solitary confinement because, unable to hear, they cannot respond to the orders of officers. According to one doctor in the south, a man with an ear ache was given drops for months but finally became so ill he was examined at a local hospital outside of prison and was diagnosed with terminal brain cancer.

I reported on a case of a woman in prison for a $11 non violent robbery who had received two consecutive life sentences. She was suffering from end stage renal disease. The subcontractor which provided health care to Mississippi prisons brought in a dialysis machine which broke down during treatment. Her condition eventually deteriorated and she was sent to a city hospital where the doctor warned the prison she would die if taken back. The prison put her back in the cell anyway. Eventually after pressure from the National Association for the Advancement of Colored People (NAACP), this woman and her sister, who was also in prison, were released by the governor on grounds that the healthy sister gives a kidney to her sister.

Herman Wallace, 71, was shut up in solitary in Louisiana for 41 years. Five years ago he was diagnosed with hepatitis C. Last year he complained of stomach cramps and weakness. He was seen by a prison doctor who said he had a stomach fungus and administered an antibiotic. A short time later, Wallace, having lost 50 pounds, still living in his tiny cell where the temperature was 96 degrees (35.6oC), became so sick he was taken to a hospital outside the prison where he was diagnosed with terminal liver cancer. His friends and lawyers requested that the state grant him compassionate release and allow the man to spend his final days with family and friends.  And, indeed, shortly before Wallace’s death, a federal judge in Louisiana, disregarding the state’s opposition, set him free. Wallace spent two days as a free man before he succumbed to the cancer.

These are not isolated cases. Every day I receive letters from people in US prisons many of them are locked in solitary confinement; fifty letters in a week. Today a man being charged money for medications goes without because he has no money to buy them. Another man with kidney and bladder ailments fears to go to lunch in case he infuriates other inmates by ‘leaking’ on a chair. A man says he hasn’t slept for days because of the constantly burning neon lights. Another says that he only catches a few minutes sleep when people around him have stopped screaming. Others stifle at the smell of excrement smeared on the walls. A young man writes he is cutting into his arm, but please don’t stress his mom by telling her. He hopes to kill himself by tomorrow night.

I have raised the question with several doctors as to why the US medical profession – doctors, nurses mental health professionals, etc – show little interest in this enormous human rights issue on their doorstep, one directly affecting public health, and one which is even recognized and studied as an epidemic. To be sure there are medical practitioners who have plunged into this morass, but they are few and far between. And there are medical bodies, including Physicians for Human Rights and the American Psychological Association, which decry solitary. Physicians for Human Rights calls for independent evaluations and reform of health care policies. Much of this work is couched in the language of scholarly discourse, and often points to promising actions in the prison business. Sitting here, reading these letters, these academic statements seem utterly disconnected with what is going on.

Help is needed now, not only in the academic arena. As a layperson it seems to me unconscionable for the medical profession to turn its back on what has become a serious, large scale human rights issue; one that can be alleviated, at least to some extent, by medical professionals employing up to date technology, not, as reported above, broken down dialysis machines.

At the same time I meet doctors who long ago worked in Africa in the Peace Corps, still returning to places like Ethiopia each year to help provide medical care. American doctors fly into Haiti to spend exhausting weeks tending to desperately poor people. But these foul prisons in their own backyards are ignored. Doctors tell me it is too complicated dealing with prisons and that even if they should show interest the wardens will turn them away at the gates.

Why can’t doctors fight? Médecins Sans Frontières/Doctors without Borders (MSF) seems to get into all sorts of difficult places amidst mass starvations, horrid natural disasters, braving fire in combat areas. When I phoned to ask MSF if they could do anything in US prisons, the answer was a bureaucratic no – can’t do business in the US. The International Red Cross is a great force for the good, and has authority to visit US prisons, but, according to a representative I spoke with, can’t reveal which prisons it enters. The UN Rapporteur on torture travels around the world visiting dreadful places, but when it comes to the US, he must go through the bureaucratic labyrinth of first securing permission from the US mission to the UN, which denies we torture, then the state department, which says we don’t torture. The US constitution and subsequent laws ban torture. The president has reiterated these bans. The Rapporteur can be turned away by wardens of state prisons where most of the prison population dwells. The press is routinely denied entrance to solitary sections of US prisons.

Prisons in the United States have become our true `Black Sites’ – our new madhouses. They are warehouses for the poor and the sick. Located all over the country, they are hiding in plain sight.

James Ridgeway is a journalist in Washington. He worked for years at the Village Voice in New York, then for Mother Jones magazine. He has written 16 books, made documentary films, and is founder and co-editor of Solitary Watch, a web site that tracks solitary in the US.

Competing Interests: JR is the cofounder and editor of Solitary Watch, an independent media and advocacy project, funded by grants and donations.

  1. Medicine is but one circumstantial aspect in World Leading Jailer Land. People love sentencing and politicians, accuser, Correction staff follow with phrase: For security. James Ridgeway and many more know better. Thanks.

  2. With the prevalence of mental illness in prisons, it seems appropriate that a policy of understanding and empathy for the mentally ill prisoner should be a major part of the discussion if real progress is to occur.

    Understanding mental illness should probably be a priority, since according to the Substance Abuse and Mental Health Services Administration: one in five Americans have suffered from some form of mental illness in the past year. Another interesting read I came across on mental illness in U.S. prisons is here:

  3. Hi,
    Great article. I appreciate, what seems be, genuine concern on your part. Thanks for reporting on this issue. I agree that it is absolutely sickening and inhumane what is going on in prisons now.
    I wonder, though, what you expect physicians to do? I am sure you are aware that prisons are now big business (see article below.) Do you really think physicians have the power to change this convoluted, corrupt system that makes massive amounts of profits for private prisons, various businesses, investors, law enforcement, military, etc?
    As a former healthcare provider (and now writer/journalist for the past 11 years), it is virtually impossible to change these corrupt systems from the inside. It must be addressed from understanding and changing the root causes, which I mentioned above. All of the above entities are profiting from keeping people locked up; and the longer increasing numbers of people are incarcerated, the more money these people make.
    What, specifically, do you expect doctors to do? Who are they supposed to fight? MD’s going into horrific situations in other countries versus these private prison systems in the U.S. is not a valid analogy for a variety of very complex reasons. It would take too long to explain the reasons in this format.
    Instead of expecting doctors to change this system, approach and demand change from the powerful entities who are the CAUSE of the heartbreaking, mass suffering in these institutions.
    Thanks for your good work!

  4. I have reason to believe many of these stores may be true. A mentally disabled (severe depression) doctor friend known to me since childhood suffered a concussion in a cross over car accident he could not escape, later committed a serious crime in the false implanted belief his family was endangered, then found himself in detention for two years, then went to a penitentiary for another three years after conviction. He reported similar priviations and problems. He had no milk or fresh fruit for over a year at a time the sheriff in charge of the detention unit profited from savings on food in that state (now changed after a successful prisoner lawsuit). He lost teeth after parole, no dental care inside. He said the years of detention in which he was presumed innocent were far worse than the penitientary he was in for older prisoners. After a fight in the showers he set his own fractured nose. He killed himself after being released for parole late one night after returning his bowl of ice cream to the freezer.
    I don’t see doctors as responsible for this problem. It’s a legal matter in which the mentally ill have been shifted from confinment in hospitals when necessary to prisions after JFK was elected (his sister Kathleen was mentally ill and had undergone a ill advised lobotomy). There were supposed to be outpatient mental clinics that never quite took over, but now the professionals have all but given up their practices, unpaid. The legislatures, Congress, Administration, and Courts are full of attorneys who know these facts to be true. A significant number may be innocent of the crime charged. The prisons are also home to innumerable sociopaths, who are inveterate liars and manipulators, usually estimated at twenty five percent. My friend was not in my opinion, but confirmed the estimate was probably correct to me before he died.

  5. Perhaps the quality metrics reported for care on the “outside”, should be reported for care in prisons. If contracts were tied to quality of care, for example care delivery and follow up, gains similar to those seen in the general public may be realized even considering case mix and patient compliance.

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