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In a Mississippi prison, a broken arm turned into an amputation. In a Minnesota county jail, a man showing classic stroke symptoms was allegedly ignored until he collapsed and died. In New York, a man detained by immigration officials — and later transferred between facilities more than 10 times over three months — temporarily lost the ability to walk due to untreated infections.
In theory, all of these medical issues were treatable — and despite the many flaws in U.S. health care, “treatable” is usually a reassuring word. In prisons, jails, and detention centers across the country, it often means something different, however. Medicines, procedures, and specialists may all exist, but people may not get access to them until permanent harm or even death occurs. Last week, The Marshall Project reported that over the last decade, in New York prisons alone, at least 30 people have died of preventable or treatable conditions.
In many of those cases, the problem begins with prison staff not taking incarcerated people seriously when they describe symptoms. In recent reporting, my colleague Joseph Neff told the story of Jason “Poppy” Phillips, who died from an infection of the epiglottis — the cartilage in the throat that directs air to the lungs and food to the stomach. The condition has a 99% recovery rate, but staff disregarded the increasingly frantic complaints of Phillips, his cellmate, and Phillips’ relatives, who were trying to secure help from the outside. After Philips collapsed, one nurse remarked that “he’s on the ground for bed.” The staff involved did not respond to Neff’s requests for comment, and the corrections department declined to discuss the case.
Similarly, at a Washington prison, Alex Kuhnhausen told officials he was coughing and sneezing blood when they put him in solitary confinement for possessing a homemade needle with suboxone, a drug used to treat opioid addiction. Clinical staff, often focused on his drug use, repeatedly misdiagnosed Kuhnhausen’s worsening illness. By the time he was hospitalized, doctors said he was too sick to survive life-saving surgery on his damaged heart valves.
“The medical staff guessed him right into the grave,” Kuhnhausen’s wife, Katie, told the news outlet Investigate West. “They essentially told him he was a junkie.”
Kuhnhausen, who was 25 years old, died of kidney failure and sepsis, and the latter is an extremely common killer in U.S. detention settings, according to a USA Today investigation published last month. In a review of Department of Justice data, reporters found that at least 1,780 sepsis or septic shock-related deaths over a recent eight-year period, and that many “would have survived sepsis had they been free to head to their doctor’s office or a nearby hospital.”
Sepsis is a condition where the body’s extreme reaction to an infection causes organ damage, and, left untreated, can lead to death. Drug use is a risk factor for sepsis, but according to USA Today, it’s common for clinicians in carceral settings to assume symptoms are a direct result of drug use, rather than of serious infection. Take Avery Borkovec, as an example. At a prison in Boulder, Colorado, Borkovec turned so pale due to a staph infection of the blood that other incarcerated people had started calling him “Casper,” like the cartoon ghost. When he collapsed, a nurse tried four times to revive him using Narcan, the opioid overdose-reversal agent, assuming that the emergency stemmed from drug use rather than an infection, according to USA Today.
Even when frontline clinicians believe the people they are treating, financial pressures often delay and dissuade appropriate care. In state prisons, health care is frequently outsourced to private contractors paid a flat rate per person — and every hospital trip, specialist visit, or course of medication comes straight out of their profit margins. According to a report earlier this year from the Prison Policy Initiative, a non-profit think tank that works to reduce mass incarceration, privatized health care behind bars “functions like a cost control service for corrections departments, organized around limiting spending and fending off lawsuits.” At the same time, the university-run prison health system in Texas — often held up as an alternative to corporate contractors — “remains underfunded, understaffed and underprioritized,” and prone to many of the same ills, according to The Texas Observer.
This week, the Chicago Sun-Times published a report based on more than 100 lawsuits against one of the largest and most notorious prison health-care companies in the country: Centurion. It found a recurring pattern of Centurion staff ignoring prisoners’ medical complaints to the point of serious complications or death. The report comes just after the state of Illinois extended a temporary contract with Centurion, to replace its prior provider, Wexford Health Sources, which has also faced similar accusations. The Sun-Times reported that Centurion did not respond to their requests for comment.
Also, on Friday, the Tampa Bay Times reported that incarcerated people with cataracts in Florida have systematically been denied eye surgeries for years, leaving some permanently blind. Centurion and the state corrections department are both defendants in a lawsuit filed in October — and neither replied to the outlet’s request for comment.
Some advocates for prisoners say this kind of delay is not only unethical, it’s also fiscally shortsighted. Mississippi Today found that corrections officials in Mississippi routinely delay treatment for hepatitis C, a curable infection that is widespread behind bars. A person with direct knowledge of care in the system told the news outlet that some patients were considered “not sick enough” for the treatment, which can cost up to $30,000. Without treatment though, many of those patients will progress to liver cancer and failure, which is more expensive to treat and has a far higher mortality rate than hepatitis C.
In jails and detention centers, the churn of short-term custody creates other ways to avoid dealing with serious illness. In Tacoma, Washington, this week, advocates said ICE tried to put Greggy Sorio — who had already had a toe amputated and was using crutches after months of vomiting blood and stomach pain — on a 20-plus-hour flight to the Philippines instead of keeping him under medical care. His attorney told The Seattle Times: “Often they [ICE] prefer to deport you, so if you are sick or you are dying, that will not be while you’re in active custody.” On Tuesday, a judge blocked Sorio’s deportation.
Hepatitis C is common behind bars, in part because it’s highly transmissible and prisons are congregate settings. Indeed, in many cases, incarceration itself generates the health problems that then go untreated. It’s also common for incarcerated people to develop vitamin deficiencies from both an insufficient diet and a lack of sunlight, reported Penn Live this week.
The Eighth Amendment prohibitions on “cruel and unusual” punishment are supposed to be a backstop for incarcerated people facing illness. To win a civil rights case over medical care though, it’s necessary to clear a “deliberate indifference” standard, and prove that officials were actually aware of a serious risk and chose to disregard it.
Last year, a Business Insider analysis of nearly 1,500 federal appellate decisions found that only about 1% of Eighth Amendment claims filed by incarcerated people clear the deliberate indifference bar.
