Investigating alleged medical neglect in U.S. prisons

Published on
November 8, 2013

There are about 60,000 Virginians in state prisons and regional jails. Providing health care for a single inmate runs $5,300 annually, and that cost has been rising 5-7 percent per year, but taxpayers may not be getting their money’s worth, and people locked up for minor crimes could be paying with their lives.

Because prisons are secure facilities, operating away from public view, this problem is largely invisible, and since the average person may care little about someone convicted of a crime, there is no great concern for conditions behind bars. My goal in producing a five-part series on prison health care in Virginia was to let listeners hear from inmates – to humanize them, and to raise questions about their treatment – often provided by for-profit contractors hired by the state or local governments.

This might seem a relatively easy task. After all, the director of correctional health care in Virginia receives more than 2,000 grievances each year from prisoners, but the project posed two significant challenges for a radio reporter. First, the state does not permit recording devices in most prisons, and inmates who have complaints may be reluctant to voice them publicly, for fear of institutional retribution.

Second, the director of the Virginia department of corrections (DOC) refused to answer questions, and only one of three for-profit prison health providers responded to my requests for interviews. Fortunately, the director of communications for Virginia’s DOC replied readily to Freedom of Information Act requests, and one company answered my questions in writing. I tried to include their viewpoints where possible and to convey to listeners that a lack of funding from their elected representatives was a key factor in what appears to be medical negligence in prisons and jails. 

To provide the prisoners’ perspective, I relied on lawyers who represent Virginia inmates and on ex-convicts. The first of these was Bobby Messick, a teenager locked up in the Newport News City Jail for violating the terms of probation after stealing from his employer. Unable to bring medication for his diabetes into jail, Messick found it difficult to get the care he needed from a jailhouse nurse and worried that his ten-day sentence could cost his life. 

It turned out his fear was well founded, as the family of another prisoner jailed in neighboring Virginia Beach was suing for wrongful death. That man was also diabetic and had also been sentenced to ten days behind bars for a non-violent crime. Both jails had contracted with the same for-profit company to provide medical services.

The series also featured Steven Jowers, an ex-con who recalled two cases of friends who died in prison. The first, nick-named Fly, was misdiagnosed.

“The doctor at Indian Creek said, ‘Oh, you have a kidney stone, or there’s nothing wrong with you,” Jowers told me. “I watched him lose 50 pounds in three months, and Fly was sick. He was really sick, and they took him to the infirmary, and he never came out. He had pancreatic cancer -- stage four. They never went and tested him. They never did anything. Three weeks later, a friend of mine -- Gary Graves -- went to medical, 7 or 8 o’clock in the evening and said, ‘I’m having chest pains. I’m not feeling well,’ and they gave him two Advil and told him to sign up for sick call, sent him back to the building. Well at five o’clock in the morning, when they woke everybody up for count, he was dead. He had a heart attack during the night.”

I asked the department to discuss these and other cases, but the director’s office declined, citing the need to protect medical privacy. Fortunately, Abigail Turner had no such concerns. She is an attorney for the Legal Aid Justice Center, which is suing the DOC on behalf of inmates who have received allegedly inadequate care. Hope Amezquita, a staff attorney with the American Civil Liberties Union of Virginia, was also forthcoming in her criticism of state contracts with private prison health providers.

“It doesn’t take a rocket scientist to know that their mission is to make money,” she said. “They’re for-profit companies. It may be cynical of me to say this, but you can’t make more money unless you cut services and treatment and staff.”

In fact, the state of Virginia has just 40 doctors to care for 30,000 prisoners. Most care is provided by about 700 nurses, some with licensed practical degrees, which require as little as one year of training.

These LPNs are allowed to keep records and medical histories, perform CPR and administer basic care, but they cannot make diagnoses or prescribe medication. When that’s needed, an LPN must contact a supervising registered nurse who, in turn, must contact a doctor. Nurses are supposed to see prisoners requesting a visit immediately if the matter is urgent or within three days if it is not.  In fact, many former inmates told me it could take a week or more to see a medical professional.

If they’d recovered by the time their appointment rolled around, former inmate Steven Jowers said they were still charged a $5 co-pay. For prisoners earning about $20 a month, that could be a significant consideration. What’s more, attorney Abigail Turner told me inmates who did not have a job were forced to accumulate debt to get health care.  Should a relative send money to buy food or personal products, it would be taken to pay their medical bills.

Our series begged the question of whether the co-pay discouraged people from getting medical help until their condition got worse and was more expensive and more difficult to treat. Prison officials responded: “That's the way it works in the outside world, and inmates need to learn social responsibility.”

We also explored the lack of mental health care for inmates and exposed what some might view as barbaric techniques for dealing with prisoners in distress. The state has just 14 psychiatrists and still keeps some people with mental illness in solitary confinement, while at least one regional jail locks depressed prisoners in an isolated, padded cell. One mental health professional told us, they are “stripped of their clothing, given a paper gown to wear, and the cell itself has nothing in it whatsoever. No mattress or anything. It’s void of any kind of visual stimulation, any kind of human contact, and your food is just given through a slot in the door, without any utensils to eat it with, and there’s a grate in the floor that has to be used for a commode.  It’s just abominable.”

Those who pose a physical threat to themselves or others can also be put in a restraining chair – their arms, legs and torsos strapped down for hours. Family counselor Harvey Yoder told us this technique was used to keep suicidal inmates from ruining their jailer’s reputation.

“The jail is operated by a sheriff who is elected,” he explained, “and one bad case of something terrible happening – someone hanging themselves, killing themselves in jail, just really tarnishes the image of the jail, so sheriffs take all kinds of precautions.”

Finally, we examined the future of prison care, given that many Virginia inmates are over 60 years of age, and caring for a single senior behind bars costs an average of $68,000 a year. For this portion of the series I was able to interview one man by phone.

Steven Colosi is eligible for parole under a rule that allows the state to release people over 60 who have served at least ten years, but Virginia’s parole board rarely grants geriatric parole.  Colosi made a compelling argument for them to do so.    

“You know I was a law and order Republican for a long time– lock ‘em up and throw away the key,” he said. “But being in here and seeing what is really going on has opened my eyes. I feel terrible for the victims out there and what they’ve had to go through, but the crime that was committed is never going to change. You can’t un-ring that bell, and believe me, there’s a lot of remorse in here.”

And from a practical standpoint, he argued Virginia could not afford to be vindictive.

“In Virginia there are 1,100 inmates that are over 60,”Colosi explained. “If you multiply that times 68 thousand, that’s $74 million. Now for $2,300 a year you can put an ankle bracelet on a man and monitor his whereabouts 24/7. So for $72 million savings, you could hire a lot of teachers, police officers and youth counselors for these kids to maybe kind of head some of this stuff off at the pass.”

Critics also point out that most elderly inmates are too frail to pose a risk to the public, but they are at risk behind prison walls. Professor Tina Maschi, at Fordham’s Graduate School of Social Service, pointed out that one key to surviving a prison experience is being tough enough to stand your ground.  She says people who are old and frail are often bullied and assaulted.

To augment the impact of our series, we created a web page with community resources for those interested in prison reform, and I will be reporting on related subjects in the months to come. 

Thoughts for other reporters:

1 -- When sending Freedom of Information Act requests, it may be wise to ask just a few questions at a time, so agencies are not overwhelmed.  I’m told the ACLU has sent extensive lists of questions to the DOC and received no response.

2 -- When dealing with corporations, it’s wise to study their websites – especially when they refuse to do interviews. You will often find relevant information, and there may be video or audio suitable for use in a radio or TV story. I was able to find a great little clip posted by one of the for-profit prison health providers that added color and helped pace my story. The firm also bragged it could save prisons or jails 15% on the cost of health care, and said it had an excellent record of repelling lawsuits, with 92% of plaintiffs receiving no payments.

3 -- Prisons receive very little coverage, but the U.S. locks up more individuals per capita than any other country in the world. We have 2.2 million people behind bars – up 500% from 30 years ago. This situation raises important questions for policy makers, and it’s a rich area for journalistic exploration.