Correctional Health: Examining Medical Neglect of the Incarcerated

Personal Statement

As a certified nursing assistant, I am currently pursuing the goal of becoming a nurse. For this paper, I decided to focus my attention on a lesser-discussed area of healthcare: that being the varying quality of care provided to the incarcerated.

Abstract

The purpose of this paper is to examine various accounts of neglect that have occurred within the United States’ incarcerated population and analyze its prevalence and plausible causes. Sub-topics covered in this material include preventable deaths, the impact of for-profit correctional healthcare companies, and the repercussions of fear within the work environment. This paper uses various sources such as news reports, scholarly sources, and government documents. To thoroughly examine such a complex topic, an interview with an expert was held specifically for this write-up. The information concluded from such research provided an abundance of evidence regarding the prevalence of medical neglect of the incarcerated, as well as possible courses of action that could prevent it from further worsening if implemented.

Keywords: Correctional Healthcare, Incarcerated, Incarceration, Malpractice, Neglect, Negligence, Preventable Death, Prisoner Healthcare.

“Help” is a common word: one that takes priority in the medical field. It is also a word that fell on deaf ears when Ta’Neasha Chappell repeated the phrase while in custody at the Jackson County Jail. For nearly sixteen hours Chappell uttered the word while being met with skepticism and Tylenol (Martinez, 2022). Those hours consisted of repeated vomiting -which she claimed consisted of blood – insistent cries for a hospital, and others relaying the message on her behalf to the faculty. When this mantra-like cry for help was finally answered, it was too late. She passed away only a few hours later in a medical center on the sixteenth of July 2021 (Duvall, 2022). Unfortunately, this is more common than one would hope. Such accounts of medical neglect in correctional facilities may often be under-reported, but that doesn’t hide the fact that correctional health needs to change.

Correctional Neglect

In 2021, Washington state paid $3.25 million dollars to the family of John Kleutsch after he passed away; his death was attributed to the poor healthcare displayed at the Monroe Correctional Complex. Seattle Times staff reporter Jim Brunner published three articles detailing the events of Kleutsch’s death. The origin of the untimely loss of life can be traced back without difficulty. Brunner reveals that 26 days earlier, Kleutsch started complaining of “excruciating pain” from a surgical incision that wasn’t healing. In return, he was offered Tylenol. As his health deteriorated, his call for help remained unanswered despite the situation being made clear to Dr. Julia Barnett who served as the medical director of the complex. With time, his ability to eat orally was gone. Vomiting became frequent. Kleutsch grew dehydrated, possibly attributed to how “medical staff forgot for more than a day to give him intravenous fluids” (Brunner, 2021, para. 9) Originally, Barnett refused to send Kleutsch to the hospital despite concerns of fluid buildup and by the time he was finally sent, the outlook was grim. “By that point he had a perforated intestine, pancreatitis, and an infection…” (Brunner, 2020, “No plan of care” section). He passed away six days later.

The negligence that Julia Barnett displayed in Kleutsch’s treatment wasn’t new to the facility. In fact, as of 2020, Barnett’s license was suspended due to similar cases of negligence backed up by “…more than 2,000 pages of records [detailing] allegations of poor medical care” for her facility, as reported by The Seattle Times (Brunner, 2020). The Department of Health’s (DOH) statement of charges includes: “failure to adequately monitor treatment; failure to identify and treat medical issues; …failure to provide appropriate levels of care, including emergent care…” It appears that those incarcerated under her care had cause for concern: “I don’t want to die here” were words uttered by inmate Lee Johnson, who also didn’t receive proper care. In a way, Johnson’s fear never came to fruition: instead, he passed away in a hospital offsite due to Barnett’s and the correctional complex’s inaction. Johnson was another of seven deaths that occurred under the care of Barnett and that have been deemed worthy of investigation (Brunner, 2020). The improvement needed extends further than Barnett herself. In fact, it seems that the Washington Department of Corrections (DOC) has “a pattern of delay that leaves the state’s 18,800 incarcerated men and women unable to access basic health services” (Pulkkinen, 2020).

Poor correctional healthcare can be seen throughout the U.S. with such accounts documented by The Marshall Project, which serves as a non-profit news organization centered on prisoner rights. “I would hear him screaming in agony before I even made it inside the building… In some ways, I felt relieved that Farrell was paralyzed. At least he couldn’t feel it when nurses went to clean his stage-four bedsore,” said Lois Ratcliff when talking about her late son, who received poor care evident by how “basic cleanliness and medical precautions were absent,” which contributed to his painful deterioration (as cited in Ratcliff & Lartey, 2021). There are many accounts like that of Ratcliff’s, events existing state to state, with whole prison and jail systems drawing criticism for their care such as in Arizona and Illinois (Meisner, 2019; Ciaramella, 2021; Denison, 2021).

Malpractice Exacerbated by Large For-Profit Healthcare Companies

The poor care provided, even when the best of intentions is displayed, was discussed in a workshop summary titled Health and Incarceration, approved by the Institute of Medicine and National Research Council (2013). Poor screening processes for diagnosing patients, inability to provide timely care, and lack of proper staffing were all noted issues (p. 11). Furthermore, treatment of the incarcerated outside of jails and prisons has also been shown to be of lesser quality. In a study entitled “Caring for Incarcerated Patients: Can it Ever be Equal?” published in the Journal of Surgical Education, 47% of surgical trainees believed that prisoners received substandard care and 71% said the holding rooms for the incarcerated were substandard (Douglas, et al., 2021).

The complications of correctional health get murkier when considering “for-profit prison and jail healthcare providers” as was revealed in the CNN published exposé entitled “‘Please Help Me Before It’s Too Late’” (Ellis & Melanie Hicken, 2019). Wellpath (formerly Correct Care Solutions, often abbreviated CCS) “is the nation’s largest for-profit provider of healthcare to correctional facilities.” (Ellis & Hicken, 2019, section 1). Priding themselves on their affordable care, Wellpath allegedly hires out to the inexperienced who are ill-equipped for the job: “workers shredded medical requests or hid them in boxes because of a lack of staff and resources. In other places, documents and interviews recount how requests had been found stuffed in drawers or ignored for weeks” (Ellis & Hicken, 2019, section 7). Wellpath claims to hire an appropriate level of competent staff, yet whistleblowers have claimed that the understaffing and inexperience of the employees was so severe that nurses had quit out of fear of losing their license (Ellis & Hicken, 2019, section 1). Some healthcare workers have directly noted a drop in quality of care when their facility went from government-supported healthcare to that of a private for-profit company, stating that the lack of care with CCS became concerning (Ellis & Hicken, 2019, section 7). It wasn’t rare to see medications often out of stock and denied, resulting in preventable deaths, and a case of disturbing self-harm from an inmate’s lack of medication for their psychosis (Ellis & Hicken, 2019). Further supporting the accusations of unprofessionalism, a “Director of Nursing jokingly announced in a loud voice in [a] clinic, ‘We had a drug holiday for one week,’ as if it were totally insignificant,” according to a memo from Grace Kingman on behalf of the Pierce County Sherriff’s Department (2016) expressing deep concern for the lack of care the CCS provided in their facility. Other for-profit correctional healthcare companies have similar reputations. One such company is “Correctional Health Partners (CHP) for their ‘deliberately indifferent policies,’” according to one mother whose son passed away under the care of CHP (Coll, 2019). The nature of providing cheap care in the form of such companies to the incarcerated is lucrative and continues to grow with CCS alone having “seventy percent of the jails that it inspects outsource their medical services…” (Coll, 2019). Granted, issues of negligence towards the incarcerated have existed before private correctional healthcare companies rose in prominence, but their emphasis on cutting corners to save money only exacerbates the issues. In addition to these problems brought up by understaffing, the private-nature of these companies could also potentially allow neglect to occur with less attention or, as David Fathi of the National Prison Project stated, “…government-run prison health care [isn’t] perfect. It’s often appallingly deficient. But, at least when a government is providing the service, there is some measure of oversight” (Coll, 2019, para 24).

The Multifaceted Origins of Poor Care for the Incarcerated

“First off, prisons and jails aren’t looking to provide the Cadillac of healthcare,” said James Ilika, who provided the clear statement a mere few minutes after our interview on correctional health began. With an M.A. in psychological counseling, Ilika served as a Psychiatric Evaluation Specialist for the King County Jail system for 17 years and occasionally saw prisoners while working in community health. My confidence in the information he shared was bolstered not only by his expertise – but also by his seemingly genuine interest in the subject.

Continuing the interview, Ilika first wanted to give needed background on the struggles that affect jails foremost before moving on to healthcare of the incarcerated in general. Ilika mentioned how jails often neglect the seriousness of drug withdrawal, and how due to the acute temporary nature of jails, a large amount of those that come in have alcohol addiction or another form of substance abuse. An adjacent cause of substance-related deaths in jails is the inability to get the incarcerated the medications that are needed, partially attributed to poor screenings that don’t provide the needed information. In other cases, the withdrawals can come from the individual having a dependence on prescriptions that were being used off the record. Those with mental health issues are at particular risk of receiving substandard care. As Ilika brings out in his 2011 article, “Mental Health Professionals and the Jail System”:

Jails however are not designed or staffed to systematically meet the needs of the mentally ill. Incarceration of the mentally ill is an imperfect temporary response to a tragic and complex social problem. Nevertheless, jail staff work with mentally ill inmates 24 hours a day, 365 days a year.

After the discussion of jails, Ilika decided to share what he viewed as the biggest obstacle to proper care: “The biggest obstacle to adequate care is the fear of being manipulated” (J. Ilika. personal communication. February 20, 2022). It was subsequently clarified that he was referring to the fact that no employee, whether correctional or medical, wants to be taken advantage of. Inherently the environment of a corrections facility is one that fosters distrust according to Ilika. And after a while, nurses develop this fear of being lied to, which can manifest as a lackadaisical approach in giving treatment. This, in turn, results in the incarcerated fearing a lack of adequate care, so they must partake in “strategic manipulation” through exaggeration of symptoms to get basic care. Similarly, another report stated that “99 percent of the time the reasons there was unconstitutional care was because there was mistrust and cynicism of what the patient was saying” (Institute of Medicine and National Research Council. 2013, p. 13).

Another source of poor care stems from a culture clash between the corrections staff and the medical department. As Ilika explained to me: The contrast between the corrections faculty and medical faculty breeds an unhealthy environment for medical workers, which in turn hurts the prisoners. The culture of the corrections department is paramilitary and punitive, while the culture of healthcare is non-paramilitary. Often correction officers see themselves as part of the punishment of incarceration when their job is intended to be one of protection. According to Ilika, it’s not uncommon for corrections to see those suffering under their care as “drug crazy” and just “another addict” undeserving of proper treatment. Nurses and therapists can be indoctrinated and corrupted by this permeating attitude (J. Ilika. personal communication. February 20, 2022). Ilika’s claim seems to be an accurate observation with similar statements made by others, including inmates as found in Crosscut’s research:

When complaints rise about medical care provided through the Department of Corrections, blame often falls on cost controls meant to ensure the department doesn’t blow its whole $1.1 billion annual budget on health services. But in interviews, more than a dozen current and former inmates, their families and their advocates argue the department maintains a culture of callousness. (Pulkkinen, 2020, para 8.)

It would be beneficial to view the punishment of incarceration as the fact that one is removed from society. The care received inside the facilities is not meant to be the punishment. The added punishment given to the incarcerated through mistrust and neglect displayed by the medical team only encourages the incarcerated to remain fearful and bitter. The goal of incarceration for most is to be reimplemented into the world as a functioning member of society. This is made difficult when one has their experience of rehabilitation be that of cruelty. With the surprisingly high number estimated for those falsely incarcerated, not even the innocent are safe from this neglect (Walsh et al., 2017).

Possible Approaches to Repair Correctional Health

The amount of negligence shown in different aspects of the correctional system is not only disturbing, but it also goes against the nature of healthcare itself. In some of the accounts discussed, negligence can go as far as breaking the Eighth Amendment: “Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted.” (“US Constitution,” Art. I, Sec. 8). As mentioned earlier, this punishment partially stems from fear. To counteract this fear that all three parties have (corrections, medical and the incarcerated), changes need to be made to the culture and mindset of the staff. According to Ilika, instead of viewing the incarcerated as possible liars not to be trusted, staff must be trained to see that this lying is no more than “strategic manipulation” to receive the care they truly need (J. Ilika. personal communication. February 20, 2022). The culture of the corrections department needs to move from one of punishment to one of protection. Ilika revealed to me that often those in the corrections department are those with aggressive personalities bordering on antisocial personality disorder. A large reason for this is the pool from where these staff members are picked. This pool often consists of those who failed to become police officers or who are looking for a sense of authority. To counteract this, personality tests and stricter screenings should be given prior to employment, and focus should be given to hiring those who once served in the forces before with a good record (J. Ilika. personal communication. February 20, 2022). With corrections having less of a negative influence on the medical faculty, negligence would surely lower. As for the for-profit correctional healthcare companies, the demonstrated emphasis on cheap care should instead shift towards proper care.

Conclusion

The medical field should be one of healing, not one of punishment. The disturbing cases, such as with Chappell’s fruitless pleading for the hospital or Julia Barnett’s willful negligence, are seen too often with little attention given to the victims due to the stigma that comes with being classified as a criminal. Regardless, the incarcerated have a reason to voice concern about their poor medical care, and we need to recognize this concern for what it is – a call for help.

References

Brunner, J. (2020, February 26). The head at Monroe prison was fired over alleged negligent care. Now seven inmate deaths are under investigation. The Seattle Times. https://www.seattletimes.com/seattle-news/the-head-doctor-at-monroe-state-prison-was-fired-over-alleged-negligent-care-now-seven-deaths-are-under-investigation

Brunner, J. (2021, June 2). Washington state to pay $3.25 million, admitting medical negligence in Monroe prison death. The Seattle Times.  https://www.seattletimes.com/seattle-news/times-watchdog/washington-state-to-pay-3-25-million-admitting-medical-negligence-in-monroe-prison-death/

Ciaramella, C. (2021, November 9). Report finds gruesome medical malpractice and death in Arizona prisons. Reason. https://reason.com/2021/11/09/report-finds-gruesome-medical-malpractice-and-death-in-arizona-prisons/

Coll, S. (2019, February 25) The jail health-care crisis. The New Yorker. https://www.newyorker.com/magazine/2019/03/04/the-jail-health-care-crisis

Denison, B. (2021, February 25). Vermillion Co. Sheriff, deputies, nurse sued over claims of negligence after inmate death. WCIA 3. https://www.wcia.com/news/local-news/vermilion-co-sheriff-deputies-accused-of-negligence-in-wrongful-death-suit-involving-jail/

Department of Health. (2020, November). Statement of charges. (Master Case No. M2019-821). State Washington Department of Health. https://www.documentcloud.org/documents/7331335-Barnett-Suspension.html

Douglas, A. D., Zaidi, M. Y., Maatman, T. K., Choi, J. N., & Meagher, A. D. (2021). Caring for incarcerated patients: Can it ever be equal? Journal of Surgical Education, 78(6), e-154-e160. https://doi.org/10.1016/j.jsurg.2021.06.009

Duvall, T. (2022, January 21). ‘Can you help me, please?’ Ta’Neasha Chappell begged for medical aid before her death. Courier Journal. https://www.courier-journal.com/story/news/crime/2022/01/21/taneasha-chappell-louisville-woman-begged-for-help-before-jail-death/6579985001/

Ellis, B., & Hicken, M. (2019, June 26). “Please help me before it’s too late.” CNN. https://edition.cnn.com/interactive/2019/06/us/jail-health-care-ccs-invs/

Ilika, J. (2011). Mental health professionals and the jail system. Frontlines. 32(2), 5-6. https://wadcr.org/assets/docs/FrontlinesFall2011.pdf

Institute of Medicine and National Research Council. 2013. Health and incarceration: A workshop summary. Washington DC: The National Academies Press. https://doi.org/10.17226/18372

Martinez, N. (2022, January 17). New jail recordings confirm Ta’Neasha Chappell told officers she was vomiting blood hours before her death. Wave 3. https://www.wave3.com/2022/01/17/new-jail-recordings-confirm-taneasha-chappell-told-officers-she-was-vomiting-blood-hours-before-her-death/

Meisner, J. (2019, August 19). Independent experts blast quality of medical care in Illinois prisons. Chicago Tribune. https://www.chicagotribune.com/news/ct-illinois-prison-medical-care-met-20150519-story.html

Pierce County Office of Prosecuting Attorney. (2016, Mar. 25). [confidential letter]. https://www.documentcloud.org/documents/5978547-Pierce-County-March-2016-memo-to-CCS.html#document/p5/a505028

Pulkkinen, L. (2020, August 6). Health care in WA prisons leaves inmates waiting months or years for help. Crosscut. https://crosscut.com/news/2020/08/health-care-wa-prisons-leaves-inmates-waiting-months-or-years-help

Ratcliff, L., & Lartey, J. (2021, July 30). A filthy New Orleans jail made my son sick. The ‘Cruel and unusual’ medical treatment at Angola prison killed him. The Marshall Project. https://www.themarshallproject.org/2021/07/29/a-filthy-new-orleans-jail-made-my-son-sick-the-cruel-and-unusual-medical-treatment-at-angola-prison-killed-him

Walsh, K., Hussemann, J., Flynn, A., Yahner, J., & Golian, L. (2017, September). Estimating the prevalence of wrongful convictions. National Criminal Justice Reference Service. https://www.ojp.gov/pdffiles1/nij/grants/251115.pdf