The Square: The Health of Prisoners

America has more people incarcerated than anywhere else in the world and there are big problems prisoners say their health care is being overlords when you sentence someone to prison you know the state own somebody basic human rights our government experts want urgent reform and they say that human rights aren't being met here in New York the square starts now welcome to Times Square I'm Sally Ayhan on this show we'll be talking about health care in prisons and we want to hear your thoughts on the issue you can contact us on Facebook or Twitter at TRT world and be part of the conversation now there are over two million adults in the u.s. who are incarcerated nearly half of them suffer from mental illness many have substance abuse problems and some have chronic health conditions but health care in prisons here is not standardized in fact according to the American Civil Liberties Union the u.s. is the only democracy in the world but has no independent authority to monitor prison conditions so let's hear more andre was released from prison ten years ago since then he's worked with other former inmates who are trying to reintegrate into society I knew that anything I got into that was negative it's gonna interfere with me getting now he was incarcerated in his early 20s for manslaughter and drug trafficking and served 16 years in a New York state prison so while inside you know I witnessed people like getting stabbed or getting cut I witness different forms of abuse by correctional officers I witnessed people being placed in solitary confinement and it wasn't all of the correction officers necessarily but there was a certain abnormality in that environment that wasn't conducive to developing human babies Andre says that being in a prison made him feel less human he understands that he lost his freedom because he broke the law but says things were worse for him because he's black the healthcare was inadequate at best and while you may have received some medical attention the attention wasn't the kind of deep attention in one we get if you have private health care are you paying for health care so not having that kind of resource to fully like deal with people's health needs people develop high blood pressure people develop diabetes because of the substandard nutritional factors inside of the food and it's not to suggest white folk didn't have some understanding of poverty and those other factors but they knew by virtue of their skin color that it gave them access to privileges that blacks and Latinos didn't have mass incarceration began in the u.s. in the 1970s the growth in America's prisons was part of a policy that demanded stricter sentencing laws and a promise to be tougher on crime today America has the highest incarceration in the world over 2 million adults are incarcerated more than 1/3 of that population is african-american that leaves nearly 3 million children with a parent behind bars health care standards vary from prison to prison depending on the state and prisoners sometimes have to pay for their health care for an incarcerated person to pay a five dollar copay it may be almost their entire month's salary bruh Maryland Rolston was convicted of first degree murder and spent 23 years in prison when I was incarcerated you know I've had to make those hard choices myself do I put in that copay requesting a visit to the doctor because my head's been hurting or my back's been hurting for two days in a row and then I have to wait a couple weeks for the visit but they put a hold on my account for that $5.00 and if all I make is eight dollars a month then that leaves me with three dollars left to spend you know and if I have more than three dollars you know what can you do with three bucks from aerelon is now the program director for project rebound an organization that supports prisoners wishing to enroll and graduate from the University she wants the prison healthcare system to be reformed and says that people in prisons struggle disproportionately with health problems findings from the American Civil Liberties Union show that nearly 12 people die each day in a US prison and nearly half of the jail population suffer from mental illness two-thirds of inmates are addicted or dependent on medications but only 11 percent received treatment romera 'ln also says the specific health needs of women aren't often met prenatal visits prenatal vitamins yes they're going to give you a bag of vitamins and then you're going to see a doctor but is it really good care you know you would have to ask the mother that they feel like they were taking care of and for my friends who were pregnant inside they never felt that they were basically you go in they take your blood pressure your temperature ask you a couple questions and if you answer them the right way then okay we'll see you in six months in California we've had a problem with no women being sterilized after they give birth you know they didn't even know that they were being sterilized she puts it down to a nonchalant attitude to health care which manifests over time we're older women inside who are menopausal you know who are going through you know just the body changing and aging because when you're inside you know there's really poor nutrition there's poor sleeping conditions ventilation is terrible no people are not sleeping well there's this overexposure to light and so folks are you know just not doing well over long periods of time there is an increasing aging prison population and many with chronic diseases Renee was one of them I woke up one morning and I couldn't see well I he was blurry everything was blurry okay maybe I need some glasses I'm not realizing that something is coming out the corner of my eye really bad and I took another guy that time you see man something's wrong with your eyes man don't see the eye doctor telling this emergency yeah okay I think I will because the vision was really bothered you know I see this nurse she wasn't our en she stepped out the room came back in with my medical chart and says you have glaucoma I said what is that you know she's had you seen it a thousand times they told me you have severe glaucoma boys so in the right eye at the left eye the prison should have told you this little topical treat I don't know why you wasn't treated but we do know that the medical sticks in prison we hear a lot of this stuff and you guys end up coming to us after it's too late prisoners are expensive to maintain the average prisoner costs about thirty four thousand dollars a year but they also make money when the state is unable or unwilling to build more prisons private companies step in and profit to maintain and run the facilities it began in the 1980s under the Reagan administration and is part of a growing trend but the theory behind private prisons isn't emulated in practice and has been strongly criticized rights groups say prison industry lobbyists have actively promoted the campaign's of anti-immigration hardliners where harsh policing and sentencing standards for drug related violations nonviolent crimes and other offenses by young and poor has fueled mass incarceration following President Donald Trump's election victory shares in private prisons skyrocketed and under his zero-tolerance policy Trump has proposed giving billions to private companies to detain illegal immigrants but evidence shows that private companies are cutting corners on essential services to turn a profit one of the nation's largest for-profit prison health care providers horizon has become the target of thousands of lawsuits the suits involve a crisis level shortage of nurses doctors psychiatrists and other medical staff and serious but treatable illnesses that when untreated and turned deadly I mean ever heard of many cases where there's somebody on the floor they're having a heart attack or they're having a seizure or some other and terrible pain in there screaming and maybe other people on the tear are screaming to the officers to get the medical care and the nurse or the officer just assumes that they're faking and then the person dies so you know their case after case like that and I think the kind of skepticism hostility disdain indifference all of those emotions that you imagine are wrapped up in a response like that you see filter through the prison medical system suicide is the leading cause of death in correctional facilities in 2014 50 out of 100 thousand inmates killed themselves that's compared to 13 people out of every 100,000 on the outside I've seen officers use force against a mentally ill prisoner who just couldn't follow the rules and that's just a snapshot that happens again in every single prison in every system around the country every day because mentally ill people have have troubled responding to orders and controlling themselves in a way that person wants them to be controlled and in solitary confinement it's it's terrible because you take someone with mental illness you put them in long-term solitary confinement and they need treatment but instead they're left to deteriorate and that's how you end up with people cutting themselves or you know as we just saw out of these photographs out of Alabama writing in blood on the wall a cry for help but legal barriers have made reforming prison conditions nearly impossible a person who commits a crime no longer has the same rights of those who don't the question though is where do those human rights start and end for those who are incarcerated people will say why should prisoners get free health care when people in the free world don't get free health care and you know the answer there is to my mind a number of answers one is because the Constitution requires it another answer is because we forced people into conditions where they are locked away from society and have no capacity to provide for their own needs so if they don't get health care they're gonna die a slow and painful death which the Supreme Court has likened to torture some experts say the solution is to limit the numbers of those incarcerated but those who've lived it feel the problem is far deeper you're culpable for the decisions that we make but we also know that the environment influences us in many different ways so you remove all of those things right then your relationships deteriorate because you may not have the kind of education you need to effectively communicate right if you don't have the monies necessarily to put food in your mouth or to pay for rent or housing in many ways right you resort to behaviors to survive when facilities are crowded you can't provide adequate health care so what you need is a commitment on the part of society to provide adequate health care for the people we have chosen to incarcerate and also a recognition that we have simply incarcerated far too many people if one of the obligations we have to the people we put in prison is to provide adequate health care we just have set up a system where it is literally impossible although people have made poor decision and have harmed people that does not exclude them from being able to redeem themselves and to live a life of contribution in some way and if we want this person to live a life of contribution upon their return and make sense to invest not only in healthcare but mental health care but also education and also like programs to support transforming this person so they come out an asset rather than a liability possibility for all of us now let's talk more about these issues with me here at ester Lim she's the director of monitoring and policy for the Correctional Association of New York and Julianne Adler he's the director of policy and research for the Center for Court innovation welcome to you both thank you now Julien why are there so many people incarcerated in the u.s. there are so many people incarcerated in this country because of deliberate policy decisions to charge and incarcerate more people for more crimes and for longer periods of time than any other nation in the world what are the driving forces behind that the driving forces are multiple one is enormous discretion at the local level by police and prosecutors to arrest charge and ultimately incarcerate people punitive policies on the state and federal level such as tough on crime legislation three strikes policies mandatory minimums as well as a punitive culture a punitive approach to thinking about how to respond to complex problems borne of even more complex circumstances and esti you've worked in both Los Angeles and New York how's the role of different state laws contribute to mass incarceration I think just the inconsistency you know plays a huge part right one state you know may look at criminal justice reform and apply criminal justice reform in the way they look at mass incarceration whereas other states may be a little bit more more conservative and more on the tough on crime you know perspective and America has an addiction problem they are addicted to mass incarceration as a way to cure social ills right in a cover of public safety how do you break that cycle ista part of the solution is looking at the way that we incarcerate why we incarcerate and also I think we're also realizing you know prison is something that we know doesn't work there studies there's research to show that putting people behind bars doesn't rehabilitation takes a f— there's still a risk of recidivism and yet we continue to you incarceration as the only solution on the table picking up on that point in fact there is a difference between jails and prisons of course jails have a higher turnover rate than prisons where inmates usually have longer sentences but while prisons have their own health concerns the health issues are particularly acute in jails why is that when you look at the challenges of attempting to regulate or standardize health care in prisons those challenges are magnified in the jail context for a number of reasons first and foremost there are over 3,000 local jail systems in the United States and there's much more variation in the quality of care there's also tremendous churn individuals coming in and out of jails in any given year we see up to 12 million jail admissions in the United States so you have heavy volumes of people entering jails leaving jails and there's really an absence of oversight or regulation unless you reach a point where your Jail is overcrowded and there's federal intervention from a health perspective the conditions are deplorable from a constitutional or legal perspective we have to remember that over 60% of the jail population in this country is still legally presumed innocent and the only reason that they're languishing behind bars and jails not receiving adequate health care or mental health care is because they can't afford to pay money bail picking up on the topic of mental health care nearly half of the people held in incarcerated institutions in this country have some sort of mental health illness how is it managed across the board the US Supreme Court through Estelle and Gamble has already said that you know when someone enters the you know carceral institution it the onus is on the prison or the jail administrators to provide that adequate health and what we're seeing nationwide is that that's not occurring we're also talking about a population that comes into the system you know within in sometimes very poor health because we you know criminalize homelessness these are folks that don't have access to medical or mental health care and then they enter into the criminal justice system and spend a lot of time in prisons can you give some examples of what you've seen so we're talking about people who you know have not engaged in preventative health care so they're already in a kind of a delicate health position and then when they are getting delays they're not able to see a doctor in a timely manner so waiting weeks or months and once this is I would just echo the point and say from a mental health perspective one thing that we know is that the majority of the incarcerated population has experienced some form of trauma and the worst place to be if you've experienced trauma if you're suffering from complex trauma or post-traumatic stress disorder is a chaotic and violent and unpredictable environment and that's exactly what you find behind bars and jails and prisons so what are the solutions here Julien do you think that there are some solutions to the problem of mental health and prisons so the good news is that at every point along the criminal justice continuum from initial contact with law enforcement the decision to arrest or divert all the way through sentencing and decisions made post sentencing there are safe and effective alternatives to pretrial detention and incarceration the reality is there are solutions to these problems it's less about the pragmatic challenges of avoid incarceration into Esther's point breaking our addiction and our default assumption that we should be incarcerated everyone who comes in contact with the justice system I wanna bring up the issue of race I think it's not an issue we can really avoid here there's a long history of race relations and the prison system in the u.s. can you give us a broader picture Esther of what you've experienced and seen in terms of race relations in the prison system I mean they feel like we can't talk about mass incarceration prison jail without talking about race you know its modern-day slavery you know when you look at who's behind bars you can't say that it is not a you know it's not a racist system you know the majority of the people that are behind bars are from black and brown communities and part of this is because we do criminalize you know black and brown America is a very racist society that we've created these racist institutions and we call that now public safety you fix a problem like that is it more than just an institutionalized problem it's certainly more than just an institutionalized problem and it really requires a reckoning with this country's racist past and a willingness to re-examine how we approach the administration of justice I would argue and I think it's important to note that it can't just be about humanizing confinement it has to be a dual project in this country of humanizing confinement and dramatically reducing the use of incarceration I'll just move on for a moment and your experience as to how have women been treated or pregnant women specifically in prisons well first I think we have to address that the population of women who are being incarcerated is steadily increasing there is a different gender lens when we look at the way that we incarcerate women you know decision making that women have that also needs to apply you know when they when they're behind bars in terms of you know access to abortion access to you know pre and postnatal care the way that they are cared for while they're pregnant also you know after they give birth when you take the primary care taker away from the home we have now created what we call a generational you know incarceration you know there's studies that show that when a child has a you know a caretaker in prison or in jail it increases the risk of that child and entering the criminal justice system we're also Julien looking at an aging population in prisons in staggering figures from 1993 to 2013 the number of inmates over the age of 55 increased by 400% and of course that would come along with some chronic health issues how do how do systems of the state manage the cost of an aging prison population I think the only way out of this problem is to reduce the length of sentences to reduce the use of incarceration and to rethink sentencing to return to a theme that we discussed earlier the specter of public safety risk research does show that there's such a thing as an age crime curve and that most individuals who engage in behavior that's criminalized age out of that kind of behavior in terms of what to do now when we of an aging population behind bars the first step is to provide adequate care right we can reach the next level of how do we provide more customized holistic responses but we're not even at the baseline of adequate care I want to pick up on the topic of privatization now what are some of the policies behind the driving force of privatization of jails I just think that when your business model is about incarcerated people that's a horrible business models start off with incarceration just doesn't work and what are they doing to make a profit is what is what I'm interested in well what I was going to say and I'm glad you asked about profit is essentially by private by privatizing prisons in jails we're adding another incentive to incarcerate we're adding a profit motive and based on what's been reported and studied the way that profit is made is by cutting cost and offering the lowest standard of care imaginable which happens to also be unconscionable one of the biggest health care providers Corizon has had over a thousand legal cases in the past five years for issues that include alleged neglect malpractice wrongful injury or death now if companies are in such legal hot water over this why wouldn't they want to just fulfill their contracts and and do what they were hired to do I mean the good thing with is that a lot of jails and prison administrators who have contracted with Corizon because of these lawsuits because you know we're seeing massive medical neglect are they're canceling contracts you know and hopefully that's one a signal that you know there needs to be more oversight over the way that health care you know is doled out inside prisons but also you know an examination of how we are privatizing justice you see that money corrupts and corrodes throughout the criminal justice system and that really what we need to do is get money out of the system and focus on that normative idea of justice which is supposed to be what justice is about in America with talking about the intricacies of the human rights of prisoners here but what about the perspective of the victim there's general notion that victims of crime would be opposed to alternatives to incarceration or the humane treatment of defendants standing before trial or inmates incarcerated in a facility is mythological and I think it walks with the myth myth of Public Safety I think these are ideas that we have that we use to rationalize bad policy and until we confront that rationalization for what it is we're never going to be able to get out of that and so where do we draw the line here I mean human rights seems like a fairly ambiguous thing when it comes to the prison system they don't have freedom freedom as it is the freedom or right to move around so you know what is the human right of prisoners in this in this case I mean I think the fact that has to be posed a question you know we have to talk about right like human rights for prisoners and and I think that is kind of the foundation kind of question that we as a society needs to really think about right that there is that there shouldn't be a difference between you know a free person and someone who's incarcerated you know my rights are you know are their rights and yet we have kind of distinguished that and therefore have allowed for you know mistreatment of people who are incarcerated for allowing you know subpar medical and mental health treatment to be allowed because it's you know that's what you deserve what's interesting though is that Americans incarcerated are the only people in the country that have the constitutional right to health care there'd be many people out there that would say well hang on I didn't do anything wrong I didn't break the law why did I get health care why should criminals get health care and again I don't accept the premise of the question and I don't accept the premise of the question when it's posed by anybody the premise of the question is that individuals were incarcerated or somehow less than human and I think this really is at the heart of all of these policies both historical and current and until we can shift the paradigm until we can treat individuals who are involved in the criminal justice system or incarcerated as fully human we are not going to get out of the mess of mass incarceration I think we'll leave it there thank you very much to you both thank you interesting discussion and lots to talk about but we'll have to leave it there for the time being so thank you to both of our guests and if you have any comments on the issues discussed in today's show you can contact us on Facebook and Twitter at TR T world and thanks to our team here in New York please join us next time on the square you

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