He is bedbound, unable to walk, unable to care for himself, unable to advocate for himself, and so confused that he cannot finish a thought, let alone a sentence. He has lost 90 pounds in the past year. He soils the bed multiple times per day. His legs and feet are so swollen and edematous that socks and shoes do not fit on his feet. The expectation is that he yells from his bed/cell if he needs something, has a problem, or even worse, he falls with the hope someone hears him in the hallway. There is no emergency call button or system. (Written by Ms. N)
This is the story of Mr. P who, after serving 20 years of a life sentence in prison, developed terminal liver cancer. He had suffered from hepatitis C for many years and, despite requesting treatment, was denied it until a lawsuit forced the Massachusetts Department of Correction to give him the medication. At that point, his end-stage liver disease was quite advanced, and he had already developed cancer.
In the United States, people who are incarcerated are the only group with a constitutional right to healthcare, yet people in jails and prisons are more likely to experience poor health and lack of quality medical care. By many measures, incarcerated people suffer greater health risks than the general population. It is estimated that for each year served, a person’s life expectancy drops by two years. They are 1.4 times more likely to have a chronic disease and over four times more likely to have an infectious disease. At the height of the pandemic, incarcerated people were 5.5 times more likely to contract COVID-19 than the general population and three times more likely to die from it.
Further, the aging of our population compounds health risks associated with incarceration. The number of state and federal prisoners in the U.S. aged 55 and older increased by 204% between 1999 and 2012, thanks to tough on crime measures, particularly from the 1970s-80s, which disproportionately targeted people of color.
Compassionate release is one mechanism embraced in some form by almost every state to address the financial, constitutional, and ethical problems of an aging prison population. Compassionate release is safer than some might think, and old age is one of the greatest protective factors against recidivism, including violent crime. While compassionate release does not address the factors that make ill health more likely among the incarcerated, it is a tool to alleviate suffering of those already dying or incapacitated.
Here at Prisoners’ Legal Services of Massachusetts, many of our clients whom we feel clearly meet the definition required for medical parole are denied it or are denied it until it’s too late for them to spend their last days outside of shackles or prison.
Mr. P was unusual in that he had a friend, Ms. N, who was a healthcare worker and was able to follow his health decline and request attention. However, even with this advocacy, months would pass as he became more confused, edematous (swollen), and developed further organ failure.
He, like many sick prisoners, was housed in a special nursing unit within the state prison. These units are poorly staffed and often rely on other prisoners to care for the sick. Medical providers, who have hundreds of people to care for, often will not see patients for long periods of time. Ms. N wrote the following:
Despite his terminal condition, Mr. P has not been seen or evaluated by a provider for over a month at a time. While living in the Infirmary, he has had recurrent falls, lacerations requiring sutures, undiagnosed and misdiagnosed infections, a fractured back, and most significantly, a head injury requiring emergency brain surgery that left him with permanent disabilities (speech impediment, tremors, balance and coordination issues, and inability to write). Clearly, his medical needs are not being met, and his care is woefully inadequate.
At the time of his petition for medical parole, Mr. P was bedbound, unable to walk, or effectively communicate with anyone. Even though he did not objectively pose a threat to anyone, he was always transported with four guards and shackles on his hands and feet, which were so edematous that special shackles had to be procured. But although every medical provider who examined him deemed him terminally ill, his petition was denied three times between 2020 and his death.
Prisoners have the same right as all other patients to informed consent and to designate a healthcare proxy to make decisions on their behalf if they are incapacitated. Mr. P was fortunate that Ms. N was able and willing to serve as his healthcare proxy when he eventually became too delirious to make decisions on his own. However, despite being very proactive in trying to find out information and knowing that the prison and his doctors all had her contact information, she recalls that, “I was never contacted when he had decompensations and there were medical decisions that needed to be made.”
At the very end of his life, Mr. P was granted medical parole, but he died 24 hours later. In practice, nothing changed for Mr. P, as he was still considered in the custody of the Department of Correction until he was moved to another facility. This meant that despite Ms. N’s best efforts, he was denied access to his family or the ability to die out of shackles.
The U.S. is notable for both the number of people we incarcerate and the length of time we keep them behind bars. And further, jails and prisons are not designed to provide healthcare but, rather, to serve as mechanisms of punishment and segregation. Under our constitution, prisoners still have a right to adequate medical care, but this is difficult to deliver in a setting designed for punishment and security.
The comparatively few successes of our clients seeking medical parole have shown how valuable this process can be to affirming human dignity and saving our system unnecessary strain in the guarding and confinement of those too feeble to pose any threat to society. As health professionals entrusted with healing all humans, we are uniquely positioned to see people, as Bryan Stevenson says, as “more than the worst thing we’ve ever done.”
Medical providers can learn more and offer help in the form of medical record review by getting involved in a local or national medical legal clinic, such as the Medical Justice Alliance.
**Feature photo obtained by standard license on Shutterstock.
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|Alice Bukhman is Director of Clinical Operations for Brigham and Women’s Faulkner Hospital’s Emergency Department and Health Care Advocate for Prisoners’ Legal Services of Massachusetts.|
|Elizabeth Matos is Executive Director of Prisoners’ Legal Services of Massachusetts.|
|Aaron Steinberg is the Communications and Development Coordinator of Prisoners’ Legal Services of Massachusetts.|