On Wednesday, April 21st, at 7:00 P.M., Mount Sinai PHR invited Dr. Robert Cohen, former director of Rikers Island Health Services, Dr. Noga Shalev, author of “From Public to Private Care The Historical Trajectory of Medical Services in a New York City Jail” and an Infectious Disease Attending at New York Presbyterian Hospital, and Jack Back, Director of the Prison Visiting Project of the Correctional Association, to speak about the provision of health care in U.S. prisons, trends towards increasing incarceration of U.S. citizens, especially minorities, the effects of privatization on prison health, and opportunities to advocate for the incarcerated. 28 students, residents, and physicians attend the event.
From left: Jack Beck, Dr. Robert Cohen, Dr. Noga Shalev; Dr. Noga Shalev gives her presentation; the Mount Sinai audience.
Dr. Cohen began his lecture by citing several cases of prisoner abuse sanctioned by medical professionals. For instance, in 1999 in Mississippi, prisoners were given an unorthodox HIV drug regimen that resulted in producing resistant HIV strains in these patients. Dr. Cohen noted that despite the role of a prominent Infectious Disease physician as medical director of the prison, the care of HIV patients was neglected and unsupervised. In 2004 at an Ohio State prison, Dr. Cohen witnessed the neglect of health care staff to vary injection sites for insulin-dependent diabetics because it was easier to provide insulin through the feeding slot. In 2007, TS, a Michigan prisoner, was shackled to a cement slab as punishment for flooding his segregation cell during a heat wave in August 2006. Despite his mental illness and severe dehydration, a nurse practitioner authorized his continued restraint, noting he had a “faint pulse.” TS later died from hyperthermia with dehydration the contributing factor. Dr. Cohen explained that despite legal entitlement to health care, prisoners are often neglected in U.S. prisons, whether due to competing, dual loyalties of health care providers to institutions and their patients or the lack of accountability for prison medical services, particular when services are privatized and receive less public scrutiny.
Dr. Noga Shalev reviewed both her work on the history of medical services in Rikers Island and her review of the provision of care in county jails. She noted that until 1971 health care was provided by the Department of Corrections, defining this role as a conflict of interest between ensuring security and providing care. Successful reform was initiated with a contract brokered by the New York DOH that established Montefiore Hospital as director of medical services in 1973. She explained that the presence of academic physicians and students was beneficial for the prisoner’s care, allowing providers to act as advocates for their treatment and condition. In 2000, the contract was awarded to Prison Health Services, Inc., a for-profit corporation that manages health care for prisons. Much less transparency now exists and it is hard to ascertain how health care is being provided. As increasing government power is used to incarcerate New York residents, responsibility for their care is increasingly outsourced to private contractors in large state and federal institutions. Dr. Shalev contrasted this situation with smaller, country jails; she demonstrated that 70% of medical services are provided by local family doctors. It is unclear if this is an effective model of health care delivery, and further study is necessary.
Jack Beck spoke of his role as an advocate for prisoners and cited the major problem of the lack of standards for what defines good care. Prison health care providers must necessarily assume the role of advocate, which can contradict with the role of the correctional officer who seeks to maintain security and “avoid incidents.” He remembered being corrected by a correctional officer for using the term patient rather than inmate. Mr. Beck turned the focus of the meeting to juvenile detention centers, citing statistics that showed they were even more dramatically stratified by race than adult institutions. He then raised future issues that will need to be studied and addressed: mental health in prisons, LGBT issues, and racism in incarceration. Lastly, he addressed the difficulties in planning interventions for the health of prisoners after re-integration, citing declining adherence rates to HIV therapy as an example.
Dr. Cohen, Dr. Shalev, and Mr. Beck responded to questions and discussed possible future directions for advocacy. Opportunities to do rotations with Brown University’s medical services in Rhode Island prisons was suggested as well as another program at Yale that provides HIV treatment to Connecticut prisoners. Jack Beck invited students to participate in prison tours and evaluations through the Prison Visiting Project. Students were encouraged to work in teams on the issue and to press local governments for accountability as well as research on prison health.