The Deadly Human Rights Crisis…in U.S. Prisons

by kris bishop on October 28, 2008

 by guest blogger Benjamin Fleury-Steiner, author of new release Dying Inside: The HIV/AIDS Ward at Limestone Prison    

Medical_Symbol[1] With the election less than a week upon us, it is not surprising but no less distressing that both Senators Obama and McCain talk about health care reform almost entirely in terms of the middle class.  This is distressing, as the uninsured poor in this country represent a truly catastrophic health care crisis. The uninsured poor, many of whom are unqualified to receive Medicaid or Medicare benefits, die far sooner of illnesses that are easily treatable if they had access to even the most basic care.  A big reason for this silent epidemic of preventable suffering and deaths of the uninsured poor is that this population’s health problems are often buried by a misguided focus on America’s failed drug war. For over three decades,  jails and prisons have increasingly been relied upon to provide care to chronically ill citizens with complex and dangerous health histories.  This problem of relying on jails and prisons as a kind of de facto health service provider for the chronically ill poor, has reached the point of crisis for a very straightforward reason:  millions of impoverished, uninsured people with horrible health histories have been swept up in the dramatically widened net of the drug war’s focus on targeting poor, non-violent drug offenders.

   Dying Inside   Two of the most lethal epidemics plaguing the nation’s carceral institutions are Hepatitis C and HIV/AIDS.  First, a myth needs to be dispelled:  The majority of prisoners do not become infected with these diseases while behind bars.  According to official statistics the overwhelming majority of prisoners are already infected upon incarceration; many are intravenous drug users who infected themselves and because of lack of care only find out about their disease after their incarceration.  In the next sections, I want to tell you a little bit about a book I’ve just written about these issues called Dying Inside:  The HIV/AIDS Ward at Limestone Prison. 


      Drawing on numerous interviews and archival sources, Dying Inside brings the reader face-to-face with the nightmarish conditions inside Limestone Prison’s Dorm 16—the segregated HIV ward. Here patients chained to beds share their space with insects and vermin in the filthy, drafty rooms; while contagious diseases spread like wildfire through a population with untreated—or poorly managed at best—HIV. 

      The book’s central argument is that while Dorm 16 is a particularly horrific human rights tragedy, it is also a symptom of a disease afflicting the entire U.S. prison system. In recent decades, prison populations have exploded as Americans made mass incarceration the solution to crime, drugs, and other social problems. Doing this even as privatization of prison services, especially health care, resulted in an overcrowded, under funded system in which the most marginalized members of our society slowly wither from what I call “lethal abandonment.”


      The book documents how a growing majority of jails and prisons in the U.S. manage health catastrophes behind bars by doing prisoner health care on the cheap; outside prison health care contractors have been a convenient way to do this.  These companies focus on cutting costs by ensuring that legal liabilities are met at the absolute minimum of standards imposed by courts. Jails and prisons are first and foremost organized to manage and control risk. In this way, regardless of health status, all incarcerated individuals are prisoners first and patients at an often distant second.


      The result has been a deadly human rights crisis, but not one at the hands of any one set of “villains” or “bad apples” working inside carceral institutions.  Instead, through a careful institutional analysis, Dying Inside demonstrates how medical catastrophes in the nation’s prisons occur at a systemic level. Prisons and jails today are overwhelmed by prisoners with multiple illnesses who need comprehensive care. They routinely lack sufficient record keeping on prisoner medical histories and a stable health care workforce the turnover rate for prison health employees is very high). The result is what the author calls the creation of catastrophic institutions in which exorbitant numbers of chronically ill prisoners needlessly die in secret.

      Drawing on numerous empirical studies of failing health care systems for the uninsured in the United States, Dying Inside makes a compelling case that the prison’s focus on cost savings and profit over care is mirrored in the nation’s health care system more broadly.  By viewing the health care crisis through the lens of the prison it becomes especially clear how dramatic reductions in incarceration rates and the creation of a system of comprehensive health care in the U.S., for both privileged and poor alike, will go a long way in turning the corner to a more humane future.


      In short, our obsession with crime has blinded us to the consequences of extreme punitiveness, gross overcrowding, and systemic meltdown inside our nation’s overburdened carceral institutions.  It is high time that we face these facts and start seeing carceral institutions for what they should be: places to hold only society’s most violent and dangerous offenders.  The overwhelming majority of chronically ill prisoners are currently incarcerated for crimes that do not fit that description and will thus be far better served by well funded community health clinics and a comprehensive and aggressive public health approach.  I hope whoever the next president might be will seriously re-consider the dangers of a simplistic, “nail ‘em and jail ‘em” approach to drugs and drug-related petty crime and start to look at the problem as one of untreated addiction, mental illness, and a malign neglect to provide proper health care to all Americans regardless of socioeconomic status. 

Click here for more info on DYING INSIDE:


















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