Access to health care for incarcerated individuals has deteriorated as a result of restrictions imposed to prevent the spread of COVID-19 behind bars, according to correctional health experts and prisoner advocates.
With many prisons and jails adopting strict lockdown policies, in some cases quarantining individuals in solitary cells, regular checkups and tests for inmates with non-COVID health issues have been cut back or cancelled, and some outside medical providers have refused to enter the facilities, a webinar was told last week.
“A lot of people [have had their] regular preventative care delayed or stopped,” said Su Ming Yeh, executive director of the Pennsylvania Institutional Law Project.
“That can be really devastating, because we know prevention is vital in medical care issues.”
In one example Yeh provided, one of her clients who was scheduled to get regular CAT scans every six months had missed his appointment because of the pandemic and “was in a lot of pain.”
Yeh was speaking on the second day of a webinar examining criminal justice challenges in Pennsylvania’s justice system.
Her remarks were echoed by Thomas Weber, CEO of PrimeCare Medical Inc., which provides correctional health services in 80 facilities across five states, who said there was a “reluctance” from outside medical specialists to enter prison facilities because of the risk of COVID.
“We provide primary care, but if someone needs orthopedic or obstetric help, we rely on community providers to work with us to provide that care,” he said. “And we found out that a number of providers weren’t seeing patients or would require negative (coronavirus) tests before they would see someone.”
Dr. David Thomas, a correctional medicine specialist who has worked with the Florida Department of Corrections, said that even primary care doctors and nurses inside prison facilities are faced with a “Catch 22” because of COVID-era restrictions that bar inmates from going to clinics or sick bay where they might be at risk of exposure.
“You try and reduce movement (by sending) your medical staff to the individual, but then it’s very, very difficult to provide the same kind of environment you have in a medical unit,” he said.
“This disease has created a situation where it’s virtually impossible to address (those issues) safely.”
In many facilities across the U.S., prison authorities were slow in addressing the threat of coronavirus to both inmates and staff, despite evidence showing how quickly the coronavirus can spread in confined environments.
Testing is now widespread in federal and state correctional systems, as well as requirements to wear masks. At the same time, incarcerated populations have been reduced as a result of court orders. But some measures instituted by facilities, such as ending work release programs, stopping family visits and confining COVID-positive inmates to solitary cells pose additional threats to the mental health of inmates.
“Courts have worked really hard to keep populations down, but some [facilities] relied on what we think are really severe and in some ways punitive lockdowns,” said Yeh. “You might be in a cell for 23 hours, getting out only to use the shower, or call friends and family.
“Once you go beyond a certain time, these conditions are [harmful] to a person’s wellbeing.”
The webinar heard warnings that facilities might begin to relax testing and other restrictions if they followed the lead of a few politicians or authorities who maintained the danger of the pandemic was easing.
“This is not going to go away any time soon,” said Weber.
“I think the most overriding difficulty we’ve had, and this is one that affects not just corrections health care but community health care is the lack of clear guidance on a national level.”
Weber said many communities felt free to ignore many of the guidelines proposed by the Centers for Disease Control and Prevention and the World Health Organization, and that attitude spilled over into the administration of county and municipal jails.
Weber said, “there has not been buy-in” from all communities about health recommendations such as mask-wearing and social-distancing, and this has resulted in a ”fragmented approach” to the pandemic in many rural and smaller detention facilities.
“Depending on the political persuasion of the particular jurisdictional area, we will have different viewpoints as to how to handle [the pandemic].”
Weber suggested that the key lesson to be learned from the spread of a COVID through the nation’s prisons was that many of those currently incarcerated have underlying health issues that could be treated outside of the correctional system.
“I think we need to explore the alternatives to incarceration to keep the population down as much as we can,” he said, noting that although some individuals do need to be locked up, many could be better served by expanding community health services in areas of mental health, and substance abuse.
“There are far too many people coming into the facilities as a result of suffering and illness as opposed to committing a crime,” he said.
Dr. Thomas noted that while medical care is constitutionally required in a correctional system, the system is “not built around it.”
“Any other place a physician or nurse works is designed for that, like hospitals, but corrections is designed for the custody and control of inmates and detainees,” he said.
“The bottom line is that the correctional staff run the system.”
The webinar was the latest in a series of regional justice workshops for journalists organized by the Center on Media, Crime and Justice at John Jay College. The event was co-hosted by the Quattrone Center for the Fair Administration of Justice at the University of Pennsylvania Carey Law School, and supported by the Charles Koch Foundation.
The previous webinar session can be accessed here.