In the month of April, an increase in allegations of medical neglect coincided with rising deaths in United States prisons due to COVID-19. 

Videos posted to social media by inmates—via contraband cell phones—revealed conditions unfit to mitigate spread of the virus. At the Fort Dix Federal prison, a video uploaded to Instagram showed a prisoner vomiting during a routine temperature check. In response, correction officers sprayed the inmate with cleaning products before whisking him away. The following video panned across dormitory style sleeping quarters in which bunk beds sit a mere three feet apart. 

In an interview with the Philadelphia Inquirer, Troy Wragg—an epileptic inmate at Fort Dix—worried over his general survival, pandemic or no pandemic. Wragg detailed his nightly experience: “the sounds of my bed shake awake one of my bunk mates—he then jumps down and holds my head to prevent a concussion and monitors me through the episode to make sure I don’t die.” 

The personal account of Wragg conjures forth memories of a not so distant past. Overpopulation coupled by inadequate health care and medical neglect remain a constant in the history of U.S. prisons and serve as a testament to the need for decarceration. 

Prior to the 1970s, the lives of prisoners in the U.S. rested solely in the hands of their neighbors. Prisons frequently tasked inmates with the responsibilities of medical professionals, asking that they perform minor surgeries, dental work (including teeth extractions), prescribe/dispense drugs and operate medical equipment. Prisons that did have medical professionals were still unequipped due to overcrowding and a lack of resources as well as knowledge on mental health. Two cases in Arkansas and Alabama in the 70s stood to alter the trajectory of health care in prisons.

The Holt v. Sarver case revealed widespread medical neglect in Arkansas, a disturbing example found at the Tuckers Prison Farm where a convict doctor tortured inmate patients with a hand-cranked electric generator. In Alabama—where the practice of convict doctors remained prominent—an epileptic patient passed away due to medical neglect. In response to an over pouring of cases such as these, the U.S. Supreme Court characterized prison conditions as “barbarous” and in violation of the 8th Amendment, which prohibits “cruel and unusual punishment.” The ruling known as the Estelle v. Gamble decision made healthcare a right for prisoners, and the American Public Health Association then instituted the first national health care standards for prisons.

Today the U.S. prison population per capita sits as the largest in the world at 2.2 million incarcerated within the industrial prison complex. 

As Angela Y. Davis states in her book “Are Prisons Obsolete?”: “Mass imprisonment generates profits as it devours social wealth, and thus tends to reproduce the very conditions that lead people to prison.” 

Crimes committed by those who enter into the system are often symptoms of social inequities such as poverty and institutionalized racism. This means, many have never received medical care before and suffer for it. “About half of the people incarcerated in state prisons have at least one chronic condition; 10 percent report heart conditions, and 15 percent report asthma, percentages far greater than those for the population at large, even when comparing similar age groups,” write Laura Hawks, MD1,2; Steffie Woolhandler, MD, MPH2,3 and Danny McCormick in their JAMA Medicine Journal article “COVID-19 in Prisons and Jails in the United States.”

To maintain the health of this population and ensure that upon release they do not further burden society, health care guarantees prisoners the right to medical examinations upon entrance and transfer, check-up’s, a primary care provider and if needed a specialist or consultation with local partnering hospitals. Despite this fundamental change, quality of care remains absent and is at odds with internal conditions, which encourage the development and progression of mental health illnesses. 

Suicide numbers in correctional facilities as well as jails have surged in past years, a key example found in Alabama which, in one prison alone, had 15 suicides in the span of 15 months. 

“The risk of suicide is so severe and imminent that the court must redress it immediately,” wrote U.S. District Judge Myron Thompsons in response to this case. “Unless and until ADOC (Alabama Department of Corrections) lives up to its Eighth Amendment obligations, avoidable tragedies will continue.”

Illustration: Sage Mace

Current failures to protect inmates’ rights to the Eighth Amendment match a historical pattern. Overpopulation, overcrowding, and medical neglect killed half of California’s San Quentin population in 1918. In the AIDS/HIV crisis of the 90s, the same shortcoming resulted in three of 10 prison deaths. Now the prison system faces the COVID-19 pandemic, and again the outcome looks dismal.

Felicity Rose, director of research and policy for criminal justice reform at referred to the current response by prisons as one of a “ticking time bomb.” Overcrowding prevails and meters to mitigate lack. 

At the Marion Correctional Institution in Ohio, more than 2,000 of 2,500 inmates have tested positive for COVID-19. At the Federal Correctional Institution Lompoc of Santa Barbara in California, nearly 70 percent of inmates have tested positive. And at the Trousdale Turner Correctional Center, a private prison in Tennessee, 1,299 of 2,444 inmates have tested positive.

The priority solution as proposed by the UN High Commissioner for Human Rights, as well as other prominent figures, is found in decarceration. Frederick Altice, an epidemiologist for the University of Yale, breaks down how this would look: “Several countries, including the USA, have extraordinarily high levels of incarceration. It will certainly be possible to release prisoners and maintain public safety,” Altice told The Lancet earlier this month.

Altice continues to advocate for the diversion of drug offenders to evidence-based treatment programs as an example. “You can take a lot of people out of the system by doing that, and these are people who are at increased risk of comorbidities such as HIV and hepatitis C, so there is an immediate public health benefit.” 

The process of decarceration is a solution to the pandemic, but also one which must continue forward as a strategy of restorative justice.