All we had was this empty hall spot. The 4-foot barrier separating the gurneys from the computer workstations had a few opened apple juice containers on top of it from the previous patient. I grabbed them and tossed them in the trash and listened to the Emergency Medical Services providers.
A paramedic chortled, “I guess he thought it was a good idea to just hit his head against the hood of the police car. It got him sent here instead of right to jail.”
Credit: Handout
Credit: Handout
“Was he in a fight or something before that too?” I interjected. “Like, is this his only injury?”
“No. Just trespassing and then he decides to go all crazy on the officers.”
The cut on his head couldn’t have been more than 2 inches, but its star-shaped pattern was mostly obscured by dried blood. In silence, he nodded his head affirming that he’d done this to himself and he confirmed that was not actually suicidal.
The real question was why this disheveled man was so seemingly unstable that he thought it a good idea to concoct an injury. Was bashing his own skull his best option?
Maybe he got an advance copy of the Justice Department’s recent findings on Georgia Department Corrections facilities and acted accordingly.
As an internist and emergency room physician in one of the busiest emergency rooms in the country, I bear witness to the consequences of our carceral system. During almost every shift, I treat mental health emergencies, help people newly released without medications through their next steps, treat the injuries of those detained by law enforcement from the scene of accidents and sometimes meet people like this man who are willing to risk bodily harm to avoid the Georgia carceral system.
In this country, jails are supposed to be a deterrent in and of themselves, so the U.S. carceral system is not designed to be the happiest place on Earth. More implicit is their function for rehabilitation and reintegration into society.
Assuredly though, these places should operate in compliance with the Eighth Amendment. The Justice Department’s yearslong investigation into abuses surrounding LGBTQ+ inmates (the investigation eventually expanded to all incarcerated people) found shortcomings and willful ignorance of inmate safety that could amount to ‘cruel and unusual punishment.’
The October report described poor conditions, preventable sexual violence to inmates particularly of the LGBTQ+ community and opaque incident reporting procedures. The irony that the report was released during LGBTQ+ history month was not lost on many.
Unfortunately, the Georgia Department of Corrections has responded to this federal report with defensiveness and whataboutisms. With so many places for improvement in this carceral system, it’s hard to pick one issue, but the least helpful response is to maintain the current state.
The DOJ investigation included findings from visits to about half the state’s prisons and hundreds of interviews over nearly eight years. The 98-page report documented sexual abuse, violence to and between inmates and a seemingly willful neglect of these dangers to the inmates.
This publicly available document might be the first look at the underbelly of our correctional system for some, but for those of us working in acute care outside of the facilities, these stories are unsurprising. These macabre stories of prison violence with improvised weapons pass through the communities with the fewest resources as cautionary tales.
Often, these stories conclude in hospital emergency departments, where we learn of them as well.
After a while, though, walking out of the trauma bay and simply shrugging shoulders becomes easier than shouting into the abyss of public opinion. Likewise, the shoulder-shrugging Department of Corrections response and subsequent resignation to the status quo is seductive in its simplicity.
Because are not these humans facing the consequences of their own bad choices? Are not the people working in these facilities doing their best in the current situation?
But the need for change is not mutually exclusive to appreciating the efforts of the people already in the system trying to improve it. Unfortunately, the climate of discourse around government institutions has prevented this nuance from being appreciated.
More than a billion dollars of Georgians’ tax bill goes to the Department of Corrections for the 800 people per 100,000 incarcerated in our prisons. This incarceration rate is higher than that of Russia and Rwanda, but this situation is our own in Georgia. The problems that have arisen are ours to solve.
Of course, no one should think that the solutions are easy. Likely, they’ll be incremental and, with hope, pragmatic. But Georgians are the people to fix it.
One element of truth from the Department of Corrections’ response is that the federal supervisor suggested by the Department of Justice usually does not prove to be useful. In this solution, the state-run Department of Corrections would cede operational control to a federal authority. This idea did not work for the Fulton County Jail system, which ended its supervision program recently.
That doesn’t invalidate the findings though. It doesn’t negate those of us who are left to repair the broken people these facilities release without medications or a path to health insurance. It doesn’t erase the emergency visits from seriously injured people who, by virtue of not dying from their injury, are churned through this hospital-prison-hospital cycle.
Perhaps abolishing exorbitant copays for mere doctor visits would be part of the fix. Perhaps providing evidence-based treatment for addiction would curb the illicit drug trade and gang activity. Perhaps a mandate to arrange health care upon release can prevent some recidivism for these people when they are trying to rebuild their lives.
Because before release, there was a person being held hostage by a cellmate. Before getting transferred to a decrepit facility, there was a person waiting nearly a month to be formally charged with a crime.
Before that charge, there was an overworked public defender who wants to spend more than just a few moments with each client. Before those moments with the public defender, there was a man who didn’t have $500 for bail and didn’t have an option better than a guilty plea.
Perhaps before that, there was an injured fellow citizen in the emergency department in front of me with a star-shaped cut on his forehead that we used a few inches of nylon stitches to close.
We all are only a few innocuous decisions away from the horrors described in the DOJ report. Perhaps selfishly, we could work to improve these facilities and system with the fear that we could end up there.
But before we solve this problem, we have to accept the reality that there is a problem.
Anwar Osborne is an internist and emergency department physician in Atlanta.
About the Author
