The following happens more than we would like to think.
“So how long has he been in jail for?” I asked.
I think that the only really acceptable answer from the corrections officers at that time would have been 20 minutes or less, but that was not the response.
I stared across the resuscitation bay at the officers who turned and walked out, passing next to the gurney. I remember the beeping from the portable monitor and the wheeze of the ventilator bag fading down the hallway.
“So, am I the only person here who thinks that this is kinda wrong?” I asked. “I mean, his core temp was 27 (degrees centigrade, or 80 degrees fahrenheit) and he was in a government building for weeks. That (expletive) doesn’t just happen, right?” “How the hell’s he gonna get that cold being inside a jail?”
Luckily, this patient lived.
Credit: contributed
Credit: contributed
Unfortunately, working over a decade in one of the busiest Emergency Departments on the East Coast has given me somewhat of a potty mouth. And even though this happened years ago to a patient of mine, I vividly remember the nauseating feeling that somehow I was complicit in this awful situation.
Bringing back that nausea for me was the tragic death of Lashawn Thompson, who died while an inmate in Fulton County Jail. It further now shows a common situation for emergency medicine physicians. In the role of the social safety net of healthcare, the ED frequently has to interact with other safety nets such as prisons and jails.
In that sense, these entities are somewhat similar, but the reporting of abuse and neglect events varies wildly among these public/private entities that are ostensibly designed for societal benefit.
In the neglect case of Mr. Thompson, the official reporting of this event was handled by the Fulton County Medical Examiner and these results are now public record. What many Atlantans may not know is that neglect cases that do not result in death fail to have the accountability of a separate entity to spur on the types of changes that voters and taxpayers would want.
Obviously, constitutional and legal precedent makes clear that healthcare neglect is a violation of the 8th Amendment of the U.S. Constitution as it meets the standard of “cruel and unusual punishment.”
Reporting neglect of a prisoner who returns to Fulton County jail alive is almost an entirely closed-loop process and, regardless of intent, can manage to avoid the scrutiny of health care providers outside of the carceral system that could be caring for the patient.
To be sure, most would struggle to find a part of the criminal justice system in Atlanta that has no areas for improvement. As such, looking at any one part of it can be overwhelmingly disheartening. But even as we debate about how the taxpayer-funded public safety training center dubbed “Cop City” may or may not be tied to putting more Atlantans in an overcrowded, dilapidated facility, we can probably agree that, once prisoners arrive there, they should be treated with as much humanity as possible in our efforts to rehabilitate them for return to society.
When the opposite of this happens, it results in what sociologists call “Social death.” It refers to people who are not accepted as fully human by society and are thus treated as if they are dead, or nonexistent. This happened to my patient years ago, to Mr. Thompson recently and more often in our carceral facilities than Atlantans would be comfortable considering.
But with all efforts to improve, we can take inventory of things that are in our control and act accordingly. My colleagues and I have put forth a “Healthcare Bill of Rights for Incarcerated Patients” that we have been gaining support for over the past several years. It has the support of several national bodies and is working its way through the American Medical Association’s legislative process.
The commonsense components of this bill are shown here, and are supported both by legal precedent and by high-quality medical evidence. By placing some of the information about the difference between loss of social-legal rights versus rights related to healthcare in the hands of the incarcerated at the point of service, we can help patients and providers advocate in a productive way.
Today, you can call your elected representatives and encourage them to support a Healthcare Bill of Rights for Incarcerated Persons.
As ungenerous a view as we may have about those who disagree with us about police training facilities and the overall value of incarceration, surely we can agree that “Social Death” is not something we would want for persons who find themselves in this system.
Anwar Osborne, M.D., M.P.M., is an associate professor in the department of emergency medicine at Emory University School of Medicine.
A proposed Healthcare Bill of Rights for people in law enforcement custody
Adult detained and incarcerated persons with decision-making capacity have the right to:
1.) Medical neutrality; equal treatment regardless of their status as a detained or incarcerated person.
2.) Speak with their provider privately in cooperation with the accompanying officer with respect to facilitating a safe and secure medical provider and patient care environment.
3.) Removal of physical restraints for the purpose of a physical exam in cooperation with the accompanying officer with respect to facilitating a safe and secure medical provider and patient care environment.
4.) Medical care at a facility that has a protocol for and supports quality analysis of medical care.
5.) Privacy and protection from inquiry regarding charges, conviction, or duration of sentence unless expressly pertinent to delivery of care.
6.) Written informed consent; to be adequately informed of diagnoses, treatment options, risks and alternatives and follow-up plans unless there is an impact to security.
7.) Written refusal of care and diagnostic testing, including nutrition, laboratory studies, medications, and procedures, with the exception of psychoactive medications if the patient is deemed a potential harm to self or others if psychoactive medications are withheld.
8.) Make their health care decisions independently, if deemed to have the decisional capacity, and to appoint an appropriate surrogate medical decision-maker in the event they become incompetent no longer have the decisional capacity. Correctional officers, sheriffs, guards, police officers, prison administrators, and other law enforcement officials are not eligible medical decision-makers.
9.) Communication with their medical decision maker according to state laws regardless of the policies of law enforcement or carceral institutions.
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