Robert Johannes, a 73 year old man, is currently incarcerated in Michigan. His attorney, Daniel E. Manville, contends that inadequate access to dental care has left Johannes missing teeth for extended periods of time and unable to eat. As Michigan Live reported, “The lawsuit claims that Johannes has had several teeth removed, including three bicuspids and two molars, since entering prison and that he requires dentures or partials to be able to chew foods.”
Michael Levy, an inmate at Arizona State Prison, arguably faced even worse neglect from prison healthcare providers. After 15 days of headaches and chest pains, he was only given ibuprofen. Fourteen days later he complained that these symptoms persisted in excruciating ways, and requested an MRI. Officials ignored the request, and he continued to file requests over several months. Eventually, Levy experienced an aneurysm and a stroke. According to Tucson News 4, “Doctors recommended the inmate do aggressive physical therapy, but Levy’s health care provider Corizon stepped in. … Corizon denied his rehab with St. Joseph Hospital and Medical Center in Phoenix ‘due to the cost of rehab.'”
These recent incidents of prison healthcare neglect are not unique. In her book Resistance Behind Bars, Victoria Law describes the case of Michelle Everett, a prisoner in Oregon who repeatedly requested medical care but was ignored. “She was given medical attention only after turning yellow,” Law writes. “After both hepatitis and cirrhosis of the liver were ruled out, she was told that a bile duct was obstructed, but that the prison could do nothing about it.”
For-profit companies often contract with prisons to provide healthcare. Yet their incentives differ substantially from what we would see from healthcare providers in a free market. While these companies are cost-sensitive due to the impact of costs on their profits, their clients are not prisoners, but the state. These contractors have a state-secured monopoly within the prison, so prisoners are not free to seek services from competing firms. These incentives predictably produce abysmal care. Victoria Law describes two companies that engaged in particularly egregious forms of neglect. One is Prison Health Services (PHS). Writes Law:
A yearlong investigation by the New York Times found that the care provided by PHS was often deficient, flawed, and/or lethal. According to the Times, state investigators scrutinizing ten prisoner deaths came to the same conclusions after finding the same circumstances in each case: to cut expenses, PHS trimmed medical staffs, hired underqualified doctors, had nurses doing tasks beyond their training and withheld prescription drugs. The investigators also found that PHS allowed patient records remain unread and employee misconduct to go unpunished.
Similar neglect has been perpetrated by Correctional Medical Services (CMS). “An investigative article in Harper’s revealed that CMS stymies those seeking treatment for hepatitis C, requiring them to fulfill a long list of conditions, known as ‘the protocol pathway,’ before they can receive any care,” writes Law. This reprehensible behavior is predictable given the incentives prison medical contractors are given.
Problems in prison and jail healthcare are systemic. Prison healthcare services are often understaffed. Moreover, prison is characterized by cruel, austere, and punitive conditions, such as hard and uncomfortable beds and inadequate or unappetizing food rations. The only way to get more bedding or better food is typically a medical exemption, which means that understaffed medical services find themselves swamped with inmates who are simply seeking better accommodations. This makes it harder to detect serious medical issues and respond to them in time.
The mentally ill, the poor, drug users, and sex workers all face increased risks of health problems. Yet our society warehouses members of these groups in institutions where healthcare access is systematically denied. Problems with prison healthcare are not isolated incidents; they’re signs of a structural problem.