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Prison Reform: Health Care in Alabama's Prisons

Alabama’s prison system has been in the news a lot this year, and not for good reasons. Violence, inmate riots, allegations of mismanagement and corruption and a failed prison building plan in the state legislature have all pointed out plenty of problems.

The Alabama Public Radio news team spent several months in a national award-winning effort examining what happens as people go into the state’s prison system and what happens when they come out.

Today, APR’s Alex AuBuchon looks at the quality of prison health care in Alabama and examines a large federal lawsuit challenging whether inmates receive the minimum care guaranteed in the Constitution.

“It hurts. He was my best friend…”

Eryka Fykes is talking about her father Phillip Anderson. She’s his youngest daughter. Anderson was arrested in Tuscaloosa in early February last year. Prosecutors say he missed a child support hearing. A week later, he was dead.

“We went down thinking he was fine, because the chief told us he was fine.”

That’s Kimberly Coats, Anderson’s sister.

“And we went to the hospital, and that’s when the doctors told us he had passed away.”

Coats says jail officials didn’t call her to say there was trouble. Anderson’s fellow inmates saw him unconscious, took his cell phone, and called the family.

"His screams were not only ignored and rejected, he was belittled. He was called a faker and a malingerer."

Attorney David Schoen is representing the Anderson family in a lawsuit. He alleges the staff at the Tuscaloosa County Jail sat and watched Anderson as he screamed in pain from a bleeding ulcer. When he finally received medical attention, it was too late.

Anderson is not alone in Alabama.

“Guys have died in lockup, beating on their door. Seriously.”

Abdullah Mumin now lives in Tuscaloosa. He spent 28 years in Alabama prisons across the state.

“You have guys trying to get this guard's attention in this cubicle, trying to get him to see what's up, and they up in there laughing or playing on their phone, and you die in your cell because this guard didn't want to open their door or because he felt you was making noise, you was keeping up a fuss. But you was only trying to get somebody there because you was dealing with an issue.”

The Southern Poverty Law Center and the Alabama Disabilities Advocacy Program are among the groups suing the Alabama Department of Corrections over inmate health care. Richard Cohen of the SPLC says he wants specific things…

“First: Ensure that people who are behind bars get a basic level of care, as the Supreme Court says that they must. Second, we hope that our lawsuit encourages the state to continue to reduce its unconscionably high levels of incarceration.”

Cohen says the overcrowding in Alabama’s prisons is one of the main reasons behind the inadequate care for inmates.

“As a result, prisoners are dying, prisoners with serious mental health problems are killing themselves... The state has an obligation to provide a basic minimum of care, and that's what it's not doing.”

Jefferson Dunn is the Commissioner of the Alabama Department of Corrections. He agrees that overcrowding is a major issue when it comes to providing medical care.

“The medical facilities, the clinics were designed for a system to hold about 13,800 inmates, and right now we’ve got 24,000 inmates in that system. So the physical facilities to provide medical care are not adequate. So that creates challenges.”

But Dunn says he thinks the care they provide is adequate.

“We have a requirement, and it’s one that we take very, very seriously, to address and meet the medical needs of our inmates. We handle the entire gamut that you can imagine, from very routine all the way up to some of the most serious medical trauma, emergency… And this particular population, as a group, tends not to be as healthy as an average population that’s not within the system… So yes, I do think they are receiving adequate medical care.”

Alongside the lawsuit, the Southern Poverty Law Center released a report in June 2014 titled Cruel Confinement. It details their investigation into the medical and mental health offerings in Alabama’s state prisons.

Maria Morris is the lead prosecutor on the case for the SPLC. She says one of the most striking things from the report was the way the Alabama Department of Corrections has handled infectious disease outbreaks.

“There is no one responsible for infection control in most facilities, and one of the things we see as a result is an extraordinarily high level of tuberculosis...”

Morris says one tuberculosis outbreak lasted for five years.

“They had an outbreak of tuberculosis at Donaldson in 2010. And you can track strains of tuberculosis, and the outbreak that occurred in 2010 at Donaldson was still going on at different prisons in 2015, which means that they were unable to eradicate that particular outbreak of tuberculosis. And that's an extraordinarily long time for any outbreak to last in a prison system.”

Morris is referring to the Donaldson Correctional Facility just west of Birmingham. Alabama DOC Commissioner Dunn says there are protocols in place to keep infections from spreading.

“We have the ability to either restrict the movement of various populations or even to, to use prison terminology, to lock down a facility and kind of quarantine it if we had to, to make sure there’s not any additional spread of an infectious disease.”

But Morris says it’s extremely common – and it’s not just obvious culprits like tuberculosis.

“Large numbers of outbreaks of other things like scabies. There was a point a couple of years ago when one third of the population of the Ventress facility had scabies. And just a month before that was determined; ADOC had been saying 'No, no, no one has scabies. Everybody just has a rash.'”

Caring for mentally ill inmates is another key element of the lawsuit and another sore spot in Alabama’s prisons. ADOC Commissioner Dunn says it’s a major priority.

“We have a very strong focus on mental health care. We have an entire staff of mental health professionals, from counselors all the way up to psychiatrists. We do residential treatment in a couple of our facilities.”

But Maria Morris says it’s a lack of mental health staff that leads to most of the problems with care.

“At St. Clair, where there are usually between 6 and 9 men on involuntary medications – which is a pretty serious thing to do to someone, to say 'You're so severely mentally ill that we're going to medicate you against your wishes.' – They don't have a psychiatrist on staff there. They have only a certified registered nurse practitioner.”

Because there are so few mental health professionals on staff with the Department of Corrections, the caseloads get overwhelming. Morris says it’s the patients who suffer.

“Some of them have caseloads of over 200 people. And they all, as a result, the counseling that they provide is really much more of a check-in. It's 5 or 10 minutes a month for people who have schizophrenia, saying 'How are you doing? Are you doing OK on your meds? Everything good? OK.' And that's really pretty much it. As one of our clients likes to say, 'It's just Hi and Goodbye.'”

But former prisoner Abdullah Mumin says you may not even get that.

“They're in lockup. So that means that, for them to see a psychiatrist, they got to have an appointment scheduled, so they gonna handcuff and shackle you and take you up here to the front office to have a sit-down and talk. But sometimes they don't even do that. They're lying. They will send you the paperwork as if you had this interview, letting you know that this is what you've improved, blah blah blah, so it's notated, saying that you've seen the psychiatrist for the month. But you never did.”

The lack of staff prompted U.S. District Judge Myron Thompson to grant class action status to the mental health portion of the lawsuit. Thompson says mental health professionals knew and communicated a need for additional staff to provide adequate care. But the Department of Corrections refused to provide funding, saying they didn’t have the resources.

Thompson says that constitutes “deliberate indifference.” Morris says that means conditions for mentally ill inmates are bleak.

“Particularly at Donaldson, we got a lot of reports from people that they get a group counseling session maybe once every two weeks or so. They almost never get pulled out of their cell for individual one-on-one counseling. They don't get to go outside. They're just sitting in a cell, and they're not getting any mental health treatment, or minimal mental health treatment. And they're just in those cells for months or years. And that's not going to make them any healthier.”

When asked to comment directly on the case, DOC Commissioner Dunn declined.

“We don’t comment on ongoing litigation. The judicial process needs to work itself out, and we just want to be as respectful of that process as we can as we work out these issues.”

The health and mental health portions of the case will go to trial on December 5. But one facet of the case has already been decided. Judge Thompson issued his final approval in September to an agreement between the Alabama Department of Corrections and the Alabama Disabilities Advocacy Program to change the way disabled inmates are housed and treated in state prisons.

“So, for example, if you say ‘How many people who use a wheelchair are in DOC custody?’ We allege they didn’t know that answer.”

J. Patrick Hackney is the legal director for the program. He says in the past, the Alabama Department of Corrections didn’t have a method to identify or quantify disabled inmates.

“And so one of the provisions of the settlement agreement sets out mechanisms whereby they can, they have a process by which they identify folks with disabilities, and then as they transfer from facility to facility, that information is shared between facilities so that the person can get the services that they need.”

Hackney says that makes a big difference in the quality of life of disabled inmates.

“Everybody at the first prison they were at may have known they had a hearing impairment, known not to come up from behind the guy, or he can’t hear you when you’re standing behind him talking to him. And when you’re moved to another prison, it’s like you’ve got to go through that whole process again and there’s no information shared between facilities.”

Under the agreement, the Alabama Department of Corrections will have nearly 3 years to make their dorms and other prison facilities more accessible to inmates with disabilities. They’ll also be redesigning classes and rehabilitation programs to allow disabled inmates to participate.

But, as Hackney says,

“This is a huge case. I mean, all three parts of it are a really large case.”

It’s unclear how Judge Thompson will rule in terms of health and mental health care in Alabama’s prisons. One thing’s for sure, though. If you find yourself in the custody of the Alabama Department of Corrections, it might be a good idea not to get sick.

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