incarcerated elders: a looming health care crisis on death row
The percentage of death-row prisoners 50+ has more than doubled. Prisons are ill-prepared to service and manage the health care concerns for elderly inmates, Friday long read from The Intercept
We go to The Intercept for this week's long listen by Jacob Biba and Lyle C. May. Read the whole story, “The Geriatric Ward: North Carolina’s Aging Death Row Population Faces Looming Health Care Crisis.” We include key excerpts below to convince you it’s worth your time.
Aging Behind Bars
When Rayford Burke, 63, lost his appetite in January, he knew something was wrong. Cases of Covid-19 had just reached a record high in North Carolina, though death row, where Burke has been incarcerated since 1993, had been spared due to its relative isolation. But it wasn’t long before Burke heard rumblings that the coronavirus was infecting people in his pod, so he started double masking and conducting his own rudimentary Covid tests, mixing a few drops of perfume oil with his lotion and every so often taking a whiff.
Burke’s loss of appetite wasn’t accompanied by a loss of taste or smell, and it closely matched a bad reaction he had two years earlier to hydrochlorothiazide, a blood pressure medication that so severely dehydrated him that he was taken by ambulance to an outside hospital for treatment. That’s what was happening again, he thought, as his lack of appetite led to weight loss and an even greater concern about his health. By the time he put in a sick call with prison staff in February, Burke estimates that he had lost between 30 and 40 pounds, down from his normal 285 or 290. He had also tested positive for Covid, as had 15 other people in his pod, he said.
“When I first tried to get them to take me to the doctor, I was so dehydrated, I couldn’t eat, couldn’t drink,” Burke told The Intercept. “I’d drink water and regurgitate it — I’d throw it back up. I’d take a bite of food — I’d throw it back up. And so I told them that. They wouldn’t do anything. They kept saying, ‘Well, we’re gonna do this. We’re gonna do that. We’re gonna get you to see somebody.’ About three days passed.”
Burke filed a grievance, and the next day he was taken to the emergency room at the prison hospital and placed on an IV. He regained his appetite a few days later and was sent back to isolate with his pod as Covid ran its course on death row. Given the circumstances, Burke was very lucky — but he’s worried that his luck will eventually run out.
Nearly two-thirds of the 135 people on death row in North Carolina, including Burke, are over the age of 50, which the state defines as “elderly.” Based on current trends, within the next 10 years, approximately 90 percent of people on death row will be considered elderly. Many have from chronic diseases and conditions such as high blood pressure, diabetes, cancer, and hepatitis C. With the passage of time, death row, in many ways, is transforming into an informal geriatric unit — one that has proved wholly unprepared to care for its aging population.
Marred by chronic understaffing; a slow, and sometimes ignored, sick-call process; a copay system that discourages people from seeking care; a utilization management program that must approve requests for specialized medical care; and the stalled implementation of a caretaker program that would teach incarcerated people how to effectively provide palliative care to their peers, the looming geriatric health care crisis on North Carolina’s death row provides a stark and dire warning for what lies ahead, especially when it comes to the economic and societal costs of incarcerating older people. North Carolina’s Department of Public Safety, or DPS, did not answer The Intercept’s questions related to medical care within the state prison system.
By the end of 2019, more than 21 percent of people incarcerated in state or federal prisons across the U.S. were age 50 or older, according to statistics from the U.S. Department of Justice. But death row is where the concentration of older people is highest: That same year, nearly 55 percent of people on death row in the U.S. were age 50 or older. Among state corrections departments, there’s no uniform definition as to what constitutes an “elderly,” “older,” or “aging” incarcerated person, though 50 or 55 are often used.
To receive medical care — whether for an emergency or a routine physical or chronic care appointment — incarcerated people in North Carolina’s prisons must submit a sick call describing their need. Typically, a nurse sees the person within a week to screen them and take vitals. If the problem warrants being seen by a doctor, a nurse makes a note of it. Seeing a doctor takes two to three weeks. If a medical issue requires specialty care, it can take a month or more. Medications, X-rays, and lab tests usually occur within a week after that. As a result, it may take six weeks after submitting a sick call to receive treatment, which requires a $5 co-pay.
Requests for specialized treatment go through the utilization management program, which continues to make crucial medical determinations with an eye on cost, deciding who receives surgery for an ACL tear or ibuprofen and an ice pack, or nothing at all, with little recourse if a claim is denied.
DPS is required to conduct a physical on all incarcerated individuals 50 or older at least once a year, but just over half of 31 older people on death row informally surveyed by The Intercept said they had received a complete checkup within the last year. Only four of 17 people who said they needed treatment for chronic diseases — such as hypertension, diabetes, HIV, or sarcoidosis — reported being seen by a chronic care doctor in the last year.
This limited access to medical care will likely lead to suffering or premature death for many people on death row and serving life without parole, Baumgartner said.
“Our options are either paying for the kind of medical care that people deserve just as a human right or warehouse people until they die of old age after terrible suffering, forgotten, thrown away in a box without adequate medical care,” he said. “Is that the country we want to be?
Read the whole article here.
Resources: State policy changes. News. Bureau of Prisons updates. State court changes. Prison holistic self care and protection. Jailhouse Lawyers Handbook.
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