This is especially important for the large proportion of aging people in New York State prisons who are more likely to have higher healthcare needs, and at the same time, be less familiar with an evolving healthcare landscape. More than 10, people aged 50 or older are currently incarcerated in New York, according to the latest available data.
Even as the total prison population in this state has gradually decreased, the number of individuals in this older adult category has jumped by 46 percent.
We support these efforts — prisons are not well suited to handle the complex and expensive healthcare needs of older adults, and are simply not humane institutions to house aging people. In addition to securing release for these individuals, it is imperative that state and local officials take steps to bolster the quality and range of healthcare services to meet their unique needs.
Currently, in New York City there is a broad slate of programs and services for older New Yorkers, and a growing network of re-entry resources, but very little overlap between the two. Older adults endure unique hardships in prisons and jails, as the facilities and staff are not adequately equipped to support them.
Crucially, family members and others in the home and community who would traditionally serve as caretakers are prevented from doing so. Likewise, few community-based organizations that serve older New Yorkers specialize in meeting the needs of returning citizens. In sum, dedicating adequate study and resources to address shortcomings in service provision at the intersection of aging and reentry will become increasingly urgent in the coming years.
Parole also has a role to play in continuity of care. Barring certain exceptional cases, our clients report that parole officers have adopted an increasingly punitive orientation over the years, and they do little to assist them to navigate the healthcare system after they arrive home. Because parole offices are situated locally, they are better positioned than upstate prisons to assist people to access care in their communities.
In addition to making information about area providers available, parole officers should take initiative to build relationships with health-home networks and help returning citizens resolve bureaucratic issues with Medicaid and other agencies. When used properly, EMRs have potential to assist healthcare management identify and resolve problems, balance staffing with demand, and deliver evidence-based care. In the case of individual patients, those who transfer or reenter a facility are less likely to experience serious lapses in care, and schedulers can be alerted when chronic care follow-up deadlines are missed or specialty care is delayed.
At the system-wide level, EMRs can help identify trends, bolster quality improvement, and improve transparency regarding health outcomes. In order for a person to receive transition-related medication they will first need a diagnosis of Gender Dysphoria. This can be problematic to many people who do not have access to safe and affordable healthcare in the community prior to arrest and will only delay their necessary treatment once detained.
Transgender clients frequently report delays in accessing sick call and scheduling an appointment for a diagnosis evaluation. It is important to note that those who do need medical treatment related to their transition often do not receive consistent treatment. Doctors recommend changing sanitary napkins or tampons every four to eight hours to prevent bacterial and fungal infections that may lead to serious health problems.
All women who are incarcerated should have access to feminine hygiene products in sufficient quantities to meet their individual needs. According to a recent survey by the Correctional Association, 54 percent of respondents in New York prisons said they did not get enough sanitary napkins each month. This is consistent with the experience of our attorneys and social workers supporting our clients detained at Rikers. Some clients tell us that they are given only 12 sanitary napkins at a time.
In other blocks, pads are left out in a bucket or box in the bathroom.
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This supply is sometimes insufficient for women with heavier flows. Women without a sufficient supply must then request additional napkins from guards, who often use the request as a way to control women and assert their authority over her. Our clients tell us that they have to beg officers for more free pads only to be treated with disrespect that make them feel ashamed. Furthermore, the free napkins provided at Rikers are of very poor quality and most of our clients will go to great lengths to purchase name brand napkins from the Commissary.
Our clients report that the free napkins are not properly absorbent and thus easily lead to staining of their uniforms. Renee, a year-old BDS client, spent nine months detained on Rikers. She asked her BDS social worker not to visit her while she was on her period because she was worried about leaking through her uniform and having to walk the halls of the jail with a bloodstain. Renee had to choose between the shame of leaking blood while on her period and meeting with her legal team.
Renee comes from a low-income family and worked overtime in the jail to pay for her basic needs including deodorant, soap and sanitary napkins. She shared that she did not have enough sanitary napkins and she would try to wear the same napkin for as long as possible to ration the supply she was able to purchase from the Commissary because the free pads were of such low quality.
Many of our female clients have a history of physical and sexual abuse prior to incarceration. For many of these women, their trauma has never been processed. It is essential for medical staff to be trained on how to treat women with a history of trauma because pelvic and breast exams can be re-traumatizing. In addition, women should be allowed to choose female doctors for gynecological care. At the Rose M. Singer Center, the female facility on Rikers Island, many of our female clients have reported feeling unsafe visiting a male doctor.
This becomes a barrier and our clients will not seek medical attention, even during urgent and critical situations due to the fear of being assessed by a male staffer. Unfortunately, our client waited several months to hear if she had been approved to the nursery and was sent to the General Population Unit at Bedford Hills upon transfer. Our client had a high risk pregnancy and needed a setting that would allow a stable and orderly environment.
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Being in General Population only increased her stress levels, putting her unborn child at greater risk. It is important for there to be a streamlined process for expecting mothers in our jails, awaiting transfer to a state facility, so there is no gap in care or appropriate housing. We urge an end to the use of private healthcare contractors in correctional facilities across New York.
It is too early to assess the full impact of the change; however, certain improvements are apparent. More generally, we believe there are several strong arguments for replacing private companies who are primarily concerned with their bottom line, with mission-driven and public health oriented providers. The most obvious concern is that private companies will aim to cut costs by providing substandard care. After many years with Corizon in New York City jails, we believe this is a legitimate concern. Moreover, it is our experience that the contracting relationship with for-profit companies only exacerbates issues of dual loyalty.
When healthcare providers feel beholden to corrections officials to retain their contracts, managers and line-staff alike are less willing to raise objections in the face of abuse or neglect.
Guess who's really paying for New York inmates to use tablets? Their families
Furthermore, utilizing private companies only deepens the challenge to recruit qualified and enthusiastic providers to work in correctional settings. It is unlikely that young healthcare professionals, eager to contribute to health justice, will be inspired join a private company with misaligned values.
On the other hand, public health systems or mission-driven non-profits may attract more talent. As mass incarceration continues to garner the widespread attention across the country, it should be possible to recruit passionate healthcare providers to work in prisons in much the same way humanitarian organizations recruit doctors to treat patients in warzones and refugee camps.
To close, I would like to address the issue of solitary confinement; as this practice represents the coalescence of all the issues discussed already and is of grave concern to our office. As you probably already know, solitary confinement entails locking a person in a cell hours per day, with one hour of recreation alone in what amounts to a slightly larger cell. The health impacts of solitary confinement are significant and well documented. Physiological conditions brought on by solitary confinement include gastrointestinal and urinary issues, deterioration of eyesight, lethargy, chronic exhaustion, headaches and heart palpitations among others.
Scientific and legal understandings of the harm of solitary confinement are not new. Stuart Grassian identified what has been called SHU Syndrome, which includes the aforementioned symptoms. A study revealed that people subjected to solitary confinement in New York City jails were 6. Nevertheless, New York State prisons hold a disturbing number of people in solitary confinement, at a much higher rate than the national average with more subjected to the practice in county jails across the state. Contrary to clear direction from the National Commission on Correctional Health, [20] healthcare staff in prisons and jails are generally complicit in subjecting people to the harms of solitary confinement.
Worse, healthcare staff are too often complicit in cases where solitary is clearly being used to cover up brutality. Once someone is placed in solitary confinement, the problems with access to care are exacerbated. Officers have even more control over access to sick call, and securing escorts from high security units to appointments is increasingly difficult. These units were intended to protect people with serious mental illness from the harms of solitary confinement under the SHU Exclusion Law.
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Instead people in RMHU were subjected to the same kind of punitive isolation without input from mental health staff, and in direct violation of the law. Horrifying accounts of verbal and physical abuse in the unit make the report even more disturbing. It is not only possible, it is absolutely and urgently necessary that we in New York follow suit.
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The New York Times conducted an investigation last year and found Black people to be far more likely to be subject to solitary confinement in New York State prisons, which, in addition to the aforementioned effects, exacerbates disparities in release determinations, as people in SHU are far less likely to be granted parole. We have ample client stories that illustrate the immense and often irreparable harm of solitary confinement, but by now you likely know what happened to Kalief Browder and others like him.
This issue is beyond debate; action to pass HALT is needed now. To improve healthcare in prisons and jails, it is necessary consider the broader context and circumstances that allow for substandard healthcare and outcomes to be the norm. Mary T. Bassett, M. Should we work harder to ensure that black lives matter? The article does not explicitly address healthcare in prisons and jails, or correctional healthcare providers, but the author cites as her inspiration another matter of the criminal legal system: police killings of unarmed Black people — with no legal sanctions — and the public uprisings that followed.
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