CHICAGOIn 2010, the court of the Northern District of Illinois received a handwritten complaint from Don Lippert, a diabetic inmate at Stateville Correctional Center outside of this city, claiming he was being denied his twice-daily dose of insulin. In the roughly six years since, that case has snowballed into a lawsuit filed on behalf of every prisoner in Illinois.
Lippert v. Baldwin argues that health care inside the Illinois Department of Corrections systematically puts inmates at risk of pain, injury, and death. By failing to address fundamental needs, it alleges, Illinois is not meeting its constitutional mandate to protect against cruel and unusual punishment. If someone has a broken arm and you let them suffer, thats really no different than putting them on the rack and stretching them, said Alan Mills, one of the lead attorneys on the suit. If conditions cause treatable pain and there is a failure to treat the causes of that pain, then thats punishment for no good penological reason.
Prisons and jails are difficult settings for the delivery of medical care, between high illness rates among offenders and worries about safety. Inmates also dont have a right to the countrys best health resourcesno American does. But they do, uniquely, have a right to care that prevents needless suffering.
The Lippert case formally began when the court decided his story had merit and assigned him a pro bono attorney, Jason Stiehl. Stiehl had never before handled a prisoners case, so he started searching for similar ones in Illinois to understand the basic legal terrain. He found hundreds.
After about a month of background research, Stiehl made what he considered to be a reasonable demand from the state as restitution for his client: moderate financial compensation and changes to the management of Lipperts insulin regimen. The state refused, arguing that payment over one complaint would open public coffers to a flood of health-care claims. It could indicate that the state was open for business, so to speak, Stiehl said. With Lipperts consent, he decided to pursue the case as a class-action suita designation that means a particular problem has been shown to be systemic in nature. In April, Judge Jorge Alonso formally granted the lawsuit that status.
As part of their work on the case, Stiehl and Mills traveled across Illinois to take depositions from medical staff in different prisons. (Mills, who directs a legal-advocacy organization, has handled prisoner health-care cases for decades and joined Stiehl early on.) They subpoenaed state agencies for medical records and began slogging through documents, looking to compile information about why the system wasnt working, Stiehl said. They also sought documentation from Wexford Health Sources, a private correctional health-care company to which Illinois started outsourcing the majority of its prison health services in 1992. The most recent contract, signed in 2011, covers 10 years and pays out $1.36 billion.
After two years of Stiehl and Millss digging, a temporary truce went into effect. There was an agreement between the parties to stand down for an expert report, said Camille Bennett, an attorney at the ACLU of Illinois, which joined the lawsuit on behalf of the plaintiffs in 2013. Dr. Ronald Shansky, an internist in Chicago at the time, was appointed to lead the audit, along with another medical doctor, a registered nurse, and a dentist. They were charged with investigating a sample of eight prisons statewide. Their final reportwhich the Associated Press called scathingconcluded that Illinois has been unable to meet minimal constitutional standards with regards to the adequacy of its health-care program for the population it serves.
The findings offer a dire picture of medical care in the states prisons. Facilities were significantly short-staffed35 percent of budgeted medical positions at Stateville were vacantand slips in routine care, like the irregular administration of necessary medication that Lippert reportedly faced, were widespread. Inmates with health issues in solitary confinement received medical consultations conducted through a solid steel door. In 60 percent of inmate deaths from nonviolent causes, the audit found significant lapses of care.
These issues are by no means exclusive to Illinois. Jails and prisons can make the practice of medicine challenging. For one, their inhabitants are under a much heavier disease burden than the broader American public. When the Bureau of Justice Statistics compared illness in jails and prisons with rates in the general population, it found a striking divide. While the average rate of infectious disease, like tuberculosis or hepatitis, among those incarcerated is 21 percent, the rate for those outside of prison is under 5 percent. Estimates suggest that, on average, prisoners bodies function at a physiological age 10 to 15 years older than their chronological age. A growing geriatric population also complicates the work of doctors and nurses.
There are logistical factors, too, that make providing care tough. Like other states with strict budget constraints, Illinois is running its facilities above capacity, at 147 percent, and its per capita funding for prisoner health care ranks 48th out of 50 states, according to a 2014 report. Facilities nationwide also maintain an unusual chain of command, in which guardswhose primary focus is securityare often the first to encounter inmates with medical complaints. Under this informal system of triage, urgent symptoms may go unrecognized.
Health-care providers must also balance treatment against legitimate safety concerns. In a recent example, an inmate from Illinoiss Kane County Jail was granted medical furlough to visit a nearby hospital. While in the emergency room, he took a nurse hostage, and was eventually shot and killed after broken negotiations and a SWAT team standoff.
At the same time, the negligence of prison medical staff sometimes seems baffling in its callousness. Predating Shanskys report, in the spring of 2012 an inmate in Illinoiss Taylorville Correctional Center, who had lost 42 pounds in three years, was diagnosed for a second time with hemorrhoids after he complained of bleeding from his rectum. Within weeks he was placed in diapers and having up to 40 bloody and watery bowel movements a day. Not until July was the man sent to a hospital, where he was diagnosed with late-stage colon cancer that had metastasized to his liver and lungs. He died one month later.
In his report, Shansky documented numerous deaths similar to this one that he said were caused by a failure to identify serious instabilitya severe case of internal bleeding that went unmanaged, sepsis that went undiagnosed. In sum, he found an unacceptably high rate of deviations from the standard of care. (Shansky declined a request for comment, as he will likely be called to testify in the case. The state corrections department, which criticized his report, and Wexford Health Sources both declined to comment.)
After his findings were released in 2014, both the plaintiffs and the state of Illinois began moving toward a consent order that included court oversight of prison health care, according to Bennett from the ACLU. But the election of Republican Governor Bruce Rauner shifted the political winds. Rauners administration, she suggested, preferred a private settlement that precluded that oversight, which was a deal-breaker. Negotiation fell apart and the case returned to active litigation.
Class-action suits over prison health care are not uncommon; some target the system as a whole, others focus on a failure to provide one or another specific treatment or service. Illinois, for instance, settled a suit focused on the provision of mental health in 2015, and a similar case is now working its way through Alabama courts. California settled a class-action lawsuit in 2017, as did Florida in 2016though they now face another one. And Wisconsin settled a suit in 2010. This is a pervasive nationwide problem that our class-action in Illinois is not going to solve, Stiehl said. He alleged that privatization of prison health care is one of the factors driving this litigation: They underbid, then overrun costs, and end up having these huge gaps in the way that services are delivered.
Compounding Illinoiss issues are financial woes so severe that Politico recently labeled it a failed state. The government holds $14.6 billion in unpaid bills and, despite running a deficit of $6 billion, has been unable to negotiate a budget in nearly two years. Throughout the case, Stiehl said, the state has argued it cannot pay for many of the recommendations in Shanskys reportrecommendations like hiring to fill vacancies, or updating medical equipment, or scheduling more frequent appointments for chronically ill patients. My response, Stiehl said, is that you shouldnt incarcerate tens of thousands of people if you cant take care of them. If the case is eventually found in the plaintiffs favor, the state will likely be forced to comply with the orders for reform, despite its budget problems.
With class-action status now approved, the plaintiffs lawyers are trying to determine whether the state corrections department has heeded any of the recommendations from the expert report. The team has asked the state to present a witness for deposition who is most knowledgeable on the subject. In the meantime, occasional contact with the six named plaintiffs is the only slim view of the inside they have.
Roughly two months ago, Lippert faced a crisis situation, Stiehl said. For three days he received no insulin shots, and his blood sugar climbed dangerously high. Stiehl talked to his client on the phone, and he considered a court injunction to get Lippert back on his regimen before the prison resumed treatment. Such ongoing complications signal to him that conditions have not improved inside the facility. He checks on Lippert, but is not there to monitor his care each day. They literally missed him for three days, Stiehl alleged. They forgot about him.
Read the original post:
Does Bad Health Care Constitute Cruel and Unusual Punishment? - The Atlantic
- How good is fish for your diet? - November 8th, 2009 [November 8th, 2009]
- What foods have both fiber and protein? - November 8th, 2009 [November 8th, 2009]
- Is There Evidence That Acupuncture Works? - November 8th, 2009 [November 8th, 2009]
- What are some good fiber foods? - November 8th, 2009 [November 8th, 2009]
- Can Green Tea fight HIV infection? - November 8th, 2009 [November 8th, 2009]
- Quality of GNC Supplements - November 8th, 2009 [November 8th, 2009]
- The Gene Smart Diet - November 8th, 2009 [November 8th, 2009]
- Tips for eating in a vegetarian lifestyle - November 8th, 2009 [November 8th, 2009]
- Regarding the Starting of a new diet regimen - November 8th, 2009 [November 8th, 2009]
- Thoughts on Dropping Weight - November 8th, 2009 [November 8th, 2009]
- What do doctors think about vitamin E supplements? - November 8th, 2009 [November 8th, 2009]
- What herbs or supplements are commonly used for depression? - November 8th, 2009 [November 8th, 2009]
- Is there a safe way to lose a lot of weight? - November 8th, 2009 [November 8th, 2009]
- Diets that promise you will lose weight - November 8th, 2009 [November 8th, 2009]
- Are Fish Toxins Linked to Diabetes? - November 8th, 2009 [November 8th, 2009]
- Can Plastic Surgery Help Migraines? - November 8th, 2009 [November 8th, 2009]
- Weight Loss Surgery Eradicates Diabetes Symptoms - November 8th, 2009 [November 8th, 2009]
- Found: A Gene That Controls Fat Cells - November 8th, 2009 [November 8th, 2009]
- Sugars and Starches, what's the difference? - November 8th, 2009 [November 8th, 2009]
- Improving your health with a serving of nuts? - November 8th, 2009 [November 8th, 2009]
- Is Your Diet Causing You To Be Depressed? - December 13th, 2009 [December 13th, 2009]
- Placebo Effect: Magnetic Bracelet Therapy - December 13th, 2009 [December 13th, 2009]
- Does serotonin promote sleep? - December 13th, 2009 [December 13th, 2009]
- Decreased energy levels - Overeating, Sleep, Nutrition - February 1st, 2010 [February 1st, 2010]
- When will the body begin to cannibalize muscle tissue? - February 7th, 2010 [February 7th, 2010]
- Foods that are high in antioxidants - February 7th, 2010 [February 7th, 2010]
- Editorial: Reduce health care costs by cutting administrative overhead - April 1st, 2012 [April 1st, 2012]
- Health Care Winners: Centene, Onyxx - April 25th, 2012 [April 25th, 2012]
- Dan Morain: Nurses union puts politics ahead of health - April 25th, 2012 [April 25th, 2012]
- What's next if Obamacare falls? - April 25th, 2012 [April 25th, 2012]
- Global Managed Health Care Services Industry - April 25th, 2012 [April 25th, 2012]
- Immigration Fight Echoes Health-Care Case at High Court - April 25th, 2012 [April 25th, 2012]
- Medical Centers Lead Workplace Wellness Effort - April 25th, 2012 [April 25th, 2012]
- The next health care overhaul? Look to employers - April 25th, 2012 [April 25th, 2012]
- Capital BlueCross Hosts Community Health Care Forums Focused on Managing Costs While Maintaining Quality - April 25th, 2012 [April 25th, 2012]
- County committee to look at area health care - April 25th, 2012 [April 25th, 2012]
- President Obama Calls on Students to Tell Congress: #DontDoubleMyRate - Video - April 25th, 2012 [April 25th, 2012]
- Sen. Coburn: Competition in Health Care to Allocate Resources - Video - April 25th, 2012 [April 25th, 2012]
- Jesse Kelly health care - Video - April 25th, 2012 [April 25th, 2012]
- PHC Vision Statement (short version) - Video - April 30th, 2012 [April 30th, 2012]
- The Bioeconomy Blueprint Panel - Video - April 30th, 2012 [April 30th, 2012]
- Providence Health Care's Vision Statement - Video - April 30th, 2012 [April 30th, 2012]
- Department of Health and Human Services: Minority Health Blogger Townhall - Video - April 30th, 2012 [April 30th, 2012]
- Health care worker accused of stealing identities of brain i - Video - April 30th, 2012 [April 30th, 2012]
- Health Care Reform, Part 1 of 3 | KYVE Insiders Roundtable - Video - April 30th, 2012 [April 30th, 2012]
- Health Care Reform: The ACA and Beyond - Video - April 30th, 2012 [April 30th, 2012]
- Is Broccoli Like Health Insurance? - Video - April 30th, 2012 [April 30th, 2012]
- Did Obama make a mistake on health care? - Video - April 30th, 2012 [April 30th, 2012]
- How Democrats Lie About Health Care - Video - April 30th, 2012 [April 30th, 2012]
- Toobin on Health Care: This was a "judicial hissy-fit" - Video - April 30th, 2012 [April 30th, 2012]
- President Obama says health care law will stand - Video - April 30th, 2012 [April 30th, 2012]
- Obama Defends Health Care Law From 'Judicial Activism' - Video - April 30th, 2012 [April 30th, 2012]
- Obama Healthcare Individual Mandate - Video - April 30th, 2012 [April 30th, 2012]
- President Obama attacks Supreme Court on health care - Video - April 30th, 2012 [April 30th, 2012]
- Raw Audio: High Court Dissects Health Care Act - Video - April 30th, 2012 [April 30th, 2012]
- Health care on trial - Video - April 30th, 2012 [April 30th, 2012]
- Final Day of Health Care Law Arguments Before Supreme Court - Video - April 30th, 2012 [April 30th, 2012]
- Feds to put up $1.9B for Oregon health overhaul - May 4th, 2012 [May 4th, 2012]
- Scuttling health care act will freeze Medicare, White House warns - May 4th, 2012 [May 4th, 2012]
- U.S. Health Care Spending High, But Quality Lags: Report - May 4th, 2012 [May 4th, 2012]
- Yes, the Health-Care Mandate Is About Liberty - May 4th, 2012 [May 4th, 2012]
- Health center gets $1M federal grant - May 4th, 2012 [May 4th, 2012]
- Health-care reform panel considers exchange options for Va. - May 4th, 2012 [May 4th, 2012]
- Hmong health care gap focus of Healthy House dinner - May 4th, 2012 [May 4th, 2012]
- Walsh-led health bill to be unveiled - May 4th, 2012 [May 4th, 2012]
- Ontario health system confusing for ailing seniors, study finds - May 4th, 2012 [May 4th, 2012]
- 'Health Care Deserts' More Common in Black Neighborhoods - May 5th, 2012 [May 5th, 2012]
- With federal money, Oregon kicks health care reform into high gear - May 5th, 2012 [May 5th, 2012]
- Nurse practitioners tackling more 'doctor' tasks - May 5th, 2012 [May 5th, 2012]
- Konza Prairie Health Center Receives $4.5 Million Grant - May 5th, 2012 [May 5th, 2012]
- Alberta wages hurting Sask. health care - May 5th, 2012 [May 5th, 2012]
- House releases plan to cut growth of Massachusetts health spending in half - May 5th, 2012 [May 5th, 2012]
- Mass. House Will Unveil Bill Seeking To Rein In Health Costs - May 5th, 2012 [May 5th, 2012]
- President Obama Welcomes the Kentucky Wildcats - Video - May 5th, 2012 [May 5th, 2012]
- President Obama Speaks on College Affordability - Video - May 5th, 2012 [May 5th, 2012]
- My First Job: Gene Sperling - Video - May 5th, 2012 [May 5th, 2012]
- Health-care costs worry near-retirees - May 7th, 2012 [May 7th, 2012]
- Massachusetts Institutes Health-Care Price Controls. Is America Next? - May 7th, 2012 [May 7th, 2012]
- Massachusetts Moves Toward Health-Care Price Controls. Is America Next? - May 7th, 2012 [May 7th, 2012]
- GOP plan boosts Pentagon, cuts social programs - May 7th, 2012 [May 7th, 2012]