Monthly Archives: May 2011

The patients no one wants

I spent time at the turn of the year reporting a piece on a group of doctors, based at Brown University, who have made their careers and a distinguished history out of treating prisoners, easily the most neglected segment of our population. That’s a population that’s grown to unbelievable heights, and keeps growing: 2.3 million prisoners in all. Mass incarceration is one of the few areas in which the U.S. still leads the world.

This is a topic on which I’m going to continue reporting, particularly the individual stories of those affected by our correctional-industrial complex. I’m open to any ideas for those who’d like to offer suggestions.

In the meantime, here’s the online version of the story. It’ll be in print this week; the magazine is sent to all Brown alumni.

Here is the story’s introduction:

On the second Tuesday in January, Professor of Medicine Josiah “Jody” Rich began his seventeenth year of weekly visits to Rhode Island’s state prison, the Adult Correctional Institution (ACI). The first inmate he saw that morning was a familiar one.

“How far do we go back?” Rich asked Charles Long.

Long shook his head mournfully. “Way back,” he said, his voice trailing off.

They talked inside a small examination room at the minimum-security prison on ACI’s sprawling campus in Cranston. Rich, an infectious-disease specialist and professor of medicine and community health at the Warren Alpert Medical School, sat behind an old metal desk that supported an outdated computer. Long rested on a plastic chair next to an exam table. Nearby were a young resident and the prison’s head nurse.

Laid low by drugs and sixteen prison stays in twenty-two years, Long, at sixty-one, was in bad shape. He had tested positive for HIV eighteen years earlier while incarcerated at the ACI, and the effects were catching up to him. His breathing was labored. He coughed frequently. His kidneys and heart were failing. His thin hair was arranged in cornrows above his small, weathered face, and his prison garb was a study in beige: beige sandals, beige flannels, and a light-beige thermal undershirt.

Inmates in Long’s condition are not uncommon among the 2.3 million prisoners in the United States, a number that forty years ago was only 200,000. More than half of those 2.3 million have a history of substance abuse or mental illness. Thanks to mandatory sentences for even minor drug violations, and to the deinstitutionalization of the mentally ill, prisons have often become overcrowded warehouses mixing young and old, sick and healthy, hardened criminals with men and women guilty mostly of being foolish and young.

Not until 1976 did the U.S. Supreme Court rule that the Constitution guarantees prisoners the right to health care. Yet how that right is acknowledged varies greatly from state to state. Jody Rich is one of several Brown doctors who over the past quarter century have quietly established Rhode Island as a national model for providing quality health care to incarcerated citizens. From the treatment of HIV infection to the easing of addiction, Brown physicians like Rich have been not only on a mission to ensure that people who have broken the law get adequate health care; they have also used their prestige to advocate for better living conditions in prisons more generally.

“These guys at Brown took some of the basics of providing health care to prisoners and they took it to another level, with the research and the systematic approach and the continuity of care,” says Dr. Mark Malek, the director of preventive medicine and epidemiology at the Los Angeles County Jail. He met Rich two years ago after asking the National Institutes of Health (NIH) about grants for treating prisoners with HIV. “I was told there’s a great group in Rhode Island I could learn a lot from.”

Malek says that Rich and his collaborators have approached prisoner health care as a public health mandate, and have streamlined the transition of health care for prisoners as they are released back into the community. The doctors are, Malek says, “an example for the rest of the country.”

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