If a chronic pain or addiction patient experiences any medical abnormalities in jail or prison in this country, it is almost always ignored as “just withdrawals.” Medical staff hired at these facilities do not infrequently have problems getting along with patients, and the prison setting gives them an opportunity to work where patient satisfaction is not a concern. They then often undergo training to see the prisoners as devious and malingering, reinforcing this predisposition. There is also the issue of recourse. If your doctor on the outside makes a boneheaded mistake, you might be jetting around in his nice boat next year. In prison, the standard is much different. You must prove that the medical staff “knew” what you had and chose to ignore it. That means a doctor willing to claim complete ignorance can allow you to die from anything at all, no matter how classic the symptoms.
This is seen most commonly in the case of chest pain (always heartburn until you die) and withdrawal symptoms. Sudden cessation of many medications can kill you. The blood pressure agent clonidine and most beta-blockers have a well-known rebound effect that can push your blood above 250 over 150 and kill you with a stroke or heart attack. If your blood pressure is not taken prior to your death, this cause is not detectable after the fact. Thousands of Americans every day are denied their medications while in American jails and prisons, often by jail staff, without any medically trained person being consulted, and when the prisoner dies, these deaths are always determined to be “natural causes,” and in a way, they are. If we take away the medicines keeping you alive, naturally, you’ll die. However, there is a special case when it comes to controlled medication withdrawals.
Even doctors and nurses mistakenly believe that withdrawals are a sign of addiction in everyone. That is not true. Tolerance and withdrawals are an expected consequence of long-term therapy with almost any medication. Withdrawals are simply the result of a biological system having adjusted to the changes brought about by your medication and rebounding to an abnormal state when the medication is suddenly not present. This causes hypertension when it comes to blood pressure medications and increased pain and diarrhea when it comes to opioids. Benzodiazepines are in their own category, with sudden cessation being notoriously fatal. Benzodiazepines reduce neuronal activity by potentiating the effects of GABA, the brain’s major inhibitory neurotransmitter. Over time, if the patient survives the withdrawals, the body will usually adjust to the absence of the medication, recalibrating to the new normal.
But not every patient is this lucky. Elisa Serna was a vibrant twenty-four-year-old young woman in her twenties living in that supposedly most liberal of states, California. She was suspected of committing the terrible crimes of petty theft and minor possession. Elisa indeed had substance abuse problems and explained this to the jail. The jail supposedly had a Medication-Assisted Treatment Program, but many of these programs exist in name only, administered by those who despise drug users and don’t actually use any evidence-based treatments. This is what happened to Elisa. She was denied any effective treatment and quickly developed nausea and vomiting, being moved to the jail’s medical observation unit on her fifth day there. Staff watched as she continued to suffer from vomiting and diarrhea, becoming so weak that she fell over a dozen times. Continuing to watch until she eventually had seizures and died, lying in her own filth. Her family and even strangers protested, but no real changes were made.
There was a lawsuit and eventually some state charges but no federal. The difference is that it is harder for states to hide evidence from federal investigators. But somehow, once you are labeled as an addict, the federal government’s Civil Rights Division can’t see you anymore, and this last is important. Jails get away with murder by falsely blaming deaths of medical neglect on overdose. In Plano, Texas, in 2018, a teacher was thrown in jail and deprived of all his medications by jail staff without consulting anyone with medical credentials. The teacher had been on benzodiazepines for over a decade and had last taken them the night before. They didn’t care. Depriving people of their medicine is an easy way to show power over them and make them suffer. He first asked and then begged for his medications, explaining that he was having anxiety attacks and had PTSD, eventually pounding his fists on the cell walls until they told him to be quiet. He was found seizing a few hours later, but nothing was done for him.
An hour later, it was too late, and he died shortly after being taken to the ER. His family was told that he had died of an overdose by jail staff before the coroner’s autopsy had been performed. It showed heart failure with a coronary artery blockage contributing, but no apologies or corrections were ever made. Daniel Williams was a 22-year-old father serving time for theft in an Alabama jail. Death in Alabama jails is about five times the national average, according to Carla Crowder, a prisoner’s rights activist. According to the lawyer for William’s family, Andrew Menefee, Williams was tied to a bunk and rented out for abuse by other inmates, with the guards doing nothing to stop it. The alleged ringleader of the gang that assaulted Daniel had been accused of sexually assaulting other inmates nine times. The jailers were aware, but no investigations were ever initiated. The accused was not placed in segregation or even punished in any way. Indeed, they didn’t even bother to annotate his record.
Daniel was tied up in a corner of the dormitory and beaten and raped until he was unconscious. Eventually, when he did not wake up, the guards took him to the hospital, where they let him lie for over a week without notifying the family, probably hoping the bruises would disappear. Once notified, the family hired an attorney, but Daniel died the next day. The assault was not written up as a crime, and no disciplinary charges were filed. No federal criminal charges were brought against the guards to date, but a federal lawsuit filed finally filed by the DOJ alleges that jails in Alabama (and I will add everywhere) routinely: 1-mix violent predators with non violent inmates, 2-fail investigate crimes and complaints, 3-discourage reporting, 4-allow a complaining inmate to be assaulted as punishment, 5-take privileges away from those who report sexual assault, 6-fail to intercept (and I’ll often add actually provide) drugs to inmates, and 7-use the presence of drugs to diminish incidents of sexual assault and murder.
Did they know that the accused ringleader might be dangerous? Well, in 2015, an inmate was found slumped over and covered in blood with stab wounds to the head, neck, chest, back, and arms, with the weapon found near the ringleader’s cell, and, we call this a clue: blood all over his clothes. He was convicted of assault eight years later with no punishment or removal from general population. He was later cited for possessing a weapon and had eighteen disciplinary charges, but no action was taken. In 2017, a guard saw him physically attack another inmate to force him to agree to sex, but nothing was done. Then he stabbed and sexually assaulted another inmate who refused. In both cases, there was evidence but no follow-up investigation. He sexually assaulted an inmate in April of 2018 and another in May of 2019. Tried to stab a man later in 2019 and sexually assaulted a man at Bibb Correctional Facility in 2020 so badly that the victim had to be taken to a hospital. I mean, really… How could they have known?
How bad has it gotten in Alabama? The Department of Justice compiled a list from just a four-month period that showed. A prisoner at Bibb was drugged and awoke in the middle of being raped. A prisoner at Bullock cut his own wrist after an attempted gang rape “because he feared being in population and needed to be placed in a single cell.” A prisoner at Donaldson cut his wrist with a razor, saying he had been sexually assaulted in a bathroom. Doctors had to perform emergency surgery on a Donaldson inmate to remove a broomstick that had been jammed into his rectum. A prisoner at Fountain reported he had been sexually assaulted every day since his arrival at the prison. A Holman prisoner said he awoke to one prisoner punching him in the eye. “Then four or five prisoners put a partition around his bed and took turns raping him.” Too often, according to Carla Crowder, “…choices were made over and over again to take no investigative or corrective action in numerous cases of sexual assault at five different prisons.”
In almost all of these cases, the authorities claim that “drugs were involved” as if that admission alone does not indict them for failing to protect those incarcerated under their care. Who let the drugs in? Who is responsible for the security of the facility and the safety of the prisoners? Citizens are so often sent to prison under the argument that they “knew, should have known, or was willfully blind…” If the state and federal authorities were held to the same standard, I think we would all get a huge tax break from the saved salaries. Shouldn’t prisons be, even if still dark and cold, a place for reflection and growth? Learning and security? With at least the potential to come home better? Or at least, to come home at all? Instead of a gladiatorial combat school where the prisoners learn to fight or be raped or even die? There is no country on this Earth where more life years are taken away from the people than the United States of America. Not China. Not even North Korea. And while the US doesn’t part us out for spare organs (yet), what difference does that make to the dead?
