Research Concludes Inmates Lack Adequate Access To Timely Health Care Behind Bars In South Florida

Dec 5, 2018

Federal law requires prisons and jails to provide medical care to people who are incarcerated. But in a recent medical journal, a group of South Florida researchers make the case that too many inmates suffer and die in part because "they lack adequate access to timely care."

"We wanted to know: what are people dying of while they're incarcerated in Miami-Dade County?" says Dr. Tanya Zakrison, a trauma surgeon at Jackson Memorial Hospital in Miami.

To begin to answer that question, Zakrison and colleagues from Jackson and the University of Miami analyzed years of autopsy records from inmates in jails and prisons in Miami-Dade County. Some of their findings were published in an article in the journal JAMA Surgery.

What stood out to the researchers was what happened when prisoners appeared to need surgery:

  • About a quarter of the inmate deaths were due to trauma or illnesses that call for emergency surgery.
  • But two thirds of those cases showed no indication that the prisoner had gotten surgery for the injury that killed them.

Zakrison talked about the findings with Health News Florida:

Zakrison describes her team's concerns about finding death records for injuries that aren't usually fatal outside of prison:

"Typically it would be extremely unusual for anyone to die in the general population from cases of bowel obstruction, or groin hernias, or acute appendicitis, or again these emergency general surgery cases.

And to us it just indicates someone did not have access to the surgical intervention or medical intervention that they needed."

On the limits of what we know about how inmates access health care:

"Are inmates accessing care in a timely fashion? Our data would indicate probably not, if they're succumbing to preventable surgical illness.

But we really do not know what's happening behind bars. And I think that's our number one concern as a research team."

Zakrison says part of what sparked the research was the Miami Herald's reporting on the brutal death of Darren Rainey. Rainey was a prisoner with schizophrenia at the Dade Correctional Institution. He died in a scalding shower while other inmates reported hearing his screams for mercy.

Third degree burns, like the ones paramedics reported finding on Rainey, would normally require surgical treatment.

Zakrison expected Rainey's autopsy report to be included in the initial records request. But like the reporters and family members before them, the researchers were denied access to his records while the state kept its investigation open:

"So the fact that we couldn't get access to Darren Rainey's file, that simply means to me that our data is only the tip of the iceberg.

We have no idea how many other Darren Raineys exist because his story, against all odds, leaked out to the media."

On her role as a surgeon who treats incarcerated individuals who come to Jackson:

"We see them, we see them in our clinics, they come in. When they require the surgery that they need, they come in as trauma patients, also.

But they'll come in when it's decided that it's time for them to come in. So we might not be seeing everyone who needs the care that we provide.

These inmates, if something is happening to them—like there's systematic abuse or torture or violence happening within that prison system—it's not like they can call 911."

What she wants to see happen next:

"We definitely need a nationwide, accurate and quality-based registry of all inmates in terms of tracking their medical and surgical conditions. And we need to know if those conditions are being treated in a timely fashion the way they would be for any civilian on the outside world.

This is a human rights issue first and foremost.

And also we need to have some sort of independent, external board that can review the medical records of inmates to ensure that they are getting access to care in a timely fashion, and people with external eyes, I think, as watchdogs sort of looking from the outside in to ensure that human rights are not being violated."

You can find the research paper, "Postmortem Incidence of Acute Surgical- and Trauma-Associated Pathologic Conditions in Prison Inmates in Miami Dade County, Florida," at the JAMA Surgery website.

Health News Florida reached out to county, state and federal prison officials for comment. Only state representatives responded. Here is the full text of that response:

The Department contracts with Centurion of Florida for comprehensive health services for inmates. All Florida inmates are provided treatment for medically necessary care – routine visits, dental, treatment of infectious diseases, emergency care, cancer treatment, etc.

When a patient’s care needs exceed what can be provided by institutional primary care clinicians, a referral is made to a specialty care provider for further assessment. If the specialty care provider makes a recommendation, it is routed through a review process, which uses evidenced-based clinical criteria to assess the medical necessity and appropriateness of the recommended healthcare procedure/intervention.