Even With Treatment for Hepatitis C, Abu-Jamal’s Health Not Guaranteed


This is the final part of a series on Mumia Abu-Jamal’s fight for acceptable health care for himself and for over 2 million inmates across the country. (Click here for Part I, here for Part II, or here for Part III)

In Abu-Jamal’s case, most of the legal and media discussion has focused on the denial of hepatitis treatment to him and inmates across the country. And while that alone is malpractice, what is even more appalling was the failure to treat his diabetes. Diabetes care is a cornerstone of basic healthcare. Abu-Jamal’s case illustrates that inmates are denied not only expensive medical treatments but also widely available, inexpensive treatments. Moreover, it demonstrates a failure of correctional healthcare systems to provide even the most basic health care for its patients.

Abu-Jamal tested positive for diabetes while imprisoned, and yet it was intentionally left untreated. In his medical records, blood tests taken on March 8, 2015 showed a glucose level of 419, well exceeding the diabetic level of 200.

There are two major forms of Diabetes. Type 1 Diabetes is the kind that frequently presents young in life. While it is very common for this form of diabetes to be initially diagnosed in a crisis setting (coma, severe dehydration, electrolyte disturbances), Type 2 Diabetes, the form that typically starts in adulthood and the form that Abu-Jamal has, very rarely gets to that point because it develops more slowly and is caught early before it ever reaches that level of severity.

In his chart, someone circled the blood sugar value and wrote by it “on steroids.” What this note suggests is that the provider felt that since there was an explanation for his high blood sugar, there was no need to treat it. That lack of action is equivalent to looking at a patient whose pneumonia is so severe that they need a breathing machine and then saying, “We know why they’re not breathing well. They have pneumonia.” Just because you know the cause of a finding doesn’t mean it doesn’t have to be treated.

Lab results from Abu-Jamal’s medical record

Standard of care for a blood sugar that high is to immediately give medication to lower it, or at least monitor three times a day. One of the main medications for the treatment of diabetes is metformin. It costs $4 a month. But because he didn’t get any treatment, his sugars climbed to levels so toxic that his brain stopped functioning and he went into a diabetic coma.

Countrywide epidemic of neglectful healthcare

Sadly, Abu-Jamal’s healthcare is not an exception. It’s an example of the poor healthcare that is rampant in prisons and jails across the country. Examples of the felonious level of healthcare are so numerous that they are impossible to list in their entirety. However a few examples illustrate the severity of the negligence.

Anthony Carvajal, a Florida inmate, needed treatment for cancer, but instead was given ibuprofen for six months. An inmate in California was denied cardiac medications after being discharged from the hospital for heart failure. Ieasha Meyers, an inmate in Iowa, was forced to give birth without medical personnel on the floor of her cell when her reports of contractions went ignored.

The situation in jails is even more deplorable. Because jails are seen as temporary holding institutions, the quality of healthcare falls short of even that of prisons. The justification for this is that the average length of stay in jails is less than 30 days so only minimal healthcare services are needed. However, because of prison over-crowding, inmates can reside there much longer. Dr. Smith (named changed out of fear of retaliation) is a physician who worked for Advanced Correctional Health Care, a private company that provided services for a network of jails. According to her experience, she saw inmates that were there for over 7 months on a regular basis.

Dr. Smith recalls struggling daily to provide basic the medical care that she knew the inmates deserved. Whether she was requesting a procedure as simple as a dental extraction, attempting to secure a needed medication, or trying to order indicated blood tests, she always came up against the same mantra, “The bottom line of what they said is that you just want to keep people alive. You don’t actually need to treat anything unless to prevent a deterioration of their health.”

The facilities and lack of access horrified her. She provided care for four different jails and opportunities for inmates to see her were extremely limited. She would provide access to patients for 1 or 2 hours once or twice a week at most at each location. Given that most patient visits last 15-20 minutes, at maximum she would see only 8 patients a day. One facility only had her come only once every two weeks. Inmates were required to request appointments, and if there wasn’t enough space, they just didn’t get to see the doctor.

Dr. Smith recalls a case where she was called in the middle of the night for a medical emergency. A woman who was 8 months pregnant was being held for failing to appear in court for a minor offense. While there she developed acute abdominal pain that Dr. Smith realized she needed hospital care to treat. She was worried it could be fatal to both the inmate and her fetus.

By the time the guards had called Dr. Smith the woman had been suffering for four hours and her pain was getting worse. When she asked why it had taken the guards so long to contact her, they responded that they thought that the inmate was just whining. Though Dr. Smith insisted that they call an ambulance immediately, as precious time had already been lost, it took them several more hours to transport the patient because they required that she first complete all the paperwork to be “released on her own recognizance.” According to Dr. Smith, this was routine. By doing this, the medical bills would be charged to the patient rather than the jail.

Unfortunately, Advanced Correctional Health Care is no different than most of the other companies in this industry. The four largest companies in corrections healthcare are Corizon Healthcare, Correct Care Solutions, MHM Correctional Services, and Wexford Health Services. Together, the top four companies are responsible for the healthcare of nearly half of the incarcerated population in the United States. Just as in prisons, the examples and lawsuits over egregiously poor healthcare in jails are too numerous to catalog in their entirety, but a few examples demonstrate the atrocities.

InAlabama, Tanish Jefferson died from something as simple as constipation. New York City recently terminated their contract with Corizon due to at least two cases where the company’s employees contributed to the deaths of inmates. Bradley Ballard, an inmate at Rikers Island, died after being denied insulin, food, and running water for nearly a week. Correct Care Solutions has been sued for allowing Farah Saleh Farah to die from dehydration in a Virginia jail. In New York, Rashad McNulty died in Westchester County Jail after his complaints of chest pain were ignored. He was having a fatal heart attack. In North Carolina, Jen McCormack also died from a heart attack that was ignored while in jail custody. The list goes on and on.

All of these companies are for-profit organizations. The motivation of greed over human life is illustrated in not only the poor medical care, but also the poor ethics at the core of these companies.

The president of Correctional Medical Associates, a subsidiary of Corizon, was indicted for embezzlement when he was a medical student. In Alabama, Corizon employed two physicians who had previously lost their licenses for sexual misconduct with patients. Nurses in a California prison are continually so short staffed that in April they threatened to go on strike. The Department of Investigation in New York found 658 fingerprint cards, accumulated over 4 years, that had never processed as part of Corizon’s employee background checks. These self-serving, immoral practices are clearly incompatible with providing healthcare, an industry focused solely on the welfare of patients.

Sustainable change requires a systematic intervention

What’s shocking is that these companies continue to operate despite consistent malpractice. The lack of regulatory oversight of healthcare in correctional facilities is appalling.

Private companies have exploited the poor regulatory standards. There has been a growing trend for correctional facilities to outsource their healthcare. Typically these contracts are negotiated on a per inmate fee. This creates a perverse incentive where the less the healthcare companies spend on each inmate’s health, the more profit they make.

The privatization of healthcare in correctional facilities has been fingered as the root cause of poor healthcare for the over 2 million inmates in US jails and prisons. It is true that greedy business practices that value money over human life is the most direct causal agent to these atrocious conditions. However, they are only exploiting a government that doesn’t care enough to require standards to begin with.

Individual whistle blowing, institution-level inquiries, and journalism have identified poor healthcare for years and yet these poor conditions persist. Interventions on an individual level do not create sustained change. What’s needed is a systems level approach.

For example, if every department of corrections in the country required accreditation within the first six months of every contract, conditions would improve. In a recent review it was found that “there is considerable evidence…that accreditation programs improve clinical outcomes.”

Money is what really influences behavior, even in the most benevolent of companies. Tying payment to health outcomes guarantees that standards will be met, a fact so obvious that mainstream healthcare systems have been moving in this direction for years. Insurance companies such as Medicare will only pay for services at facilities that meet certain standards, usually indicated by an accreditation from a recognized organization such as The Joint Commission.

Another possibility would be to create a more robust quality tracking system that is tied to payment. For example, one could create a contract that required meeting certain quality metrics. Failure to do so would result in fines or payment withheld. Metrics could range from service indicators such as the time delay between when a patient requests an appointment and is actually seen, to clinical indicators such as how frequently cholesterol is being checked. This is already becoming the standard in the mainstream healthcare system.

It’s possible that linking payment to quality will save the system so much money in litigation and preventable healthcare complications that correctional facilities will suffer no additional cost burden. But it’s also possible that our correctional healthcare budgets are simply too small and that providing humane healthcare will require more money. If that’s the case, as citizens who support a system of involuntary confinement, the responsibility rests on our shoulders.

The majority of inmates are not psychopathic serial killers, but actually people not all that different than those of us outside of bars. They just can’t afford to pay their speeding tickets on time so they’re sent to jail; they just don’t have a solid network of financially stable friends and family that can help them weather tough financial times so they steal things; they just don’t have any educational or career opportunities so they join gangs.

This is our system. We punish people who were born with the cards stacked against them. Then, on top of that, we refuse to provide them with basic healthcare, which then only makes it more difficult for them to create fulfilling, productive lives when they are released.

It’s convenient to blame profit-driven corporations for the poor state of healthcare in prisons and jails so we point our fingers and play the blame game. It’s much harder to realize that we are also culpable.


More articles by:

JESS GUH, MD is a member of ThisCantBeHappening!, the independent, uncompromised, five-time Project Censored Award-winning online alternative news site.

March 19, 2018
Henry Heller
The Moment of Trump
John Davis
Pristine Buildings, Tarnished Architect
Uri Avnery
The Fake Enemy
Patrick Cockburn
The Fall of Afrin and the Next Phase of the Syrian War
Nick Pemberton
The Democrats Can’t Save Us
Nomi Prins 
Jared Kushner, RIP: a Political Obituary for the President’s Son-in-Law
Georgina Downs
The Double Standards and Hypocrisy of the UK Government Over the ‘Nerve Agent’ Spy Poisoning
Dean Baker
Trump and the Federal Reserve
Colin Todhunter
The Strategy of Tension Towards Russia and the Push to Nuclear War
Kevin Zeese - Margaret Flowers
US Empire on Decline
Ralph Nader
Ahoy America, Give Trump a Taste of His Own Medicine Starting on Trump Imitation Day
Robert Dodge
Eliminate Nuclear Weapons by Divesting from Them
Laura Finley
Shame on You, Katy Perry
Weekend Edition
March 16, 2018
Friday - Sunday
Michael Uhl
The Tip of the Iceberg: My Lai Fifty Years On
Bruce E. Levine
School Shootings: Who to Listen to Instead of Mainstream Shrinks
Mel Goodman
Caveat Emptor: MSNBC and CNN Use CIA Apologists for False Commentary
Paul Street
The Obama Presidency Gets Some Early High Historiography
Kathy Deacon
Me, My Parents and Red Scares Long Gone
Jeffrey St. Clair
Roaming Charges: Rexless Abandon
Andrew Levine
Good Enemies Are Hard To Find: Therefore Worry
Jim Kavanagh
What to Expect From a Trump / Kim Summit
Ron Jacobs
Trump and His Tariffs
Joshua Frank
Drenched in Crude: It’s an Oil Free For All, But That’s Not a New Thing
Gary Leupp
What If There Was No Collusion?
Matthew Stevenson
Why Vietnam Still Matters: Bernard Fall Dies on the Street Without Joy
Robert Fantina
Bad to Worse: Tillerson, Pompeo and Haspel
Brian Cloughley
Be Prepared, Iran, Because They Want to Destroy You
Richard Moser
What is Organizing?
Scott McLarty
Working Americans Need Independent Politics
Rohullah Naderi
American Gun Violence From an Afghan Perspective
Sharmini Peries - Michael Hudson
Why Trump’s Tariff Travesty Will Not Re-Industrialize the US
Ted Rall
Democrats Should Run on Impeachment
Robert Fisk
Will We Ever See Al Jazeera’s Investigation Into the Israel Lobby?
Kristine Mattis
Superunknown: Scientific Integrity Within the Academic and Media Industrial Complexes
John W. Whitehead
Say No to “Hardening” the Schools with Zero Tolerance Policies and Gun-Toting Cops
Edward Hunt
UN: US Attack On Syrian Civilians Violated International Law
Barbara Nimri Aziz
Iraq Outside History
Wilfred Burchett
Vietnam Will Win: The Long Hard Road
Victor Grossman
Germany: New Faces, Old Policies
Medea Benjamin - Nicolas J. S. Davies
The Iraq Death Toll 15 Years After the US Invasion
Binoy Kampmark
Amazon’s Initiative: Digital Assistants, Home Surveillance and Data
Chuck Collins
Business Leaders Agree: Inequality Hurts The Bottom Line
Jill Richardson
What We Talk About When We Talk About “Free Trade”
Eric Lerner – Jay Arena
A Spark to a Wider Fire: Movement Against Immigrant Detention in New Jersey
Negin Owliaei
Teachers Deserve a Raise: Here’s How to Fund It