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December 4, 2023

"Excess mortality in U.S. prisons during the COVID-19 pandemic"

The title of this post is the title of this new article by multiple authors just published in the journal Science Advances.  Here is its abstract:

U.S. prisons were especially susceptible to COVID-19 infection and death; however, data limitations have precluded a national accounting of prison mortality (including but not limited to COVID-19 mortality) during the pandemic.  Our analysis of mortality data collected from public records requests (supplemented with publicly available data) from 48 Departments of Corrections provides the most comprehensive understanding to date of in-custody mortality during 2020. We find that total mortality increased by 77% in 2020 relative to 2019, corresponding to 3.4 times the mortality increase in the general population, and that mortality in prisons increased across all age groups (49 and under, 50 to 64, and 65 and older).  COVID-19 was the primary driver for increases in mortality due to natural causes; some states also experienced substantial increases due to unnatural causes.  These findings provide critical information about the pandemic’s toll on some of the country’s most vulnerable individuals while underscoring the need for data transparency and standardized reporting in carceral settings.

December 4, 2023 at 09:34 PM | Permalink


Having dealt with these characters for most of my career, my strong guess is that they're getting much, much better health care in prison than they got for themselves on the outside.

Posted by: Bill Otis | Dec 5, 2023 10:41:23 AM

Bill Otis: You may appreciate that most Federal prison inmates (at least 75%) have substantial drug and alcohol abuse histories. Others have health issues caused by gunshot and knife wounds and even venereal diseases. I have heard it said that the average BOP inmate has a body that is medically 10+ years older than his or her chronological age. If you can dig down into the numbers, you would see that the BOP spends hundreds of millions of dollars per year on inmate healthcare, including the costs for having inmates treated in outside hospitals, when necessary (such as when Derek Chauvin was stabbed 22 times). The BOP is a mixed bag when it comes to the quality of medical and dental care that inmates receive, although I agree with you that most inmates receive far better care than they did on the street, before entering prison. Yet, I have also seen incredibly bad situations happen to some inmates. One inmate in his early 30s entered FCI - Petersburg, Virginia with a serious medical condition, Crohn's Disease. Upon admission, the BOP cut off his medication, steroids, which he had been on for years, and which is the classic treatment for the disease. In 60 days, he had lost 40 pounds and had daily vomiting and diarrhea, as well as blood in his stool. He could have fought the BOP doctor's decision thru administrative remedies, which could have taken months. Instead, I wrote a letter for him about his medical issues to his sentencing Judge, who I figured would recall him from being sentenced 3-4 months earlier. His District Judge helped save his life. She attached a copy of his letter to a letter from her to the Director of the Federal Bureau of Prisons, in D.C. The Director turned the letter over to the Medical Director of the BOP the inmate's steroids were restored within 10 days of the time we mailed the letter to his sentencing Judge. A stranger situation is that one need not have a medical license to work as a Doctor in a Federal prison. BOP physicians are not actually employees, but have 2-year renewable contracts. There is no Federal medical license; all medical licenses are issued by the states and D.C. About 2002, the Medical Director of FCI - Cumberland, Maryland was a black, African born and educated (medical school) "Doctor". The problem was that he did not hold an American medical license and he had FAILED THE MARYLAND LICENSING EXAM 3 TIMES. The prison's dentist (who was actually an Oral Surgeon) was deeply offended that his man was in charge of the medical care for 1,600 inmates. The dentist had a private practice in the community but worked 2 days per week treating inmates' dental problems. He finally started telling the inmates that the prison's Medical Director didn't have a medical license, and the inmates started filing dozens of administrative remedy requests, mentioning that the Medical Director doesn't have a medical license. The Warden and the Regional Director realized that they had a serious problem brewing, so they found a creative way to fire the "Doctor" early; they purported to fire him over his business cards, which referred to him as "John Smith, M.D." - but because he didn't actually have a medical license, he couldn't legally call himself an "M.D.". At the other end of the spectrum, the BOP employes significant numbers of foreign trained physicians (who cannot get into U.S. residency programs) as Physician's Assistants. Many of these foreigners actually practiced medicine for years in their home countries, so they have significant practice experiences that many American-trained P.A.s do not. I have a physician friend who was a practicing surgeon for 35 years before he went to prison for being a script doctor. On three occasions over 10 years, he saved the lives of other inmates by explaining to the prison doctor what was wrong with the inmate (diagnosis) and how to treat it.

Posted by: Jim Gormley | Dec 5, 2023 11:39:36 AM

The reason a doctor doesn't need a state medical license to work as a doctor inside a BOP prison is that the prions are enclaves of Federal land/ jurisdiction, so state laws do not generally apply inside Federal prisons. There is no Federal law requiring BOP doctors to have a state medical license. An exception is at least some states is that County Coroners can investigate certain inmate deaths inside the prisons, which the Wardens and BOP higher ups hate.

Posted by: Jim Gormley | Dec 5, 2023 11:44:30 AM

In the last 35 years, much of the expense of treating inmate medical problems has been caused by the high rates (compared to the free world) at which inmates have HIV/AIDS and Types B & B Hepatitis (mostly caused by I.V. drug use). In the early 2000s, an Alpha Interferon treatment because available for Treating (and virtually eliminating) Hepatitis, but the treatments cost $45,000 to $80,000 per inmate. The BOP balked at paying for the Alphe Interferon treatments, by trying to call them "experimental", but they were not. Eventually, some inmates sued and won in Federal Court and Judges Ordered them to provide the Alpha Interferon treatments to inmates with Hepatitis.

Posted by: Jim Gormley | Dec 5, 2023 11:53:34 AM

Doug: I recall that about 6 months into the COVID-19 pandemic (September 2020), more than half of the cases of COVID-19 in Ohio were among inmates inside the Ohio Department of Corrections prisons. Prison employees were also getting infected and dying of COVID-19. Have you ever seen comprehensive Ohio prison numbers for COVID-19 infections and deaths between March 2020 and say, March 2023? Here in Kentucky, our recently re-elected Gov. Andy Beshear was attacked during the recent election for having released about 1,700 Kentucky inmates up to 1-year early (before their sentences would have normally ended), due to their health-related risks of contracting and/or dying from COVID-19. The Republican candidate cited the number of new criminal offenses these 1,700 inmates had committed following release, without regard to whether the offense was committed more than 1 year following release. In other words, most of those new crimes were committed after the inmates would naturally have completed their sentences and been released in the normal course.

Posted by: Jim Gormley | Dec 5, 2023 12:04:45 PM

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