Medical Justice Alliance

The Medical Justice Alliance


By: Anna Wright, MD

In early 2020 the COVID-19 pandemic descended upon the world, and schools and businesses closed their doors. People retreated into their homes and wore masks when they ventured out. From their front row seats in the emergency department, Drs. William Weber and Dr. Mark Fenig watched the crisis unfold. Personal protective equipment (PPE) supply, changing policies, and concern for their own health did not deter them from considering the impact of COVID-19 on vulnerable populations. They realized that incarcerated people were more susceptible to COVID-19. 


Jail cells often don’t have enough space for occupants to remain six feet apart, and many don’t contain sinks and running water for hygiene.1 The prison population is aging, and incarcerated people are disproportionately affected by chronic diseases which can increase the severity of COVID-19.2 


As the pandemic played out, data validated their idea. Incarcerated and detained people have experienced a disproportionate COVID-19 burden when compared to the general US population.3 In the first year of the pandemic, US prisoners were 5 times more likely to contract COVID-19 and almost 3 times as likely to die as compared to the US population.4


Their awareness of the challenges of COVID in the incarcerated population led to a deeper understanding of the other medical challenges facing incarcerated people. Acute and chronic diseases and mental illness including substance abuse and dependence occur more commonly among incarcerated people than the general population.5 The number of elderly people in jails and prisons is also increasing, and many facilities lack the resources to address their health conditions.5


Drs. Fenig and Weber wanted to make an impact. The Medical Justice Alliance was born out of their desire to address health disparities among incarcerated people. It is a network of physicians across at least thirty states. Physician volunteers provide free or reduced cost medical expert testimony. State and federal defenders, the ACLU, and non-profit advocacy organizations such as the Florence Project apply to utilize their services. 


Physicians from a range of medical specialties agree to take about two cases per year, and they receive training and mentorship during their first assignment. Usually, they spend between 4 and 6 hours working on each case. Because the cost of such expertise would easily exceed several thousand dollars, most incarcerated or detained people could not otherwise afford this service. 


Describing a success story, Dr. Weber detailed the time compassionate release was granted to a 90-year-old man who was wheelchair bound and dependent on oxygen. Cases also involve weighing in on the necessity of surgical treatment, securing medical devices such as a CPAP machine, and advocating for standard treatment of chronic medical conditions such as hypertension.


The 8th Amendment to the U.S. Constitution serves as the basis for the Medical Justice Alliance’s advocacy. According to interpretations of this amendment, incarcerated people are guaranteed medical care and are protected from experiencing severe consequences because of unaddressed medical needs.6 Upholding this 8th Amendment right sometimes requires advocacy. 


“There is very little accountability in prisons,” Dr. Weber shared as he described one case. Yanet* was seeking asylum from Cuba, and she was residing in a detention center when she developed chest pain and palpitations. Her heart rate reached 160 beats per minute, and yet her work-up consisted only of a thyroid panel. While an accrediting body for correctional healthcare exists, agreements with correctional healthcare providers often lack specific penalties for failing to adhere to these standards.7 Accreditation is voluntary, and even accredited facilities lack the type of regulations and oversight required by the Joint Commission.8


The prison healthcare delivery system also creates challenges for incarcerated people. More than half of US jails hire private companies to provide healthcare.9 Several large companies provide most of these services.9 Cost-saving is a large motivation for contracting with a private company.9 Many correctional facilities even charge inmates a co-pay that is usually cost-prohibitive based on their ability to pay.10

*Not her true name.

Dr. Weber also provided tips on beginning social medicine projects. He says a lot of opportunities for addressing social determinants of health in the ED are grassroots efforts. All it takes is to keep your eyes open. 

He helped start a clothing closet in his department. Staff members donate clothing, and the items are sorted and packaged by size. Going home in paper scrubs after having their clothes cut off during a trauma evaluation can be dehumanizing. The clothing closet provides a small opportunity to dignify the experience.

He also organized an emergency department food pantry and organized discrete condom distribution. His efforts reveal how one person can make a difference. He did have to wonder what his neighbors thought when a very large box of condoms was delivered to his apartment, though!




References:

  1. Kajstura A, Landon J. Since You Asked: Is Social Distancing Possible Behind Bars? Prison Policy Initiative. Published online April 3, 2020. https://www.prisonpolicy.org/blog/2020/04/03/density/

  2. Li W, Lewis N. This Chart Shows Why the Prison Population is So Vulnerable to COVID-19. The Marshall Project. Published online March 19, 2020. https://www.themarshallproject.org/2020/03/19/this-chart-shows-why-the-prison-population-is-so-vulnerable-to-covid-19

  3. U.S. Department of Justice. Federal Prisoner Statistics Collected under the First Step Act, 2021. Bureau of Justice Statistics. 2021;NCJ 301582. https://bjs.ojp.gov/content/pub/pdf/fpscfsa21.pdf

  4. Marquez N, Ward JA, Parish K, Saloner B, Dolovich S. COVID-19 Incidence and Mortality in Federal and State Prisons Compared With the US Population, April 5, 2020, to April 3, 2021. JAMA. 2021;326(18):1865-1867. doi:10.1001/jama.2021.17575

  5. Office of Disease Prevention and Health Promotion. Healthy People 2020: Incarceration. U.S. Departement of Health and Human Services; 2021. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/incarceration

  6. ACLU National Prison Project. Know Your Rights: Medical, Dental, and Mental Health Care. ACLU. Published online November 2005. https://www.aclu.org/sites/default/files/images/asset_upload_file690_25743.pdf

  7. Huh, Kil, Boucher A, McGaffey F, McKillop M, Schiff M. Jails: Inadvertent Healthcare Providers. The Pew Charitable Trusts. Published online January 2018. https://www.pewtrusts.org/-/media/assets/2018/01/sfh_jails_inadvertent_health_care_providers.pdf

  8. Olson MG, Khatri UG, Winkelman TNA. Aligning Correctional Health Standards with Medicaid-Covered Benefits. JAMA Health Forum. 2020;1(7):e200885-e200885. doi:10.1001/jamahealthforum.2020.0885

  9. Szep J, Parker N, So L, Eisler P, Smith G. US Jails are Outsourcing Medical Care- and the Death Toll is Rising. Reuters. Published online October 26, 2020. https://www.reuters.com/article/us-usa-jails-privatization-special-repor/special-report-u-s-jails-are-outsourcing-medical-care-and-the-death-toll-is-rising-idUSKBN27B1DH

  10. Sawyer W. The Steep Cost of Medical Co-pays in Prison Puts Health at Risk. Prison Policy. Published online April 19, 2017. https://www.prisonpolicy.org/blog/2017/04/19/copays/

John Purakal