Doing Double Time: Chronic Diseases a Chronic Problem in Prisons

David Smith (name changed to protect him and the identity of people associated with his crime), a prisoner at Rhode Island's John J. Moran Medium Security Prison, watches television during free time from his bed on December 10, 2013 in Cranston, Rhode Island. Smith, who is 70, is currently six years into a 40-year sentence for attempted murder. Smith says prior to his most recent conviction he was working as a mechanic, though illness and financial issues eventually led to him trying to murder his brother's sister. He now suffers from a long list of medical problems including chronic obstructive pulmonary disease, bronchitis, diabetes and ulcers. His list of medications includes an oxygen tank, 13 pills taken on various daily and weekly schedules, two inhalers and daily insulin injections. Smith is one of the rare prisoners who gets a cell to himself, due to his medical condition. Andrew Burton/Getty

Gregory Finney, then 37, felt extremely unlucky but in good physical condition when he arrived at Louisiana State Penitentiary in 2001. He had been shipped to the notorious maximum-security prison in Angola to serve 15 years for drug possession and shoplifting. Up to that point in his life, Finney hadn’t worried much about his health, in part because he was too busy scrambling to hold a job and avoid getting arrested.

It turned out his health should have been a main concern. Not long after he got there, the prison clinic informed Finney he was on a fast track to heart disease that could kill him—he was diabetic and had hypertension. Angola is the largest maximum-security prison in the U.S. and one of the most dangerous, so Finney suddenly realized he would now be fighting for his life in more ways than one. “I didn’t want to die in Angola,” he says.

In the years that followed, Finney struggled to get decent health care. The prison doctors prescribed insulin shots and gave him pills to manage his diabetes and high blood pressure, but two to three months might pass before he was able to see a physician for a follow-up exam. The clinic had too many patients and too many with far more serious illnesses. If Finney’s blood pressure happened to be too high on a day when he finally got an exam, the doctor would simply give him more medications instead of conducting further evaluation to determine how best to adjust his treatment. By the time he was released 15 years later, he was taking 13 different medications, and the treatment plan hadn’t done much to improve his condition.

The health care system at Angola was tragically slow and mostly useless, says Finney. “In prison, you won't be seen when you have the illness; you get seen when they have the time.”

The Other Life Sentence

In the U.S., the only citizens constitutionally guaranteed to have access to health care are prisoners, but experts agree that the treatment of serious chronic illnesses in prisons is a disgrace.

The U.S. Centers for Disease Control and Prevention recently released its first-ever national study on the state of prison health systems throughout the U.S. It suggests that most state prisons are well aware that chronic medical conditions are a serious threat to this population, but the care after an inmate is diagnosed is inconsistent and sometimes does more harm than good.

Staffing is a problem. In addition to medical emergencies, health care services in prison tend to focus on conditions that could have an immediate and widespread impact, such as infectious diseases like HIV and tuberculosis that could affect the larger population—both in prison and upon release. Psychiatric illness and addiction are also top priorities, since these disorders can result in suicide or even homicide.