The Alabama Department of Corrections (DOC) currently faces its worst tuberculosis outbreak in five years. Prison officials reported nine cases so far this year, a significant increase from the fewer than five infections documented annually.
This unprecedented public health conundrum comes on the heels of a major court case stemming from the poor medical treatment of prisoners in Alabama’s DOC and overcrowding of the correctional institutions, including St. Clair Correctional Facility, which holds 300 more inmates than space allows.
Tuberculosis, a contagious bacterial infection also known as TB, infects the lungs and spreads to other organs if not treated immediately. Common symptoms include chronic cough, fever, night sweats, and weight loss. Some experts say it’s common to confuse TB for less deadly illnesses like pneumonia or bronchitis. According to the Centers for Disease Control and Prevention, TB is more common in prisons than in the general population.
To prevent the spread of the disease, St. Clair — the site of all but one TB case — isn’t accepting new inmates, and prison officials are transferring other inmates to other institutions.
“This is a very serious outbreak,” Pam Barrett, director of the tuberculosis control, told the Associated Press. “We think we’re at the end of it. The Department of Corrections is a hotbed of TB because of the living arrangements.”
In June, the Southern Poverty Law Center (SPLC) and the Alabama Disabilities Advocacy Center filed a lawsuit against Alabama’s DOC on behalf of 40 inmates after one had his foot amputated upon contracting gangrene and another succumbed to prostate cancer, despite tests that identified “rising cancer markers.”
Joshua Dunn, an inmate with bipolar disorder, also allegedly suffered more than a dozen stab wounds and slit his wrists on a couple occasions. During a press conference, SPLC’s Maria Morris touched on the prison system’s failure to provide Dunn with adequate mental health care.
“The results that we found are shameful,” Morris told NY Daily News. “People are suffering and even dying because their obvious medical and mental health care needs are not being met. [Dunn] begged for mental health care. He wasn’t provided with mental health care. He was provided with razor blades in order to shave.”
The dearth of adequate health care is not unique to Alabama’s prison system. In 2012, more than 33,000 inmates filed a class-action lawsuit against Arizona’s department of corrections for failing to hire medical personnel and withholding mental health care to inmates suffering from thoughts of suicide. According to court documents, inmates had to wait years to receive treatment for broken teeth and fractured bones. Other inmates’ mental health reportedly declined after 24-hour stints in solitary confinement.
Earlier this year, a neutral assessment of the California prison system found that severe overcrowding led to instances preventable illness, death and suicide. According to a report compiled by the County of Monterey and a plaintiff in a high-profile case against the prison system, inmates were often hospitalized because prison officials neglected injuries and did not administer the appropriate medication. Inmates on pretrial detention also suffered fractured skull bones and vision loss upon violent contact with offenders.
Rikers Island in New York has also had its share of bad press. A four-month investigation by the New York Times found that more than 120 mentally ill inmates at the correctional facility often suffered deafening blows to the body at the hands of corrections officers during an 11-month period. Five of the reported beatings followed inmate suicide attempts. New York mental health officials said that the prison system’s inability to treat the growing mental health population — which now stands at more than 40 percent — plays a role in the violence between inmates and assaults by officers not trained to provide adequate mental health care.
According to a 2007 issue of the Journal of American Academy of Psychiatry and the Law, the majority of the nation’s prisoner population — many of whom come from economically disadvantaged backgrounds and have substance abuse problems — suffers from ailments including major depression, personality disorder, post-traumatic stress disorder, attention deficit hyperactivity disorder, and Asperger’s syndrome, a high-functioning form of autism. State prison systems have not been able to keep up.
Some experts link the overcrowding of American prisons and deterioration of mental health services to policies enacted during the Reagan administration that deinstitutionalized mental health care in the country. The prison population, which has tripled in the last 30 years, includes nearly 70 percent of inmates that suffer from mental ailments and substance abuse problems. A shift in resources from clinics and hospitals to prisons has made the Cook County prison system in Illinois, Los Angeles County’s prison system, and Rikers Island in New York three of the nation’s largest mental health care providers to date.