When preventable infections turn deadly behind bars | The Excerpt – USA Today

Analysis of In-Custody Deaths in the U.S. Correctional System and Implications for Sustainable Development Goals

A recent investigation has brought to light critical failures within the United States correctional system, resulting in a significant number of preventable deaths. These findings have profound implications for the nation’s commitment to achieving the United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), SDG 10 (Reduced Inequalities), and SDG 16 (Peace, Justice and Strong Institutions).

Failures in Upholding SDG 3: Good Health and Well-being

The core of the investigation reveals a systemic disregard for the health and well-being of incarcerated individuals, directly contravening the principles of SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages.

Key Findings on Healthcare Deficiencies

• Mortality Rate: An analysis of data from 2015 to 2023 uncovered approximately 49,000 deaths in U.S. jails and prisons.
• Preventable Deaths: At least 1,800 of these deaths were linked to sepsis, a life-threatening condition that is often survivable with basic and timely medical intervention, such as antibiotics and fluids. This figure is considered an undercount due to incomplete reporting.
• Inadequate Care: Inmates frequently face delayed or denied medical care, unhygienic conditions, and staff skepticism, which exacerbates health risks and leads to preventable fatalities.
• Barriers to Treatment: The process for inmates to request medical attention is often bureaucratic and dismissive. Staff may accuse inmates of “malingering” (faking illness), which can be a punishable offense, thereby discouraging individuals from seeking necessary care.

Case Studies: The Human Cost of Medical Neglect

1. Rick Hall: A man with no criminal history experienced a mental health crisis and was taken to jail for his own protection. While awaiting a competency hearing, he was denied communication with his family and proper medical evaluation. An untreated burst ulcer led to a fatal infection, and he died from sepsis within two weeks of his incarceration.
2. Terrell Ellis Jr.: A 26-year-old man who turned himself in on a DUI charge died from sepsis caused by pneumonia just 12 days later. Surveillance footage showed medical staff screaming at him and dismissing his pleas for help. His case was described by staff and other inmates as “The Boy Who Cried Wolf,” highlighting a culture of disbelief and neglect that proved fatal.

Challenges to SDG 16: Peace, Justice and Strong Institutions

The report exposes deep-seated institutional failures that undermine SDG 16, which calls for effective, accountable, and inclusive institutions at all levels. The correctional facilities described fail to provide justice and protect fundamental human rights.

Systemic Institutional Failures

• Resource Deficiencies: Many correctional facilities are chronically underfunded and understaffed, compromising their ability to provide constitutionally mandated healthcare.
• Outsourcing and Accountability: To manage costs, many institutions contract for-profit healthcare companies. These contractors have been the subject of numerous lawsuits for providing substandard care. They can often evade long-term accountability by declaring bankruptcy and reforming under a new name.
• Regulatory Gaps: Federal rules governing Medicare, which mandate licensed medical professionals, do not apply within correctional facilities. This allows some prisons and jails to employ staff with restricted licenses who may not be qualified to practice in standard clinical settings.

Erosion of Justice and Legal Principles

• Constitutional Violations: The denial of adequate medical care is a violation of the Eighth Amendment’s prohibition of “cruel and unusual punishment.” The Supreme Court has affirmed that inmates have a constitutional right to medical care.
• Legal Hurdles: For legal action to be successful, families must prove “deliberate indifference” on the part of staff, a high legal standard that is difficult to meet. Consequently, many cases are settled out of court or dismissed.
• Disproportionate Consequences: For individuals held on minor offenses, such as trespassing or probation violations, the failure of the system to provide basic care effectively transforms their sentence into a death sentence, a complete failure of the principle of proportional justice.

Broader Implications for Sustainable Development

Impact on SDG 10: Reduced Inequalities

The disparity in health outcomes between the incarcerated and the general population is a stark example of inequality, which SDG 10 seeks to reduce. The investigation demonstrates how a vulnerable and marginalized group is systematically denied access to a basic standard of health, perpetuating a cycle of disadvantage and poor health outcomes.

Conclusion: Societal and Financial Costs

The failure to address the healthcare crisis in correctional facilities carries significant costs that extend beyond the prison walls, impacting families, communities, and the integrity of the justice system.

Summary of Consequences

1. Human Cost: The primary cost is the loss of human life and the devastation inflicted upon families who lose loved ones to preventable conditions.
2. Ethical Cost: The system’s failures erode public trust and contradict foundational societal values, such as the presumption of innocence and the right to humane treatment.
3. Financial Cost: Lawsuits resulting from medical neglect lead to large financial settlements. When these settlements exceed insurance limits, the financial burden often falls upon taxpayers, creating a direct economic cost to the community for institutional failures.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being
   • The entire article revolves around the health outcomes of incarcerated individuals. It focuses on preventable deaths, inadequate medical care, the spread of treatable infections like sepsis, and the challenges inmates face in accessing healthcare. The mention of mental health crises and chronic illnesses (“comorbidities”) further solidifies this connection.
2. SDG 16: Peace, Justice and Strong Institutions
   • The article critically examines the justice system’s failure to protect the basic rights of people in its custody. It discusses the constitutional right to medical care under the Eighth Amendment, the lack of accountability within correctional facilities and their healthcare contractors, and the legal battles families must fight to get answers and justice. This directly relates to the effectiveness, accountability, and fairness of public institutions.
3. SDG 10: Reduced Inequalities
   • The article highlights the profound inequality in health outcomes and access to care experienced by incarcerated people, a vulnerable and marginalized group. It describes how their health needs are often dismissed, leading to death from conditions that are easily treatable in the general population. This points to a systemic failure to ensure equal opportunity and protection for all, regardless of their status.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Under SDG 3: Good Health and Well-being
   • Target 3.8: Achieve universal health coverage, including access to quality essential health-care services. The article demonstrates a clear failure to meet this target for the incarcerated population. Inmates are denied “basic treatment” like “antibiotics and fluids” for sepsis, and face significant “bureaucracy to get the treatment that they are asking for.”
   • Target 3.4: Reduce premature mortality from non-communicable diseases and promote mental health and well-being. The article details numerous premature deaths from preventable causes. The case of Rick Hall, who was jailed during a “mental health crisis” and received no adequate care, directly addresses the failure to promote mental health and well-being.
2. Under SDG 16: Peace, Justice and Strong Institutions
   • Target 16.3: Promote the rule of law and ensure equal access to justice for all. The article discusses how the legal standard of “deliberately indifferent” medical care violates inmates’ Eighth Amendment rights. The fact that families must file “hundreds of these lawsuits that happen every year” to seek accountability shows a struggle for equal access to justice.
   • Target 16.6: Develop effective, accountable and transparent institutions at all levels. The investigation itself, which required a “freedom of information lawsuit” to obtain unredacted death reports, points to a lack of transparency. The article also describes a lack of accountability, where for-profit healthcare contractors “can declare bankruptcy and just simply change their name” to evade responsibility for lawsuits.
3. Under SDG 10: Reduced Inequalities
   • Target 10.3: Ensure equal opportunity and reduce inequalities of outcome. The article exposes a severe inequality of outcome, where an infection can become a “death sentence” for an inmate but is “often survivable” for someone outside the prison system. Policies described, such as punishing inmates for “malingering,” actively create barriers and worsen these unequal outcomes.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Indicators for SDG 3 (Good Health and Well-being)
   • Mortality Rate in Custody: The article provides a direct figure: “roughly 49,000 deaths in jails and prisons over eight years.” This serves as a baseline indicator for overall mortality.
   • Cause-Specific Mortality Rate: The investigation identified “at least 1,800 tied to sepsis,” providing a specific indicator for deaths from treatable conditions.
   • Prevalence of Inadequate Care for Mental Health: The narrative of Rick Hall, who was jailed during a “mental health crisis” and died from a resulting untreated physical ailment, implies the need to track the number of inmates with mental health issues and the quality of care they receive.
2. Indicators for SDG 16 (Peace, Justice and Strong Institutions)
   • Number of Lawsuits Alleging Medical Neglect: The article states that lawyers “get calls three to four times a week” and there are “hundreds of these lawsuits that happen every year,” which can be quantified as an indicator of institutional failure and attempts to seek justice.
   • Institutional Accountability Measures: The practice of healthcare contractors changing names to avoid liability could be tracked as an indicator of poor accountability. Conversely, the number of successful lawsuits, like the “$33 million” award to Terrell Ellis’s family, can measure instances where accountability is enforced.
   • Data Transparency: The need for a “freedom of information lawsuit” to access death reports indicates a lack of transparency. The public availability of such data would be a key progress indicator.
3. Indicators for SDG 10 (Reduced Inequalities)
   • Disparity in Health Outcomes: The stark contrast between sepsis being “often survivable with basic treatment” and its deadly effect in prisons is an implicit indicator of health inequality. This could be measured by comparing mortality rates for specific conditions between incarcerated and non-incarcerated populations.
   • Existence of Punitive Healthcare Policies: The policy of punishing inmates for “malingering” by fining them or sending them to solitary confinement is a specific practice that creates inequality. Tracking the number of facilities with such policies would be a relevant indicator.

4. Summary Table of SDGs, Targets, and Indicators

Source: usatoday.com