Consider This from NPR - Why Are So Many Inmates at This Federal Prison Dying?

Episode Date: September 22, 2023

Close to five thousand people have died in federal prison since 2009.There are 100 federal prisons across the U.S. An NPR investigation found that a quarter of those deaths happened at one federal prison. Butner Federal Correctional Complex in North Carolina. Inmates have a constitutional right to health care. Being denied care is considered cruel and unusual punishment. But many of the sick inmates who wind up at Butner don't get the healthcare they are entitled to – and some end up dying. NPR's Meg Anderson tried to find out why.Email us at [e-mail] more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

This message comes from Indiana University. Indiana University performs breakthrough research every year, making discoveries that improve human health, combat climate change, and move society forward. More at iu.edu forward. The cost of health care behind bars is getting more expensive. Over the past three decades, the population of elderly people serving time in state and federal prison has skyrocketed. 15% of the men and women serving time are 55 or older. And it's not just the elderly. Prisons and jails are environments of risk.

Lauren Brinkley Rubenstein is an associate professor at Duke University. She studies the health impacts of the criminal legal system. People who are incarcerated on average have at least two chronic conditions, so they tend to be very sick, more sick than the general population. Inmates have a constitutional right to health care. Not getting that care is considered cruel and unusual punishment. But getting that care, it doesn't always happen. It didn't happen for Jeffrey Ramirez. So in this picture, my dad loved coming to the field trips

to Chaperone with my grandma. Are those Legos? Yeah. This was at Legoland. Earlier this this year yvette ramirez often found herself in her grandparents living room looking at old photos of her dad jeffrey ramirez um oh right here he's right here this is at his baseball game um god how old is he he was like five she's talking to npr's Meg Anderson about her father, showing her photos surrounded by candles, little ceramic angels, vases of fresh flowers.

This is like his altar. Everyone that comes and wants to bring him flowers, we set them up right here for him. And we sit in front of this and we pray for him. Sometimes I like to come up here and talk to him. Jeffrey Ramirez had died just a few weeks earlier of cancer. When he was first diagnosed, he was in federal prison. And Yvette thinks he died because he wasn't listened to when he first started complaining. We try not to hold hate or anger because my dad's not the only one.

NPR has been tracking what happens to people like Yvette's dad, people who died during or shortly after being in the custody of the Federal Bureau of Prisons. When NPR's investigations team started digging, they found stories of inmates across the country who went without needed medical care. Some ended up getting very sick, and some, like Jeffrey Ramirez, didn't survive. If the public knew how badly the medical issues were of these individuals, I would think they would be shocked that they're still incarcerated. Elizabeth Blackwood, a lawyer at the National Association of Criminal Defense Lawyers, says she and the lawyer she works with hear stories like this all the time.

What type of punishment are we really wanting to dole out on people? Because none of these people had death sentences. None of these people were sentenced to excruciating pain and torture while they aren't getting the medical treatment and not getting relief from their painful cancer. But yet that's being inflicted

on them every day on a regular basis. Consider this. Nearly 5,000 people have died in federal prisons since 2009. And even though there are over 100 federal prisons nationwide, an NPR investigation found that a quarter of those deaths happened in just one place, which raises the question, why are so many people dying at a single prison? An NPR investigation found that a quarter of those deaths happened in just one place, which raises the question, why are so many people dying at a single prison? From NPR, I'm Scott Detrow. It's Friday, September 22nd. This message comes from WISE, the app for doing things in other currencies. Send, spend, or receive money internationally, and always get the real-time mid-market exchange rate with no hidden fees.

Download the WISE app today or visit wise.com. T's and C's apply. This message comes from Indiana University. Indiana University drives discovery, innovation, and creative endeavors to solve some of society's greatest challenges. Groundbreaking investments in neuroscience, climate change, Alzheimer's research, and cybersecurity mean IU sets new standards to move the world forward, unlocking cures and solutions that lead to a better future for all. More at iu.edu forward. Support for NPR and the following message come from the Lemelson Foundation, dedicated to improving lives through invention, innovation, and climate action. It's Consider This from NPR. We're going to hear more about Jeffrey Ramirez and what happened

leading up to his death. NPR's Meg Anderson spoke with him a little over a week before he died, and she takes it from here. Jeff Ramirez was a federal prisoner when he first felt an inkling that something was wrong with him. I remember when I was younger, I was told, once you get to a certain age, you should check yourself. And so that's exactly what I did. It was 2020, and he found a lump in his left testicle about the size of a BB. I put in a medical slip, and they really didn't pay much attention. And well, I didn't really push it because I didn't think it was anything serious. By early 2021, the lump had gotten a lot bigger. So he asked to see a doctor.

The staff at his Phoenix prison ordered an urgent ultrasound, but... That ultrasound never came, never came. It just kind of brushed me off. He waited for months. And that whole time... It was like getting kicked in the groin. I got to the point where it was really uncomfortable. I couldn't even sit down.

When I asked the assistant warden, she told me to trust the process. And yeah, that process was very long. Ramirez didn't get an ultrasound until more than a year after he started complaining. It was January of 2022. And as he was leaving that procedure... All of a sudden, I see like three nurses running out towards us, like, you're not going anywhere. You need to be admitted. And that's when I found out that I had cancer. Ramirez was diagnosed with advanced testicular cancer. By then, it was already in his brain and lungs. He was transferred to the prison hospital at the Butner Federal Correctional Complex in North Carolina. And that's pretty common. If you get cancer in federal prison, there's a good chance you'll get sent there.

In fact, NPR obtained records from the Federal Bureau of Prisons, the BOP, and found that one in four of the people who died in its custody since 2009 died at Butner. To an extent, more deaths there make sense. The Federal Medical Center at Butner is the Bureau's main cancer treatment facility, and cancer is one of the BOP's leading causes of death. But NPR also found stories of inmates at prisons all over the country going without needed medical care. We found more than a dozen who waited months or even years for treatment. stories of inmates at prisons all over the country going without needed medical care.

We found more than a dozen who waited months or even years for treatment, including people with symptoms that were obviously concerning. Unexplained pain, bleeding, lesions, a lump that wasn't there before. Several ended up with advanced cancer, like Joseph Guadagnoli. He finally calls me and he's like, bro, I'm dying. I've got cancer that started in my kidneys and moved into my bones and has been in my lungs for a long time. Michael Boffner. The guards were convinced he was faking it. They felt that he had a tumor in his brain the size of an egg. Greg Baker.

Greg went into prison a healthy man. He came out unable to work. A completely disabled person. Another inmate waited eight months for a biopsy and seven more to see an oncologist. Another had nosebleeds several times a day for months before being diagnosed with cancer. Some of these inmates survived, some were released early, and some were sent to Butner, like Jeff Ramirez, the inmate with testicular cancer. It just fell through the cracks.

Zandra Lopez is the public defender who represented Ramirez. Jeff's case was obvious, but we've seen it in a lot of our cases. When our clients are requesting for help, the internal medical staff recognize that these people need to go out to a specialist, but it goes in this hole. She says she and her colleagues represent inmates nationwide who are not being seen fast enough. And by the time they do, it's oftentimes too late. For cancer, there's research that backs that up. Early detection is crucial. Testicular cancer, for example, is 98% curable if found early. David Vaughn, an oncology professor at the University of Pennsylvania, says a patient with a firm and

large testicle, like what Ramirez had, should get an ultrasound as soon as possible. Honestly, if someone comes into our emergency room with this complaint, they get an ultrasound while they're in the emergency room. If someone's going to see their primary care doctor, one would expect that the ultrasound would be done within a few days. That's the standard. That's what happens, you know, every day. The Bureau of Prisons declined our request for an interview, but a spokesperson told NPR the BOP is, quote, committed to providing safe, effective health care that is clinically appropriate, and that it makes a

quote, proactive effort to screen and identify disease at its earliest stages. Yet current and former staff at Butner told us they see inmates transferred to the prison when their disease is so advanced that there's not much to do beyond palliative care. One current medical staff member didn't want to use her name or her voice because she worried about retaliation, but we had an NPR editor read her words. So many inmates have told me, I complained about this lump or I complained about this pain for so long and they only gave me cream, they only gave me Motrin, they never sent me out for tests or anything. Now they send me here and I have stage 3 or stage 4 cancer. Our question is always, what took them so long to get to us, and why did they send them to us when there's nothing that we can do?

She said she believed some of their deaths could have been avoided. But even if an inmate gets to Butner fast, they still might not get the care they need, despite Butner supposedly being one of the best places to land if you get really sick in prison. This call is from a federal prison. This call is from a federal prison. This call is from Frank Carr. Frank Carr was an inmate at Butner.

Hello, Meg? Did you hear me? When he called me last fall, he had been waiting more than two years for heart surgery to repair a narrow aortic valve. Even though prosecutors acknowledged he needed it when he was sentenced in 2020. It got worse. It just began to get worse, sir. I had a heart attack. Records obtained by NPR show he emailed prison staff a year before we talked, asking for surgery. I do not want to die because I've seen so many people die in here. I witnessed people die, and I don't want to be one of the statistics.

A few months later, Carr got his surgery. But he thinks because he's a prisoner, he had to wait two years for a procedure that everyone acknowledged he needed. And it wasn't just Carr who didn't get the advanced care that Butner promises. One Butner inmate we found waited five months for surgery to treat skin cancer, a treatment which eventually wasn't feasible anymore. A dermatologist testified in court that the delay was, quote, not up to any standard of care. Another inmate died after Butner's staff failed to give him his anti-epileptic medications. A lawsuit filed by his family was settled earlier this year. And last fall, internal records show two Butner inmates died in the night after they didn't get timely medical attention. Union officials say that's because most of the prison complex has

no medical staff working at night. Butner Correctional Officer and Union President Delshawn Harding told NPR he believes staffing shortages are the primary reason for inmates not receiving needed medical care. We can't provide the security that is needed. We can't provide the medical treatment that's needed and the safety that's needed to fulfill the mission. Across the federal prison system, staffing shortages have been documented for decades. Dr. Homer Venters works as a court monitor of prison health care. He says finding cancer early or keeping a chronic problem from getting worse requires regular contact between patients and health providers.

Without enough staff to do that... It's absolutely inevitable that people's symptoms will worsen and people then come to the attention of health staff much closer to death, much more in an acute emergency than needed to have happened. Venter says after a death, prison officials should ask two questions. Did the inmate receive appropriate care? And did anything occur behind bars that contributed to the death? That is something that should happen. It would happen if you were in a nursing home and died.

It would happen if you were in a hospital. But most prisons and jails want nothing to do with that kind of accountability. The Bureau of Prisons does do a mortality review when someone dies in prison. But Venters says those reviews aren't always rigorous. In a statement, the Bureau told NPR that no healthcare system is perfect, but the BOP makes an effort to improve its processes. In fact, the BOP claims its medical facilities, like Butner, are accredited by the Joint Commission, the organization that inspects and audits most U.S.

hospitals. But when we asked the Joint Commission about that, they said the BOP's accreditation expired two years ago. In response, the BOP told NPR it's looking for a new contract, and that Butner and the other prison hospitals are still observing the commission's standards. My question is, why do we have one of the nation's biggest health services not really being overseen by anybody outside of them? Jeff Ramirez, the inmate with testicular cancer, was eventually granted compassionate release. When he arrived at the San Diego airport in the summer of 2022, his family was waiting. When he came out, it hit me like, this is reality, you know? Yvette Ramirez, his 20-year-old daughter.

But he came to us with like the biggest smile on his face. And he just like embraced all of us. And it was like the best feeling. By January, his doctors had told him they had run out of options. I'm ticked off. I'm mad. There's a lot of emotions, and there's like, what ifs? What if, for instance, he hadn't been in prison when he got cancer? He was sure he would have gone to a doctor right away. But he didn't have control over that, and now he was waiting to die. I can go almost about any day.

I can go tomorrow. I can go a week from now, a month from now. It's all on God. I try not to think about it. It hurts. But I'm just trying to just be near him day by day. Ramirez spoke to NPR on January 5th. A week later, he began having seizures at home and was hospitalized.

On the morning of January 16th, Yvette was with him when he died. It was 6.43 a.m., and I was right there. And I think that's what gives me the most peace, that I was there holding his hand in the hospital room. She says it didn't have to be that way. I definitely think if he had gotten medical attention when he asked for it, I probably would have gotten to spend more time with my dad. She's trying not to feel angry about that.

That was NPR's Meg Anderson. And by the way, the team that brings you Consider This is also behind All Things Considered, our afternoon news show. It's a mix of the deep dives you're hearing on this podcast, along with other stories you'll want to listen to. Visit npr.org slash allthingsconsidered to stream it live every afternoon, seven days a week. It's Consider This from NPR. I'm Scott Detrow.