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    “Everyone Will Die in Prison” The medical care at Louisiana prisons

    This article was originally published by ProPublica, and republished here under a Creative Commons license.

    Janice Parker has witnessed the failing medical care at Angola, the largest prison in Louisiana, on her frequent visits to see her paralyzed son. Laws passed at the behest of Gov. Jeff Landry threaten to further strain that system.

    If there’s anything I’ve learned doing these stories it’s that: 1) Private prisons should be abolished; no CEO should be profiting off of the suffering of others, and the way they increase profits is to incarcerate more people and hope they return, 2) the prison systems in the South are horrific, and 3) the entire criminal justice system was set up so that the newly freed slaves could never truly be free.

    Looking at prison statistics, there was a chart comparing every U.S. state to countries around the world and Louisiana was the highest incarcerater.

    “When compared against each other, some U.S. states appear to be far more restrained in their use of incarceration than high incarcerators like Louisiana,” said Peter Wagner, Executive Director of the Prison Policy Initiative and co-author of the report. “But all U.S. states are out of step with the rest of the world.”

    Infographic comparing the amount of money spent on prison vs. education.
    Source: ucdavis.edy

    Below is a piece by ProPublica and Verite, written by Richard A. Webster, on how a new law in Louisiana is going to affect prisoners in the state.

    This article was produced for ProPublica’s Local Reporting Network in partnership with Verite NewsSign up for Dispatches to get stories like this one as soon as they are published.

    Janice Parker walked into the medical ward at the Louisiana State Penitentiary at Angola several years back, looking for her son, Kentrell Parker.

    He should have been easy to find. The 45-year-old New Orleans native had been bedridden since an injury in a prison football game left him paralyzed from the neck down more than a decade earlier. His bed was usually positioned near a window by the nurses’ station.

    When she didn’t see him there, Janice Parker feared the worst. Her son is completely dependent on staff to keep him alive: to feed him, clean him after bowel movements, change his catheter and prevent him from choking. Because he struggles to clear his throat, even a little mucus can be life-threatening.

    A nurse pointed toward a door that was ajar. Janice Parker’s son was alive, but she was disturbed by what she saw: He was alone in a dark, grimy room slightly larger than a bathroom, with no medical staff or orderlies nearby. He was there, he told his mother in a raspy voice, because a nurse had written him up for complaining about his care. This was his punishment — the medical ward’s version of solitary confinement. He told her he had been in the room for days, Janice Parker said during a recent interview. “There was no one at his bedside. And he can’t holler for help if needed,” she said.

    For years, Janice Parker said, she has complained to nurses and prison officials — in person, over the phone and through an attorney — about the neglect that she has witnessed on her frequent visits and that her son has described. He has told her that he’s gone days without food. He has developed urinary tract infections because his catheter hasn’t been changed. At one point, Janice Parker said, he developed bedsores on his back because nurses hadn’t shifted his body every few hours.

    Her complaints have gone nowhere, she said. “I don’t know what to do anymore,” she said.

    Kentrell Parker is among the most frail inmates in Louisiana’s prison system, requiring constant care from a medical system that has largely failed to meet the needs of people like him. The deficiencies of Angola’s medical system are well documented: Department of Justice reports in the 1990s, a court-monitored lawsuit settlement in 1998 and a federal judge’s opinions in another lawsuit filed in 2015.

    Case Study: “Patient 22” Choked on Sausage After Brain Injury

    U.S. District Judge Shelly Dick

    In a November 2023 opinion, U.S. District Judge Shelly Dick wrote that Angola’s medical care had not significantly improved since she ruled in 2021 that it amounted to cruel and unusual punishment. 

    Among the cases she cited to illustrate her conclusion was “Patient 22.” What happened to this inmate, she wrote, was “the most egregious example” of the prison’s substandard care and its practice of relying on inmate orderlies rather than trained professionals to provide medical care. 

    The 60-year-old patient, who had previously suffered a traumatic brain injury, was transferred to Angola’s emergency medical unit and then to an outside hospital after he was kicked in the face by another inmate, according to a medical expert for the plaintiffs. 

    The inmate returned to the prison, where he was sent to the medical ward for two and a half months, suffering repeated falls while there. Medical staff placed him in a “locked room with nothing but a mattress on the floor,” the judge wrote. A doctor who testified on behalf of the prison said putting a mattress on the floor was appropriate because of the inmate’s risk of falling. 

    Although a speech therapist had recommended a diet of soft food because the inmate had trouble swallowing, the prison failed to provide one, the judge wrote. In January 2021, the patient choked on a piece of sausage and died. An inmate orderly administered CPR until emergency medical services arrived.

    In court filings and testimony, the state pointed to an apparent conflict in medical records regarding the patient’s recommended diet. A doctor who testified on behalf of the prison said the death was accidental, and he didn’t believe that it showed a violation of the standard of care.

    In 1994, the Justice Department reported that Angola inmates were punished for seeking medical care, with seriously ill patients placed in “isolation rooms.” Prison staff failed to “recognize, diagnose, treat, or monitor” inmates’ medical needs, including “serious chronic illnesses and dangerous infections and contagious diseases.” Two decades later, a federal judge wrote that Angola’s medical care has caused “unspeakable” harm and amounts to “abhorrent cruel and unusual punishment.”

    For years, Jeff Landry, Louisiana’s new governor, defended the quality of Angola’s medical care. When he was attorney general, a post he held from 2016 until January, he argued that inmates are entitled only to “adequate” medical care, which is what they got. During the pandemic, Landry opposed releasing elderly and medically vulnerable prisoners, warning that it could result in a “crime wave” more dangerous than the “potential public-health issue” in the state’s prisons.

    And now that Landry has moved to the governor’s mansion, the number of inmates who rely on the medical care in Louisiana’s prisons is likely to grow. Soon after Landry was sworn in, he called for a special legislative session on crime. Over nine days in February, lawmakers worked at a dizzying pace to overhaul the state’s criminal justice system. They passed a law that requires prisoners to serve at least 85% of their sentences before they can reduce their incarceration through good behavior. Another law ends parole for everyone but those who were sentenced to life for crimes they committed as juveniles.

    The “truth in sentencing” law will nearly double the number of people behind bars in Louisiana in six years, from about 28,000 to about 55,800, according to an estimate by James Austin of the JFA Institute. The Denver-based criminal justice nonprofit studies public policy regarding prison and jail populations, including the jail in New Orleans.

    Austin projects that the law will add an average of five years to each new prisoner’s incarceration, resulting in a growing number of older inmates who will further burden prisons’ medical systems. The share of inmates 50 and older already has risen substantially in the past decade, from about 18% in 2012 to about 25% in 2023, according to figures from the Department of Public Safety and Corrections.

    Although these laws aren’t retroactive and won’t affect Parker’s chance of release, they could be devastating for future inmates in his condition. Louisiana has three programs that allow for its sickest inmates to be released; two of them will be eliminated and inmates will be eligible for the third only after serving the vast majority of their sentences, according to state Rep. Debbie Villio, R-Kenner, who spearheaded the legislation.

    Absent additional resources, Austin said, a medical system that for decades has struggled to care for its most vulnerable will “only worsen.” He called what is happening in Louisiana “one of the most dramatic plans to increase prison population I’ve ever seen.”

    Villio said in an email that she disagreed with Austin’s projections. (The Landry administration didn’t respond to questions from Verite News and ProPublica.) The nonpartisan Legislative Fiscal Office, however, estimated that the state’s expenses are likely to rise because inmates will be held longer.

    All told, the bills Landry signed seem designed to ensure that “everyone will die in prison,” said Bruce Reilly, deputy director of Voice of the Experienced, a New Orleans nonprofit that advocates for the rights of the incarcerated.

    “More and more sentences of 30 to 60 years, which are not uncommon, will be death sentences,” he said. “And we do not all age gracefully or go quietly in our sleep.”

    “They Don’t Even Try to Pretend to Show Compassion”

    After a jury found Parker guilty in the 1999 murder of his girlfriend, Kawana Bernard, he was sentenced to life without parole and sent to Angola. The sprawling maximum security prison, which holds about 3,800 inmates on the site of a former slave plantation, was once known as “the bloodiest prison in America” because of rampant violence. That reputation remains.

    Louisiana State Penitentiary
    The Louisiana State Penitentiary at Angola Credit: Kathleen Flynn

    Still, it wasn’t until her paralyzed son was sent to the prison’s medical unit that Janice Parker truly feared for his life.

    In the years that he has been held there, at least 17 prisoners have died after receiving substandard health care, according to U.S. District Judge Shelly Dick, who ruled in 2021 that Angola’s medical care was unconstitutional and in November 2023 that the state had failed to significantly improve it.

    “If he stays there,” Janice Parker said, “he’s gonna die.”

    Though Parker’s movements are now limited to facial expressions and slight shifts of his head, he was once known as “Coyote” for his relentless style of play as a cornerback for the East Yard Raiders in the prison’s full-pads football league. After the team won the prison championship in 2009, he was chosen for Angola’s all-star team.

    They traveled to Elayn Hunt Correctional Center to compete against its best players. After Angola dominated most of the game, its coaches pulled their starters to prevent injury, Derrick Magee, a former teammate, said in an interview. Parker insisted on playing.

    Magee said the memory of what happened during that game continues to haunt him nearly 14 years later. The opposing team ran a short run play. As their fullback drove a few yards forward, Parker drilled him, driving his neck into the player’s torso. Nearly a dozen others piled on.

    The whistle blew. One by one, the players stood up. Parker, however, lay on the grass. “What’s going on, Coyote?” Magee asked.

    “Man, I can’t move,” Parker replied.

    He had suffered a traumatic spinal cord injury in his neck. Dr. Raman Singh, the medical director for the Department of Corrections at the time, summarized Parker’s condition in a letter a month after his injury: “He requires total assistance with all activities of daily living.”

    After about 19 months of treatment outside the prison, Parker was taken back to Angola and admitted to its hospital, which includes a 34-bed ward for prisoners who need long-term or hospice care, according to the Department of Corrections.

    Janice Parker has observed the conditions in the medical ward on her frequent visits, nearly every month for more than a decade. The smell of urine and feces permeates the infirmary. Tables and medical equipment are covered in dust and grime, she said. Patients, suffering from open wounds and sores, scream in pain throughout the day.

    On one visit, she said, clumps of her son’s hair had fallen out and the bare patches of his scalp were covered in scabs. He told her he hadn’t been bathed in weeks. Another time, she found him lying in his own feces, suffering from an infection after bacteria had “entered his blood from his stool,” according to the 2015 lawsuit filed by her son and other inmates, in which Angola’s medical care was ruled unconstitutional.

    Kentrell Parker’s sister, Keoka, said that during the many visits she has made to Angola, not once has she seen a nurse check on her brother or any other inmate. Instead, it’s the inmate orderlies — untrained men who in many cases have been convicted of violent crimes — who care for the patients.

    “The certified people — the people with degrees, the nurses — they don’t turn my brother over, they don’t feed him, they don’t wash his face, they don’t give him therapy or exercise him,” Keoka Parker said. “They don’t even try to pretend to show compassion.”

    The Department of Corrections didn’t respond to questions from Verite News and ProPublica about the complaints by Parker’s family; in documents filed in response to his lawsuit, it denied all allegations related to him.

    Like her mother, Keoka Parker said she lives in terror of a phone call from the prison informing her that her brother has died because of medical complications or neglect.

    For Lois Ratcliff, whose son spent several years in Angola’s hospital after an infection paralyzed him from the waist down, that fear was realized.

    Ratcliff said she visited her son, Farrell Sampier, at least every other weekend in the prison hospital between 2013 and 2019. She often sat and talked with Parker. Seeing them suffer needlessly left her so depressed, she said, that she contemplated suicide. Ratcliff often wondered whether the cruelty was the point.

    “I’ll never be able to get that out my head, the things I seen, and how they treat the people,” she said.

    During a 2018 visit, Ratcliff said, she found Parker lying in his bed, his face surrounded by flies. The nurses did nothing and refused to let her help him, she said. Unable to swat the flies as they buzzed about, Parker did the only thing he could to bring himself some relief: He ate them.

    Case Study: “Patient 38” Locked in an Isolation Room With a Serious Infection

    Dick, the federal judge, cited a medical expert’s conclusion that “Patient 38” had died because of delayed medical care as one example of Angola’s substandard care. 

    This inmate, who had an artificial heart valve and suffered from diabetes, hypertension and chronic obstructive pulmonary disease, developed symptoms of a potentially life-threatening infection, Dick wrote. In response, Angola’s medical staff treated him for the flu, giving him Tylenol and an antiviral drug, and locked him in a room, a medical expert for the plaintiffs testified.

    The inmate’s condition worsened over the next three days, when his lab results showed signs of sepsis, a bacterial infection and kidney failure, Dick wrote. On the third morning, his vital signs indicated he had gone into shock, but there’s no record that a doctor provided care, according to medical experts for the plaintiffs. Based on his vital signs, the plaintiffs’ experts wrote, the patient “should have been sent to a hospital. Instead, he received no care.” 

    About an hour later, the patient was found on the floor of his isolation room, the judge wrote. Staff tried to revive him, but he was pronounced dead at a local hospital after cardiorespiratory arrest stemming from pneumonia, the judge wrote. 

    A medical expert hired by the state said the patient’s care met constitutional standards and that it was appropriate to treat him for flu rather than pneumonia. “The Court is dumbfounded to understand how treating these symptoms as flu can be justified without so much as a physical examination,” Dick wrote.

    In 2015, Parker and Sampier were among a dozen named plaintiffs in a class-action lawsuit against the Department of Corrections; the agency’s secretary, James LeBlanc; Angola’s warden; and the assistant warden in charge of medical care. The suit alleged that the prison’s medical care caused inmates to suffer serious harm, including the “exacerbation of existing conditions, permanent disability, disfigurement, and even death.”

    Dick ruled in favor of the plaintiffs in 2021. In a November 2023 opinion supporting that ruling, she concluded that the prison knew inmates were sick but failed to provide them with adequate treatment, worsening their conditions and in several cases leading to their deaths. That 100-page opinion confirms many of the allegations made by Parker’s family: untrained inmates doing the work of nurses, patients locked in isolation rooms, unsanitary conditions and a medical staff that routinely ignored patients’ needs.

    The judge’s ruling came too late for Ratcliff. In 2019, her 51-year-old son died at an outside hospital while in Angola’s custody. His autopsy indicated that he had suffered a stroke.

    The state has appealed Dick’s ruling; it went before the 5th U.S. Circuit Court of Appeals this month. Newly elected Louisiana Attorney General Liz Murrill, who was Landry’s top lawyer when he held that office, argued that prison administrators have made significant improvements, including the addition of air conditioning to several dorms, telemedicine and specialty clinics.

    “I believe that the judges should give us credit for what we have done to improve conditions,” Murrill said in court.

    She also pushed back against the very premise of the lawsuit, denying that medical care at the prison was ever lacking or unconstitutional. The state has argued that Dick’s ruling was based largely on a review by plaintiffs’ medical experts of the most difficult cases and that the judge didn’t consider whether problems stemmed from medical error or differences in medical judgment.

    “We never conceded there was a violation in the first place,” Murrill told judges.

    The Cost of Being Tough on Crime

    The legal fight over Angola’s health care system was part of a broader battle to improve conditions within Louisiana’s prisons and unseat the state as the per-capita incarceration capital of the country, if not the world. In 2017, two years after inmates filed suit, a bipartisan coalition of inmate advocates, law enforcement officials and politicians pushed through a package of bills to revamp the state’s criminal justice system and help inmates like Parker.

    Case Study: “Patient 29” Had 108-Degree Temperature, but Prison Staff Didn’t Try to Cool Him

    This 28-year-old inmate had requested help repeatedly but was never assessed by a medical provider, the judge wrote. In March 2020, the inmate called for help again, complaining of stomach and back pain. He was evaluated by an EMT, but there was no indication that he received any treatment. 

    That afternoon, the man was found on the floor, foaming at the mouth with a temperature of 108.2 degrees — “obviously a heat stroke,” according to a medical expert who testified for the plaintiffs. Medical staff did not try to cool the inmate with ice, Dick wrote. Instead, they inserted a catheter in an apparent effort to test his urine for illicit drugs. 

    An expert for the defense testified that there was no reason to administer ice. “You can only do so much when someone isn’t breathing and doesn’t have a heartbeat,” he said. “This was essentially a dead man.”

    That, Dick wrote, was the least of the failures. The larger problem, she wrote, is that the inmate’s calls for help were dismissed. The way this patient was treated, she wrote, showed “an attitude of general indifference.”

    In a January filing in federal appeals court, lawyers for the state wrote that prison medical staff use ice in heat stroke cases “when appropriate.” Even if the state were to concede that the patient should have been cooled with ice, lawyers argued, “This case would be at most a case of medical negligence.”

    That effort was hailed nationally and placed Louisiana at the forefront of a movement to combat mass incarceration. But it would be relatively short-lived. Landry would soon promise to roll back most of these changes as he campaigned for governor on a platform of fighting a post-pandemic spike in crime.

    In 2017, Department of Corrections officials went to the state Capitol to warn lawmakers that medical costs were taking up an exorbitant portion of their budget. LeBlanc, the corrections secretary, cited one chronically ill inmate who cost the agency more than $1 million a year. He told lawmakers that one of the best ways to tackle the problem was to reduce the prison population, in part by releasing terminally ill or bed-bound inmates.

    “I have inmates in Angola that are in fetal positions, who are paralyzed from the neck down, are in hospice,” LeBlanc said in a 2017 interview. “Their life is over, it’s done, they’re finished. Why do we need to keep them in prison? There’s no reason for that. They can spend their last few days with their family.”

    Lawmakers responded by dialing back some of the state’s more draconian penalties. They softened a “three strikes” sentencing law that put people in prison for life even for nonviolent offenses and created a medical furlough program that allowed bed-bound inmates and those unable to perform basic self-care to be released to a health care facility. All told, legislation enacted in 2017 resulted in a 26% decrease in the state’s prison population by the end of 2021 and nearly $153 million in savings by June 2022.

    While those changes saved money and freed up space in prisons, the programs to release infirm patients were flawed, said Dr. Anjali Niyogi, founder of the Formerly Incarcerated Transitions Clinic and co-author of a legislative task force report about those programs. The process was complicated, it was unclear how decisions were made and prison officials often overruled the opinion of medical professionals, she said.

    Case in point: Although Parker was initially sent to a medical facility after he was injured, the Department of Corrections brought him back to Angola. (Janice Parker has a copy of a letter from LeBlanc to Angola’s warden saying it was because Parker’s condition had changed, but her attorney was told years later that it had been because of an unspecified behavioral issue.) Since then, Parker has been repeatedly denied any kind of medical release, even though Angola’s medical director, unit warden and a mental health team have recommended it.

    In 2019, prison officials recommended that Kentrell Parker be approved for a medical furlough, which would allow him to serve the remainder of his sentence in a health care facility. Department of Public Safety and Corrections Secretary James LeBlanc declined to move Parker’s case forward to the state Committee on Parole, which has the final say. Parker’s family said LeBlanc has never explained his decision. Credit: obtained by Verite News and ProPublica. Highlighting by ProPublica

    The Department of Corrections declined to comment on Parker’s attempts to be released, saying any information would be contained in department documents provided by his family to Verite News and ProPublica.

    In 2022, state Sen. Royce Duplessis, D-New Orleans, tried to address shortcomings in the medical release programs. But by then, the political dynamics had shifted. Gov. John Bel Edwards, a moderate Democrat, was on his way out; Landry was taking high-profile stands against crime as he laid the groundwork for his gubernatorial campaign.

    Villio, a Landry ally, led the charge against Duplessis’ bill. When advocates contended that even prisoners convicted of violent crimes should be allowed to die with dignity, she responded: “Did the victims of murder have an opportunity to die with dignity? Were the victims of rape dignified in that act?”

    She took a similar message into last month’s legislative session as the new chair of the powerful House Committee on the Administration of Criminal Justice. Her bill requiring inmates to serve at least 85% of their sentences represents a dramatic change; today, inmates serve an average of 40%, largely because of credit earned for good behavior, said Austin, the consultant who projected how Villio’s bill would affect the state’s prison population.

    But Villio told fellow lawmakers that her bills raising the minimum time served and ending parole wouldn’t increase the prison population or spending. She reasoned that because the bills would create certainty in sentencing, they would spur judges to issue shorter sentences. “There is no intent to ramp up the prison population,” she said in a February legislative committee hearing.

    The Legislative Fiscal Office, however, concluded otherwise. The bill ending parole could add between $5.7 million and $14.2 million to the Department of Corrections’ costs, legislative staffers wrote. The truth in sentencing bill would “likely result in a significant increase” in spending, they wrote — at least $5 million in the first full fiscal year, based on Department of Corrections figures. The department estimated those costs would increase every month.

    Landry’s current budget proposal would increase funding for the Corrections Department by about $53 million, or 7.4%, but it does not project a significant expansion in the incarcerated population, nor would it increase health care funding.

    Tennessee attorney David Louis Raybin, who helped draft a truth in sentencing law there in 1979, said he knows what Louisiana is in for. Tennessee’s law was repealed six years later, after a string of riots in the state’s overcrowded prisons. But in 2022, Tennessee lawmakers adopted yet another truth in sentencing law over Raybin’s objections.

    “It takes about three years for this to have its effect. But once it does, it hits with a vengeance,” said Raybin, a self-described conservative Democrat who previously worked as a prosecutor and helped draft the state’s death penalty statute. “You guys are going to get whacked down there. Your population is going to go through the ceiling.”

    Three days after the legislative session ended, Janice Parker visited her son. He was in severe pain from a distended stomach and a blockage in his catheter. She said the prison’s medical staff didn’t answer her questions about what was wrong and refused to send him to a hospital.

    As she sat by her son’s bedside and held his limp hand, she didn’t have the heart to tell him that their fears of what would happen if Landry became governor had come true: Louisiana was returning to its punitive roots.

    Though her son still is technically eligible for some sort of medical release, she worried that after 14 years of suffering and disappointment, news of the changes would sever his last thread of hope.

    Do You Have a Connection to Louisiana’s Prisons? Get in Touch.

    ProPublica and Verite News are investigating how changes to Louisiana’s criminal justice system will affect people. If you know someone who has been incarcerated in a Louisiana prison, or if you have worked in one, please fill out the form below. We may reach out as we continue our reporting.

    Case study document illustrations by ProPublica.

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