He didn’t even have a tissue to hand the man, the healthcare worker recalled, describing the first potential COVID-19 patient he examined at Rikers Island, because nobody ever cries in jail. Well, some people do. The patient was running a fever and didn’t need to be told what that could mean. He was weeping.
The healthcare worker was afraid too, he said, speaking with The Indypendent on condition that we not reveal his identity. The fear reminded him of treating HIV patients in the grim early years of that epidemic when so much was unknown. Faced with what felt like a fight-or-flight decision, the fear wasn’t existential anymore, but pragmatic, a survival alert. Another member of the medical team handed the detainee a square of gauze to dry his tears. Together, they pulled up their masks and stepped closer to examine their patient.
Don’t put them in there, and if they’re in there, get them out.
The worsening COVID-19 pandemic at Rikers Island, where, as of April 8, 287 inmates and 441 staff have tested positive for the virus, highlights the complexities of correctional healthcare and the conflict between public health, with all its inequities, and the perception of public safety.
All five of NYC’s district attorneys and the city’s special narcotics prosecutor signed a letter to Mayor Bill de Blasio and Corrections Commissioner Cynthia Brann on March 30, protesting the city’s planned early release of some detainees. The rolls of those scheduled to be let go, they argued, included inmates convicted of violent or sex-related crimes, compromising public safety.
At the same time, they wrote, the city must “immediately reassure the public and the courts that the city’s jail system is capable of appropriately managing the health needs of the remaining inmates, in a manner consistent with recent guidance from the CDC for managing COVID-19 in correctional and detention facilities.”
The DAs were failing “to appreciate the public health disaster unfolding before our eyes,” Rikers’ Chief Physician, Dr. Ross MacDonald, tweeted in response to the letter. “I can assure you we were following the CDC guidelines before they were issued. We could have written them ourselves. In essence, we did, as they were wholly consistent with our plans as this virus approached.”
The healthcare worker whom The Indy spoke with emphatically agreed, describing the perceived dichotomy between public health and public safety as a false one. As of Wednesday, the infection rate in New York City’s jails was 3.91 percent, indicating that for every thousand people, 39.1 are infected. By contrast, the infection rate among the city’s wider population is .5 percent or five for every thousand. But there is little to prevent the virus from cycling out of New York’s correctional institutions.
As one inmate who spoke with The Indy last month noted: “Prisons and jails are hidden but they’re not totally disconnected from society.”
Pushing back on the DAs’ accusation that the city’s Correctional Health Services leadership was unprepared for the outbreak, the health worker said it developed a step-by-step plan for sequestering and treating different populations within Rikers and other city jails as soon as COVID-19 reared its head.
CHS employs around 1500 health professionals, including doctors, nurses, physician assistants and pharmacists — the vaunted “front line” in the more protracted war of providing treatment amid the structural inequalities and institutional racism of the prison system and society at large.
The long-term institutional violence that detainees experience before, during and after incarceration is reflected in the healthcare worker’s interactions with them in a clinical context, he says. The current crisis only reinforces the need for correctional care providers to understand and bear witness to the effects of that violence and to gain the trust and respect of their patients who are deeply suspicious of them. Doing so requires space and time with individual detainees — a challenging if near-impossible task in a jailhouse setting.
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Like other workers deemed essential to the city, the medical worker takes public transportation to Rikers, from train to the Q100 bus that services the island itself, where he shows his ID at the first security gate. Once admitted, he takes a shuttle to the unit, one of six on the island, where he works.
There, he passes through more refined, “airport-style” security, just as he did before the crisis. The difference now is that the procedure is more invasive and includes a temperature check by infrared thermometer.
Inside the facility, he goes first to a large room, divided into cubicles, where individual consultations between clinicians and detainees take place. Prisoners have either signed up voluntarily for “sick call,” which some are reluctant to do, or have been called down from their cell block by corrections staff.
Roughly half of the cell blocks in the medical workers unit are now designated for “asymptomatic exposed patients,” meaning at least one inmate from that block has a presumptive COVID-19 diagnosis. Within the unit, once a detainee has tested positive, they are first quarantined in what’s called the “COVID dorm,” a large, cafeteria-like space lined with cots.
Shadowed by a corrections officer, clinical teams that include a doctor and a nurse or physician’s assistant make daily rounds through the dorm. They check quarantined detainees’ temperature, blood oxygen levels and other indicators of the illness’s progress.
The prisoners who test positive are detained in one of three locations on the island: a designated block within the women’s jail; the Communicable Disease Unit; or a formerly closed facility, the Eric M. Taylor Center (EMTC) — recently reopened to deal with the pandemic. The most severely ill are taken off-island, to one of the city’s two public hospitals with secure or “locked” wards, Bellevue in Manhattan or Elmhurst in Queens.
The decision to end a detainee’s quarantine is based on the federal Centers for Disease Control criteria: one week since the onset of symptoms, no fewer than three days without a fever and a general sense of “feeling well.”
Asked about the quantity and quality of protective gear given to him and other CHS and Department of Corrections personnel, the healthcare worker says, so far so good. But, he adds, the rationing of gear remains an issue, and even the simplest of choices have consequences. If a staff member wishes to have lunch, for instance, he or she must suit up in uncontaminated gear again after their break, straining supplies.
Prior to the pandemic, he said, corrections officers often viewed healthcare workers as outsiders, as guests in their house. As the crisis developed, there were initial tensions between CHS and DOC staff over access to information and equipment.
That conflict appears to have cooled. Citywide, the intake of new detainees has declined dramatically, which helps. The population inside city jails is at its lowest level since WWII. New York has the fastest rate of decarceration in the nation. That, the medical worker argues, is the most important step in containing the virus among those who remain locked up.
Don’t put them in there, and if they’re in there, get them out, he says.
Thus far, 900 detainees citywide have been granted that release, the majority of them from Rikers, out of a population of 4,604 as of March 31.
More needs to be done, and quickly, to move as many detainees out of incarceration as possible, particularly the elderly or those with prior medical conditions who are most at risk, as well as those being held for parole violations and other minor infractions.
On Sunday, Michael Tyson, a 53-year-old Bronx native, died of COVID-19 related complications at Bellevue after he was transferred from Rikers. He’d been held since late February for failing to check in with his parole officer.