LAUSR

In 1974, when health care administrator Seth B. Goldsmith published his review of prison health care in Public Health Reports, 400 000 people were incarcerated in the prisons and jails of the United States, a number that would jump 51⁄2 times during the next 40 years. His views, described in more detail in his book Prison Health Care: Travesty of Justice, reflected careful consideration of the vast neglect and deliberately imposed suffering in what passed for carceral health care. His findings demonstrated the difficulties of measuring happenings in the thousands of systems run by states, cities, and the federal government when no real statistics were kept and no oversight outside the correctional system existed. His analysis, given the lack of data, reflected what could be known about the conditions at the beginning of what is now labeled the mass incarceration era. This era of imprisonment began in the 1960s and grew as the War on Poverty became instead the War on Crime. It expanded in the early 1970s after President Richard Nixon declared a war on drugs and the so-called Rockefeller Drug Laws in New York State began to be copied in other states, leading to life sentences for people who possessed just 4 ounces of narcotics. (Named after Nelson Rockefeller, governor of New York during 1959-1973, the laws put into place in 1973 drastically increased prison sentences for minor drug offenses.) The deinstitutionalization of patients in the state mental hospitals that had begun in the 1950s affected incarceration by the 1970s, too, as the mentally ill were swept out of hospitals, into the streets, and then into jails and prisons. Concern with prisons was not a new issue, but the rebellions of the 1960s and 1970s put prisons and their multiplying populations on the societal radar. In turn, prison health care, as one of the key manifestations of the dehumanizing of incarcerated people, became a central focus of outcries and lawsuits. It had always been a crucial issue, of course, as generations of incarcerated people and their families and allies tried to make sure imprisonment meted out in days, months, or years did not turn out to be death sentences through incompetence, ignorance, and intentional malfeasance. If not death, as one researcher argued in the title of her article, the concern was that “incarceration [became] a catalyst for worsening health.” Prison health care does not exist in a health care system vacuum. Our nation still treats health care as a privilege—not a right—outside the prison’s gates, while concerns about control over prisoners and fiscal parsimoniousness in the carceral setting usually trumps care at almost every turn. Another assessment of prison health care, at the same time as Goldsmith’s, by Brecher and Della Penna in 1975, concluded that modernization in the provision of health care had eluded prisons and jails. Such care was still stuck in the “horse-and-buggy” era, this national report claimed, where the physician merely stopped by but could, or would, do very little. It was not just the terrible level of care but the ways in which “sick call” (a request by the prisoner to ask to be seen by health care personnel) was viewed by wardens and correctional officers mainly as an opportunity for prisoner malingering, and suffering was believed to be part of punishment. Medical care was subordinated to the demand for control over the prisoners to remind them of the lack of freedom that underlies the prison rationale. The Supreme Court finally dropped its hands-off approach to prison health care 2 years after Goldsmith wrote his assessment. The court’s justices realized the ways that substandard and cruel medical care violated the Constitution in their ruling in Gamble v Estelle in 1976: “deliberate indifference by prison personnel to a prisoner’s serious illness or injury constitutes cruel and unusual punishment contravening the Eighth Amendment.”