A court filing on Tuesday shed new light on the effect of the city jail system’s staffing crisis on health care, with missed appointments leading to severe health consequences.
It started with a toothache.
A 25-year-old man taken into custody last winter asked New York City jail officials if he could see a dentist for cavities. But his consistent requests for care went unanswered, according to court records and lawyers for the man, even as it became difficult for him to eat and sleep because of the pain.
His mouth became infected, leaking blood and pus. He was in agony by the time he finally saw a dentist last month, nearly a year since he first requested medical treatment. He was told he would need extensive surgery.
His story is emblematic of the basic medical neglect in New York City’s jails, where data from the city itself shows that thousands of incarcerated people miss appointments each month. Lawyers for the detainees say that the lack of timely care, even for simple ailments, leads to extreme sickness and pain: surgery dates delayed for months, stab and burn victims whose wounds are left untreated and bug bites that swell up to take over prisoners’ entire legs.
Last year, 16 people died in New York City jails, the highest number in years. The chief medical officer of Correctional Health Services, Dr. Ross MacDonald, attributed the deaths to a collapse in basic jail operations, including the delays in medical care, which he said were caused by the unavailability of correction officers — hundreds of whom do not show up for work each day.
“In a population of thousands of people, many of whom have been there for years, there will be serious medical problems,” said Dr. Robert Cohen, a member of the city’s Board of Correction, a watchdog agency that monitors jails and a former director of health services on Rikers Island. “If they don’t get to the clinic when they need to, when they don’t get the laboratory tests that they need, when they don’t get to the hospital when they need to, serious complications are inevitable.”
Understand the Crisis at Rikers Island
Amid the pandemic and a staffing emergency, New York City’s main jail complex has been embroiled in a continuing crisis.
- What to Know: Rikers has long been characterized by dysfunction and violence, but recently the situation has spun out of control.
- Inside Rikers: With staffing shortages and the basic functions of the jail disrupted, detainees had free rein inside the complex.
- ‘Fight Night’: Videos obtained by The Times reveal scenes of violence as the city struggles to restore order in the jail complex.
- Decades of Dysfunction: For years, city officials have presided over shortcuts and blunders that have led to chaos at Rikers.
In court documents filed on Tuesday in New York State Supreme Court, lawyers for detainees who say they are denied adequate medical care called for the Department of Correction to be held in contempt for failing to comply with a court order compelling the department to provide it. The filing also seeks monetary redress for every instance since early December in which a detainee was denied medical care.
“When the court has ordered them to explicitly state and show that they are meeting their obligations to provide access to care, they are unable to do that,” said Veronica Vela, a lawyer with the Legal Aid Society’s prisoners rights project, which is representing the detainees along with Brooklyn Defender Services and the law firm Milbank LLP.
A spokesman for the city law department said that the department was reviewing the motion. The Department of Correction and the union that represents correction officers did not immediately respond to request for comment.
In their motion, the lawyers pointed to an affidavit from the city that showed that more than 1,000 people in December alone did not make a scheduled medical appointment because a guard was not available to escort them. And while the city claims that more 5,000 detainees that month refused to attend scheduled medical appointments, the filing cast doubt on that number, and a doctor who recently left Correctional Health Services said the number was probably overblown.
Brooke Menschel, a lawyer with Brooklyn Defender Services, said that the organizations had received hundreds of reports over the last several years from people who the Department of Correction said had refused medical care, but who said they were not, in fact, offered care by the department.
“We’ve got people who’ve been asking to go to the clinic for months, begging for care,” Ms. Menschel said. “And then all of a sudden, D.O.C. is saying they’re refusing. Logically speaking, that doesn’t really make sense.”
Data published by the department shows that over the last six months, an average of 6,400 people each month have refused medical care. But people with experience providing medical services for detainees say that while refusals do happen, the department’s numbers are almost certainly misleading.
Dr. Rachael Bedard, the former director of Geriatrics and Complex Care Services for the jail system, said that some portion of the refusals were most likely miscategorized by correction officers, who are responsible both for escorting detainees to appointments and for noting reasons appointments are not made.
“The officers are going to put refusal a lot when refusal didn’t happen,” she said.
There are two ways for detainees in city jails to receive medical care: They can ask a correction officer to escort them to a clinic, or call a hotline to Correctional Health Services. According to court documents, the lack of correction officers has compelled detainees to use the phones. But access to the phones is often obstructed, both by gangs, who sometimes demand forms of payment before providing access, and by correction officers, who deny detainees needing medical care access as a form of punishment, according to an affidavit from a lawyer with the Brooklyn Defender Services.
The court documents listed examples of serious delays in treatment, including access to dental care, irregular treatment of burn wounds and serious delays in receiving medication to manage chronic illness, including H.I.V. One man said that, despite being bitten in the face by another detainee, he had not received medical care for more than a week and a correction officer falsely recorded that he had refused care.
Dr. Bedard, who left Correctional Health Services this month, said that care on Rikers Island had been further shaped by the ongoing dysfunction at the jail complex.
“There is so much disorder and there’s so much violence that a lot of time is getting taken up attending to the consequences of that violence,” she said, adding that the medical clinic was compelled to spend much of its time addressing injuries caused by fights and other forms of violence.
She said that the lack of access to medical care, including mental health care, contributed to a situation in which health services were forced to react to medical crises, rather than pre-empting such emergencies.
“It is absolutely contributing, probably in ways we cannot totally measure and understand, to worse health outcomes,” she said. “But it is also very much a symptom of a larger dysfunction in a system that cannot keep people safe for lots of different reasons.”
