Caring for the Incarcerated

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By Jesse Duthrie

Between 1980 and 2013, Connecticut’s incarcerated numbers skyrocketed from roughly 4,000 to 16,000 men and women. Tough on crime policies filled up correctional institutions not just in Connecticut, but also across the United States. 95 percent of men and women incarcerated finish their sentences and are released back to the public. Providing end of life care for the other five percent has proven to be an ethically and legally challenging problem. Over 2,500 prisoners die annually of natural causes in this country.

This national issue has moved right to the heart of Connecticut. This January, SecureCare won a Bill to develop and house 95 end-of-life inmates from correctional facilities across the state of Connecticut. The nursing home, a hospice center for the incarcerated, began development after a 2011 General Assembly Bill. Now, commotion has erupted from the townspeople, corrections union leaders, and town officials.

The Department of Mental Health and Addiction Services (DMHAS) has laid out a clear and concise plan for the development of the building. According to DMHAS, “Nursing homes can provide the level of medical care needed while receiving over 5.5 million dollars in federal Medicaid reimbursement annually.” The DMHAS plan goes on to say that the location was chosen because of its prior use as a nursing home, therefore it would need only minimal modifications. 24-hour on-site security would be provided to control patient movement.

Residents of Rocky Hill remain fearful of housing close to a hundred prisoners near their homes, even if they were to remain under close security. In a December 20, 2012 article by David Drury of the Hartford Courant, a Rocky Hill resident named Tony Coco expressed his concerns about having prisoners living nearly 50 feet from his home. His worries were amplified by the recent Sandy Hook shootings. He went so far as to say, ‘“If the governor was going to do this in Newton what do you think the people of Newton would do after what happened?”’

Coco’s claim comes without consideration of facts. 0 percent of elderly inmates in end-of-life treatment have ever escaped hospice treatment. Furthermore, the shooter at Sandy Hook Elementary School, Adam Lanza, was in no way associated with hospice centers. He was a 20-year-old male. He was not an ex-inmate, and there’s no connection of him escaping any form of a correctional institute.

In the yards of pages the Hartford Courant has run on this topic, it’s hard to find a citizen of Rocky Hill that has come out to support the nursing home. It’s feasible to ask why they should. Ira R. Byock, M.D., the Director of Excellence in End of Life Care and a public proponent of hospice programs for incarcerated citizens, has written a book and several articles on the topic. He is currently the Chair of Pallative Medicine and a Professor at Dartmouth Medical School. When asked why people should care how prisoners die, he wrote, “There are striking similarities between being given a long prison sentence and receiving the diagnosis of a debilitating or terminal illness.” He draws in a connection with the reader and end-of-life prisoners. He goes on to say, “Death has been called the ‘great equalizer;’ so are its cousins: illness, dementia, physical debility, and advanced age…People who are most frail and elderly can be made to feel guilty by society, and at times by their own families, for the crime of being seriously ill or debilitated and not dying quickly enough.”

Dr. Byock doesn’t rely solely on his reader’s empathy. In his article “Dying Well in Corrections: Why Should We Care?” Byock cites court cases and legal proceedings over the past thirty years that have led up to the necessity of hospice care for end-of-life prisoners. He cites Estelle v. Gamble (1976), a case in which American courts “distinguished punishment from brutality and…affirmed society’s responsibility to provide a community level of care for prisoners.” Still, there is an ongoing struggle waging to provide excellent health care to all Americans, and this challenge is not being met. National agencies like the National Hospice Organization Standards and Accreditation Committee and the Last Ask Task Force have banded together to rethink the way hospice operates in our country. Byock’s challenge is to figure out where incarcerated citizens fit in to the puzzle.

One state proponent of the nursing home, prison reform champion Allison Bassett, claims the vocal rejection speaks to the nature of “Not in My Backyard” (NIMBY). In an article for Rocky Hill Patch by Jeffrey Gebreu, she says, “’NIMBY is far too prevalent in a lot of areas in Connecticut.’” The argument suggests that there is resistance from affluent communities to fight “unwanted” projects in their towns, so that they may be “redirected” to less affluent parts of the state. She goes on to say, “[The prisoners] get placed in unsafe, impoverished neighborhoods where under funding actually does create a safety risk.”

For the end-of-life patients the stay at the proposed nursing home will offer an opportunity for family visitation before they die. Bassett’s sentiments, as well as those who proposed the bill, are to offer humane treatment to those in their final days of life. The individuals expected to receive care at the nursing home will be transitioned from DMHAS or from the infirmaries at Department of Corrections. According to the DMHAS outline, these patients will have “serious or chronic medical impairment that may include dementia, strokes, paralysis, and cancer. Some individuals may be dealing with conditions such as Parkinson, Huntington or Multiple Sclerosis. Individuals may be confined to wheelchairs or require walkers, or other adaptive devices for mobility or self-care.”

The nursing home is scheduled to open in February of 2012, but legal action and public outcry will likely halt that start. Officials in Rocky Hill are attempting to sue the company that would operate the nursing home, iCare management and its subsidiary SecureCare Realty, for not getting the local zoning approvals needed to open the nursing home and hold inmates. On December 20th, the same day of the announcement of the lawsuit against iCare and SecureCare Realty, a local town hall meeting was canceled by state officials at the last minute. The town hall meeting was anticipated to draw in hundred of Rocky Hill residents. Rocky Hill Mayor Anthony LaRosa, State Senator Paul Doyle, State Representative Tony Gurerra, and the Town Union all oppose the nursing home. It was political chess, out in the open for everyone to see. The town takes the state’s pawn, so the state takes a rook.

A similar issue occurred in Connecticut almost twenty years ago that dealt with caring for the incarcerated in a residential area.

John Dempsey Hospital sits near Route 4 in Farmington, Connecticut. To an average passerby, nothing unique stands out about the hospital. Yet seventeen years ago, a deal was brokered between Governor Rowland and the Department of Corrections that would go on to infuriate the townspeople of Farmington and cause legal backfire from city attorneys.

In 1995, the University of Connecticut took over for all Correctional Managed Health Care for the state of Connecticut. Department of Correction’s medical wards were soon staffed with UCONN nurses and doctors. Yet one issue had not been resolved: what would happen with emergency patients? Prior to the contract with UCONN Medical Center, correctional inmates needing emergency treatment had been shipped out of their prisons, escorted to nearby hospitals, and put under 24 hour surveillance while they received emergency care. This process was not only laborious but also expensive.

A solution was put up by Department of Corrections and the Governor’s office: make John Dempsey Hospital the center for all emergency correctional health treatment. Department of Correction’s spokesman William Flower summed up the fiscal benefits in a November 30, 1995 Hartford Courant article, saying, “The consolidation would save more than $2 million a year in transportation and other costs.”

Representative Demitrios Giannaros, a state legislator from Farmington, voiced concerns for the safety of his constituents. In an October Hartford Courant article, he says, “The hospital is right in the middle of our community. To have so many prisoners transported to the hospital and held in the special quarters is of great concern to us.” Giannaros was backed by Representative Kevin Sullivan of West Hartford, who added that the hospital had neither “the appropriate design nor the proper location to house such a facility.”

By November of 1995, residents of Farmington took legal action to stop the development of the correctional medical ward at John Dempsey Hospital. In the same November 30, 1995 Hartford Courant article, town attorney John McGee was working on a complaint seeking temporary injunction against the ward to be filed by week’s end. If the junction would be granted, he would seek permanent injunction. The article, written by Courant staff writer Michael Greenwood, tells how signs protesting the ward “popped up along Route 4 and more than 100 residents attended Tuesday’s council meeting to voice their opposition.”

McGee’s injunction, and the complaints of over 100 Farmington residents, would go unheard. There was no temporary injunction formed and by the beginning of 1996, John Dempsey Hospital took over as the main center of emergency medical health treatment for the state. And since it’s opened as the center of all emergency correctional medical care, there hasn’t been once security threat to the town of Farmington.

When it comes to opening the nursing home in Rocky Hill, there are a lot of invested parties: the town officials, the corrections officers, the townspeople, and the prisoners who will be receiving care. There are also the prison reform advocates who see the opening of the nursing home in a residential neighborhood as step away from the perspectives of NIMBY. Certain risk is involved in transporting incarcerated men to residential areas. Still, driving down Route 4 in Farmington, it’s impossible to tell who’s occupying the tan hospital building that once caused so much commotion.

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