By Taylor Knopf
When a group of local researchers set out to understand more about health care services in jails in the Southeast, they discovered that there are many informal ways incarcerated people are released early because they have various health conditions.
Jails are required by law to provide health services for those in custody, and research has shown over time that the jail population tends to be sicker than the general population. Incarcerated individuals have higher rates of bloodborne illnesses, chronic illnesses and mental illness, largely because they come from low wealth communities and have had limited access to health care before they were incarcerated.
But sometimes, the needs of their inmates exceed a jail’s available resources, or the nature of the health condition creates a liability risk for the jail, the researchers explain in a recent paper, Jail Health and Early Release Practices, published in a journal out of the law school at the College of William and Mary.
The study authors interviewed health administrators in jails across four southeastern states — Alabama, Georgia, North Carolina and South Carolina — and found that one of the most commonly cited reasons for early release from jail was pregnancy. Other common reasons included significant injuries, serious illnesses requiring medical attention such as cancer, illnesses with expensive medications such as HIV and Hepatitis C, and serious mental illness.
The researchers found that none of the states in their study have clear legal procedures to take health factors into account when deciding the conditions for determining bond or pretrial detention. That means that jail detainees with serious health conditions are at the mercy of the local judges and jail staff. And depending on a jail’s resources and ability to pay for medical treatment, two people with the same charges could end up treated differently depending on their health condition.
“Even without much in the way of strong regulation or guidance, the jails have developed a lot of informal ways to try to address different health needs,” said study co-author Brandon Garrett, a Duke University law professor and researcher.
“Some of [the informal methods] may have some positive effects where people can get better treatment outside of jail,” he said. “And some … may be somewhat self-interested and counterproductive, where jails just don’t want to deal with costs and may shunt off people in crisis to places where they will not get good treatment, but the serious health consequences, costs and maybe even deaths won’t be on their books.”
He and his fellow researchers concluded that health needs, including for mental health issues, should be formally considered in every pretrial hearing in every state. Garrett explained that the costs and benefits of detaining an individual are supposed to be considered by a judge, and they are “quite literally considering costs because they’re posing a cash bail amount.”
But statutes around the country rarely consider health needs, he said. The arbitrary nature of a jail’s early release practices often come down to the local facility’s resources.
Lack of resources
In interviews with jail administrators, study co-author Jessica Carda-Auten, researcher at UNC Chapel Hill, said she would ask staff to walk her through the intake process from the time someone walks into the door to when they’re booked in a cell. When she asked about how jails dealt with urgent health needs, Carda-Auten said she was surprised by how often early release was considered and occurred and how much ambiguity there was in the process.
In most cases, she said the reason they considered early release was due to a lack of resources, whether it was lack of staff to transport a patient to outside medical care or the inability to manage a particular health condition in jail. The study cites several specific examples of incidents and conditions when jail staff sought ways to get an inmate early release or their bond lowered so they could get medical care elsewhere.
One jail staffer interviewed in the study recalled a time when a judge released a pregnant woman on her own recognizance — with a promise to appear in court — so she could have her baby with proper medical care and then set her court date for a few months after the birth.
Others cited liability concerns that motivated them to help get early release in cases where pregnant women came in with opioid use disorder and would be going through opioid withdrawal. These can be tricky cases to manage because withdrawal symptoms can affect the developing fetus and overall health of the pregnancy.
Jail staff also told the researchers of cases of early release when the detainee’s care was believed to be overly burdensome.
“I go to the jail admin and try and get them out of custody … If they got cancer … Those are the only people that I’ve had that come in on those high dose of morphine,” one jail staff member told researchers in the study. “If they’re on that kinda medication and they’re on hospice care, then they’re sicker than we wanna deal with.”
More than one jail administrator brought up the challenges of providing care to a person who needs dialysis for kidney disease. These patients have to be transported by officers to their dialysis appointments several times a week, and officers must wait with them during the appointment.
“We have [had people on dialysis], but they don’t stay… I’m gonna get with the colonel, and they’re gonna get out of here,” one jail staff worker told researchers. “They’re not staying, no, cuz the deputy has to transport them, and the deputy’s gonna have to sit there for hours, and he’s gonna get with colonel that’s over the roll patrol. He’s gonna be like, ‘Colonel, you’ve just gotta get him out of here.’”
Additionally, jail administrators told researchers about efforts to get early release for the detainees they referred to as “high-dollar inmates,” namely, people in need of expensive medicines for diseases including HIV and hepatitis C.
“Somebody who’s really sick that we already anticipate that it’s gonna be, what I call, a high-dollar inmate,” one jail worker told researchers. “It has to be a low-risk inmate. If it’s somebody who’s a high-risk inmate who was here for a serious crime, then you just have to eat that. If it’s something minor or some child support. We pay child support. We could’ve paid the child support bill.”
In some cases, Carda-Auten said the jail staff seemed to have “benevolent intentions” in their push for early releases, particularly for those with serious mental illness. Mental health issues often go untreated in carceral settings. Sometimes when incarcerated people with mental illness become too difficult to manage, they are placed alone in solitary confinement.
In one example cited in the study, a man attempted suicide in jail, and the jail staff advised the man’s mother to get him out on bond and secure an involuntary commitment so he could get court-ordered treatment in an inpatient psychiatric facility.
“That actually ended up workin’ a lot better because in situations like that at the jail, the downfall there is he would’ve sat here and waited months for a [psychiatric] bed,” a jail staff member told researchers. “Cuz they’d have been like, ‘Well, y’all can watch him.’ This isn’t somewhere for somebody to get psychiatric help. This is a jail. Yeah, they can talk to [the psychiatrist] through there, and we can give them medicine, but it’s not the same. It’s not the help that he needed… Hopefully, he is getting the help he needs now.”
Policies and oversight
The study authors argue that jails should have standards that “provide defined, rather than informal, health-related rights.”
“While there is a right to health care in jails, in practice, it can be lacking. It’s difficult to enforce. So what we see is very little health care in jails, which leads jail staff to having to make these decisions,” said study co-author David Rosen, associate professor at UNC School of Medicine’s Division of Infectious Diseases.
“For people who are released, circumstances vary. Some will have greater access to care in the community than in jail, but others will have less,” he said. “In sum, this phenomenon reflects jails’ struggle to deliver healthcare, but also the very arbitrary nature of the legal system in that two people with similar charges could be treated very differently based on their health and on resources of their local jail.”
Rosen added that in a recent unpublished survey of jails in the Southeast, his team found that 30 percent of jails in North Carolina said that they had engaged in an early release for health reasons in the last month.
Additionally, the researchers found that while jails have written policies for health care delivery, overall health care services in jail are lacking and without much oversight. They found in states like North Carolina, there is little meaningful tracking of health outcomes in the jail population.
Eddie Caldwell of the North Carolina Sheriffs’ Association said that county jail policies are not shared with the association. He added that each county is required by the state law to have an inmate medical health plan that complies with the applicable General Statutes, and that his association has no role in it.
“In the absence of meaningful statewide regulation, there is often considerable within-state variation in jail health funding, services, and providers. Providing healthcare is typically a significant burden on jails and resources are limited,” the study authors write.
The study authors contend that because few states require jails to collect and report health data in a timely manner, incarcerated individuals’ needs go unmet.
“For instance, even though North Carolina requires counties to establish jail medical plans, local health departments provide minimal oversight of the plans, which, coupled with a lack of comprehensive jail health data, makes it difficult to assess whether jails are following the policies set out in their plans,” the study authors wrote.