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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. In the United States, nine out of every 100 people are known to have been infected with the coronavirus. Inside United States prisons, that number is not nine, but 34 out of every 100 people, more than three times as high. Here in New York, it took a court ruling to force the city's hand to offer vaccinations to incarcerated people as a congregate living group.

According to a recent New York Times investigation, more than 1,400 new cases and seven deaths are reported inside facilities, jails, and prisons every day, but despite the high risk, incarcerated people have not been prioritized in the vaccine rollout and vaccine hesitancy remains high, both among incarcerated people and very much among corrections officers from what we're hearing.

While the pandemic has certainly highlighted enormous failings, the problem of substandard health care for incarcerated individuals long preceded COVID-19. Here's a stat, a year after returning home from prison, formerly incarcerated people have a mortality rate nearly four times the national average. That's in large part because many prison administrators don't want to spend money on health plans that would offer preventative or personalized care, instead opting for cheap plans from for-profit providers that cut corners at the expense of keeping people healthy, at least that's the accusation.

Here with me now are Dr. Homer Venters, Clinical Associate Professor at NYU's College of Global Public Health, also a newly appointed member of the Biden Harris COVID-19 Health Equity Task Force. He's also the former Chief Medical Officer of the New York City Correctional Health Services, and author of Life and Death in Rikers Island.

Also, with us is Bianca Tylek, Executive Director of the advocacy group Worth Rises. As many of you know by now, this segment is part of our series in partnership with the Green Space and Worth Rises about the business side of the prison industry. We have these conversations every week to preview a Tuesday night Green Space event on the same topic that'll happen tonight at seven o'clock on this one, and you can sign up by going to thegreenspace.org. Okay, hi, Bianca. Welcome back. Dr. Venters, welcome to WNYC.

Dr. Home Venters: Thank you.

Bianca Tylek: Good morning, Brian.

Brian: Dr. Venters, I see you've had a fascinating job over the past year, which is actually inspecting correctional institutions to see how equipped they are in dealing with the pandemic, and you said during that process you ask yourself three questions. What are those?

Dr. Venters: Yes. I've been in about two dozen facilities doing these inspections. I want to know is the facility finding or detecting new cases and responding to them

the way they should? Are they taking measures to slow the spread of the virus? Are they finding and protecting high-risk people? There's a variety of tools and standards to use, but those are the three buckets of work that I focus on when I talk to detained people, review their medical records, and see what's happening.

Brian: What did you find in answer to those questions, in general?

Dr. Venters: In general, I found that care before COVID was substandard in most places, that once COVID hit, it really ran like wildfire through these places and that many people went without testing or care when COVID hit their housing areas or their buildings. Despite really a lot of work and effort on behalf of the correctional authorities, the people who work in these places, the responses really felt very far short even of what the CDC recommended.

Brian: In your role on the President's COVID-19 Health Equity Task Force, which just released his first set of recommendations last week, I see you're pushing for jails and prisons to be included as congregate settings, the classification nursing homes have, for example, what would that mean in an official capacity? What could it change in terms of access to vaccines, which I assume is why you're looking at this right now?

Dr. Venters: Yes, in promoting that approach, what I and what the task force want to do is acknowledge reality, which is these are congregate settings. The numbers you just quoted about the incredibly high rates of infection and death behind bars reflect that reality, and so science tells us that we need to treat jails and prisons and the people in them as being in congregate settings.

We need to then work with Governor's offices to prioritize access to vaccines, both for incarcerated people and also for staff in these congregate settings the way we would in a nursing home or long-term care facility. We need national and statewide leadership, but we can't do that if we don't explicitly state the jails, prisons, ICE detention centers are congregate settings.

Brian: Let me ask you in relation to today's news about the recommended suspension in use of the Johnson & Johnson vaccine, while they investigate six cases of serious blood clots in women between the ages of 18 and 48, how much is the J&J as a single dose vaccine been used in jails and prisons, and how much would this suspension or pause set back the effort to vaccinate incarcerated people? 

Dr. Venters: Well, I think that the impact may be more felt in pre-trial settings, or short-stay settings where the J&J vaccine was already being considered is more optimal. I think in state prisons, in a lot of settings where people are spending more time, it may not really have as great an effect.

Brian: Now listeners, we can take a few phone calls about your experiences in jail or prison during the pandemic as an incarcerated person, or a person with a loved one who is incarcerated, or maybe someone who works in a facility as a guard and administrator or a health care provider, 646-435-7280.

As part of this Punishment and Profit series that we've been doing on Mondays or

Tuesdays pretty much all this year so far is to hear your experiences and help us and help the group Worth Rises report this story. 646-435-7280. Call in and say something worth saying about your experience in jail or prison during the pandemic as an incarcerated person with respect to your treatment during the pandemic, that's pandemic relevant. Or if you have a loved one who's incarcerated, or maybe you work in a facility as a guard or administrator or a health care provider, what can you add to this conversation? 646-435-7280. 646-435-7280.

Bianca Tylek, let me go to you in the context of this series Punishment and Profit, where we're looking at the business side of the prison industry based on a major report you did on that. Who are the major private health care providers in jails and prisons? How much profit do they generate, and how do you see the profit motive affecting the quality of health care for incarcerated people?

Bianca: Yes, great question, Brian. The prison healthcare space much like many of the other sectors of the prison industry is highly consolidated. There are a few very large corporations in the space like Wexford House, Corizon, and the largest Wellpath, which is estimated to bring in $1.5 billion a year for its healthcare contracts in prisons and jails.

All together, we estimate that the prison, specifically privatized prison healthcare brings in over $4 billion, that's because we have now privatized health care in 28 states at least, an estimated over 60% of local jails. A large reason that states are moving towards privatized care is because they get promised the idea of lower-cost health care after staff cost is the second-largest budget line item for correctional facilities.

Going to privatized care that is going to claim to provide care for cheaper is an attractive option. Fortunately, the way in which they provide cheaper care is by cutting costs in that provision, and therefore cutting in many cases quality. We've seen some really disastrous cases of privatized health care happening all over the country. In fact, Corizon, one of the two largest prison healthcare companies is on average sued every other day for malpractice inside of prison or jail.

Brian: Wow. Your report states that copays for doctor visits in state prisons run about $2 to $5. Now, that might not sound like much to listeners who are used to paying a lot more than $5 in copays. How do you want listeners to hear that stat?

Bianca: Yes, it's really, really critical for people to understand how much money people actually make in prisons and jails. The average amount of work or hours of work that an incarcerated person has to do in order to afford a single copay is roughly 25 hours of work. Sure, we might be used to paying $20 copays which even on minimum wage might be two to three hours of work. For somebody who's incarcerated, we're talking essentially 10 times that. Really understanding those pieces, and as a result, who ends up paying for that it's families, or as a debt or a lien on people's accounts, and then when they're released, should they be released, they are then later collected on that.

There's a number of different ways that those copays factor in and I'll just give two quick stats, which is until very recently the copay in Texas was $100 a year. In Texas, people earn $0 an hour for their work. So understanding where that money comes from. Now, that's been changed, families were able to advocate for change, it's still over $13 for a copay, and now it's per visit. People understanding that point is really clear.

Then the other piece that I'll just say is that sometimes we also see because of the poor quality of care that these copays are used and what we've seen in colloquial and certain jails, say, "Well, it's the $20 Tylenol." "Why?" Because there's no Tylenol on the commissary sheet, so you can't just go to the commissary and buy a pain reliever. Instead, you have to go to medical, you have to pay $20, and more than likely for not just everything from a headache to really significant harmful pains that should be treated with much more care, they're giving Tylenol. You really do see quite a range of what that copay costs.

Brian: Doctor Venters, I see that you wrote a recent op-ed, jails and prisons will benefit from oversight by the same groups that promote quality in hospitals and community clinics. I think some people who don't think about this very often might be surprised to learn that it's a different oversight system. Can you explain it?

Dr. Venters: Sure. This, for me is at the heart of both what's wrong with health and healthcare behind bars, but also what COVID has provided some opening to address, which is that these organizations, the Centers for Disease Control, HHS at a national level, and State Department's of health are pretty much on involved in figuring out what the health needs are behind bars or whether or not the healthcare is good or bad. Because of the funding decisions that really flow all the way back to 1964, under the Social Security Act, all the funding is local.

You have sheriff's trying to figure out how they can get money for what they're going to spend money on or State Department of Corrections doing the same, and so the funding is local. What that means also is that we don't have oversight. The State Department of Health might be involved in figuring out if nursing homes and hospitals are doing a good job. So would, for instance, CMS or other national organizations, and the CDC would be looking at lots of health outcomes or health trends in these places.

Those structures aren't involved, and so what we've done is we've left these really core decisions about the scope of services, for instance, is somebody going to get treatment for this substance use issues, and also the quality and transparency of the care. We've left that to sheriffs, and commissioners of corrections who are not health administrators, they are not health experts.

For me, it is the greatest and most ongoing example of racism and health in our country that all of these evidence-based structures that we, that I rely on, if I go to the hospital, or if I get a medicine, those are all absent, essentially, behind bars. We do have as I said, this opening because those groups like DOHS at the state level and the CDC had been platooned into helping with some of the COVID responses.

Brian: Jeremy in the Bronx, you're on WNYC. Hi, Jeremy. Thank you for calling in.

Jeremy: Hi, thank you. I was up until February incarcerated at the federal corrections at Otisville a medium-security prison. I was there throughout the first year of the pandemic really. I was horrified at the lack of basic precautions that were taken. The staff did not regularly wear masks. I didn't get a COVID test until I was being released. The way that the administration gave short shrift to the science was really very disheartening.

At one point I asked the warden how we could be protected against staff who don't wear masks, and the warden's answer to me was just wash your hands. The staff would congregate in offices without social distancing and without wearing masks. When inmates complained about this, what they did was they replaced the window on the lieutenant's office with mirrored glass, so we could no longer see them congregating without masks and without social distancing, rather than having them actually put on masks.

When we asked the warden, "What are you doing to prevent one sick staff member from becoming 26 staff members before anybody knows the first one is sick?" Their answer was, "Don't worry about that." How are people supposed to protect themselves in an environment like that, and why are the prison officials not being held responsible for this irresponsible behavior?

Brian: Thank you for detailing all of that. Wow. Bianca, would you like to respond and maybe try to answer his question at a policy level?

Bianca: Yes, I think actually the vendor is probably-- With regard to how we hold people accountable, but I think that the challenge-- We've been hearing these nightmare stories all over, which is around COVID, in particular, and is one of the reasons that thankfully, The New York Times just did this really, really powerful article about how fast COVID was spreading inside and that we knew. One of the things that also people need to understand is that we saw DOCs, prisons, and jails all over the country stop this. Those are for families and things of that sort.

I think most of us understood that that was probably necessary for some period of time. It was also such a empty gesture when we heard that this was necessary to keep COVID out of our prisons and jails when we knew that they were doing almost nothing to protect people inside from the staff that were coming in and out, that weren't as he just shared, wearing masks or keeping their own distance. That they weren't being provided the other easy necessary things from soap, on a prior episode, we talked about the fact that soap in some facilities is not even provided in bathrooms, or to people.

We heard nightmares in New York about handkerchiefs that couldn't even actually be tied around the back of somebody's head because they were so small. People were walking around holding these napkins to their faces, essentially. You cut off the one outlet that people have to their families, and you blame the pandemic, but you do almost nothing else to actually keep them safe, including the testing that Dr. Venters

was talking about. Yes, I'd love Dr. Venters to weigh more on how do we hold them accountable.

Brian: Doctor, go ahead.

Dr. Venters: Sure. I think that, for me, the first thing I do when I get to a facility is talk to people who are detained or incarcerated and try and figure out what they're experiencing. Almost inexorably, they report experiences that are 180 degrees from what's being reported publicly by the facility administrators. Putting together, I would say that all the places I have gone have put a fair amount of effort into responding, but the effort hasn't been adequate.

I think that one of the difficulties is to understand how impossible it is. The CDC came out with these recommendations back in March of 2020, how impossible it is to copy and paste hospital-style infection control into jails and prisons that have never really paid attention to infection control. It's true that I would always often hear about officers not wearing masks, about a lack of access to soap, use of solitary as a primary response to being sick. This is the consequence of neglecting these places for so, so long with our basic public health organizations.

I have seen over the months, though, that in some of the facilities, there have been a significant improvement in many of these areas. It takes, unfortunately, with our current model litigation, it takes some effort to get judges to order independent inspections to identify what's really going on because these are places that are set up to avoid transparency, to avoid outside prying eyes. Just having public health people come and talk to facility administrators, which I've seen lots and lots of times, yields a sense of what's going on that's completely untrue.

Brian: We're almost out of time. Let me get one more call in here. It's Jennifer in Arizona, who works with nurses for social justice. Jennifer, you're on WNYC. Hello, from New York.

Jennifer: Hi, Brian. I'm actually normally a New Yorker, I happen to be living out of my RV that I got in part to do this nonprofit work which started in New York City, working with public defenders, working with medical records with public defenders. Right now over the past year during COVID, I've been reading medical records of people who are incarcerated. Instead of hospital records, I'm reading the ones from docs. I just wanted to let you know, and your listeners know, that the difference between the healthcare that people are receiving when they're incarcerated in New York and the healthcare that they would receive outside is not just subpar, sub-optimal.

It is actually causing them to develop things like heart disease and diabetes. It puts them at great risk. Normally, you and I would get an annual physical exam every year. If we're healthy, even we would do that to keep on top of things, but people who have high blood pressure, don't get that monitored when they're incarcerated in the right way. They can be on blood pressure medication and that's not monitored correctly.

During COVID, this has put them at crazy risk people who are obese and have diabetes and heart disease, but just like normally living in this situation for many, many years, the health issues that they have just go unchecked and unmonitored and they suffer terribly for it. This is really a human rights issue that's going on in these facilities, that people aren't being-- Like I was saying, you and I would get an annual physical every year, but someone who's incarcerated gets one every five years if they're lucky,

Brian: Jennifer, thank you for that call. We'll end on this point because Dr. Venters, I know you also recently wrote that the CDC should include incarcerated people in its broad areas of health promotion and protection instead of limiting its interest behind bars to infectious diseases, right?

Dr. Venters: I think that Jennifer raises this point, that really is at the core of what I've been trying to address really unsuccessfully for years. Which is that incarceration harms health. The reason we need all these public health evidence-based organizations involved in these spaces is because we need to accurately understand all the health risks that are conferred to people by these settings. That includes solitary confinement, physical abuse, sexual abuse, medical, neglect, and infection too. Until we start accurately understanding and measuring how health is harmed by incarceration, we won't really I think have a really honest debate about the risks and benefits of mass incarceration and how we undo it.

Brian: Dr. Homer Venters, Clinical Associate Professor at NYU College of Global Public Health and also newly appointed member of the Biden Harris COVID 19 Health Equity Task Force and Bianca Tyler Worth Rises Executive Director. You can learn more about this topic tonight because the Worth Rises and Green Space series continues. It'll be a panel discussion about the issues of healthcare for incarcerated people tonight at seven o'clock. Dr. Venters will be there along with other guests. You can find a link to that on our segment page along with more information about this fantastic ongoing series; Punishment and Profit. Thank you both so much for joining us today.

Dr. Venters: Thank you.

Bianca: Thank you, Brian.

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