This article is inspired by and expands upon an original piece published in collaboration with Vice.
The sheer volume of hand injuries was the first thing that struck me. Working as a physician within the confines of a city jail, I was confronted daily with sprained fingers, bruised knuckles, and swollen hands, often adorned with intricate tattoos. These weren’t accidental injuries; they were manifestations of frustration and pent-up anger. Inmates, grappling with denied bail, postponed court dates, or the silence of loved ones on the phone, would lash out at walls and steel cell doors. Sometimes, their anger turned towards each other, leading to facial injuries, also surprisingly common.
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A stark glimpse into life within the criminal justice system.
Yet, in the world of correctional healthcare, these hand injuries were almost routine. An X-ray, a simple ACE bandage, a short course of Ibuprofen, and the inmate would be back in their unit. It was a cycle of easily addressed physical ailments, a surface-level view of the deeper health challenges within the jail.
My role as a Prison Doctor on the urgent care line revealed a landscape dominated by minor traumas. Acid reflux, a constant companion fueled by the notoriously greasy jail food, was rampant. Back pain, exacerbated by the unyielding concrete slabs serving as beds, was another frequent complaint. Anxiety, often manifesting as chest pain, was a common presentation. Uncontrolled blood sugar in inmates with Type 2 diabetes and skin infections that could quickly escalate into serious abscesses added to the daily caseload.
These conditions, while demanding attention, were, in a way, straightforward. They were the predictable health issues arising from the stresses and environment of incarceration. They were, ultimately, manageable within the limited resources and protocols of the jail’s medical unit.
Then there were cases like Jay’s. Initially, I categorized him as another “easy” case, another routine appointment in a day filled with them.
Just days prior to our encounter, Jay had been brought into a local emergency room, his mind clouded and actions dictated by a dangerous mix of illicit stimulants and depressants. His discharge paperwork indicated a brief detox period in the ER before his transfer to the jail – standard procedure. Jail protocol, a rigid framework governing every aspect of inmate life, mandated a physician follow-up for any inmate recently discharged from a hospital.
I anticipated a quick, uncomplicated consultation with Jay. My shift was nearing its end, and I still had eight more patients awaiting my attention. His file, detailing numerous short stays in jail over recent years, offered a glimpse into a troubled past. After a cursory review, I asked a nearby officer to summon him to the medical floor. Inmates classified as nonviolent, like Jay, were permitted a degree of movement within the jail, allowing him to walk unescorted from his unit to the medical area.
He entered the examination room with a subdued demeanor, settling into the hard plastic chair across from me. His posture was closed off – arms crossed, head lowered. Like so many of the men I treated, he was a young Black man, clad in the standard green jumpsuit and bright orange sandals of the incarcerated. The ever-present officers in black uniforms moved about in the hallway just beyond the open doorway.
The layout of the exam room was peculiar. The inmate chair was positioned directly between me and the open door, effectively placing me between the patient and the bright red panic button – a stark reminder of the inherent tension of the environment. Yet, despite this setup, I had never felt the urge to press it. There was a different kind of tension, a systemic one, that was far more concerning than any individual interaction.
“Hi, Jay, I’m Dr. Moore. I see you were recently at the hospital. How are you feeling now?” I began, aiming for a conversational tone to ease the encounter.
“Not good,” he mumbled, his voice quiet. Yet, physically, he appeared stable – clean, clear-eyed, with no obvious signs of withdrawal or lingering effects from the substances he’d reportedly used.
“What’s making you feel unwell?” I probed gently.
“I’m in jail,” he stated simply.
I had encountered my share of cynicism and sarcasm in this setting. “Yes, but about the hospital visit? How are you recovering from that experience?” I redirected, trying to focus on the medical aspect.
“You know, I was really messed up. I can’t even remember most of it,” he admitted, finally making eye contact.
Despite the ER not conducting a formal drug screen, Jay had confessed to using methamphetamine and heroin to the emergency room physicians. He was aware of his situation.
“I went there to get clean,” he continued, his gaze now fixed on mine. “I’ve been messed up for a long time. I was hoping they’d send me to rehab.” His words were devoid of anger or self-pity, replaced by a palpable sense of resignation.
“Do you know when you might be released?” I asked, wondering if this jail stay was a short-term consequence, a minor probation violation, something that might soon resolve itself. Perhaps release was imminent, offering a path to the rehab he desired.
“Who knows. I think… I think I’m going to prison.” The weight of his words hung in the sterile air of the exam room.
Had Jay simply presented at the ER disoriented and intoxicated, it might have ended there – a medical episode addressed and resolved. However, the presence of residual drugs in his possession upon arrival changed everything. The police became involved, transforming a health crisis into a legal one.
“I begged the cops not to search me. I pleaded with them to just ignore the drugs. Just let me go to rehab, man,” Jay recounted, his voice still lacking anger, still imbued with that weary resignation. It was a demeanor I had witnessed before, a sense of acceptance that bordered on despair.
During my residency, I had spent a month shadowing physicians at the Administrative Maximum Facility – the notorious federal supermax prison in rural Colorado. There, amidst hardened criminals and extreme security measures, I had seen a similar expression on the face of a white supremacist inmate. “WHITE POWER” was tattooed across his forehead. His criminal record was long and violent. He seemed haunted by demons he believed were inescapable. Yet, despite his outward persona, he spoke with a similar resignation. He was nearing release and told me, through the thick glass partition, that he planned to retreat to a secluded cabin in the mountains, to spend his remaining days in isolation. He had accepted his fate and would live accordingly.
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Opening Statement
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I found myself wishing that Jay had presented with the classic, treatable symptoms of heroin withdrawal – tremors, anxiety, nausea. That was something I could address: prescribe hydroxyzine for anxiety, clonidine for withdrawal symptoms, offer electrolyte-replenishing Gatorade. Easy. Manageable. Within my scope of practice and the jail’s limited resources.
“You’re going to lose your Medicaid while you’re in here,” I informed him, shifting to practicalities. “You need to re-enroll as soon as you’re released. And you need to connect with a primary care doctor. They can help you navigate getting into rehab.”
Beyond my jail duties, I also worked as a primary care physician at a safety-net clinic. There, I collaborated with a network of social workers, case managers, patient navigators, and psychologists – a multidisciplinary team dedicated to supporting vulnerable populations. I had experience guiding patients with addiction towards community-based rehabilitation programs, with varying degrees of success. But here, within the jail, those resources were virtually nonexistent. Drug treatment was not an option. Detoxification was the extent of the jail’s offerings.
I turned back to Jay’s intake form, scanning for any medical history, any clues to pre-existing conditions. It was blank. “It looks like you didn’t provide any medical history. Do you have any other medical problems?” I asked.
“I’ll tell you,” he responded, then added with a hint of desperation, “but please, please don’t just tell me to send a $7 kite to talk about it later.” He was referring to the jail’s system for initiating healthcare requests. While correctional healthcare was constitutionally mandated, every new appointment request (“kite”) came with a $7 fee for the inmate – a significant barrier for those with limited or no funds. “I have hypertension. When I’ve been here before, they put me on water pills.”
I stood up and checked his blood pressure. As expected, it was elevated. Hypertension was a near-universal finding among the jail population. Easy, in a grimly predictable way.
“Can I also get a low-salt diet? I always get a low-salt diet when I’m in here,” he requested, a small attempt to exert some control within a system that offered so little.
I dutifully scribbled the orders into his chart: hydrochlorothiazide, daily blood pressure monitoring, and a low-sodium diet. These were the standard, readily available interventions.
He stood, offered a quiet “thank you,” and left the exam room, returning to the impersonal routine of jail life.
It was the bare minimum I could provide. In truth, it was almost everything I was permitted to provide. Easy? Perhaps, in the narrow, procedural sense. But profoundly inadequate in the face of the complex human being before me and the systemic failures that had brought him here.
Alia Moore is a primary-care prison doctor in Colorado. She has dedicated time to serving at a city jail and contributes part-time to a local safety-net hospital. Her research focuses on the critical area of healthcare continuity for individuals transitioning out of incarceration.
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Tags: →Drug Treatment →Prison Doctors →Health Care →Prison Health
