Five years ago, Dr. Rachael BedardI was finishing a fellowship for geriatrics & palliative care in a hospital in ManhattanWhen she started to wonder if there might be elderly detainees who needed care, East River, at Rikers Island.
Dr. Bedard wrote to the chief of medicine for the city’s jail system and asked if Rikers had “an aging problem.” HeShe was offered a job.
“It was a really amazing, door-opening opportunity to come and learn about a population that’s generally underrecognized,” Dr. Bedard said of joining the jails’ public health care provider, which had replaced a for-profit contractor the year before.
DataShe began to put together the job quickly and it soon became apparent that, even though the jail population was shrinking the number of 55-year-old detainees was growing, which was almost 10% in 2019. OlderSix times more detainees died in jail than were the younger ones. AndThey didn’t have the opportunity to receive the specialized care that they needed.
Now Dr. BedardThe director of GeriatricsAnd Complex Care ServicesFor New York City’s jail system and is perhaps the only dedicated jail-based geriatrician in the country. She and her colleagues, who work with patients’ lawyers to coordinate their care with the courts, have secured the compassionate release of more than 150 gravely ill detainees.
Last month, Dr. BedardWith The New York Times. TheThe following interview has been edited.
Q. WhatIs this a typical day at work for you?
A. ThereThere are eight operating jails. Rikers IslandEach one has a space for clinical research. LikeWe have appointments for primary care offices. AndWe see patients with urgent care needs. ThereWe also have 110 of the most sickest people in our infirmary. It’s much closer to a nursing home, where nurses and doctors can walk around to somebody’s bed. I will go there and talk to the primary care providers and say, “Who are you worried about?” AndThen I can see them.
How closely do you work with detainees’ family members?
QuiteA bit. It’s critical that people are in touch with their loved ones when they’re seriously ill, but jail makes that very hard; just the fact that family members can’t call their incarcerated loved ones directly is a huge barrier. We’ll advocate for families to have expanded access to people who are hospitalized and very ill. AndWhen making re-entry plans, we keep in touch a lot with families.
Are your patients’ stays in jail generally brief?
They should be, but they’re not. Remember that it’s not prison: TheThe vast majority of our people are currently in pretrial detention. This means that they were arrested relatively recently. The idea is that they’re going to have their speedy trial and they’re either going to be sentenced or released.
InPractice, however, is a great place to be. AndOlder people tend to stay longer because of their poor health. ForFor example, if someone is ill or in hospital, they may miss their court dates. WeAlso, this is an area where the courts are uncomfortable when an older person returns to the community without having a plan that they consider safe.
CanYou can give an example of the possibilities.
OneOne of my first cases was with a man in his 80s. ItHis first arrest since he was very young. HeAffected a family member and had a very severe form of dementia. WhenHis family called police. Instead of taking him to the hospital, police arrested him and sent him to jail.
EverybodyWe are all disappointed by this outcome. The courts didn’t want to sentence this guy to prison, but they also felt that he wasn’t safe to go home to his family. So they wanted him to go to a nursing home, and it’s very hard to get people from jail directly into nursing homes. SoThe man was kept in pretrial confinement for three years, while we worked out a discharge strategy.
HowIs providing health care in a correctional environment different from providing it?
JailsPrisons and other institutions where staff and patients interact are characterized fundamentally by mistrust are called prisons. People don’t get to choose who their provider is. They don’t get to control when they’re seen or how they’re seen. So, the entire interaction starts from a place where you are representing a system that is oppressing them, and they need something from you and don’t trust that you’re going to be able to deliver it.
DoThe circumstances may limit your ability to offer clinically.
There’s this tension — this potential dual loyalty — where on the one hand, as physicians our primary concern is for our patients, and on the other hand, we work within a system that has different priorities around security and safety.
I care for people suffering from advanced illnesses, such as advanced cancer. In the community, if I was that person’s hospice doctor, I would likely be prescribing them opioids that could be available to them as frequently as every two hours and that could be escalating in dose. In the jail setting, people can’t just walk around with oxycodone in their pocket.
You’ve voiced support for legislation that would make people 55 and over who have served 15 years of their sentence eligible for parole.
I’ve had this incredibly intimate exposure to what it’s like for older people to be incarcerated. I feel more of their suffering than most people. It also has a profound effect on my perception of society. We are happy to keep 85-year olds in chains. That doesn’t feel like the world I want to live in.
TheThe other side of the coin is a question about public safety. AndIt is clear from the data that recidivism rates in older prisoners and people who have served more than 10 years in prison are extremely low.
YouThis job was offered to me by the city’s shiftTo a public, independent provider correctional healthcare. WhatWas that the result of that change?
In 2019, New York CityThree deaths occurred in custody ThisThis was the lowest in-custody mortality rate of any jail system in America, and the lowest inincarceration rate in the country. New York City’s history. MoreThis was more than anything a testament to suicide prevention efforts and the overdose prevention efforts of my colleagues.
ButThis year, there were at least 14 people in New York CityThree jails, including three that were 55 or older, have already been closed.
Correctional health alone can’t mitigate all of the harms of incarceration when security is not functional.
WeFundamentally, they are practising in an environment that exposes people to risk. JailsThese are dangerous places to be if you want to concentrate people who are in crisis. And harm reduction can only go so far if the situation’s dangerousness escalates. SoI have seen the last year from a perspective of relative danger and imprisonment. New York has escalated, correctional health’s ability to mitigate that has been compromised.
Source: NY Times