“So how long has he been in jail?  I mean his core temp is 27.”

I think that the only acceptable answer from the corrections officers at that time would have been “20 minutes or less,” but that was not the response.

I sighed, wondering if I was the only person who thought that this situation was dubious. After perusing this with residents and colleagues for more than five years, I now think the nature of the possible prisoner-abuse situation would have been clear to anyone, but the next steps have never been as clear. What was clear was the story in my head of a black male, just like me, arrested because he had mental illness. Then, through some stroke of the universe, ending up in front of me, cold to the touch with sacral pressure sores.

Casual observers of the American criminal-justice system could assume a rate of abuse that they may or may not find acceptable.  But because carceral facilities are so plentiful, disparate, and poor at reporting on these types of incidents, reliable data remain difficult to come by.  However, in a study of inmate interviews in the early 2000s, some 14 percent of incarcerated people in state prisons reported that they were “intentionally injured” by staff or other persons in prison. Seeing as how the Eighth Amendment to the Constitution protects U.S. citizens against cruel and unusual punishment and further, that this idea has been adjudicated multiple times in the context of abuse and neglect, American citizens would likely have little appetite for this occurring with their tax dollars at even seemingly low rates.

For this patient, who ultimately had an otherwise uneventful resuscitation and subsequent ICU stay, I figured the next step was to email the medical director later in the week that I felt the patient had been neglected and imploring them to find some sort of root cause or follow-up for this and other types of situations involving carceral facilities.  He pointed me to our public safety officer on campus who interfaces with the corrections facilities, and that officer explained that I needed to make a formal complaint. 

In Georgia, and in many other states, the process for filing a complaint about neglect is complex and involves working with facilities and persons who have very limited communication.  Obviously, abuse can be reported to national non-profit organizations such as the American Civil Liberties Union and the National Prison Project, but navigating the privacy and confidentiality of the patient’s chart can prove to be very cumbersome.

In this case, I chose to work with the institution, and it led to filing a complaint alleging that an incarcerated person was left on a cold floor and became hypothermic because of neglect.  Ultimately, the case was referred out to the Georgia Bureau of Investigation … and that’s the last I heard of the case for months.  I guess I don’t know what I expected them to find or share because asking a federal agency to investigate a state agency is essentially tantamount to asking one of my kids to evaluate the bedmaking of the other kid.

As emergency physicians, we cannot help but advocate for our patients. As the gatekeepers to so much health care, advocacy is essential to the profession. Yes, we can advocate for a consultant to come see a patient in person and yes, we can advocate for our underserved patients to be treated like everyone else in navigating appointments. But I posit that we can further advocate by telling our stories and by working with (and within) our organizations to spur change in other ways.

For this, one of my colleagues pushed me to share this experience through the lens of social death.  A sociological term, “social death,” aligns with the surreptitious sentiment that all incarcerated persons have little to offer society and are not missed when removed from it.  Sharing this led to some discussion in medical circles about the plight of these persons, and these discussions led us further, to develop a patient-facing effort to let incarcerated persons know that they are, in fact, very much like any other patient. The Incarcerated Persons’ Bill of Rights, was presented during ACEP’s 2022 council meeting and was sent to the Board, where it was to be integrated in broader efforts. More locally, we took this resolution to our state American Medical Association (AMA) convention where it was adopted as a resolution and is working its way through national AMA to, hopefully, become national policy. Of course, there were countless revisions, rewords, and presentations to stakeholders, but this effort was initiated and led by an emergency medicine resident working with a single faculty member.

It’s true that my patient left the hospital in worse shape and I’m disappointed that we couldn’t quickly remedy this situation once and for all, but this years-long journey stands exemplar of the power that emergency physicians could have, by simply recognizing that our advocacy can spread beyond our hospital’s footprint. I certainly didn’t think that carceral health care or health policy would be part of my career when I finished medical school. But we can bear witness to what entities like ACEP and the AMA can do and we can hope fewer patients will suffer, thanks to our efforts. 

DR. OSBORNE is an associate program director, associate professor of emergency medicine, and associate professor internal medicine and Emory University School of Medicine Department of Emergency Medicine.