On Rikers Island, a doctor for older inmates

Five years ago, Dr Rachael Bedard was completing a Geriatrics and Hospice Fellowship at a Manhattan hospital when she began to wonder if there were any elderly inmates in need of care just across the way. from the East River to Rikers Island.

Dr Bedard wrote to the town’s chief of medicine in the prison system and asked if Rikers had “an aging problem”. He offered her a job.

“It was a truly amazing opportunity to come and discover a population that is generally under-recognized,” Dr Bedard said of his membership in the public prison health care provider, which had replaced a for-profit entrepreneur l ‘last year.

The data she began to collect on the job quickly showed that even as the prison population was shrinking, the share of inmates 55 and over was rising from 4 percent in 2009 to almost 10 percent in 2019. Older inmates were six times more likely to die while incarcerated as younger. And they had little access to the specialized care they needed.

Now, Dr Bedard is the director of geriatric and complex care services for the New York City prison system and is perhaps the only specialist prison geriatrician in the country. She and her colleagues, who work with patient lawyers to coordinate their care with the courts, have secured the compassionate release of more than 150 critically ill detainees.

Last month, Dr Bedard spoke with The New York Times. The following interview has been edited and condensed.

Q. What is a typical working day for you?

A. There are eight functioning prisons on Rikers Island, and each has a clinical space. Like a primary care practice, we have scheduled appointments. And we are seeing people with urgent care issues. There is also an infirmary where we have the 110 sickest people. It’s much closer to a nursing home, where nurses and doctors can walk to someone’s bed. I’ll go over there and talk to the primary care providers and say, “Who are you worried about? And then I can see these people.

How closely do you work with family members of detainees?

A little. It is essential that people are in contact with their loved ones when they are seriously ill, but prison makes this very difficult; the simple fact that family members cannot directly call their incarcerated relatives is a huge obstacle. We will advocate for families to have greater access to hospitalized and very sick people. And we are in contact with families a lot when developing reintegration plans.

Are your patients usually short in prison?

They should be, but they are not. Remember this is not jail: the vast majority of our people are in pre-trial detention, which means their arrest was relatively recent. The idea is that they will have their trial speedy and they will either be sentenced or released.

In practice, however, we have tons of people sticking around for months, if not years. And older people actually tend to stay longer than their younger counterparts, in part for reasons related to their poor health. For example, when people are sick or hospitalized, they miss court dates. We also see this problem when the courts are uncomfortable with an elderly person returning to the community without a plan that they believe is safe for them.

Can you give an example of what can happen?

One of my first cases was a guy in the early 80’s. It was his first arrest since he was a very young man. He suffered from fairly severe dementia and had injured a member of his family. When the family called the police, the police arrested him rather than take him to the hospital, and he was sent to jail.

Everyone deplored this result. The courts did not want to sentence this guy to jail, but they also found that he was not safe to return home with his family. So they wanted him to go to a retirement home, and it’s very difficult to bring people from prison directly to retirement homes. So this guy was stuck for three years in pre-trial detention while we were trying to come up with a release plan.

How is the delivery of correctional health care different?

Prisons and prisons are places where interactions between staff and patients are fundamentally characterized by mistrust. People don’t choose who their supplier is. They don’t control when they are seen or how they are seen. So all the interaction starts from a place where you represent a system that oppresses them, and they need something from you and don’t believe that you will be able to provide it to them.

Do circumstances limit what you can offer clinically?

There’s this tension – this potential double 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 when it comes to security and safety.

I take care of people with advanced illness who sometimes have severe pain, such as advanced cancer. In the community, if I were that person’s hospice doctor, I would probably prescribe opioids that might be available to them as often as every two hours and that might increase in dose. In prison, people cannot just walk around with oxycodone in their pocket.

You expressed your support for legislation that would make those 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 to be incarcerated for the elderly. I have a greater sense than most of their suffering, which is acute and extensive, and also of what it means to us as a society that we are willing to keep 85 year olds in chains. It doesn’t sound like the world I want to live in.

The flip side is a matter of public safety. And the data is incredibly clear that the recidivism rates for people who have spent more than a decade in prison and who are older are very, very low.

You accepted this job because of the change of city to a public, independent correctional health care provider. What was the impact of this change?

In 2019, New York City recorded three deaths in custody. It was the lowest in-custody death rate of any prison system in the country and the lowest in New York City history. More than anything, it was a testament to the suicide prevention efforts, the overdose prevention efforts that my colleagues made.

But this year, at least 14 people in New York City jails have died so far, including three aged 55 or older.

Correctional health alone cannot mitigate all of the harms of incarceration when security is not functioning.

We practice, fundamentally, in an environment that puts people at risk: prisons are incredibly dangerous places where you concentrate people who are in crisis. And harm reduction can only go so far if the dangerousness of the situation worsens. So my take on the past year has been that as the relative dangerousness of being incarcerated in New York City has intensified, the ability of correctional health to mitigate that has been compromised.

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