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Levand by then was living near Albuquerque, New Mexico, where she now works as a paraprofessional special-education teacher and a receptionist. That October, she invited her daughter to stay with her. Levand called the police, and Gignilliat was arrested for aggravated battery and property damage, and was taken to the Sandoval County Detention Center. The health services at the jail were provided by Correctional Healthcare, the company that was later acquired by Wellpath.

Medical staff noted that Gignilliat had mental-health needs, but she refused to take medication.

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In fact, neither the company nor the jail had legal authority to do so; in New Mexico, such action requires state-court approval. She was allowed to leave it only to take a shower or to consult with a social worker or with medical staff; some days, she refused a shower and did not leave her cell at all.

By mid-December, she had become deeply delusional, and the warden finally transferred her to the emergency room at the University of New Mexico Hospital.

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A doctor there diagnosed bipolar disorder and psychosis, treated her with anti-anxiety medication, and persuaded her to eat—according to Levand, she had lost about twenty pounds. She was then sent back to jail, where she again went unmedicated. Staff there obtained a court-appointed treatment guardianship, and, in late January of , she was administered medication, and her condition stabilized. At the end of March, the district attorney dropped the criminal charges against her, and she went back to Georgia. Photographs taken there show her smiling as she embraces her children.

Yet, on June 12th, she swallowed a fatal dose of pills; she died two days later, at the age of thirty-nine.

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However, court papers filed by Levand describe starkly the daily suffering that her daughter endured while in segregation. Ultimately, the county and the company agreed to a confidential financial settlement. The situation that Gignilliat encountered is not uncommon: few local jails have dedicated mental-health facilities, and operators often resort to managing people by placing them in segregation. Yet even in jails that do provide dedicated care the quality can be poor.

He was thirty-nine years old and suffered from diabetes, but he had previously received a diagnosis of schizophrenia, and was assigned to the mental-health unit. Under a contract signed with the city in , Corizon Health shared responsibility for medical services at Rikers and oversaw the mental-health facility. In September, according to a legal complaint, Ballard was moved to solitary confinement, after dancing provocatively in front of a female corrections officer. For six days, medical personnel and jail guards looked in on him, but did not offer him any assistance.

He was then discovered lying naked and covered in his own waste.

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He had mutilated his genitals, and died hours after being found, from sepsis and diabetic ketoacidosis. Corizon did not contribute any of the funds, because, according to Martha Harbin, the contract stipulated that the city would bear financial responsibility for all malpractice claims. A group of New York-based nonprofit health-care providers has since taken over the provision of medical services at Rikers.

Both jail operators and private health-care companies recognize that it would be better to treat mentally ill people, especially those who are nonviolent, in specialized hospitals or in dedicated units in jails. Opioid addiction, too, is an area in which jail health care is increasingly relied on by default.

Last year, according to a preliminary estimate from the Centers for Disease Control and Prevention, more than seventy-two thousand people died from overdoses—almost two hundred people a day.

The C. And many people suffering from addiction pass through jails on charges related to their habit. Madaline Pitkin was one of them. She grew up in Portland, Oregon, and attended Catholic school, where she was a good student.

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At some point in her twenties, she drifted into heroin addiction, and, in April of , she was arrested on a warrant for an earlier arrest and for possession. During her booking at the Washington County jail, which, until May of , had a contract with Corizon Health, she told a nurse that she used a gram of heroin a day. A week later, at the age of twenty-six, she died of dehydration, after vomiting and suffering diarrhea as she went through withdrawal. Company personnel allegedly failed to provide an I.

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I feel like I am very close to death. Please help me. Corizon had fully indemnified the county. In other jurisdictions, sheriffs and administrators do follow the recommendations of public-health advocates who argue that the best way to defeat addiction is to guide people toward long-term treatment, with access to methadone or to similar drugs that can allow them to either safely maintain their opioid use or gradually reduce and cease it.

The National Commission recommends that prisons and jails adopt a comprehensive treatment plan that includes medications to ease withdrawal and others, such as buprenorphine, that safely satisfy cravings for drugs. The commission also advises psychological counselling and in-detention meetings with recovery groups, such as Narcotics Anonymous.

But the resources to support such public-health approaches are small in comparison with the vast sums spent on jails and prisons themselves.

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The Presidential election was less than three months away, and Hillary Clinton , who was then leading Donald Trump comfortably in most polls, tweeted her support, suggesting that the order would stand if she won the White House. After Trump was inaugurated, one of the first acts of his Attorney General, Jeff Sessions , was to rescind the Yates order. Opponents of privatized detention have argued, on philosophical and constitutional grounds, that certain governmental powers—such as those to wage war, to use lethal force in the name of the law, and to hold people in detention—should not be hired out to profit-seekers.

The concurrent rise of for-profit health care in jails and prisons has not been accompanied by the kind of public debate, congressional scrutiny, or scholarly research that has informed other fields of health policy. Yet there are notable public and nonprofit alternatives.

In some European Union countries, where universal access to health care is fully established, prison and jail health care is often administered by state health services. In this country, some physicians and health-care specialists advocate for greater investment in community treatment centers—residential and nonresidential facilities that seek to treat and stabilize individuals suffering from addiction or mental illness through medication, peer counselling, and social services, and where nonviolent offenders suffering from these conditions might be directed, as an alternative to jail.

Other practitioners argue that prison health services in the United States work best when they are provided by nonprofits that also deliver medical services for the general population as is now the case in New York City. Since the late nineteen-eighties, four states—Texas, Georgia, New Jersey, and Connecticut—have contracted prison medical services to their state university systems, whose facilities also serve the public.

Newton Kendig, a physician specializing in infectious diseases and a clinical professor of medicine at George Washington University, in Washington, D. The University of Texas has pioneered the use of telemedicine, or videoconferencing, to treat the incarcerated. Last July, after a woman gave birth in her cell at the York Correctional Institution, in Niantic, Connecticut, where health care was overseen by the University of Connecticut, and where there had been other complaints about care, officials transferred responsibility for prisoner health care statewide back to the state corrections agency.

After twenty years of service, he retired as a rear admiral and an Assistant Surgeon General. The Commissioned Corps is another public model that might be adapted to provide an alternative to privatization. It is a uniformed medical civil service of more than six thousand physicians, public-health specialists, and other professionals. Among other duties, members design and manage medical and mental-health programs for federal prisoners. They also work for the C.


There are, nevertheless, signs that the country is moving toward a new consensus on criminal-justice reform. That includes support within the Republican Party for public policies that may improve medical services for the incarcerated. A major advancement in the field was reached in May of last year, when the Texas state legislature passed the Sandra Bland Act.

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