Empty hospital bed.

Do No Harm: A Call for Decarceration in Hospitals

By Zainab Ahmed

In an era of mass suffering, some still suffer more than others. What’s worse, there is nothing natural about it. It is human made.

As an emergency medicine resident at a large academic hospital in Los Angeles, I see how incarcerated patients’ suffering is sanctioned by hospitals and medical professionals, despite their pledge to do no harm.

Though strict protocol typically governs everything in hospitals, for prisoners, those rules seem to go out the window, without deliberation. This heightens the cruelty of incarceration.

For example, typically, before a patient is placed in restraints, there has to be a face-to-face evaluation on initiation and frequent reassessment. Restraints are only supposed to be ordered for patients who are interfering with their medical devices or agitated.

Nebraska Twenty, however, in his corner room of the Intensive Care Unit, remained shackled to his bed, despite being intubated, sedated, and sometimes paralyzed. He was neither agitated nor interfering with the tubes and lines running into and out of him. But no one, including me, questioned his cuffing to the bedrail.

Patients from the general population are only assigned names and numbers if they are at risk of targeted violence or are found without identifying information. Neither of these circumstances applied to Nebraska Twenty. Yet, I never used his real name.

I routinely passed by his room with two officers posted outside at all times. They leafed through magazines or scrolled on their phones, waiting. They too had become part of my daily routine, but I never spoke to them directly.

His family was not allowed to know where he was being treated. They would not have been able to visit, even if they did know. To provide updates to his loved ones, we dialed through an outside line. If the medical staff required consent for an invasive procedure, one of the officers would have had to witness the conversation. But they rarely paid attention to his clinical state. Nebraska Twenty eventually died — alone.

It is equally impossible to fulfill the basic principles of health care delivery — like safe discharge planning — for incarcerated patients in other medical settings, such as the emergency room.

Mr. J was brought to the Emergency Department with a cough, but after a test, we learned he was COVID positive. Because his vital signs were stable, he did not have to be admitted to the hospital. He told me out of earshot of the accompanying officers that he used fentanyl in jail and was nervous that he might be withdrawing. Clinically, it was difficult to discern if it was COVID-19 or withdrawal triggering his body aches and diarrhea. I loaded him with buprenorphine, worried that his next dose may not be scheduled in time.

He was discharged back to jail with return precautions: “Please come back to the Emergency Department if you feel short of breath, develop chest pain, fever or any new or concerning symptoms.”

I knew this would not happen. Just as there was no assurance of masking or social distancing in prisons, there was no guarantee of follow-up. Most patients with severe COVID did not present with obvious respiratory distress. I would often tell my patients to check their blood oxygen level with a pulse oximeter at home and to come back if their reading was low. I knew Mr. J would not be able check his oxygen saturation at will. I did not know how he would fare after he was “medically cleared” to return to an overcrowded jail.

The pandemic put into stark relief that the most vulnerable to death and disease were met with the least care and attention.

Although the setting varies, from the acute testing provided in the Emergency Department, to critical long-term management in the ICU, the challenge remains the same. How does one provide care when the patient is being punished?

Health care delivery centers on quality and safety. Incarceration compromises both, and physicians have become complicit in the harm inflicted by the carceral system. Personal interventions are simple — using a patient’s real name, or anticipating difficulties with medication refills in jail.

More meaningful reforms will require limiting the role of prison guards, advocating for compassionate release, standardizing exceptional care, and redrafting institutional policy to safeguard the rights of inmates. In other words, the hospital should be a staging place for decarceration.

Zainab Ahmed, MD is a resident in Emergency Medicine at UCLA.

* Identifying details have been changed to protect patient privacy. Views and opinions expressed are those of the author and do not represent affiliated institutions.

The Petrie-Flom Center Staff

The Petrie-Flom Center staff often posts updates, announcements, and guests posts on behalf of others.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.