We are Code Black RI, a coalition of medical professionals, healthcare workers and trainees taking a stand against racism and racist systems. Our coalition was founded in response to the deaths of Ahmaud Arbery, Breaonna Taylor, Tony McDade, George Floyd and many others who lost their lives to police violence. Today, we are taking action to amplify the calls for justice and denounce the harm enacted upon those incarcerated at the ACI. We mourn the death of an incarcerated person who died from COVID complications last week, and hold vigil for all those still at risk for untimely death at the ACI.

Mass incarceration is a threat to health equity and a public health crisis. As of December 17th, greater than 90% of the inmates in maximum security tested positive for COVID. Cases are rising at the surrounding facilities. None of these outcomes are due to happenstance. Since March, the Decarcerate NOW Coalition and many others have called for the state to halt arrests; release as many incarcerated people as possible on parole and into community confinement – centering elderly and medically vulnerable people; and provide adequate PPE and universal testing to incarcerated people.

These measures were not taken, or taken in half-measure. After releasing 52 people in April, the number of people detained pretrial climbed by 20% between April and October of this year. Family members of those who are incarcerated have repeatedly reported that their loved ones do not have access to adequate PPE and that mask wearing is not enforced by correctional officers, despite declarations of intervention on access to PPE from the Rhode Island Department of Health and the Department of Corrections. There is a discrepancy between RIDOH’s calls for intervention and the actual implementation on site.

It is important to recognize that these outcomes are not only the result of state negligence towards incarcerated people during a global pandemic. They are the product of an environment that is inherently detrimental to the wellbeing of those who exist within it. Prisons and jails are the perfect storm for infectious diseases to spread due to multiple factors: high-density population, unsanitary conditions and poor ventilation. Many incarcerated individuals have chronic conditions that put them at higher risk for COVID-19. The carceral system plays a role in this deterioration of health – people in correctional facilities have significantly higher rates of disease than the general population due in part to overcrowding, violence, poor nutrition, dilapidated facilities, inadequate healthcare access, and solitary confinement. Evidence has demonstrated a dose-response to incarceration: each year in detention translates to a 2-year decline in life expectancy. Now, in addition to the adverse health impacts of incarceration, individuals in detention are at five times greater risk for contracting the virus compared to the general population.

The root causes of this public health crisis lie in capitalism, racism and the racist policies that created the carceral system. Over 50% of the people who have been sentenced or awaiting trial in Rhode Island are Latinx or Black. Also in our state, Black people are significantly more likely to be arrested for nonviolent crimes in RI than white people. In 2012, for example, Black individuals were arrested at a rate of at least 3.4 times higher than white individuals in every RI police department, and as high as 9 times in some departments. Nationally, adults living in poverty are 3 times more likely to be arrested than those who aren’t, and people who earn less than 150% of the federal poverty level ($32,580 for a 3 person household in RI) are at 15 times greater risk to be charged with a felony, and thus receive longer sentences, than their counterparts who have higher incomes. Across the country, numerous cities, counties and states have declared racism as a public health crisis. We urge Governor Raimondo and the people of Rhode Island to take this necessary step in working towards health equity. Racism is a public health crisis. Incarceration is a public health crisis.

Today, we stand in solidarity with the Decarcerate NOW Coalition and their following demands:

1. Halt arrests and grant personal recognizance to limit the number of people indefinitely trapped in the ACI’s Intake Center, waiting for court hearings and trials.
2. Reduce the prison population to control the spread of disease. Restore lost good time. Expedite parole hearings and release all eligible individuals. Utilize medical parole for all terminally ill, elderly, and immunocompromised individuals. Release all other eligible individuals into community confinement.
3. Recognize all incarcerated people as a priority community (Phase 1) for the COVID-19 vaccination, with an informed consent and opt-out process for the population.
4. Provide our loved ones with adequate PPE (masks, soap, hand sanitizer) as recommended by the CDC.
5. Regularly administer universal testing across the population, including asymptomatic people.
6. Provide transparency and accountability to incarcerated people’s families. Publicly release a formal process for family members to report noncompliance with COVID measures. Report daily COVID-19 numbers on the RIDOC website and social media, with the same level of documentation and transparency as that provided around every other Rhode Island population.

We recognize the measures that the Department of Health (3-5) has endeavored to take to provide personal protective equipment (PPE), administer universal testing and to prioritize people for the vaccine who are older than 65 and immunocompromised. However, currently all correctional officers at the ACI will be offered the vaccine in Level 1.3, while anyone in the general ACI population who does not qualify under the prioritized group will still be at high risk, and without access to vaccination, until Phase 2. This prioritization of a dominant group over a marginalized group is healthcare inequity. We know that stopping the spread of COVID on the inside will make a healthier community for all, both inside and out. In order to decrease the astonishingly high spread of COVID, the greater ACI population must have access to vaccines and the number of people  entering the facilities must be decreased. By continuing to arrest and detain community members, we increase the number of people carrying COVID who are being brought into the prison – not to mention the downstream effects of both short- and long-term negative health outcomes. Due to the high positivity rate in the community, it seems inevitable that transmission from the outside will continue in this form as the pandemic rages on unless further intervention is taken.

The current criteria for granting medical parole as it stands is restrictive and does not adequately capture the risks posed to many of the chronically ill individuals at the ACI. As health care providers, we strongly advocate that an important long term goal should be to expand eligibility for medical parole to more accurately capture health risks posed to individuals. Along these lines, releasing geriatric individuals who are up for parole is another compassionate measure that would reduce the prison population. An even larger impact would be made if the age for geriatric parole was reduced to 50. This is documented in activist Leonard Jefferson’s recent testimony to state legislators, in which he cites evidence of significantly reduced life expectancy for those who are incarcerated for years at a time. Beyond the benefit to released individuals and their loved ones, such a step would allow medical care and resources to be directed to other incarcerated people and reduce overall healthcare costs for the prison system. In the end, to have healthy communities, the goal is to reintegrate our formerly incarcerated loved ones back into society.

Until we target the racist systems that perpetuate health inequity, we will continue to see the downstream effects and watch people die from preventable causes. We have joined the field of healthcare to heal and “do no harm”, although all too often we find ourselves a part of systems which inflict harm on our patients. We cannot continue to perpetuate harmful systems. We must work to change them. Today, we stand in solidarity with all whose lives have been devastated by mass incarceration.

References:

1. https://ajph.aphapublications.org/doi/10.2105/AJPH.2020.305707
2. https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2019.305475?utm_source=TrendMD&utm_medium=cpc&utm_campaign=Am_J_Public_Health_TrendMD_0
3. Cloud DH, Parsons J, Delany-Brumsey A. Addressing mass incarceration: a clarion call for public health. Am J Public Health. 2014;104(3):389-391
4. https://www.aafp.org/about/policies/all/incarceration.html
5. Petition from Public Defender https://www.providencejournal.com/story/news/courts/2020/12/02/rhode-island-public-defender-asks-state-supreme-court-ease-bail-guidelines-covid-cases-spike-aci-acr/3793153001/
6. Response from Gov Dec 3rd https://www.wpri.com/video/video-now-gov-raimondo-discusses-significant-spike-in-covid-19-at-aci/6085873/