Prison: A Dangerous Place to Get Sick

According to a study by researchers at the University of Miami Miller School of Medicine, getting out of prison alive doesn’t always depend on the length of one’s sentence. An alarming number of inmates die simply because they lack access to proper surgical care.

From left, Hahn Soe-Lin, M.D., MS, Roderick King, M.D., MPH, and Tanya Zakrison, M.D., MHSc, MPH.

The study, published in a recent edition of JAMA Surgery, revealed a troubling trend in the availability and quality of care provided to Miami-Dade County’s prison population.

“We found that close to one in four inmates in Miami-Dade County who died between 2008-2014 died of trauma or acute surgical problems,” said Tanya Zakrison, M.D., MHSc, MPH, associate professor of surgery at the Miller School, acute care surgeon at Ryder Trauma Center, and lead author of the study.

“Just because someone is in prison doesn’t mean they should have to die from treatable conditions such as groin hernias, or bowel obstructions,” Zakrison said.

Zakrison and her team of researchers examined more than 300 autopsy reports for inmates who died while incarcerated. What they found surprised them: two-thirds of those who needed surgery for a non-liver-related condition never got it, meaning their deaths could potentially have been prevented with proper and timely care.

Rishi Rattan, M.D.

Many of these cases were for conditions that shouldn’t necessarily be fatal but can be if left untreated. Of even greater concern is that the actual number of preventable prison deaths may be far larger than reported, Zakrison notes.

“Not all correctional facilities have mandatory autopsy requirements, as this is left to the discretion of the medical examiner,” Zakrison said, “and data collection on mortality is in part voluntary.”

The research team was denied records to well-publicized cases where the prisoner’s death was suspicious for torture by prison guards, so they were unable to factor these into their study. This is also a concern, given that there is no truly mandatory reporting system for these deaths. Moreover, the team reviewed only those cases in which a prisoner died; others may have suffered complications from delayed diagnosis or care but survived.

If the findings from this study were to be extrapolated to the entire United States, which has the highest rate and number of incarcerated individuals in the world — currently estimated at 2.3 million — then Zakrison suggests this may be a widespread human rights issue that warrants further investigation.

“Part of the problem likely has to do with the fact that prisons in Miami-Dade County and throughout the U.S. are overcrowded and underfunded, limiting inmates’ access to surgical care,” Zakrison said. “In addition, prison health care is often outsourced to for-profit companies with variable quality standards, which means inmates aren’t necessarily receiving adequate care.”

Other Miller School faculty involved in the study include Hahn Soe-Lin, M.D., MS, clinical fellow; Rishi Rattan, M.D., assistant professor of surgery; and Roderick King, M.D., MPH, director of the M.D./MPH Program and assistant dean for Public Health Education.