HJNO Jul/Aug 2020

HEALTHCARE JOURNAL OF NEW ORLEANS I  JUL / AUG 2020 19 “We are proud of the job we have done managing the pandemic thus far,” he said, “and the results bear out that our plan con- tinues to be successful.” Yet, in the twomonths after Louisiana pris- ons recorded their first cases of the novel coronavirus in late March, the corrections department tested only about 3% of the roughly 14,150men incarcerated in state pris- ons, official figures indicate. The authorities have since conducted about 400 more tests. Prisons and jails now account for most of the biggest COVID-19 hot spots in the coun- try, with thousands of cases documented at penitentiaries in Texas, Ohio, California and other states. But corrections officials have reported striking differences in the impact of the virus. As some states have begun mass testing, they have found prison infection rates as high as 70%. Yet, a surprisingly low death rate in prisons across the country has allowed some officials to downplay or even hide the spread of the virus behind bars. Even prisons likeAngola, with older male inmates who are particularly vulnerable to the disease, have not shown mortality rates close to those of nursing homes. Arecent New York Times analysis showed that nursing homes accounted for about 11% of the coun- try’s coronavirus cases but 35% of deaths. A ProPublica investigation of the coro- navirus outbreak at Angola — long the most troubled prison in a state with the country’s highest inmate mortality rate — offers a vivid, inside look at how some dramatic and largely unseen chapters of the COVID-19 crisis have unfolded. This article is based on telephone conver- sations, email messages and other commu- nications with more than two dozenAngola inmates, as well as interviews withmany law- yers and relatives who have been in touch with them and a review of more than 900 email reports sent by inmates to a prisoner support group during the pandemic. It also draws on interviews with current and former officials, and statements and documents pro- duced in two federal lawsuits over medical treatment at Angola. In many cases, prisoners said, inmates who were obviously sick with the corona- virus were denied even cursory medical examinations, mostly because they did not register sufficiently high fevers. Men passed out and were told they were dehydrated. Oth- ers, who complained of bad coughs, aches, fatigue and stomach pains were treated with Tylenol, Pepto-Bismol and Tums. Countless sick prisoners were left to re- cover in their bunks, which are typically set less than 4 feet apart in Angola’s crowded dormitories. Firsthand accounts from 11 of those dormitories, which collectively house nearly 1,000 inmates, suggest that most of the men inside became infected. Some sick prisoners concealed their symp- toms to try to avoid losing their freedom of movement and other privileges to extended quarantines, inmates said. But the efforts at containment have also been haphazard, they added, with sick prisoners frequently brought back to quarantined areas and staff moving between dorms that were under quarantine and others that were not. Perhaps the most serious problem has been Angola’s unwillingness to test inmates more widely. Like other parts of the country, Louisiana did face testing shortages early on. However, the corrections department’s former medical director, Dr. John Morrison, said there were thousands of test kits available to the prisons when he left that job inmid-April. Official re- ports show that the corrections department also obtained 4,100more tests a month later. Yet, even after public health officials be- gan to urge widespread testing in prisons and Gov. John Bel Edwards promised such screening, Angola has moved very slowly to increase testing, official statistics show. Ac- cording to national statistics compiled by the COVID Prison Project, a nonprofit pub- lic health group, Louisiana’s reported testing rate trails far behind other states that have suffered serious outbreaks. Louisiana corrections officials have not re- ported any testing or infection figures for the 13,844 state prisoners who are held in more than 100 parish jails under a long-standing arrangement to relieve overcrowding. “The surest way not to have a coronavirus crisis is not to test for it,”said Haller Jackson, who was recently released fromAngola after serving a five-year sentence. “We all joked when we saw the ambulance coming, ‘Oh, somebody else is dehydrated.’” Louisiana is hardly the only state that has been slow to test prisoners. Only Michigan and Tennessee had tested more than half of their inmates by mid-May. Since then, how- ever, at least nine others have done so. The accounts from Angola inmates and others cast new light on the prison’s health care system, one that has been a focus of criticism, litigation and halting reform for almost half a century. Lawyers for a dozen inmates who filed a class-action lawsuit in 2015 argued that An- gola’s medical care was so egregiously poor, it violated the EighthAmendment’s prohibi- tion against cruel and unusual punishment. The federal judge hearing the case in Baton Rouge, Shelly D. Dick, said in February that she will find the state’s practices “unconstitu- tional in some respects,” but her final ruling is still pending. Nearly all of the doctors who work full time at Angola ended up there after the state medical board suspended their licenses for violations ranging from drug dealing to sex- ual misconduct. The prison’s medical direc- tor, Dr. Randy Lavespere, served a federal prison sentence for buying $8,000 worth of methamphetamine in a Home Depot parking lot. He is now overseeing health care for the entire corrections department. Inmates describe some of the doctors, nurses and paramedics as able and well-in- tentioned. But they and their advocates said the staff was unable to deal adequately with the day-to-day medical problems of its 5,500 inmates long before the virus hit. Cancers and other slow-growing diseases are often discovered late — sometimes af- ter years of medical complaints that were ignored. Prisoners with chronic illnesses have often had trouble getting specialized care or even regular medication. Louisiana prisons have long punished inmates who are