HJNO Jul/Aug 2020

20 JUL / AUG 2020  I  HEALTHCARE JOURNAL OF NEW ORLEANS PRISON HEALTH determined to be faking illness, or malinger- ing, a rule that advocates for the prisoners say discourages them from making or pressing their medical complaints. “Surgeries are delayed, diagnoses are de- layed, until it’s too late to do anything,”Melvin Thornton, an inmate who led a petition drive seeking wider coronavirus testing, wrote in an email. “They can’t deal with that, and then you add a pandemic.” Angola takes its name from a plantation that once occupied the land on which it was set, in a deep bend of the Mississippi River. Most prisoners now work those same fields, picking soybeans and okra for as little as 4 cents an hour. For years, Angola was notorious for its vio- lence, a place where guards brutalized the in- mates and inmates beat, raped andmurdered one another as a matter of routine. Nowa- days, it is better known as a monument to mass incarceration, filled with aging, often medically fragile inmates. Three-fourths of them areAfricanAmerican. Virtually all were sentenced to hard labor; most serving life without the possibility of parole. The medical treatment of Angola’s prison- ers has been challenged in the federal courts almost continuously since 1971. Deficient health care — along with rampant violence, overcrowding and racial segregation — led to a federal consent decree in 1983 and supervi- sion by a federal judge of reforms across the state corrections system. Angola was especially slow to comply; it remained under federal oversight for the next 16 years. As the violence diminished, state officials drew attention to improvements like the prison law library, educational programs and an elaborate system of privileges and rewards for inmates who followed the rules. But the health care problems proved more intractable. “Prisoners report horror story after hor- ror story,” lawyers for the plaintiffs wrote in their 2015 complaint. “Aman denied medical attention four times during a stroke, leaving himblind and paralyzed; a man denied access to a specialist for four years while his throat cancer advanced; a blind man denied even a cane for 16 years.” A team of leading prison-health experts, hired by the lawyers to evaluate Angola’s health system, called it “one of the worst we have ever reviewed.” For years, Louisi- ana prisons have consistently recorded the country’s highest mortality rate. With proper care, the experts concluded, many of those inmates might have survived. “It is our opin- ion that these preventable excess deaths are a consequence of the systemic inadequacies in the health program,” they wrote. When the pandemic struck, some of the same civil rights lawyers sued to block a state plan to quarantine coronavirus patients from parish jails in an abandoned punishment block at Angola known as Camp J. But Dick upheld the plan, saying the advocates’claims that dozens or even hundreds of prisoners could die were “based primarily on specula- tion and conjecture.” The judge appeared to be especially per- suaded by what she called the “deliberate and thoughtful efforts” led by Morrison, a well- regarded surgeon on the faculty at Louisiana State University medical center who designed the corrections department’s pandemic plan as its medical director. State records show that in mid-February, more than three weeks before Louisiana registered its first COVID-19 case, Morrison began contacting state health officials about the pandemic threat. He also directed pris- on wardens and doctors to review existing manuals for outbreaks of infectious disease. By March 12, three days after Louisiana’s first documented coronavirus case, the state’s prisons suspended family visits, tours and other outside contacts. Officials also began “reverse-quarantining,” isolating medically vulnerable inmates at Angola and elsewhere from people who might infect them. “We are taking any measures we can in an attempt to keep the virus from entering our state-run fa- cilities,”Morrison wrote in an email that day. In a recent interview, Morrison said he be- lieved from the start that extensive testing for the virus would be an essential component of the corrections department’s response. Although Louisiana faced the same short- age of test kits in March that constrained other state governments, Morrison pushed to obtain the largest possible supply of test kits and contracted with a private labora- tory to help. But inmid-April, before substantial testing had even begun, Morrison left the correc- tions department to return to the LSU faculty, a change he said he had been planning for some time. When he left, he said: “We had plenty of tests available to us. We were tell- ing them to test people. They were sending tests out to the prisons as needed. We told the facilities, let us know when you’re low.” Early outbreaks eruptedat twowomen’s pris- ons in the state system. When the authorities tested about 500 inmates in those facilities, they found infection rates of 87% in one and over 60%in the other, Pastorick, the corrections spokesman, confirmed.Those relatively small prisons remain the only ones wheremass test- ing has been done. The wardens at Angola did not follow suit, even though inmates said many were falling ill and a guard lieutenant had died from the virus in late March. The corrections depart- ment has been more willing to test guards and other staff who work inside the prisons, reporting more than 1,000 tests by June 22, with about 19% of them positive. Corrections officials said that the medical staff at Angola worked to educate inmates about the virus, warn them of the risks and prepare them to protect themselves. But many prisoners said they were told noth- ing about how to prevent the spread of COVID-19. Darrill Henry, who was in his 16th year of a life sentence for double murder, noticed that “free folks” — as inmates call the guards and medical staff — suddenly began wearing face masks. One guard vomited in a hallway; others began missing work. “I’m wondering what’s going on,”he recalled. “Nobody is tell- ing us anything. Then, we see on TV, they’re talking about coronavirus every day.” When the prison staff finally began to dis- tribute cloth-and-string masks weeks later, most inmates wore them for about a week,