Surviving versus Thriving
September 14, 2021
In late August, Washington County, Arkansas, county official Eva Madison raised an important issue during what would otherwise have been a typical county budget meeting. The Washington County jail’s physician, Dr. Rob Karas, asked for more money to his contractual agreement as part of the budget review process. (The sheriff praised the medical team for their work during COVID and felt the amount was justified.) Madison said that she had heard from a county employee, who was prescribed ivermectin after a negative COVID test at the jail. (The prescription was $76.) Rightfully concerned, the employee asked his primary care physician – who told him to throw it out – and told Madison that he was concerned people inside the jail were receiving ivermectin, despite all medical advice advising against it. “Dr. Karas’s position on how he is treating inmates at the jail raises eyebrows…at a time where people are laughing at us for taking cow dewormer” she said. “I don’t care how much Dr. Karas wants for his contract. We need someone new,” she concluded.
After speaking, Madison left the meeting, and other county officials asked more questions about how medical care was being provided in the jail. (This was already flagged as a concern because of the proposed price hike.)
A shout-out to Shawndra Washington in the quorum, who continued to ask questions about regulating health care in the jail until she was cut off. Additional information came out about the contract — the sheriff liked Karas because he was a “local” guy, and the contract with Karas has not been renegotiated since 2015. This was framed as getting the best price, but it’s also reflective of the general problem within sheriff’s offices — long-term contracts that are never re-examined.
Sheriff Tim Helder, who is in charge of all jail operations, later admitted that Karas was prescribing people housed in the jail ivermectin as a treatment for COVID-19 even though ivermectin is not a viable treatment for COVID (and has been the subject of conspiracy-minded theories among anti-vax groups). He continued to defend Karas’s decision.
Aside: Karas also runs Karas Health Care, which advertised on Facebook ivermectin prescriptions. He has continued, improbably, to defend prescribing ivermectin on his Facebook page both as a treatment and as a preventative. He says he’s taken it (and had COVID twice) and gave it to family members. (Karas raised eyebrows earlier this year when he opposed mask-wearing.)
Patients say they were told that the ivermectin treatments were “vitamins.” One man who received ivermectin after a positive COVID test told CBS News:
We were running fevers, throwing up, diarrhea ... and so we figured that they were here to help us. ... We never knew that they were running experiments on us, giving us ivermectin. We never knew that.
The Arkansas ACLU has asked that Sheriff Helder stop allowing Karas to distribute ivermectin and has requested documents from the sheriff’s office to better understand how many people may have taken the drug unknowingly. Even the Arkansas medical board is investigating Karas.
This is not the first time that people confined to jails and prisons have been used for medical experimentation and subjected to nonconsensual, substandard medical care. Late last year, it became public knowledge the physicians in a Georgia ICE detention facility were sterilizing women without permission; this also happened in California prisons. Prisons and jails also are known for substandard care, employing physicians who are not qualified to work in other medical centers (generally because they have histories of poor performance) and outsourcing medical care to for-profit companies who have incentives to cut corners.
Incarcerated people do not have the opportunity to determine their care; often, they don’t even know what medications they are receiving or why they are being prescribed. While the county employee could get a second opinion on ivermectin, people incarcerated cannot.
In Alameda County, the jail’s medical director was fired last year when authorities found out she had been using her post to write fake prescriptions for opioids. She was in charge of the jail’s response to COVID and may have underestimated the risks, misinformed her patients, and failed to implement proper protocols to prevent the spread of the virus.
The director was an employee of Wellpath, a for-profit, private equity-owned company that specializes in correctional health care and has been sued over 1,300 times since 2003. The Alameda County sheriff’s office contracts with Wellpath to provide care – and, of course, they are responsible for ensuring that Wellpath provides constitutionally adequate health care – but the use of a third-party provider is a layer of political insulation for sheriffs and jailers.
Here, I come to a confession – daily, as I work, I struggle with the tension between a desire to abolish carceral systems and the need to ensure that people within them can, in the words of one advocate, “survive.” “People cannot thrive in jail,” she said. But, she pointed out, they need to survive.
Law professor Andrea Armstrong discusses this in her work, which was excellently explained in Eyal Press’s recent New Yorker story. Armstrong makes a persuasive case that prison and jail conditions should be a larger part of any reform or (I’d add) abolitionist project. She points out that, in some cases, improving prison and jail conditions actually increases incarceration rates and allows for sheriffs and other carceral administrators to expand their power fiscally and politically. But, she writes:
At a minimum, people should not end their judicially set sentences of incarceration worse off than when they entered.
One point she makes is the failure of linking political efforts to decrease the financial impact of the criminal legal system with decreasing the human impact of incarceration. Marie Gottshalk discusses this in the context of Texas prisons and jails, arguing (persuasively, I think) that austerity efforts do more harm than good, particularly when it comes to the conditions of confinement. Texas prisons charge one of the highest fees as copayments for medical care. Jails are even less regulated and subject to variable cash flows alongside the carceral politics of county and state governments. Jail staff are often untrained or inadequately trained, jails deaths are not properly reported under Texas law, and sheriffs have found creative ways to skit the state laws that do exist by, for example, “releasing” people who are on the brink of death. (Texas Jail Project has been documenting stories and the abuses of people inside of jails across the state.)
Armstrong also points out that jail conditions, in particular, have a disproportionate impact on women because women are more likely to be housed in such facilities due to the nature of their charges. In Louisiana, 70% of incarcerated women are serving time in county jails, not prison. Jails present some special difficulties in conditions and health care – because they are designed to hold people for short periods of time, they do not have the facilities or staffing to handle medical issues (one reason why the COVID-19 pandemic has been so brutal in county jails). County jails are also run by sheriffs or county jailers who lack the kind of oversight state prison authorities do. There are inconsistencies in reporting and, often, no reporting requirements at all.
It’s all something I am going to think about.
I am generally of the mind that when there’s tension in my work, it means I should sit with that. Tension is, I think, productive, although it also makes it more difficult for me to “offer solutions,” as they say one should do at the end of a piece of journalism. I am often not sure; I do all my work with not-knowingness. In my better moments, I think not-knowingness is how I manifest humility in the face of other peoples’ pain and struggle. I worry about missing something. I worry that I think, like many people, I am doing the right thing when I am not.
This is why I prefer writing over litigation. I didn’t like the requirement in litigation that one pick a side, that you were supposed to interpret all of the facts to support your point of view. I worry about all of those people I thought I was helping, but I actually just made it worse. I don’t judge other litigators who do a lot of admirable work – it’s also possible I was just not a good litigator. (It didn’t help that judges yelling at me made me cry.)
Sometimes people ask me why I do this work, and I think they are looking for a story to explain why I am this way. I understand this from fiction writing. All of the characters in my early fiction had a backstory, an easy explanation to explain why they are the way they are. Usually, it was traumatic – someone died, someone was abused, someone got their heart broken. I guess people want to know my internal truth, perhaps to see if my intentions are good or if they are honest.
I don’t like the question and avoid it by giving an intellectual or political answer. I don’t think that my internal fight is relevant, I will say. Maybe I am wrong. Again, there is that tension. The older I get, the more uneasy I am with the idea of distilling everything into one focal point. And if I were to give an answer, it would be most unsatisfactory, I would say. Because it’s not a story with an opening scene, a nut graf, an explanation, and a resolution. Once a professor asked if lives were stories. No, I said. I objected. They aren’t stories. Or if they are, they are always changing. Or if they are, they can never be right. He told me I was wrong. Everything is a story, he said. Mine maybe isn’t ready just yet.
I really appreciate these comments about uncertainty. I have come to think of stubborn insistence on uncertainty as a inverse corollary of curiosity - refusing to settle with an answer, troubling it to learn more, being deeply suspicious of the satisfaction of ever having the "right" answer. Maybe it's a consequence of being lied to about hell through my early years in a cult-adjacent fundamentalist evangelical church, but my alarm bells start ringing as soon as someone want to convince me that some particular take is "the" answer.