Mayor de Blasio & company make an announcement (photo: Michael Appleton/Mayor's Office)

What is going on at Rikers Island? As former physicians on Rikers Island and in other city jails, we have been horrified to hear of the unsafe, unhygienic, violent, and deadly conditions there. Over 12 people have died this year alone. To prevent more suffering and death, courts need to release thousands of people immediately and to stop sending more people in.

Despite limitations associated with the jail setting, we worked hard to provide excellent medical care for people who were incarcerated. The clinics provided evidence-based substance use disorder treatment, gender affirming hormone therapy, dental care, and mental health care — services oftentimes difficult to access in the community. The electronic medical record was queried by administrators to ensure that patients had appropriately scheduled follow-up appointments and that patterns of injuries were systematically addressed. Providers followed evidence-based algorithms in caring for patients with chronic diseases, referred patients for specialty care, and attended best-practice lectures common to academic medical institutions. On paper, the medical care provided in the jails was exceptional compared to other carceral systems.

Now, we hear from former colleagues and impacted communities that the provision of even basic healthcare is nearly impossible in the jails. We’re told that providers are waiting in the medical clinics for patients who are never brought. We’re told that patients in need of emergency care are waiting for hours for Department of Correction (DOC) escorts to transport them to the hospital.

We read in this letter from Dr. Ross MacDonald, the Chief Medical Officer of Correctional Health Services (and our former boss), that people are waiting for days in intake prior to seeing a medical provider, and that intake areas are overcrowded and violent. We’ve learned that people with positive COVID-19 tests routinely wait more than 24 hours in crowded “pens” prior to being put in isolation.

Elected officials have toured the facilities, testifying about filthy conditions, people sleeping in showers, and even a witnessed suicide attempt. Recently released inmates have shared their stories: days and weeks in intake, sleeping on bed-bug-ridden mats, and without showers, clean water, masks, and adequate food. 

To date, proposed solutions to these problems have largely focused on increasing staffing and reopening strategically shuttered facilities. But the idea that improved staffing will magically improve conditions on the Island is not grounded in reality. The truth is that, even in times of adequate staffing, the care we provided in the medical clinics was marred by the violent and inhumane setting in which our clinics were embedded.

Our exam rooms were not private. The clinic was disturbingly loud with guards and inmates yelling profanities and threats at each other or with people in “pens” begging to be seen right away or struggling psychiatrically. Patients reported trying to get appointments for weeks but being denied care by guards who wouldn’t sign them up for or escort them to the clinic. Providers were limited in what we could prescribe because even pretty harmless things like chapstick were considered “contraband.” Improving staffing will not fix any of these problems.

The only just solution to the problems at Rikers is reducing the ever-growing incarcerated population. To do this, we need to listen to impacted communities and their advocates. As healthcare workers committed to addressing upstream social determinants of health, we heed these suggestions in full, including:

-Stopping the prosecution of minor offenses like drug possession and sex work, like they have done in Baltimore and have started to do in Brooklyn District Attorney Eric Gonzalez’s office. This policy should be applied retroactively so that people with pending cases, warrants, or on probation for these offenses are impacted. 

-Release people who are held in jail for failure to appear in court, especially if they are not there on a serious offense.

-Prosecutors and defense should file for early release for people in prison who have less than one year left in their sentence.

-Prosecutors and defense and probation services should work to eliminate probation for minor offenses and decline to incarcerate on technical violations.

-Allow review of bail petitions with an eye toward more flexibility on release given the humanitarian crisis.

Surely, some might worry that these changes could make the city less safe, and the city needs to meet with communities to address their concerns. In the meantime, we are convinced by evidence that shows that large-scale decarceration efforts have been successful in the past, and that decarceration can improve both public health and public safety. 

In 1992, Vernon C. Bain Center, the barge now docked at Hunts Point, the Bronx, was opened as a temporary solution to jail overcrowding. Once it was staffed, it became a permanent facility and now “houses” nearly 600 people. Last month, Stephan Khadu, only 24 years old, died on that barge, marking the twelfth and most recent death associated with the city jails this year. The Rikers Island crisis highlights that there is really no such thing as a “safe jail for staff and patients,” and if concerns today are met with increased staffing and facility re-opening instead of large-scale decarceration efforts, we will move further from health justice. What people need and deserve is comprehensive healthcare in their own communities where they live, not in city jails. 

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Zoey Thill, MD, MPH, MPP, is a member of the Public Health Advisory Group for RAPP (Release Aging People in Prisons). Kimberly Sue, MD, PhD, is an Instructor at the Yale School of Medicine, Program in Addiction Medicine and Medical Director of the National Harm Reduction Coalition.