A Historical Look at Health Care on Riker's Island by Dr. Noga Shalev
Riker's Island
The June 2009 edition of the American Journal of Public Health contains an article entitled: From Public to Private Care The Historical Trajectory of Medical Services in a New York City Jail” written by Noga Shalev, MD. Dr. Shalev is a graduate of the Residency Program in Social Medicine and this work developed from her 2006 Social Medicine Project. The article describes the evolution of health care services at Riker’s Island.
The Riker’s Island Penitentiary sits in New York City’s East River between Queens and the Bronx, just to west of La Guardia Airport. Riker’s is quite literally an island, connected to the Borough of Queens by a single bridge. It is one of the world’s largest correctional facilities with an average daily census of about 13,000 prisoners. Administratively, the facility houses ten jails that sit on the island and the Vernon C. Bain Center, an 800 person facility located on a barge just off of Hunts Point in the Bronx.
Vernon C. Bain Prison Barge
Dr. Shalev divides the history of health care at Rikers into three periods. From the opening of the prison in 1932 until 1973 medical services were provided by various New York City agencies. During this period numerous reports documented the poor quality of care provided to inmates. It seems clear that the Department of Correction’s concern for security trumped attempts to provide medical care to inmates. As noted in a 1958 report: “The Department of Correction is not now in background, equipment, or personnel capable of giving modern medical care—whether preventative or therapeutic—to the prisoner.”
Attempts to remedy this situation made little progress until the early 1970′s when a series of prison revolts including those at the upstate Attica prison and the Manhattan House of Detention (commonly known as “the Tombs”) led to reforms. This resulted in the second period of medical care at Rikers. From 1973 to 1996 Montefiore Medical Center provided health care under an affiliation agreement with the City. Health care on the island improved and the service was “the first correctional medical program in the country to be accredited by the Joint Commission on Accreditation of Healthcare Organizations” (JCAHO). However this period also coincided with the HIV epidemic and in its wake a resurgence of tuberculosis; prisoners were particularly affected by these twin epidemics. Costs for medical care increased substantially and in 1996 the Giuliani Administration decided to turn health care at the island over to a private contactor. The initial agreement with St. Barnabus Hospital was generally recognized as a failure. Costs did not decrease and there were ongoing concerns about the quality of care. Currently, care on the island is provided by the private, for-profit Prison Health Service, Incorporated. Concerns over costs and quality of care remain. Dr. Shalev characterizes this final period from 1996 to the present as one of “managed care” and the overarching theme of her paper is that health services at Riker’s have moved from public hands (the city) into private hands (for-profit corporations).
Dr. Shalev’s careful historical research, butressed by interviews with Montefiore staff, tell the story of a particular and certainly unique experience in incarceration. But the unique story of Riker’s illustrates the larger themes of how corrections have come to be seen as one more commodity on which profit can be made. And this gives powerful players a vested interests in keeping jails full. The result is a system described by some as a prison-industrial complex, by others as a penal state.
Here is the abstract of Dr. Shalev’s paper:
Over the past 25 years, incarceration rates in the United States have more than tripled. Providing health care services for this growing number of inmates poses immense medical and public health challenges. Focusing on the administrative and financial shifts in health care delivery, I examined the history of medical services in one of the nation’s largest correctional facilities, Rikers Island in New York City. Over time, medical services at Rikers have become increasingly privatized. This trend toward privatization is mirrored nationwide and coincides with the rising prevalence of incarceration.
posted by Matt Anderson, MD
Dr. Shalev have done great work in health facilities. These were the reports due to which the health authorities based on and provide more better facilities.