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The recent apparent suicide of Jeffrey Epstein has once again shined a light on jail conditions and medical care for inmates.  Two bedrock principles of American jurisprudence, quotable by every eighth grader are 1) you are innocent until proven guilty and 2) no person should be deprived of liberty without due process of law.

Jeffrey Epstein, like thousands of other Americans, was charged but not convicted with a crime.  At the time of his death, despite the media reports and seemingly overwhelming evidence, he was (or should have been) nevertheless presumed innocent.  As such, the question becomes, what duties does our government owe a person that is being held in jail awaiting a trial?

As someone who has handled numerous jail death cases, I can tell you that the law is clear.  The government is responsible for ensuring that an inmate is treated to medical and mental healthcare that is commensurate with that of the surrounding community.

When you are free, you can go see a doctor whenever you want. In an emergency, you can call 911 and an ambulance will rush to your side.

In jail, on the other hand, you must rely on the guards to provide for you.  Jail guards take on a role that requires them to not only keep you locked up and away from society, but also, keep you safe.  They are solely responsible for your well-being and medical care.

In Kentucky for example, the duties on the jailer and guards are set forth in both statute and regulation.  501 KAR 3:090 outlines the minimum standards for medical services and expressly states that “[e]mergency medical, vision, and dental care shall be available to all prisoners commensurate with the level of care available to the community.”  Id. at (13).

Further, with respect to suicides or attempted suicides, Kentucky law, like other states, requires “[j] ailers, jail administrators, or jail personnel … report suicides or attempted suicides that constitute a serious health situation to the department within twenty-four (24) hours.”  Id. at (11).  “Each jail shall have a written policy and procedure outlining jail personnel response to detainees who are at risk for suicide or have attempted or completed suicide.”  Id. at (12).

Over the last decade, as prison populations and medical costs have skyrocketed, many jails and prisons have begun to outsource their duty to provide health care to private companies.  Many of these companies are paid a flat monthly fee for providing care to inmates.

Consequently, they are incentivized to use low cost providers, typically LPN nurses and nurse practitioners, to handle large patient populations.  These private companies are usually on site for a limited number of hours per day, taking care of passing out medicine, checking blood sugars, monitoring withdrawal and conducting physicals on all the inmates.  Frankly its an overwhelming amount of work.

The result is that inmates are dying in custody at alarming rates.  A recent article in the Guardian outlines some of the reasons for this, noting the shift to these private companies as a main cause.

I have represented several people that have suffered and died due to similar outsourcing and lack of care.  As a society, we cannot meet our constitutional obligations if we continue to incarcerate more and more people and attempt to do so for less and less money.  In the end, the government has to put people before profits.

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