Medical Examiner

“Like a Cruise Ship Mixed With a Nursing Home, Plus Violence”

The coronavirus comes to Rikers Island.

A big sign says, "Department of Correction, Rikers Island, Home of New York City's Boldest."
The sign marking the entrance to the New York City Department of Correction Rikers Island facility, picture on Feb. 14, 2018. Shannon Stapleton/Reuters

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Dr. Rachael Bedard is the senior director of geriatrics and complex care services at New York City’s jail complex on Rikers Island. For the past few years, Bedard has worked primarily with the sick and elderly at the jail as part of NYC Correctional Health Services. Lately, she’s had that same anxious feeling a lot of doctors have had as the coronavirus has hit the city. According to the Legal Aid Society, the infection rate at Rikers is nearly eight times the infection rate for the rest of New York City. On Sunday, the first infected inmate in Rikers died. Bedard is trying to help patients there as much as she can, but Rikers, like jails across the country, is not built for a crisis like this.

On Monday’s episode of Slate’s daily news podcast What Next, I spoke with Bedard about what Rikers and others jails need to do to save their inmates from COVID-19. Our conversation has been edited and condensed for clarity.

Mary Harris: What was the first conversation you remember having at work about the coronavirus?

Rachael Bedard: The first conversation I really remember was a text exchange that I had with my boss when somebody else had tweeted something like, This virus is going to be a disaster for correctional settings. Someone described it as seeing a tsunami coming from the shore.

When I’ve talked about jails recently, I’ve described them as the world’s worst cruise ship crossed with the world’s worst nursing home, plus violence. It’s people who are trapped together, reliant on communal services for things like food and recreation. And my patients are particularly vulnerable.

How are the conditions inside Rikers like or unlike what’s going on outside?

They’re not even comparable. Rikers’ buildings are quite decrepit and have had very little investment over the past 20 years. There are rotting floors where patients are at risk of falling through. Patients and colleagues have described seeing rodents in their housing areas. The buildings are drafty in a way that makes you feel uncomfortable.

You’ve talked about having dorm meetings with inmates to try to explain how they can protect themselves. Given what’s happening now, can you take me inside one of those?

When we talk about dorms, we’re really talking about these large barracks-style rooms where there are 35 or 45 guys in one entirely open room, sleeping in cots that are a few feet apart from one another. They have a shared bathroom with maybe three sinks for all of them to use. The inmates share showers. They share toilets. There’s very, very little privacy, as you might imagine.

It sounds like an ideal breeding ground for an infectious disease.

Absolutely. I talk to my patients in the infirmary and tell them: “We’re going to do our very best to keep you safe here. Please wash your hands as frequently as you can. Try to kind of stay apart from one another.” But their beds are not even 6 feet apart. There’s no way for them to observe social distancing. It’s not just that people are trapped near one another, but they also don’t get to do things for themselves. So when a person in a housing area needs to be moved to the clinic for evaluation, an officer has to open a gate and walk them down the hall. When a person goes to the hospital, they are transported on a bus with officers at their side. When people move from one facility to another, they might be handcuffed. When they are given medication, a pharmacist holds the medication and gives it to them. When they’re given their meals, a worker comes around with trays and hands them out. There’s just an incredible amount of excess contact that happens in this setting that is a function of jail and can’t really be minimized.

I know you doctors are doing everything you can, but I imagine you must feel the frustration of not being able to reach everyone in their time of need.

Jail is a terrible place to be sick. If you’re in a hospital or at home, there are ways for you to call out for help and reach a person whom you trust to come and help you. But everything in jail is like a game of broken telephone. A person in their cell might be getting sicker, and that might not come to attention for a while. And then, when it does, it might be to an officer and not to a health professional. And it’s on that officer, who has many other things to do, to then communicate that so the right response happens.

In the situation we’re in right now, where people are sick in this acute way—jail’s a really hard place to take care of a lot of people like that. So it’s been clear to myself and my colleagues since the beginning that the only meaningful intervention here would be to reduce the jail population.

You’re not the only people saying that. The New York City Board of Correction wrote this letter weeks ago basically saying, We know the best efforts we have will not be enough to prevent the transmission of this virus in Rikers. The board recommended releasing people over 50 as well as people with underlying conditions, people who are there for administrative reasons like a technical violation of parole or failing to meet curfew, and people serving sentences under a year. But how many people are still inside?

I think today there are about 4,400. The challenge is the amount that we need the population to decrease to make a real difference in terms of the public health benefit. We’re not there yet. And it’s not just about how many detainees are sharing a dorm—it’s also about staffing. If you have a dorm that has 30 people and now you’ve released a bunch and have 18 people, you still need staff for that dorm. There are still officers there 24/7. There’s still health staff coming around to give up medications and check on people. There are still workers giving out those meal trays. So all of that movement in and out is what’s going to make it impossible for us to totally say that we have anything contained.

I’ve seen this compelling argument made that when you think about jails, you have to think about them not just in terms of the people inside but like a continuous churn of people coming in and out on a daily basis.

Jails are the emergency rooms of correctional facilities. Most people who come in and out of jails in this country spend relatively few nights there. Jails are not fortresses, and they’re not closed systems. They are very, very permeable. That applies for everybody coming in and out: the detainees, the officers, health staff, attorneys, and visitors. I saw that there are multiple correctional officers who have died already. That’s extraordinary and devastating. Those folks are not health professionals. They don’t need to be on the front lines of this crisis, but they are.

What does a good response look like here? What would you have done from the beginning?

I wouldn’t do a ton differently from what we have done in terms of the health care response. We have aggressively tried to identify people with symptoms—we are really lucky that we can test those people and that we’ve had tests for a long time. We can separate the people who are positive and keep a really close eye on them. On the facilities side, I wish that our patients had better access to cleaning supplies and more control over their environment than they’re allowed in jail.

What are some of the stories you’ve heard from patients who are unable to get what they need?

At least a couple of weeks ago, it was true that things were clogged and nonfunctional, or toilets were overflowing, or there were 40 men sharing a bathroom. One issue is being able to keep up with things as they break down from use. The other thing is that surfaces are very seldom disinfected. Also, business visits were cut off several weeks ago. The only access our patients have to the outside world right now is a shared telephone in the dorm. And that means that you have 30 or 35 guys who are lining up to hold the same phone receiver up to their mouths. They’re supposed to have access to supplies to be able to wipe it down between uses. But can I say with certainty that that is actually happening, that those supplies don’t run out? I can’t.

I wish the jail population were even lower than it is now. If I could change anything about the past month, I would have preferred that we got more people out faster. Having said that, it’s still vitally important that we get as many people out now as we can.

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