Where Social Distancing Is Impossible

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S2: That number again is 2 0 2 8 8 8 2 5 8 8. You can also just track me down on Twitter. I’m at Mary’s desk. OK, onto the show.

S3: I was looking for Twitter and it looks like you. You’ve got an account back in 2010, but you’ve had like two tweets on there until the last month.

S4: Yes, I mean, I have been until very recently.

S5: LARCKER And the most I ever really did was like some other tweet. And then a few weeks ago, I started tweeting. And now I seem to treat every day.

S6: Rachel Bedard has one of those jobs where until recently it seemed better to be anonymous. She’s a doctor in New York City, but the patients she treats live on Riker’s Island. That’s the jail complex in the middle of the East River between Queens and the Bronx.


S1: For the last month, Rachel’s had the same anxious feeling a lot of doctors have had. Anticipating the arrival of this new coronavirus, she warned her family about it, worried about it on the job. What was the first conversation you remember having at work about coronavirus?


S4: The first conversation I actually really remember was a text exchange that I had with my boss, where somebody else had sort of tweeted this virus is going to be a disaster for correctional settings. Someone described it as seeing a tsunami coming in from the shore. And at the same time, it sort of felt like a shared delusion because it wasn’t here yet. And so a little bit it felt like being in the crucible. You know, we were all sort of infecting one another with this anxiety, but this anxiety got real fast.


S2: According to the Legal Aid Society, the infection rate at Rikers is nearly eight times the infection rate in New York City. And if you know anything about the situation in New York City, you know it’s bad here when I’ve been talking about jails recently.

S4: I keep describing them as the world’s worst cruise ship crossed with the world’s worst nursing home. Plus, violence.

S7: So, you know, it’s people who are trapped together, reliant on communal services for things like food and recreation. And so, you know, my patients are particularly vulnerable.

S8: And the thing about Rachel’s patients is that their infections came from the outside. And they’ll make their way back out again. Today on the show, Rachel Bedard says Rikers and jails around the country need to drastically reduce their populations to weather the coming storm. We’ll talk about why that’s so hard. I’m Mary Harris. You’re listening to what next. Stick with us.


S1: Rachel Bedard may have kept quiet publicly before this crisis, but she’s used to being an advocate for the last few years. She has worked primarily with the sick and elderly at Rikers, part of correctional health services for patients need to leave the island for, say, cancer treatment. She’s the first person to raise her voice and say, hey, this person needs attention. Can you describe like the baseline health situation in Rikers in terms of how much soap is there? How often are your patients who are inmates? How often are they being able to get a shower or wash their hands like before all this happened? What were the sanitary conditions like inside?


S4: Yeah. So, you know, I think a couple of things that are important to understand. So we are an independent health authority, which means that we are a city agency that provides the health care, but we are separate from the Department of Corrections, which is a really important fact, because it means that there are sort of two different forces, very different leadership and very different priorities.


S9: When I imagine it’s so that your patients can trust you because you’re not the jailers, you hope.

S4: You hope so. I mean, I think it does it does help obviate some of the dual loyalty concerns that come with being physicians who work for the correctional agency.

S3: So as an independent observer. Are the conditions inside? How are they like or unlike what situations on the outside are?

S4: I mean, it’s not comparable remotely. So the first thing done, citizens, is independent health authority thing. The second thing to understand is that the infrastructure of Rikers, the buildings themselves are quite decrepit and have had very little investment over the last 20 years.


S10: I mean, literally things like rotting floors where patients are at risk of falling through. And patients and colleagues have described seeing rodents in their housing areas.

S4: And the buildings are drafty in a way that, you know, just makes you feel sort of uncomfortable. And at the same time, the area is very close and it feels like the circulation is not great.

S3: And you’ve worked there for how many years now? Three and a half. So you’ve described these pretty rough settings like what life is like inside, even without coronavirus. You’ve talked about having these dorm meetings with prisoners to try to explain how they can protect themselves. Given what’s happening now, can you take me inside one of those?


S11: Yeah, it’s really horrible day.

S10: So when we talk with dorms, you know, we’re really talking with these sort of large barracks style rooms where there are thirty five forty forty five guys in one room in the room sleeping in a room in cots that are a few feet apart from one another that’s entirely open.

S4: They have a shared bathroom with maybe three sinks for all of them to use. Those facilities are maintained by the Department of Corrections and not by us. They share showers. They share toilets. There’s very, very little privacy, as you might imagine.

S3: And it also sounds like a fantastic breeding ground for an infectious disease.


S4: Yeah, absolutely. And and we walked around to talk to my patients in the infirmary and we talked about, you know, this is happening in the community. We’re going to do our very best to keep you safe here. Please wash your hands as frequently as you can. You know, try to kind of stay apart from one another. But I mean, like, they’re not their beds are six feet apart. Right. Like, there’s sort of no way for them to observe social distancing the way that we’re all sort of trying so diligently to do in the community. The other thing that really is important to understand about jail is that and this is why the nursing home comparison is almost more apt than the cruise ship is. 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 bring them there, walk them down the hall. When a person goes to the hospital, they are transported on a bus. Officers at their side, when they move from one facility to another, they might be cuffed. When they are given medication. That pharmacist holds the medication and gives it to them when they’re given their meals. You know, a worker comes around with trays and hands out those trays. 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.


S3: Yeah, that’s a really good way of putting it. The sort of access touch and the access contact. And I know you guys as 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. Like I read one one incarcerated person’s story, someone who is inside Rikers, and they said, you know, there was someone in their dorm who is coughing and coughing and coughing. And finally, another inmate who had worked in the clinic, jerry rigged a setup with a soda bottle and a catheter to kind of get whatever was in his throat up. And that was like the only way that someone would pay attention to what exactly was happening with this guy.

S12: Yeah. I mean, it’s funny to talk about our work because I am simultaneously incredibly proud of what our health service has managed to put in place over the last month. But jail is a terrible place to be sick.

S4: You’re in the hospital, you have a call button if you’re at home, even if you’re home alone and sick. You have a telephone, right? Like there are ways for you to sort of call out for help and reach the person who you trust to come and help you. Everything in jail is a little bit of a game of broken telephone. You know, that person in their cell might be getting sicker. And until someone notices, you know, that might not come to attention. And when it comes to attention, that might come to the attention of an officer and not a health professional. And it’s on that officer who has many other things to do to communicate that and figure out how to communicate that to so that the right response happens. Jail’s not bad at dealing with true emergencies, but in the situation we’re in right now where people are sick in this kind of sub acute way, jails are really hard place to take care of. A lot of people like that. And so it’s been sort of clear to myself and my colleagues since the beginning that the only meaningful intervention here would be to reduce the jail population.


S9: Yeah, and you’re not the only people saying that. I mean, the New York City Board of Corrections wrote this letter two weeks ago, basically saying, we know that the best efforts we have will not be enough to prevent transmission of this virus in Rikers. And they cited other cities, Los Angeles, Chicago said they were doing more to release prisoners in New York City and they had a whole list of people. They recommended releasing people, over 50 people with underlying conditions, people who were there for administrative reasons, like a technical violation of parole, like failing to meet curfew, people serving sentences under a year. I know that as of March, 30 of about 650 inmates have been released from Rikers. Do we know what the latest count is?

S12: My impression is that it’s over a thousand.

S9: How many people are still inside?

S4: I think today there’s about 40, 400 in a non-covered scenario. We were not in the midst of a global pandemic. To have reduced the jail population by a thousand in a matter of weeks would have been beyond my wildest dreams. But 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. I think and it’s not just about how many detainees are sharing a dorm. It’s really about staffing also. Right. So if you have a dorm that has 30 people and now you’ve released a bunch and you have 18 people, you still need staff to staff that dorm. There are still officers there 24/7 and there’s still health staff coming around to give up medications and check on people. Are still workers giving out those meal trays? And all of that movement in and out is what is going to make it just impossible for us to totally see that we have anything contained?

S9: Yeah, I’ve seen this really this really 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 the continuous churn of people coming in and out of the jail on a daily basis. And it’s sort of what separates jails from prisons, too, because there’s less churn at a prison where there’s fewer inmates coming in and out all of the time. So jails are sort of uniquely positioned in this way.

S12: Yeah. I mean, you know, 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. And jails are not fortresses. They’re not closed systems. They are very, very permeable. And that applies for everybody coming in and out. The. Detainees, the officers, health staff, attorneys, visitors, all of that, at least as of yesterday that I believe I saw that there are four correctional officers who have died already. That’s extraordinary and devastating. And those folks are not people who, you know, they’re not health professionals. Like they don’t need to be on the front line of this crisis, but they are. And those people then go out and live in New York or they live in the surrounding communities. You know, CEOs live on Long Island and in West Chester and in New Jersey.

S3: And CEOs or correctional officers.

S12: Yes. And what they come in contact with in the jails, they’re going to bring home the same way that I’m gonna bring home when I come in contact with them. The jails. Yeah.

S13: I mean, it’s been interesting to me to see politicians find their footing here, like talk about what needs to happen, because as more and more people have been released over the last couple of weeks from Rikers, district attorneys have started speaking out sometimes saying things that seem in conflict, like the district attorney here in Brooklyn wrote something in The New York Times saying we need to release more people from prisons and jails. And then he wrote a letter to Mayor Bill de Blasio and said, hey, I’m a little worried about who you’re releasing from jails. And frankly, his concerns seemed understandable. He was worried about people accused of domestic violence and sexual predators being released. And whether those people might.


S4: Revictimize people, they had been put in jail so that they would be away from something that I’ve been saying a lot in the last couple of weeks is that I am a doctor and I’m I’m not in the risk assessment game. So I know I’m no more skilled than the average civilian in assessing someone’s public safety risk. And so I defer to the d.a.’s on and, you know, others on those hardest decisions and don’t envy them the choices that they’re facing right now. And at the same time, my pushback would be we certainly have not released all of the technical parole violation, folks. We have not you know, there’s still low hanging fruit. Can go in until all of those folks have left. I’m not actually sort of prepared to engage the anxiety around releasing the folks who might be considered most dangerous. The other thing that I think is so critical to understand is that there’s a real difference between people who have been convicted and people who are in pretrial detention.

S14: And those things get really conflated for my patients a lot.

S5: I do feel really cautious about getting overly certain about who really poses a public safety risk when we’re talking about folks where they haven’t been convicted in the evidence of their charge has not been thoroughly evaluated.

S1: What does a good response look like here, like if you could design from scratch? What happens at Rikers when it comes to covered? What would you do?

S11: Honestly, I would do a ton differently from what we have done in terms of the health care response. So I think the way in which we have sort of aggressively tried to identify people as symptoms, we are really lucky that we can test those people. And we’ve had tests for a long time, sort of more than the community has had. And then segregate out the people who are positive and keep a really close eye on them. From a health care perspective, I think first one of doing what we can do, I think on the facilities side, I wish that our patients had better access to the cleaning supplies and just more control over their environments than they’re allowed in jail.


S1: What are some of the stories you’ve heard from patients who talk about what they are unable to get? They need.

S11: Well, I mean, I think, you know, at least a couple of weeks ago, it was just true that, you know, instincts were clogged and non-functional or toilets are overflowing or, you know, like 40 men sharing a bathroom. It doesn’t go decorate it. Right. So that’s one issue is just sort of being able to keep up with things as they break down from use. The other thing is just that surfaces are normally are very seldom disinfected. You have to picture that with visits were cut off several weeks ago, the only access that 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. Right.

S1: And how often is that disinfected?

S11: So now they’re supposed to have access 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, that everyone does it? I can’t. The other thing I would say is that I wish the population was even lower than it is now. And I wish that we had gotten people out earlier. So we started agitating for the population at the beginning of March. And, you know, by the time L.A. had released seventeen hundred people, we’d released maybe a couple of hundred. Larry Krassner, the D.A. in Philadelphia, who has just been so smart in the way that he has talked about this, keeps repeating the phrase like that the virus doesn’t move at the pace of government, by which he means the normal sort of pace of criminal justice reform or criminal justice decisions where, you know, an individual case like get quibbled about back and forth over weeks. It’s not fast enough to make a difference here. And so if I could change anything about the last month, it would be that we would’ve gotten more people out faster. And even having said that, it’s still vitally important that we get as many people out now as we can.


S1: So when do you go back to work?

S11: Tomorrow. We’re back tomorrow.

S3: Do you know what you’re walking into tomorrow?

S4: I’m walking into ongoing work around the release stuff. So continuing to try to think about patients who are at risk, provide information to attorneys who are requesting it in order to make bail applications. And then later in the week, I’m going to see patients in the infirmary who are covered positive and patients not in the infirmary who are covered positive and spend a lot of time rounding in our covered confirmed areas. And I think that’s going to be really intense.

S2: How do you prepare for that?

S4: Well, on a practical level, I’m preparing for it by thinking about the PPE question and the detective gear. Yeah, exactly right. Emotionally, I. I mean, frankly, I’m like eager to go and all of my colleagues in and out of the jails, all of the doctors I’ve been talking to everybody in a way that they find incredibly moving.

S11: Everybody wants to be with patients right now. It doesn’t feel good to know that our colleagues are on the front lines when we are at home. And I want to go be with my guys. You know, they’re going through something incredibly difficult and they’re cut off from the world to an even greater degree than they normally are.

S5: And it feels incredibly important to me to be able to walk around and provide some comfort or clinical care in that situation.

S15: Rachel Bedard, thank you so much for joining me. Thank you for having me.

S6: Dr. Rachel Bedard is senior director of geriatrics and Complex Care Services at New York City’s jail complex on Rikers Island. You can follow her on Twitter at Rachele Godard. Not long after we recorded our interview with Rachel, we got a message on our answering machine from an inmate at Rikers.


S16: Hi, I’m a detainee NGO Rikers Island Combat Energous mpw and there was a fall bomber qualifies as inhumane at this that I’m surrounded by. Also living in my life, hell, due to a lack of social position, cleaning supplies and how much they switch in me. Professional assistance out have it. I’m also being a proud father. Yeah. As far as global Basque terrorists, we have as a quote just that she would foreclose on it being held in a largely as also for non-existent here.

S17: Half of medical assassin is not being that because we’ll be clean. I think we’ve Haskell’s are call if I have a soul mate. That’s serious. It’s hard to get the score. Also, detainees are very good on being caught up in not receiving any recreational privileges, and it causes problems and creates a hostile environment. Minimum standards are not being met and one of them is out of faith. Doesn’t that be sad and Buddhist? And I pray for a solution.

S15: And that’s the show. We want to thank you for calling and leaving messages about how you’re getting through this really strange period. Our number, if you need it, it’s 2 0 2 8 8 8 2 5 8 8. Your voicemail could inform our reporting or get played on the show. What next is produced by Daniel Hewat, Mary Wilson, Morris Silvers and Jason De Leon. Thanks for listening. I’m Mary Harris. I’ll talk to you tomorrow.