Chronic Disease Linked to Poverty Affects Deaths Behind Bars

When Sandra Bland was found dead in her Texas jail cell after she was arrested during a traffic stop, the story made national headlines.

Her death was later ruled a suicide. The circumstances surrounding her arrest and death raised suspicions about possible misconduct by authorities. And it also put a spotlight on how people die in jail.

The most common cause of death while in custody in pre-trial detention facilities is not suicide; it’s chronic disease linked to poverty.

Research shows that people who are behind bars have chronic health conditions at significantly higher rates than the general population. Men and women who are incarcerated often have multiple health problems, and being locked up can exacerbate them.

Of the 72 people who died in custody at Cook County Jail between 2009 and 2014, chronic illnesses ranging from cancer to heart disease and cirrhosis of the liver accounted for nearly 70 percent of the deaths. About 19 percent of all deaths were from suicides, according to the Cook County Sheriff’s Office.

Reflecting the jail’s population, most were men (89 percent) and, disproportionately, people of color. Sixty-one percent were African- American, 27 percent were white and 11 percent were Latino.

Most of those who died had spent an extended time behind bars. One man, who died at 41 of a pulmonary embolism and metastatic cancer in 2013, had been in jail for more than three years.

Jails tend to house a vulnerable population of people who – because of the widespread use of cash bail in places like Cook County – often are forced to wait for weeks or months behind bars before they get a trial. Those who can’t afford to post bail are also the likeliest to suffer from chronic health conditions that can be made worse by crowded living quarters and limited opportunities to exercise.

“Going to jail is a hugely stressful experience,” said Melanie Newport, a PhD candidate at Temple University who is writing her dissertation on the history of Cook County Jail. “Think about how it would be if you had high blood pressure or heart disease. The jail isn’t built for old people or sick people. But increasingly, that’s who we find there.”

Overcrowding has been a problem at Cook County Jail for years, said Cara Smith, a former director of the jail and now a strategist for the Cook County Sheriff’s Office. She said the jail’s hospital unit remains overpopulated, even as officials work to lower its numbers.

“We are always extremely concerned when we see very sick people being arrested and remanded to the custody of the jail,” Smith said.

It’s frustrating, she said, when high bonds are set for people who are ill and can’t afford to pay, forcing them to remain behind bars for weeks or months.

“We have no discretion,” she said. “We can’t say, because this person is on dialysis or has cancer, they shouldn’t be in jail.”

Officials at Cermak Health Services, the branch of the Cook County Health and Hospital System that provides medical care to inmates and detainees, declined to be interviewed about the issue.

“Cermak offers more services on-site than many other correctional health facilities,” spokeswoman Alexandra Normington said in an email. “While the overall jail census has decreased in the past two years, the patients we are caring for are increasingly older and sicker with multiple chronic, serious co-morbidities.”

Both Smith and Normington emphasized that deaths in custody usually do not occur within the walls of the jail but in hospitals or hospice care. According to county data, 80 percent died in a hospital, 2 percent died in Cermak, 3 percent died in transit and 15 percent in one of the jail divisions.

Gina Polo filed a lawsuit earlier this year after her husband, Daniel Paredes, died while being released from the jail in April 2014. Smith and Cermak Health Services declined to comment on the case because of pending litigation. Polo said Paredes, who was 49 and paralyzed on one side of his body due to a stroke, was regularly forced to walk to court or the visitation room without a wheelchair or cane.

Paredes, who had been arrested on a minor drug charge, had spent more than a month in the jail because his family couldn’t come up with the money to pay his bond, initially set at $20,000. Polo said the family was able to pay the bond when a judge reduced it to $2,000.

Polo has been receiving disability income for several years. Before that, she cleaned houses for a living.

“We struggle to make ends meet as it is, and that was just a ridiculous amount of money to ask us to pay,” she said. “He wasn’t a flight risk. He could barely walk.”

“The hardest thing is that I still don’t understand what happened to him,” Polo said. “He had health problems, but for him to die? Every time I saw him after he was arrested, he was in pain.”While Polo was posting bail and Paredes was being prepared for release, Paredes collapsed and lost consciousness. He died later that night.

According to federal government data, suicide and heart disease have been the top two causes of death nationally since data collection on causes of death began in 2000. A report released earlier this summer by the Bureau of Justice Statistics showed that the overall number of inmates in local jails declined between 2012 and 2013, but the mortality rate increased.

In 2013, 34 percent of jail deaths were due to suicide. The typical inmate who died in 2013 was male (87 percent), white (54 percent), 35 or older (70 percent) and in custody for fewer than seven days (40 percent).

But not much is known about why inmates die behind bars.

Earlier this month, the California Department of Justice launched a website with detailed information about deaths among jail detainees and prison inmates in the state. But in general, Newport says it has become increasingly difficult to track deaths in custody since the 1990s.

“Without access to the records,” she said, “it’s very hard to know what’s going on.”

The Chicago Reporter is a non-profit investigative news organization that focuses on race, poverty and income inequality.