Medical care in federal prison
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Federal prisoners retain a constitutional right to adequate medical care under the Eighth Amendment's prohibition on cruel and unusual punishment, which obliges the Bureau of Prisons to provide essential physical, dental and mental health services. The Supreme Court established in Estelle v. Gamble that ignoring serious medical needs is unconstitutional. Kiriakou describes the default posture of prison medical staff toward any prisoner reporting illness as cynicism, the starting assumption being that the prisoner is lying.

He cites the February 2015 seizure of the Willacy County Correctional Center in Texas by as many as 2,800 prisoners protesting the quality of medical care, and an attorney with the Texas Civil Rights Project who said he was not surprised that inadequate medical care could ignite a riot.

Frank

Kiriakou's bunkmate Frank was 65, diabetic, insulin-dependent and had a history of heart trouble. One evening Frank felt a sudden tightness in his chest on top of a day spent short of breath. The two went together to the correctional officer on duty, who told them there was nothing he could do and that Frank would have to wait for sick call, which ran from 6:00 to 6:15 a.m. on weekdays.

Frank queued the next morning and was given Tylenol. The physician's assistant said he would apply to the regional medical office in Pittsburgh to approve an EKG. Months passed; the tightness worsened, and Frank described it as feeling as though somebody were sitting on his chest. The physician's assistant maintained there was nothing he could do and that the decision rested with the regional office.

Another two months later Frank collapsed unconscious in the insulin line. He survived, spending eleven days in a local hospital chained to the bed before undergoing two angioplasties and the installation of two stents. Bypass surgery, which Kiriakou describes as the better solution, was refused as too expensive; the Bureau then transferred Frank to a prison hospital in Massachusetts, a fifteen-hour drive from his family and support.

Larry

Larry lived near the chapel where Kiriakou worked as an orderly. He had been reporting severe back pain for over a year and had each time been given Tylenol at sick call. Over the following weeks he progressed from walking hunched over, to a cane, to a walker, to a wheelchair. Kiriakou raised Larry's case at the chapel's weekly staff meeting and asked the chaplain to intervene; the chaplain went to the medical unit and demanded Larry be sent to an outside hospital for testing.

Two more weeks passed before the regional medical office agreed to pay. An MRI at an outside hospital diagnosed stage-four cancer of the spine. Larry was returned to Loretto, where he died in his bunk two weeks later, having received no treatment of any kind beyond Tylenol and never having been considered for compassionate release.

Kiriakou's own collapse

In a letter from Loretto dated 12 September 2014, Kiriakou described his own case. He has type 2 diabetes but is not insulin-dependent. After a routine quarterly blood test whose results were never communicated to him, he was called not to his physician's assistant but to the pharmacy, where he was handed a bottle of glyburide. Asked what it was for, the pharmacist said diabetes; asked whether there was a problem, the pharmacist said he did not know. Because only insulin-dependent diabetics were permitted testing meters, Kiriakou had no way to read his own blood sugar.

On the second night he woke at 2 a.m. drenched in sweat and steadied himself by eating a cookie. After the third dose he woke soaked again, became dizzy on the way to the bathroom, and was told by a fellow prisoner named Waheed, a pharmacist before his conviction, that his blood sugar was crashing. He passed out on the concrete floor and woke fifteen minutes later in a wheelchair in the medical unit.

His blood pressure read 88 over 60 twice. The nurse suggested he was not taking the medication correctly, then diagnosed dehydration, then declined to give an IV on the grounds that "we don't do that." An EKG came back normal. Kiriakou was told to sit in the hall and return to his unit at the 8:25 a.m. move and take it easy for the day. He never saw a doctor or a physician's assistant, and had still not seen one three weeks later when he wrote the letter.

His father-in-law, a physician and former pharmacist in Cincinnati, told him to stop the drug immediately: glyburide is a last resort before insulin, can damage the pancreas, and continued use in his case could be expected to lead to heart failure. Kiriakou threw the pills away. On the day he wrote the letter, he received an electronic message that his refill was ready.

The pattern

Kiriakou describes a friend serving two years for keeping an illegal poker machine in his bar who told the medical unit on arrival that he had hepatitis C and needed treatment. He asked repeatedly for eighteen months and was ignored. Two weeks before release he was offered the treatment on condition that he give up his halfway-house and home-confinement time, an offer Kiriakou believes was designed to be refused, so that the Bureau could record that treatment had been offered. When the man phoned his wife that night in anger, he was placed in solitary confinement for insolence and held there until his release date.

He quotes at length from an account given to Op-Ed News by Judy White, wife of Gary White, a man caught up in the political prosecution of former Alabama governor Don Siegelman, describing a 71-year-old prisoner at FCI Forest City whose blood in the urine was ignored for two years until he refused to leave the medical unit, at which point hospital staff found multiple tumours and told him he would otherwise have been in the obituaries.

Kiriakou also notes, citing Prison Legal News, that the European Court of Human Rights refused to extradite a terrorism suspect from the United Kingdom to the United States on the grounds that his health would deteriorate significantly in the more hostile American prison system.

His verdict on Larry, that there are genuinely bad people at Loretto but that none of them had been sentenced to death, and that in a lot of ways Larry was ignored to death, stands as his summary of the system.

The count he gave on release

The earliest tally in the corpus is also the bluntest, given in February 2015 while he was still under home confinement and asked simply what the conditions had been like. He named medical care as the worse of the two problems he raised, "the medical care was even worse" than the food, and gave a number rather than an impression: "there were almost a half a dozen deaths of prisoners while I was there in prison, and almost every one of those deaths was preventable."

The named cases he has since given, Frank, Larry, and his own collapse, sit inside that count.

See also

- FCI Loretto
- Bureau of Prisons
- Letter from Loretto
- Prison Legal News
- Solitary confinement
