Special Investigation

By Katie Rose Quandt and James Ridgeway

A 6-month investigation into Louisiana’s Angola prison, the largest maximum-security state prison in the country, reveals substandard and inhumane healthcare—leading to extremely high death rates for prisoners. Does this amount to unconstitutional “cruel and unusual punishment”?

DECEMBER ISSUE | December 20, 2016

---

On a hot day this August, Francis Brauner, 51, wheels his chair through the halls of the Villa Feliciana Medical Complex, a state-run nursing facility in Jackson, La. Love bugs, clinging together in pairs, swarm on the complex’s low-slung brick buildings. Brauner has just learned his protein levels are too low to proceed with the surgery scheduled for the following week, and he is trying to come to terms with his disappointment.

Brauner, imprisoned on a rape conviction he maintains was wrongful, had his life change forever in 2005 when, working in the fields at Dixon Correctional Institute, he suffered a back injury that left him paralyzed from the waist down.

Brauner was transferred from Dixon to Louisiana State Penitentiary, better known as Angola. Classified by an officer as dangerous—despite being unable to walk—Brauner was placed on a bed in solitary confinement, without access to a wheelchair. The pressure of his own body wore on his skin and created bedsores, which became infected. The infection tunneled through his buttocks and scrotum, exposing bone. Within a month, it reached his blood and heart, requiring emergency surgery.

Brauner’s surgery saved his life but left deep, gaping wounds that failed to heal. He spent the next 10 years fighting the prison for medical care. As the official grievances he filed went nowhere, Brauner began to fear for his life. “I started seeing that they don’t treat nobody,” he says. “You get hurt, you get sick, or you can’t produce for them no more in their fields or in the hobby shop. … They put you on a ward on a bed and let you die.”

Old times there are not forgotten

Tucked into a bend of the Mississippi River, Angola is the largest maximum-security state prison in the country. It is also a working plantation bigger than Manhattan. Home to more than 6,250 male convicts and hundreds of “freepeople” (employees and their families), the penitentiary gets its name from the Angolan slaves who once worked its fields. Today, the cotton is picked and the sugar cane cut by crews of prisoners, who are mostly black, overseen by armed guards on horseback.

From 1995 to 2015, Angola’s warden was the controversial and larger-than-life Burl Cain. Under his reign, the prison received regular media attention, particularly during the “inmate rodeo” held eight weekends a year, where incarcerated men are tossed like rag dolls by charging bulls in a prisoner-built arena that can hold 10,000 cheering spectators. Cain opened the prison gates to film crews, reporters and curious tourists who wanted to visit the on-site golf course, museum and gift shop selling “Angola: A Gated Community” shirts. Evangelical Christians revered him for his work building chapels on Angola’s expansive grounds and bringing captive souls to Jesus.

Cain, who stepped down in 2015 amid revelations of suspect real estate dealings with relatives of prisoners, spent his career one step ahead of scandal: During his tenure, a journalist accused him of extortion, the FDA seized cases of expired evaporated milk that prisoners were labeling for resale, and prisoners brought suits alleging discrimination against non-Evangelicals. He always managed to avoid court, assisted by his deep family connections, charisma and the reputation he cultivated for ending Angola’s era as America’s bloodiest prison (though the violence receded long before he took the job).

Angola is also widely known for its on-site hospice, where dying men receive end-of-life care from fellow prisoners. The hospice is the subject of a feature-length documentary produced by Oprah and narrated by Forest Whitaker. Prisoners who die at Angola receive elaborate funerals, complete with a horse-drawn hearse, a handmade coffin and burial in one of two prison graveyards.

Yet, judging by the experience of Brauner and hundreds of other incarcerated men, the respect offered to the dead and dying at Angola deflects attention from a brutal reality: Death at Angola comes earlier than it should, and sickness and suffering are more prevalent than they need to be—all due to the miserable level of healthcare the State of Louisiana offers Angola’s prisoners.

Death on the installment plan

Desperate for better care, Brauner secretly recorded the details of his medical treatment, hoping to build a lawsuit against the prison and medical staff. “Day by day, I documented,” he says. “What date, what doctor came to see me, what he said, what he didn’t say, what he didn’t do. What the nurses are doing, what time they’re doing it, if I was left to lay there half the day before my dressings got changed.” He befriended other men in the nursing ward and began keeping records of their treatment as well. “I watched so many people die that didn’t need to die,” he says.

Brauner kept the logs hidden in his locker, and in 2012 showed them to Nick Trenticosta, a New Orleans-based attorney who was considering using Brauner as a witness in an unrelated death penalty appeal. Trenticosta looked around the nursing ward and saw open garbage containers, showers filled with mold and mildew, and tape covered in dead flies hanging over patients’ beds. He connected Brauner to several prisoners’ rights attorneys who began meeting with other Angola prisoners.

In May 2015, a group of incarcerated plaintiffs filed a class action lawsuit on behalf of the thousands of men held at Angola, alleging that the prison’s medical care violates the Constitution’s Eighth Amendment prohibition against “cruel and unusual punishment.” They are represented by attorneys from four firms—Advocacy Center, ACLU of Louisiana, Promise of Justice Initiative and Cohen Milstein Sellers & Toll PLLC—and are suing four defendants: Darrel Vannoy, who replaced Cain as head warden in late 2015; Stephanie Lamartiniere, assistant warden for health services; James LeBlanc, Louisiana’s secretary of corrections; and the state Department of Corrections (DOC) itself. The lawyers interviewed hundreds of men to build their case and documented one medical horror story after another.

Plaintiff Shannon Hurd, 41, was charged with first-degree robbery in 2003 for breaking into a family’s home and stealing $14, and was convicted by a non-unanimous jury. No one was harmed, but since Hurd had prior felonies, he received a mandatory sentence of life in prison without parole.

According to the complaint, at Angola, Hurd developed extreme pain in his side. He repeatedly requested medical attention starting in 2010, but his pain was dismissed as gas. Over the following five years, he developed numbness in his feet, legs and fingertips, lost his appetite, and dropped nearly 100 pounds. When he finally received a CT scan in 2015, he was diagnosed with stage 4 cancer in his kidneys and lungs—most likely a terminal condition.

Another plaintiff, Alton Adams, 53, suffers from peripheral artery disease, but allegedly was told the state could not afford the stent he needed to save his right leg. A blood clot formed that led to three consecutive amputations. According to the complaint, Adams sees the same issues developing in his left leg, but fears that if he pushes for care, he will face retaliation.

The Louisiana Department of Corrections, which runs the prison, did not respond to requests for comment by In These Times, citing ongoing litigation. In a 2015 media statement, the DOC said that despite challenges like the high numbers of older prisoners and those with chronic diseases, the prison “has provided appropriate, quality care.”

Sandy Netherland-Roberts, a nurse who ran the prison hospice from 2009 to 2011, maintains that Angola’s healthcare is comparable to care on the outside. “Does the system get backed up some? Absolutely. But if you’re in a charity system, even free people on the outside, do they not wait for several months to get an appointment if it’s non-emergent? Absolutely.”

Dr. Anjali Niyogi, who directs a transition clinic for the recently incarcerated in New Orleans and treats current Angola prisoners as a physician at University Medical Center, has a different perspective. “We do see a lot of delayed care coming out of Angola,” she tells In These Times. “People who probably should have been seen honestly, years or months earlier.”

Suspected malingerers

Angola has a documented history of substandard medical care. In the 1990s, prompted by a class action lawsuit, the Department of Justice conducted an investigation and reported to the court that Angola “fails to recognize, diagnose, treat or monitor the serious medical needs of inmates.” The prison and plaintiffs reached an agreement in 1998 that put Angola under a temporary federal monitor.

The current lawsuit points out that many of the medical practices described by the plaintiffs echo those condemned by the DOJ 25 years ago, including delays in care, underqualified staff and a “malingering” rule that effectively punishes people for requesting medical assistance.

According to the lawsuit and interviews conducted by In These Times, at Angola today, emergency medical technicians (EMTs)—not physicians, physician assistants or nurses—are the gatekeepers who determine which patients need urgent medical treatment and which should be sent back to their cells. EMTs receive between 140 and 1,111 hours of training, compared to the years required for medical degrees.

If the EMTs suspect a patient of malingering, or faking illness to get out of work, he may receive a disciplinary write-up, which can lead to extended solitary confinement. Clifford Doleman, who was incarcerated at Angola from 1994 to 2016 and worked as a prisoner orderly there, says that the ailing men he assisted were afraid to request medical care, thanks to a general assumption that prisoners were faking.

In a deposition in August, Angola Medical Director Randy Lavespere explained his biggest challenge was determining “who’s telling the truth.”

“A lot of them use the medical department for reasons not to go to work,” he said. “In Angola, they don’t necessarily want to get well.”

Plaintiffs say the EMT triage system and distrust of prisoners cause long delays in care. In a 2014 email entered as trial evidence, the LSU hospital stroke coordinator complained, “In the past month and a half I have had three inmates from Angola that presented with obvious stroke symptoms. All of them were out of the window [for treatment] because it either took them a while to get here or the medical staff at Angola did not think the inmate was having a stroke.”

Brauner says he’s seen the same thing happen to cancer patients. “They keep complaining about the same thing [but] the EMTs will just say, ‘Well you got a stomach virus, give him Pepto-Bismol, just give him something and get him out of here.’ If you go there too much, they’ll write you up for malingering. So then all of a sudden they decide to finally send him out, well, he’s already got Stage 3 cancer. Because they procrastinated and procrastinated, this guy’s dying.”

And people do die at Angola, at extremely high rates. In 2015, there were 58 deaths—more than one a week. That mortality rate—923 deaths per 100,000 prisoners—dwarfs the nationwide average in state prisons, which was 274 deaths per 100,000 in 2013 (the most recent year data was available).

One factor is the large proportion of Angola’s prisoners serving life sentences—more than 65 percent—thanks to Louisiana’s draconian sentencing laws, like the one that sent Shannon Hurd to prison for life over $14. Twenty-five percent of Angola’s prisoners are 55 or older, compared to just 10 percent in state and federal prisons nationwide.

But it’s not just old men who are dying. Last year, mortality rates at Angola were higher than the 2013 national averages for prisoners in every single age group over 25.