Prisoner Healthcare, Guaranteed by Law: Are the Germans Getting it Right?

From Jennifer Allison:

I am very excited to have been accepted as a guest author for this excellent blog on prisoners’ rights law.  Like Margaret, I am also a law librarian who is deeply interested in prisoners’ rights.  My research specialization is in foreign and international law.  As I read German proficiently, my research focuses primarily on German-speaking countries.

Last summer I started a research project exploring the laws that define prisoner healthcare rights in Germany, with the eventual goal of comparing them to those rights of prisoners in the United States.  I undertook this project mainly to keep my German skills fresh; however, it quickly became an area of great interest to me.  As I was researching this topic, I found myself thinking about prisoner healthcare in a much deeper way, and asking myself a lot of questions.  How much healthcare do prisoners deserve?  Should they receive better care than law-abiding citizens on the outside?  Can prison be a place where people who are completely ignorant of basic healthy practices become educated about them?  Should it be?  What do the quantity and nature of healthcare services we provide to prisoners say about us as a society?

In Germany, healthcare rights for prisoners are guaranteed under the federal government’s Prison Code (Strafvollzugsgesetz – abbreviated in German as StVollzG).  Several German states (Länder) also have their own prison codes guaranteeing similar, if not additional, healthcare rights for prisoners.

The Strafvollzugsgesetz includes general health care provisions that apply to all prisoners, as well as additional provisions that apply expressly to female inmates.  German correctional facilities must to provide physical and emotional healthcare services to prisoners, who are legally obligated to act in accordance with their best health-related interests. (StVollzG § 56)  Periodic medical exams and cancer screenings are required by law, as is medical treatment for illnesses.  (StVollzG § 57)  Medical treatment is defined as the provision of services which are necessary to diagnose and treat illness, prevent an illness’s progression, and relieve suffering.  (StVollzG § 59)  If the prison’s medical facilities cannot provide sufficient treatment for an inmate’s medical needs, then the inmate has the legal right to be treated at a facility outside the prison.  (StVollzG § 65)

Pregnant inmates also have the right to certain medical services under the Strafvollzugsgesetz: pregnancy testing, prenatal care, medication, and care from a doctor and/or a midwife during labor and delivery.  (StVollzG §§ 76-77)  Absent any special circumstances, a female inmate must be transported outside of the prison facility to give birth.  (StVollzG § 76)

This information represents just the start of my research on this topic.  However, I am already impressed by the thorough description of prisoner healthcare access rights in Germany’s federal statutory law.  As my research progresses, I will seek to compare the legal guarantees for prisoner healthcare in Germany to those in the United States.  I have to admit that, based on my initial research, I am not confident that American prisoners enjoy nearly the same rights and access to the healthcare services that are mandated by law for German prisoners.  This is especially true for female inmates, on whom I intend to focus my future research in this area. 

“Reassessing Solitary Confinement: The Human Rights, Fiscal and Public Safety Consequences”

On June 19, 2012, Professor Michael B. Mushlin submitted the following testimony in the Hearing before the Senate Judiciary Subcommittee on the Constitution, Civil Rights, and Human Rights (Chairman: The Honorable Dick Durbin, Ranking Member: The Honorable Lindsey Graham):

Thank you for holding this important hearing and inviting testimony. My name is Michael B. Mushlin. I am a Professor of Law at Pace Law School in White Plains, New York. I am the author of Rights of Prisoners,¹ a four volume treatise, and a member of the American Bar Association’s Task Force on the Legal Status of Prisoners. I am also a co-chair of the American Bar Association, Subcommittee on Implementation of the ABA Resolution on Prison Oversight,² and have served as chair of the Committee on Correction of the New York City Bar Association, the Correctional Association of New York and the Osborne Association, an organization that provides training and support programs for people in jail and prison or who are being diverted from imprisonment. Currently, I am a vice chair of the Correctional Association of New York, a 168 year old organization endowed by New York law with the authority to visit New York State Prisons with the responsibility to report on their condition to the New York state legislature. With colleagues, including Prof. Michele Deitch of the University of Texas, I participated in the organization of two national conferences on prison reform, the first Prison ReformRevisited: The Unfinished Agenda held at Pace Law School and the second, OpeningUp a Closed World: What Constitutes Effective Prison Oversight held at the University of Texas. Both conferences drew together professionals from all segments of the criminal justice and corrections fields to discuss improvement to the operation and oversight of the American prison system. For seven years, I was staff counsel and then the Project Director of the Prisoners’ Rights Project of the Legal Aid Society. I also served as staff counsel with Harlem Assertion of Rights Inc., and was the Associate Director of the Children’s Rights Project of the American Civil Liberties Union. For the 2012/13 academic year, I will be a Visiting Professor of Law at Brooklyn Law School.

I first confronted conditions in solitary confinement units over thirty years ago when I served as trial counsel in a federal civil rights case involving Unit 14, the solitary confinement unit at Clinton prison in upstate New York close to the Canadian border. What I saw there was deeply disturbing. Inmates were locked for 23 hours each day into small windowless cages for months and years on end. No programs or activities were provided to them. Without access to any meaningful activity, they were separated from one another spending almost all of their time entirely by themselves. During that one precious hour per day when a Unit 14 inmate could leave his cell there was only one place to go: a small space directly behind his cell called a “tiger cage.” The tiger cage was a small empty space with a barren floor surrounded on all sides by high concrete walls which were not covered by a roof. An inmate could walk only a few steps in one direction before turning. If he looked up he could glimpse a bit of the sky but nothing else of the outside world.³

Working on that case I witnessed firsthand the awful consequences of subjecting human beings to solitary confinement. I will never forget looking into the eyes of those inmates struggling to maintain a foothold on reality and sanity. Afterwards, when visiting other solitary confinement units, no matter where, I see that same pained, desperate stare. I have seen it so often, and in so many different places, that I have come to recognize it instantly as the gaze of a tortured person.

Arizona's deadly prisons

Bob Ortega, senior investigative reporter at the Arizona Republic, has recently written a series of articles on "a prison system that houses inmates under brutal conditions that can foster self-harm, allows deadly drugs to flow in from the outside, leaves inmates to die from treatable medical conditions and fails to protect inmates from prison predators."  The individual articles cover the high number of deaths, including suicides, the struggle to control the availability of drugs in prison, the inadequate medical care prisoners receive, and the deaths that result from increasing inmate-on-inmate violence.    

Aging Prisoners

We often think of prisons as places filled to the brim with young aggressive men.  However, according to a report issued today by Human Rights Watch entitled Old Behind Bars: The Aging Prison Population in the United States the reality is that many prisoners today are more in need of old age homes than they are of prison cells.  The report found that the number of sentenced state and federal prisoners age 65 or older grew at 94 times the rate of the overall prison population between 2007 and 2010. The number of sentenced prisoners age 55 or older grew at six times the rate of the overall prison population between 1995 and 2010.  The reason for this upsurge in the number of elderly prisoners is sentencing laws in the United States.  Currently over 10% of the prison population are serving life sentences and another 11% have sentences of greater than 20 years. 

Prisons are not designed as geriatric centers. Thus, for the growing number of older prisoners, many of whom are frail, with myriad of problems associated with old age, prison confinement without adequate attention to their needs becomes harsh and punitive.  The report makes three recommendations. The first is that sentencing and release policies be modified to allow for release of prisoners whose condition no longer justifies incarceration. Second that plans be developed for housing, medical care, and programs for this population of older prisoners. And finally that prison rules that make no sense for older inmates be reformed. The report, which is important and timely, is found at http://www.hrw.org/reports/2012/01/26/old-behind-bars.

Michael B. Mushlin

Professor of Law

Pace Law School