by Alex Dietz, Civil Rights Attorney at PCVA

The state of healthcare in American prisons and jails has reached a critical point. As someone who regularly represents incarcerated individuals fighting for their basic right to medical care, I’ve witnessed firsthand how our system routinely fails those behind bars. What many don’t realize is that this crisis affects not just those who are convicted, but also pretrial detainees who are presumed innocent until proven guilty.

How Did We Get Here?

The story begins in the 1970s when the U.S. Supreme Court ruled that depriving prisoners of medical care violates the Eighth Amendment. This landmark decision sparked the creation of prison healthcare systems nationwide. However, what started as a constitutional mandate has evolved into a profit-driven industry that often prioritizes cost-cutting over human lives.

Today, over 60% of jail medical services are provided by private companies who promise cost savings but deliver substandard care. These corporations, often owned by private equity firms, have found ways to cut costs that directly impact patient care: understaffing, hiring under qualified personnel, limiting outside hospital visits, and delaying necessary treatments.

The Real Cost of Delayed Care

“Healthcare delayed is healthcare denied.” This isn’t just a catchphrase—it’s a devastating reality for those in custody in Washington state and across the country. Incarcerated individuals routinely wait months or even years for essential medical procedures. The consequences are severe: research shows that each year spent in custody reduces life expectancy by approximately two years.  Lack of proper medical treatment plays a significant role in this reduced life expectancy.  But those who survive their time incarcerated are the lucky ones, as hundreds of people behind bars die each year throughout the United States due to medical neglect.  Many of these people were never convicted of any crime.

For those with mental health conditions, the situation is particularly dire. Many individuals end up in jail due to mental health related episodes, often accused of minor offenses like trespassing. Once inside, they face a system ill-equipped to handle their needs, staffed by personnel who lack proper training in how to recognize the signs that someone is experiencing a mental health crisis.  Untrained correctional staff will often assume a detainee or inmate is resisting or faking symptoms instead of arranging for someone with the required expertise to determine if there is a genuine emergency.  This can lead to dire, and entirely preventable, consequences for those suffering from mental health conditions.

Understanding Your Rights

If you’re incarcerated or have a loved one in custody, here are crucial points to understand:

1. Your Rights Begin Immediately: From the moment you enter a facility, you have a constitutional right to medical care. This includes:

A medical screening upon arrival

Ongoing evaluation of medical needs

Treatment for serious medical conditions

If you take medication, advise jail staff and request continuation of your medication.  It’s your right

2. Documentation Is Critical:

Always submit formal requests for medical care (often called “kites”)

Keep copies of all medical-related communications

Request your medical records regularly

If possible, have family members maintain copies of your records

3. Persistence Matters:

Continue requesting care even if initially denied

Be specific about your symptoms and needs

Alert staff to any pre-existing conditions

Don’t assume visible symptoms will automatically receive attention

Taking Action

For those facing medical neglect in custody, here are essential steps:

1. Document Everything:

Keep detailed records of all medical requests

Note dates, times, and names of staff involved

Record any symptoms or changes in your condition

Request copies of your medical records regularly

2. Seek Legal Help Early:

Don’t wait until a crisis occurs

Attorneys can often intervene before serious harm occurs

Legal pressure can help expedite necessary care

3. Know Your Rights:

The Constitution protects your right to adequate medical care

This right applies whether you’re convicted or awaiting trial

Private companies must meet the same constitutional standards as government providers

Why This Matters to Everyone

Some might ask why they should care about correctional healthcare if they don’t have a personal connection to the system. The answer is twofold:

First, our justice system isn’t perfect.  Not everyone in jail has actually committed a criminal offense. Many people in custody are pretrial detainees who haven’t been convicted of any crime. Others are there due to mental health crises rather than criminal intent. The system affects not just those accused of serious crimes, but also individuals detained for minor offenses who couldn’t afford bail.

Second, this is a public health issue. Most incarcerated individuals eventually return to their communities. When we deny them proper healthcare, we’re not only being inhumane—we’re creating broader public health challenges that affect everyone.

The Path Forward

The solution to this crisis requires systemic change. Private companies must be held accountable when they prioritize profits over patient care. This accountability often comes through litigation, but it also requires public awareness and advocacy.

For real change to occur, we must make it more expensive for facilities to deny care than to provide it. This means:

Supporting litigation that challenges inadequate care

Advocating for stronger oversight of private healthcare providers

Pushing for transparency in prison healthcare systems

Demanding better training and proper staffing for correctional healthcare systems

Remember: speaking up about inadequate medical care isn’t just about your own health—it’s about improving the system for everyone. Every time an incarcerated person stands up for their right to adequate medical care, they’re helping to create positive change for others in the system.

Taking the First Step

If you or a loved one is experiencing medical neglect in custody, don’t stay silent. Document everything, persist in requesting care, call your representatives to demand that they ensure proper medical care is provided in correctional facilities, and reach out to an attorney like me who specializes in prisoner rights.

Alex Dietz is a  Civil Rights Attorney with  
Pfau Cochran Vertetis Amala PLLC.
909 A Street Suite 700 Tacoma, WA 98402
adietz@pcvalaw.com • (253) 289-1412