WITHOUT A RATIONAL PLAN: How and Why the Massachusetts DOC
Caused Covid-19 To Ravage State Prisons

A Lifers' Group Reoort
•

I

Prepared by
Dirk Greineder, MD, PhD

February 2021

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MCI-Norfolk
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Norfolk, MA 02056

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WITHOUT A RATIONAL PLAN: How and Why the Massachusetts DOC
Caused Covid-19 To Ravage State Prisons
Dirk Greineder, MD, PhD
For Lifers' Group Inc., February 2021
accessible at www.realcostofprisons.org/writing
FAILURE TO PLAN
From the beginning of the Covid-19 pandemic, it has been clear that prisoners
would be and were, in fact, among those at highest risk due to crowded
aggregate living conditions. This concern was validated early on by studies
showing significantly higher rates of infection and death in prisons
nationally and locally (1). In Massachusetts, a June 2, 2020 decision by the
Supreme Judicial Court (SJC) did not find constitutional violations in the
Massachusetts Department of Correction (DOC) failure to expedite release of
prisoners in order to decrease prison crowding. The SJC, however, did alert
the DOC that failure to plan ahead to reasonably protect prisoners from
infection might result in constitutional violations, especially if the DOC
failed to decrease crowding (2).
It is incontrovertible that the DOC chose to ignore this advice and--as we
shall see--failed to institute any other viable plan to mitigate Covid-19
infections and deaths in state prisons. By early January 2021, this had
resulted in an overall DOC prisoner infection rate over 35% while, even after
the winter and holiday surges, the community rate was only 6%. Here at MCINorfolk, 41% of prisoners had tested positive (3). Similarly, the prisoner
death rate rose to 333/100,000, exceeding the community death rate of
approximately 200/100,000 (4). This result is especially surprising because
the fraction of the prisoner population aged 70 and older, those most likely
to die from Covid, is only one-third that seen in the community (5).
It is fair to argue that the DOC had no plan to deal with the pandemic in
prison other than a hope that, miraculously, it would be possible to prevent
infection from penetrating prison walls. This futile hope was then further
dashed by the DOC's lack of foresight in implementing rational procedures to
keep infection out by adequately screening or quarantining guards. This report
addresses some of the most serious failings that have led to the staggering
rates of infection and death seen in Massachusetts state prisons to date. Many
of these issues also have been timely highlighted and discussed in prior
reports and in "Updates from MCI-Norfolk", all of which are available for
review online (6).
CROWDING
In addressing the major concern about crowding voiced by the SJC, it is clear
that the DOC failed to expedite release of even short-term and/or parole
eligible prisoners. Additionally, the DOC actively resisted releasing eligible
prisoners on home confinement (with or without GPS monitors) even though the
SJC ruled that the DOC had that authority (7). Equally troubling is the
observation that, by various means including but not limited to reducing
access to "earned good time", the DOC released some 500 fewer prisoners AprilNovember 2020 compared to the same periods during the four preceding years,
2016-2019 (8). Although the DOC custody population was reduced by
approximately 1000 prisoners during 2020, it is important to remember that
there have been virtually no new criminal commitments since April 2020 because
Without a Rational Plan, Page 1 of 6

of court closures. Normally this influx would far exceed the observed
reduction, confirming that fewer prisoners than normal were released in 2020
( 9) • By contrast, other states have released large numbers of prisoners,
including NJ with over 4000 and California with over 8000 ( 10) ) • Here in
Massachusetts, reductions in individual prisons have been minimal with no
notable effect on crowding. For example, MCI-Norfolk, operating at
approximately 97% of capacity on April 4, 2020, the date starting the 24/7
lockdown, saw a reduction of only 34 prisoners (2.6% of a 1267 total) by
November, when the pandemic was ravaging the prison (11). The unmitigated
crowding was a major contributor that allowed waves of infection to decimate
the prison population in November-December. Without preparation or a viable
plan, the administration had no effective means to limit the spread.
LOCKDOWN
Once the pandemic took hold in the community in the spring of 2020, the DOC
mindlessly implemented its typical universal remedy for any prison crisis: a
24/7 lockdown of all prisoners into cells and tiers. As amply documented in
prior "Updates", this lockdown dramatically exacerbated conditions likely to
spread infection (12). Prisoners were forced into close, intimate contact with
each other 24/7 while sharing communal living space, bathrooms, tight tiers,
chow and medication lines, as well as communal closed-circuit ventilation
systems. Paradoxically and tragically, these conditions were exquisitely
effective means of providing ideal, incubator-like conditions that would
maximize the spread of virus once it entered the prison (13).
PRISONER WORKERS DEPLOYED
Initially, the lockdown was complete but within weeks cost-saving expediencies
and pragmatic considerations moved the administration to make self-serving
adjustments. While most prisoners remained isolated and crammed into tight
communal quarters, hundreds of prisoner workers were returned to congregate
settings to work in Industries, mainline kitchen, maintenance and janitorial
services. Their only PPE were masks. These workers had frequent contact with
prison staff who lived in the community and entered the prison daily. A major
failing was that prison staff were not routinely tested, creating a steady
source of potential infections. Similarly, prisoner workers also were not
tested unless reporting symptoms--a serious omission since each worker
returned to their original, otherwise quarantined, housing unit each evening.
This inexcusable violation of quarantine procedures obviated any benefit
derived from the draconian isolation imposed upon all other prisoners. This
poorly conceived and deeply flawed strategy set the stage for the eventual
efficient distribution of infection throughout the prison population.
TESTING
Another critical misstep by the DOC was the failure to regularly test.
Prisoner workers, including unit food handlers and servers, were not screened
with testing. The first wide-spread testing was done late May and not repeated
until the first week in November. By then, here at Norfolk, many symptomatic
cases were springing up and testing revealed multiple housing units with up to
three-quarters of prisoners testing positive. Even worse, results were slow to
be reported, leaving infected prisoners in prolonged contact with others
before they were "isolated" in a dormitory setting. However, even in units
Without a Rational Plan, Page 2 of 6

testing negative, many prisoners began experiencing symptoms within days after
their negative tests, obviously infected but missed, in these cases, by the
marginally premature test. These infected prisoners were not reported or
isolated and infection spread rapidly throughout most housing units. The next
round of testing did not occur for 5 more weeks. Many symptomatic prisoners
had recovered by then and tested negative, thereby never being counted among
the infected, even while infection continued to rage through the prison
without official accounting or attention.
MASKING
Almost certainly among the most egregious mistakes made by the DOC (other than
rebuffing all efforts to reduce crowding) were the decisions made on prisoner
mask usage. After the initial lockdown on April 4, during which prisoners were
confined to cells 24/7 (except for brief intervals to use communal showers and
phones), outbreaks had begun to crop up in several prisons. By late April, the
DOC responded appropriately by issuing commercial surgical masks to prisoners
with a mandate to wear these in congregate settings. These masks were the
standard multilayer, soft masks normally used in surgical theaters, as N95 and
other high-efficiency masks were still in short supply in the U.S.. In
response to increasing prisoner compliance with masking, and as reported in a
study of DOC masking policy, prison rates of infection promptly diminished. By
late May new infections were virtually eliminated in all prisons (14). New
surgical masks were being issued to prisoners every 2 to 3 weeks until a
fateful DOC decision announced on October 14, 2020. On that date the DOC
distributed pairs of new home-made, washable masks made by prisoners in
Industries based on haphazard templates and designs. Prisoners were required
to wear only these new masks, which were the only ones authorized for use.
These masks were immediately recognized as poorly designed and likely to have
limited effectiveness. They were too big, fitting loosely and made with only a
single layer of fabric, a serious flaw which by then had been widely
criticized by experts. Too large and without a wire to mold around the nose,
the oversize masks leaked air around all margins and typically slipped off the
nose, further compromising efficacy.
Despite prisoner complaints, including some grievances, that these masks were
inadequate and likely ineffective, the DOC continued to mandate their
exclusive use. One grievance was dismissively answered by stating that " ••• a
cloth mask for an inmate in general population is appropriate ••• ". The
consequences of this poorly conceived, cost-saving measure were almost
immediate: within two weeks case numbers started to climb throughout most
prisons, reaching epidemic proportions by the third week (15). This surge has
continued well into the new year, by which time it was likely that virtually
all prisoners had been exposed (see an analysis of likely infection rates in
the January 20, 2021 Norfolk "Update" (16)). Because prisoners have been in
24/7 lockdown quarantine and continuously confined to the same indoor housing
units since April, this surge of infections cannot be attributed, as it has
been in community surges, to cold weather indoor exposure or changes in the
aggregation of prisoners. Rather, it is clear that this ill-conceived penny
wise and pound foolish decision by the DOC not to spend trivial sums (probably
no more than 50¢ each) to purchase effective surgical masks had devastating
impacts upon the prisoner population. Without effective masks and no
opportunity to social distance or protect themselves from the ravages of
widespread infection, prisoners succumbed to Covid-19 in droves.
Without a Rational Plan, Page 3 of 6

SPREAD

&

ISOLATION

Because of the aforementioned lack of preparation, planning and the failure to
reduce crowding, here at Norfolk there was no safe place to isolate prisoners
once large numbers tested positive. Desperate, the administration resorted to
reopening the previously condemned probation units. This fateful mistake
clustered up to 70 infected prisoners into an onerous dormitory setting with
double bunks a scant 3 feet apart and no amenities. The building was known to
be mold-infested and had a closed-circuit ventilation system that recycled
air. Aware that reporting symptoms would cause them to be "isolated" in this
dormitory setting that offered neither benefits nor any treatment, kept many
prisoners from timely reporting symptoms in order to remain in their housing
units--while inadvertently infecting others. Guards rarely reported even
blatantly symptomatic prisoners, in part because they had tested negative in
early November and because there were so few beds for isolation. Only those
complaining of the most serious medical difficulties, often requiring
hospitalization, were reported. The remaining prisoners were left in their
cells, further spreading infection. Although later on a high-security unit was
cleared to be used as a supplemental isolation area, the damage had been done,
with Covid-19 infection firmly entrenched at Norfolk. This yielded the
documented 41% rate of positive tests by late December even though many
unreported symptomatic prisoners tested negative by that time. Norfolk has the
most elderly and vulnerable, longest serving prisoner population in the DOC.
This group was subject to the many serious medical consequences of Covid-19,
including chronic, long-lasting after-effects of infection and even death. In
a blatant attempt to dissimulate the number of prisoners dying in custody, the
DOC even resorted to releasing some prisoners on "medical parole" only hours
before their demise, in order to claim that they were not prisoners at the
time of death (17).
MISSTEPS
Multiple other bad decisions and missteps were made, many likely motivated by
the desire to save money and maximizing the use of virtually free prisoner
labor. A particularly poor choice at MCI-Norfolk was an early decision to stop
using costly disposable food trays for meals. Dishwashing machines with coldsterilization functions had been shut down and washable food tray use
discontinued. Without disposable trays, prisoners were required to use
individually owned bowls to receive food. This resulted in food servers
needing to handle and return prisoners' reusable bowls with every meal,
maximizing cross-contamination. Moreover, food servers were not screened or
tested for infection. A consequence in my unit, for example, was that delayed
test results during the December mass screening caused asymptomatic but
infected food servers to continue serving for a week while their tests were
pending. During this time they were daily in close proximity with prisoners
and handled their bowls during each meal.
Many other troublesome decisions included restricted access to cleaning and
disinfection supplies. No effective measures were instituted to provide for
systematic sanitation of communal bathrooms, showers and many other shared
spaces. Bleach, always contraband in prison, was not accessible. Later, a
roving team sprayed some common areas with diluted bleach solution every one
or two days, but this had little effect on the crowded tiers and bathrooms.
Hand sanitizer, initially not available, was later sequestered in the guards'
offices, inaccessible to prisoners in most situations. These and other similar
Without a Rational Plan, Page 4 of 6

issues, in conjunction with the underlying close quarters and persistent
locking in of prisoners, actively facilitated and encouraged wide-spread
infection in prisons. This resulted in frequent tragic outcomes, including
deaths as well as burdening substantial numbers of vulnerable and elderly
prisoners with well-reported long-term, often devastating and persistent
health consequences of Covid-19 (18).
VACCINATION
A particularly deplorable, even tragic consequence of the DOC' s lack of
prepartion, planning and mitigation of infection in prisons is that had the
prison surge of infections been delayed by only a few months, early
vaccination would have protected this vulnerable population. Commendably, the
Commonwealth Covid-19 task-force included prisoners among the first wave to be
vaccinated. This was, in fact, accomplished during January 2021. However, by
that time, the majority of prisoners had been exposed and infected before they
were ever vaccinated. Thus, lamentably, their deaths or disabling long-hauler
Covid-,-19 disabilities could have been prevented had DOC preparations and
policies been effective at delaying the infection surge in prisons.
CONCLUSION
These facts make clear that the DOC' s failure to act is inexcusable and
directly responsible for the devastation imposed on this literally captive
population. Thousands of prisoners have become infected in these crowded
quarters, inadequately protected by ineffective masks. In addition to the
elderly and vulnerable suffering long-term consequences, all prisoners have
been adversely affected by the enforced lockdown and lack of educational,
rehabilitative and self-help programs because of the persistently large
numbers of infections and high risks.
This lack of foresight and negligent execution is not unique in DOC
operations. Similar failings have chronically afflicted operations regarding
the use of .solitary confinement, disciplinary procedures, the provision of
medical and mental health care, and the lack of accountability of DOC staff
regarding the need to educate, rehabilitate and re-integrate prisoners back
into society. This persistent lack of concern for prisoners' needs leads to
dehumanization and debasement of prisoners that, overall, severely impair the
ability of prisoners to maintain positive adjustments while in prison but,
critically, also once returned to the community after release. In this way,
the Department of Corrections not only fails to "correct", but actually
exacerbates the risk of recidivism once prisoners are released.
ENDNOTES
1. Strassle C, Jardas E, Ochoa J, et al. "Covid-19 Vaccine Trials and
Incarcerated People--The Ethics of Inclusion". N Engl J Med 383:1897-99
(2020); Saloner B, Parish K, Ward JA, et al. "Covid-19 Cases and Deaths in
Federal and State Prisons, JAMA, 324:602-3 (2020); Jimenez MC, Cowger TL,
Simon LE, et al. "Epidemiology of Covid-19 Among Incarcerated Individuals and
Staff
in
Massachusetts
Jails
and
Prisons",
JAMA
Netw
Open
3(8):e2018851.doi:10.1001 (2020); Lifers' Group Fast Facts: "Excessive Rates
of Covid-19 Cases and Deaths in Massachusetts State Prisons, August 2020.
2. Foster & Others v Commissioner of Correction & Others (No.I), SJC-12935,
June 2, 2020.

Without a Rational Plan, Page 5 of 6

3. www.mass.gov/doc/sjc-12926-special-master-weekly-report-011321.
4. Crimaldi L. "Inmates start getting vaccinated", Boston Globe, 1/23/21, Bl.

5. Lifers' Group Fast Facts: "Excessive Rates of Covid-19 Cases and Deaths in
Massachusetts State Prisons, August 2020.
6. Norfolk Updates (dated May 10 & 20; June 1, 13 & 30; July 15 & 29; August
17; Sept 12; Oct 13 & 31; Nov 30; Dec 8 & 29; Jan 20, 2021) plus Lifers' Group
Fast Facts (see n.5, 8, 14) accessible at www.realcostofprisons.org/writing.
7. Prisoners' Legal Services. PLS Notes, "PLS Continues to Litigate for Relief
Amidst Covid-19 Pandemic", Winter 2020/2021, p4.
8. Lifers' Group Fast Facts: "Falling State Prisoner Numbers: Incidental to
Pandemic court Closure or Real Expedited Release?" November 2020.
9. Ibid.
10. Tully T. "New Jersey to Release More than 2000 Prisoners in One Day",
Boston Globe, 11/5/20, A2.
11. www.mass.gov/doc/sjc-12926-special-master-weekly-report-011321.
12. See n.6.
13. Ibid.
14. Lifers' Group Fast Facts: "For Want of a Reliable Mask: How the
Massachusetts DOC Endangered Prisoner Lives and Health To Avoid Paying For
Effective Masks During the Covid-19 Pandemic", January 2021.
15. Ibid.
16. See n.6.
17. Becker D. "2 Mass. Prisoners Hospitalized for Covid-19 Die A Day After
Being Granted Medical Parole", WBUR, November 30, 2020.
18. del Rio C, Collins LF, & Malani P. "Long-Term Heal th Consequences of
Covid-19" J Am Med Assoc (JAMA); 324:1723-24 (2020); Rubin R. "As Their
Numbers Grow, Covid-19 "Long-Haulers" Stump Experts"; JAMA; 324:1381-83
(2020).
All Lifers' Group reports and Norfolk Updates (May 2020 to
January 2021) are available at www.realcostofprisons.org/writing.
Without a Rational Plan, Page 6 of 6