Imagine being behind bars and not having access to the one medication you need to live. What if you were screaming for help, in agony from high blood sugars, but no one listened? Despite your repeated pleas for a simple glucose test or insulin injection, your calls for medical assistance were ignored by the uniformed people standing guard?

Unfortunately, that's not a stretch of the imagination for many of those who end up behind bars. They say that too often jails and prisons do not have adequate diabetes care, which can be life-threatening depending on how long the incarceration lasts.

These situations are exactly what's being called out in a trio of federal lawsuits against the country's largest private for-profit prison company, CoreCivic. The company runs the Trousdale Turner Correctional Facility, Tennessee's newest and largest prison, and also the place where several incarcerated PWDs have made accusations of not receiving adequate D-care -- and a few have even died.

The American Diabetes Association wants to intervene, saying they could represent all the other PWDs out there who currently do or possibly could face similar situations across the country. As of now, the federal court hasn't ruled on whether the ADA will be allowed to be a part of this case. That decision could come at any time, determining just how much ADA can get involved when claims of this sort from incarcerated PWDs arise.


CoreCivil Prison Lawsuits

In the respective lawsuits against CoreCivic, many of the claims mirror each other:

A lawsuit filed earlier this year follows the May 2017 death of inmate Jonathan Salada in Tennessee-based Trousdale Turner Correctional Facility. Autopsy records filed with the court show he had dangerously high blood sugars that any PWD or medical professional knows can lead to excruciating pain. Yet, his official cause of death is listed as an overdose of a prescription opioid painkiller while diabetes is noted as a contributing factor. Salada's family has filed the lawsuit alleging that prison staff left him screaming in DKA-level pain for hours in his cell, without access to insulin in the days before his death.

Eerily, he's not the only PWD who has died in that facility during the past year; and both point to drug use as the main reasons for their death. Another inmate, John Randall Young, was found unconscious in his cell in March 2018 and died soon after at a nearby hospital, following similar claims about inadequate D-care in that prison. But after his death this past Spring, he's been removed as a plaintiff in the lawsuit; his autopsy showed drugs in his blood, including meth and anti-depressants.

Meanwhile, the main lawsuit the ADA has asked to join involves PWD-inmate Douglas Dodson at Trousdale, a lead plaintiff in a class-action lawsuit filed in the Middle District of TN court. The group suing CoreCivic allege that 60 PWDs incarcerated there at one point -- and by extension, any inmate with diabetes -- face daily risk to their health because of unhealthy food, unpredictable meal times and unreliable access to insulin shots. They say the wait-time for insulin alone can be hours beyond when they're supposed to receive injections, a result of both insufficient staffing but also frequent lockdowns when routine medical care is suspended.

One hand-written letter within the court filings describes in detail the kind of insufficient D-care happening at that federal prison facility:

"For the past two-and-a-half weeks we have been on lockdown, and it has been several evenings that we have not been called in to the clinic to get our insulin," Dodson wrote on his prisoner complaint form, now an exhibit as part of the lawsuit. "I know my insulin is keeping me alive and I really need it every day. This has went on long enough here at this facility."

A third case filed two years ago in 2016 involves former Trousdale inmate Thomas Leach, who makes similar claims to the ones Dodson's group makes in their lawsuit.

As of now, in all three lawsuits, CoreCivic has denied doing any wrongdoing.


Blaming the Prisoners for Poor Care

Amazingly, the private prison company insists that the PWD-plaintiffs in these class action cases are responsible for their own diabetes complications (!) That's an incredible assertion to make, given that prisoners have so little freedom or access to needed care or medications.

"Just as children depend on adults to assist with their diabetes care, individuals who are incarcerated are at the mercy of prison staff to provide them with access to the health care tools, medications and reasonable accommodations necessary to manage their diabetes,” the ADA's litigation director Sarah Fech-Baughman said in a news release. “These individuals do not have access to appropriate medical care and have been subjected to discrimination on the basis of their diabetes. The ADA challenges both of these issues on behalf of this vulnerable population.”

If a trial actually happens, it could be more than a year from now -- the court docket currently shows a June 2019 date. Until then or when the court actually rules, what happens will largely be confined to documents each side files in arguing their respective positions.

In March 2018, the ADA filed a motion to intervene in the Dodson case and the court has yet to decide on that issue. The org's news release said it hopes to be allowed to participate on behalf of all PWDs who might be at risk for this type of poor care behind bars, and the ADA's pushing for a standard-setting ruling that could force all CoreCivic locations -- more than 65 state and federal facilities across the USA -- to improve its diabetes care for all prisoners.

Whatever happens in this particular case, there is clearly an issue with how diabetes care is handled in many prisons and jails across the country.


Diabetes Mom Advocates for Son in Federal Prison

D-Mom Laura C. in Minnesota shares her heartache related to the lack of diabetes care available to her son J., currently incarcerated at a federal correctional facility in Milan, MI, where he's the only T1 PWD that she’s aware of at that facility. He’s been behind bars for five years and has two years left on his sentence for armed robbery.

Diagnosed with T1D at age 8, her son is now 35 years old and she says before being incarcerated he maintained good care of himself with A1Cs in the 6% area. But since being in prison, his A1Cs are never lower than 8% and have reached double digits, and he’s also had several severe hypos that required paramedics. 

“This is a huge problem,” she says. “Law enforcement and prison systems operate in their own closed system and seem to answer to no one. Every day, I am scared for my son's life because of the lack of understanding about type 1 diabetes in these systems.” 

She says her son has struggled to get even basic insulin injections and BG checks, because the prison doesn’t administer insulin more than twice a day; they don’t even have rapid-acting insulin, only the older Regular R insulin that is more volatile and takes longer to work. It took her son five months to be allowed insulin at lunch time, after repeated requests verbally and officially in writing. If a staff issue comes up (which happens often, she says), no one is there to give him that lunch-time insulin so he’s required to eat without any insulin to cover his food.

He’s had to file endless “administrative remedy” complaint forms to fight for his care, Laura tells us, but despite trying to work within that system he makes very little progress. As a result of what she describes as “bare minimum” care behind bars, her son has developed diabetes complications. Proper eye exams and dental care are also an issue, she says.

“As long as he is walking and breathing they see nothing wrong with him,” she says.

Ironically, she says they have provided her son with his own “tester” for glucose monitoring, but that really is no good since he doesn’t have access to insulin when needed and there are no doctors to review his BG results. He has to purchase his own snacks to treat and prevent Lows, although the station guards have glucose gel and his cellmates do alert the guards about any hypos overnight.

While her family has reached out to the American Diabetes Association and reviewed available resources, Laura is skeptical about the ADA being able to influence policy within the prison system for inmates with T1D. Her son’s requests for transfer have been denied by the Bureau of Prisons (BOP) to date.

If there was anything that could be done, Laura says one possibility would be to create sentencing guidelines that lay out in writing how to treat and manage T1 PWDs in these facilities. As it stands now at the policy level, BOP guidelines do not distinguish T1 and T2D for care level assignments.


Diabetes Care Behind Bars: ADA Resources Exist

There is no definitive data on how many PWDs are part of the prison population across the USA. But a decade ago, the ADA estimated that of the total 2 million individuals incarcerated nationwide there were likely 800,000 living with diabetes.

While Laura's family hasn't been able to find what they're hoping for with the ADA, the diabetes org does offer a decent amount of resources related to incarceration. As part of the ADA’s Legal Advocacy Program, they offer assistance to all PWDs who experience discrimination -- including those behind bars.

They've published a comprehensive guide on legal rights for attorneys and inmates, and part of that is a PDF that also cites important court rulings that help set the stage for the D-care that people have a right to when incarcerated. The ADA issued a position statement in 2011, regarding diabetes care for those behind bars in correctional facilities, intended to ensure care that complies with national standards -- everything from medical assessments at intake, diabetes screenings, uninterrupted D-management for inmates, and adequate training for staff on diabetes.

Unfortunately, as new lawsuits and individual D-stories stack up, we can see that we still have a long way to go. Hopefully, these lawsuits can lead to change sooner rather than later.