Review: Homer Venters’ Life and Death in Rikers Island
Reviewed by Ezelle Sanford III
At this moment, the United States confronts multiple crises. COVID-19 has killed more than 200,000 people and infected more than six million, though these numbers are certainly undercounted. The virus’s impact, though indiscriminate, is disproportionately felt in communities of color who are more likely to experience serious illness, hospitalization, and death. Amid this pandemic, Americans flooded streets across this country, protesting George Floyd’s murder at the hands of police, unleashing mounting frustration and rage as similar scenes replayed one too many times.
This pandemic, like pandemics of the past, has laid bare the flaws of our society. While public scrutiny has shifted to police brutality, a slow moving but no less horrifying crisis has been unfolding, out of sight, in the nation’s carceral system.
As of this writing, over 1,000 incarcerated people have died while more than 130,000 have been infected, as reported by The COVID Prison Project. After a lengthy investigation of Angola, Louisiana’s infamous maximum security prison, ProPublica found that “prisons and jails now account for most of the biggest COVID-19 hot spots in the country, with thousands of cases documented at penitentiaries in Texas, Ohio, California, and other states.” Low mortality rates have only encouraged inaction on the part of prison officials, who largely ignore the problem. Concern shifted to Rikers Island, when COVID-19 cases spiked in New York City. While 276 carceral patients are confirmed to have COVID-19 as of this writing, more than 1400 Rikers staff members have been infected with the virus. This is frightening, given new discoveries of “long haulers,” individuals experiencing long-term debility from the virus. Whether Angola or Rikers Island, or any other carceral space, regardless of how grave or minor the legal infraction, guilt, or innocence, awaiting trial, or convicted, incarceration increases risk of death. In this pandemic, the risk is even greater.
Life and Death in Rikers Island
By Homer Venters
Johns Hopkins University Press, 2019
200 pages
Homer Venter’s prescient Life and Death in Rikers Island explains why improving carceral health is important and deserving of more attention. In the COVID-19 era, this argument gains even greater significance. Jails and prisons accelerate spread of disease, impacting communities, carceral staff, and incarcerated people. Venters, former Rikers Island Chief Medical Officer and current advocate for carceral health and human rights, has brought his years of medical expertise and interpersonal experiences to address growing concern for and critical analysis of carceral and detention systems and the place of racial (in)justice within them. The book is also a searing exposé that powerfully illustrates the health risks of incarceration in New York City, as well as those risks that lead to incarceration in the first place. And it adds to the strong case for closing Rikers Island, which is planned to be shuttered by 2026.
Venters argues that “Incarceration harms health,”, a short but powerful opening salvo that reverberates throughout the book. It is not easy to read in one sitting, especially in these times. The author skillfully narrates episodes poignantly illustrating pain, brutality, injury, and death experienced not only by incarcerated people, but the staff who serve them.
As Venters demonstrates, carceral patients are stuck in a double bind — they are often survivors of other failed social systems, while incarceration worsens health and increases risk of early death. Ironically, incarcerated people are the only population guaranteed the constitutional right to health care in the United States. In his introduction, the author describes the case of J. W. Gamble, who was injured during his incarceration. His case, Estelle v. Gamble (1976), went all the way to the United States Supreme Court, establishing “the right to health care for prisoners…, making them the only group with this constitutional guarantee.” Despite this precedent, Venters notes that “health care is not a top priority in jail.”
Throughout the book, Venters illustrates the stories of his “patients,” who are all the incarcerated people on Rikers Island. The author adopts a human rights framework to correctional health, a perspective he developed while serving as the Chief Medical Officer for New York City Jails. He acknowledges that his “goal in relating their stories… is to show the role of the jail system in their trauma, injuries, and deaths.… The systemic failures of the jail system became their personal health risks. My goal is to provide an honest assessment of exactly how jail creates these health risks and to reveal the true costs of incarceration and the benefit of alternative strategies.” He further argues that, “incarceration is a space of common and profound abuse, neglect, and substandard care for patients.” This revelation emerged when Venters connected his experiences in carceral health, to his earlier time as a medical resident, documenting torture-related injuries of those seeking asylum.
Each thematic chapter masterfully weaves horrifying anecdotes, quantitative data, public policy, news reports, and legal proceedings to powerfully describe how that theme contributes to ill health. The book’s sixth chapter, centered on the theme of “Race,” uses the case of Kalief Browder, which was championed by rapper Jay-Z in his feature docuseries Time (2016). In this compelling chapter, Venters describes how race, combined with incarceration, is both a risk factor for imprisonment and a factor compounding structural and social health risks for people of color. Each chapter has the ability to stand alone, while working in concert to delineate how the health risks posed by incarceration are structural and products of design, both of the physical space, but also the prioritization (or lack thereof) of health within the carceral system. He writes, “as a result, many of the health risks of jail are structural, arising from the basic design of the jail.” Venters is careful to describe a sometimes collaborative, but often combative, relationship between carceral health and the oft-prioritized security apparatus. Throughout the work, Venters outlines how these mostly opposing forces in carceral spaces were intentionally designed and evolved to be that way.
Venters makes clear that in carceral spaces like Rikers Island, health often falls secondary to the security apparatus. It begs the question: how did this come to be? The author passively engages with the history of medicine, citing Samuel Cartwright’s pseudoscientific creation of “drapetomania,” an “illness” that caused enslaved people to escape bondage. He compares this to the contemporary diagnosis of “excited delirium,” often used to explain away questionable injuries to detained people. Yet no mention is made to how medical professionals often exploited incarcerated populations for biomedical research. One might consider the case of Dr. Albert Kligman, whose dermatological experiments at Philadelphia’s Holmesburg prison ending in the 1970s left numerous individuals mentally and physically scarred for life. This case was documented in the book, Acres of Skin (1998). It is unclear whether the position and power of carceral health professionals has waned since that time, or if the author himself is sympathetic to the plight of correctional health staff today. Nonetheless, Venters successfully intervenes in the healthcare literature, bringing from the shadows the hidden sphere of carceral health. Additionally, this book contributes to the growing carceral studies literature. His deep analysis of incarceration itself as a significant health risk — both to incarcerated people and the communities from which they come — is an insight that other scholars might build upon.
While calls for prison abolition have grown in recent years, the author does not take a clear position in this debate. He writes, “because every setting will tackle decarceration with different appetite and effectiveness, it’s worth noting the real ways that injuries in jail can be reduced for the incarcerated.” The author’s focus lies with improving carceral health, in the current carceral system or how it would look in a reimagined system. This is clear when he writes, “this book explores the evidence to find ways in which we can identify and reduce the health risks of jail, but we need to start by acknowledging that incarceration brings a risk of death.” His argument, that incarceration is a new social determinant of health which increases risks of early mortality, could easily make the strong case for prison abolition at most, reform at least.
Venters proposes several alternatives to improve carceral health services — some of which he implemented during his time as Chief Medical Officer on Rikers Island, including tracking a standardized measure of jail-attributed deaths and creating alternative housing units for people experiencing mental illness. He also proposes the use of technologies, like information technology systems, to track the movement and location of incarcerated people. Much of this story, however, hinges on the failure of technologies, like cameras. While cameras promised around-the-clock surveillance, their suspect failures coincident with injury befalling incarcerated people is striking. Such a subtext should prompt reformers to contemplate how this technology will not only improve carceral health outcomes but also, how this technology could possibly fail? Or worse yet, be exploited? Such a perspective constrains the overwhelming faith that new technologies will always operate in the way that they were intended, and that they will improve the status quo.
It seems that year after year, sensational stories of prison-related death horrify us. Venters explains, “in the United States, because of the hidden and paramilitary nature of health care in jails and prisons and the lack of any universal standards to monitor care, we end up having the same sad discussion around every tragedy.” Following investigations, lawsuits, and public outcry, the health conditions of incarceration rarely change at the systemic level. This is the book’s most disheartening revelation, that while fatal flaws are repeatedly identified, they continually result in unnecessary death. Venter’s appeal to both the reader’s emotion and logic offer a powerful indictment of the conditions of jails and prisons on Rikers Island and by extension, Americas entire carceral system. This book will be of interest to readers who follow health, medicine, and the carceral system, as well as activists and policy makers working to improve conditions for incarcerated people.
Ezelle Sanford III is currently a Postdoctoral Research Associate in the Program on Race, Science, and Society (PRSS) at the University of Pennsylvania. There he manages the Penn Medicine and the Afterlives of Slavery project (PMAS) while also working on a book project, Segregated Medicine: How Racial Politics Shaped American Health Care.