The Inadequacy of Prison Food Allergy Policies
by Jamie Longazel and Rachel Archer
Michael Saffioti was arrested on a misdemeanor marijuana charge and held at the Snohomish County Jail (SCJ) in Washington State. On the morning of July 2, 2012, he arrived at the center of his module where breakfast was being served. Because he had a severe dairy allergy, Saffioti examined very closely the pancake and oatmeal he was given. Video footage obtained by local news agency KIRO-7 showed him discussing his food with guards, servers and fellow prisoners. This was not the first time Saffioti was held at the SCJ, so his allergy was on record. Yet jail staff had brought no special diet trays to his module that morning; they instead simply removed the pancake from his tray and assured him the oatmeal would be safe to eat.
After taking just a few bites, Saffioti began to experience shortness of breath. Video footage showed him approaching a guard’s desk, where reports say he asked for his inhaler and to see a nurse. He was given the inhaler but his request for a nurse was denied, and shortly afterwards he was sent back to his cell. Once there, according to a subsequent lawsuit, he pressed his call button and repeatedly asked when the nurse would arrive. By looking closely at the video footage, one can see how he later began jumping up and down in his cell, seeking assistance. Thirty-five minutes later a guard found Saffioti unconscious. After attempts to perform CPR were unsuccessful, he was rushed to a nearby hospital where he was pronounced dead.
Saffioti’s tragic death raises many important questions about food allergy policies in U.S. prisons and jails – a subject that has been relatively overlooked, likely to the detriment of many prisoners. The federal Bureau of Prisons (BOP) estimates that 0.2% to 3.5% of all prisoners suffer from food allergies. And a recent study by the Centers for Disease Control and Prevention reported a 50% increase in food allergies among children since 1997. With approximately 2.2 million people confined in U.S. prisons and jails today, this means prison food allergy policies impact as many as 77,000 prisoners and likely many more in years to come, including some like Saffioti whose allergies are so severe that meal choices can literally mean life or death.
As far as we can tell, there is no reliable data on how common it is for prisoners with food allergies to die or otherwise suffer from unmet dietary needs. We do know that prisoners file a fair number of lawsuits pertaining to food allergies each year. Given the many legal obstacles confronted by those challenging the conditions of their confinement, these cases are likely just the tip of the iceberg. In an effort to shine more light on the issue, we sent public records requests to all fifty states (we received responses from 39), asking about the food allergy policies used in their prison systems.
Three observations become apparent after analyzing these policies. The first is that many are lacking – in some cases, substantially. The implication is that some prisoners likely suffer from food allergies that the facilities at which they are confined do not recognize. An official in Kansas responded to our inquiry by noting that they “do not have a procedure in place on this subject.” California – whose prison system houses more than 117,000 people (as many as 4,000 with food allergies, if the BOP’s estimate is accurate) – has a very vague policy that places limits on the therapeutic diets that physicians are able to order for prisoners. Neighboring Oregon only recognizes food allergies that are “life threatening.” This policy thus excludes prisoners who suffer from soy allergies, for example, a condition that the Mayo Clinic notes is “rarely ... life threatening” but could nonetheless cause substantial discomfort with symptoms that include tingling in the mouth, hives, swelling, abdominal pain, diarrhea, nausea or vomiting.
New Hampshire’s policy identifies only certain allergies as “acceptable” – specifically, the “main food allergies (i.e. onion, tomato, egg, and peanut).” Saffioti’s severe dairy allergy would not have been recognized under this policy, nor would someone suffering from a wheat or gluten allergy, among many others. Georgia draws a slightly different line between allergies that are acknowledged and those that are not. They “honor the following Food Allergies: Milk, Egg, Wheat, Gluten, Fish/Shellfish, Peanut/Nut, Chocolate, and Tomato.”
The second observation is that even among states that do acknowledge an array of allergies, prisoners face a substantial burden in becoming eligible for alternative diets. Many states require that an allergy be “verifiable and documented,” and that “written medical proof” be provided. This means either that prisoners must have had access to allergy tests before their confinement – which for the uninsured can cost hundreds of dollars – or that they be tested while behind bars. In the latter case, the trouble is that some states impose limits on who can be tested for food allergies.
For example, Arizona’s policy stipulates: “Inmates should only be allergy tested when there is sufficient evidence to do so.” This raises concern for those who suffer from allergies where physical symptoms are absent, such as celiac disease. As the National Digestive Diseases Information Clearinghouse points out, “People with celiac disease may have no symptoms but can still develop complications of the disease over time. Long-term complications include malnutrition – which can lead to anemia, osteoporosis, and miscarriage, among other problems – liver diseases, and cancers of the intestine.” In other words, a diet can be doing substantial harm to a prisoner’s body and some existing food allergy policies provide no means by which that harm can be avoided.
At least one state has a policy in place that actually deters prisoners from being tested for food allergies. Kentucky’s policy permits prisoners to take an allergy test, but stipulates that prisoners will be charged for tests that come up negative. One can assume that this is an attempt to root out false claims, but even if it succeeds in doing so, the policy may disaffect those who really do suffer from allergies. As Food Allergy Research and Education points out, allergy tests “do not always provide clear-cut answers” and patients “may have to take more than one test before receiving [a] diagnosis.” Even under the circumstances when all the hoops are jumped through and prisoners do manage to furnish acceptable “proof” of their allergy, a number of states require continual renewal of such proof, usually every 90 days.
A final observation is that the burden is often on the prisoner to make choices about their food. This is not to say that prisoners with food allergies should not be well aware of their condition and have a firm understanding of how to respond in the event of an allergic reaction, but rather to point out the lack of institutional support for food allergy issues. Choices about what to eat and what to avoid are especially difficult to make when prisoners are served food they did not prepare. Yet some institutions tell prisoners to fend for themselves, often without recognizing how difficult doing so can be.
Take Oregon’s policy, for example: “We encourage inmates to self-select from the line. For example, if an inmate has a peanut allergy and we are serving peanut butter & jelly sandwiches, they may select the meal alternative tray which consists of beans, rice, vegetables, fruits, and bread.” South Carolina’s policy similarly states little more than the obvious: “If an inmate notifies medical staff of a food allergy, the medical staff will instruct the inmate to avoid that allergy in his/her food choices.” Georgia’s policy is that once a prisoner receives a food tray, they are considered compliant. This policy also brings Saffioti’s case to mind, for technically after servers handed him the pancake and oatmeal breakfast tray, he would have been considered compliant and his desperate attempts to learn the contents of the food would have been irrelevant in a lawsuit.
In conclusion, our content analysis of prison food allergy policies provides cause for alarm. Granted, it is possible that prison staff go beyond what is listed on policy forms in helping prisoners meet their dietary needs. However, given the conditions of confinement that have characterized our nation’s overcrowded prisons in this era of mass imprisonment, we have little reason to be so optimistic. Consider that in the realm of health care, containment has taken precedent over healing, as was recently exposed in California’s sweeping Brown v. Plata class-action lawsuit.
Along similar lines, cost cutting rather than nutritional adequacy seems to be increasingly emphasized in the realm of prison food. A recent Prison Legal News article, for example, detailed the great lengths that Aramark – a company that contracts with more than 600 correctional facilities – goes through to cut costs. A class-action lawsuit filed by prisoners in Illinois protesting the high amounts of soy in their diet is another example of providing prison food “on the cheap” to the detriment of prisoners’ health. The likelihood that prisoners with food allergies have their needs met is thus diminished as they confront not just a set of inadequate policies, but also a system whose main concern is not their health and well-being.
Jamie Longazel is an Assistant Professor of Sociology at the University of Dayton, Ohio. He is co-author (with Benjamin Fleury-Steiner) of the book, The Pains of Mass Imprisonment (Routledge, 2013). Rachel Archer is a Criminal Justice Studies major at the University of Dayton who has research interests in the areas of food allergies, law and prison conditions. They provided this article exclusively for Prison Legal News.