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Inadequate Health Services for Native American Prisoners

by Edward B. Lyon, Jr.

Members of various Native Americans tribes live in reservations across the United States, where they police themselves and maintain tribal jails for detention. Federal funds are used to operate those facilities and a multitude of agencies – including the Bureau of Indian Affairs (BIA), Interior Department, and Department of Health and Human Services’ Indian Health Service (IHS) – contribute to daily operations and medical care for approximately 80 jails scattered between Alaska and Mississippi.

The facilities house around 2,500 prisoners, and the BIA exercises oversight for all the jails and manages about 20 of them. [See: PLN, Aug. 2015, p.15].

Inadequate medical staffing at tribal jails results in guards having to dispense medications, a job they are not qualified to perform, which has resulted in prisoners sometimes not receiving correct medications. Further, one prisoner in a Washington tribal jail pounded on his cell door for hours, begging for pain medication for his broken leg, but never received any. At another facility, according to a March 31, 2018 Los Angeles Times article, a diabetic prisoner was not provided with insulin.

“It’s not really safe for really anybody,” said Lynette Bonar, chief executive of the Tuba City Regional Health Care Corporation, a hospital on the Navajo Nation reservation.

The IHS and local tribal health clinics are the primary medical providers at tribal jails.

Funding is such a severe problem that in 2017, U.S. Senator John McCain asked all the federal agencies involved in tribal jail operations how many people were needed to provide adequate health care and what the standards were in those facilities. The BIA complied with less than half the Freedom of Information Act requests it received regarding medical care in tribal jails.

Staffing at the facilities is so sparse that whenever guards have to escort prisoners to clinics or hospitals for emergency care, the jails are at risk in case of violent or other serious incidents due to understaffing.

The San Carlos Apache Reservation’s tribal jail in Arizona has a room designated for detainees arrested for public intoxication. The room is called a holding area. Deputy Fernando Castro would not call it a “detox unit,” saying that incorrectly suggests there’s medical staff to monitor prisoners while they sober up. He added, “Whether it’s medical or mental [health], we just don’t have care on site.”

In June 2017, the National Congress of American Indians (NCAI) adopted a resolution calling for increased funding for correctional health care in tribal and BIA-operated jails. The resolution noted that the BIA and IHS have “no correctional health care budget,” and that “the absence of medical staff in tribal jails compromises the health and safety of inmates and detention personnel because inmates often are not given a medical evaluation when they are taken into custody, which in one instance, resulted in a serious tuberculosis outbreak in a newly constructed tribal jail that effected [sic] over 40 inmates and staff.”

The NCAI called on the BIA to partner with the U.S. Public Health Service to assign medical staff to tribal jails, for the BIA to “include a correctional healthcare line item in its annual budget” and for Congress to “amend Medicaid to allow reimbursement for outpatient services that are provided to individuals who are incarcerated in Indian Country detention facilities,” among other provisions to improve health care at tribal jails. 



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