The Atlanta Journal-Constitution
A bigger jail won’t cure health care woes
Overcrowding just one factor as an inadequate system fails to address needs of inmates.
As emergency and internal medicine physicians, we experience firsthand many shortcomings in the intersection of public health and public safety. Simultaneously tragic and not rare enough, signs of medical neglect often accompany the shackled humans brought from facilities proven incapable of keeping their occupants safe.
Because of its sudden national prominence, we often hear misconceptions about the Fulton County Jail (FCJ). As physicians with decades of lived experience in this nexus, we submit several common myths related to the ongoing carceral crises.
1. The Fulton County Jail is overcrowded due to rising crime
Fulton has close to 3,000 people in custody, with nearly 2,000 at the main Rice street jail. Others have been sent to jails in surrounding counties. The vast majority of these people are legally innocent and not yet convicted of a crime.
Since its inception in 1989, the FCJ has experienced overcrowding. Despite federal oversight for similar concerns from 2005-2015, the jail remains overcrowded and federal and state investigations are once again underway. There are many factors contributing to overcrowding, but they have less to do with abundant “criminals” and more to do with an overreliance on the legal system to address public safety.
While the pandemic brought instability, and with it a rise in some types of violent crime in Atlanta, with the most troubling of these being homicide, these rates are now falling, and overall crime rates remain at historic lows. Criminalization of poverty-related misdemeanors and underuse of available diversion programs manifest to us as armed officers accompanying homeless patients with severe mental illness arrested for trespassing seeking care for minor injuries.
Having our carceral system plagued by slow indictments using wealth-based detention also drives overcrowding and serves to create a powder keg contributing to the frequent violence and medical neglect seen in the facilities.
As physicians in the safety net, we find ourselves picking up the pieces of this carceral catastrophe. We bear witness not just to fatalities that make the news, but more common nonfatal injuries and poor medical care that don’t garner any coverage.
2. The criminal legal system provides comprehensive care
Some have claimed FCJ is the largest mental health facility in the state. Implicit in this is that individuals are being adequately treated. It is much more accurate to refer to FCJ as a warehouse for people with mental health disorders — a far cry from a “mental health facility.”
FCJ, or any jail for that matter, is unsurprisingly not an ideal therapeutic environment. Many procedural elements of how carceral facilities function further hamper access to timely or adequate care. Despite often well-meaning and competent health care providers, incarcerated individuals can be made to wait long periods of time to have their concerns addressed and rely on adequate staffing to get them to and from medical appointments. Medications available often differ between the jail and hospital or clinic setting, with some treatments rarely offered at all.
Despite a constitutional right to health care and decades of health care-related litigation toward carceral facilities across the United States, the reality remains far from the “rule of law” and health care provision far from the standard of care in community settings. The results of this can be seen in the 10 tragic preventable deaths in Fulton facilities in 2023 alone, including of 19-year-old Noni Battiste-Kosoko, who died at the Atlanta City Detention Center. This facility, leased by the county from the city, was meant to address overcrowding and its prisoner safety issues, but it has done neither.
3. To fix overcrowding, we should build a bigger jail
While conditions in the ever-overcrowded Rice Street facility have always been poor, it has become more obvious that this constitutes an ongoing human rights crisis. The search for effective solutions continues to elude our lawmakers, leading them to consider the oxymoronic myth of a “health focused” jail. People likely to experience incarceration in Fulton County are disproportionately low-income, Black and suffer a high burden of physical and psychiatric conditions.
When we see these patients, it is clear carceral facilities exacerbate instead of alleviate many of their needs. We are led to believe a new jail will somehow rehabilitate these individuals, when their needs were already systematically ignored through lack of investment in their communities prior to their incarceration. As health care providers, we recognize incarceration as a threat to both individual and community health. Our experiences are backed by robust public health evidence showing incarceration is destabilizing, traumatizing and ultimately decreases life expectancy significantly. That this is done in the name of “public safety” becomes even more dubious considering the decades of studies telling us incarceration does not decrease the chance of future criminal activity and may in fact increase it.
Perhaps, the solution lies in moving away from criminalization and toward an economy of care. The assumption that an ever-increasing number of people will require a Fulton-sponsored cage fails to align with the underlying drivers of poor health outcomes. Economic opportunity, housing and access to health care, time and again, demonstrate themselves as the factors that keep communities safe.
A newer, bigger or supplemental jail is unlikely to address the true needs of its occupants and moreover our community which pines for real solutions for public health and safety.