I am really really sick need to lay back down I hurt so cold.
These were Nikki Rust’s last known words, recorded in her journal on Wednesday, January 8th, 2014.
At 2:00 am on January 11th, Deanna Rust, Nikki’s mother, received a phone call from the McPherson’s Unit prison chaplain informing her that her daughter had died. In a half-waken stupor of dread, she remembers the chaplain telling her that her daughter had been hospitalized earlier that day, and—with the patronizing certainty of men in positions of authority—he reassured her that Nikki’s death was a result of natural causes.
***
Natural causes.
In relationship to death, the phrase conjures imagery of a peaceful passing on. A gray-haired human being, in the comfort of one’s own bed, crossing over at the end of a long and full life. At the very least “natural causes” implies a welcome inevitability that is supposed to provide comfort for the living. To say someone died of natural causes is to tell the living that it was, “just this person’s time.” However, in the codified language of government agencies, the phrase has a more specific and legally protective nature.
The Bureau of Justice Statistics collects data on deaths in custody nation-wide, and divides cause-of-deaths up into the following categories: natural, accident, homicide, suicide, and undetermined. Natural deaths are described as “Deaths attributed to natural agents such as illness or internal malfunctions of the body.” This clinical definition disguises any death not attributable to an act of violence, deliberate or not, to a failing of the human body. This medical practice is not unique to Department of justice, as the health care system of the United states is rooted in a sense that health and illness are the domain of Providence and individual responsibility. What this institutional definition fails to account for, and what Nikki’s family is attempting to bring to public attention, is the question: At what point could death by illness be considered a wrongful death as result of negligence, rather than simply a malfunctioning of the body?
Nikki died at 12:32 am January 11, 2014 at the White River Medical Center in Batesville, Arkansas. The cause of death—listed by the attending physician and medical examiner—was sepsis and staphylococcus pneumonia.
She had arrived at White River Medical Center several hours prior to her death, after being transferred from the Intensive Care Unit at Harris Hospital in Newport Arkansas. Her medical team at Harris Hospital determined that they were unequipped to adequately treat Nikki’s illness because the Harris Hospital lacked a pulmonologist. Despite this inability to receive the necessary treatment, Nikki had to spend hours waiting at Harris Hospital while her medical team attempted to get her moved to a facility capable of treating her illness. First, they tried to secure an emergency medical flight to transport Nikki to St. Vincent’s Hospital in Little Rock. Unable to secure a helicopter for transport to the larger and more well-equipped hospital, the medical team eventually decided to transport her by ambulance to a closer medical facility in Batesville, but it was too late for Nikki.
On January 10th at approximately noon, Nikki arrived at Harris Hospital after being medically discharged from the infirmary at McPherson. The medical staff at McPherson documented that Nikki was experiencing “difficulty breathing,” that she was extremely dehydrated, and that they were unable to administer necessary fluids via an IV. It was noted in Nikki’s medical records from the infirmary that she had reported that she had been experiencing vomiting and diarrhea for the previous two days before finally securing a visit to the Infirmary at approximately 11:40 am.
Nikki had spent less than a half hour with infirmary staff at McPherson’s Unit before they had determined that her health had deteriorated beyond their ability to administer treatment on site. Nikki had spent four days submitting sick call request forms, while watching her symptoms grow worse, before she was granted a follow-up appointment from her initial infirmary visit on January 6th, where she was recorded to have a slight fever and “flu-like” symptoms.
***
What about this scenario screams negligence? Certainly, Nikki’s death was tragic, and it is possible to sincerely feel for her mother, her sister and her surviving family, but four days isn’t that long to go before being able to secure a second medical appointment is it? Even with the passage of the Affordable Care Act, tens of millions of Americans (myself included) are uninsured and have limited-to-no access to a doctor. What makes the life of one criminal more valuable than my life? Why should I have paid for Nikki to have instant access to qualified medical care when am I unable to seek out medical treatment for myself, even under the most alarming of circumstances. She did get admitted to a hospital eventually, right? And she even got transferred to one with the correct facilities to treat her condition. How can you be so sure that she would have received more adequate care if she had been outside of prison on her own? Not-to-mention, it’s a contentious claim to say that a woman convicted of first-degree battery for causing a major vehicular collision while driving under the influence deserves the same quality of care as the people her actions injured in the first place. What about this case warrants any more public attention than any number of more pressing public health, safety or security issues?
***
The official record of Nikki’s death leaves a clinically vague picture of an illness-related death that makes it easy to dismiss the concerns of her family with the same sentiment that we generally attribute to the phrase “natural causes.” Individually, we direct our sympathies to the family for their loss. Socially, we issue a kind obituary and then return to business as usual.
However, illness, like criminal action, does not occur in the isolation of individual bodies—it occurs within a social and public health context, that must be understood before its causes, effects and consequences can be fully addressed.
In a free-market democracy, where we treat health generally as an individual issue instead of a public one, it can be confusing to understand the public’s responsibility for the health of inmates held within the Department of Corrections. After all, correctional facilities exist to limit and control the freedoms of the individuals under their influence. With nearly half of Americans living paycheck-to-paycheck and lacking the reserved funds to pay the deductible for an emergency room visit of their own1, the cost of medical care in prisons is an understandably contentious issue.
In the 2014 fiscal year, the State of Arkansas had to pay $323.44 dollars a month for every incarcerated individual it held in custody.2 On average, over this same period, Arkansans were spending $284.74 a month on their own health care, if they could afford it.3 Why is it necessary to pay for the health care of those responsible for violating the laws of our state?
Philosophically, these are the reasons why:
- Incarcerated individuals are, by codified law, wards of the state. Inmates are locked up in close proximity to other individuals, and none of them get to control their exposure to contagious diseases.
- The Constitution, under the 8th Amendment, guarantees U.S. citizens freedom from cruel and unusual punishment, and the Supreme Court has upheld that deliberate indifference by prison personnel to a prisoner’s serious illness or injury constitutes cruel and unusual punishment.4
Historically, the debate over the necessity of providing health care to violators of the law extends back to the origins of the prison reform movement of the late 18th century. The desire to keep the conditions of incarceration harsh enough to deter recidivism has been countered by the risk to public health that can develop from letting illness spread through incarcerated populations.5 Without a certain level of care, entire communities surrounding prisons are placed at risk for contagious break out.
It is worth considering why the Center of Disease Control approaches issues of health as threats to public health, while our healthcare and insurance systems continue to treat health and wellness as an individual concern, but that discussion is beyond the scope of the Department of Corrections. As far as Nikki and Nikki’s family must be concerned, access to medical care is a constitutionally protected right for all those incarcerated. But what does “adequate medical health” care look like?
On January 1st, 2014, Nikki’s bunkmate Jan Maier, along with several other inmates in Nikki’s barracks became ill with flu-like symptoms. By the time of Nikki’s first visit to the infirmary with symptoms of her own on January 6th, she described her bunkmate’s condition as “deathly ill.” Nikki and Jan’s other barracks-mates began begging guards for Jan to receive medical attention, and even submitting sick-call request forms on her behalf. However, she did not receive additional medical attention until the early hours of January 7th, when her health deteriorated to the point that she stopped breathing in her bunk. Correctional officers and infirmary employees attempted to resuscitate Jan, but they were instructed to stop by the warden and by 3:15 Jan Maier was dead.
Jan’s death is listed as a result of natural causes. According to Nikki’s Journal entry from Tuesday the 7th,
Today has been hard Lord. My Bunkie/friend Jan died. She has joined you. Last night we tried to get them to take her back to medical, for she was so pale, feverish, weak, not breathing good. Well finally at approximately 2 a.m. they took her. At 3 a.m., they were packing her things. Lord, I am so sick and am sad.
By January 9th, Nikki’s own illness had progressed to the point that she was too sick to attend her computer accounting class, hosted in McPherson’s Unit, through Riverside Vocational Technical School. Unlike students outside of carceral facilities, students within prisons tend to avoid missing learning opportunities out of fear that they will lose them. Nikki’s absence on this date, therefore, is a strong indicator that she was too ill to get out of bed, and not a student playing hooky.
Because of the death of her bunkmate and the severity of her illness, Nikki—and several of her barracks-mates—spent the day requesting and eventually begging the guards to process Nikki’s sick-call request immediately. Even so, it was another 24 hours before she was brought into the infirmary, and then immediately sent on to the local hospital. It is difficult to say, for certain, that Nikki would be alive today if she had received immediate medical attention, or at what point on the 9th of January her condition went from treatable to terminal. However, it is even more difficult to suggest that those lengthy delays did not significantly decrease her chances of ever seeing her family again.
But Nikki’s family didn’t even know she was sick.
This is the injustice upon which her sister Bonnie is resting her legal case against the Department of Corrections upon. Despite her mother being listed as Nikki’s institutional emergency contact on her inmate information form, and despite the fact she had spent nearly half a week suffering from an illness that had contributed to the death of her bunk-mate, the first anyone in the family heard of her illness was at 2 am on the 11th, after Nikki had already passed away.
The warden claims that Nikki’s medical situation was never classified as an emergency, and thus no call was made while she was still housed in McPherson’s Unit. However, Nikki spent over 12 hours receiving critical care at two separate hospitals, and yet still her family never received notice that their daughter/sister/mother was fighting a life-threatening illness.
Regardless of whether, it was nature or negligence that resulted in Nikki’s death, it is difficult not to see callousness in the institutional response that her family, her mother, her sister, her two children, have suffered.
In a world where information is so often just a click of a button away, it is easy to see why, for so many incarcerated people, that world of human and familial contact feels like one far, far away.
- “The [Federal Reserve Board] asked respondents how they would pay for a $400 emergency. The answer: 47 percent of respondents said that either they would cover the expense by borrowing or selling something, or they would not be able to come up with the $400 at all.” Gabler, Neal. “The Secret Shame of Middle-Class Americans,” The Atlantic, May 2016.
- Hobbs, Ray, “Department of Corrections Annual Report”, Arkansas Department of Corrections, 2015.
- Arkansas Heath Connection. “2014 Arkansas Health Plans,” http://insurance.arkansas.gov/QHP-Rate-Overview2014.pdf. Accessed 11 Mar. 2017.
- Estelle v. Gamble, 429 U.S. 97, 103 (1976).
- McGowen, Randall, “The Well-Ordered Prison.” Eds. Morris Norval and David J. Rothman, The Oxford History of the Prison. Oxford University Press, 1998. pp. 97.