Deaths in state and federal prisons across America rose nearly 50 percent during the first year of the pandemic, and in six states they more than doubled, according to the first comprehensive data on prison fatalities in the era of Covid-19.
The tremendous jump in deaths in 2020 was more than twice the increase in the United States overall, and even exceeded estimates of the percentage increase at nursing homes, among the hardest-hit sectors nationwide. In many states, the data showed, high rates continued in 2021.
While there was ample evidence that prisons were Covid hot spots, an examination of the data by The New York Times underscored how quickly the virus rampaged through crowded facilities, and how an aging inmate population, a correctional staffing shortage and ill-equipped medical personnel combined to make prisoners especially vulnerable during the worst public health crisis in a century.
“There are so many who passed away due to not getting the medical care they needed,” said Teresa Bebeau, whose imprisoned friend died from complications of Covid and cancer in South Carolina. “Most of these people, they didn’t go in there with death sentences, but they’re dying.”
Covid infections drove the death totals, but inmates also succumbed to other illnesses, suicide and violence, according to the data, which was collected by law school researchers at the University of California, Los Angeles, and provides a more detailed, accurate look at deaths in prison systems during the pandemic than earlier efforts.
Altogether, at least 6,182 people died in American prisons in 2020, compared with 4,240 the previous year, even as the country’s prison population declined to about 1.3 million from more than 1.4 million.
Several of the states with the highest mortality rates in 2020 had a history of elevated prison deaths, including Alabama, Arkansas, South Carolina and West Virginia. Researchers said the high numbers — 96 deaths per 10,000 prisoners in West Virginia, more than in any other state — stemmed from long sentences, harsh conditions and relatively poor public health overall.
“Clearly the pandemic is the story, but it is just a part of the story,” said Aaron Littman, an assistant professor and the acting director of the U.C.L.A. Law Behind Bars Data Project.
Chrysti Shain, a spokeswoman for the South Carolina Corrections Department, said a lack of testing early in the pandemic had contributed to increased infections. “South Carolina has made significant changes in both its medical and mental health care systems over the past decade” to improve care in prisons, she said. Prison officials in the three other states did not respond to requests for comment.
Even some states with typically lower death rates saw a surge. Michigan and Nevada both had about 70 fatalities per 10,000 inmates in 2020, up from about 30 the previous year.
In New York, an early epicenter of the pandemic, the rate rose to 32 deaths per 10,000 inmates in 2020, from 25 the year before, while New Jersey recorded 51 deaths per 10,000, up from 21. Texas, which has the largest prison population in the country, had 48 deaths per 10,000, up from 28, and California, with the second-highest number of inmates, had 43 per 10,000 in 2020, up from 32.
A handful of states, including Vermont and Wyoming, saw death rates fall, their small prison populations largely spared when the first waves of the virus struck.
“If you have a lower population, then it’s less likely that people are going to be hurt or suffer from major life-threatening issues,” said Nicholas Deml, commissioner of the Vermont Department of Corrections.
Deaths in the federal prison system rose, but the rate was lower than those in most states.
For years, the Justice Department collected and analyzed data about federal and state prison deaths to help track health and safety problems. But that stopped in 2019 on the eve of the pandemic because of bureaucratic changes within the department. Since then, it has published only imprecise counts of fatalities, which often do not match the complete data.
A bipartisan Senate investigation in September found that the department was “failing to effectively implement” a 2013 law that required data collection. The Government Accountability Office also looked into the matter, and found that the department’s figures for 2021 had missed at least 340 deaths reported publicly by states.
After that investigation, Maureen Henneberg, deputy assistant attorney general for the Office of Justice Programs, told the Senate that the department had trouble gathering information because there was “significant underreporting of deaths in custody” in many states, and that the department “would like to work with Congress to improve the collection of this data.” The Justice Department did not respond to requests for further comment.
The U.C.L.A. Law project is among various efforts trying to fill that void. Researchers used public records requests and other means to collect data — which included the tally of deaths, and in many cases, information like the cause of death and the age of the inmate — from 49 states and the federal government. Data from 2021 is only partially complete, but reports from 28 states that together house about half the country’s prisoners showed death rates above prepandemic levels.
“It is essential that we as the public know what happens in institutions that incarcerate people in our name,” Mr. Littman said. “But unfortunately that has never been the case to the appropriate extent, and it has become worse over time.”
Aging Behind Bars
Nationally, the prison population is graying — in part because of inmates who were incarcerated under tough sentencing laws in the 1980s and 1990s.
In 2009, about 10 percent of all prisoners were 50 or older; by 2019, that number had jumped to 21 percent, according to the Justice Department. By the time they reach their 50s, prisoners are considered elderly, their expected life spans shortened by their years behind bars and, in many cases, drug use and poverty.
The aging, and often ailing, prison population was especially at risk when the pandemic hit, the data review showed, not only because the virus raged unchecked but because medical care for other illnesses could be slow or inadequate. Of the 46 inmates who died in West Virginia in 2020, 42 were older than 50; six were in their 80s.
“We have high rates of depression and suicide, high rates of obesity,” said Lydia Milnes, a lawyer with Mountain State Justice, a nonprofit in West Virginia. She said the opioid epidemic had plagued many prisoners, whose health continued to decline even after they were denied access to the drugs.
Some states have attempted to deal with an aging prison population through compassionate release programs, and others let out inmates early in 2020 because of Covid concerns. Vermont, for example, cut its number of inmates by 28 percent between 2009 and 2019. But such efforts can be a hard sell because many of the oldest and longest-serving inmates have been convicted of violent crimes like murder and sexual assault.
In Michigan, where lawmakers have held firm on laws imposing lengthy sentences, nearly 90 percent of the 248 who died in 2020 were 50 or older.
“They have people down there who have Huntington’s, who are mentally ill, bedridden, but they’re still here,” said Yusef Qualls, who was convicted at age 17 as the driver in a murder case and has been incarcerated in Michigan for 27 years. “They’re still holding them, you know? It’s kind of hard to see.”
Chris Gautz, a spokesman for the Michigan Corrections Department, said the state’s prisons had pushed to test inmates for Covid and get them early access to vaccines.
“Michigan has the oldest prisoner population in the country, but that is not because we as a department choose to keep prisoners longer,” he said, adding that the state legislature had increased the minimum amount of time people must serve and that courts had sentenced people to longer terms.
Amid a debate in 2021 about reducing sentences for good behavior, Dana Nessel, Michigan’s attorney general, a Democrat, argued in an opinion piece in the Detroit News that changing the law would undermine efforts to “provide victims and the community a sense of security and stability.”
A Health Care Crisis
Current and former inmates interviewed by The Times, as well as advocacy groups, said poor health care was a major factor in prison deaths. They described systems in which prisoners were charged for seeing a doctor, though many of them found it hard to afford. And when inmates received an appointment, they said, medical staff viewed them with suspicion.
“Doctors or providers will think a patient is malingering or somehow exaggerating their symptoms,” said Andrea Armstrong, a law professor at Loyola University in New Orleans who has been documenting and researching deaths in Louisiana prisons.
Correctional facilities have a hard time attracting nurses and doctors — a problem exacerbated during the pandemic, when it was also difficult to transport people to appointments outside the prison, and when fears of contracting Covid led to absenteeism among prison staff.
Some patients who died in 2020 had seen their health decline for years.
At Huttonsville Correctional Center in West Virginia, Robbie Campbell had been complaining of severe constipation and rectal bleeding since the beginning of 2016, according to medical records contained in a lawsuit. Mr. Campbell, a former coal miner who pleaded guilty to murder in 2010, had submitted multiple requests for medical care, but he was taken to the hospital only in June 2017 after he passed out from a loss of blood. He was diagnosed with colon cancer and died in 2020.
Mark Trammell, who was incarcerated in Lieber Correctional Institute in South Carolina, caught Covid-19 while being treated for liver cancer, after going years before receiving treatment for hepatitis C that he had contracted in prison, according to state records and his family and friends. He died in June 2020 after serving more than 40 years for voluntary manslaughter.
Not Enough Workers
For years, prisons throughout the country were seen as a boon in rural areas, where they were major employers. But towns that once served as recruiting grounds for correctional officers have been gutted by population declines, and prison jobs — with their low wages and potential dangers — have become less of a draw.
In South Carolina, the prison system has long contended with understaffing — as much as 50 percent below the required levels, according to a 2018 report by the state Corrections Department.
“That’s the root cause of pretty much every prison problem,” said Hayden Smith, a criminal justice professor at the University of South Carolina. The state has had recurringly high mortality rates in its prisons, including in 2020.
Ms. Shain, the corrections spokeswoman, agreed that the state, like many others, had staffing struggles. She said its prisons had provided “historic raises for security staff” in 2022 and more in 2023 and had since seen improvements in staffing.
Some states, like Florida and West Virginia, have called in the National Guard to augment understaffed facilities.
The lack of personnel means that violence can go unchecked, and that inmates at risk of suicide can be left without adequate supervision.
Even before the pandemic, prisons were increasingly relying on lockdowns and solitary confinement to control their populations, tactics that in turn restricted physical and mental health care.
“You have people just locked up alone for months,” Mr. Smith said. “If they didn’t have a mental health condition to start with, they certainly do by the end of that.”
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