Your incarcerated loved one is hospitalized for COVID-19. You might not be notified until it’s too late. - North Carolina Health News
By Hannah Critchfield
Rob Thomas Jr. was looking for his namesake.
The 30-year-old had not heard from his father, Rob Thomas Sr., a prisoner at Neuse Correctional Institution, in four days.
His father told him he’d been feeling sick. He was housed at the prison with the largest COVID-19 outbreak in the state, which was widely reported in the media. Now calls had dried up, and Thomas Jr. was having no luck getting in touch.
Guards assured the son that his father was fine but would answer no questions about his condition or location and declined requests to connect the two.
By the time they gave him information, his father had been in the hospital for almost a week with COVID-19 and could no longer speak.
The North Carolina Department of Public Safety, which oversees state prisons, has been reluctant to disclose the number of prisoners in its custody who have been hospitalized due to COVID-19.
On April 29, Robert Thomas Sr. was one of them.
His story highlights that sometimes, prison officials withhold this information even from a person’s emergency contact.
His family searched for answers in vain for almost a week before prison officials let them know where he was. Meanwhile, he was slowly succumbing to the virus. He was placed on a ventilator and sedated.
Loved ones often face barriers to information about an incarcerated person’s health conditions, as they reach across prison walls, security concerns and bureaucracy to seek information. COVID-19 has exposed this problem in high relief.
The virus has taken many prisoners, and taken them quickly — meaning families might not get a chance to contact incarcerated loved ones until it’s too late.
Rob Thomas Sr. had been in prison eight years when COVID-19 struck his facility in April. The 59-year-old was understandably nervous — he had diabetes, hypertension and cardiomyopathy, conditions which placed him at an increased risk for severe illness from the virus.
With two years left in his sentence, he’d hoped to be one of the prisoners who was granted early release. Nonetheless, he was denied — a felony charge for robbery disqualified him from the compassionate release program.
The virus spread throughout Neuse Correctional Institution, infecting 60 percent of inmates and killing two by late April. Daily phone conversations with his son, and with former wife Tiffany Thomas, who remained a close friend, sustained Thomas Sr. during this time.
But suddenly, he was tired. Tired in his bones. The allotted 15-minute calls became too much.
“Throughout his whole eight years that he’s been incarcerated, you know, he’s never not finished the phone call,” recalled Thomas Jr., a longtime activist and the community liaison for the Racial Justice Coalition in Asheville. “So that’s how I knew he really wasn’t doing well.”
Thomas Sr. lost his appetite. He lost weight — in all, the coronavirus would strip him of about 20 pounds — and his sense of smell.
“Each time I spoke with him after that, he was getting worse,” said Thomas Jr.
The prison did mass testing of all inmates on April 15. A week later, Thomas Sr. called his son. He said he still hadn’t gotten results back from correctional officials but was feeling very sick and very scared.
Then, on April 29, he vanished.
Notification at the discretion
When an incarcerated person has an emergency hospitalization, state prison officials across the country may or may not notify the inmate’s emergency contact.
States have a constitutional mandate to provide health care for people in their custody — including individuals in prison. Though prisons provide some medical services in house, they typically rely on hospitals for more intensive care or procedures.
“In general, family members are not informed that an offender has been transferred to an outside hospital for medical care because notification of an offender’s presence at an unsecured location presents unacceptable security risks,” said John Bull, spokesperson for N.C. DPS.
The choice to notify an emergency contact is often at the discretion of prison officials. In North Carolina, a contact is notified only when a hospitalized person is classified as “seriously ill or critically ill” or dead, according to the DPS Health Services and Policy Procedure Manual.
Of the 25 states who responded to a public information request by North Carolina Health News, 18 of them — over 70 percent — said they operate under a similar “by discretion” policy in the face of a “serious or life-threatening illness.”
For diseases such as COVID-19, this can have a devastating impact on family members, who may not get the chance to say goodbye before their loved one dies.
“If it was left up to the prison system, I just would have been contacted when they put them on a ventilator,” Thomas Jr. said. “And he couldn’t talk. That would have been it.”
Few states have adjusted their prisons’ emergency notification policy during these extraordinary times — the exception being Illinois, whose Department of Corrections is currently operating on an ad hoc principle to notify contacts each time a person is hospitalized for COVID-19.
A stranger’s call
Neuse prison officials didn’t call Thomas Jr. when his father was sent to Wayne Memorial Hospital for severe COVID-19 symptoms.
“It was a family member of another inmate, my father’s bunkmate,” recalled Thomas Jr. “They said their incarcerated loved one had called and asked them to notify me that my father had been taken to the hospital.”
Thomas Jr. immediately contacted the prison, he said.
“They just told me that my father was ‘fine,’ and that they would ‘contact me if necessary,’” he alleged. “They wouldn’t even tell me that he was at the hospital.”
He explained the call he’d gotten, insisting he was certain his father was at the hospital and asked to speak to a supervisor. His call was transferred to several prison guards – with each, he said he met the same conversation.
“They would only say, ‘He’s fine, we’ll contact you if necessary,’” said Thomas Jr. “I guess that’s the line they were scripted to say.“
Neither Tiffany Thomas, Robert Thomas Jr., or Robert Thomas Sr. himself were clear who was designated as Thomas Sr.’s emergency contact at Neuse Correctional Institution. After his initial experience with the guards, Thomas Jr. figured it must be his mother. By the same token, Tiffany Thomas thought it must be Thomas Jr. — but only because when she called, she got the same answer.
“Pretty much everything I learned was through my son,” she said.
Thomas Jr. was eventually able to find out about his father’s condition despite prison officials’ obfuscation, through a network of connections.
A local pastor Amy Cantrell, co-director of BeLoved Asheville, a nonprofit that seeks to end homelessness and a Racial Justice Coalition member organization, said she’d come to know and love Thomas Jr.’s family, including his father, over the years.
“So of course I wanted to help,” said Cantrell. “I often can wield that authority and push more than other people. Similar to lawyers, we can go into prisons in ways that other people cannot.
“So I’m very used to, as a faith leader, getting more access to information.”
Cantrell said that societal authority can translate to access to people confined in the criminal justice system.
“It became really clear that I could try to use my status as a faith leader to try to get information,” she said.
Cantrell said she’d originally tried calling the prison first.
“The more questions I asked, I just kept getting, ‘He’s fine, he’s fine, he’s fine,’” she said.
“Well, he was not fine.”
Cantrell knew Wayne Memorial was the closest hospital to the prison. She decided to contact them directly.
A nurse in the emergency room confirmed Thomas Sr. was there and had COVID-19 and pneumonia. At the time, he was conscious.
Even after that, it was not easy to connect, Thomas Jr. and Cantrell said.
The next day, Thomas Jr. had a friend, who was a health professional at a hospital in Georgia, initiate a three-way call to him and Wayne Memorial. The friend was able to connect to Thomas Sr.’s room, Room 721, and father and son were able to talk briefly.
Every other time Thomas Jr. attempted to call his father at the hospital, he was denied — a correctional officer guarding the room would be given the phone and would tell him that “no one by that name” was in the room.
Cantrell, on the other hand, said each time she called the hospital someone was able to confirm that Thomas Sr. hadn’t died or been transferred out of the hospital and was still in the same room.
“It was like pulling teeth every time,” said Cantrell. “I know Rob was thinking the absolute worst because you hear all these horror stories.”
Four days later, on May 4, the prison contacted Thomas Jr. about his father for the first time.
The 59-year-old had been placed in the hospital and was on a ventilator, sedated and non-communicative.
When is an illness ‘serious?’
Pinpointing how prison officials define a condition as “serious” enough to inform family members is difficult.
Arlene Davis is a faculty member at the Center for Bioethics in the UNC School of Medicine and co-chair of the UNC Hospitals Ethics Committee. She said it may be when a hospitalized prisoner’s health worsens to the point where they are no longer conscious, and the hospital needs a designated person to make medical decisions on their behalf.
“Much of it, in my experience, rests with the patient’s ability to offer consent,” she said. “One they’re no longer able to make decisions for themselves — that’s the ‘critical illness.’”
In those instances, the medical team will contact the prison system and let them know they need to speak to a “surrogate decision-maker,” according to Davis, and prison staff will notify the emergency contact for the first time.
Unlike with other critically ill patients where hospital staff would contact the family directly.“it must go through the safety procedures of the prison system,” said Davis.
Lauren Brinkley-Rubinstein, a researcher and faculty member at the Center for Health Equity Research at the UNC School of Medicine, said the policy raises ethical issues in the time of COVID-19.
“The fact that prisoners, in general, don’t have the right to have a family member contacted if they are admitted into the hospital is alone an ethical issue,” said Brinkley-Rubinstein. “But there’s certainly justification to say that being admitted to the hospital for COVID-19 reasons is serious enough to have this event be defined as ‘life-threatening,’ based on what we know about the risk for folks who are incarcerated.
“We know COVID-19 is very serious and overrepresented in these settings,” she added. “We certainly don’t know enough about COVID-19 yet to be able to say that it’s not life-threatening.”
A ‘security issue’?
It can be equally murky to pinpoint how prisons balance public safety concerns with providing ethical care, particularly as they relate to illnesses like COVID-19 that could easily evolve to be “life-threatening.”
“Prisoners don’t get to learn about when they’re going to a procedure at a hospital or when they’re being discharged, nor do families, because those all are thought to provoke safety and security concerns, as is the shackling of patients within the room and the presence of a correctional officer,” said Davis, who also serves as the director of clinical ethics services for UNC Hospitals. “But I think from the medical side it’s sometimes hard to see what concerns are prompting that level of security.”
There is no national system for tracking escapes by prisoners in health care settings, according to a 2016 report from the International Association for Healthcare Security and Safety Foundation. But anecdotal instances of escape attempts from hospitals each year raise fear that family communication will be used to assist with a loved one’s escape. This leads many state correctional agencies to adopt policies such as requiring an officer guarding an inmate patient to be the only one allowed to answer hospital room phone calls. A similar study from the organization identified 99 attempted escapes from hospitals across the country in 2010, though most were prompted by improper removal of a prisoner’s restraints by correctional or hospital staff rather than the assistance of an outside family member or friend.
“I really can’t speak to the number of times visitors caused escapes,” said Thomas Smith, president of Healthcare Security Consultants in Chapel Hill, former director of hospital police and transportation at UNC Hospitals and co-author of the report. However, he noted that visitors still present a serious risk. “You read about it in some of the most outrageous cases, but I couldn’t say it’s a high volume – or that that’s a data point that jumped out from our look at it.”
In the COVID-19 era, ‘visits’ for all patients – incarcerated or not – have often been reduced to phone calls.
Smith said phone calls are more at the discretion of the correctional agency than visitations, which tend to have a clearly defined protocol established by correctional and hospital leadership.
“Security’s a real issue with prisoners,” Smith said. “Reducing communication helps minimize the risk. But the question that comes into play when somebody is really critically ill, is when is that call [to emergency contacts] made, and what’s reasonable? And I guess that’s going to be based on the circumstances of the time.
“And with COVID, my goodness, prisons are overwhelmed. I’m sure in some cases, they just don’t have the staff to be communicating as well as we’d like,” said Smith.
He noted that he had to communicate virtually with his own mother-in-law, who died of COVID-19 nine days after she was admitted to the hospital this spring. “From personal experience, it’s a hideous situation. It’s very difficult for a normal family member, let alone someone who’s a prisoner.”
Brinkley-Rubenstein of UNC said she believes there’s room for flexibility in adapting policies to create more humane patient experiences for prisoners and their families.
“If we don’t think the security measures in place mitigate the risk [of escape], then instead of making the blanket decision to not let people talk to their family members in times of serious illness, perhaps we could make the security measures more robust,” said Brinkley-Rubenstein.
“We don’t have to go all the way to no visitors, no notification, period,” she added. “We could instead say, ‘Okay, how can we honor the humanity of this person? We have security concerns, let’s devote resources to assuaging those concerns, instead of not treating someone with dignity.’”
“I’m grateful to be alive”
Thomas Sr. was in a coma for three weeks battling COVID-19.
“It was really scary,” said his former wife Tiffany Thomas, who hadn’t had the chance to speak with Thomas Sr. before he was sedated. “He was really knocking at death’s door; he wasn’t supposed to make it.”
Once he was on a ventilator, his family said they were finally able to call the hospital with a patient ID number to check on his condition.
But when he recovered enough to be transferred, the family was not informed by either the prison or the hospital. He was, simply, missing again.
“I didn’t even get the chance to tell them I was leaving,” said Thomas Sr. in a call with North Carolina Health News.
During this time, Thomas Sr. had woken up, after what he said felt like a long, dreamless nap.
He was horrified to find that he had a “Do Not Resuscitate” band on his wrist – something he alleged he was neither asked about nor consented to.
“I asked the doctor after I woke up, and he said, ‘What, you want us to break bones?’” Thomas Sr. recalled. “I said, ‘I don’t care what you break. Try to bring me back.’ I didn’t sign no papers saying it was okay for them to do that either.”
DPS has said it does not make “Do Not Resuscitate” decisions.
“The offender may make that decision in consultation with prison staff prior to hospitalization or, if at the hospital, in consultation with medical staff at the hospital,” said Bull, spokesperson for DPS. A Wayne Memorial Hospital representative said they cannot comment on an individual patient’s case, citing the federal HIPAA patient privacy law.
Thomas Sr. was returned to Central Prison, a Raleigh facility with a large on-site hospital unit, to quarantine. He spent three weeks inside a single cell, which he called “the hole,” a colloquial phrase for solitary confinement.
“I was in isolation. And I hated that,” said Thomas Sr., who said guards slid food through a hole in his door three times a day and he remained hooked up to a monitor during this time. “But I’m grateful to be alive. That COVID is somethin’ fierce.”
Thomas Sr. was able to call his family again, as well as NC Health News, after he was released from isolation and returned to Neuse Correctional Institution.
He said he’d requested the prison notify his family when he was hospitalized, but they declined.
“They weren’t gonna tell nobody,” said Thomas Sr. “If I hadn’t had my bunkmate call Rob, they [his family] never would have known I left the can.”
He recalled thinking he was going to die in the days before he was placed under sedation in the hospital.
“It wasn’t looking good,” Thomas Sr. said. “But God blessed has brought me on through. I’m just lucky to be alive.”
“Rob’s story, unfortunately, is not an outlier,” said Dawn Blagrove, attorney and executive director of Emancipate NC, an organization that works against mass incarceration in the state. “I hear from lots and lots of families who have almost identical experiences.
She mentioned one woman whose son, another prisoner at Neuse who suffers from asthma, was hospitalized for unknown reasons. His friend and a fellow inmate had called the mother to tell her, and she reached out to Blagrove after prison officials refused to confirm if the hospitalization was COVID-19-related. Neither was able to receive an answer (they only learned he did not have the virus after he returned to the prison and called her directly).
Another woman, Christina Grady, whose husband William Lane is incarcerated at Neuse, said it’s been difficult to get information about COVID-19 illnesses in general, even prior to a hospitalization. She said a prison staffer told her that Lane was “fine” — using similar language to what Thomas Jr. alleged he received — minutes after her husband called to say he’d received a positive COVID-19 test result.
“My husband is a hospital nurse,” said Blagrove. “And I know that this has always been the protocol even before COVID, to not let families know. But I think that there is a certain level of cruelty to keeping that information from family members during the pandemic.
“Because they could die, and no one knows where they are,” she added. “Even if you can’t disclose to family members what hospital their family member was taken to, why wouldn’t you be able to tell them if they’re sick with COVID? Or if they’re not, so families can stop worrying.”