One word simplifies the reality of the prison system—broken. The reasons are many, but one view, which focuses on democratic governance, identifies the fundamental problem as a reflection of the greater societal structure. Society does not pressure those who are accountable for administering the criminal justice system to improve the prison system. After all, is it not true that the effects of the broken system are far removed from the average person who votes? The people who are most directly and most adversely affected by the broken system are considered society’s “lowest rung.” The seemingly tenuous connection between the broken prison system and the well-being of the average person gives little reason for the average person to care—at least from the “rational self-interest” point of view.

Appealing to rational self-interest is not the only way to convince average people to care about society’s lowest rung, but it may be the most effective. Highlighting the connection between the effects of the broken prison system and the lives of average citizens would motivate people to consider these issues more important, and hold leaders accountable for failing to improve the dismal condition of the prison system. This does not mean that more people should be subject to incarceration. In fact, high incarceration rates are counterproductive. The United States, for example, has the highest incarceration rate by far, yet its prison system can hardly be considered a model. Rather, the detriments of the broken system, and benefits of improvement, must be connected to the needs and interests of the average citizen. This can be done on many levels.

This article will draw a connection between prison conditions and fundamental human needs. More specifically, the focus will be on a particular case where the prison health care system caused a person enormous pain and strife. Every person has fundamental health care needs. In the prison context, where the prisoner is forced to be confined with no means of seeking medical care, an obligation arises to treat that prisoner when they have a medical need. In the United States, a law known as EMTALA requires a hospital to treat a person in need of emergency medical care regardless of ability to pay. As to non-emergency care, the United States has a program known as Medicaid, which provides health insurance for the poor and other categories of people in need. Similarly, the United States Supreme Court has ruled that the Eighth Amendment to the United States Constitution, which proscribes cruel and unusual punishment, requires that the prisoners be provided necessary medical care.

EMTALA, Medicaid, and the Eighth Amendment amount to a safety net where fundamental medical needs of people who are unable to afford or procure their own health care are able to get it. This is far from ideal. The system should be structured in a way so as to allow individuals to seek out and procure health care on their own terms. However, the astronomical cost of health care in the United States make self-reliance a pipe dream for the needy and working poor. Even so, a meaningful distinction must be made between prisoners and all others. By nature of being a prisoner whose freedom has been taken away, they are least able to seek out their own medical care. In most cases, prisoners have no choice but to rely on the prison medical system to get the care that the United States Constitution guarantees for them.

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In May 2007, Russell Percy Dunham was driving over 125 kilometers per hour on a residential street when he ran a stop sign and crashed into another vehicle. The accident tragically killed the driver of the other vehicle, Pennie Sue Sharp, and Dunham’s passenger, Carolyn Merrill.  Dunham sustained serious injuries, and was in critical condition when police arrived.  Most notably, his foot was completely shattered and knee was broken in several places.  Dunham had a blood alcohol level of 0.17, which was over double the legal limit.  The most aggravating circumstance was that Dunham was a repeat offender, having several drunk driving charges on his record at the time of the incident.

Dunham was taken to the hospital for his injuries.  The doctors considered amputating Dunham’s leg, as it seemed the leg was beyond repair.  However, the chief surgeon reconsidered the case and decided to try to save Dunham’s leg.  In a feat of medical ingenuity, the doctors were able to reconstruct Dunham’s foot, which healed successfully over the course of years of physical therapy.  The doctors were also planning on replacing Dunham’s destroyed knee, which required a series of four or five surgeries.  Unfortunately for Dunham, he was sentenced and incarcerated before all the necessary knee surgeries were completed.

Carolyn and Pennie were not the only victims.  Their families were both heartbroken and enraged for the loss of these young women—27 and 43, respectively.  During Dunham’s criminal trial, family members wrote letters to be read into the record, expressing their agony as they had to endure their tragic loss caused by Dunham’s reckless actions.  They wanted their daughter back, their sister back, and their mother back, but they knew this was not possible.  All they had left was to seek out justice for Carolyn and Pennie.  Once Dunham was sentenced to concurrent prison terms of 34 to 60 years, the family felt that justice was done, but they also accepted that they could never be made whole.

Once Dunham was incarcerated, he was still undergoing several phases of knee surgeries, which came to a halt as he was being re-evaluated by the Michigan Department of Corrections and their health care agency, Corizon Health Services.  The first doctor that Dunham saw made the correct diagnosis—degenerative joint disease and “malunion,” which meant that his knee did not join together his upper and lower leg.  Knee replacement was recommended.  This made sense because the Dunham was already undergoing several phases of surgeries to replace his knee when he arrived in prison.  Nevertheless, another doctor, without ever even seeing Dunham in person, denied knee surgery.  One report written by an MDOC Physician’s Assistant stated the following:

“[Dunham] had been referred to an MDOC orthopedic doctor & was seen 10/09/08 for evaluation of [his leg] problem. . . . [The]recommendation was to send the patient back to his surgeon to pick up where he left off. . . . [T]his referral was deferred in favor of pain management. . . . Even though I had told him he needs to use this knee, he says the pain is too much.”

To an onlooker, what was starting to become clear was that the prison health service was going to deny Dunham the completion of his knee surgery.  An important question to ask at this point is whether a prisoner with debilitating pain is worth treating despite the cost, especially when that same prisoner is responsible for the death of two innocent individuals?  Does this prisoner deserve to endure this pain? After all it was his actions that caused his condition—it was all his fault.  Do taxpayers have an obligation to pay for this prisoner’s treatment?  These are all legitimate questions.

Despite these pointed and important questions of moral obligation, crime, and punishment, the ultimate authority is that of the rule of law.  As already explained, the United States Constitution requires that prisoners be given necessary medical care, otherwise it is considered cruel and unusual punishment.

To some, it may seem that Dunham deserved to endure the pain of his destroyed knee.  Perhaps the victims and their families, who suffered the ultimate loss, believed that denying medical care to the person responsible for the deaths of Carolyn and Pennie was morally right and just.  After all, to them, no amount of pain that Dunham could endure would ever come close to the pain of the losses they suffered.

Despite these sentiments, the rule of law must prevail, and fundamental human rights take precedence.  The justice system should not be in the business of torture.  Denying medical treatment to a prisoner who cannot seek out his own treatment and causing pain and suffering beyond the sentence handed down by a judge and jury is not justice, but sadism.  Unfortunately for Dunham, the Michigan Department of Corrections was of the mind that Dunham did not deserve the medical treatment that would have alleviated the excruciating pain of his broken knee.

After three years of taking over-the-counter pain medication and appealing denials for surgery, Dunham sought the assistance of the Michigan State University College of Law Civil Rights Clinic.  Only after Dunham “lawyered-up,” did the Michigan Department of Corrections prison health system suddenly change their course of treatment and allowed Dunham to get his knee replacement surgery.  However, this surgery did not occur until 2012, more than 3 years after Dunham was incarcerated.

Litigation over whether prison officials were “deliberately indifferent” to Dunham’s medical needs in violation the United States Constitution’s Eight Amendment is ongoing.

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Dunham’s case is one of a countless many.  There are numerous examples of prison officials ignoring the medical needs of prisoners.  In some of the most egregious cases, prisoners have died from the indifference of prison officials.  This is unacceptable.

Everybody makes mistakes.  Some people must pay a higher price for these mistakes than others. Nevertheless, when the criminal justice system incarcerates an individual for their crime, the sentence should be carried out in accordance with the rule of law.  As is clear from Dunham’s case, departure from the rule of law leads to tyranny and violations of human rights.

If Nelson Mandela is correct in saying that a society should be judged based on how it treats its prisoners—its “lowest citizens”—then we all have a responsibility to speak up and exert pressure on our respective criminal justice systems.

About the Author:

Michael Shpunt is a Human Rights Advocate , recent graduate of Michigan State College of Law, and soon-to-be member of the Michigan State Bar.  His experience includes work on issues such as education, genocide, prisoner’s rights, children’s rights, and healthcare.  For more information, visit www.LinkedIn.com/in/MikeThinkBig.  He can be further contacted at shpuntmi@gmail.com.