Death on the Installment Plan

Medical neglect, chronic disease, a hepatitis epidemic. Some Colorado prisoners pay for their crimes with their lives.

You keep this up most of the day, dodging the drug-testing squad. You think you are getting the dope out of your system, like flushing a radiator, but you are actually taking on water faster than your kidneys can eliminate it. You don't know that water intoxication can cause serious problems. Nobody told you what happens to the marathon runners, the Grand Canyon tourists, the psychotic compulsives and others who drown their thirst without replacing electrolytes -- how they sometimes become disoriented, fatigued, even gravely ill. You haven't heard about those rave-hopping, Ecstasy-addled kids who suck down water until their brain swells, cutting off its own oxygen supply, a condition that can lead to a coma and brain death.

By the time the authorities catch up with you that evening, you can't feel your legs. Maybe all the water sloshing inside of you will confuse the test, maybe not, but it's sure left you confused. You tell the medical staff you have taken something, but you won't tell them what it was. Noting your "deteriorating mental status" and suspecting a drug overdose, the staff finally calls for an ambulance.

You arrive at a Pueblo hospital after midnight. The electrolyte imbalance isn't detected until after you slip into a coma. You are rushed to intensive care, but it's already too late. The following morning, an electroencephalogram shows no brain activity. After several days, your family asks that your body be taken off life support, and you are officially pronounced dead at 1:09 p.m. on June 26, 2001.

Terry Akers is trying to get treatment for hepatitis C in prison.
Brett Amole
Terry Akers is trying to get treatment for hepatitis C in prison.
Terry Akers is trying to get treatment for hepatitis C in prison.
Brett Amole
Terry Akers is trying to get treatment for hepatitis C in prison.

Manner of death: accidental. Cause: probable acute water intoxication. In the course of the autopsy, various tests are performed.

Just as you feared, your urine tests positive for marijuana.

Prisoners die in all sorts of ways. The violent prison deaths you see in movies and TV shows -- stabbings, beatings, hangings, that suspicious "accident" in the license-plate factory -- are only a small part of the picture. The DOC averages one or two homicides a year, and just as few suicides.

Drug overdoses, accidental or not, aren't all that common, either. Occasionally, autopsies do turn up a lethal amount of heroin, morphine or some other controlled substance that's supposed to be impossible to obtain on the inside. (Note on the death certificate of one Arkansas Valley casualty: "Ingested three balloons filled with cocaine that ruptured.") But the ODs are not as frequent as you might think. The state's prisons had three such cases in 2000, two in 2001 and none at all in the first seven months of this year.

The vast majority of prisoner deaths aren't cinematic. Inmates get clogged arteries, diabetes, dementia. After protracted battles, they succumb to lung cancer, kidney failure, cirrhosis or AIDS. In some cases, the end comes amid such a muddle of diseases and complications that the coroner offers a catch-all phrase as cause: "failure to thrive."

Regardless of the cause, certain patterns have emerged that suggest dying inside is a very different matter from dying outside. Some prisoners perish of what appear to be very treatable medical problems, raising questions about the kind of health care they receive. And for the most part, they die young.

Although Colorado's prison population is getting older, with more inmates serving longer sentences, doing time is still chiefly a young man's fate. The average age of prisoners coming into the system in 2001 was right at 32 years old. The average age among prisoners who died last year was 48. By contrast, the average life expectancy of the non-incarcerated American male is 74 and rising.

Of course, most prisoners will do their time and get out alive. A statistician might argue that the relatively low age of those who die is largely a reflection of the demographics of the incarcerated; since there are more people in their forties and fifties than senior citizens behind bars, it follows that they account for a larger number of fatalities, too. But such a heavy concentration of "natural" deaths in such a narrow (and commonly survivable) age range can't be easily explained.

McGarry, the DOC's chief medical officer, attributes the early expiration of some prisoners to their dismal medical histories, which might include gunshot and knife wounds, alcoholism and drug addiction, as well as decades of little or no contact with the health-care system. A criminal lifestyle, he notes, is not conducive to a long and happy existence.

"People coming into our prisons are sicker and have had less medical attention than the rest of the folks out there," he says. "They have a much higher incidence of disease. There's a lot more trauma, a much greater history of abuse and substance abuse. In general, their income is less than any cross-section of the population, and studies have shown that the amount of money you make has a direct relationship to how long you live. For these people, it's almost like you move the biological clock up ten or fifteen years. A person who's forty in prison has the health of someone who's fifty or fifty-five."

Although prisoners complain frequently about the quality of health care they receive, in many cases it's probably better than what they're used to on the street. The DOC screens new arrivals for a panoply of infectious diseases, and most of those who are diagnosed with tuberculosis or hepatitis C were previously unaware that they had the disease.

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