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"I am currently incarcerated at a medium-security prison," writes James Mackenzie, in a letter to Diabetes Health from a jail in Shirley, Massachusetts. "I am 38 years old and suffer from diabetes and severe pain in my spine. The medical staff has tried to reduce my blood sugars—which range from 140 to 427 mg/dl. The problem is that it brings my readings into the hypoglycemia range of 50 to 72 mg/dl. This happens even with the lowest dosages.
I was hospitalized for two weeks because of my back pain and was given codeine. It reduced my blood sugars to the normal range of 90 to 120 mg/dl. Now that I am among the prison population again, the medical staff is refusing to give me the codeine, even though inmates here do receive codeine, hydrocodeine, etc. when they get a doctor to explain that pain can cause high blood sugar. I have nowhere to turn."
Unfair Treatment of People with Diabetes
If it were a simple as being treated in accordance with federal law, people with diabetes would not be risking their lives when they are arrested or incarcerated. But, in all truth, reality falls far from the ideal.
Or, at least that's the case with a number of people with diabetes who have been arrested or incarcerated over the past decade for a variety of charges—some as minor as a traffic violation—and mistreated while under the custody of police authorities. The abuses range from being denied insulin to control their high sugar levels or food to offset lows to being physically beaten for making these special requests. Such incidents have raised eyebrows on a national scale and led to a series of probing inquires by concerned parties—including, most recently, a lawsuit by the American Diabetes Association (ADA) and a case by the Federal Bureau of Investigations (FBI).
The Story Be Told
The lawsuit filed by the ADA was inspired by the case of Steven Rosen, a small-business owner in Philadelphia, Pennsylvania, whose arrest led to hospitalization after he was denied insulin while being detained. Rosen, a pump user, was arrested in 1999 by local police for a liquor code violation (the charges were eventually dropped). Rosen informed the officers about his medical condition, but was ignored when he asked for assistance after becoming hypoglycemic. After pleading, he was given something sweet to drink. But, then he was denied insulin when he asked for some to refill his pump. He was subsequently brought to the emergency room, where his blood sugar level was measured at 446 mg/dl.
The ADA is now issuing a lawsuit—which was upgraded to a class action lawsuit in March of this year—representing all people with diabetes in the city who will be or have been mistreated while under police custody. The lawsuit, being represented by attorney Alan Yatvin, of Popper & Yatvin, is demanding that the City of Philadelphia adhere to federal guidelines requiring fair treatment of people with diabetes.
"It's not a simple thing," Michael Greene, chair of the ADA's Legal Advocacy Subcommittee, told Diabetes Health. "We are going to require that they change their procedure concerning access to insulin, access to blood testing, access to food, access to medical attention, and we are going to monitor it."
Since the lawsuit was filed, one man by the name of Jose Santiago recently died from diabetic ketoacidosis in a Philadelphia prison after being denied insulin for one and a half days.
"They are basically denying people with diabetes anything to deal with any kind of acute problem," says Greene. "And it's causing medical problems for some people."
What Is the Law, Anyway?
The Americans with Disabilities Act, signed into law in 1990, protects the rights of people with physical and mental impairments.
What One Lawsuit Can Do
After the ADA brought attention to the Rosen incident, six other people came forward with their stories of abuse and joined the lawsuit as plaintiffs.
"This case matters because we care about the health and safety of people with diabetes," Shereen Arent, national director of legal advocacy for the ADA, told Diabetes Health.
The ADA is demanding a monitoring provision that requires the City of Philadelphia to provide information about the treatment of people with diabetes.
"There's a history in the city of not living up to agreements," says Arent. "We want to make sure that the agreement is followed."
Currently, the two parties are under settlement negotiations.
The city has been "very difficult and very slow" about reaching a settlement, according to Greene. "They are reluctant to change," he says. "We are only going to dance so long, then we are going to start activating the case and going forward [with it]."
The FBI Steps In
In another case of mistreatment, the FBI began a criminal investigation of police brutality after a report that sheriff's deputies in the Orange County, California jail beat a man with diabetes while he was being held on a misdemeanor charge.
The man, John Kenneth Lolli, claims deputies physically abused him in October 1999 when he asked for a snack to avoid hypoglycemia.
This report is the second claiming police brutality at the Orange County Jail, which prompted the FBI investigation.
Jonathan Slipp, Lolli's attorney, told the Los Angeles Times that he asked the FBI to consider the case after he watched a jailhouse videotape of the apparent assault by many deputies.
Lolli was arrested and booked at the Orange County Jail on October 9, 1999, in Brea, California, for failing to make a court appearance for a traffic violation, according to the lawsuit filed by Lolli. While he was being detained, Lolli said he told the staff that he needed food to maintain his blood sugar, according to the Huntington Beach police report. The report stated that several hours later Lolli said that he felt dizzy and asked for food again. According to Lolli, four deputies then took him from the booking cell, threw him to the floor and beat and kicked him. He was released the next day.
The officers wrote reports about the incident claiming that Lolli displayed hostility and resisted being handcuffed. Their reports said they punched and pepper sprayed him in order to control him.
More Cases of Poor Treatment
Other incidents of abuse have been reported across the nation. In Fredrick County, Virginia, a man named Fredrick T. Moore was pulled over by local police in 1998 for suspected drunk driving. When Moore failed to follow their instructions because he was, in fact, falling into a diabetic coma, the officers broke one of his truck windows, used pepper spray on him and hit him with a police baton. Once they figured out that he had diabetes, they called for help. Fredrick was hospitalized for four days afterward. His complaints about the episode prompted investigations of civil rights violations by the U.S. Justice Department and the FBI, according to ABC News.
In a case publicized by Amnesty International, an elderly black woman in Queens, New York, was assaulted by police officers in 1988 when they saw her taking her diabetes medications in her car and suspected her of drug dealing.
In their report on misbehavior by the New York City Police Department, Amnesty International wrote, "there remains a serious problem of police brutality and excessive force, which the organization believes needs to be urgently addressed."
Not So Safe Behind Bars
The treatment of people with diabetes in correctional facilities is another ball game altogether, as James Mackenzie's letter suggests.
The ADA ran an investigative feature article in 1995 profiling the treatment of people with diabetes in jails ("Diabetes Behind Bars," Diabetes Forecast, September 1995). The author, Craig Steinburg, provides a comprehensive explanation of how insulin is administered and inmates manage their diabetes.
"The one good thing about jails and prisons," one inmate was quoted as saying in regard to issuing insulin doses, "[is that] everything is on a schedule."
And one nurse said, "most guards aren't going to ignore a prisoner's need for care."
However, other factors—such as lack of access to healthcare at night, high-sugar diets, little or no diabetes education, limited exercise time and stress—add to the difficulties of inmates' controlling their diabetes, according to Steinburg.
The Unfortunate Facts
The unfortunate fact remains that human rights advocates in the United States have not yet been able to ensure proper treatment of these individuals.
"It will be several years before my release and I feel something terrible will happen to me if this is not under control [i.e., complications such as blindness or loss of limbs]," Mackenzie writes from behind the bars of his cell. "You may publish this letter because, without proper treatment, it may be my last."
Diabetes Health is the essential resource for people living with diabetes- both newly diagnosed and experienced as well as the professionals who care for them. We provide balanced expert news and information on living healthfully with diabetes. Each issue includes cutting-edge editorial coverage of new products, research, treatment options, and meaningful lifestyle issues.