WEBVTT - Special Episode: Dr. Homer Venters & Outbreak Behind Bars 0:00:43.400 --> 0:00:46.959 Hi, I'm Aaron Welsh and this is This Podcast Will 0:00:47.040 --> 0:00:50.600 Kill You. You're tuning in to the latest episode of 0:00:50.680 --> 0:00:54.120 the tp w k Y book Club series, where I 0:00:54.200 --> 0:00:57.360 chat with authors of popular science and medicine books about 0:00:57.360 --> 0:01:01.440 their latest work. We have covered some great books and 0:01:01.520 --> 0:01:04.800 topics so far this season, from the history of phage 0:01:04.800 --> 0:01:08.920 therapy to the origins of language, from the exciting science 0:01:08.920 --> 0:01:13.440 of regenerative medicine to the surprising reality that everything truly 0:01:13.520 --> 0:01:17.360 seems to be tuberculosis. And we've got more book club 0:01:17.400 --> 0:01:20.080 episodes on the way. If you'd like to check out 0:01:20.120 --> 0:01:22.440 the full list of books that we've covered this season 0:01:22.600 --> 0:01:25.320 and past seasons, as well as get a sneak peek 0:01:25.360 --> 0:01:27.760 at the ones we've got coming up, head over to 0:01:27.800 --> 0:01:31.119 our website This Podcast Will Kill You dot com. Under 0:01:31.160 --> 0:01:33.880 the Extras tab, you'll find a link to our bookshop 0:01:33.920 --> 0:01:39.199 dot org affiliate page, which has a bunch of TPWKY booklists, 0:01:39.240 --> 0:01:43.000 including one for this book club series. This is a 0:01:43.319 --> 0:01:46.160 great place to find gift ideas for the book lovers 0:01:46.160 --> 0:01:49.640 in your life. Seriously, check in on these lists regularly 0:01:49.760 --> 0:01:54.040 because I'm always updating them. As always, we love hearing 0:01:54.040 --> 0:01:57.480 from you all about these episodes and about our other episodes. 0:01:57.600 --> 0:01:59.600 So if you have anything that you'd like to share, 0:02:00.080 --> 0:02:02.919 reach out through the contact ust form on our website. 0:02:03.440 --> 0:02:05.920 Two last things before moving on to the Book of 0:02:05.960 --> 0:02:09.960 the week. First, please rate, review and subscribe. It really 0:02:10.000 --> 0:02:13.160 does help us out. And second, you can now find 0:02:13.200 --> 0:02:16.639 full video versions of most of our newest episodes on YouTube. 0:02:17.040 --> 0:02:20.359 Make sure you're subscribed to exactly write Media's YouTube channel 0:02:20.440 --> 0:02:24.240 so you never miss a new episode drop. Our modern 0:02:24.320 --> 0:02:27.800 day public health toolkit to prevent and control the spread 0:02:27.840 --> 0:02:32.800 of disease is jam packed. We have diagnostic technology, we 0:02:32.840 --> 0:02:37.200 have medical interventions and treatments, we have epidemiological policies to 0:02:37.320 --> 0:02:41.640 interrupt the chain of transmission, and we have intricate knowledge 0:02:41.680 --> 0:02:47.040 about how communicable diseases behave under different conditions. In short, 0:02:47.440 --> 0:02:51.280 we have the tools to greatly reduce morbidity and mortality 0:02:51.360 --> 0:02:55.400 from infectious diseases. What we still lack, however, is the 0:02:55.440 --> 0:02:59.400 will and the resources to apply these tools everywhere they 0:02:59.440 --> 0:03:02.760 are needed. And one area of great need is our 0:03:02.800 --> 0:03:08.720 correctional facilities, jails, prisons, immigration detention centers and juvenile detention centers, 0:03:09.280 --> 0:03:14.720 places where overcrowded, unsanitary conditions and inadequate medical care allow 0:03:14.800 --> 0:03:21.079 communicable diseases to spread unchecked. This pervasive neglect will continue 0:03:21.120 --> 0:03:25.400 to fuel health inequities until healthcare in these settings is reformed. 0:03:26.160 --> 0:03:29.799 What might meaningful reform look like? The author of this 0:03:29.840 --> 0:03:34.560 week's book holds the answer. In Outbreak Behind Bars, Spider Bites, 0:03:34.720 --> 0:03:38.640 Human Rights and the Unseen Danger to Public Health, correctional 0:03:38.640 --> 0:03:43.320 health physician and epidemiologist, doctor Homer Venors reveals the systemic 0:03:43.400 --> 0:03:47.680 issues driving the rampant spread of disease in correctional facilities. 0:03:48.320 --> 0:03:51.000 As the former chief medical officer of the New York 0:03:51.040 --> 0:03:54.200 City Jail System. Check out his previous book titled Life 0:03:54.280 --> 0:03:57.440 and Death in Riker's Island, and through his current work 0:03:57.480 --> 0:04:00.440 as a federal monitor of health services in several jail 0:04:00.480 --> 0:04:04.920 and prison settings, doctor Venters has extensive firsthand knowledge of 0:04:04.960 --> 0:04:08.320 the barriers that prevent adequate medical care to be delivered 0:04:08.440 --> 0:04:13.600 to these populations, and he has evidence based solutions. The 0:04:13.680 --> 0:04:17.960 scope of this problem is massive, and as this administration 0:04:18.120 --> 0:04:21.440 ramps up its ice raids and expands federal policing, we 0:04:21.520 --> 0:04:24.800 can only expect it to grow. This book serves as 0:04:24.839 --> 0:04:29.400 a powerful and practical overview of the challenges facing healthcare 0:04:29.480 --> 0:04:33.880 in correctional facilities and clearly demonstrates the need for a 0:04:34.000 --> 0:04:37.400 human rights approach to this issue. Before I share this 0:04:37.480 --> 0:04:39.520 interview with you all, I do want to mention that 0:04:39.600 --> 0:04:43.760 both suicide and violence are discussed, so please listen with discretion. 0:04:44.600 --> 0:04:46.560 Let's take a quick break and then we'll get right 0:04:46.560 --> 0:05:13.800 into the interview. Doctor Venters, thank you so much for 0:05:13.880 --> 0:05:14.720 joining me today. 0:05:15.400 --> 0:05:18.159 Thanks for having me. I'm really thrilled to talk about 0:05:18.160 --> 0:05:21.400 the content and also, as I said, I'm really just 0:05:21.640 --> 0:05:25.159 fascinated with all the topics you've delved into already. Oh. 0:05:25.160 --> 0:05:26.840 Thank you. Well. 0:05:26.920 --> 0:05:30.200 As the former chief medical officer of the New York 0:05:30.200 --> 0:05:35.120 City jail System, you have extensive firsthand experience witnessing the 0:05:35.160 --> 0:05:39.120 ways that certain diseases in the institutional settings such as jails, 0:05:39.160 --> 0:05:43.000 can truly thrive, which is what you explore in your book, 0:05:43.040 --> 0:05:46.520 Outbreak Behind Bars. Can you tell me about the making 0:05:46.640 --> 0:05:48.720 of this book and when you decided to write it. 0:05:49.640 --> 0:05:53.560 Yeah, I really thought about writing it. I was actually 0:05:53.560 --> 0:05:56.160 going to. I wrote originally a book on called Life 0:05:56.160 --> 0:05:58.039 and Death in Wrikers Island that was about some of 0:05:58.040 --> 0:06:02.159 the horrible causes of mortality and violence behind bars. But 0:06:02.320 --> 0:06:05.440 then I was going to write a second book about 0:06:05.440 --> 0:06:09.839 something else. And then when COVID hit, I was the 0:06:09.880 --> 0:06:13.000 president of a really small nonprofit and I handed that 0:06:13.200 --> 0:06:15.640 off to people who were probably better at running it 0:06:15.720 --> 0:06:18.200 than I was, and I just started responding to COVID 0:06:18.240 --> 0:06:20.480 outbreaks around the country. So for a couple of years, 0:06:21.120 --> 0:06:24.240 I was on the road constantly, going from outbreak to outbreak, 0:06:24.640 --> 0:06:27.120 different reasons that I would get into the jail. Sometimes 0:06:27.120 --> 0:06:29.599 I'd be invited in, sometimes I'd be have to force 0:06:29.640 --> 0:06:32.880 my way in with through litigation. But for a couple 0:06:32.880 --> 0:06:34.760 of years I was really on the road. I went 0:06:34.760 --> 0:06:38.479 to about maybe sixty or seventy outbreaks, and so as 0:06:38.560 --> 0:06:43.240 I was going around developing tools for myself to use 0:06:43.279 --> 0:06:46.760 to understand the adequacy of the COVID response, it really 0:06:46.800 --> 0:06:50.680 helped me see the broad spectrum of infection control practices 0:06:50.800 --> 0:06:54.680 and resources and you know, learning writers, I learned a 0:06:54.680 --> 0:06:57.120 lot about one place, and in doing all of these 0:06:57.160 --> 0:07:00.599 COVID responses, it taught me a lot about some of 0:07:00.600 --> 0:07:04.080 the common pitfall some of the common gaps, and some 0:07:04.160 --> 0:07:08.080 of the really successful strategies when it comes to infection control, 0:07:08.240 --> 0:07:11.680 infection prevention response, things like that, And so it really 0:07:12.360 --> 0:07:14.440 became a no brainer for me to think as I 0:07:14.560 --> 0:07:17.360 looked back and in the field were kind of lightened 0:07:17.440 --> 0:07:19.760 up for me to think about putting this together in 0:07:19.800 --> 0:07:20.280 a book. 0:07:21.240 --> 0:07:25.440 And as you describe in your book, correctional facilities truly 0:07:25.840 --> 0:07:28.960 really promote the spread of certain diseases for a number 0:07:29.000 --> 0:07:32.280 of reasons, you know, from things like the architecture or 0:07:32.360 --> 0:07:36.160 organization of the buildings themselves to the neglect that's often 0:07:36.200 --> 0:07:38.960 present in these settings. Can you take me through some 0:07:39.080 --> 0:07:43.440 of the systemic factors that drive disease transmission in these settings? 0:07:44.080 --> 0:07:46.040 Sure? And I think you know, I came across a 0:07:46.040 --> 0:07:50.240 word actually on your website ecology, which is really such 0:07:50.280 --> 0:07:52.640 a great term which we don't use much in public 0:07:52.640 --> 0:07:55.000 health and like a lot of public health settings that 0:07:55.040 --> 0:07:57.880 I've encountered, but it's such a perfect way to encapsulate 0:07:58.720 --> 0:08:02.080 the intersection between people's health and these outbreaks and their 0:08:02.120 --> 0:08:07.200 physical surroundings. And so I think most people understand that 0:08:07.440 --> 0:08:12.840 the close proximity of prisons, jails, immigration detention, juvenile detention 0:08:13.000 --> 0:08:16.080 centers that promotes the spread of disease that's communicable. That 0:08:16.800 --> 0:08:20.280 makes sense. I think what is not so apparent to 0:08:20.320 --> 0:08:22.920 a lot of people is that the lack of sanitation, 0:08:23.120 --> 0:08:28.960 the incredibly filthy, unsanitary conditions also promote that spread when 0:08:29.120 --> 0:08:31.880 the conditions are even more cramped than normal. So if 0:08:31.960 --> 0:08:35.320 people are sleeping on floors, touching each other, sleeping in 0:08:35.440 --> 0:08:39.319 common pens and areas that are never cleaned, that promotes 0:08:39.360 --> 0:08:43.160 the spread. And then there's this much more hidden set 0:08:43.360 --> 0:08:49.720 of promoters of outbreaks that include barriers to medical care 0:08:50.000 --> 0:08:53.360 for individuals people can't get to you know, when they 0:08:53.360 --> 0:08:56.280 have a new symptom, they can't get to care, Barriers 0:08:56.320 --> 0:08:59.280 to outside health agencies being involved. So the local public 0:08:59.320 --> 0:09:02.880 health environment might do a great job at a outbreak 0:09:02.920 --> 0:09:04.880 at a church or a nursing home might not be 0:09:04.920 --> 0:09:08.959 involved behind bars. And then I think there are also 0:09:09.520 --> 0:09:13.920 real barriers in terms of infection control resources. One thing 0:09:13.960 --> 0:09:15.800 I often find is that I'll get to a jail 0:09:15.840 --> 0:09:19.000 or prison, I'll get the staffing matrix and there will 0:09:19.040 --> 0:09:21.840 be a line on there for an infection control nurse 0:09:21.920 --> 0:09:25.080 or maybe a half of a part time of part time, 0:09:25.280 --> 0:09:29.559 like a half fte of infection control nurse. That line 0:09:29.600 --> 0:09:32.320 is often unfilled. It's a way to kind of save 0:09:32.400 --> 0:09:34.959 money or not fill a line that some people think 0:09:35.040 --> 0:09:37.600 is an important. And there might also be by the way, 0:09:37.720 --> 0:09:41.560 an infection control officer who's supposed to have like a 0:09:41.600 --> 0:09:45.560 security middle manager like a sergeant or a lieutenant, who's 0:09:45.559 --> 0:09:48.120 supposed to spend a quarter or half of their time 0:09:48.200 --> 0:09:52.120 on infection control, and those lines often are just not filled, 0:09:52.120 --> 0:09:55.079 and so you don't have the people that are doing 0:09:55.080 --> 0:09:55.960 the jobs that we think. 0:09:55.880 --> 0:10:01.120 Are important, right, And it is really just and disturbing 0:10:01.160 --> 0:10:04.560 how much of it is just a money saving aspect. 0:10:04.600 --> 0:10:07.319 It's just let's save money, and it's sort of this 0:10:07.440 --> 0:10:10.640 you know, ounce of prevention, pound of cure, etc. But 0:10:11.160 --> 0:10:15.959 there are these systemic and structural problems with delivering adequate 0:10:16.000 --> 0:10:18.960 medical care to those in prisons and people in prisons 0:10:19.280 --> 0:10:23.120 and other institutional settings accessing medical care. But there are 0:10:23.120 --> 0:10:27.120 also these issues that you discuss stemming from bias leading 0:10:27.559 --> 0:10:29.760 some of those who might be in the position to 0:10:30.280 --> 0:10:33.440 give someone or let someone get access to medical care, 0:10:34.000 --> 0:10:38.439 leading those to downplay or dismiss someone's concerns. What are 0:10:38.440 --> 0:10:41.880 some of the ways that this neglect or this bias manifests. 0:10:42.480 --> 0:10:45.200 Well, I think it starts with just patients who have 0:10:46.120 --> 0:10:49.960 symptoms not being believed. So in the IMMERSA chapter, I 0:10:50.000 --> 0:10:52.440 talk about this I think in actually almost every chapter 0:10:52.480 --> 0:10:56.280 I talk about this, where people are reporting symptoms that 0:10:56.360 --> 0:10:59.640 are exactly kind of textbook symptoms that we would want 0:10:59.640 --> 0:11:02.800 them to so we can know either that a new 0:11:02.960 --> 0:11:05.800 outbreak is afoot, or that it's spreading to a new area, 0:11:06.160 --> 0:11:10.160 or that maybe treatment wasn't complete or effective. But often 0:11:10.200 --> 0:11:13.000 they're either disbelieved or they're kind of fended off with 0:11:13.280 --> 0:11:18.760 very rote and ineffective healthcare encounters. There's something called a 0:11:18.760 --> 0:11:21.720 sick call encounter where a patient might have to pay 0:11:21.880 --> 0:11:24.880 to see a nurse. That nurse might just talk to 0:11:24.920 --> 0:11:27.600 them briefly, might not even do much of a physical exam. 0:11:27.679 --> 0:11:30.840 They might never see a doctor or a nurse practitioner 0:11:30.960 --> 0:11:33.800 or a physician assistant, And they might have to go 0:11:33.920 --> 0:11:36.680 through that cycle of seeing a sick call nurse over 0:11:36.760 --> 0:11:41.000 and over and over, not getting any effective diagnosis or treatment. 0:11:41.040 --> 0:11:46.800 And so those barriers are built into jail's, prisons, immigration 0:11:46.840 --> 0:11:51.320 detention centers in many of the outbreaks I've investigated. So 0:11:51.480 --> 0:11:51.960 there's this. 0:11:52.120 --> 0:11:55.480 Sort of just inherent stance of you really have to 0:11:55.559 --> 0:11:59.960 fight to have your medical concerns addressed at all. 0:12:00.160 --> 0:12:02.840 Yes, and there's a downside to that. I mean there 0:12:02.920 --> 0:12:07.320 is these are paramilitary settings, so unlike you know, as 0:12:07.400 --> 0:12:09.880 much as it's difficult to work in a hospital or 0:12:09.920 --> 0:12:14.800 a clinic, these are places where raising alarm or raising 0:12:14.920 --> 0:12:17.439 concern in a way that makes you stand out from 0:12:17.480 --> 0:12:21.760 everybody else can bring very swift retaliation all the way 0:12:21.760 --> 0:12:25.840 from losing services, being locked in a cell by yourself, 0:12:26.040 --> 0:12:30.600 put into solitary confinement, beaten or subject to physical or 0:12:30.640 --> 0:12:33.560 sexual abuse. And so those things don't happen all the 0:12:33.600 --> 0:12:37.720 time to everybody, but that risk of raising your hand 0:12:37.760 --> 0:12:40.920 and pushing harder than everybody around you to get your 0:12:40.920 --> 0:12:45.640 point across about health issues, there is that risk inherent 0:12:46.640 --> 0:12:50.079 because of the power and security dynamic. 0:12:51.120 --> 0:12:57.080 And you also talk about how mistrust flows in every direction. 0:12:57.280 --> 0:12:58.840 Can you say a little bit more about what you 0:12:58.920 --> 0:12:59.559 mean by that. 0:13:00.400 --> 0:13:04.440 Yeah, it's really profound. You know, we talk a lot 0:13:04.559 --> 0:13:06.440 well at Wrikers. We would talk a lot about this 0:13:06.480 --> 0:13:09.320 problem with dual loyalty, which is when your health staff 0:13:09.360 --> 0:13:12.080 really aren't working to the benefit of the patients that 0:13:12.120 --> 0:13:16.440 they're there to take care of, but the mistrust from 0:13:16.440 --> 0:13:19.480 the patient standpoint, the health service may be involved in 0:13:19.559 --> 0:13:22.960 punishing them or in withholding care in ways that has 0:13:23.000 --> 0:13:26.360 really dramatically impacted them. So imagine you're a person who 0:13:26.360 --> 0:13:29.760 has a mental health crisis and you get in trouble, 0:13:29.800 --> 0:13:32.600 you break the rules of the facility, and then health 0:13:32.640 --> 0:13:36.319 staff say it's okay for you to be punished via 0:13:36.480 --> 0:13:42.520 solitary confinement, which is horrible, punishing, tortuous experience. There are 0:13:43.240 --> 0:13:46.560 many ways in which the health staff may be co 0:13:46.600 --> 0:13:50.440 opted in the patient's view as to become agents of 0:13:50.440 --> 0:13:53.120 the security service, so they're not really acting on behalf 0:13:53.160 --> 0:13:55.959 of the patients. So you know, fast forward to when 0:13:55.960 --> 0:13:58.560 an outbreak occurs, you may not feel like those health staff, 0:13:58.600 --> 0:14:02.560 those nurses, those doctors are really there to help you. 0:14:02.679 --> 0:14:06.160 And I think that the current problems around the country 0:14:06.200 --> 0:14:09.360 with excessive use of lockdowns. This is when people are 0:14:09.400 --> 0:14:11.800 locked in a cell or locked in their housing area, 0:14:12.360 --> 0:14:14.800 and then health staff may come and kind of minister 0:14:15.000 --> 0:14:18.800 to the unit in very limited fashion. I think it's 0:14:18.880 --> 0:14:21.880 easy for patients who are locked up to feel like 0:14:21.920 --> 0:14:25.000 the health staff aren't helping them. And then from the 0:14:25.040 --> 0:14:29.160 perspective of the health staff, they may both distrust the patients, 0:14:29.200 --> 0:14:30.880 they may be afraid of them, but they also may 0:14:30.920 --> 0:14:33.840 only see them in moments of crisis. So in that 0:14:33.880 --> 0:14:37.200 same lockdown scenario, if the doctor or the nurse can 0:14:37.800 --> 0:14:40.800 rarely get to see their patients, those patients may be 0:14:40.880 --> 0:14:46.080 in very agitated, upset moods or frames of mind, very sick, 0:14:46.400 --> 0:14:49.880 So it doesn't help the dynamic of those two engaging. 0:14:50.360 --> 0:14:52.720 And then there's the dynamic of the security service. The 0:14:52.760 --> 0:14:55.680 health staff may both be afraid of them and also 0:14:56.480 --> 0:14:59.280 rely on them for physical protection. So it's a pretty 0:14:59.640 --> 0:15:03.400 difficult cult scenario even when things operate the way they're 0:15:03.440 --> 0:15:07.360 supposed to buy policies, and obviously it's often the case 0:15:07.400 --> 0:15:08.760 that they're not operating that way. 0:15:10.160 --> 0:15:12.400 Let's take a quick break, and when we get back, 0:15:12.520 --> 0:15:32.760 there's still so much to discuss. Welcome back everyone. I've 0:15:32.760 --> 0:15:36.120 been chatting with doctor Homer Venters about his book Outbreak, 0:15:36.160 --> 0:15:40.400 Behind Bars, Spider Bites, Human Rights, and the Unseen danger 0:15:40.480 --> 0:15:44.480 to public health. Let's get back into things, and of 0:15:44.600 --> 0:15:50.040 course this will affect every aspect of health in these settings. 0:15:50.520 --> 0:15:54.640 But you discuss certain diseases or types of diseases that 0:15:54.720 --> 0:15:58.880 have a propensity to spread or to have greater severity 0:15:58.960 --> 0:16:02.720 in prisons, jail, immigration detention centers. What are some of 0:16:02.720 --> 0:16:06.360 those types of diseases that really do thrive in these conditions. 0:16:06.880 --> 0:16:11.280 I think there are many, many communicable diseases that thrive 0:16:11.400 --> 0:16:15.080 in these places for different reasons. So, you know, for 0:16:15.440 --> 0:16:17.960 places that have a great churn of lots of people 0:16:18.000 --> 0:16:21.400 coming in and have lots of overcrowding, especially overcrowding among 0:16:21.480 --> 0:16:25.400 people who just arrived, you may find housing areas or 0:16:25.480 --> 0:16:29.120 pens intake pens where scores of people are sleeping on 0:16:29.160 --> 0:16:32.640 the floor, touching each other, in physical places that are 0:16:32.680 --> 0:16:36.720 never cleaned, that have fecal material that are completely filthy, dirty, 0:16:36.920 --> 0:16:39.520 no sanitation, may not have those people may not have 0:16:39.560 --> 0:16:44.960 access to bathrooms sometimes, and so that dynamic certainly promotes 0:16:45.000 --> 0:16:48.960 the spread of both staphylococcal skin infections, anything that's on 0:16:49.000 --> 0:16:52.600 the skin scavy's light, but also you know, respiratory infections. 0:16:52.600 --> 0:16:58.320 That's one dynamic. Another is that behind bars, almost every 0:16:58.400 --> 0:17:01.560 health crisis is met with the patient being thrown in 0:17:01.600 --> 0:17:05.800 a locked cell. So this sounds insane for people who 0:17:05.880 --> 0:17:09.240 work in other settings, but you know, the leading cause 0:17:09.440 --> 0:17:11.840 of death in US jails has for a long time 0:17:11.880 --> 0:17:15.520 been suicide. Many of those suicides occur when a person 0:17:15.600 --> 0:17:17.879 has been identified as having some mental health issue and 0:17:17.920 --> 0:17:20.160 then they're thrown in a locked cell for what might 0:17:20.200 --> 0:17:23.840 be called a mental observation, or they may be in 0:17:23.840 --> 0:17:28.000 withdrawal or both right withdrawal and having a mental health crisis. 0:17:29.040 --> 0:17:32.040 Those people who are thrown into those locked cells for 0:17:32.440 --> 0:17:38.280 a range of real health crises then are often forgotten. 0:17:38.880 --> 0:17:41.119 And I don't mean forgotten. It may be that a 0:17:41.160 --> 0:17:43.720 mental health person comes by their cells and says something 0:17:43.720 --> 0:17:45.920 to them through a locked door a couple times a day. 0:17:46.680 --> 0:17:53.320 But in the last few years, I've investigated several starvation deaths, 0:17:54.160 --> 0:17:56.840 human beings who are in a jail, a fully staffed 0:17:56.960 --> 0:17:59.600 jail or prison, who starve to death in one of 0:17:59.640 --> 0:18:04.560 these cells. And that happens because people stop caring about 0:18:04.640 --> 0:18:08.600 or even thinking about their physical health. And if you 0:18:09.320 --> 0:18:13.120 look at who has died from starvation, you often find 0:18:13.119 --> 0:18:17.879 that they also have horrible scabies or life infestations. And 0:18:17.960 --> 0:18:21.480 so that tendency to take people with a health crisis 0:18:21.480 --> 0:18:24.200 behind bars and lock them in a cell is another 0:18:24.359 --> 0:18:29.320 type very serious infection risk infection control problem because those 0:18:29.320 --> 0:18:31.880 cells are never going to those cells almost never get cleaned, 0:18:32.000 --> 0:18:34.040 never get effectively, so the next person who come in 0:18:34.119 --> 0:18:36.800 could you get the same problem. So there are other 0:18:36.920 --> 0:18:40.080 dynamics for sure behind bars. But those are two that 0:18:40.160 --> 0:18:42.840 I think really stand out. One is the new intake 0:18:43.359 --> 0:18:45.679 people crammed together and intake pens, and the other is 0:18:45.680 --> 0:18:48.480 this kind of people who are sick from a behavior 0:18:48.480 --> 0:18:50.840 health standpoint, just being locked in a cell by themselves 0:18:50.920 --> 0:18:53.119 and forgotten from a physical health standpoint. 0:18:53.760 --> 0:18:59.520 It is truly horrifying to think about how these problems 0:18:59.520 --> 0:19:03.680 that are so rampant that clearly many solutions are needed, 0:19:03.720 --> 0:19:06.720 and they're needed at all these different stages. 0:19:06.840 --> 0:19:07.000 Right. 0:19:07.000 --> 0:19:10.119 They're needed for preventing the spread of a disease in 0:19:10.160 --> 0:19:14.359 the first place. There's controlling its spread, which has a 0:19:14.400 --> 0:19:17.000 different set of strategies and tools that you need, and 0:19:17.000 --> 0:19:21.280 then there's reducing morbidity and mortality. What are some of 0:19:21.320 --> 0:19:25.400 the solutions that you think will help address these issues? 0:19:25.680 --> 0:19:27.879 I guess practical solutions, and then what are some of 0:19:27.920 --> 0:19:31.240 the barriers to implementing those solutions. 0:19:32.320 --> 0:19:36.200 I think that one of the kind of medium term, 0:19:36.359 --> 0:19:38.680 like it's not the smallest thing, but it's a pretty 0:19:38.720 --> 0:19:41.160 decent thing for a facility, is to make sure these 0:19:41.160 --> 0:19:44.680 infection control rules are filled. It's not hard to find, 0:19:44.800 --> 0:19:47.639 you know, nurses all over this country, millions and millions 0:19:47.680 --> 0:19:50.320 of nurses know about infection control, so do doctors and 0:19:50.359 --> 0:19:53.800 pas and ps, and so it's not hard to find 0:19:53.800 --> 0:19:57.400 people who understand the basics of infection control. I can find, 0:19:57.560 --> 0:19:59.840 you know, the weak spots in a facility where things 0:20:00.160 --> 0:20:02.840 need to be improved. But when those lines are allowed 0:20:02.840 --> 0:20:05.800 to go unfilled or when somebody who's supposed to be 0:20:05.840 --> 0:20:11.760 halftime infection control has like three other full time equivalents 0:20:11.760 --> 0:20:13.600 of work to do, it's not going to happen. And 0:20:13.600 --> 0:20:15.400 the same for the security staff. And so I've seen 0:20:15.560 --> 0:20:20.280 very effective partnerships between the infection control nursing staff and 0:20:20.520 --> 0:20:23.040 security staff when they really are you know, have the 0:20:23.119 --> 0:20:27.080 resources of time. I think, from my standpoint, most of 0:20:27.080 --> 0:20:29.800 my work now is a federal monitor, which means a 0:20:29.800 --> 0:20:32.720 federal court will put me in the role of tracking 0:20:32.760 --> 0:20:35.720 and helping to improve healthcare in a prisoner a jail, 0:20:35.960 --> 0:20:38.719 and that can take years. And so as a federal monitor, 0:20:38.880 --> 0:20:41.080 it's great because I get to work with a facility. 0:20:41.480 --> 0:20:43.679 There's a settlement agreement that other people came up with, 0:20:43.720 --> 0:20:45.080 but then I get to come up with a plan, 0:20:45.440 --> 0:20:49.000 you know, with the facility and track it quarter and 0:20:49.080 --> 0:20:51.400 or quarter. And one of the things that I think 0:20:51.480 --> 0:20:57.520 is most effective is building connections with the outside health 0:20:57.520 --> 0:21:01.080 department outside of jail or a prison. Because we could 0:21:01.119 --> 0:21:04.920 go to about seven thousand jails, prisons, detention centers of 0:21:04.960 --> 0:21:08.520 different stripes around the country. It's pretty rare that a 0:21:08.560 --> 0:21:12.320 local health department is really involved in assessing the adequacy 0:21:12.520 --> 0:21:16.880 of anything that happens inside those boxes. And so from 0:21:16.920 --> 0:21:20.520 my standpoint, infection control and outbreak response is one of 0:21:20.560 --> 0:21:24.480 the few areas where you do have sometimes some involvement 0:21:24.600 --> 0:21:28.000 where a local health department or maybe the state or 0:21:28.000 --> 0:21:31.840 maybe the CDC might be involved. And so when I'm 0:21:31.880 --> 0:21:34.159 a monitor, one of the first things I put on 0:21:34.200 --> 0:21:35.960 the table is I think it's important for us to 0:21:36.040 --> 0:21:38.320 all once we get to the point where we say 0:21:38.520 --> 0:21:42.040 healthcare has improved, we're all feel like the requirements have 0:21:42.080 --> 0:21:44.919 been met, that one of the things where we see 0:21:44.920 --> 0:21:47.679 on the table is a physical connection, an involvement of 0:21:47.680 --> 0:21:50.040 the local health department, so that when we all walk 0:21:50.080 --> 0:21:52.159 away from whatever the legal case is, we know that 0:21:52.240 --> 0:21:55.600 the local health department will be looking checking these things. 0:21:55.600 --> 0:21:58.600 And that's really, from my standpoint, really really important. 0:21:59.160 --> 0:22:01.720 I'm so curue where is how you got into this 0:22:01.880 --> 0:22:04.280 line of work? Like, how how did you find yourself 0:22:04.320 --> 0:22:07.520 in this position and involved in this type of work. 0:22:08.080 --> 0:22:11.520 You know. I was a resident in social medicine at 0:22:11.560 --> 0:22:15.119 Montefior at Albert Einstein, and I loved that program. I 0:22:15.200 --> 0:22:16.840 went to that program because I knew that there would 0:22:16.840 --> 0:22:20.679 be more training in human rights and epidemiology. And I 0:22:20.720 --> 0:22:23.320 had patients at our clinic in the South Bronx who 0:22:23.320 --> 0:22:27.280 would tell me these really incredible stories about what happened 0:22:27.320 --> 0:22:30.400 to them in jail, like in Wrikers and other places. 0:22:30.480 --> 0:22:35.200 And I then I started a project as a resident 0:22:35.720 --> 0:22:38.679 seeing patients over in the Legal Bronx Defenders, which is 0:22:38.720 --> 0:22:41.560 like illegal aid type organization across the street from US, 0:22:41.560 --> 0:22:45.360 and I just learned so much. And then I then 0:22:45.400 --> 0:22:48.400 my fellowship looked at healthcare for people in immigration detention, 0:22:49.880 --> 0:22:51.720 and I was also working as an attending in the 0:22:51.960 --> 0:22:54.399 Bellvue as a program for survivors of torture, and I 0:22:54.520 --> 0:23:01.280 just this kind of interplay between human rights and health, 0:23:01.520 --> 0:23:04.720 I think is so makes this such a natural area 0:23:04.840 --> 0:23:09.479 to want to be in, because you know, in some ways, 0:23:09.960 --> 0:23:13.479 traditional public health and medicine are really antithetical to some 0:23:13.560 --> 0:23:16.600 of the precepts of human rights in that we're not 0:23:16.640 --> 0:23:19.000 trained in a hospital to kind of identify problems and 0:23:19.080 --> 0:23:22.320 not fix them. You know, we find a problem and 0:23:22.359 --> 0:23:24.600 we fix it, right, and you wouldn't want to be 0:23:24.640 --> 0:23:26.919 on the hook for not fixing a problem. But in 0:23:27.680 --> 0:23:30.040 you know, some of the core principles of human rights 0:23:30.080 --> 0:23:35.320 involve documenting with your patients or survivors what's happening to them, 0:23:35.760 --> 0:23:38.359 with the notion that you might not fix that, but 0:23:38.440 --> 0:23:40.480 to tell the truth, like use your skills as a 0:23:40.480 --> 0:23:43.159 doctor or an engineer or whatever it is. And so 0:23:43.960 --> 0:23:47.160 I found that and we did publish a lot when 0:23:47.160 --> 0:23:50.280 I was at Rikers about a human rights framework how 0:23:50.280 --> 0:23:52.640 we thought it was important to correct health hasn't really 0:23:52.680 --> 0:23:56.439 taken off like wildfire, but I find it just really 0:23:57.000 --> 0:23:59.960 gratifying in terms of this, you know, learning from patient. 0:24:00.040 --> 0:24:03.400 It's about the reality of their experience. Using whatever little 0:24:03.440 --> 0:24:05.480 skills you have and authority you have to kind of 0:24:05.520 --> 0:24:08.040 like put that on the map and say this is 0:24:08.119 --> 0:24:11.199 what they say. It might be consistent or inconsistent with 0:24:11.320 --> 0:24:15.000 other sources of data, and that kind of help get 0:24:15.040 --> 0:24:18.080 that information into the crucible of you know, how we 0:24:18.080 --> 0:24:19.080 should make decisions. 0:24:19.880 --> 0:24:24.159 It's an incredibly important and I think especially with this 0:24:24.280 --> 0:24:27.000 current administration, which maybe we'll talk a little bit more 0:24:27.000 --> 0:24:29.720 about later sort of all of what's happening with ice raids. 0:24:29.800 --> 0:24:32.280 But you know, I want to touch on a story 0:24:32.280 --> 0:24:36.440 that you discuss in your book, which is about tuberculosis, 0:24:36.480 --> 0:24:39.720 and you kind of highlight tuberculosis as this case study 0:24:40.280 --> 0:24:44.840 in how diseases can be spread through systemic failings. You 0:24:44.920 --> 0:24:47.520 describe how delivering medical care is a you know, quote 0:24:47.600 --> 0:24:51.480 unquote constant exercise in interruptions. What are some of those 0:24:51.480 --> 0:24:55.720 interruptions when it comes to something like tuberculosis TB. 0:24:57.000 --> 0:25:00.960 You know, I have a great friend, slash Mentor Mukherjee 0:25:00.960 --> 0:25:03.200 who's partners in health, who I really have learned so 0:25:03.280 --> 0:25:06.119 much from over the years. But I think she would 0:25:06.160 --> 0:25:11.080 often describe, and many others before her, for zillions of years, 0:25:11.080 --> 0:25:14.000 have described TV as a poor people's disease, and so 0:25:14.640 --> 0:25:17.200 I think that it is. One of the things about 0:25:17.240 --> 0:25:20.960 tuberculosis is that most jails and prisons in this country 0:25:21.800 --> 0:25:24.119 care about it like it for a long time has 0:25:24.119 --> 0:25:26.320 been established as something that you don't want to have 0:25:26.400 --> 0:25:29.000 happened in your facility, and so most places have a 0:25:29.040 --> 0:25:32.440 system to check people for active pulmonary TV when they 0:25:32.440 --> 0:25:35.520 come through the front door. And that could and then 0:25:35.600 --> 0:25:38.800 evolves some questions about screening and involve a PPD. It 0:25:38.880 --> 0:25:41.520 might involve some other things like an interfer on gamma 0:25:41.520 --> 0:25:45.440 test or a chest X ray, but there's some effort. 0:25:45.680 --> 0:25:48.800 Then once a year, if you look at most prisons, 0:25:49.440 --> 0:25:51.639 for people who have been in any state prison system 0:25:51.760 --> 0:25:54.720 or the federal prison system, for you know, any amount 0:25:54.760 --> 0:25:56.879 of time, there's supposed to be a check once a 0:25:56.960 --> 0:25:59.640 year to see do you have new symptoms that might 0:25:59.640 --> 0:26:03.760 indicate you have pulinary TV. That kind of yearly check, 0:26:03.840 --> 0:26:05.679 if it's not a big priority, and this is the 0:26:05.720 --> 0:26:08.280 case I mentioned in the book, could be swept aside 0:26:08.359 --> 0:26:11.320 or could be kind of ignored. And you know, we 0:26:11.440 --> 0:26:14.520 know that probably five or more percent of people with 0:26:14.680 --> 0:26:18.480 latent tuberculous infection will develop at some point in their 0:26:18.480 --> 0:26:22.000 lives pulmonary TV. And so when we stop looking for it, 0:26:22.160 --> 0:26:24.359 then it obviously is going to occur because it's a 0:26:24.359 --> 0:26:29.600 pretty prevalent situation. And then there's also the component of 0:26:29.680 --> 0:26:33.080 people not being believed. So people may report actively report 0:26:33.160 --> 0:26:36.320 that they have symptoms that are indicative of pulinary TV, 0:26:36.400 --> 0:26:40.680 they might not be believed. But I think another part 0:26:40.720 --> 0:26:43.080 of this is in this country. Let's say we have 0:26:43.119 --> 0:26:46.879 two million people about incarcerated today or locked up in 0:26:46.920 --> 0:26:51.440 different places. That might represent about ten million or eight 0:26:51.480 --> 0:26:54.920 million incarcerations a year because of the churn, But most 0:26:54.920 --> 0:26:59.240 of those those incarcerations are happening in county jails. County 0:26:59.320 --> 0:27:03.600 jails rarely get into the business of assessing if you 0:27:03.720 --> 0:27:07.720 have latent tuberculosis infection, are we going to initiate treatment 0:27:07.760 --> 0:27:12.080 for you? Because the idea is the smaller the circle 0:27:12.119 --> 0:27:14.359 of things we care about as the health service of 0:27:14.400 --> 0:27:17.200 a jail, the less we have to do. So if 0:27:17.200 --> 0:27:19.600 you're a big county and you're let's say in New 0:27:19.680 --> 0:27:24.119 York or Chicago or Seattle, and your jail is also 0:27:24.280 --> 0:27:27.320 part of a local health department or a public hospital service, 0:27:27.760 --> 0:27:30.400 then you care. Then you want to know everybody who 0:27:30.400 --> 0:27:32.880 has latent tuberculus infection, and you want to make sure 0:27:32.920 --> 0:27:35.920 that they get connected, you know, with their consent to treatment, 0:27:36.240 --> 0:27:38.359 whether it's in the jail or when they go home. 0:27:38.880 --> 0:27:43.119 But for most of the three thousand or so county 0:27:43.160 --> 0:27:46.520 jails in this country, the circle of things they care 0:27:46.560 --> 0:27:49.080 about is pretty small, and it has to do with 0:27:49.119 --> 0:27:51.720 trying to prevent death. For the little time they're in jail, 0:27:52.200 --> 0:27:54.800 and so you miss that, and I think that it 0:27:54.880 --> 0:27:59.600 really goes towards this framing of healthcare. Behind bars is 0:27:59.720 --> 0:28:03.919 most mostly cut away from the rest of healthcare in 0:28:03.920 --> 0:28:06.400 this country, and so the things we say are important 0:28:06.560 --> 0:28:11.960 about quality, about continuity everywhere else kind of evaporate for 0:28:12.000 --> 0:28:13.360 a lot of people who are locked up. 0:28:14.440 --> 0:28:16.879 Let's take a quick break here. We'll be back before 0:28:16.920 --> 0:28:33.720 you know it. Welcome back, everyone. I'm here chatting with 0:28:33.840 --> 0:28:37.840 doctor Homer Venters about his book Outbreak behind Bars. Let's 0:28:37.840 --> 0:28:42.400 get into some more questions. In addition to tuberculosis, another 0:28:42.920 --> 0:28:46.640 infection that you touched on previously is MRSA or methasilone 0:28:46.680 --> 0:28:50.640 resistance Staphocloccus aureus, which is of course spread through close 0:28:50.720 --> 0:28:54.320 quarters and absolutely thrives. And this is something that you know, 0:28:54.400 --> 0:28:57.240 We've known about the hazards of MRSA and the challenges 0:28:57.280 --> 0:29:01.720 with controlling its spread for decades, and yet it continues 0:29:01.800 --> 0:29:05.720 to cause severe infections in these settings, in jails, prisons, 0:29:06.080 --> 0:29:10.160 immigration detention centers. What are some of the reasons for this, 0:29:10.320 --> 0:29:15.040 Like how does MRSA manifest differently, not manifest differently, but 0:29:15.520 --> 0:29:18.320 sort of play out differently in these settings compared to 0:29:18.440 --> 0:29:20.400 you know, community or hospital settings. 0:29:21.480 --> 0:29:27.200 Hospitals generally have a pretty strong rubric or structure of 0:29:27.200 --> 0:29:32.200 infection control because hospitals know that there are bugs of 0:29:32.240 --> 0:29:35.480 all sorts and hospitals, and that when people get infections 0:29:35.560 --> 0:29:38.320 new infections, they're more likely to die, They're more likely 0:29:38.320 --> 0:29:42.120 to get sick. It's very bad for the hospital for 0:29:42.200 --> 0:29:45.200 a variety of reasons. Just like you said, we know 0:29:45.360 --> 0:29:49.200 and have known for decades that these staphlocarcical skin infections 0:29:49.240 --> 0:29:53.320 are a serious problem behind bars. Anytime we find ourselves 0:29:53.360 --> 0:29:58.000 cramming more people into space than we know is a 0:29:58.000 --> 0:30:02.320 good idea. Anytime we stop doing the basic sanitation of 0:30:02.360 --> 0:30:05.920 these places, anytime we start to fall down on things 0:30:06.000 --> 0:30:09.320 like sick call or letting people get assessed for the 0:30:09.360 --> 0:30:14.280 care they need, then these are very quick response outbreaks. 0:30:14.280 --> 0:30:16.760 It's not some of these outbreaks could take a long 0:30:16.800 --> 0:30:20.560 time to develop, but these can flourish very quickly when 0:30:20.560 --> 0:30:24.200 these conditions get bad, when access to care is denied. 0:30:24.240 --> 0:30:26.200 I mean, one of the things I usually start with 0:30:26.760 --> 0:30:30.920 as a monitor is looking at I'll get all of 0:30:30.960 --> 0:30:34.600 the records of people who reported a boil, a blister, 0:30:34.920 --> 0:30:37.320 a sore on the skin, and then I'll go through 0:30:37.320 --> 0:30:40.040 those records and compare those to who got a culture, 0:30:40.720 --> 0:30:44.800 and you know, I'll find often that a great number 0:30:44.800 --> 0:30:48.120 of people had an open ulcer or sore on their 0:30:48.120 --> 0:30:51.040 skin that did not get a culture. That lack of 0:30:51.240 --> 0:30:57.480 adequate diagnosis means that we're undercounting likely these are staff 0:30:57.480 --> 0:30:59.840 for cocko skin infections, that some of them are MURSA. 0:31:00.440 --> 0:31:02.680 I would add in that, you know, the few times 0:31:02.800 --> 0:31:08.480 the researchers have looked at colonization rates colonization rates that 0:31:09.000 --> 0:31:10.880 I can think of two or three different studies where 0:31:10.880 --> 0:31:13.720 they find that the rate of colonization for MRSA behind 0:31:13.760 --> 0:31:16.440 bars is about ten times higher than in the community. 0:31:16.920 --> 0:31:18.600 And it's a little bit of a chicken in the 0:31:18.600 --> 0:31:22.120 egg like think of that solitary cell I mentioned where 0:31:22.120 --> 0:31:24.400 somebody was stuck in there for months. If that kind 0:31:24.400 --> 0:31:26.960 of place doesn't get cleaned, or these intake pens don't 0:31:26.960 --> 0:31:31.800 get cleaned, then you cycle people through and you develop 0:31:31.920 --> 0:31:35.040 newly colonized people. Even if they don't develop an infection 0:31:35.200 --> 0:31:36.440 that's an acute you know. 0:31:36.360 --> 0:31:42.360 Boil or sore, there's no effort for prevention or control 0:31:42.480 --> 0:31:45.600 once once it's already there, it just sort of is 0:31:45.800 --> 0:31:49.080 you know, managed the best you can, and you talk 0:31:49.120 --> 0:31:51.640 about you touch on this issue of the problems with 0:31:51.760 --> 0:31:56.640 data and accurate reporting, and in terms of reportable diseases, 0:31:57.000 --> 0:32:01.280 MRSA and someone ELLA do but they don't necessarily, as 0:32:01.320 --> 0:32:05.480 you said, are accurately reported. But something like heat doesn't count. 0:32:05.600 --> 0:32:09.840 So there are other ways that morbidity and mortality and 0:32:10.240 --> 0:32:14.760 you know, disease can manifest in these settings but may 0:32:14.800 --> 0:32:18.120 not be accurately reported. What are some of the issues 0:32:18.160 --> 0:32:18.560 with this? 0:32:19.640 --> 0:32:23.040 Both MRSA and heat are interesting because so MRSA, there's 0:32:23.080 --> 0:32:26.040 a great variation in what's reportable, but most states, if 0:32:26.080 --> 0:32:28.280 you have what you think is a MRSA outbreak, you're 0:32:28.280 --> 0:32:31.320 supposed to report it to the department of health. I 0:32:31.320 --> 0:32:33.280 think that in my position would be if you have 0:32:33.320 --> 0:32:35.800 a mercy case in a jail or a prison, somebody 0:32:35.800 --> 0:32:38.320 needs to go figure out is that an outbreak because 0:32:38.360 --> 0:32:40.760 it's hard to imagine a mercy case in a jail 0:32:40.840 --> 0:32:42.960 or a prison where you don't have exposure of other 0:32:43.000 --> 0:32:46.800 people and maybe other cases. So I think that that's 0:32:46.800 --> 0:32:48.880 a great example of where if you have a local 0:32:48.920 --> 0:32:51.400 health department with a little savvy who's been in a 0:32:51.480 --> 0:32:54.440 jail or prison, they would say, geez, we got one case, 0:32:54.480 --> 0:32:57.080 then maybe we should go look. I think heat is 0:32:57.120 --> 0:33:01.080 a great example, because you know, there are many jails 0:33:01.080 --> 0:33:04.000 and prisons and immigration detention centers around the country that 0:33:04.080 --> 0:33:06.800 have high heat conditions, so over eighty five degrees in 0:33:06.920 --> 0:33:10.480 living spaces, and you know that's sporadic, right. It might 0:33:10.520 --> 0:33:13.040 happen sometimes and it might go for days, it might 0:33:13.080 --> 0:33:15.640 go for one day. One of the things that all 0:33:15.680 --> 0:33:19.719 of these places know is they know which patients are 0:33:19.720 --> 0:33:23.680 heat sensitive. So there's a standard list that's used to 0:33:23.840 --> 0:33:27.560 identify people who are older, high bmi, anti who are 0:33:27.560 --> 0:33:31.720 taking anti psychotics, diuretics, certain there's like in New York City, 0:33:31.720 --> 0:33:35.160 we had a standard list where we looked at everybody 0:33:35.160 --> 0:33:38.880 coming in the door during I think maybe from April 0:33:38.920 --> 0:33:41.680 to October, and we would say are you heat sensitive? 0:33:41.760 --> 0:33:45.400 Yes or no? And then on high heat days it 0:33:45.440 --> 0:33:47.400 was the job of the Health Service and the security 0:33:47.480 --> 0:33:49.240 service to make sure all those people were in air 0:33:49.280 --> 0:33:52.920 conditioned housing. And most jails and prisons can't do that. 0:33:53.840 --> 0:33:57.239 And that is a problem because first of all, there 0:33:57.240 --> 0:33:59.520 are a lot of places, and Texas is where a 0:33:59.520 --> 0:34:02.080 lot of the cases I cite are from there are 0:34:02.080 --> 0:34:03.760 a lot of places that just have no air conditioning. 0:34:04.120 --> 0:34:06.959 But even the places that have air conditioning do have 0:34:07.000 --> 0:34:10.160 air conditioning that breaks down, you know, or there's an emergency, 0:34:10.239 --> 0:34:12.520 or people have you move housing areas something like that. 0:34:12.600 --> 0:34:16.000 And so this data about who's heats sensitive is known, 0:34:16.520 --> 0:34:20.000 but my experience is it's not really utilized by the 0:34:20.040 --> 0:34:22.879 Health service because nobody's given them the job. Look, these 0:34:22.880 --> 0:34:26.680 are high heat conditions. You may have to this circumstance 0:34:26.719 --> 0:34:29.120 or that circumstance, find who's heat sensitive, and then go 0:34:29.160 --> 0:34:31.200 do extra monitoring of them, or check on them, or 0:34:31.200 --> 0:34:33.360 make sure they're okay, or get them into AC housing. 0:34:34.080 --> 0:34:36.520 But I think that this is increasingly a problem because 0:34:36.560 --> 0:34:40.239 you have more facilities in the Midwest. I mentioned, you 0:34:40.280 --> 0:34:43.000 know that I was in the Northwest and it was 0:34:43.080 --> 0:34:45.480 like over one hundred and fifteen degrees one hundred and 0:34:45.520 --> 0:34:48.120 eighteen degrees or something in Washington, and so it was 0:34:48.160 --> 0:34:51.600 a good exercise for us to practice. But this is 0:34:51.640 --> 0:34:55.719 an increasing problem, and as AC units break or as 0:34:55.800 --> 0:34:59.080 people are in places that weren't previously so hot, you know, 0:34:59.120 --> 0:35:01.560 we need to figure out how to keep people safe. 0:35:02.080 --> 0:35:05.120 The things that we've talked about are the ways that 0:35:05.320 --> 0:35:10.600 disease spreads differently in these settings compared to community settings. 0:35:11.280 --> 0:35:15.640 And there also seems to be this barrier of just 0:35:16.080 --> 0:35:19.640 you know, caring about attention to these issues. And so, 0:35:20.040 --> 0:35:23.600 you know, did disease spread within correctional facilities really only 0:35:23.600 --> 0:35:25.840 seem to matter to people when a disease threatens to 0:35:25.880 --> 0:35:29.719 spill over to the into the community. But how do 0:35:29.960 --> 0:35:34.319 infections behind bars also drive community outbreaks? And why is 0:35:34.360 --> 0:35:37.840 that reality so often either ignored or denied? 0:35:38.560 --> 0:35:41.839 Well, that last part is a pretty deep question. I'm 0:35:41.840 --> 0:35:46.560 not sure I have expertise or insights to answer. I 0:35:46.560 --> 0:35:50.840 think you know, a colleague, Eric Reinhardt, who's a physician 0:35:50.880 --> 0:35:53.640 and an epidemiologist, did some great He and a team 0:35:53.680 --> 0:35:58.600 did great, great research around COVID in the Cook County 0:35:58.680 --> 0:36:02.560 jails in Chicago's County jails driving local outbreaks. So they 0:36:02.880 --> 0:36:06.640 tabulated what it looked like, how many cases for an 0:36:06.840 --> 0:36:09.960 in jail outbreak we're driving out of jail context, much 0:36:10.000 --> 0:36:12.440 more than you would expect from just normal community spread. 0:36:12.840 --> 0:36:15.640 And certainly if you pick any one of these diseases, 0:36:16.040 --> 0:36:18.600 keeping in mind, especially with jails, you have the churn 0:36:18.640 --> 0:36:20.440 of people going in and out, in and out in 0:36:20.520 --> 0:36:24.400 and out or immigration detention where it's like a pinball 0:36:24.440 --> 0:36:26.360 machine where people are going from one place to another 0:36:26.400 --> 0:36:30.480 to another to another. That obviously can drive transmission from 0:36:30.480 --> 0:36:33.759 staff and other people around them, whether they're going home 0:36:33.840 --> 0:36:35.560 or they're just going to a new facility. And so 0:36:35.840 --> 0:36:40.360 I think that the concept is pretty understandable. I don't 0:36:40.360 --> 0:36:44.200 know why it is hard to figure out a better 0:36:44.280 --> 0:36:46.919 path to pay attention to. I think that a big 0:36:46.960 --> 0:36:50.080 part of it is people ultimately don't care. A lot 0:36:50.120 --> 0:36:53.720 of policymakers just don't have as a high priority these people, 0:36:53.880 --> 0:36:57.800 or their families or their communities. One of the last 0:36:57.800 --> 0:36:59.879 things we did before I left Rikers is we looked 0:36:59.920 --> 0:37:03.200 at blows to the head. So most jails and prisons 0:37:03.239 --> 0:37:07.080 don't report anything about TBI or how often their patients 0:37:07.080 --> 0:37:09.160 get hit in the head. But what we did is we, 0:37:09.280 --> 0:37:11.680 because we had an electronic medical record, we built in 0:37:11.760 --> 0:37:14.600 this like very good tool for tracking new blows to 0:37:14.640 --> 0:37:16.719 the head. We then tried to extrapolate to the rest 0:37:16.800 --> 0:37:20.840 of the country how many people were accruing new blows 0:37:20.840 --> 0:37:25.360 to the head, new concussions or more severe traumatic brain injury, 0:37:25.880 --> 0:37:28.400 and then what that means for their communities and their families, 0:37:28.400 --> 0:37:31.080 is they go home not just for the shortened medium 0:37:31.160 --> 0:37:34.040 term TBI, but for CTE to think we have all 0:37:34.040 --> 0:37:38.319 these poor communities, heavily police communities where people are going 0:37:38.440 --> 0:37:41.640 home with having new blows to the head. They also 0:37:41.680 --> 0:37:43.960 either way have like all these obligations of things they're 0:37:43.960 --> 0:37:46.640 supposed to do, appointments they're supposed to keep, and so 0:37:46.719 --> 0:37:49.640 we try to calculate kind of what we estimate the 0:37:49.719 --> 0:37:53.360 national rate of this TBI could be. But it goes 0:37:53.400 --> 0:37:56.319 towards this question you asked, which is you know who 0:37:56.400 --> 0:38:00.640 cares about this? And I think that health people and 0:38:00.719 --> 0:38:03.279 doctors are not going to fix these social problems. But 0:38:03.320 --> 0:38:05.640 I do think it's the role of public health agencies 0:38:05.640 --> 0:38:08.000 to care about them. So if you're a local health department, 0:38:08.120 --> 0:38:11.080 you should know that people have come home from a 0:38:11.160 --> 0:38:14.720 jail with scabies and they didn't get the forty dollars 0:38:14.760 --> 0:38:18.600 treatment or you know, a second forty dollars treatment that 0:38:18.640 --> 0:38:20.400 they needed because it was ineffective in the jail, or 0:38:20.440 --> 0:38:22.160 you should know that they came home with these problems. 0:38:22.200 --> 0:38:25.160 Because these do it should matter for you as a 0:38:25.200 --> 0:38:26.320 public health authority. 0:38:26.840 --> 0:38:31.640 And I think what rolls into this too is resources 0:38:31.840 --> 0:38:35.799 and just the investment cost upfront. And you know, the 0:38:35.880 --> 0:38:40.400 for profit prison system is dystopian and horrific for a 0:38:40.480 --> 0:38:43.880 myriad of reasons, endless reasons. And one of those reasons 0:38:44.080 --> 0:38:46.360 that you discuss in your book is that there's often 0:38:46.480 --> 0:38:50.040 or sometimes a policy of withholding medical care to save 0:38:50.160 --> 0:38:54.760 on expenses. How does this approach lead to just overall 0:38:54.840 --> 0:38:58.319 higher death and disability, especially from treatable conditions. 0:38:58.920 --> 0:39:01.920 Well, I think it goes towards this question of like, 0:39:02.160 --> 0:39:05.799 how narrowly have you drawn this circle about health things 0:39:05.880 --> 0:39:08.960 that you care about inside? So you know, a good 0:39:09.160 --> 0:39:14.759 example is goneria chlamydia diagnosis and treatment. So we know 0:39:14.960 --> 0:39:20.200 that if you test males for connery and chlamydia who 0:39:20.200 --> 0:39:23.440 are coming into jails who are asymptomatic, we know that 0:39:23.440 --> 0:39:25.680 that's not just effective for them personally, but it's also 0:39:25.800 --> 0:39:27.960 effective for their partners. There are sexual partners when they 0:39:28.000 --> 0:39:31.279 go out, and so that makes very good sense from 0:39:31.320 --> 0:39:35.280 a cost effectiveness and also a kind of a public 0:39:35.320 --> 0:39:40.200 health framework for reducing high risk pregnancies for instance, for 0:39:40.440 --> 0:39:43.839 you know, transmission of gunneryia chlamydia. I think though, that 0:39:44.160 --> 0:39:47.080 the sanity or the good evidence behind these ideas isn't 0:39:47.120 --> 0:39:50.200 hard to represent. I think it just shows kind of 0:39:50.200 --> 0:39:53.240 the relative weakness of public health in our country, especially 0:39:53.280 --> 0:39:57.600 now that we know we have good strategies for effective treatment. 0:39:58.080 --> 0:40:01.400 We know that putting people behind ours who have a 0:40:01.400 --> 0:40:04.840 mental health crisis or behavioral health crisis or of substance 0:40:04.920 --> 0:40:08.200 use issues isn't an effective way to treat their substance 0:40:08.280 --> 0:40:11.000 use or their mental health problems. But there is. I 0:40:11.040 --> 0:40:13.160 don't think it's just that there are champions of the 0:40:13.200 --> 0:40:16.640 policies that are bad for public health. It's that there 0:40:17.080 --> 0:40:18.960 is a long list of people who will make a 0:40:19.000 --> 0:40:22.120 lot of money off of those policies being implemented in 0:40:22.120 --> 0:40:23.800 a way that causes harm. 0:40:24.400 --> 0:40:28.279 One of the things that you discuss, and one of 0:40:28.320 --> 0:40:33.239 the biggest sources of harm, of course, is the COVID pandemic, 0:40:33.320 --> 0:40:38.520 and you write about ones in specific, the Farmville super 0:40:38.520 --> 0:40:42.359 spreader event and sort of the bureaucratic apathy that really 0:40:42.400 --> 0:40:45.920 fanned the flames of this virus. Can you take me 0:40:46.080 --> 0:40:49.320 through this event briefly, just you know how it began, 0:40:49.480 --> 0:40:52.040 how it worsened, some of the errors that were made, 0:40:52.160 --> 0:40:55.080 and hopefully any lessons that we have learned from that. 0:40:56.040 --> 0:41:02.240 Yeah, I don't again. You finished with the hardest, most 0:41:02.360 --> 0:41:06.680 sobering part which lessons learned. Jeez, I think that you know, 0:41:06.719 --> 0:41:08.640 when I wrote the book, I was worried that the 0:41:08.680 --> 0:41:12.480 Farmville chapter would seem fantastic or over the top, the 0:41:12.520 --> 0:41:15.560 story of what I kind of knew happened and the 0:41:15.640 --> 0:41:19.200 reporting that people, not me, but others did. But now 0:41:19.800 --> 0:41:24.280 it doesn't seem so fantastic. But the problem was COVID 0:41:24.360 --> 0:41:27.000 was in full swaying. It was the summer of twenty twenty. 0:41:27.360 --> 0:41:30.319 The CDC had already given very good guidance about some 0:41:30.520 --> 0:41:34.359 basic steps to prevent COVID in detention setting. So this 0:41:34.520 --> 0:41:37.600 was the CDC had come out with specific guidance for 0:41:37.680 --> 0:41:40.120 what to do and not to do behind bars, and 0:41:40.200 --> 0:41:44.200 two of the things were don't move people around, certainly, 0:41:44.239 --> 0:41:47.160 don't move them from places with COVID place without COVID. 0:41:47.600 --> 0:41:49.640 And when they get to the new place, they're going 0:41:49.680 --> 0:41:52.160 to take all these steps to make sure that they 0:41:52.160 --> 0:41:54.879 don't have COVID before you put them into the main 0:41:55.120 --> 0:41:57.680 kind of area with everybody else. Those are two things 0:41:57.719 --> 0:42:01.000 actually that were happening at farm So Farmville is a 0:42:01.040 --> 0:42:03.919 for profit detention center that was, you know, an ice 0:42:03.960 --> 0:42:07.920 detention center, but then, for reasons that weren't clear to 0:42:07.960 --> 0:42:09.960 me or I didn't know about when I did the inspection, 0:42:10.640 --> 0:42:16.200 people were moved in the summer from three ICE facilities 0:42:16.600 --> 0:42:19.960 that had current or very recent COVID cases, two in Arizona, 0:42:20.040 --> 0:42:24.120 one down in Florida. Seventy four people moved into the 0:42:24.160 --> 0:42:27.919 Farmville Detention Center, and this place had never received seventy four. 0:42:27.960 --> 0:42:30.239 I'm not sure they had really received seven or eight 0:42:30.760 --> 0:42:32.800 very often, but certainly they'd never gotten this kind of 0:42:32.920 --> 0:42:35.880 big group of people before they tried to stop it. 0:42:36.000 --> 0:42:40.319 They were steamrolled by you know, ICE authorities, and not 0:42:40.480 --> 0:42:44.600 only were all these people forced upon them, but then 0:42:45.200 --> 0:42:48.520 their standard approach, which had been very effective up to 0:42:48.560 --> 0:42:51.160 that point, which was to keep people off site for 0:42:51.239 --> 0:42:55.120 fourteen days in a separate building for their intake quarantine, 0:42:55.520 --> 0:42:57.560 that also was steamrolled. So they said, no, you have 0:42:57.600 --> 0:43:00.640 to go right into let's push that process. So these 0:43:00.640 --> 0:43:03.640 two things the CDC had said you should do, which 0:43:03.680 --> 0:43:06.640 is not moving people from places with COVID into places 0:43:06.640 --> 0:43:11.120 without COVID, this kind of fourteen day quarantine that obviously 0:43:11.200 --> 0:43:14.120 was pushed aside, and within days people had COVID symptoms 0:43:14.120 --> 0:43:16.640 and they went from zero COVID to about ninety percent 0:43:16.680 --> 0:43:20.600 of the people in this facility getting COVID, including a 0:43:20.680 --> 0:43:24.520 man from Canada who died from COVID and his family, 0:43:24.560 --> 0:43:28.560 I put in the book heartbreakingly had pleaded to let 0:43:28.640 --> 0:43:30.799 him just come home to Canada. They were going to 0:43:30.800 --> 0:43:32.720 set up a special place for him in their house 0:43:32.719 --> 0:43:36.400 where he could do an actual intake quarantine in the house. 0:43:36.800 --> 0:43:40.560 They made changes, and he's the gentleman who died. But 0:43:41.120 --> 0:43:44.319 I think that what came out afterwards this wasn't part 0:43:44.320 --> 0:43:47.040 of my work, But what the Washington Post report was 0:43:47.080 --> 0:43:50.480 that this was kind of a crass effort to get 0:43:50.560 --> 0:43:53.600 ice and federal agents moved from one part of the 0:43:53.600 --> 0:43:56.120 country to another part of the country, and that there 0:43:56.120 --> 0:43:59.240 were apparently some federal laws or regulations about you couldn't 0:43:59.280 --> 0:44:02.000 just move them around, and so somebody had ended up 0:44:02.040 --> 0:44:04.600 this idea that well, we'll move these all these people 0:44:04.760 --> 0:44:07.359 and then with them move these federal agents so that 0:44:07.400 --> 0:44:09.800 they can be in the DC area to put down 0:44:10.040 --> 0:44:13.480 the Black Lives Matter protests. That's the reporting of the 0:44:13.600 --> 0:44:17.640 Washington Post. You know, what I saw was just the 0:44:17.680 --> 0:44:20.600 outbreak side of this, which was this place had this 0:44:21.320 --> 0:44:25.160 pretty standard approach. It was pushed aside, and then you know, 0:44:25.239 --> 0:44:27.880 COVID was everywhere in the facility. 0:44:27.920 --> 0:44:30.640 And there was really this ultimately kind of this lack 0:44:30.680 --> 0:44:31.960 of accountability. 0:44:32.520 --> 0:44:36.239 I think there are two important principles that you need 0:44:36.320 --> 0:44:40.720 both of one is transparency and the other is accountability 0:44:40.880 --> 0:44:43.200 and so and this is again where I think human 0:44:43.280 --> 0:44:45.440 rights framing is very effective. Although you could find this 0:44:45.480 --> 0:44:49.239 in community health too, But the transparency about what's the 0:44:49.280 --> 0:44:54.160 truth of what happened, what actually occurred, was hard to understand, 0:44:54.160 --> 0:44:57.480 but we've eventually got there. The accountability, which is well, 0:44:57.520 --> 0:45:01.719 who is punished, who gets in trouble, who pays for this? 0:45:01.920 --> 0:45:04.920 I'm not sure. I think that there was a lawsuit. 0:45:05.000 --> 0:45:07.160 I was there because there was litigation, and so I 0:45:07.239 --> 0:45:10.040 was an expert for people, family members I think, and 0:45:10.160 --> 0:45:13.480 others who had brought this suit. And for a while 0:45:13.560 --> 0:45:15.799 the facility was limited in how many people they could 0:45:15.840 --> 0:45:19.959 have in the building by the courts. But I think 0:45:20.000 --> 0:45:22.279 that it goes towards this much bigger issue. You know, 0:45:22.320 --> 0:45:26.040 if a hospital or a dialysis clinic screws up in 0:45:26.080 --> 0:45:29.440 a way that really harms people, they often will lose 0:45:29.480 --> 0:45:33.120 their ability to either function. Right. If a transplant team 0:45:33.400 --> 0:45:36.160 or a central line infections whatever, they may lose their 0:45:36.200 --> 0:45:40.799 license the state Department of Health or CMS. There are 0:45:40.840 --> 0:45:44.319 real consequences for health systems that screw up in a 0:45:44.320 --> 0:45:48.760 way that's disavoidable and that hurts people. This is almost 0:45:48.800 --> 0:45:51.640 never the case behind bars, even though these are big 0:45:51.680 --> 0:45:54.160 health systems, and it really goes to the fact that 0:45:54.520 --> 0:45:57.960 the structures that do that important job, not just to 0:45:58.040 --> 0:46:02.319 the transparency but the accountability, they're pretty much a wall 0:46:02.640 --> 0:46:04.400 when it comes to healthcare behind bars. 0:46:05.280 --> 0:46:09.799 Mmmmm hm. And you discuss in your book and you 0:46:09.840 --> 0:46:13.239 have mentioned that you carry out inspections, you know at 0:46:13.280 --> 0:46:16.200 these different settings in jails and prisons. What are you 0:46:16.760 --> 0:46:19.960 looking for with these inspections and why is an in 0:46:20.080 --> 0:46:24.160 person inspection so critical compared to like a video inspection 0:46:24.280 --> 0:46:24.920 for example. 0:46:25.400 --> 0:46:27.960 Another thing I've learned in human rights is there's always 0:46:28.000 --> 0:46:30.919 a legal context for what you're doing, so you may 0:46:30.960 --> 0:46:34.360 not if you find yourself in a place doing something, 0:46:35.320 --> 0:46:37.440 you really need to understand what's the context for what 0:46:37.480 --> 0:46:40.080 you what got you there? And so for me, you know, 0:46:40.120 --> 0:46:42.399 when I go to a jail or prison, it may 0:46:42.400 --> 0:46:45.960 be that me being there if I'm there is a 0:46:46.040 --> 0:46:49.719 monitor where every like a court or the state of 0:46:50.040 --> 0:46:53.400 whatever a governor's officer or somebody has asked me to 0:46:53.440 --> 0:46:56.480 go there, then I'm able to kind of go pretty 0:46:56.480 --> 0:46:58.680 broadly and look in all the nooks and crannies that 0:46:58.680 --> 0:47:01.000 I need to. If I'm there, it's part of litigation. 0:47:01.160 --> 0:47:04.720 There may have been a very serious fight about either 0:47:05.040 --> 0:47:06.880 keeping me out of the facility, and then if I 0:47:06.920 --> 0:47:10.440 am ultimately able to go in limiting my ability who 0:47:10.480 --> 0:47:12.400 I can talk to, what I can do, what I 0:47:12.400 --> 0:47:15.680 can look at, and so from my standpoint, it's important 0:47:15.719 --> 0:47:18.279 to understand at the outside what am I there to do. 0:47:18.840 --> 0:47:22.040 So if it's a COVID outbreak, I want to know 0:47:22.360 --> 0:47:24.439 kind of some basic questions about what are they doing 0:47:24.480 --> 0:47:27.680 to prevent COVID coming in, what are they doing to 0:47:27.760 --> 0:47:31.360 diagnose and treat people once COVID is inside, and what 0:47:31.400 --> 0:47:33.279 are they doing to protect high risk people. So there 0:47:33.320 --> 0:47:36.680 are certain physical places I'll want to go, data I'll 0:47:36.719 --> 0:47:40.239 want to review, but probably the most one of the 0:47:40.239 --> 0:47:44.440 most essential tools is confidential interviews with people who are there. 0:47:44.760 --> 0:47:47.080 Those people sometimes take a risk in talking to an 0:47:47.080 --> 0:47:51.960 outside inspector because it's knowable, right, It's known who is 0:47:52.040 --> 0:47:54.839 talking to this outsider, and I wouldn't say every time, 0:47:54.880 --> 0:47:57.920 but I often hear from people that they were warned 0:47:58.520 --> 0:48:00.920 or threatened before they speak with me or speak with 0:48:00.960 --> 0:48:05.560 somebody else. But those confidential interviews are really critical because it's, 0:48:05.920 --> 0:48:08.360 you know, it's as if you're walking into a hospital 0:48:08.400 --> 0:48:10.680 and you don't know how the hospital works, or what 0:48:10.800 --> 0:48:14.759 floor anything's on or where you know. So those confidential 0:48:14.760 --> 0:48:17.560 interviews for me are important for the inspection, but they're 0:48:17.560 --> 0:48:19.919 also important for you know, what documents do I ask 0:48:20.000 --> 0:48:23.160 for or what parts of medical records do I look at? 0:48:23.880 --> 0:48:25.919 I want to touch on, you know, something that we've 0:48:26.040 --> 0:48:28.239 kind of circled around a bit here and there, and 0:48:28.280 --> 0:48:33.200 that is this astronomical rise in ice raids and a 0:48:33.320 --> 0:48:36.560 number of people that are being put in or moved 0:48:36.600 --> 0:48:40.880 around these immigration detention centers with this current administration. And 0:48:41.520 --> 0:48:45.000 in your book, you discussed this horrifying story from twenty 0:48:45.080 --> 0:48:47.880 nineteen about the sixteen year old boy who was diagnosed 0:48:47.880 --> 0:48:51.200 with influenza and died in a holding cell after being 0:48:51.360 --> 0:48:55.239 detained by border patrol. And I was curious to hear 0:48:55.320 --> 0:48:58.480 your thoughts on you know, what do you see happening 0:48:58.560 --> 0:49:01.120 and how much or will will we actually hear about 0:49:01.200 --> 0:49:04.359 or learn about these things as they're happening, versus in 0:49:04.400 --> 0:49:06.080 the future in. 0:49:06.000 --> 0:49:11.520 The narrow frame of outbreaks. I worry a lot about 0:49:11.560 --> 0:49:15.680 people having infections or communicable diseases that they can spread 0:49:15.719 --> 0:49:18.680 to each other. One of the problems at Farmville is 0:49:18.719 --> 0:49:22.520 the basic infection control measures that were in place that 0:49:22.600 --> 0:49:25.719 Ice said let's do this, those got pushed aside just 0:49:25.719 --> 0:49:28.080 so you could cram more people into this box. I 0:49:28.120 --> 0:49:32.520 think that that approach, I'm concerned is much more widespread now. 0:49:32.560 --> 0:49:36.840 If people are being put into a system in places 0:49:36.880 --> 0:49:40.080 that aren't used, like if they're being, for instance, put 0:49:40.080 --> 0:49:43.319 into offices, if they're put into gymnasiums, if they've been 0:49:43.320 --> 0:49:46.720 put into these places and they're not being screened for 0:49:47.920 --> 0:49:50.799 all the basic kind of health issues, including signs and 0:49:50.800 --> 0:49:53.400 symptoms of infections when they come in, then it not 0:49:53.480 --> 0:49:57.120 only increases their risk of morbidity and mortality, but it 0:49:57.160 --> 0:50:01.279 also actively dramatically increases the risk of spread of all 0:50:01.280 --> 0:50:05.839 these problems. I think that, you know, the problem sometimes 0:50:05.960 --> 0:50:11.960 with assessing morbidity and mortality for people in immigration detention 0:50:12.200 --> 0:50:15.560 is that many of them end up somewhere else. They 0:50:15.560 --> 0:50:17.920 get off a plane or a bus or somewhere in 0:50:17.960 --> 0:50:20.120 another country, so we don't know what happened to them. 0:50:20.200 --> 0:50:23.400 So if a person you know, was just about to 0:50:23.400 --> 0:50:26.360 start dialysis and then they get off the plane in 0:50:26.400 --> 0:50:28.480 a place where they're never going to get dialysis, we 0:50:28.520 --> 0:50:30.400 don't know that they're going to die of renal failure, 0:50:30.400 --> 0:50:33.160 but they may. The same goes for you know, infection, 0:50:33.360 --> 0:50:36.880 for people that have any kind of communicable disease. So 0:50:36.920 --> 0:50:40.600 I think that my experience is that when you jam 0:50:40.719 --> 0:50:44.399 and cram more humans into these tight spaces and move 0:50:44.440 --> 0:50:48.399 them around, if you also at the same time push 0:50:48.440 --> 0:50:53.319 aside your basic infection control and medical screening processes, which 0:50:53.400 --> 0:50:56.480 was the case in Farmville, then you really create a 0:50:56.600 --> 0:51:00.399 much higher likelihood of the spread of communicable disease for them, 0:51:00.520 --> 0:51:03.799 but also for the staff or you know, doing all 0:51:03.840 --> 0:51:07.600 this transportation and interacting with people. 0:51:08.560 --> 0:51:12.399 We have touched on so many different issues and at 0:51:12.440 --> 0:51:17.279 every level, from you know, individual bias, to these structural 0:51:17.320 --> 0:51:21.400 problems to these like systemic issues that are so pervasive 0:51:21.600 --> 0:51:25.440 in these settings, and it really does feel in some 0:51:25.480 --> 0:51:29.920 ways almost like this massive, insurmountable problem. But I'd like 0:51:30.000 --> 0:51:32.480 to end our conversation with just sort of talking about 0:51:32.560 --> 0:51:35.560 what you might see as a path forward. Like, I 0:51:35.600 --> 0:51:38.880 know this is another maybe difficult question, but like what 0:51:39.080 --> 0:51:41.440 are the immediate steps that can be taken, and I 0:51:41.480 --> 0:51:44.000 know you touched on some of them, but how do 0:51:44.080 --> 0:51:48.200 we ultimately overcome the apathy and disregard for human rights? 0:51:48.320 --> 0:51:52.479 Which maybe is again that the deep philosophical question that's 0:51:52.840 --> 0:51:54.040 really challenging to answer. 0:51:54.719 --> 0:51:56.600 I mean it is. I don't think it is a 0:51:56.680 --> 0:52:00.000 kind of existential problem or question, but I do say 0:52:00.000 --> 0:52:02.840 think that having a little bit of humility about our ability, 0:52:02.960 --> 0:52:06.319 like in epidemiology and medicine and public health. Most of 0:52:06.360 --> 0:52:09.960 the world is not in those domains, but we do 0:52:10.040 --> 0:52:12.839 have local health departments and state health departments, and in 0:52:12.880 --> 0:52:15.560 some circumstances we can hold them to account to say, 0:52:15.560 --> 0:52:18.080 you need to worry about these things. And the fact 0:52:18.120 --> 0:52:20.480 that we're losing right now, the fact that we're you know, 0:52:20.800 --> 0:52:24.360 resources are being stripped away. I understand that it's a horrible, 0:52:24.400 --> 0:52:28.560 painful process, but I do think that it's important as 0:52:28.600 --> 0:52:32.400 a principle to establish or to keep circling back to. 0:52:33.200 --> 0:52:35.920 You know, if you're a health department, you have to 0:52:36.000 --> 0:52:40.040 care about the health of the most vulnerable people, the 0:52:40.040 --> 0:52:44.160 people who have conditions that we want to diagnose and treat, 0:52:44.719 --> 0:52:47.759 and that shouldn't and can't stop when they're behind the 0:52:47.760 --> 0:52:49.879 bars of a jail or a prison or a nice 0:52:49.920 --> 0:52:54.280 detention center, and so as a monitor in very few places. 0:52:54.280 --> 0:52:56.840 But one of the things I've been able to push 0:52:56.920 --> 0:52:59.160 for is to get a local health department to build 0:52:59.239 --> 0:53:02.240 up some resource to do that. And I think that 0:53:02.239 --> 0:53:04.920 that won't fix some of the problems. There are inherent 0:53:05.480 --> 0:53:08.680 health risks of incarceration. So this is kind of your 0:53:09.239 --> 0:53:12.279 where I love this this term. You know the ecology 0:53:12.320 --> 0:53:15.040 of epidemics, but people should know that who are in 0:53:15.080 --> 0:53:17.200 the health departments, they should understand that, and they should 0:53:17.200 --> 0:53:19.920 be they should have on their radar and their responsibility 0:53:19.960 --> 0:53:23.279 list being involved in those risks and being involved in 0:53:23.320 --> 0:53:26.399 those places. And so I think that anywhere that I'm 0:53:26.440 --> 0:53:29.640 involved now recently and for the rest of my career, 0:53:30.120 --> 0:53:32.320 it will be how can we get the health public 0:53:32.320 --> 0:53:36.080 health experts on the hook for looking into these places. 0:53:37.000 --> 0:53:40.359 Doctor Venters, This has been just such an insightful and 0:53:40.560 --> 0:53:44.000 really important conversation and I really appreciate you taking the 0:53:44.000 --> 0:53:45.200 time to chat with me today. 0:53:45.640 --> 0:53:47.719 Thank you so much. It was really great to meet 0:53:47.760 --> 0:53:50.759 you to learn about your podcast and the other fantastic 0:53:50.840 --> 0:53:52.160 episodes you've done, so thank you. 0:54:12.160 --> 0:54:14.680 A big thank you again to doctor Homer Venors for 0:54:14.760 --> 0:54:18.000 taking the time to chat with me. This is such 0:54:18.120 --> 0:54:21.640 a crucial topic, especially with the current political climate. If 0:54:21.640 --> 0:54:23.720 you would like to learn more about the topics featured 0:54:23.760 --> 0:54:26.799 on this episode, check out our website This podcast will 0:54:26.840 --> 0:54:29.040 Kill You dot com, where I'll post a link to 0:54:29.080 --> 0:54:33.240 where you can find outbreak behind Bars, spider Bites, human Rights, 0:54:33.239 --> 0:54:36.160 and the Unseen Danger to Public Health, as well as 0:54:36.160 --> 0:54:38.479 a link to doctor Venter's website where you can find 0:54:38.480 --> 0:54:41.120 his other great work, like his other book, Life and 0:54:41.200 --> 0:54:44.200 Death in Riker's Island and Don't Forget. 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