A Rikers Island Doctor Speaks Out to Save Her Elderly Patients from the Coronavirus20 March 2020
On Wednesday, we published a tweet thread that Dr. Rachael Bedard, the former Osborne Board Member and geriatrics and palliative care physician who works on Rikers Island. Today, the New Yorker published an interview with Dr. Bedard.
That day, Mayor Bill de Blasio announced plans to release forty people from the jail system in light of the coronavirus outbreak (a number that Bedard and advocates say is not sufficient.)
Jennifer Gonnerman asked Dr. Bedard about her job, the pressures she faces now, and what she and her colleagues are doing to try to stop the spread of the virus inside the city’s jails.
You can read the interview here in its original form. The interview is also copied below.
By Jennifer Gonnerman
March 20, 2020
Rachael Bedard is a geriatrician who works on Rikers Island, caring for the oldest and sickest people in the New York City jail system. This week, as Mayor Bill de Blasio banned large gatherings and considered a citywide lockdown, Bedard and a few of her colleagues spoke out on behalf of their patients. “We need to take the unprecedented step TODAY of providing urgent release to everyone in the jails who is at risk of serious morbidity and mortality from COVID,” Bedard wrote on Twitter, on Wednesday. That day, local news outlets reported that the coronavirus had arrived on Rikers: an incarcerated person and a correction officer who worked at a security gate near the island’s entrance had both tested positive for covid-19. There are about fifty-four hundred people in the city’s jails, and more than nine hundred of them are fifty and older, according to the Board of Correction. Most have not been convicted of the charges against them; they are waiting for their cases to move through the courts.
By Thursday, Bedard, who is thirty-seven, had a low-grade fever and stayed home from work; she has not yet been tested for covid-19. When we spoke on the phone that afternoon, she sometimes had to pause because, she said, “I’m a little short of breath.” That day, de Blasio announced plans to release forty people from the jail system in light of the coronavirus outbreak, a number that Bedard and advocates say is not sufficient. When we spoke, I asked Bedard about her job, the pressures she faces now, and what she and her colleagues are doing to try to stop the spread of the virus inside the city’s jails. Our conversation has been edited for length and clarity.
People talk about jails and prisons being incubators for infection. How does that work exactly on Rikers?
Rikers Island is a mini city unto itself. It is not just detainees and guards. It is thousands of people coming on and off every day. And so, in the same way that the city is struggling with the complexity of its response, we are doing that on our smaller but almost more urgent scale because, like a nursing home, a jail is a perfect setup for an outbreak.
Before covid-19 appeared on Rikers Island, what was your job? What types of individuals were you caring for on a daily basis?
I’m the senior director of the geriatrics and complex-care service. My specialty is taking care of people who are older and sick and then also coördinating with the courts to come up with creative solutions to get these folks out of custody as often as possible. I run a team of two other clinicians—a nurse and a nurse practitioner—social workers, and reëntry specialists. And we, as a team, follow the hundred and eighty-five oldest and sickest patients in the jail system through the facilities, as they go to the hospital, and then for a period of time after they leave.
Tell me about some of your patients. What health problems do they have?
First of all, I think there’s this incredible misconception about who’s sitting in jail. I have taken care of, in my three-and-a-half-year jail career, multiple patients over ninety. I currently have a patient over ninety.
You have a patient on Rikers who is older than ninety?
Yes. This is a guy currently being held in pretrial detention. I have multiple patients in their eighties. I have patients who are A.D.L.-impaired—which means that they cannot attend to their own activities of daily living and would be nursing-home- or assisted-living-eligible if they were in the community—who need daily assistance with really basic tasks like toileting and changing themselves. I have patients who are paraplegic with significant wounds that require daily wound care. I have multiple patients who have active cancer and are getting chemotherapy and are both sick and immunosuppressed from their medication.
I have taken care of patients who are on dialysis, who have to be transported three times a week to be dialyzed. I have taken care of patients who have bounced back and forth from the hospital in the last several months. I take care of patients who are H.I.V.-positive with low CD4 counts. We see an enormous amount of folks who have substance-use disorders, who have had a history of traumatic brain injury.
Jails are a place where you see an incredible concentration of pathology for a variety of reasons. On the whole, our population has poor access to primary preventative health care. These are folks who have been living on the margins. Poor socioeconomic status, homelessness, etc., are obviously incredibly prevalent for our guys.
The popular misconception, I think, is that jails are full of healthy and aggressive young men. And I can’t emphasize enough how different that is from the experience I have when I walk through our infirmary and visit with my patients.
When did you start worrying about what impact the coronavirus could have on Rikers Island?
For at least two weeks, this has been basically all I have been working on, thinking about: How are we going to identify people? What will we do if somebody has a fever? All of those things. But as the situation has evolved locally and nationally, obviously our protocols have evolved as well. It has just been incredibly clear to us—as it always is—that the jails are not a closed system. They are vulnerable to whatever is happening in the city. So if the city was not going to be able to contain and mitigate viral spread, we had absolutely no chance of doing that any more effectively in the jails.
We’re talking about an average daily population [of incarcerated people] that’s come down dramatically in the last couple of years but is about five thousand four hundred people. But picture those five thousand four hundred people all living in congregate settings, either dormitories of forty men, beds three and a half feet apart, or cell blocks where everybody is sharing one common space, one common hallway. These spaces are locked. These guys have absolutely no freedom of movement.
When they are moved from one location to another, a person has to take them there. That person has to open the door for them, and they have to be let through it and be walked down the hallway. When they are moved from one facility to another, somebody has to touch them and put cuffs on them. When we bring them their food, workers go from housing area to housing area with trays that have to be distributed. When we give them their medication, that has to be done for them. They can’t do it for themselves. And so, if you think about how many excess human contacts that is, even compared to something like a shelter setting, you can imagine why viral spread in this environment is extra dangerous.
How are you and your colleagues trying to head off an outbreak?
It’s still evolving. What we are doing right now is vigilant screening of patients in all clinical encounters for symptoms and encouraging patients to self-report symptoms as much as possible. Whenever somebody screens positive—whenever somebody, for example, has a fever, presents with something that could be an influenza-like illness—a mask is put on that person, they are isolated, and then they are taken out of their housing area and transferred to a medical unit. They are put in medical isolation and cared for by a different team of health-care providers.
We do have testing capacity on the island. They’re getting flu-swabbed. We have the capacity to test for other respiratory viruses, because there are lots of illnesses that are going around, and not everything that looks like covid is covid.
What happens to someone if you suspect they have the coronavirus?
They’re currently in the C.D.U. [Communicable Disease Unit], which is where we have capacity to take care of patients who have any kind of respiratory illness. People who have the flu also go there. It’s the unit that was built for TB outbreaks.
What is the Communicable Disease Unit?
There are these military sprungs [aluminum structures with a white plastic covering] that were built to have capacity to take care of TB patients and other patients who needed to be in isolation during prior jail eras. They have rooms that are actually a little bigger than the average cell. And they have some negative pressure rooms that have these antechambers, so you don’t just open the door and have air mixing. It’s a little bit more of a clinical unit. There is nursing and medical staff.
I have read that there are seventy cells in the Communicable Disease Unit. Is that accurate?
I’m not positive about it. Whatever there is, if there was an outbreak, we’re going to have more patients than we can house there. What are we going to do when we exceed our capacity? They’re talking about it all the time—how we would identify additional areas to house people.
What are you doing to protect your patients who are at such a high risk if they do get infected?
For the last two weeks, we have been using the term “bubble wrap.” That’s not an official public-health term. What we mean is, to the best of our abilities, we want to try to preventively protect the people we are most worried about getting sick. That means that, instead of having sixty- and seventy- and seventy-five-year-old guys—or people who have serious illness—spread all over in G.P. [the general population], we are trying to find them, make sure that they are not sick now, test them if we can, make sure that they are negative, and then put them together so we can have some sort of increased surveillance about what is going on in those dorms specifically, and try to protect those units, limiting what staff are going to go into those buildings, screening staff even more stringently there.
I walked around last week and talked to patients in our infirmary about covid, and we had these sort of dorm meetings. They are smart and logical and know how at risk they are. They said, “You’re coming in and out. Officers are coming in and out. How do we know you don’t have it?” And they’re right. We know that there is likely an asymptomatic spread of this disease. So when staff and officers and others are coming in and out, we just cannot make a commitment that we can protect them. It’s not a fortress.