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When Your Insulin Pump is Contraband

What diabetics face behind bars.

On May 1, 2010, the medical technician making the morning rounds at Stateville prison in Illinois allegedly denied Donald Lippert, a type I diabetic, his shot of insulin. Lippert’s blood sugar shot up, and after growing dizzy, he collapsed onto the floor of his cell and urinated on himself. According to a grievance he filed with the prison, Lippert’s glucose level was a staggering 451 when nurses arrived around lunchtime. The average range is between 70 and 180.

Nurses sent Lippert to the emergency unit and administered a shot of insulin, and doctors prescribed him another injection after his evening meal. But later that night, Lippert claims he was again denied his insulin. For the second time that day, he fell to the floor of his cell and began vomiting from hyperglycemia (the medical term for dangerously high blood sugar). A guard found Lippert on the ground when he came around for the night-time count. His blood sugar level had jumped to 277, and he was again given an emergency shot.

Lippert is among a growing number of inmates in state and federal facilities who have diabetes. According to a Bureau of Justice Statistics report released in February, the rate of prisoners who reported ever having diabetes or high blood sugar almost doubled from nearly 5 percent in 2004 to nearly 9 percent in 2012.

Inmates like Lippert — who has been in prison for murder since 1996 — are often at the mercy of prison staff to manage their diabetes. Lippert, for example, is served the same high-carbohydrate, high-sugar meals as the rest of the prison. He cannot administer his own insulin or glucose checks. While he needs short-acting insulin before his meals, medical staff, until recently, operated on their own schedule. Lippert’s lawyer claimed the lack of coordination would cause his blood sugar to spike and plummet throughout the day.

“Nobody could control their diabetes on that schedule. It’s the worst possible treatment,” said Lippert’s lawyer, Alan Mills, executive director of the Uptown People’s Law Center. Lippert is the lead plaintiff in an ongoing suit claiming inadequate medical care for Illinois state prisoners.

The Uptown People’s Law Center filed a separate complaint in January on behalf of an Illinois prisoner with diabetes who has lost portions of his left heel due to ulcers — a risk of the disease. The plaintiff in the case, Anthony Rodesky, claimed he was denied special diabetic shoes and could not get adequate treatment for what began as minor blisters. He may ultimately lose his entire foot.

The Illinois Department of Corrections declined a request for comment, saying they could not discuss pending litigation. Wexford Health Source, the for-profit health care provider serving Illinois state prisons, did not respond to an inquiry.

Despite the increased prevalence of the disease, lawyers said many prisons and jails still struggle to accommodate diabetics. “There are some simple solutions that can be implemented when prison officials are open-minded, which is pretty rare,” said Sarah Fech, staff attorney with the American Diabetes Association’s legal advocacy program. Fech corresponds with diabetics in prisons across the country about their treatment, and advises lawyers working on cases alleging abuse.

How prisons handle diabetes varies from state to state and facility to facility. The federal Bureau of Prisons has a list of guidelines on how to treat diabetic inmates, and the American Diabetes Association publishes their own set of best practices. Both advise that facilities carefully coordinate insulin injections with mealtimes, provide healthy food alternatives, and allow people to self-administer insulin when possible (under close supervision).

Though the guidelines are non-binding, some state and county facilities follow them. But budget restraints, bureaucracy, and security concerns can make it difficult for corrections staff to meet a diabetic inmate’s needs, especially in smaller facilities. “We hear many tragic stories of folks not getting medication at all in pretrial detention in city jails,” Fech said. In 2003, the ADA sued Philadelphia for neglecting diabetics awaiting trial.

A 23-year-old man died of diabetic ketoacidosis (acids that accumulate in the blood without insulin to regulate them) in 2008 in a small county jail in Illinois, where he was held on suspicion of a misdemeanor property crime. His family claims the jail did not give him regular insulin injections or blood sugar tests during his 69 days in jail — most of which were spent in solitary confinement. The jail denied any wrongdoing and the case is ongoing. A Texas woman fell into a diabetic coma and died two months after she arrived in a private state jail in 2010, when medical staff allegedly changed her insulin dosages and put her on oral medication. Corrections Corporation of America, the private jail operator named in the suit, also denied any wrongdoing, and told local media they were “firmly committed to the health and safety of the inmates entrusted to our care.” The case was ultimately dismissed.

Prisoners who feel that their health is being neglected have the option of filing a grievance or lawsuit, which can take years to resolve, claiming that the prison has violated legal protections for people with disabilities. The complaint that Fech hears most often from prisoners is how difficult it is to manage diabetes on a prison’s standard menu. Prison food “is sort of the opposite of what would be a medically appropriate diabetes diet,” she said. Many also complain about the timing of injections or testing.

Even if prisoners avoid a diabetic emergency behind bars, the long-term consequences of mistreating the disease can crop up years later. “These multiple highs after meals...would add up over many years to increase the risk of diabetes complications,” said Dr. Tom Donner, director of the Diabetes Center at Johns Hopkins University. “You can see the potential of the eyes being affected, damage to the nerves, [and] increased risk for heart attacks and strokes.”

According to Lippert’s lawyer, the Illinois Department of Corrections has recently started administering insulin right before meals, though other treatment problems remain. In late March, the Department of Corrections withdrew from settlement talks. The case is likely headed to trial.