When someone in jail needs surgery, it’s no simple operation

Darrell Palmer, Jr., lays for a portrait in UPMC Magee-Women’s Hospital days after surgery for a ventral hernia, Sunday, March 17, 2024, in South Oakland. The surgery had been repeatedly scheduled, but never conducted, while he was incarcerated in the Allegheny County Jail. (Photo by Stephanie Strasburg/PublicSource)

A few dozen times a year, someone held in the Allegheny County Jail gets surgery. Getting medical attention, staff approval, transportation and the needed procedure can be a painful process.

by Jordana Rosenfeld, PublicSource

In October, Darrell Palmer, Jr., wrote on a grievance form to Allegheny County Jail administrators: “I need to know the procedure for if I was to die in here?” 

He was suffering from a large ventral hernia that had become unbearably painful while incarcerated from March 2021 to November 2022 and then again from August to October 2023. The hernia looked like “a baby arm sticking out of his stomach,” according to Brian Englert, the correctional officers’ union president.

Palmer recalled the intense pain. 

“Imagine your intestines coming out of your abdominal wall with the only thing holding it in is this much skin … So the pain never goes away, it’s a constant thing. Sometimes more, sometimes less,” he said in an interview.  

Darrell Palmer, Jr., stands for a portrait to display the large ventral hernia in his abdomen on March 11, two days before his surgery, in Wilkinsburg. (Photo by Stephanie Strasburg/PublicSource)

The only solution was hernia repair surgery, which Palmer expected the jail would be able to provide. Incarcerated people are the only American population with a constitutional right to health care, owing to a 1976 Supreme Court ruling. But there’s nothing simple about how that’s administered. 

“The Constitution doesn’t require that [incarcerated] people get the best care, it just requires that they get some care,” said Alexandra Morgan-Kurtz, an attorney and deputy director of the Pennsylvania Institutional Law Project who litigates cases related to conditions at the county jail and other state lockups.

In Allegheny County, the procedures, logistics and funding for surgery for incarcerated people are complex and opaque. A new county administration is just beginning to wrap its arms around those challenges. 

Obstacles related to a lack of staff, overwhelming medical need and organizational difficulties limit incarcerated individuals’ access to medically necessary surgery, according to former jail employees. Correctional health care experts say most of those challenges aren’t unique. 

Allegheny County Jail spokesperson Jesse Geleynse said ACJ is providing appropriate medical care and facilitating surgery when warranted.

“There have been approximately 100 surgeries performed on incarcerated patients in the past three years, which indicates ample access to surgical procedures,” Geleynse wrote in a statement. “There are also numerous off-site appointments that incarcerated patients attend daily. The ACJ continues to provide appropriate medical care to its incarcerated population, despite assertions to the contrary.”

Critics of the county jail are hopeful that new leadership, including the first permanent medical director in more than a year, a new county administration and significant turnover at the Jail Oversight Board will provide opportunities to expand and improve access to surgery.

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